Those who enjoy "Easttown Nightmare" will likely appreciate this film; those who read "The Truth About Generic Drugs" shouldn't miss it.
I can only say that this film, both in terms of theme and narrative style, is simply to my taste.
At the beginning of the first episode, it uses a "Godfather"-like opening, with the camera slowly pulling away as a gentle person narrates the impact of pain on individuals:
Coexisting with pain means not being able to live out oneself, means not being able to live the best life, and even not being considered alive, because suffering strips away our ability to think, feel, and even love.
The narration flows smoothly, like a gentle savior—he vows to save those who cannot live out themselves due to pain.
However, this is the film's biggest "Boss," the culprit behind the addiction of millions—Richard Sackler.
The film opens by introducing the predicament faced by Purdue Pharma, controlled by the Sackler family: the patent for the popular drug "OxyContin" is about to expire, meaning other generic drug companies can legally replicate and sell it at lower prices, which is a fatal blow for Purdue. Therefore, as the company's chairman, Richard urgently needs a new drug to uphold profits.
Of course, Richard is not just trying to save the family pharmaceutical company; he wants to prove himself—to break free from being a marginal figure in the family.
Thus, the generation of the "miracle drug" OxyContin is born.
The film starts small, telling the story of a mining town. First, the people of this town live by mining, inevitably encountering various injuries and pains, making them a potential user group for OxyContin; second, the small-scale story strikes a chord, contrasting the vastness of Purdue with the smallness of the people. This is very similar to "Easttown Nightmare," with a small-town story, a semi-familiar society, and a good-hearted police officer (doctor) who ultimately causes chaos, making it easy for the audience to empathize.
To enhance the sense of suspense, the director employs flashbacks and interjections, disrupting the timeline of events, especially the timeline of the Black female DEA agent and the prosecutor, which unfolds in an intersecting manner, initially leaving viewers confused. But once you understand this order, it becomes clear: the female officer starts the investigation, becomes disheartened and stops a few years later, at which point three prosecutors take over the investigation, with interjections explaining the reasons for the officer's abandonment.
What impressed me deeply was the deceptive tactic employed by Purdue: creating legitimacy.
If symptoms cannot be described, then invent a new term to gain legitimacy, such as when patients still feel pain after taking medication, it is described as "breakthrough pain," with the treatment plan being to increase the dosage; furthermore, marketing pain as the fifth vital sign after temperature, blood pressure, heart rate, and respiratory rate; also, allowing different people to use different dosages, rather than starting from the initial 10mg, vigorously promoting "individualized dosing"; even going so far as to bring in "professionals" to claim that drug addiction is "pseudo-addiction," placing the blame not on the drug but on the individual, attempting to shirk responsibility...
From its sale in 1996, to the DEA's intervention in 2001, and the light misdemeanor penalties for several executives in 2007, these interventions did not stop the continued sale of OxyContin. Why? The Black female officer in the film actually provides the answer: these officials are signaling to future potential employers... this is the so-called "revolving door," where officials provide conveniences while in office and then take high-paying jobs in companies after resigning.
The film only mentions that three prosecutors sued several Purdue executives, initially intending to use the executives' testimony to send the Sackler family behind the scenes to prison. But unexpectedly, even the court was bought off, and in the end, they could only accept a settlement, resulting in a misdemeanor and a hefty fine, with the Sackler family facing no consequences.
However, the story is not over. I wonder if Hulu is preparing for a second season, as there are still over a decade's worth of stories to tell.
I found a timeline of real events that can serve as a reference.
