Hulu’s “Dopesick,” Retells The Chilling True Story Of The Opioid Crisis’s Sinister Roots

When Dopesick’s version of Richard Sackler, based on the real former president of Purdue Pharma, puts forth his rationale for why he is promoting the drug OxyContin so aggressively, you can almost see where he’s coming from. He, he claims, wants to cure the world of its pain. 

And yes, the powerful opioid drugs that the Sackler family’s company made billions peddling do in fact have a remarkable ability to reduce pain. But, for many patients, they can do so only temporarily, and at an utterly devastating cost. 

Based on a non-fiction book by Beth Macy called Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, the eight-episode mini series Dopesick premiered on Hulu with its first three episodes on October 13th. After that, a fourth was released on the 20th and one more will be released every Wednesday until the series is complete.

The show tells the mostly-true story of how the brutally manipulative marketing tactics and “criminal misbranding” that Purdue used to sell enormous quantities of the powerful opioid OxyContin fueled the devastating epidemic of opioid addiction that ravages America to this day. 

And I can confidently say that it’s mostly true because my initial viewing of the series inspired me to further explore the actual origins of the opioid crisis and its heartbreaking, horrifying scope. This quest led me to the acclaimed HBO documentary Crime Of The Century as well as through a mesmerizing minefield of internet articles, several of which are listed as sources below. 

Dopesick is at once a detective story about the eventual legal investigation into Purdue’s misconduct and an incredibly wide-ranging exploration of the opioid crisis’s myriad effects on individuals and communities, taking place over a span of more than twenty years. In one timeline, we track the Sacklers’ recklessly pushing their new flagship product, Oxycontin, while, in another, a DEA agent and two intrepid attorneys work to unravel their web of deceit. 

Prior to Oxycontin’s release, opioids were mostly used for end of life patients and to combat cancer pain, and Purdue’s time-release morphine pill, MS Contin, was a major player. But the imminent expiration of Purdue’s patent on MS Contin inspired them to create OxyContin as a replacement. 

This pill used a similar time release formulation, but has as its active ingredient oxycodone, an opiate that is twice as strong as morphine. And as end-of-life cancer pain was an inherently limited market, the decision was made to try and reach new horizons with this new drug and target sufferers of other types of pain as well. Thus, Purdue went to war with doctors’ wariness of prescribing the powerful narcotics, which they called “opiophobia.” 

One way that they did this was by obtaining special approval from the FDA (granted by an official who would later come to work for Purdue) that would allow them to claim that its time release delivery system made it essentially non-addictive, since the drug would be released into patients’ bloodstreams gradually and prevent them from feeling a briefer and more intense high as with other opioids. 

Unfortunately, it eventually became clear that abusers of OxyContin could easily circumvent the safeguard by simply crushing up the pills, as well as that addiction could occur even in patients who used the drug as directed. 

Purdue and their reps also frequently cited a “study” claiming that less than one percent of patients who took opioid painkillers would become addicted. But this “study” appeared in a prominent medical journal not as such but only as a letter to the editor, and referred to a group of hospitalized patients who were given the drug in a highly controlled context and who had no history of addiction. 

The author himself was astounded by this one-paragraph letter’s use out of context to fuel Purdue’s wildly hyperbolic claim. Studies now suggest that the true rate of addiction among patients taking opioids for chronic pain is somewhere between 3 and 40 percent. 

While chronic pain is a very real problem, opioid use is an exceedingly dangerous and often ineffective way to address it. The drugs do have an initially powerful analgesic effect and have helped some chronic pain patients to be able to live more normal lives, a case that was made by Purdue in a widely shared promotional video for OxyContin called “I Got My Life Back,” which is referenced in Dopesick as part of the case against them. 

But tolerance builds quickly, and, eventually, for a significant portion of patients, the amount of medication needed for pain relief becomes enough to prohibit normal functioning, foster severe dependence, and even risk overdose. One woman who appeared in the video later lost her job, her home, and nearly her life to the consequences of her opioid addiction, while another ultimately died in a car accident after falling asleep at the wheel in an opioid haze. 

