Empire of Pain: The Secret History of the Sackler Dynasty

Encourage readers to connect the book’s themes and characters with their personal experiences.

1. Empire of Pain explores how ambition, when unchecked by ethics, can lead to disastrous consequences. Have you ever encountered a situation—either personally or in the workplace—where ambition overrode ethical concerns? How did you or those around you respond? 

2. The Sacklers maintained secrecy about the source of their wealth while using philanthropy to bolster their reputation. Have you ever supported or admired a company, celebrity, or institution only to later learn troubling details about their actions? How did that affect your perception of them? 

3. The book highlights how denial played a key role in the Sackler family’s failure to take responsibility for the opioid crisis. Have you ever witnessed or experienced a situation where people refused to acknowledge the harm they caused? How do you think individuals or institutions should handle accountability? 

4. Nan Goldin and Maura Healey dedicated themselves to exposing the Sacklers and holding them accountable. Have you ever felt compelled to take a stand against something you believed was unjust? What was that experience like?

5. The book details how many institutions, including museums and universities, removed the Sackler name from their buildings due to public pressure. Do you think this was an appropriate response? Should institutions be required to return donations that come from ethically questionable sources?

Examine the book’s relevance to societal issues, historical events, or cultural themes.

1. The Sacklers took advantage of the close relationship between business and government regulators to push OxyContin into the market with minimal oversight. What does this say about the role of regulatory agencies in protecting public health? Do you think the government does enough to prevent corporate influence in policy decisions?  What do you think should be done to ensure corporate responsibility, whether in the pharmaceutical sector or in other industries? 

2. Empire of Pain depicts American medicine as shaped by capitalism, with pharmaceutical companies prioritizing profit over patient well-being. How do you think this compares to healthcare systems in other countries? Does the work suggest that medicine be treated more as a public good rather than a business?

3. The opioid crisis disproportionately affected communities with high rates of workplace injuries and economic instability. What does this reveal about how systemic issues, such as poverty and lack of healthcare access, contribute to public health crises? How can policymakers address these underlying problems?

Dive into the book’s structure, characters, themes, and symbolism.

1. The book is structured as both an investigative exposé and a multigenerational family saga. How does Keefe use storytelling techniques typically found in fiction—such as character development, foreshadowing, and tension—to enhance the impact of the book? How does Empire of Pain compare to other works that take a “literary” approach to journalism or archival research—e.g., Truman Capote’s In Cold Blood or Erik Larson’s The Devil in the White City?

2. The metaphor of trees, roots, and origins is woven throughout Empire of Pain, from the Sackler family tree to the imagery of hidden corruption. How does this motif help convey the themes of legacy, secrecy, and consequence? 

3. Keefe compares the Sackler family’s business practices to organized crime, particularly in their use of secrecy, loyalty, and strategic legal maneuvers to maintain power. Do you think this comparison is justified? How does it influence the reader’s perception of the family?

4. The Sacklers used art and philanthropy to distance themselves from their company’s role in the opioid crisis. How does Keefe contrast their approach to art with that of activist-artist Nan Goldin? What does this contrast say about the power of representation in storytelling?