The Crime of the Century (2021) s01e01 Episode Script

1
Morning, morning.
Oh, so they're
working on him?
They worked on him.
- Oh, really?
- Yeah.
- Which unit is it?
- Upstairs?
- It's up on the top corner.
- On top here?
January 13, 2021.
We'll get started
at 0540 hours.
Victim's information:
date of birth: 9,'97.
Long history of drug use.
The mother called in
at 0306 hours
for medical assistance
for her son, the victim.
She found him in his bedroom.
She said he was cold
to the touch.
Officers and medics arrived
on scene.
The lower half of the body--
The legs--were cold,
but the upper body
was still warm,
so officers and the medics
started performing CPR
for approximately 15 minutes.
See if it works.
It's worked like money
the last several times
I've done it.
♪
In the victim's bedroom,
we found a spoon
with a brown residue
inside of a shoebox
as well as a needle
and several baggies.
So that's positive
off the spoon.
Fentanyl.
Yeah.
Ultimately
was pronounced deceased
0336 hours.
Well, it's gonna be
a beautiful, sunny day today.
And we can expect
much more of the same
♪
♪
narrator:
For thousands of years,
a demand for opioid has
attracted commerce
and crime.
The narcotic comes
from the resin
that oozes from the bulb
of the poppy.
From the reign of King Tut,
the Egyptians were the first
to cultivate vast fields
of the drug,
which they sold
throughout the Mediterranean.
Alexander the Great
expanded the market
by introducing opium to India,
where today it is
still cultivated by hand.
It's known for soothing pain,
but carries the looming danger
of desperate addiction.
During the Inquisition,
Catholic clerics called it
the stuff of the devil,
but its lure
and commercial value
were hard to resist.
By the 16th century,
the resin was rolled
into black pills
called "Stones of Immortality"
and marketed as a pain killer
called laudanum.
During
the Industrial Revolution,
infants were narcotized
with laudanum
by mothers without childcare
who needed to leave home
to work the factories
and the mines.
The smoking of opium expanded
the global market into China,
where millions
became addicted.
By the 19th century,
the British East India Company
built vast opium factories,
where the stuff was rolled
into cannonballs
and then shipped off
to Chinese merchants
called the hong.
American dealers
like John Jacob Astor
and FDR's grandfather,
Warren Delano,
cashed in by manufacturing
the stuff in Turkey.
By 1839,
opium was the world's
most traded commodity.
Concerned by addiction
and overdoses,
the Chinese emperor
appointed a drug czar,
who dumped thousands
of cannonballs of opium
into the sea.
In a fury, opium companies
pushed the British government
to start a war with China
to keep the profits flowing.
In time, opium developed
as a prescription drug.
The Merck Company
launched a product
called morphine.
Bayer introduced
a cough suppressant
called heroin.
When addiction rose
to dangerous levels,
the U.S. made heroin illegal,
creating a new
global crime business
dominated by the Italian mafia
and Mexican cartels.
Big pharma turned
to the mass manufacturer
of other opium products
like morphine and oxycodone
and learned how
to mechanize the process.
They created a demand
for narcotics,
addicting millions
of men, women, and children
which, in turn, fueled
the illegal drug trade
from pill mills
to heroin dealers,
to illegal fentanyl factories.
The terrible truth
is that the business
of criminal cartels
and pharmaceutical companies
is connected.
Together, they generate
$100 billion of income a year
by cultivating and catering
to a desperate need
for opioids.
That business model has
a terrible cost.
Within the last 20 years,
more than 500,000 Americans
have been killed by overdoses.
♪
You know,
when I started off
telling the story
of the opium crisis,
I'd never written about
the pharmaceutical industry
before,
but I'd written a lot
about illicit drugs.
I had done some big stories
about
the Sinaloa drug cartel.
I was impressed
by the logistical complexity
and the seriousness with which
they thought about the idea
of innovating product lines.
Like when they first
were really rolling out
methamphetamine in a big way,
they would actually send
free samples to key markets,
and the way they thought
about wholesale distribution,
sort of how far down the chain
they'd go,
bringing the money
back to Mexico,
the way they'd
institutionalized corruption.
So I was looking at cocaine
and methamphetamine,
but increasingly it seemed that
Mexican heroin was making
a comeback in a big way
in the United States.
What creates the market
for this very dynamic
drug cartel,
where they're thinking
all the time
about their different products,
and what should we send,
and, you know, how's pot doing
versus cocaine,
and--no, truly--
And what they realize is, God,
there's all these people now
who want heroin.
It turns out that
that was a population
of hundreds of thousands,
and millions of people
who had been abusing
prescription drugs,
whether they were getting them
from a doctor
or buying them on the street.
And for a variety of reasons,
it was getting harder
to obtain,
and they find themselves
buying heroin.
You suddenly had this
huge population of buyers
who'd kind of come
into the market
through the back door.
They'd come in
through the world
of illicit pharmaceuticals.
And I started looking
at opioids,
and when you do that,
you pretty quickly stumble
on the Sackler family.
♪
I often say
I approach collecting
as a biologist,
that I want enough data
to be able to draw
valid conclusions.
Art is a passion
pursued with discipline.
Science is a discipline
pursued with passion.
You have to really pursue
the object.
You just don't sit there
and have the objects come
to you.
You want to be
a great collector,
you better think of the fact
that you're gonna
commit yourself
to a real passionate hunt.
Narrator:
Arthur Sackler's passion
as a collector
made him famous.
With his brothers,
the Sackler family
chiseled its reputation
for generosity
on the walls of museums
and colleges.
♪
No American family
has profited more
from controlled substances--
From Valium to OxyContin--
Than the Sacklers.
They built a fortune
of more than $14 billion
by becoming some
of the world's
most successful drug pushers.
I'm your mama,
I'm your daddy ♪
I'm that nigga
in the alley ♪
I'm your doctor
when in need ♪
Want some coke?
Have some weed ♪
You know me,
I'm your friend ♪
Your main boy,
thick and thin ♪
I'm your pusherman ♪
♪
I'm your pusherman ♪
Lord, Lord, hm ♪
♪
So there are
three Sackler brothers.
They grew up in Flatbush
in Brooklyn.
They had immigrant parents
who'd come from eastern Europe,
and they were
kind of quintessential
hungry sons of immigrants,
early 20th century,
trying to go out there
and make a name
for themselves.
All three brothers end up
going to medical school.
And Arthur Sackler,
who was the oldest brother
and kind of the patriarch--
Almost as much a parent
to his younger brothers
as he was an older brother--
Kind of leads the charge,
and he ends up, in the '40s,
at Creedmoor Psychiatric
Hospital in Queens,
which is this vast asylum.
6,000 beds.
And Arthur ends up bringing
his younger brothers
into the fold.
Something he often did
in their lives,
is he brings Raymond
and Mortimer,
his two brothers,
along with him.
And at that time,
there were certain stubborn
medical mysteries
having to do
with mental illness.
There were new innovations,
and one of them was
electroshock therapy.
And the Sackler brothers
end up in a situation
in which they are
administering
electroshock therapy
between the three of them
to thousands of patients
at this place.
♪
It struck them as crude
and inhumane,
and the brothers were
kind of repulsed by this.
And so they start trying
to find other solutions
to these mysteries,
and they become convinced
that it's brain chemistry
that is causing things
like schizophrenia,
and that
if it's a chemical problem,
then there's probably
a chemical solution.
So the idea that, you know,
there's no affliction for which
we might not be able
to devise a pill.
So the Sacklers buy
a small pharmaceutical company
in 1952,
a company called
Purdue Frederick.
♪
It was this little concern.
You know, they sold tonics
and kind of
unglamorous products.
Ear wax remover.
That kind of thing.
While his brothers
are running Purdue Frederick,
Arthur Sackler ends up
buying and owning
a medical advertising company
called MacAdams
and in pretty rapid succession,
comes up with a whole series
of revolutionary ideas
that completely transform
the landscape
of how we sell drugs
in this country.
Narrator: Arthur Sackler
was a pioneer
in bringing
Madison Avenue techniques
to the selling of drugs.
But in doing so,
he often crossed the line
from promotion to fraud.
The essential trick was
to hire doctors
and use them as pitchmen
to sell to other doctors.
He even paid a division head
at the FDA
to promote his drugs.
Occasionally, he would invent
expert witnesses.
One of the companies
that he represents
has an ad,
and it just had a series
of business cards
of doctors
from different parts
of the country.
At the time when this ad runs,
there was
an investigative reporter
who decides he wants
to get in touch
with these doctors.
So he writes letters
to all of them.
And the doctors don't exist.
So you see pretty quickly
how this can get
kind of perverted,
and at a certain point,
the idea that the doctor,
who we're raised to think of
as a real kind of custodian
of our health,
can be enlisted in a sham
or just outright invented
in the interest
of selling a product.
I get the impression
that you have a very good time.
I'm having a ball.
Narrator: In the 1960s,
Sackler became incredibly rich
by expanding the market
for addictive tranquilizers,
convincing doctors
and patients
that they needed Librium
and Valium
for everyday anxiety.
When widespread abuse
and addiction followed,
a senate committee
investigated
Sackler's
promotional campaign.
Sackler would blame
the problem
on reckless patients.
In Arthur's case,
he said
when asked about the idea
that people became addicted
to drugs like Valium,
"The drug isn't the problem.
