“Dopesick” is one of those series that is almost unforgettable in an unsettling way. The eight-part miniseries focuses on the opioid epidemic, which has claimed the lives of many Americans. It is mostly based on Beth Macy’s non-fiction book, though it takes the liberty to fictionalize certain stories to create a better impact. Taking place between 1995 and 2006, the series deals with how the drug OxyContin impacted the lives of the Appalachian population, the DEA’s attempt to stop the widespread drug abuse, and the US Attorney of West Virginia’s desperate effort to indict the top executives of Purdue Pharma, who manufactured and marketed the drug. A drug that was introduced as a painkiller for moderate to extreme pain got the entire nation hooked on it. The series traces how Purdue Pharma attempted to get away with money and power.
Spoilers Ahead
‘Dopesick’ Plot Summary: What Is The Mini Series About?
In 1986, Richard Sackler announced that their company must rethink pain medication not just because living with pain is tough but also because their most popular drug, MS Contin’s patent would soon expire. The Sackler family needed to come up with another drug that would generate wealth, and Richard Sackler believed OxyContin was the answer. The plan was to market it for moderate pain and approve it for long-term use. In 1995, Purdue Pharma introduced OxyContin to the market. Sales representatives were required to aggressively pitch its safety to the doctors and coax them to prescribe it. The time-release mechanism of the drug was what they constantly promoted. It was said that the drug was effective for 12 hours, and the release was gradual and not sudden, thereby preventing the patients from experiencing euphoria. The FDA’s approval made doctors and patients put their trust in the medication. It was stated that “less than 1% become addicted” due to the delayed absorption provided by the tablet.
Betsy Mallum, brilliantly portrayed by Kaitlyn Dever, worked with her father in the mines in a small Appalachian mining town, Finch Creek. She had always dreamt of becoming a miner, just like her ancestors. She wanted to prove those who believed that a girl could not work in the mines wrong, and to that end, she worked hard. Her parents were believers, even though Betsy never felt close to the higher power. She was a closeted lesbian and struggled to bring up the topic of sexuality with her parents. She was in love with Grace, who was openly lesbian and also worked at the mines. Her father did not approve of Betsy’s friendship with Grace, believing that she could ruin his daughter. Even though Grace wanted to run away to a queer-friendly neighborhood with Betsy, she did not wish to give up her mining job. But it was all disrupted when Betsy injured her back in a mining accident and chose to live with the pain for a few days. She was introduced to OxyContin by Dr. Finnix, and from that point, Betsy desired nothing more than the drug.
Michael Keaton, as the small-town doctor, is convincing in his subtlety. Dr. Samuel Fennix has been an integral part of the mining town for nearly forty years now. His wife, Shelly, wanted to provide free health care to the community, and that is how he ended up in the small Appalachian town. Even though his wife had passed away, he chose to stay there and serve the people. It was a sales representative, Billy Cutler, who familiarized Fennix with the OxyContin tablets. Even though he refused to accept that a narcotic could be less addictive, he could not help but be convinced by the FDA label. He knew how the mining population suffered from pain, and the fact that a drug could make their lives better enticed him. After reading about it, he started recommending the drugs to his patients with chronic pain and noticed how much they appreciated them. He was convinced, though gradually, everything started to fall apart.
The Assistant US Attorneys of West Virginia, Rick Mountcastle, and Randy Ramseyer, started to study the abuse of OxyContin within their community. They knew that Purdue Pharma was lying to the public with less addictive wordings when, in reality, it was behind the rise of mass-scale abuse. Going against Purdue Pharma would not be easy, considering how they won all 65 public litigation. Yet the US Attorney of West Virginia, John Brownlee, encouraged them to proceed with the case, though he warned them that they needed a massive amount of evidence considering the power that the Sackler family possessed. With shots from the 2005 trial, we know that the federal prosecutors were able to gather enough evidence to build a case.
