Dopesick: A compelling drama of the opioid crisis

The Hulu miniseries Dopesick, created by Danny Strong, is based on the 2018 nonfiction book Dopesick: Dealers, Doctors and the Drug Company that Addicted America by Beth Macy.

The eight-episode series is a devastating indictment of the American pharmaceutical industry. Nearly 1 million people have died in the US since 1999 from drug overdoses and over 70 percent of such deaths have involved an opioid, according to the National Center for Drug Abuse Statistics. In the 12-month period ending in April 2021, the first year of the pandemic, more than 100,000 people in the US succumbed to an overdose. One hundred thousand people … in one year.

“Dopesick” is a term used by the drug-addicted to describe the hellish physical and mental process of withdrawing from opiates, which only encourages the continued use of drugs to avoid this agony.

The Hulu series details how the over-prescription of the painkiller OxyContin, ruthlessly pushed on the population by Purdue Pharma, helped set off the deadly opioid epidemic in the US.

Dopesick spans the period from the mid-1990s to the mid-2000s and is unrelenting in its criticism of Purdue and its sympathy for the epidemic’s victims. The series does not simply flesh out a collection of statistics—the creators, writers and actors have produced a genuinely compelling social drama.

Macy, in her book, points to the social and class dimensions of the epidemic. “Appalachia was among the first places where the malaise of opioid pills hit the nation in the mid-1990s, ensnaring coal miners, loggers, furniture makers, and their kids,” she writes.

In this regard, the overall response of the media and reviewers to Dopesick, which rises to the level of mild interest, is telling. This is not their meat, so to speak. The mini-series concentrates on a demographic and geographic region of no great concern to affluent layers in the major cities. A drama or a horror film along racial or gender lines, such as Dear White People (2014), Get Out (2017), Promising Young Woman (2020) or Them (2021), sets the critics alight. The devastation of working-class communities is another matter.

Dopesick opens in 1986. Richard Sackler (Michael Stuhlbarg), one of the chief executives of the family-owned Purdue pharmaceutical company, outlines his mission: “The time has come to redefine the nature of pain. For too long the American medical community has ignored chronic pain and this has created an epidemic of suffering.” Sackler continues in the same vein: “When we live with pain we are not living our true selves. We are not living our best selves. We are not even living at all because the pain overtakes our ability to think, feel and even love.” The reader can determine for him or herself the proportions here of self-delusion and crude justification for profit-making. Sackler will become one of the most rapacious archangels of death.

In Finch Creek, a small mining town in the Appalachian Mountains, Dr. Sam Finnix (Michael Keaton) ministers devotedly to its residents, many suffering from injuries resulting from their laborious and dangerous occupations. In 1996, Purdue sales rep Billy Cutler (Will Poulter) introduces OxyContin to Sam, with the claim that the painkiller addicts less that 1 percent of its users and has a Food and Drug Administration (FDA)-approved special label to back up its claims. Sam is skeptical, as no Schedule II narcotic (a substance with a high potential for abuse) has ever been given such an imprimatur before. When young Betsy Mallum (Kaitlyn Dever) suffers a serious back injury from a mining accident, she becomes Sam’s first patient to be prescribed OxyContin.

In 2002, District Attorney John Brownlee (Jake McDorman) and his team, Rick Mountcastle (Peter Sarsgaard) and Randy Ramseyer (John Hoogenakker), begin investigating the lethal opioid. The Drug Enforcement Administration’s (DEA) Bridget Meyer (Rosario Dawson) has discovered that the FDA’s medical review officer, Curtis Wright, had approved the drug’s deceptive label, helping to perpetuate a massive lie for which he was rewarded a $400,000 a year salary from Purdue.

“A few months ago, we caught a doctor selling pills out of his car to an 11-year-old girl ... and when we arrested him, he thanked us,” prosecutor Randy tells Bridget. “At that moment, we knew that what we got going on in coal country is similar to San Francisco at the start of the AIDS crisis … Our community is ground zero for a growing national catastrophe.”

