Dopesick (2021) s01e04 Episode Script
Pseudo-Addiction
1
If fraud was too high a bar,
what would you charge him with?
I'd charge them
with criminal misbranding.
Permission granted to release requested documents relating to marketing and distribution.
They're drowning us in paperwork.
I'm promoting you.
I'd like you to be deputy director of the Diversion Division.
I accept.
The worst thing that aââ a parent could hear is that her kid is, you know, queer.
It'd kill me if you were, Bets.
I guess you're dead, then.
Do you realize that men might be dead 'cause of you? I don't understand what's happening to me.
If we get Germany uncontrolled, it will serve as a gateway to the rest of Europe.
Please tell me I'm gonna see you in Orlando in a few weeks.
That's why I'm calling.
I wasââ 20 milligrams of OxyContin.
Got it.
Hey, dude.
Hi, how are you doing? What's your in on? Bam.
Oh, fuck.
Yeah.
Cheers to that.
Hey, hey, what you doing, man? I was just gonna pop it.
No, man.
You gotta snort 'em.
Here, I'll show you.
What the fuck's your problem? Elizabeth Ann, are you in? It hits way faster.
Are you sure, man? Trust me, yeah.
'Cause, we've popped them normal before.
Did Purdue say it was easy for someone to bypass the timeârelease coating on an OxyContin pill? No, Purdue claimed the coating was difficult to get around, and therefore, OxyContin would be unappealing to abusers.
Was the coating difficult to dissolve? No, it was very easy.
All you had to do is dissolve it in saliva and then scrape it off.
And then the abuser would have immediate access to the full 12âhour supply.
They just crush it off then snort it.
Yeah! Oh, here we go! Holy shit.
Fuck yeah.
I think I'm getting a chubby.
Where's, uh, where's Elizabeth Ann? Elizabeth Ann? Hey! What the fuck you doing? Get your ass over here.
Hey, it's good.
Don't worry.
Go, you're up next.
First time is the best time.
Yeah! Yeah! Oh, shit.
Hey, hey! All right, I'm up next, right? Yeah, you got to see Oh, my God.
Oh, my God.
Don't you fucking die, Ryder! You're gonna be all right, don't worry about it.
Let's take him to his mom's house.
We can't go to his mom's house! Can we take him to a fucking hospital? We can't take him to a hospital.
Get him out of there.
What should we do? Oh, John, don't die, please.
Fuck, come on.
Please.
What the fuck is that? They didn't have any ice.
Is that a fish? It's frozen.
It'll wake him up.
Wake up.
Why? Wake the fuck up.
Fuck! Let's get out of here.
No, wait, we can't leave him here! Come on! We can't leave him! Elizabeth Ann! Come on! Here.
What the fuck is this? These are fucking 10s.
ER doctor was on to me.
Only gave me four days' worth.
God damn it.
What the fuck? I'ma be really sick tomorrow.
Yeah, and I'm not? You're the fucking drug dealer! Why is this on me? And what about Florida? We can hit one of the pain clinics.
That's too far.
We'll get fired.
Yeah, well, we got nowhere else to go 'cause you keep burning up all the God damned ERs.
I'm not good at this.
They don't believe me.
That's why it's gotta be Florida, okay? They don't care down there.
We can get whatever the fuck we want.
I can't go.
I can't go.
All right, then get the fuck out.
What? I said, get the fuck out! Jesus Christ, Walt.
Fuck! How about right here? Oh, yeah.
It'sââit'sââit's getting worse.
Yeah.
Can't even wake up without a pill anymore.
Yeah.
You're taking them twice a day? Yeah, but where does that help? Okay, you're having pain even when you don't take it.
Oh, 100%.
But I want off of this stuff.
Yeah.
I'mââI'm either falling asleep all day or thinking about the next pill.
Mmâhmm, okay.
Well, we're just gonna taper you off there, buddy.
Weââwe tried that.
Yeah, I know, we're trying again.
I'm gonna lower your dose from 80 milligrams down to 40, okay? And if you're experiencing any withdrawal symptoms, I'll cut that with some Xanax, okay? We'll get this right.
How many pills do you have left in that bottle? A few.
A few here.
Okay, just leave the bottle on the table there, and, uh, we'll lower your dose here, buddy.
All right.
We'll get you feeling better, okay? It'll be all right.
Thanks, doc.
We are so proud to be honoring my great brother, Arthur Sackler, into the Medical Advertising Hall of Fame.
In many ways, Arthur Sackler invented medical advertising.
