Radden Keefe subtitles the work’s prologue “The Taproot,” a botanical reference with thematic significance throughout Empire of Pain. Taproots are the fundamental base from which a tree grows. In her deposition, borrowing a metaphor from New York Attorney General Leticia James, Kathe Sackler presents herself as OxyContin’s “taproot” (6)—and Radden Keefe argues that the drug itself served the same function in a public health crisis around opioid use disorder and overprescription.

Radden Keefe’s book continues the metaphor of the root system. The Sackler family tree at the book’s beginning underlines the importance of familial roots to the story of Purdue. By opening with an in-depth analysis of the life of Arthur Sackler, Radden Keefe suggests that OxyContin’s origin story is, in fact, a family story. When Arthur’s wife Jillian and his daughter Elizabeth attempt to divorce Arthur from OxyContin, they will also evoke the same botanical metaphor—that their side of the family tree has a healthy root, unlike that of Mortimer, Raymond, or Richard.

Radden Keefe’s work is a counterargument to this line of thinking, since he demonstrates that Arthur, too, relied on corruption, secrecy, and the avoidance of liability to make his fortune.