While building the case, Rick and Randy found that the DEA had pursued the case before they did, but it was closed abruptly. They reached out to DEA agent Bridget Meyer, who headed the case. Bridget pointed out how the FDA’s labeling was the major cause of the problem. Bridget chose to not share any further details about the case, perhaps because it reminded her of how she had failed to bring justice even though she dedicated her life to it. Her failed marriage was a result of her constant involvement with the case, and that was something she still had to get over.
“Dopesick” connects these stories to form a cohesive idea about how tactfully Purdue Pharma designed its product. They had connections to the top, and when they did not, they paid their way to make it work. The cunningness of the Sackler family, particularly Richard Sackler, pushed the drug for public consumption as hard as they could. He dedicatedly called each sales representative to convince doctors to prescribe the drug even though he and his entire family knew they were selling a lie and that the drug was addictive. They knew that it was the addiction that led to the rapid increase in sales, yet they chose to bask in its glory.
See More: ‘Dopesick’ Episode 1 Recap/Ending, Explained – The Birth of OxyContin
What Were The Tactics Employed By The Sackler Family To Sell Oxycontin?
Rick and Randy started studying the promotional videos for OxyContin, and they noticed how none of those who were in the video ever uttered the word “OxyContin .”They decided to reach out to those who vouched for the drug and found that some had died while the others were addicted to it. They also uncovered that the reason why they did not name the drug was that they were told it was a public service announcement for pain management. Therefore, the video was fraudulent. They also learned that several doctors were treated to special dinners and vacations to induce them to prescribe OxyContin to their patients, and they doubled the doses whenever the patients developed tolerance.
Apart from the FDA label and studies by the various pain management groups, the sales representatives also discussed a new word to address pain; they called it “breakthrough pain.” Richard Sackler came up with the term when the drug did not work for the entire 12-hour period. Doctors were asked to simply double the doses if the effect of the drug was not strong enough. Billy Cutler was not too convinced about the breakthrough pain. He could not help but think that maybe the drug was not working as they were told it would, yet the double paycheck made him sell what the company wanted him to.
Purdue Pharma also hosted a weekend seminar for healthcare professionals. An all-paid trip to a luxurious hotel where members from various pain societies discussed the effectiveness of the drugs and how OxyContin was different from other opioids. Data charts were shown to prove their point, all of which were later found to be manipulated. Prominent doctors were even paid to discuss how the drug changed the lives of their patients in an attempt to convince those attending to prescribe more of the drug and to have complete faith in Purdue Pharma.
Soon, the 80mg pill was also introduced to cater to those who were already on the 40mg pill but continued to face “breakthrough pain .”The company also popularized the idea of “individualizing the doses” to completely stop the “breakthrough pain .”They believed that there was no point in starting a patient with 10 mg when they eventually required 20 mg or 40 mg. Therefore, they suggested that according to the pain level, doctors could start a patient with a higher dose of the drug. This would not only solve the problem of breakthrough pain but also bring in an enormous amount of revenue.
When Randy was admitted to the hospital for his cancer treatment, he noticed how the nurse was forcefully suggesting that he opt for OxyContin to deal with the pain he was experiencing, but he chose to go with an alternative, knowing the consequence. He then realized how easily one could be introduced to the drug and how he could have been an addict himself had he not been studying the case. It also made him wonder if the healthcare professionals were receiving benefits for trying to push the drug as much as they could. The doctor responded to his doubt by stating that it was the management who were after the doctors and nurses if they were unsuccessful in managing the pain that the patient experienced. Pain has become one of the most discussed topics in healthcare and was announced as the fifth vital sign. Randy remarked that the pain societies had infiltrated the hospital spaces, and they were the ones pushing for the usage of OxyContin.