The user is the problem."
♪
Arthur Sackler died
before OxyContin
was ever invented,
but Arthur Sackler
created the world
in which Purdue
and the Sackler family
would be very successful.
♪
Their first really big hit
is a pain drug
called MS Contin.
MS Contin is morphine,
but they developed a system
that they called contin,
which is short for continuous.
It's essentially a seal
around a pill
so that if you take that pill,
the active chemical in it
will enter your bloodstream
slowly, continuously
over a long period of time.
MS Contin was
an innovative drug.
It was used chiefly in
cancer pain-type situations.
And at a certain point,
the company knew
that the patent
on MS Contin--
The company's exclusive right
to produce it--
Was going to be expiring soon.
At the point where you lose
that exclusive right,
you have generic versions
of that drug
and you're just gonna
see your profits nosedive.
So they start thinking,
"Well, what are we gonna find
to replace this?"
They start talking
about oxycodone.
Oxycodone is
a very powerful opioid,
much more powerful
than morphine.
It's also quite addictive,
but they had this notion.
"You know, what if we took
"the contin system
that we created
"for morphine
and used it with oxycodone?"
So rather than it being
a huge dose
that will just overwhelm
your system,
it slowly goes
into your bloodstream
over the course of 12 hours.
Narrator: Controlled-release
oxycodone, or OxyContin,
would be the drug
that triggered
what we call
the opioid crisis.
But what if we discovered
that the crisis
started with a crime?
Through a set
of secret documents
and never-before-released
depositions,
we found powerful evidence
that Purdue may have hidden
the dangers of OxyContin
in favor of the profits
that would come
from touting its benefits.
Would you state
your name, please?
Richard Sackler.
Everybody who worked
at Purdue Pharma,
I think, was pretty heavily
invested in OxyContin,
but no one more so
than Raymond's son,
Richard Sackler,
who was also a doctor.
- That's correct.
- Yep.
He wants to do things
that are
a little more ambitious.
He's got big visions.
He was working
around the clock.
He was incredibly demanding.
He would be
micromanaging staff.
If you sent him an email
at, you know, midnight,
he would write you back
right away.
Very fixated on the success
of this drug.
Narrator: Sackler launched
OxyContin with one
of the largest pharmaceutical
marketing campaigns
in history, but oddly,
he kept his own role hidden
and never gave interviews
about the drug
until he was forced to testify
in this deposition
when the state of Kentucky
sued
and ultimately settled
with Purdue
for its history
of deceptive marketing.
We had a product
that had tremendous potential.
For 100 years, and even today,
there is no drug
that is more effective
or safer than opioids
for treating pain
over a long term.
But whether
it's effective or not
also depends on other factors
such as abuse.
I mean, you can kill somebody
and take away their pain,
but that certainly wouldn't
be effective, would it?
I don't think that death
would be considered a sign
of efficacy.
- Correct.
- Yes, I mean,
in the extreme,
yes, what you say is correct.
So just because
it takes away pain
doesn't mean it's a good drug,
does it?
No.
♪
Andrew: When we talk
about opioid pain medicines,
you're converting
the natural molecules
that exist in opium
into this stronger version
that gets into the brain
faster,
that has
a more rewarding effect.
That's basically
the same process
for making heroin.
So when we talk about drugs
like hydrocodone and oxycodone,
you're talking about drugs
that are semisynthetic,
just like heroin
and that produce effects
that are indistinguishable
from heroin.
These are essentially
heroin pills,
which doesn't mean that doctors
should never prescribe them.
These are good medicines
for easing pain
at the end of life,
for a couple of days
after major surgery
or a serious accident.
But unfortunately,
Purdue Pharma
and other opioid makers
started to promote
their opioids
for common
chronic pain conditions
where opioids
are much more likely
to harm patients
than help them.
♪
narrator: In 1994, Purdue
started its FDA application
for the approval of OxyContin.
Not only did Purdue minimize
the addictive nature
of the drug,
its executives launched
a plan,
with the approval
of the Sackler family,
to market the drug to
the widest possible audience.
The risks of OxyContin
might have been acceptable
for some people,
like patients painfully dying
from cancer,
but not for teenagers
with knee pain.
So in its application
to the FDA,
Purdue promoted the safety
of OxyContin.
Had Purdue submitted
an application to FDA
seeking approval of OxyContin
for treating pain at the end
of life from cancer,
the burden would have
been easier for Purdue,
but they never would've really
been interested in that
because you can't really get
a blockbuster drug
if the drug is
gonna be promoted
for pain at the end of life.
There aren't enough patients
with end-of-life cancer pain
and they're not gonna be
on the product for very long.
You've got to get
that drug prescribed
for common conditions.
But to get FDA approval
to do that,
you need the evidence
that the drug is
both safe and effective
for these common conditions.
Narrator: But Purdue
didn't have any evidence
that the drug was safe,
so the company
obtained the help
of a medical officer at FDA.
His name was Curtis Wright.
♪
Working closely with Purdue,
Wright allowed the company
to claim
that OxyContin
was not very addictive
or prone to abuse.
Purdue executives camped out
for three days
in a rented room
near Wright's office
and worked with him to draft
the official FDA review
of OxyContin
in a way that Wright promised
would be promptly approved.
♪
Okay,
so this is a document
that was leaked to us
that showed a pretty unusual
amount of interaction
between Purdue officials
and Curtis Wright at the FDA.
Wow, uh
This is the first time
I've ever seen this, uh
This isn't just unethical.
I-I think
this could be illegal,
that they allowed Purdue
to do this.
And if it's illegal,
it would look as though
both Purdue and Curtis Wright
may have broken the law.
There's no way that
this should be allowed,
that a drug company
would be involved
in drafting the review
of its application.
And this is a document
from the medical officer review
of Curtis Wright.
This is part
of the approval.
- Part of the FDA approval.
- Right.
And he's the guy that actually
approved it to be sold
or, you know, allow you all
to sell it, from the FDA.
That's my recollection.
Y'all ultimately hired him
a few years later,
didn't you?
Um
We did hire him
but not after his tenure
at the FDA.
Um,
we discussed it and agreed
that we should not hire
somebody who had ju--
Who had reviewed our product
and then left.
And so he went
to another company.
He went there
for a short period of time
and then came to work
for you all.
- I don't remember.
- It was certainly
It was certainly--
I--my recollection is
a couple of years,
two or three years,
but I don't recall exactly.
The record, I'm certain,
could be produced.
All right,
well, let's take a look
narrator: The record shows
that Wright joined Purdue
just over a year
after leaving the FDA.
In his first year at Purdue,
Wright's compensation
was greater than $370,000.
It was a tidy sum for the man
who had allowed Purdue
to use
the OxyContin package insert
as a marketing tool.
Suggesting
that low-dose patients
wouldn't get addicted,
the insert also claimed,
without any evidence,
that the product was believed
to reduce
abuse liability.
If you're Richard Sackler,
if you're Purdue,
that is a tremendously
helpful thing
to have in the package insert,
right?
Because it means that your army
of hundreds and hundreds
of sales reps
can go out and meet
with doctors and say,
"Look, Doc, it's right here
in the package insert.
The FDA approved this,"
with this crucial line
about how
the delayed absorption
is believed
to reduce the abuse liability.
Like, believed
by Purdue Pharma,
you know, on a hopeful,
"wishful thinking" kind of day.
♪
It's a phrase that gives rise
to the opioid epidemic.
♪
This was a momentous,
historic mistake
by the agency.
Rescue 45.
In the area.
- This event right here.
- 1-11.
209 Northwest.
What motivated me
to become a EMT,
my freshman year
when I was in high school,
I had two classmates
that had overdosed on opioids
as I was in the English class
learning on grammar
and punctuation.
I was sitting
in the front room--
The classroom--
And heard two thumps
of two classmates falling out
of their desks.
Started foaming at the mouth.
♪
961 Wise.
We'll be in the area.
Do you have a description of
what the residents look like?
♪
I have ran a overdose call
where I had four overdoses
at once.
Me and my coworker walked
into the household,
where we had two 16-year-olds.
One of them was a brother.
The other one was a cousin.
And the parents.
They, all four,
had both overdosed
on oxycodone.
I work
sometimes 100 hours-plus
a week
for two jobs,
and the stuff I do see,
it does have a bad mix
with my family life.
There has been times
to where I have
went to a room by myself
and
just sit there
and talk to myself,
and basically
broke down crying.
I ask myself sometimes
if I want to continue
doing this job.
It's made a hard impact.
They had a terrible problem
down in Lee County,
which was not in my territory,
but it was next door to it.
All that area,
that was the first area
where the abuse exploded,
down around Norton
and Richlands.
It exploded right there first,
from what I could see,
and then moved into Bluefield,
and Princeton, and Beckley,
and then on down to Bristol
and Wytheville.
And it spread like cancer.
Almost heaven ♪
West Virginia ♪
Blue Ridge Mountains ♪
Shenandoah River ♪
♪
both: Life is old there ♪
Older than the trees ♪
Younger than the mountains ♪
- Hey, buddy, you with us?
- Growin' like a breeze ♪
Country roads ♪
- Take me home ♪
- Go.
To the place ♪
I belong ♪
West Virginia,
mountain mama ♪
Was it always West Virginia
for you?
