Patrick Radden Keefe opens with an extensive account of the Sackler family's rise to extraordinary wealth through pharmaceutical marketing innovation, tracing the family dynasty that would later become central to the opioid crisis narrative.

Why this family history provides essential context:

• Understanding the Sackler family's decades-long history of aggressive, innovative pharmaceutical marketing provides necessary context for the specific practices later associated with OxyContin's marketing
• Keefe's extensive research illustrates a pattern of aggressive marketing tactics developed and refined well before OxyContin specifically, showing continuity in family business practice
• This historical grounding distinguishes the book from accounts focused narrowly on OxyContin alone, situating it within a longer family business history

This opening establishes the extensive historical and family context necessary for understanding the book's subsequent detailed examination of the opioid crisis specifically.