Patrick Radden Keefe: The opioid crisis—origin, guilty parties, and the difficult path forward

**Peter Attia** (0:11)
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My guest this week is Patrick Radden Keefe. Patrick is an award-winning staff writer at The New Yorker Magazine and a New York Times bestselling author. His most recent book is about the opioid epidemic. It's a New York Times bestseller. The title of that book is Empire of Pain, The Secret History of the Sackler Dynasty. I've been wanting to do a podcast on the opioid epidemic for some time, and I've been trying to think of the right way to do it. Recently, I saw the HBO documentary, The Crime of the Century, and I thought it was a really good and thorough overview of the problem. Now, this is a problem that has many layers to it, right? It has the organizations that actually make these drugs, so the producers of the pharma companies. It has the organizations that distribute these drugs between the producers and the end stage or end use retailers, so the intermediaries. It has then, of course, the retail side of things where these drugs are purchased, the physicians who prescribe these drugs, the patients who use these drugs, the enforcement agencies that regulate them, the FDA that approves these drugs, and even the medical advocacy groups that provide guidance to physicians about them.
When you consider the landscape of this problem and all of the actors that I just went through, you come to realize that every one of them plays some role in the situation we're in now, the situation where basically half a million people have died in the past 25 years from opioid overdose, and where opioid overdose now represents the leading cause of accidental death in the United States ahead of car accidents, gunshots, things like that.
What Patrick's book does is go straight to the heart of the matter. How did this begin? What was the thin end of the wedge that created this epidemic? And he makes a very compelling case that it was the company Purdue Pharma, a privately held company run by the Sackler family. In this episode, we talk at great length about the history of the Purdue Pharma Company and its management team. We talk about the implicit and at sometimes explicit corruption that existed. And we talk about the other players in this channel, the physicians, the regulators, the politicians. Again, none of whom really get off scot-free in this assessment.
This is a bit of a depressing episode. I'm not gonna lie to you. I don't think we come away from this with an enormous sense of optimism that this solution is in hand and that five years from now, we'll look back at this and marvel at how easily it was able to be solved. I personally don't have a great sense of how that's going to happen. But nevertheless, I feel it is important to at least expose and shed some light on how we got here. So without further delay, I hope you'll enjoy my conversation with Patrick Radden Keefe.
Hey, Patrick, thank you so much for making time to sit down. I know you've done a number of these interviews, and one of the things I always like to do is try to go places, or at least deeper than maybe you've gone before. So we'll see if that can be accomplished. There's certainly no shortage of material here to dive into, but I guess I kind of want to start with a question that I know you've probably spoken about before, which is what drew you to this story? Because the depths that you've gone to to research your book have been...
Certainly at the upper decile, I would suppose of what an investigative journalist would do.

**Patrick Radden Keefe** (4:24)
It's great to be with you and happy to talk about how I came to this. I've always been interested in drugs as a subject, the way in which drugs fit into our society, how we feel about them, which drugs are illicit, which drugs are illicit. I wrote a big piece a number of years ago about the legalization of cannabis in Washington state. Very interested in this idea that, you know, you have this existing industry, this pot industry that's been around for decades with the stroke of a pen, you know, at midnight, it's legalized. And what does that look like? How do you turn it into a taxed and regulated economy? And I had done a lot of writing on Mexican drug cartels. So I did a big piece, actually, before I was full-time at The New Yorker, I did a cover story for The New York Times Magazine back in 2012 about the Sinaloa drug cartel.