Well, my first eight years
was in Ohio,
up around in Medina,
right around Cleveland,
in a log cabin.
All my memories ♪
Dad worked
at a Chevrolet plant
where they made transmissions.
But he had a mid-life crisis,
I guess, in his 40s,
and he got the urge
to come home to West Virginia,
where he and my mom
were raised.
And it was about the same time
"Take Me Home, Country Roads"
came out too.
And so maybe that had
something to do with it.
Country roads ♪
Take me home ♪
Moved to a place called
Sundial, West Virginia.
Down in the coal fields.
I had four brothers
and one sister.
Dad worked in the mines
till he blew out his lungs
from black lung
and from asthma
from being in belt fires.
Dad wanted me to go to college.
I wanted to go.
I first asked him if I could
go into the mines like him,
you know.
"That paid good money.
How about that, Dad?"
He said, "No, Mark."
He says, "You're so clumsy,
you'll get killed
the first shift."
So I went to college
at Concord University,
down in the southern part
of the state of West Virginia
at Athens
and got a degree to teach
biology and chemistry
in high school.
But the first job
that I got out of college
was a pharmaceutical job
with Mead Johnson
about 1988.
I didn't know much about sales,
and I'm not even--
I wasn't even sure
that I would really stick
with it or liked it,
but I came to be hired on
with Purdue
when I was called
by Mark Radcliffe,
who was my district manager.
He's pretty infamous right now.
He's been in a federal prison.
He called me and said,
"If you work hard,
you'll make tremendous amounts
of money."
Uncapped bonus.
That's what caught my ear,
was uncapped bonus.
There was no cap on it.
No ceiling.
And I thought, "Well,
that's the kind of money
I'd like to make."
I started in April of '98,
signing on to sell OxyContin
primarily.
OxyContin was
what they stressed
they wanted sales out of.
It was supposed to me
that it was a veritable
treasure chest
of untapped sales out there
because there were
so many people
that were undertreated
for pain,
or they weren't being treated
at all
because physicians were afraid
to use
stronger pain medications
for them,
and they were suffering.
And I could see the mission
being described to me,
and then I signed onto it.
It sounded like
a very honorable thing to do.
Helping patients that
were suffering from pain,
get their relief,
and give 'em their life back.
♪
Today, we essentially
consider pain
in any form to be dangerous,
that the experience of pain
leaves a kind of psychic scar.
The origin of this concept
really comes from Freud,
that when we have traumatic
childhood experiences,
those can influence
the development
of adult psychopathology,
and that that can often happen
on an unconscious level.
You can not be aware
that certain
neurotic tendencies
that you have as an adult
have their origins
in some kind of
early traumatic experience.
And that, in and of itself,
was a very modern
and new idea.
150 years ago,
doctors believed
that pain was actually good
for you,
that when patients
experience pain
during a surgical procedure,
for example,
that that would boost
the cardiovascular response,
that would boost
the immune response,
that it helped
with the healing process,
that there was
a spiritual component.
You know, this whole idea that
what doesn't kill you
makes you stronger.
That was very much ingrained
in medical training
and in the medical system
to the point
that in the mid-1800s,
when anesthesia
was first invented,
some of the most prominent
surgeons in this country
didn't want to adopt it
because they wanted
their patients to feel pain
during procedures
in order to expedite
the healing process.
Like, we don't think that way
about pain anymore.
You know, now we think,
"Oh, my goodness, pain!
Like, I've got to get rid of it
immediately."
But what makes
the opioid crisis unique
is that the pills themselves
are so inherently addictive
that if you then add that
to all
of the business incentives
to overprescribe,
you do end up with
this kind of perfect storm
that leads to the crisis
that we have today.
You know, guys,
you know, as far as the Purdue
Frederick Sales Organization
is concerned,
it's a high-energy sales
organization.
It's one of the best
sales organizations
in the pharmaceutical industry,
and they're hard-driven.
And if we're gonna write a song
for these folks,
it's a song that's gotta smoke.
Okay.
♪
Purdue, are you ready to rock?
Whoo!
Well, I want to tell you
a story ♪
About people ♪
About a company
called Purdue Frederick ♪
And they did so good in '96 ♪
Now, people ♪
I think they're really ready
to rock right now.
I said, are you ready
to rock right now?
Put your hands together
if you're ready now.
Narrator: In the late '90s,
Purdue celebrated
its marketing muscle.
There were 600 sales reps
pitching healthcare providers
all over the country.
Using parties and junkets
to lure doctors
to write scripts,
Purdue's pitchmen banked
$40 million a year in bonuses.
At the turn of the century,
OxyContin sales exceeded
$1 billion a year,
passing Viagra as America's
most profitable drug.
You know you make me
want to sell ♪
- New prescriptions ♪
- Sell! ♪
I was very gladdened
to see that OxyContin
was meeting
with such a strong,
positive reception,
by both physicians
and patients.
Hey, hey ♪
Ladies, and gentlemen
The doctors
that we targeted,
they called me Moneybags
and Easy Money,
I guess,
because in their mind,
once you got them on OxyContin
or a opioid
and they got hooked,
you were going to get
reoccurring prescriptions.
And the monthly bonus checks.
My first year with Purdue,
I believe I made
in the neighborhood
of about 170.
170,000.
Selling MS Contin ♪
Every day ♪
Selling OxyContin ♪
My final year,
it was almost 300,000.
Now wait a minute! ♪
- You know you make me want ♪
- Sell! ♪
- New prescriptions ♪
- Sell! ♪
Expenses risen ♪
Sometimes doctors tell us
they feel
that our sales representatives
have been pushy.
They are insistent
because they're on a mission
to bring this medication
to people who need it
to restore their quality
of life.
- Hi, Lauren.
- Hi, Doctor.
- Nice to see you today.
- Nice to see you as well.
Yeah, they called me
Easy Money,
but there wasn't nothing easy
about it
because we had such a wall
to break away.
At least early on, doctors
were afraid of the opiates,
and they didn't believe
in using high doses.
They didn't believe in using it
in non-cancer pain,
so we had to overcome all that.
In this program,
these and other patients,
all of whom have suffered
through years
of varying degrees
of chronic pain,
tell the story of their long,
often frustrating,
always painful search
for adequate treatment.
They had a video called
"I Got My Life Back"
I played many a-times
in physicians' offices,
sort of humanize the idea
of treating pain patients.
Since I've been
on this new pain medication
I'm more of a partner
to my husband again.
- Now I can go to a movie.
- I'm still alive.
When they mentioned
the dosages
that they were on
I'm currently
at 1,200 milligrams
of OxyContin.
You know,
some physicians,
their mouth would drop open
and, you know,
we would explain to them that
there was no maximum
on the dosage,
that you could go
with a pure opioid
that had no secondary product
in it
like Tylenol, or ibuprofen,
or aspirin.
This medication does
not turn you into a zombie.
The opioids have
given my life back to me.
The gold nugget was
non-cancer, chronic pain.
OxyContin, it's the one
to start with
and the one to stay with.
What is pain?
Pain is suffering.
Pain is soreness.
Throbbing. Aching.
Pain is whatever the person
experiencing the pain
says it is.
Amazing!
Purdue was so generous.
They had video tapes.
They had manuals.
They had posters.
They disseminated that
to all the hospitals
in the country
who had to educate
their doctors.
It meant that I,
a psychiatrist,
had to go
an all-day-long course on pain.
I didn't have to go
to an all-day-long course
on, you know, cardiology
or radiology.
The fact is that
pain should be treated
as aggressively
as the underlying condition
that causes the pain.
I was taught that
pain should be treated
like the fifth vital sign.
When you take blood pressure,
when you take
respiratory rate,
when you take heart rate,
temperature,
you should show them
this scale from one to ten.
One is like tiny,
little bit of pain,
and ten is the worst pain
you could imagine.
Incorporating
pain management
into nursing education
at all levels
will produce staff members
who are skilled
in pain management.
We were constantly being told
that there was
a growing epidemic of pain,
that more and more people
were in pain,
that it was the responsibility
of the doctors
to alleviate pain.
There is always
something that can be done
to reduce pain.
You needed to
"Get over your opioid phobia."
We doctors
were wrong in thinking
that opioids can't be used
long-term.
"No dose is too high
and your patient
can't get addicted."
Less than 1%
of patients
taking opioids
actually
become addicted.
"And if you don't use them,
"you are a bad doctor.
You want people to suffer."
Take opioids seriously.
So we tried to abate
all their fears
that were well-founded,
that they had acquired
through medical school
and through practicing
before we got to 'em
about opioids.
We took all that away
and then turned them loose.
♪
There was
great recognition
that we had millions
and millions of Americans
who deserved to have
their pain treated
more humanely.
Frankly, that's why we go
to medical school, right?
We're there really to provide
relief of suffering
as much as anything.
Only once every generation
or two
is there such a dramatic shift
in the way in which
we can help patients
in such a large way
that I thought
I was at the beginning
of this new frontier.
And that's how I became
addicted to the treatment
of pain.
Hello, everyone.
I'm Lynn Webster.
For many people that
experience chronic pain,
it's as malignant as a cancer.
I had a lot of experience
with Lynn Webster
over the years.
He's unfortunately been one
of the leading educators
across the country
on opioid prescribing,
taking lots of money
from drug companies--
Hundreds of thousands--
Probably more than
any other key opinion leader.