Sackler and Purdue are hell-bent on making OxyContin the “greatest pain killer in human history ... taking its place next to penicillin—the most important drug in the history of medicine.” The aggressive, money-obsessed sales force is armed with psychological profiles of the doctors in their territories and the ability to offer them unlimited perks and junkets. Other sales tools include the use of comforting formulas—for example, that “pain is the fifth vital sign,” giving it equal status alongside blood pressure, heart rate, respiratory rate and temperature, that “pain is being undertreated,” etc.

Charlatan “experts” such as Dr. David Haddox (Aaron Serotsky), who coined the phrase “pseudo-addiction,” argue that addiction is a fantasy. When it comes to light that the “miracle” painkiller only lasts 12 hours, Purdue invents the term “breakthrough pain” and recommends doubling the dose. The company begins with a 10mg pill, followed by a 40mg pill, and eventually manufactures a 160mg tablet! “Individualizing the dose means individualizing your bonus,” is a euphemism for pushing ever increasing amounts of OxyContin. As the WSWS has noted, “between 2006 to 2012, drug companies—with Purdue in the lead—poured 76 billion oxycodone and hydrocodone pills into US neighborhoods, enough to provide every adult and child in the country with 36 pills each per year.”

Author Macy writes that “Internal documents referred to reps as royal crusaders and knights, and supervisors went by such nicknames as the Wizard of OxyContin, the Supreme Sovereign of Pain Management, and the Empress of Analgesia. Purdue’s head of pain care sales signed his memos simply ‘King’...

“Industrywide, pharmaceutical companies spent $4.04 billion in direct marketing to doctors in 2000, up 64 percent from 1996.”

Sam attends a Purdue pain management seminar in Arizona, where he naively speaks from the heart about what he believes to be the drug’s benefits. The lonely widower is seduced by the company’s dazzling promotions—as well as a redheaded pharma employee. Nothing is too underhanded for Purdue’s profit-driven entrapment schemes. When Sam becomes hooked himself after a car accident, he begins traveling out of state desperately searching for OxyContin prescriptions.

Now several of Sam’s patients are also addicted. Betsy, who had envisioned a life away from Finch Creek with her girlfriend Grace (Cleopatra Coleman), begins financing her habit by stealing from her parents, Jerry and Diane (Ray McKinnon and Mare Winningham). Distraught by their daughter’s acute drug dependency, they set aside deeply held religious beliefs and accept Betsy’s homosexuality as they fight for her life.

Walt the drug dealer (Nicholas Logan) teaches Sam how to get high faster by licking the coating, rubbing it off and crushing the Oxy into a powder to snort, sadly causing the physician to hallucinate that he is dancing with his beloved deceased wife. Eventually in rehab, Sam is cautioned that the alternative is either “jail or the morgue.”

Betsy, also desperately trying to kick her drug compulsion, agrees to seek help. But pushers are everywhere, even in the supposed sanctity of a Narcotics Anonymous meeting. Purdue tenaciously adds fuel to the OxyContin epidemic fire. Quacks like Haddox advance the fable that addicts have a genetic disorder that requires increasing dosages to deal with the “torture” of withdrawal. Richard Sackler insists that “addiction symptoms in actuality are the symptoms of untreated pain.” While he lavishes loving attention on his pet dog, the pulseless drug lord drones on about “hammering the abusers.”

In one notable scene, at a DEA Museum presentation, the “9/11 celebrity” Rudy Giuliani (Trevor Long), former New York City mayor, is a featured guest. He singles out Bridget and commends her for being one of the highest-ranking females in the DEA. She is star-struck and flattered until Giuliani tells her that Purdue is his law firm’s major client. There is less of a revolving door between “public service” and the drug companies than a wide open one.

Another case in point is that of the US Attorney of Maine Jay McCloskey (David Alexander), who in 2000, sent a letter to every doctor in Maine, warning about prescription drug abuse, including opioids. It wasn’t long before McCloskey became a paid advocate for Purdue.

