Now Arthur’s brothers and his nephew Richard would make the same pivot with a painkiller: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. The beauty of the minor tranquilizers was that they were for everyone. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. It was a “major” tranquilizer that worked wonders on patients who were psychotic. In the 1940s, Arthur Sackler had watched the introduction of Thorazine. What if you could figure out a way to market this new drug, Ox圜ontin, to all those patients? The plan would have to remain secret for the time being, but in his memo to the Sacklers, Friedman confirmed that the intention was “to expand the use of Ox圜ontin beyond Cancer patients to chronic non-malignant pain.” This was a hugely audacious scheme.

If that was even somewhat true, it represented an enormous untapped market. According to the wrestler turned pain doctor John Bonica, one in three Americans was suffering from untreated chronic pain. But what if, over time, the drug extended beyond that? There was a much greater market for other types of pain: back pain, neck pain, arthritis, fibromyalgia. “We believe that the FDA will restrict our initial launch of Ox圜ontin to the Cancer pain market,” Friedman wrote. In fact, there were three-quarters of a million prescriptions just for MS Contin.

The market for cancer pain was significant, Friedman pointed out: four million prescriptions a year.

“In 1994, Friedman wrote a memo marked “Very Confidential” to Raymond, Mortimer, and Richard Sackler.

Sackler dynasty