- Thank you.
- Helping them market
or serving on advisory boards.
He's spoken at hundreds
of medical events.
The problem
is not hydrocodone.
The problem's
hydrocodone abuse.
I don't think there's anyone
he wouldn't work for.
I don't know.
My space in lecturing was
what I viewed
was more academic.
But you--
You were sometimes paid
by pharmaceutical firms.
- Not--no, no. Not to speak.
- Oh.
Now, pharmaceutical companies
may hire an educational company
to put together a program.
I would be contracted then
with an educational company
to put on the program,
so it wouldn't be directly.
It's indirectly, I suppose,
but they had no,
no influence on the content.
Zero.
I would never do that.
Thank you very much.
Hello, everyone.
Most of my speaking
was about the risk of opioids.
Opioids can be used safer
than they have been used
in the past
because it is, frankly,
your health.
You know, I think that
the definition of addiction,
um, has to be defined.
You have to be exposed
to a drug that's rewarding,
like an opioid,
in order to develop the disease
of addiction,
but it's not sufficient,
meaning most people exposed
to an opioid
will never develop
an addiction to it,
regardless of how long
they're on it.
A whole generation of doctors
bought into this idea
that it's okay
to use opioids liberally
as long as you're giving them
to a patient in pain,
that somehow there's
a magic halo effect
with that prescription pad,
and your patient
won't get addicted.
And if they look like
they're getting addicted,
they're not really addicted.
They're pseudoaddicted.
Now, what's pseudoaddiction?
Pseudoaddiction is
when a patient is
looking like a drug addict
because they're pursuing
pain relief.
"Pseudoaddiction"
was a made-up word
It only came out about 1990,
but it's crucial.
In a single case report.
The doctors who wrote
that case report said,
"Aha, we discovered
that this individual
"who looks like
someone who's addicted
"isn't really addicted.
They are 'pseudoaddicted.'"
Relief-seeking behavior
mistaken as drug addiction.
"They're really in pain,
and you just need to go up
on the dose."
- Hold on for just a moment.
- Let me bring in David Haddox.
One of the authors
of that study was Haddox,
who went on to work
for Purdue Pharma.
Good morning.
And was a lead spokesperson
for them
around more
opioid prescribing.
No one's talked
about the patients.
There was never
any science
behind the concept
of pseudoaddiction.
This message
about pseudoaddiction
was probably the single
most dangerous message
in this whole campaign
because it's exactly
the opposite
of what a prescriber should do.
A lot of us were,
at that time--
Still today--
Wonder sometimes
if addiction is really
a behavior.
How do we differentiate
a behavior
that is really somebody
experiencing unrelenting pain,
or they want the drug
for the psychological effect?
You know, I've been criticized
because I said
the treatment of--differen--
I mean, one treat--
One option in trying
to understand
if it's in pseudoaddiction,
the treatment should be,
give more drug.
The idea
of pseudoaddiction,
that was talked about
in training a fair amount.
And the way you need
to explain it to a physician
is--was false addiction.
They do look like
they're becoming addicted
or drug-seeking,
and that's a sign you need
to increase the dose.
It made sense when your--
Your eyes are glossed over
with a mission
to treat untreated pain.
It filled right in a gap
of any of your knowledge,
and the story seemed
to build on itself.
And, "Yeah, that makes sense.
Pseudoaddiction."
Well, looking back on it,
you know,
that's pretty hypocritical
and crazy.
You don't think
that there was
a great enthusiasm
for higher doses
without being concerned
about the possible downside?
- Oh, yes.
- Absolutely.
I think that there was
a lot of enthusiasm.
I owned it because I thought--
I thought I could
just give enough,
and my patients
would have a normal life.
I know, and all
anesthesiologists know,
you can give enough opioid
to take away the pain.
The problem is,
will they be awake,
or alive?
♪
I served a mission
for my church,
a Church of Jesus Christ
of Latter-day Saints.
After returning
from that mission,
I was a pediatric psychiatrist
at the local hospital,
and Carol was graduating
as a nurse
from Weber State University,
and that's where we met.
♪
With our first child,
the due date had passed,
and she said, "We've got
to get this on the road.
"Go get Dad's boat.
We're going to Pineview Dam.
We get up there.
She skis a lap,
beaches on the sand,
and says, "Okay, I'm ready
to have the baby."
She wasn't afraid of anything.
This never should've happened.
One day,
Carol and my oldest son
were going to Sam's Club,
and an 84-year-old woman
ran the stop sign,
and my son's vehicle
T-boned her car,
and she was thrown
into the windshield.
A neurosurgeon
rebuilt her neck
with a plate and screws.
There was pain associated.
It was being managed very well
by our primary care physician,
but then a neighbor came
to visit Carol one day,
who was suffering
from lower back issues,
and he recommended
that Carol go see
Lifetree Pain Clinic.
Dr. Lynn Webster,
he ran the clinic.
Why did you name
your clinic "Lifetree"?
Well, I had
to name it something.
I wanted people to feel like
there was some stability
to my clinic.
That's the roots basically
of a tree.
I was hoping it to be
really a strength
for my patients.
Webster prescribed
oxycodone.
She was on fentanyl.
She was on amitriptyline.
She was on a hypnotic
for sleep.
Her mannerisms, her behavior,
everything changed after
she started going to Lifetree
in a negative way.
She would take the medication,
and then she would
get confused.
She would get loopy.
And then, you know,
a half hour, 45 minutes later,
she would think, "Oh, I've got
to take my medication."
She'd take it again.
Numerous times,
I found her unconscious
in the strangest of places.
And then,
when she'd come out of it,
she would have no knowledge
of it.
And so I started
taking pictures
of when I would find her.
And the only reason
I took the pictures
is so that I could show her
because she did not believe me.
♪
We'd end up
in the emergency room.
And my son, John,
got all of the pills
that Lifetree had prescribed,
and we took them out there.
And I remember the physician
saying,
"You got to be kidding me.
You got to be kidding me.
You got to be kidding me."
And he was able to convince her
to go in the program.
She was able to get off
of all of the pills,
all of the patches.
She was in great shape.
She was happy.
She was smiling.
She was involved.
And she was on Tylenol.
And the next thing
that I know is that
she informed me that
Dr. Webster wanted to meet
with she and I
to discuss her condition.
So we went down,
and I'll never forget.
He made a statement,
and I'm still baffled by it.
He said,
"A chronic pain sufferer
"cannot be an addict.
"I am her physician.
"I will prescribe
the medications
"that I think she needs,
"and she will be
under my care.
And that will be
the end of it."
I would often say
to my patients,
when I was giving them
higher doses of opioids,
I'd say,
"Take this medicine
just as I say.
Or you may not wake up
in the morning."
Almost inevitably,
these patients would stop,
and look me in the eye,
and say, "Doc,
"that's okay.
I can't live
with the pain I have."
He gets her back
on all these medications,
and immediately
she was dissociative.
She was lethargic
all the time.
But Dr. Webster refused
to listen to the family.
My children, I tried.
We would call up and say,
"We need to get a message
to Dr. Webster
that he--that Carol
is not in a good way."
There was always some tension
between the family
and my patient,
and my effort
to try to find a way
to help her with her pain
within a reasonable framework
of what her family would accept
was a challenge.
He didn't spend
really any time with her
on a monthly basis.
He had PAs that were
doling out medicine.
Webster wasn't minding
the store.
He was traveling
around the country,
and he was promoting
the use of opioids.
It was money.
It was ego.
Whenever we're looking
at providing a treatment,
we're always looking
at the potential risk
versus the potential harm,
and opioids can provide
more potential benefit
than the potential harm.
♪
♪
narrator: 10,000 miles
from its headquarters
in Connecticut,
Purdue Pharma sought
the solution
to a pressing
production problem.
The company was so successful
that it was running out
of opium.
To find enough supply
for the soaring demand,
Purdue turned
to a company famous
for its promise
of "no more tears."
In just this one moment,
your baby is getting
even more than clean.
The scent, the lather.
Even the tiny bubbles
of a Johnson's bath
are helping
to enhance the experience.
Johnson & Johnson,
They have this brand
that makes people think
of baby shampoo,
and talcum powder,
and wholesome products.
But they are also the kingpin
in the opioid crisis.
Johnson & Johnson wasn't just
selling its own opioids
and promoting them
for conditions
where we shouldn't use them,
promoting long-term use,
high-dose use.
Johnson & Johnson was
also supplying Purdue
and all of the other
opioid manufacturers
in the United States
with the opium
that was making it possible
for the U.S.
to be flooded with opioids.
The traditional way to extract
opium is you lance
the poppy head.
Then someone goes
through the field,
scraping off the opium sap.
And it's very labor-intensive.
But in Tasmania,
what Johnson & Johnson did
was to really industrialize
the process,
creating a product called
concentrate of poppy straw.
They would basically cut
the whole plant
at a certain point
where it's richest
in the alkaloids,
and then process the straw
to get the opium out.
Narrator: Johnson & Johnson
also genetically altered
the nature of the plant
to create a super poppy,
that was surging
with thebaine,
a narcotic in oxycodone.
To persuade Tasmanian farmers
to switch from potatoes
to poppies,
J&J offered luxury vacations
and awarded prizes--
Mercedes and BMWs--
To farmers
who could produce
the most potent crop.