After Rick attended a meeting conducted by the “Appalachian Pain Foundation,” he realized that the members were simply the mouthpiece of the company. It was found that a grand donation from Purdue Pharma helped in starting the organization. It was not only the Appalachian Pain Foundation but also the American Pain Society that received a significant number of donations from Purdue. The Pharma also funded the American Academy of Pain Medicine, and it had spent thousands of dollars on the committee formed to write a report urging for the use of narcotics to treat pain. The National Foundation for the Treatment of Pain, the American Chronic Pain Association, and others were all funded by Purdue Pharma to promote the use of opioids in medicine. Even the pain chart that has become popular was created by Partners with Pain, an organization that is completely funded and operated by Purdue. The Partners with Pain website essentially directed patients to doctors who were known for prescribing OxyContin. Therefore, to make pain the talking point in the medical community, Purdue funded groups that claimed to be independent, and they created an urgency for a pain medication that Purdue delivered through OxyContin. It was only after establishing how Purdue manipulated the entire system that the judge allowed for the release of documentation used in marketing, research, and distribution.
What Led To The End Of Bridget Meyer’s Case Against Purdue Pharma?
Bridget Meyer started to notice the daily news report about OxyContin overdoses. She visited a pain clinic in Kentucky and realized how grave the situation was. Every patient she saw lining up at the clinic was an addict. She learned from the nurse at the clinic that the patients had to only visit the doctor once and that they could simply pick up their prescription and pay for their refills. After leaving the clinic, she found a schoolboy attempting to rob a woman. Bridget caught hold of him. She took him to a local eatery and found out that he was not after the money but after the prescription. He also said that half of his school population was addicted to opiates. She was also later informed by pharmacists how sales representatives of Purdue Pharma would force them to carry OxyContin even if they did not want to by threatening to sue them with lawsuits. The situation was worse than she had assumed, and she planned to bring justice.
She gave up her gun and became the deputy director of the diversions department to work on the case. The DEA held a press conference targeting OxyContin after Purdue Pharma repeatedly refused to take a step to solve the issue of drug abuse. She intended to pressurize the FDA to restrict the drug for specific use only. The FDA explained their stance that they would only take a measure if the DEA could prove that the drug was faulty and if there were cases of deaths after patients had taken the drug as prescribed. While Bridget started to create a report on all the deaths caused by Oxy as prescribed, the FDA decided to opt for a black box label. It was the press conference that created pressure on the FDA. The chances of getting a black box label got the entire Sackler family on its toes. They sought expert advice from Curtis Wright, who approved OxyContin as a safe opioid drug when he was working for the FDA. After retiring from there, he joined Purdue Pharma. Wright helped them to get words that might work in their favor even if they received a black box label. The FDA did go ahead with the black box labeling, but they also allowed the usage of certain terms. The label could say that the addiction was “reported” to be rare and they could also add that the drug could be used for an extended period of time, therefore, indirectly allowing them to proclaim that the drug can be used lifelong if required. This was a win-win situation for Purdue Pharma, and they couldn’t care less about the black box label now.
When Bridget showed the FDA that a high number of people died as a result of OxyContin even after taking it as prescribed, both the FDA and Purdue Pharma disregarded the study and labeled it inconclusive. That was when Bridget realized that it was almost impossible to stop the rampant usage of the drug.
‘Dopesick’ Ending Explained: What Happened To The Sackler Family In The End?
Doctors came forward to testify against Purdue Pharma after they saw their patients die as a result. Dr. Finnix knew how harmful the drug was after experiencing its effects firsthand. When he was in an accident, he was prescribed OxyContin, and from then on, he could not stop himself from consuming the drug. It was only after meeting Dr. Art Van Del, one of the first few doctors who had widely spoken against OxyContin, and after taking therapy sessions, that he could get back his life. After losing Betsy to an overdose, he took it upon himself to see to it that his patients at Finch Creek would receive treatment for oxy addiction. He dedicated his life to the cause and later started a wellness center to help those who suffered from addiction.