Source: "Timeline of Real Events in 'Dopesick' (elle.com)
| Date | Major Events |
|---|---|
| January 1980 | The New England Journal of Medicine published a five-sentence letter to the editor written by Jane Porter and Dr. Hershel Jick, which Purdue Pharma later used to claim, "Less than one percent of patients treated with opioids become addicted." The letter cited a study that only involved hospitalized patients and concluded, "We conclude that, although narcotic analgesics are widely used in hospitals, the development of addiction is rare in medical patients with no history of addiction." |
| 1989 | J. David Haddox created the now-debunked concept of "pseudoaddiction," which, according to Wired, posits that addictive behavior is evidence of undertreated pain, with the solution being to prescribe more opioids. Haddox later became Purdue Pharma's Vice President of Health Policy. |
| December 1995 | The FDA approved OxyContin (an opioid painkiller) for the treatment of moderate to severe pain. |
| 1996 | Purdue Pharma began selling OxyContin. |
| 1997 | FDA reviewer Curtis Wright, who oversaw the approval of OxyContin, left the agency. The following year, he began working for Purdue Pharma with a salary of $400,000. |
| 1998 | Purdue Pharma distributed a promotional video titled "I Got My Life Back" to thousands of doctors, showcasing patients whose health improved with OxyContin. In 2012, Milwaukee-Wisconsin Magazine-Sentinel spoke with seven patients featured in the video and found that two had opioid use disorder at the time of their deaths, and a third person with opioid use disorder lost their job and home before leaving OxyContin. |
| 1999 | Richard Sackler, the mastermind behind the promotion of OxyContin, became the president of Purdue Pharma. |
| Early 2000 | The number of overdose deaths related to OxyContin increased; according to the FDA, "the number of people admitting to using OxyContin for non-medical purposes surged from about 400,000 in 1999 to 1.9 million in 2002, and to 2.8 million in 2003." |
| February 2000 | U.S. Attorney Jay McCloskey in Maine sent a letter to the state's doctors warning about the drug's diversion and abuse. That same year, OxyContin sales surpassed $1 billion. |
| April 2001 | FDA officials met with Purdue Pharma to discuss the drug's abuse, leading Purdue to suspend sales of its 160 mg OxyContin pill. |
| Spring 2001 | According to the Office of Inspector General, the DEA launched a national action plan for OxyContin, marking the agency's first-ever "plan targeting a specific brand of controlled substance, focusing on enforcement and regulatory investigations of diversion points." |
| July 2001 | The FDA added a new "black box warning" to the OxyContin label, alerting to its potential for misuse and abuse. It also removed the statement that "the delayed absorption provided by OxyContin tablets is believed to reduce the abuse liability of the drug." |
| 2001 | According to The Washington Post, Richard Sackler stated in a confidential email that Purdue needed to "combat abusers in every way possible," as the "culprit and problem" of drug diversion and abuse. |
| 2002 | Purdue Pharma hired Rudy Giuliani, who had just completed his tenure as mayor of New York City and was widely popular for guiding the city through the 9/11 attacks. According to The New York Times, Giuliani was hired "to help stop the controversy surrounding OxyContin." U.S. Attorney John L. Brownlee in the Western District of Virginia began investigating Purdue's marketing practices. He appointed Assistant U.S. Attorneys Randy Ramseyer and Rick Mountcastle to lead the investigation into Purdue. |
| January 2003 | The FDA sent a warning letter to Purdue Pharma regarding misleading advertising about OxyContin. |
| 2005 | After receiving a call from Purdue's attorney, then-Deputy Attorney General James Comey called Brownlee to inquire about his investigation. According to excerpts from Dopesick published in Politico, Comey told Brownlee, "Go back to Virginia and do your case." |
| May 2007 | The investigation ended with a plea agreement. Purdue Pharma admitted to criminally misbranding and misrepresenting its addiction risks. According to The Times, three of its executives pleaded guilty to misdemeanor "misbranding" charges, with the company and executives paying a total of $634.5 million in fines. Purdue also admitted that the company trained sales representatives to tell doctors that OxyContin was less addictive and easier to abuse than competing opioids, which exceeded the FDA-approved claims, according to The Times. Although prosecutors recommended felony charges against the executives, which could lead to imprisonment if convicted, Justice Department officials did not follow those recommendations. |
| 2010 | The FDA approved a new formulation of OxyContin. |
| September 2019 | Purdue Pharma filed for bankruptcy. According to The New York Post, at that time, the company and members of the Sackler family faced 3,000 lawsuits for fueling the opioid crisis. |
| October 2020 | According to The Times, ending a lengthy federal investigation, Purdue Pharma agreed to plead guilty to criminal charges related to the marketing of OxyContin, fraud against federal health agencies, and paying illegal kickbacks to doctors. The company faced about $8.3 billion in fines, the largest fine ever imposed on a pharmaceutical company. Members of the Sackler family also agreed to pay $225 million in civil penalties, a small fraction of their estimated $13 billion net worth. |
| 2021 | In August of this year, Richard Sackler told the court that Purdue Pharma and the Sackler couple bore no responsibility for the opioid epidemic. According to The New York Post, in September, a federal judge approved Purdue Pharma's "bankruptcy reorganization plan," which would resolve thousands of opioid-related lawsuits against the company and protect members of the Sackler family from future related lawsuits. (Although NPR reported that the family would not be protected from criminal charges, only civil lawsuits. According to The Washington Post, the plan was to dissolve Purdue Pharma and transfer its assets to a "new company owned by a trust fund to combat the opioid epidemic," with the Sackler couple contributing $4.5 billion. Some states intend to appeal the ruling.) |