♪
Soon, 74,000 acres of Tasmania
were devoted
to opium.
J&J lobbied
the U.S. government
for unlimited access
to American markets
and promoted its product
in a brochure
called "Finding Relief."
In the United States, Purdue
used the opioids from Tasmania
to flood the country
with OxyContin.
But the pills
weren't just for pain.
They were being diverted
from doctors
to people looking
for a heroin high.
From the mid-'90s,
the company's sales reps
weren't willing or able
to recognize the abuse that
was happening all around them.
Looking back
and reflecting on it,
what Purdue also did
to their benefit--
And I sincerely think
it was probably a strategy--
Was when they hired people,
they hired representatives
from other companies
that didn't sell opioids.
They didn't like
to have people,
from what I've seen,
come in to their company
that was preexposed
to the problems
with abuse diversion
and things like that.
You see what I'm saying?
The number one thing we were
taught about addiction was,
in the package insert,
it says,
"Delayed absorption
of OxyContin
is believed to reduce
the abuse potential."
That sentence was pounded in.
I pounded it in doctors' heads.
"Delayed absorption
of OxyContin
is believed to reduce
the abuse potential."
Over and over and over
and over and over.
"Delayed absorption
of OxyContin
is believed to reduce
the abuse potential."
And I would always
let them know it,
you know, "Nothing gets
in these package inserts
"that hasn't been reviewed,
you know, excruciatingly
by the FDA."
From the inception of
the launch of OxyContin,
we focused
our salesmen's attention
to physicians whose practice--
And their practice was to use--
Write a lot of prescriptions
for opioids.
We didn't go to people
who didn't write them.
We went to people who did.
Dr. Frank Sutherland
was a osteopath
down in Grundy, Virginia.
Grundy, Virginia is a little
old Podunk town, coal town
that's down in a bowl
coming from Richlands.
It's just straight down,
swerve-y and curvy,
and you get down there,
and there's a lot of
hardworking people down there,
but there's a lot of people
that, um,
are, um
druggies, I guess
you should say.
I went in to see Frank,
and pretty quickly,
he jumped on the bandwagon,
writing OxyContin
very regularly,
probably seeing
80 patients a day.
I also noticed
in his waiting room
more and more I went,
that he had patients in there
that looked like they were
rough around the edges.
And I would hear conversations,
pick up a tidbit about,
you know, "You need to ask
for this many."
And they was talking
about OxyContin.
♪
I didn't sell opioids before.
I didn't abuse them,
so I didn't know
you could crush it
and snort it.
But obviously,
if you do crush it,
you get away
from the time release,
therefore there's trouble.
You could get the whole dose.
I brought that
to Frank's attention.
He says, "I know who they are.
I know who they are."
You know, I said, "Okay.
"You know, as long as you know
who they are.
"You know, I don't want you
to prescribe--give OxyContin
to somebody you know
that's abusing."
But then I had a doctor
that I actually seen one time.
I went in, and he was
wiping his nose
and doing this trick,
coming up from his desk.
He was cutting up OxyContin
and snorting them
right off his own desk.
As it went on,
you kept hearing
more and more stories.
You had, say,
the nurse in the office
explain to you
that her grandson
pulled one
out of the drug cabinet
and snorted it and overdosed.
You know,
"What? Are you kidding me?"
You know, and I start hearing
more and more stories
from nurses that I knew
for 15 years.
And by the time it got to
the end of '99,
I was pretty convinced
that we had
a major problem on our hands.
That's when I started trying
to pass the information
up to the top.
The emails that I sent up
were right to the point.
You know, "There's gonna be
a death train coming.
"We've got to do something
about this.
This is just chaos out here.
I can't believe it."
I thought that they would
at least have the decency
to listen to one
of their best reps
with some concerns,
but they did not even want
to entertain the discussion.
You know, "It's not your job
to be a policeman.
"Go in there and sell.
You're a salesman."
You know, I was sort of like
a canary in a coal mine,
but nobody was running,
nobody was leaving.
♪
I was at work one day,
sitting around the newsroom,
and an editor came over to me.
He said, "I've gotten a tip,"
from a source of his
that was on a pharmacy board,
who told him there was
this new drug, OxyContin.
It had become the hottest drug
on the street,
and the number of overdoses
were rising.
And he thought we should be
looking into what was going on.
We started calling around,
speaking to pharmacists,
speaking to doctors,
trying to get
an understanding,
because prior to this,
I had never really done
any reporting
about the drug industry.
So all the things
that I was learning
were relatively new to me.
They were also kind of strange
and appalling at the same time.
♪
One of the real turning points
for me
came when I found there was
a study that was done
in the late 1990s,
which showed that
drug addicts were seeking out
long-acting opioids
because they were pure
and because they had
much higher volumes
of the active narcotic
than the shorter-acting drugs.
This seems
to disprove the theory
that long-acting opioids
are less prone to abuse,
but there was no question
that OxyContin was
being promoted as,
like, a safer, better,
more effective, less abusable
form of pain treatment.
- It says here under--
- On page 30,
"OxyContin's wide availability
"may have increased
opportunities
for illicit use."
Did you ever do any studies
on abuse liability
for OxyContin
before you all put it
on the market?
I'm not aware of any.
♪
And I wondered whether
Purdue knew about that study,
whether they had distributed
that study,
whether they told the FDA
about that study.
I asked them
all those questions,
which they refused to answer.
Purdue, when we started
speaking to them,
were adamant
that neither the drug
nor their manner
of promoting the drug
had anything to do
with the overdoses.
I became somewhat obsessed
with learning
about what Purdue knew
and when they knew it.
Narrator: Beginning
with a series of articles
for "The New York Times,"
Barry Meier began
to investigate possible crimes
committed by Purdue
and the Sackler family.
That led to a book called
"Pain Killer,"
which was the first
detailed account
of the opioid crisis
and how it had spread
from Maine to Mexico.
It focused on Appalachia
and the westernmost sliver
of Virginia
that points like a knife
between the heartlands
of Kentucky and Tennessee.
In the town of St. Charles,
Barry Meier discovered
a citizens' crusade
to protect local communities
against the assault
of OxyContin
led by a doctor
named Art Van Zee.
If you're in a small town,
and you have
a hospital practice,
and you're involved
in a lot of things
in internal medicine
for 44 years,
you do get to do
a lot of things
that are meaningful to you
and rewarding.
How many babies
do you suspect
you delivered in that time?
Oh, I don't deliver babies.
So I've seen a lot
of young people grow up,
and I've been involved
with multiple generations
of some families, you know,
in terms of their care,
but, yeah--
But we don't deliver babies.
It was 1999, 2000
when OxyContin really came
like a tsunami
into the coal fields.
9% of the seventh graders
had tried OxyContin
at least once
and 25% of the 11th graders.
It's morphine.
It's being, like,
on a morphine high.
You're kind of numb.
You're free,
and you're like, "Ah,"
but you're itching.
I was going in
after midnight sometimes
to take care of young people
overdosed
on OxyContin, on respirators.
I was really, in many ways,
unprepared for this.
Where were these pills
coming from?
They're everywhere.
Early on
in the reporting,
when we were
tracking down doctors
and tracking down pharmacists,
I spoke to Art by phone,
and we began to chat
quite a bit.
He was increasingly
freaked out
by how Purdue
was marketing the drug.
And he would supply me with
materials that
he had sent to Purdue.
Letters and some emails
about what we were seeing.
"Dear Dr. Haddox,
I'm writing you
"as medical director
at Purdue Pharmaceuticals
"to give you
further information.
"Over the last two years,
"we've seen numerous
young people abusing
"and becoming addicted
to OxyContin.
"Frequent overdoses,
infections,
"abscesses, Hepatitis C
"related to intravenous
drug abuse.
"About 70% of serious crimes
in the county
"are now drug related.
"Some counties in Maine are
experiencing similar problems.
"These problems
are enormous ones
"for poor rural areas
such as ours
"with minimal resources
"for dealing with
hard-core narcotic addiction.
"I would look forward
to having a dialogue with you
"further about this.
Sincerely, Art Van Zee."
They indicated they were
concerned about it.
Narrator: When Purdue
wrote back to Dr. Van Zee,
the correspondence included
two former FDA officials
who now work for Purdue.
One of them was the man
who had pushed through
the approval of OxyContin,
Curtis Wright.
While the tone
was conciliatory,
the message was clear:
Purdue wasn't gonna fix
the problem.
So Van Zee dug in
for a longer battle.
I became more involved,
but, I mean, it was
the whole community that
was becoming more involved.
We had a community-wide
meeting at the high school
to address and speak to
the OxyContin problem.
There was something
on the order of 800 people
that--it was
an overflow crowd.
I mean, you couldn't get
800 people
in that high school auditorium
for any other thing
except maybe the high school
football state championship
or something like that.
♪
Not too long after that,
we got a call
from Dr. Haddox.
He wanted to know
if he could meet with me.
We've been very actively
educating physicians
and other
healthcare practitioners
on appropriate
selection criteria
to get the right drug
to the right patients.
We met
in Duffield, Virginia
at a motel there.
They offered us $100,000
to try to deal with--
To deal with the problem.
And we just felt,
you know, at the time,
that it just kind of
been a setup.
We thought it was more
of a publicity deal
than a real attempt to
deal with the problems.