To prove that the drug was misbranded, AUSA gathered the graph charts that Purdue used to convince their customers about the safety of the drug. The plateau effect, which they propagated, was false since it was manipulated. Even the FDA had warned them to not use it for marketing, yet they did.
Another breakthrough for the case was when Rick and Randy figured out what the Porter/Jick study was, which Purdue and several pain societies referred to whenever they discussed the safety of opioids. The less than 1% addictive claim that Purdue made was based on the Porter/Jick study, and the prosecutors knew that if they could figure out how truthful the study was, they could build a strong case. The only problem was that the study was nowhere to be found, even though it was referred to several times. After numerous calls and searches, they finally found that the study was published in a 1980 issue of the New England Journal of Medicine. They started going through every issue that was published that year, and what they found was stunning. They noticed that what was claimed to be the “Porter/Jick study” was actually five lines written by Dr. Jick about how patients whom he observed at a hospital were mostly not addicted to the narcotics medication. It was an observation and not a study, as it was claimed to be. Dr. Jick later testified, stating that he was unaware of how his letter to the editor was used as a study by the pain societies. When he discussed the less than 1% addiction rate, he was specifically discussing a confined hospital setting and not a general study. Therefore, the FDA labeling and the Purdue claim were proven to be false and baseless.
To indict the top executives of Purdue Pharma, they gathered evidence on how the executives knew how addictive the drug was even before the year 2000, something that they stated in front of Congress. Thereby proving that they lied to Congress about their knowledge of the negative effect of the drug. The false testimonies were even faxed to sales representatives to prove that the top executives were by their sides.
John Brownlee made it clear to the Purdue Pharma defense lawyer that they would not budge for anything other than a plea of guilty for the executives. Though he was aware of how difficult it would be to be granted individual indictment knowing the influence the family had. The US Attorney of West Virginia charged them with conspiracy, mail fraud, wire fraud, distribution of a misbranded drug, intent to defraud, conspiracy to money laundering, and money laundering. Brownlee received a call stating how the fraud unit agreed to the prosecution charge, but the criminal division was not on the same page. The catch was that Purdue agreed to settle for a misdemeanor against their executives, and the company would plead guilty to the felony and pay the fine. Brownlee could either indict the executives and end up losing the case, or he could agree to the settlement and confirm some punishment for the crime. Brownlee accepted the misdemeanor charge even though he never truly wanted to settle for it. He could not risk it all, knowing that they had a great chance of losing the case. Purdue Pharma ended up paying 600 million dollars for the damage caused. The misdemeanor case was able to gather enough negative media attention to bring the problem to light and to shame the Sackler family and Purdue Pharma.
It was this fight that, in 2019, encouraged the Attorney Generals of twenty-five states to file class-action suits against Purdue. From news clippings, we learn that Katie Sackler and David Sackler defended their family. They had to pay 4.5 billion dollars for the lawsuits. They also had to forfeit ownership of the company and disclose 33 million documents, and in return, they could not be sued. Essentially, the Sackler family used the bankruptcy of their company to protect themselves from facing civil liability. Although there was a new settlement in March 2022 where they agreed to pay 5.5–6 billion dollars to a trust, the money would be used to settle the opioid addiction crisis. It is known that even when the United States was going through the opioid epidemic, and Purdue Pharma was facing the consequences, Richard Sackler did not give up hope of making money from the drug. He continued to call his sales representatives and asked them to be even more aggressive about selling the drugs and making the doctors believe that they were safe at the end of the day. No doubt, the Sackler family is labeled as complete evil; even after all the chaos, no members of the Sackler family could be sent to prison even though it is clear that they knew the harm the drug could cause. Yet, they chose to play with the lives of thousands of citizens to make a profit. Opiate abuse continues to be a problem even to this day, and “Dopesick” has been able to make opiate abuse a part of mainstream conversation.
“Dopesick” is a 2021 Biopic Drama Series created by Danny Strong.
