TV Review – Dopesick

Chapter excerpted from the upcoming book:

ADDICTED IN FILM

Movies We Love About the Habits We Hate
(And How They Can Help Anyone Recover Successfully
and Lead a Happier Life)

by Ted Perkins, Facilitator and “Tips & Tools Guy”

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Note: this review of Dopesick TV series expresses the opinion of Ted Perkins only, and is not intended to express the views of SMART Recovery as an organization.

I’m the first guy to tell you that movies and TV shows are a business first and foremost, which is why most screenwriters and producers like me strive to make them as provocative, romantic, comedic, horrifying, and/or thrilling as possible. Unfortunately, many media critics bemoan the negative impact of commercial imperatives on “quality” storytelling, and why Marvel superhero franchise films usually take the brunt of the criticism. But Hollywood is also known to take chances from time to time, and some of its greatest artistic and public-service accomplishments have occurred when it dramatizes important current events. Hulu’s original series DOPESICK is a prime example of how producers endeavored to take on a difficult and challenging issue like the opioid epidemic and hit it out of the park.

It must have been no small undertaking. The now well-documented and exhaustively researched story of how Purdue Pharma and the Sackler Family managed to flood the country with a highly addictive pain medication like OxyContin could fill volumes. For an in-depth look, I highly recommend Patrick Radden Keefe’s bestseller Empire of Pain: The Secret History of the Sackler Dynasty. HBO also produced a powerful documentary on the subject called The Crime of The Century. These two dispassionate takes on the story are vital to the national discourse on the topic, but with DOPESICK the producers have managed to give this complex story a deeply human, very emotional dimension.

DOPESICK tells the OxyContin story from several different vantage points—from the coal mines of West Virginia to the Boardrooms of Purdue Pharma to the halls of the FDA. The story is anchored around no-nonsense country doctor Samuel Finnix, played by Michael Keaton, in a role for which he won the 2022 Golden Globe Award for Best Performance by an Actor in a Miniseries. If you haven’t seen his acceptance speech, I highly recommend you watch it on YouTube. The series itself is an emotional rollercoaster as it is; Keaton’s speech in real life takes it to a whole other level.

Finnix is an everyman good guy family practitioner who dotes over his low-income patients in a small West Virginia mining town. Many come in for help with the injuries and the associated chronic pain caused by hard physical labor in the mines. One of them is Betsy, played by Kaitlyn Dever, who suffered a back injury. Her physical pains are further compounded by the emotional stress of keeping her sexuality a secret from her Christian parents and community. Writer/Producer Danny Strong made a wonderful decision to humanize Betsy in such a way that her subsequent fictional addiction to OxyContin is caused by a multiplicity of factors (physical and emotional), just like addiction is in non-fictional real life.

Betsy’s injury just happens to (unfortunately) coincide with the rollout of a new “miracle drug” pain medication called OxyContin. Finnix learns about it when he receives a visit from a polished drug sales rep named Billy, played by Will Poulter. Billy’s the pride of the Purdue Pharma sales and marketing department, a boiler-room that thrusts young and eager 20-something overachievers into every doctor’s office in America to sell a lie: OxyContin isn’t addictive. While Finnix has enough common sense and medical knowledge to doubt this spurious claim, Billy’s sales pitch does sound pretty compelling. So, he writes Betsy a prescription for her pain. And to test OxyContin out for himself, he tries one (but just one) pill from the countless free samples Billy leaves behind as promotional freebees. You can guess where this is going.

The story then rewinds a few years to show the architect of all the ensuing misery, Richard Sackler, played with surreal creepiness by Michael Stuhlbarg. Somewhat miraculously, the writers have managed to humanize one of the most despicable characters in recent memory. Sackler comes off as a sad rich kid overshadowed by the achievements of his father and grandfather. OxyContin—a new “blockbuster drug” —is his desperate attempt to earn his family’s love and respect. So, what if, for him to earn his gold star, it’ll endanger and destroy the lives of hundreds of thousands of people? Ah, the banality of evil.