We started on a petition
to ask the FDA
to recall OxyContin,
that it was causing
an unordinary amount
of harm and suffering,
and that it should be recalled.
Purdue Pharma
reportedly spent $26 million
last year educating doctors as
to the wonders of OxyContin,
but Art Van Zee believes
the drug was overpromoted
and is now being
overprescribed.
They've very heavily marketed
to the extent that no other
narcotic has ever been
marketed.
Narrator:
Dr. Van Zee decided
to take the matter
to Congress.
Surely U.S. senators
would be concerned
about a drug epidemic
that was costing tens
of thousands of lives
all over the country.
I was pretty much terrified
about speaking publicly
and speaking
before the Senate.
A lot of the Purdue people
were there.
Senator Clinton was there.
And Chris Dodd was there.
Narrator: Chris Dodd was
the senator from Connecticut,
where Purdue Pharma had
its headquarters.
A proud booster
of the company,
Dodd asked Dr. Van Zee
why he thought
Purdue should be held
to account.
I said something
to the effect of,
"In general, the experience is
"is if you got a abusable drug
"that's highly available,
it's gonna be highly abused."
And he kind of mused about,
"Is that a little
Appalachian saying?"
Or something like that.
Narrator: Dodd defended Purdue
by suggesting
that the real problem was
drug addicts in rural areas.
"Instead of blaming
the company,
why not blame the addicts
for killing themselves?"
It was a grim talking point,
and it mirrored
Purdue's perspective
that OxyContin was not
responsible for addiction,
made in a meeting with Dodd
before the hearing.
Van Zee was unprepared
for the firestorm
of Purdue's
corporate campaign.
I thought this is like that
huge wildfire at Yellowstone,
where we're sitting on one side
of the fire line
with squirt guns
and a lot of press
gathered around,
and then, on the back end,
they're dropping the napalm.
Narrator:
Soon after the hearing,
Purdue rewarded Dodd
with a campaign contribution
that was 10 times larger
than what Purdue gave
to any other politician.
Art Van Zee returned
to western Virginia,
and the rest of the country
went about its business,
but the opioid crisis
did not go away.
It got worse.
By the end of 2002,
non-medical opioid use
in the U.S. increased
by 2.5 million Americans.
Addictions rates soared,
and so did overdoses.
As these stories
start filtering out
from across the country,
there was a bit of
a bunker mentality,
I think, at the company,
a siege mentality,
a sense that they needed to
protect this product of theirs,
which was bringing them
billions of dollars
at that time.
Richard Sackler,
he's angry,
and you can feel the anger
in these emails.
He says, quote,
"We have to hammer
on the abusers
"in every way possible.
"They are the culprits
and the problem.
They are reckless criminals."
Yeah, yeah.
Well, the first response
I had to that:
there's only one reckless
criminal in this situation,
and it's Purdue Pharma.
They had no morals.
They had no ethics about 'em.
In Richard Sackler's mind,
and this is a framework
that you then see
throughout the company,
and over the decades,
even today--
They argue that, "Drug abusers
would be abusing drugs
"no matter what.
You know,
if it wasn't OxyContin,
"it would be something else.
"And legitimate pain patients
who take the drug as prescribed
don't get addicted."
You know,
this idea being that
you're dealing
with two separate species,
well, that's not how
it really is.
You know, patients who misuse
and get addicted to opioids
are legitimate pain patients.
Far from apologizing,
Purdue Pharma
is fighting back,
saying its only intent is
to get relief
to the 50 million Americans
in pain.
But with the growing number
of doctors saying
they're afraid
to prescribe OxyContin
and at least two
major supermarket chains
refusing to carry it
for fear of robbery,
Purdue Pharma found itself
in need of a PR miracle,
so it went out and hired one.
Well, we've been working
with Purdue
for about four months now.
Seen here in a
company-provided news release,
former New York City Mayor
Rudy Giuliani,
has agreed to lend
his considerable credibility
to the drug maker's battle
to save its bestseller.
They hire Rudy Giuliani.
This is right after he leaves
government in New York.
He's America's mayor
and becomes kind of
a hatchet man
for Purdue.
This should be available
to people
so that they can have
not just a life,
but a quality of life.
It's astonishing.
The real fervor
with which they pursued
and advanced this idea that,
"We're out here fighting for
the legitimate pain patients.
"For access.
"Access to the thing
that I am selling
and making billions
of dollars."
Purdue ends up getting pursued
by the authorities.
There's a federal prosecutor
in Virginia
who goes after them.
The investigation
was conducted
by a very small office.
The United States
Attorney's Office
for the Western District
of Virginia,
in Abingdon, Virginia,
which is a beautiful,
little historic town
in the foothills
of the Appalachians.
Well, good afternoon, and
thank you all for being here.
We had a problem.
We had death rates.
We had reports
from medical examiners.
We had crime rates going up
in certain parts
of our community.
We had an explosion
of OxyContin availability
in our community.
And so, all of those things
led us to believe that
we needed to take a look
at this issue.
Narrator: In 2001,
John Brownlee was
the U.S. attorney
in western Virginia.
With a small team
of investigators,
Brownlee began to look
into claims of OxyContin abuse
in Appalachia
and if Purdue
and the Sackler family
knew what was happening.
They spent years gathering
documents from Purdue,
bringing people
before grand juries,
really doing a very extensive
investigation.
It just kept going
and going and going.
Once you had
these millions of records,
these investigators
and lawyers
pieced together a case.
And then, when
you put it all together,
it equals a crime.
♪
We at Purdue
are very distressed
that OxyContin,
which as you've heard
is providing so much relief
to so many people,
is being abused as well,
and we deeply regret
the tragic consequences
the have resulted from
the misuse of this medicine.
Narrator: Just as Brownlee was
beginning his investigation,
Purdue's chief medical officer
was testifying
before Congress.
He was responding to an outcry
over an article
in "The Boston Globe"
about widespread
OxyContin abuse in Maine.
Everybody was taken
by surprise, what happened.
We launched OxyContin in 1996,
and for the first four years
on the market,
we did not hear
of any particular problem.
In February of 2000,
was the first time
we became aware
that something different
was going on.
In February of 2000,
we got a copy of a letter
that then-U.S. Attorney
Jay McCloskey of Maine
sent to physicians in Maine,
warning them of problems
of OxyContin
that were occurring
in certain communities.
And since that time,
I am proud of our response.
As an executive
of this company,
I am very proud to be working
for this company.
Nobody has taken
the kind of initiative
for a problem that is not
just an OxyContin problem.
This is a problem
of drug abuse.
This is a problem
of prescription drug abuse,
and OxyContin is now clearly,
squarely in the midst
of that problem.
We've been advocates
of proper pain management.
That testimony
by Goldenheim,
his sense of shock
and effrontery
you know, at the idea that
it was only in early 2000
when the company discovered
that the product
was being abused
and they immediately
sprung into action
and took it seriously,
and then to contrast that
with his own emails--
Years of his own emails--
In which it becomes clear
that that's all lies.
He knew.
The company knew.
They knew that OxyContin
was being abused.
They discussed it.
They looked into it.
They saw it as a problem.
Literally there's a moment
where Goldenheim says
he wants to remove any
discussions about addiction
from email
because it's too sensitive.
♪
It's clear Goldenheim lied
under oath
in testimony to Congress.
Narrator: It was also clear
to federal prosecutors.
They were discovering,
through witnesses
and the company's own emails,
that starting in 1996,
all the top Purdue executives
and the Sacklers
knew that
their time-release opioids,
MS Contin and OxyContin,
were easily and widely abused.
The company conducted
its own spoon and shoot study,
which revealed that addicts
could crush the pills,
add water,
and then shoot the drugs
with a needle.
In 1998,
key Sackler board members
and Purdue executives
were well-informed
about the street traffic
for their drugs.
30-milligram MS Contin pills
were selling for $40 a pop.
They were known
as purple peelers
because users looking
for a heroin high
would just peel off
the time-release coating.
The same went for OxyContin.
While you were
still at Purdue,
do you recall hearing
any information
about OxyContin being abused
in West Virginia?
Sure.
And when was the earliest
you recalled hearing about it?
Maybe a couple years
after its launch.
Would that be 1988?
- '97.
- All right.
And what did you hear?
That it was called
hillbilly heroin
in Appalachia.
What was the source
of that information,
if you recall?
Just gossip
throughout the company.
Narrator: Sales reps
routinely warned Purdue
about abuse of the drug,
but the company
didn't urge caution.
Instead,
Purdue encouraged reps
to push higher
and higher doses to doctors.
That alarmed
one Purdue official,
who sent a note about
a new 160-milligram pill
to the company's
chief legal officer.
"They're killing themselves
with the 80s.
Why would we come out
with a 160?"
There are actually
instances of reps
being aware that
there are patients
who are being prescribed just
unheard of, superhuman,
"enough to kill an elephant"
quantities of OxyContin
and apparently being all right
with that.
Narrator:
In Naples, Florida,
prosecutors discovered
a plan by Purdue
to use a patient
as a poster child
for high doses of OxyContin.
The man's name was Gary Blinn.
A former heroin addict with
a high tolerance for opioids,
he told me he was looking
for relief
from crippling back pain
when he stumbled on a doctor
named Stephen Montaldi.
♪
So I found Steve Montaldi.