He was the first to realize it wasn't patients who decided what drugs they took.
It was their doctors.
Shunned by Madison Avenue for being Jewish, he formed his own company specifically targeting doctors with articles from scientific journals and studies from medical societies.
Sure, sometimes the societies and the experts were financed by Arthur.
Who do you think is the bigger asshole? Uncle Mortimer or Uncle Arthur? C, all the above.
Not only changed the way medicine is marketed in this country; it changed the medical industry forever.
Your uncle was good.
For his time.
Hmm.
This one's missing the zombies that valium turned some patients into.
He got away with it.
Barely.
But it made him rich.
Beth, darling, would you give us a few minutes, please? Sure.
Thank you.
You had to do it, didn't you? Do what? You had to say it was nonâaddictive.
Dad, even the FDAââ Oh, please.
Call notes are starting to come in that patients are showing signs of addiction.
Just a few pockets of West Virginia.
It's cultural.
All those hillbillies do is get addicted.
And Maine and Kentucky.
All our phase one states.
If it becomes accepted that more than 1% become addicted, it's dead.
And one year of strong sales isn't gonna make up for the 40 million you spent.
Any suggestions? Take a page from Arthur's playbook.
Get an expert who'll tell doctors the truth of our wonder drug.
We've got Russell Portenoy.
No, I'm thinking someone more aggressive, especially if your 1% claim is, um, hmm.
What's that medical term? Fucking bullshit.
Fine.
We'll find an aggressive expert.
No, theââthe osteoarthritis was truly debilitating, and nothing seemed to work until I realized that the patient needed something strong enough to stop the breakthrough pain.
So I started the patient on methadone, and she was back to normal within just a few days.
Methadone? You said find me aggressive.
He has a theory called pseudo addiction, which basically means addiction doesn't exist.
Who is this guy? David Haddox.
He went to dental school but now heads the Pain Management Department at Emory.
Aââa fitting progression.
You wanna meet with him? God, yes.
So you really feel opioids are underâprescribed? For decades.
Now, the Porter/Jick study is exactly right.
Under the proper care, opioids are totally safe.
IââI recently read a theory of yours, which is why Iââ I wanted to meet.
Thank you.
Let me guess: pseudo addiction? Correct.
How'd you come up withââ mm, uh.
Where did you discover pseudo addiction? Yeah, so I was, um, so I was, uh, was working with a 17âyearâold leukemia patient who showed classic signs of addiction.
And yet we upped his medication, and he was fine.
Turns out that he wasn't addicted at all.
It was that that underlying pain hadn't been properly treated.
So pseudo addiction means that, uh, addiction symptoms are, in actuality, the symptoms of untreated pain? That's correct.
Yeah, taking away a patient's medication isn't helping them.
It's torturing them.
What they need is more medication, and then these supposed addiction symptoms will quickly go away.
Soââ so do you think all addiction is, in actuality, pseudo addiction? In relation to medication? Yes.
Huh.
I look in those rare instances when a patient truly is an addict; that's not the fault of the drug or the doctor.
No, the patient was most likely a drug addict to begin with due to genetic defects.
What about cigarettes? Addiction or pseudo addiction? Yeah, smokingââsmoking is definitely pseudo addiction.
It's all in their heads.
How would you like to work for Purdue Pharma? Morning, boss.
Still no update on the funding? Well, good morning to you too, Randy.
How's Jennifer? The kids? Sorry, good morning.
Nailed it.
You know, it seems pretty darn odd if these FBI guys won't grant us a small amount of resources.
Could just be, as my son would say, a dysfunctional government.
Your son's four, Rick.
Feeling a little inadequate right now.
Good morning, guys.
Morning.
What's up? Still haven't heard back from the Medicaid office, and Dr.
Jick's office finally called me back and said, "The doctor's unavailable.
" Unavailable? Today? Nope.
She said unavailable, period.
Yes, I told you, Dr.
Jick is unavailable.
Well, I've called multiple times, and I'd just like an explanation as to why Dr.
Jick refuses to speak to me.
He said he's very busy, but I'll leave a message.
Thank you.
Well, this just got interesting.
So what's the latest? Well, as you know, Purdue aggressively pushed the drug as nonâaddictive with the phrase "less than 1% get addicted.
" That figure comes from the Porter/Jick study that was done by Dr.
Hershel Jick at, uh Boston.
Boston University.
Boston University.
Well, let me guess, it's that the fraudulent study that was secretly funded by Purdue? Just like the pain study? Well, that's one theory.
We actually called Dr.