On the other hand, Dr. Van Zee (Raymond Dooley), a physician in Pennington Gap, Virginia, considered to be among the very first professionals to sound the alarm about the opioid addiction problem, also features in the series and in Macy’s book.

He explains that OxyContin changes the user’s brain chemistry. “Not a week goes by that I’m not talking with parents about their young adult children that are losing their jobs, spouses, children, and homes to this addiction,” Van Zee wrote in a 2000 letter to Purdue executives, noting that 20 percent of local high-school seniors had reported trying Oxy. And in another letter that year: “My fear is that these [addiction-hit rural communities] are sentinel areas, just as San Francisco and New York were in the early years of HIV.”

Van Zee wrote this poem, “OxyContin,” published in the Annals of Internal Medicine:

It might have been easier
if OxyContin swallowed the mountains, and took
the promises of tens of thousands of young lives,
Slowly, like ever-encroaching kudzu.
it engulfed us,
gently as napalm
would a school-yard.
Mama said
As hard as it was to bury Papa
after the top fell
in the mine up Caney Creek,
it was harder yet to find Sis that morning
cold and blue,
with a needle stuck up her arm.
Top of her class,
with nothing but promise ahead
until hi-jacked by
the torment of needle and spoon.

In September 2019, Purdue Pharma filed for bankruptcy to protect itself from 2,600 lawsuits. Every state in the nation had a claim against the company, totaling more than $2 trillion.

In a 2021 settlement agreement, the Sackler family agreed to pay $4.3 billion to mitigate OxyContin misuse and forfeit ownership of Purdue Pharma.

However, the deal also granted the Sacklers immunity from liability lawsuits.

The family, which made north of $10 billion selling OxyContin, admitted no wrongdoing and offered no apologies to the victims of their drug and its marketing.

“It’s outrageous,” Macy told Healthline. “There’s two systems of justice—the guy who was selling weed is in jail, and the Sacklers are not only not going to jail, but even after the settlement, the family will walk away even wealthier than it is now.”

In a 2019 interview included at the end of her book, Macy stated that the crisis has continued to worsen in most states. Americans are now more likely to die of an accidental opioid overdose (1 in 96) than they are from a car crash (1 in 103).

Dopesick is unusual in its unvarnished hostility to the legal pill mill, presided over by the Sackler family and the three Purdue executives who realized OxyContin was being abused early in the crisis. Investigators have proof that Howard Udell (Brendan Patrick Connor), Michael Friedman (Will Chase), and Curtis Wright lied to Congress in 2000 because they have emails showing the trio knew about the drug’s lethality as early as 1997.

Richard Sackler is well played by Stuhlbarg as a profit-crazed madman, while the enormously talented Keaton’s Sam Finnix, a doctor who moves from Pennsylvania to run a small practice amidst coal miners, is the moral axis on which the series turns. Dopesick elevates the decent, hard-working people, who are ensnared by the corporate criminals and their sales agent-sirens working to create one “big pill-popping, zombie nation.”

Sarsgaard, Cutler, Hoogenakker, Dever and Dawson also make outstanding contributions. Cast and crew give it their all in the exposure of what creator Danny Strong, in an October 2021 New York Times interview, termed “the dark side of American capitalism, where you have the collusion of government and industry.” Brought to the screen are the lives of people who don’t count in America, except—literally—in Centers for Disease Control and Prevention mortality data.

Although the Sacklers obviously bear major responsibility, they are hardly alone. The pandemic has witnessed vast and legal price-gouging and profiteering by Big Pharma. The industry has no interest in boosting vaccine manufacturing capacity that would push down prices for poorer nations, nor in eradicating a virus that has proved to be a gold mine. Dopesick makes an unanswerable case for the takeover of these enterprises run by sharks and their transformation into public utilities operated according to the health needs of the population.