We started
with steroid injections,
and he knew
how severe the case was,
and so he hit me
with the morphine.
I came out of the office
one day,
and there was a very attractive
young lady out there.
Asked if she could talk to me.
I said, "Sure."
She introduced herself.
"I'm Stephanie Cauffman.
"And I'm a representative
of Purdue.
"And we have a drug
called OxyContin.
"And we'd like to offer you a--
"a deal, a trial.
"You know, we pick up
all the costs
if you'd consider switching
to our drugs."
She said,
"There's a special formula.
"You just take
as much as you need.
"You can keep going up until
you get enough pain relief.
And chances of overdosing
are very slim."
You know, so no money.
They were gonna pay
for everything.
I said, "Sounds like a deal."
narrator: Stephanie Cauffman
was the Purdue sales rep
for Southwest Florida.
She would also enter
into a sexual relationship
with Blinn's doctor, Montaldi.
She knew my history.
She was prepped.
Why did Stephanie say
she was willing
to give you the drugs for free?
Because it was a trial
from Purdue--excuse me.
You know, it was a--
They were testing it.
They started me with
maybe eight or ten,
twice a day.
It's the highest dose.
And that wasn't working,
so they just kept on
raising it.
12, two times a day.
Then 15.
It wasn't doing it,
so we went up to 20.
And I said,
"This still isn't doing it."
So he made the phone call.
He told me it was
to the doctors at Purdue.
And they said, you know,
"Give him more."
♪
So that's when we got up
to the 25.
Twice a day.
50 pills a day.
It would almost
take me 15 minutes
just to eat them all.
You know, it was like sitting
down to a bowl of Cheerios.
You know?
I was starting to feel
a little toxic,
like my body
was telling me that
we're not doing well.
But, I mean, what can I do
but take more?
You know what I'm saying?
I mean
When you're in that much pain
and--
And you're addicted to that--
Such a high dose,
no matter what it is,
I mean,
you're a trapped rat.
Narrator: Blinn was
taking the equivalent
of 200 hits of heroin a day.
He kept the prescription
bottle for 20 years
because he thought
something was not right.
I knew I was being used.
My doses were--
Were for being a guinea pig
or an example.
I think their plan
didn't start off like,
"Here's what we're gonna do
with this guy."
When they saw that I--
I was, uh,
you know, functioning
taking the higher doses,
I believe they thought
they could just,
you know, "Okay, give him
as many as he wants."
You know, they knew
that was a goal,
to keep on adding more.
Narrator:
When Montaldi left town,
he kept prescribing
high dosages for Blinn
without reviewing
his condition.
Cauffman herself would
deliver the drugs to Blinn.
Even though
the pills were free,
Cauffman got a bonus
for the high doses.
More important, Purdue
used Blinn's prescription
as a marketing tool
to prove to other doctors
that no dose of OxyContin
was too high.
That seems
kind of over the line,
but for somebody like Cauffman,
you know,
was she punished?
Was she fired?
What happened to her?
She was promoted.
She--
She was promoted.
She, um
She got moved up
to headquarters,
and they gave her
a new position
training other sales reps.
Our objective
in communicating with doctors
through trained
sales representatives,
literature,
and educational programs
is to educate them about
the proper use of OxyContin.
♪
Somewhere there
in the middle of my career,
I got a subpoena in the mail
from the federal
prosecuting attorney
from Abingdon, Virginia,
and I needed to be there
at this time
and be ready to testify
in front of a grand jury.
That floored me.
That scared me.
It run a chill down my spine.
They wanted information
concerning
Dr. Frank Sutherland
and how he was overprescribing
OxyContin.
When I called Howard Udell,
the lead counsel
for Purdue Pharma,
he listened to me,
and he chuckled
when I said I needed
some representation.
He said, "You're on your own."
Said, "That shouldn't be
any problem."
I said, "Are you kidding me?
"You know, I'm being subpoenaed
"by the federal government
over OxyContin, and you're
not gonna send anybody down?"
"Well, no.
No, you'll be all right."
Click.
Narrator:
In addition to Mark Ross,
Stephanie Cauffman,
Gary Blinn,
and scores of doctors,
patients, and sales reps
were called before
Brownlee's grand jury.
That testimony, plus
internal Purdue documents,
became a part of
a 120-page prosecution memo.
While it's still
a secret government document,
we managed to obtain a copy.
It makes a powerful case for a
nationwide criminal conspiracy
that included fraud,
pill mills,
doctors trading drugs for sex,
false statements to Congress,
and attempts
to target key officials
of the Bush Administration.
It argues that
the FDA was used
to falsely and fraudulently
market OxyContin
and that key executives
and the Sacklers
helped conceal the abuse
and addictive nature
of the drug.
♪
In 2006,
Brownlee sent the memo
to the Department of Justice
for final review.
100-page or more pros' memos
are fairly rare.
It had an incredible amount
of detail.
I thought that it was
an overwhelming case
of criminal liability
by the company,
and by the individuals.
I'll read you
what my deputy said to us
about this evidence
in this case.
"Perhaps no case in history
rivals
"the burden placed
on public health and safety
"as that articulated
by our line prosecutors
"in western district
of Virginia.
"OxyContin abuse
has significantly impacted
"the lives of millions
of Americans
"in the fraudulent scheme
and conduct articulated
"in this matter
as a direct correlation
to that threat."
So that was front and center
for us
and for the prosecutors.
The charges were wire fraud,
mail fraud,
and misbranding.
There were money laundering
charges as well
and conspiracy, of course,
because this was
a very complex fact pattern
that many people
were involved in,
making sure that this crime
both was committed
and was committed effectively.
Narrator: It looked like
there might finally be justice
for the damage done,
but when Purdue heard
that some of its executives
might go to prison,
the company mounted
an influence campaign
Yeah, one last question.
All right.
One last answer.
Narrator: Led by former
U.S. Attorney's Mary Jo White
and Rudolph Giuliani.
- Thank you very much.
- Mr. Mayor?
Narrator:
They went over the heads
of Brownlee's prosecutors
to Alice Fisher, the head
of the Criminal Division,
and to Fisher's boss,
Paul McNulty.
One of them bowed
to political pressure
and agreed not to put
the executives on trial.
When questioned
about the decision,
neither one would
take responsibility
for trading a guilty plea
in exchange for bearing
the most damning evidence
against Purdue.
Based upon
what I had seen,
I was mortified.
There could be
no rhyme or reason
that you would've squashed
the prosecutors
from prosecuting
these executives
to the full extent of the law
and to prosecute the company
to the full extent of the law,
because that's what
the Department of Justice
missionized us to do.
Lots of times,
why you prosecute these cases
is to get out
in the public milieu
exactly what was going on.
Even if we lose,
the public is gonna know
this was a righteous case
that we really
should've prosecuted.
Narrator:
The Department of Justice
manufactured a press release
to make the deal look tough.
The company,
as an institution,
pled guilty to a felony
and paid a $600 million fine.
Also, Purdue's
chief executive officer
Michael Friedman,
general counsel Howard Udell,
and former chief medical
officer Paul Goldenheim,
pleaded guilty
to a misdemeanor charge
in misbranding OxyContin
and collectively paid
$34.5 million in penalties.
Narrator: It was the illusion
of justice.
At the courthouse,
the parents of children
who had died of overdoses
showed up to be heard.
Some had a chance
to speak directly
to the Purdue executives
about the children
they had lost.
Said one mother,
"You created this drug.
"You pushed it.
You lied about it.
"You killed my son
and so many others,
and continued to do so
as I speak."
♪
While waiting for the bus
to take them
to the corporate jet,
the Purdue executives
and their lawyers
expressed no remorse
and denied
any personal responsibility.
None of them would spend a day
in prison.
Purdue paid the executives'
fines and legal costs
and gave two of them bonuses
to compensate them
for the pain
they had suffered.
Do you believe
Purdue's marketing
was overly aggressive?
No.
Yeah. Do you believe
Purdue's marketing
was appropriate?
I believe so.
When the deal
was announced,
Purdue represented it
as a shocking verdict
that was extremely onerous
for them
and hugely damaging
to the reputation
of the executives.
Was that your view
inside the department?
No, I think the general view
inside the department is,
they paid the speeding ticket.
You know, what happens
to the company is,
you know, it's something
we just didn't look into.
Purdue Pharma,
up until 2006,
they made about $9 billion
marketing OxyContin.
$9 billion.
They paid somewhere
in the neighborhood
of $600-to $700-million
as a fine.
Why would anyone
not repeat that conduct?
If the worst that could happen
is you have to give,
what I would say, is
a miniscule amount of that--
Of those profits
to the government?
You can keep doing business
the way you've been doing it.
You are basically telling
pharmaceutical companies,
"You have a green light
to do this."
Yes.
♪
After the settlement,
Purdue doesn't pull
the emergency brake.
They don't recall the drug.
Instead, they double down.
They keep selling.
And the Sacklers
start wondering
how they can
keep sales increasing.
And there's two answers.
One is, "We want
to sell bigger doses,
and we want people on them
for longer."
To say as explicitly
as the Sacklers said,
in the face
of the opioid crisis,
"How do we keep this show
going?"
You know, it was
breathtakingly cynical.
Do you know how much
the Sackler family has made
off the sale of OxyContin?
I don't know.
But fair to say
it's over a billion dollars?