And for more minor and transitory aches and pains, opioids may be even more inappropriate. Recent studies actually show that surgery patients who are prescribed opioids have worse outcomes than do patients who are prescribed ordinary over the counter pain medication, and that the opioids were not any better at relieving patients’ pain. 

Though the extent of OxyContin’s dangers may have been unknown at the time, Purdue does seem to have been guilty of downplaying its risks—for instance, not correcting the misconception that it wasn’t as strong as morphine. 

And, along with misrepresenting the potency of the drug, in the process of promoting it, they coerced doctors with blatant bribery, threatened them with the prospect of lawsuits if they inadequately addressed patients’ pain, and invited them to lavish conferences where “pain specialists” who were on Purdue’s payroll gave speeches touting the benefits of the drug.

Companies that appeared to be patient advocacy groups or coalitions of experts but that were secretly funded by Purdue published persuasive statements on the benefits of opioids and the importance of treating pain, suggesting they should monitor it as a “fifth vital sign” so that more pain would be detected and more drugs prescribed. The ploys worked, but they worked a little too well. As mostly well-meaning doctors began to prescribe the drug to their patients, rates of iatrogenic addiction began to soar.

Purdue was also savvy in targeting rural, midwestern, states in which a large percentage of the population suffered from musculoskeletal pain from their manual labor jobs. But such states also had a surplus of emotional pain driven by lack of opportunity due to the collapse of the coal industry and other economic woes, and opioid drugs can numb feelings of anxiety and despair nearly as effectively as they can combat physical aches.

Opioid overdose and addiction rates soared substantially higher in the states where Purdue concentrated more of these marketing efforts, with patients who became hooked on prescription opioids often eventually turning to cheaper and more powerful illegal opiates like heroin and fentanyl.

The result devastated entire communities— turning peaceful towns into criminal wastelands and school kids into dope fiends. As Patrick Radden Keefe put it in the New Yorker: “to map the geographic distribution of the drug was also to map a rash of addiction, abuse, and death.”

In one hard hit county in Kentucky, a full thirty percent of residents knew someone who had died from using OxyContin. And the numbers only get worse from there. 1.6 million people are thought to have suffered from an opioid use disorder in the last year; an episode of the podcast The Uncertain Hour compared the amount of deaths caused by the opioid crisis to a loss on the scale of 9/11 every 3 weeks; and opioid overdoses have gone from under 10,000 a year in 1999 to nearly 50,000 by the mid-2000s. Unfortunately, the COVID-19 pandemic only worsened matters, with US News reporting a 30 percent increase in opioid overdoses “from about 70,000 the previous year to 93,000 in 2020.”

However, statistics, useful though they may be, don’t have the same impact on us as human stories. So it’s important that, along with creatively conveying the basics of how the opioid crisis came to be, Dopesick zones in on two very human stories of addiction and gives us glimpses of many others. 

One of these stories is that of Betsy (Kaitlyn Dever), a young woman who is prescribed opiates after injuring her back in the coal mines where she works and who eventually becomes addicted to them. Initially, we are charmed by her spunky attitude and sympathize with her due to obstacles she faces as a lesbian in a conservative town and a woman trying to make it in the male-dominated mines. 

However, her life slowly unravels as all is subsumed into her pursuit of drugs, and scenes of her as she endures brutal withdrawal are juxtaposed with those of her nodding off in relief after she gets a hit. 

Long after her physical pain is gone, she stays hooked on the drug to avoid the physical side effects of detox and to keep numbing a more nebulous kind of pain—to get relief from the discomfort she has always felt around other people. 

Her efforts to get clean are undermined by opiates’ power as well as by their pervasiveness: in one chilling scene set at a twelve step meeting, Betsy has finally begun another agonizing round of detox only to be offered drugs by a fellow attendee. 

Then there’s the story of Dr. Sam Finnick (Michael Keaton), who prescribed Betsy her first fateful pills. Later, he comes to regret this immensely, and it’s clear that he genuinely cares about her and about the rest of his patients.

