Review: Hulu’s “Dopesick”

I’ve already reviewed Beth Macy’s excellent book by the same name in my blog on 10/30/2018. This Hulu series was based on her book. I feared the series would be a let-down, as so often happens when books try to travel to television. But several of my patients saw it and told me it was very well done, so last week my husband and I started watching the series. We just finished several days ago.

My review for the series in a word is “Powerful.”

The series shows it all.

This series humanized the people who developed addiction to OxyContin and showed that good people became addicted to this medication. It showed the devastation of their lives and the suffering of family and loved ones. Some of the main characters were composites of the real people involved, such as Dr. Finnix, a physician who initially prescribed OxyContin after he’s influenced by a feckless OxyContin drug representative. He develops his own problems (I won’t spoil the story by giving too much detail). His character was based on several physicians that the author knew, and some of the other main characters were also composites. All the actors gave brilliant performances.

I thought the series gave devastating depictions of the ruthless greed of the Sackler family. Their ability to rationalize and ignore any publicized suffering caused by their drug is mind-blowing. They had the audacity to try to blame the rising tide of addiction and death on the very people who were prescribed their drug. The Sacklers tried to make a distinction between “bad” addicts and “good” patients who used the drug for pain, when reality is a whole lot messier.

The Sacklers probably weren’t happy with how they were portrayed, especially Richard Sackler.  He was portrayed as a difficult man who wasn’t satisfied with any degree of success. He was driven to make ever more money for Purdue Pharma and the Sackler family with no concern about damages being done to patients, their families, or their communities.

He was savvy about keeping himself out of trouble, too. When he saw legal problems on the horizon, he stepped down as president of Purdue Pharma. He promoted another executive, Michael Friedman, who was one of the three executives who pled guilty to criminal misbranding of medication in 2007. The series implies that Sackler got himself out of a position of power before the Department of Justice presented charges and things got bad for Purdue.

The FDA (Food and Drug Administration) got a deserved black eye in the series. The series showed how an FDA official helped Purdue Pharma get their unusual labeling approval and how he ended up working for Purdue several years later. That official was representative of what was wrong with the weakened FDA at that time.

It’s not only the FDA employees who jump from government to the private industries they may have formerly been tasked with overseeing. Government workers jump to private industry all the time. For example, the head of CSAT division of SAMHSA left that job to work for Reckitt Benckiser, the drug company who sold Suboxone and Subutex.

There are heroes in this story, and at the top I’d put the indefatigable investigators, the assistant U.S. attorneys Randy Ramseyer and Rick Mountcastle. They are the lawyers who painstakingly went through mountains of evidence and gradually realized the extent of Purdue Pharma’s wrongdoing. They assembled the case for John Brownlee, the attorney general for Virginia’s Western District. These diligent public servants not only investigated Purdue Pharma for wrongdoing, but also had to fend off efforts to sabotage their investigation from the inside of the DOJ.

One episode depicted a meeting of all three lawyers, Ramseyer, Mountcastle, and Brownlee, with the then-deputy attorney general James Comey. Comey commanded their presence and then asked what their problem was with the “chicken guy.” Apparently, Comey thought the lawyers were gathering evidence against Perdue Farms, not Purdue Pharma. But when the confusion cleared, Comey told them to proceed with their case, giving his approval.

The three lawyers faced incredible pressure from government insiders and from Purdue Pharma. One scene in the series shows Richard Sackler talking with an associate, wondering how he should deal with these lawyers. The associate tells him that these men don’t care about money and can’t be bought. They are present-day “untouchables,” people whose moral code can’t be corrupted.

What a tribute. They are heroes.

In the end, they had a tremendous victory with the Purdue settlement: the drug company settled for a fine of $600 million, and the top three executives settled for $34.5 million and a misdemeanor conviction for misbranding a drug.

In retrospect… it was small potatoes compared to what the company was making and continued to make. Purdue didn’t re-formulate their OxyContin until 2010, when their patent was set to expire.

I have a few minor complaints about the series.

First, I heard no mention of Barry Meier, investigative journalist who used to write for the New York Times. He wrote his extraordinary book, “Pain Killer: A Wonder Drug’s Trail of Addiction and Death,” in 2003, amazingly early in the opioid epidemic. “Dopesick” by Beth Macy, wasn’t published until 2018, fifteen years after Meier’s powerful groundbreaking book. He deserves credit for putting together facts on which further investigations were built.

Second, I don’t like how the series skips around. Of course, it’s a complicated story, and difficult to tell in a sequential manner. But I don’t like this new trend of books and movies where the beginning is in the middle and the end at the beginning, and so on. What happened to the traditional beginning, middle, and end? I predict this jumping around during storytelling is a fad that will pass.

Third, the series represented physicians in recovery can’t keep or regain their medical license if they are prescribed Suboxone or methadone. I don’t think that’s accurate in all states, thankfully. In North Carolina, I know the Board of Nursing allows nurses to work while on MOUD, and I think the medical board does the same for physicians and extenders, under some provisions. However, if the state in question is Tennessee…probably not.

Lastly, I didn’t like the scene when one of the main characters goes to an Alcoholic Anonymous meeting, and she gets offered OxyContin for sale by a woman in the AA meeting. That gives an unfairly negative image about what happens at 12-step meetings. I’ve attended over three thousand 12-step meetings and have never once been offered drugs. I’m not saying it doesn’t ever happen, just that it’s rare. I hate when people at12-step meetings tear down the benefits of MOUD (medications for opioid use disorder), but I equally hate when people not in 12-step recovery paint a negative picture about what they think happens at meetings. In a perfect world, all forms of recovery would support each other.

Other than these minor criticisms, I loved the series. I loved that the characters talked about how helpful Suboxone was to them, but a little sad at how methadone was portrayed.

Beth Macy has a new book coming out in August titled: “Raising Lazarus: The Search for Hope and Justice, and the Future of America’s Overdose Crisis.” I’ve already pre-ordered it on Amazon and look forward to reading it.

This opioid epidemic won’t be over for a very long time.

3 responses to this post.

  1. Posted by Charles E on May 9, 2022 at 12:54 pm

    I agree regarding the onscreen depiction of an “AA meeting”. Pushing drugs in the restroom? I have been to many, many AA bathrooms and that has never happened in my presence. Also, typically and here also, they show a meeting where the facilitator puts people on the spot, requesting that they share their stories. I have been to countless AA meetings and I have never seen that kind of “top down” dynamic. It goes against the principle of self-agency that AA espouses, namely that it’s up to the person if or whether to share. Jeezus.

    Reply

  2. Posted by William F. Taylor, MD on May 9, 2022 at 2:29 pm

    The other large but untold story is that, thanks to the Sackler excess and the reaction to it, patients with real pain from real illness and injury are unable to find doctors who will prescribe the opiates they need for a decent quality of life, or are involuntarily tapered from effective doses.

    Reply

    • Posted by Charles Erickson on May 9, 2022 at 5:06 pm

      That IS the other side to it. And it is not trivial. People in real pain are treated as drug-seekers by fearful physicians. Gaddam it, can’t we have some sense on this issue without ping-ponging from one extreme to the other?

      Reply

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