It would be fair
to say that, yes.
Do you know
if it's over $10 billion?
I don't think so.
Do you know
if it's over $5 billion?
- I don't know.
- All right.
Narrator: The Sackler family
is worth over $10 billion,
in the neighborhood
of the Mellons
and the Rockefellers.
The world's
most famous museums,
including the Museum
of Natural History,
the Smithsonian,
and the Tate Modern,
boast collections
bearing the Sackler name.
An article on the family's
real estate holdings
showcase sprawling estates
with vast grounds, pools,
and tennis courts
and a New York City townhouse
likely worth
more than $50 million.
The Sacklers bought
the Caribbean luxury getaway
of Amanyara
and scores of opulent hotels.
They collected a portfolio
of 17 ski resorts,
many in states scarred
by the opioid crisis.
The family moved billions
out of the company
as the money from OxyContin
kept rolling in.
♪
After the 2007 settlement,
Purdue's revenue soared
to a company record
of $3 billion a year,
the best performance
in the company's history.
Following Purdue's example,
other manufacturers
and distributors
rushed into the opioid market.
They flooded towns and
counties in the United States
with 100 billion pills.
The companies knew exactly
where the pills were going
and that many
were not for pain.
Addiction rates soared,
and so did overdoses.
160,000 Americans died
in the seven years
after the Purdue settlement.
What'd she take?
Acknowledge me
if you can hear me.
- Waking up?
- Are you coming out of it?
Narrator:
For more than 20 years,
Americans have watched
the human cost
of the opioid crisis
as if it were an epidemic
without a cause.
Open your eyes.
Narrator: But what if
we had seen early on
the evidence that
the crisis was manufactured
by a series of cynical crimes?
- You're all right.
- You're all right.
Narrator:
More than a decade passed
before that evidence
began to surface,
in leaks
of the prosecution memo
that had buried
when the government failed
to bring Purdue to trial.
Reading the prosecution memo
was like an incredible slap
in the face.
The tragedy of this episode
really does relate
to how this case was resolved
because by burying
the prosecution memo,
the Justice Department
effectively agreed
to bury critical information
that doctors,
public health officials,
and patients needed to know
about the dangers of opioids.
It was the day
before Thanksgiving.
I got home
around 3:00 to 4:00
in the afternoon,
and I found Carol in the den,
on the floor,
with her head
under one of the chairs
and a telephone
right by the side of her.
Turned her over,
grabbed the phone,
called 911,
and began CPR.
Based on what I know now,
it appears that she passed away
sometime between 10:00
and 11:00 that morning.
♪
We sued Lynn Webster
and Lifetree.
And before it was settled,
there is what's called
a DOPL hearing--
Which a DOPL stands
for Department
of Professional Licensing--
And Lynn Webster was
in that meeting.
And that's when he asserted
that Carol was suicidal.
He tried to put all
of the responsibility
onto Carol Ann.
He couldn't accept
responsibility of his actions.
I did not have
any direct communication,
other than to look
across the table
and basically tell him that
he killed my wife.
Let me tell you something.
I had several patients die
in my practice.
- At Lifetree?
- At Lifetree, yeah.
And I was very cognizant always
that opioids could contribute
to an overdose.
And I was also cognizant that
without treatment of pain,
then they could commit suicide,
so it's--
What are you to do?
I mean, here's the story
of so many people
with severe pain:
life is not worth living
unless they have
their pain treated.
You, as a clinician,
are always there
trying to decide,
is the lack of treatment
going to cause more harm
than the treatment?
Every one of my patients,
I had to give
that consideration to.
It's not easy
to make the right choice
all of the time.
In her final
monthly prescription,
one week prior to her death,
she was given
60 50-milligram tablets
of amitriptyline,
30 40-milligram tablets
of Celexa,
224 30-milligram tablets
of oxycodone,
112 10/325-milligram tablets
of Percocet,
60 1-milligram tablets
of Requip,
60 1-milligram tablets
of Xanax,
and a--oh, sorry--
60 4-milligram tablets
of Zanaflex.
It's a muscle relaxant.
So if you saw
that monthly level
of prescription for a patient,
would that be a rather
significant pain dose?
I think for any patient,
except maybe someone who's
near the very end of life,
if I were to learn
that a physician had prescribed
that regimen
to a patient, I would--
I would, I think, contact
the state medical board
and report that prescriber
because they are clearly
putting that patient's life
at risk.
♪
narrator: In 2009, there were
so many overdose deaths tied
to the Lifetree Pain Clinic
that the medical examiner's
office felt compelled
to report them.
The next year,
the DEA launched a raid
on Lifetree.
They came in with badges,
and, I mean,
pretty frightening to my staff.
- And the office was full--
- Guns?
- They didn't have guns drawn.
- No.
But they had guns.
They were obvious.
I mean, I felt--
I was
on a wonderful career path
of feeling like
at the end of the game,
I'd feel proud that I had, um--
I was able to be
in this profession
and I could help people.
I still feel that way,
but, um, that event
has forever tarnished me.
Narrator: Webster was also
tarnished by the evidence.
Records from Lifetree
show a pattern
of prescribing unusually
high amounts of opioids
as well as confirmations
of a number of patient deaths.
♪
There were as many
as 100 overdose deaths
at your clinic, or they're
suspecting that there were.
Was--would that have been
a large number
relative
to your patient population?
Well, I think so.
I think that--I think, uh--
I think--
You know, I don't know
what is a large number
or what isn't a large number.
Remember, these are
high-risk patients.
Many of these, not all,
but many of these
were high-risk patients.
Many people
who used these drugs
for the wrong reason,
and I'm sure I had some,
in my practice,
are at risk of overdosing.
Plus, I also had people
who die of old age,
cancer.
I don't know
what that number means.
That, to me, sounds
like mass manslaughter.
You know, having two patients
die of opioid treatment,
when you're treating back pain,
is a high number.
Patients shouldn't die
from treatment
for non-life threatening
conditions.
Narrator: The DEA sought to
prosecute Webster and Lifetree
for the illegal distribution
of controlled substances
and possible manslaughter.
I wanted to know if I could
ask you a couple of questions.
We've been trying
to reach out to your team to--
I've got an appointment
right now.
Narrator: But despite
an 80-page summary report
containing forensic details
of possible crimes,
the Department of Justice
declined to prosecute,
citing lack of evidence.
Will you answer
a couple questions for us?
No.
You don't want
to answer any questions?
- No.
- Okay.
You know, I think
the criminalization
of trying
to treat people in pain
who are doing the right thing
or attempt to
project a criminal event,
is very chilling.
What happened has happened,
and there's been a lot said
that I think is painful,
and all I could do is fuel,
I think, more pain
if I discussed it anymore.
We're supposed to forgive.
I have tried
to forgive Webster.
But at the same time,
we shouldn't forget.
And if we don't learn
from things,
we go nowhere.
Let's get it started ♪
In here ♪
♪
narrator: But we didn't learn.
Starting in 2013,
a powerful synthetic opioid
surged in popularity.
Fentanyl.
A transdermal system
that releases ♪
Fentanyl through ♪
narrator: It's 100 times
more powerful than morphine.
Rather than reckoning
with its dangers,
companies sold it
as aggressively
as drug cartels.
But instead of gun-toting
dealers on street corners,
men and women in suits
and lab coats
pushed opioids
with cash bonuses,
PowerPoint presentations,
and pain management jamborees.
Flushed with campaign cash
from big pharma,
Congress would look
the other way,
letting American companies
flaunt bottles of deadly drugs
like parade floats.
Yo, oh,
you think you're bad? ♪
Well, I'm the baddest,
I was created in a lab ♪
With the latest tactics ♪
♪
This is my poem
to Purdue Pharma
called "Death Train."
"When we first met,
I loved what I saw.
"It was a natural fit.
"Together, we had no walls.
"Your mission was my mission.
We were inseparable.
"The extent I would work
for you was incalculable.
"I cut you a path that
was extremely lucrative.
"Maximizing sales
was our imperative.
"But I learned that
you never would listen.
"And if you did, you would
never change your position.
"I tried four separate times
"to warn you
of this death train.
"But despite all my efforts,
they ended in vain.
"You and your strategies
caused massive abuse,
"addiction, and death.
"Oh, what a tragedy.
Oh, what a mess.
"The very fiber
of our communities
"was ripped to sunder
"as you continued to rape,
pillage, and plunder.
"So many families torn apart.
"Teenagers dying
alone in the dark.
"The deeds
you've done
"gave you no shame.
"Now you want
to blame others.
"You want others
to take the blame.
"Though the victims
of your crime
"can never be made whole,
"Purdue Pharma should give back
"all the money they stole.
"And if need be,
the authorities should squeeze
"all the OxyContin
billions
"out of your souls.
"Then the company
should be ripped apart
and thrown deep in a hole."
♪
♪
You can make
a lot of money
getting doctors to prescribe
a medication
to people who don't need it.
And none of it's doable,
unless you break the rules.
This was a new
drug cartel
that was being established
in the United States.
What they
would do is bribe doctors
to write as many scripts
as we possibly can.
People were dying
by the tens of thousands,
and their own representatives
- are selling them down the river.
- Lights.
Get on the ground!
The whole thing is disgusting.
Clearly we're breaking the law.
Back then, did I really care
about being responsible? No.
♪