What is so striking about DOPESICK is the way the story goes on to portray the complexity of how Sackler and his Purdue Pharma foot soldiers cleverly managed to manipulate, dupe, and/or bribe seemingly respectable doctors and medical opinion leaders into endorsing a product that even a first-year medical student could have told you would be highly addictive. Purdue even put one over on the FDA to keep OxyContin off the list of heavily controlled substances. Equally fascinating (albeit horrifying) is how Purdue’s sales teams continually doubled down on the lies told by their sales reps every time anyone raised a red flag. And if that didn’t work, they just doubled and quadrupled the dosages per pill in order to combat “Breakthrough Pain,” a made-up medical condition that was really just users building up a tolerance to the drug and needing higher and higher dosages so they wouldn’t get dopesick. Talk about pouring gasoline on a fire.

With Sackler and Purdue firmly established as the ultimate Goliath, the story then introduces us to the Davids, no-nonsense country lawyers Richard Mountcastle (the always amazing Peter Sarsgaard) and Randy Ramseyer (John Hoogenakker). Their slow and methodical search for the truth, and their crusade to bring Purdue and the Sacklers to justice, plays out like an Agatha Christie mystery crossed with Erin Brockovich. To call these two guys “heroes” is an understatement, both in the series and in real life. Mountcastle gives up any semblance of a personal life during his decades- long investigation. Ramseyer even goes so far as to refuse to take OxyContin to relieve the pain of his prostate cancer surgery. Not because he thinks he’ll become addicted, but because it would put more blood money into Richard Sackler’s pocket.

Equally heroic is Bridget Meyer, a scrappy and ambitious DEA agent played by Rosario Dawson. Dawson does a superb job of looking calm and collected (albeit indignant) as the OxyContin catastrophe unfolds in plain sight all around her. Her sclerotic agency seems to be too afraid of intergovernmental red tape to do much about it, and she gets stonewalled at the FDA—an agency seemingly beset by an admixture of dark money influencers (mostly funded by Sackler) and unscrupulous regulators (many of whom went on to cushy six-figure jobs at—you guessed it— Purdue Pharma!).

As the conspiracy investigation unfolds, we eventually circle back around to Purdue’s primary victims in the story, Dr. Finnix and his patient Betsy. Her well-intentioned effort to use OxyContin “as prescribed” for pain quickly spirals out of control. She’s reduced to turning tricks in seedy back alleys after she loses her job for being high. Overly dramatic made-for-TV overkill? Not at all. Betsy’s fictional story is similar to that of many people swept up in the opioid crisis in real life. Most had jobs, were well-educated, had families, paid their taxes, walked their dogs. The farthest thing from their mind was to become addicted to drugs. Problem is, they had pain. Real physical pain. And for that they simply wanted help. But they got something else.

Finnix (Michael Keaton), the one guy you’d think would know better, quickly gets consumed by the drug as well. Desperate for money, he gets recruited into the Purdue Pharma “Speakers Series”—basically Ted Talk for OxyContin apologists and liars. All he has to do is step in front of the mike, say he’s an MD, and tell everyone the drug isn’t addictive. And all of this as he himself is addicted and high as a kite. Granted, Finnix is a fictional character, but his path to the “dark side” mirrors that taken by countless other once-respectable medical professionals who the Sacklers bought off to help them overcome critics and move more inventory.

What makes DOPESICK especially relevant to the overall conversation about recovery is just how difficult it was for treatment providers and mutual support groups to combat such an addictive drug. Betsy white-knuckles it at 12-Step meetings and attends group prayer at her church. But neither NA nor the Almighty seem to be any match for Purdue Pharma’s “miracle pain reliever.” While Narcotics Anonymous may have helped some individuals overcome their addiction, in Betsy’s case her meetings turn out to be secret OxyContin swap meets. (I have reached out to long-time SMART Recovery facilitators to see what their experiences were with meeting participants struggling with OxyContin addiction at the time.)

Finnix, meanwhile, loses everything, including his medical license. He goes to a rehab facility. However, like many people legally mandated into recovery, his initial (defensive) reaction is to feel like an outsider. He’s not addicted like “those people,” no sir. What’s worse, he realizes that many of the other patients at the facility have cycled through several times before. Whatever it is that’s supposed to be “working” in this rehab facility clearly isn’t. But that could be said about many rehab facilities at that time. When it came to the fight against OxyContin, literally everyone in the recovery universe seemed to be boxing outside of their weight class. Such was the power of this drug. Finnix eventually leaves the facility, relapses, then seeks recovery help at a methadone clinic.