Yet, he was still swept up into Purdue’s deceptive marketing tactics, and, after a minor car accident, he is prescribed powerful opioids by an ER doctor and quickly finds himself becoming dependent and spinning out of control. 

You could almost brush off his story as an overdramatic twist if not for its many real life analogues, enumerated in one of the source articles listed below. A peddler of poison painkillers falling under their spell is just one more oddly appropriate irony to add to the story of how one company’s quest to free the world of pain ushered in a brand new epidemic of it, as are cuts from the Sacklers’ opulent mansions to scenes of a desperate opiate addict living out of her car and selling her body to survive. 

If you give the Sacklers the benefit of the doubt, their crime may simply have been that they did not stop to think about the implications of what they were doing. If viewed less charitably, though, one might find pure, unadulterated greed. Courts eventually forced the family to pay an eight billion dollar settlement in recompense for their misbranding of the drug, but that figure barely makes a dent in the family’s fortune and is small compensation for the incalculable human suffering that they have caused. 

Dopesick isn’t a perfect series, with its multiple timelines and wide scope sometimes becoming difficult to make sense of and its messaging occasionally getting a bit heavy-handed, but it does get a great many things right. Hopefully, viewers who tune in will come away with a little more empathy for the victims of the opioid crisis and an understanding of the true risks of opioid use, and will know to think twice before blindly following a doctor’s advice or passively taking whatever else the system throws at them. 

Because, yes, it all sort of comes down to the system, doesn’t it? The system that allows, in the words of one Dopesick character, people like the Sacklers to “buy their way out of trouble” while “black kids selling weed go to jail for decades.” Our nightmarish landscape of toxic capitalism normalizes large-scale selfishness and corporate domination at the expense of basic human compassion, leaving too many people without safety nets and thus with no escape from their circumstances besides the one that pharmaceuticals can provide. 

Perhaps America has a painkiller problem because America has a pain problem, and that because our individualistic, dog-eat-dog culture uniquely fosters alienation. The pressure of toxic positivity and every man for himself pushes us to suppress all evidence of our pain, rather than to come to terms with it or to help each other to heal. Wounds then fester until we are forced to numb ourselves into oblivion, falling prey to the seeming quick-fix of a drug that eventually transforms us into black holes of want. 

Or, as Sam Quinones puts in the book Dreamland:

“And—this is my bigger point—what we are seeing is the end result of 35 years of exalting the free market, exalting the private sector, exalting the consumer and the individual, despising government, despising the public sector, despising the community assets that the public sector can and should provide. The end result of that is heroin—a drug that turns people into narcissistic, self-absorbed, intensely individualistic hyperconsumers. That is the point.”

But, it isn’t the end point. With a whole lot of courage and some very hard work, anyone who is struggling with an addiction can be brave enough to end the cycle of self-numbing and step into a brighter future. At Reco Intensive, our comprehensive treatment program will help you address the root causes of your substance abuse disorder, holistically process your pain rather than run from it, and connect to a vibrant recovery community.

Whatever you’re dealing with, you don’t have to keep dealing with it alone. To learn more, feel free to reach out to us at (561) 464-6533.

Sources:

youtube.com/watch?v=JTR3R2jYw4Q

newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

archive.jsonline.com/watchdog/watchdogreports/what-happened-to-the-poster-children-of-oxycontin-r65r0lo-169056206.html/

www.newyorker.com/magazine/2017/06/05/the-addicts-next-door

theatlantic.com/magazine/archive/2019/05/opioid-epidemic-west-virginia-doctor/586036/

papers.ssrn.com/sol3/papers.cfm?abstract_id=3496477

www.usnews.com/news/health-news/articles/2021-10-01/how-the-covid-pandemic-made-the-opioid-epidemic-worse-even-as-telehealth-helped

www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates

www.verywellhealth.com/tylenol-vs-opioids-post-surgical-pain-5190069