DOPESICK culminates in Mountcastle and Randy Ramseyer’s successful prosecution of Purdue’s deceptive marketing and business practices. This eventually led to Purdue’s bankruptcy and multi-billion-dollar settlements (still in contention today). It’s a satisfying ending to a sad story, but in many ways it’s cold comfort. It took the U.S. judicial system more than a decade to put a halt to a tragedy that was blatantly obvious to anyone who cared to look. Thousands of people died needlessly. Entire communities were ravaged. All while the Sackler family made billions. So, was it just the Sacklers’ fault? Well, yes and no.

DOPESICK lets us peel back the curtain and see all the moving parts of this consumer product catastrophe. It was a perfect storm of contributory negligence. Purdue’s chemists knew the drug was highly addictive, so they bribed medical professionals to say it wasn’t. They submitted skewed data sets with sampling errors to regulators, whose job it was to know better. Purdue’s legal team knew they would never pass muster with the FDA, so they rewarded the FDA chief (Curtis Wright) with a $400,000 a year job at Purdue if he would help them create a loophole. Purdue’s marketing department knew the drug was addictive, so they paid users to say it wasn’t in promotional videos. Purdue’s sales department was under pressure to meet its targets, so they offered ridiculous commission structures to motivate its avaricious young sales teams. Yes, everyone at Purdue could say they were “just following orders.” But that didn’t work at Nuremberg, so why should it work here?

Not surprisingly, we see money at the root of this evil. A perverse amount of money. The financial incentives created by Purdue to market and sell the drug cascaded down the value chain. Small private pharmacies could mark up OxyContin and make higher margins on its sales (but in all fairness, they were also afraid that Purdue would sue them if they didn’t sell the pills). Medical and treatment professionals with prescription privileges stood to make a lot of money too. After all, they were helping people manage chronic pain, right? And thus, the infamous “Pill-Mills” formed around the country. Watchdog groups could reap millions in off-the-books “sponsorship” revenue from Purdue if they looked the other way. If all of this doesn’t smack of a criminal conspiracy, what does?

By revealing the interdependence of all these bad faith actors, DOPESICK does a wonderful (if maddening) public service. It illustrates how actual conspiracies work. How criminality is allowed to fester in plain sight because it seems too outlandish to believe it’s actually happening (I’m reminded of the quote attributed to Edmund Burke: “The only thing necessary for the triumph of evil is for good men to do nothing”). This situation demonstrates how a lie told enough times eventually becomes the truth. And if that doesn’t work, just pay more people more money to parrot your talking points. These are painful lessons society seems to have to relearn over and over
again.

I also think DOPESICK is an important series to watch because it’s an unflinching look at addiction in general. Both what addiction is, and what people think and say it is. OxyContin is a case study in how real societal harm and death is caused by the language we use to describe and stigmatize individuals who suffer from addiction. We often hear in church, “Love the Sinner; Hate the Sin.” Well, the Sacklers made billions and avoided criminal prosecution by just flipping the sentence around: “Hate the addict, love the addiction.” OxyContin was harmless. The Sacklers were innocent victims of a vast left-wing anti-business conspiracy. It’s all the “pill-heads’” fault. Sound crazy? No, not at all. The Sacklers were just channeling the idea that addiction is a moral failing, completely unmoored from any physiological or mental health considerations. This idea is out of date, it’s wrong, and it’s killing people. SMART Recovery’s been saying this all along and will continue to say it as part of its support of Harm Reduction. Luckily, public views on addiction are slowly changing thanks to groundbreaking work by scientists like Dr. Nora Volkow (recently featured in a SMART Recovery webinar).

While DOPESICK spreads out culpability for the OxyContin Opioid Epidemic among many participants and institutions, I’m reminded of something my father once told me: “The fish rots from the head down.” And in my mind, that rotten head was Richard Sackler’s. He was the architect of the drug, the crimes, and the coverup. To date, he and his minions have avoided criminal prosecution in exchange for billions in civil settlement fines. As you read this, these settlements are still under review and appeal. On the one side, victims are demanding personal accountability from the Sacklers; on the other, states desperately need that settlement money to help clean up the mess they made. The Sacklers recently participated in a court proceeding where family members of OxyContin victims were allowed to confront their tormentors. Richard Sackler joined via Zoom, but only because he was forced to. His camera was turned off.

NOTE: Read about a real world example of pharmaceutical companies influencing doctors to prescribe OxyContin.

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IMPORTANT NOTE:

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