Jick to discuss it with him, but something very interesting occurred.
He wouldn't get on the phone with us.
Well, nothing says suspect quite like an unanswered phone call.
If that 1% study is indeed fraudulent, it's a home run in proving criminal misbranding.
Yeah, and if you can find the highâlevel Purdue exec that oversaw it Could indict them for fraud.
Yeah, that's right.
It sounds like a great lead.
Yeah, this case is starting to take up so much time.
That's right.
We need more funding for prosecutors for our nonâPurdue cases.
Yeah, I know, I know.
I mean, why won't the FBI or the DEA give us additional funding? You know, I don't know.
Maybe they're not, uh, connected to the issue.
You know what you should do, you should try the Virginia State Police.
Try Virginia Medicaid Fraud Unit.
They'll get it.
And you know, the more we find, the more it opens up those coffers.
Yeah, but it, it justââ it is really difficult to find anything without the proper resources.
I mean, I knew we'd be outspent, but I did not expect to not have access to the most basic things, like highâspeed computers and scanners.
Look, guys, IââI get it, trust me.
But we just keep pushing, all right? Yeah.
We'll see where it goes, sir.
All right, boys.
You can enjoy your lunch.
Thank you.
Keep me posted.
Oh, Randy.
Sir? Uh, how you doing, healthâwise? I actually just had my oneâyear scan, and I am cancerâfree.
Yeah, he's good.
That's great news.
OxyContin is becoming the leading cause of overdose in the country.
Newspapers are filled with arrests in rural areas where crime directly related to the drug is skyrocketing.
Isn't Diversion and local authorities supposed to deal with these crime issues? Yes, but what makes this so overwhelming for law enforcement is the sheer ease with which users can get access to the drug.
I mean, they are available in every pharmacy in the country.
What do you feel is the best approach? I think the most effective way to solve this problem is to limit the drug's use for severe pain only.
It is a very strong narcotic that is being prescribed for issues such as basic dental work and even headaches.
If it was no longer allowed for moderate pain, then overnight, millions of pills will be off the streets.
What about the millions of legitimate pain patients that will lose access to the drug? If they have severe pain, they will not lose access.
But this recent practice of opioid use for moderate pain is causing a startling new wave of crime and addiction.
The role of the FDA is to make sure medicine is safe.
And when this drug is taken as prescribed, this medicine is safe.
And I disagree.
Anecdotes about abuse and crime are not a scientific analysis of the drug's safety.
They're tales of addicts abusing pharmaceuticals, which happens with all opioids.
So until you can prove the drug itself is dangerous, I don't see how we can put restrictions on it.
Okay.
Well, you're not gonna take action, then I will call in Purdue, discuss it with them directly.
I think you should.
I will.
And your warning label that this drug is somehow less addictive is total bullshit.
You should look into changing that immediately.
Why would you start him on 20 milligrams when 40 milligrams sounds like it's gonna be more effective? Hey, yo, Teddy.
Yo.
Right, that's why you keep titrating 'em up until all there's left to say is thank you.
I managed to scrounge up a couple of Hokies tickets if you're interested.
You are the hardestâworking nurse in the state.
All right, you deserve a spa weekend.
Listen, I think win or lose, we go to the bar.
That'sââthat's what I've been saying.
Individualizing the dose is everything.
I work I work, I work I work, baby I work, I work I'll get the job done I work I work, baby Which means that most symptoms of addiction are, in reality, untreated pain.
And the cure for pseudo addiction is that the patient needs more medication.
More than 100,000 physicians, almost half of all doctors in the country will be sent pseudo addiction pamphlets.
Give one to any doctor if their patients show signs of addictââ sorry, pseudo addiction.
Questions? Yes.
Last week, I had a doctor tell me he had two patients taking way more pills than he prescribed.
Like, he was very worried they were addicted to the medication.
No, no, no, no, it sounds like your physician's actually under prescribing.
No, he's not.
They're already taking 80 milligrams a day.
Look, if I tell them that they're pseudo addicted and need to be bumped up to 160 milligrams, he'll just kick me out of his office.
Now that is a defeatist attitude.
Dr.
Haddox is giving us innovative concepts, and he deserves respect and appreciation for his expertise.
Uh, ma'am, if people are living with unnecessary pain, and they're being stigmatized when the solution is right in front of themââ if people are suffering, they need a higher dose.
Hey, I'm Sandra.
Hey.
Billy.
So, um, which territories do you cover? Uh, Virginia.
Appalachia mostly.
Wow, lucky you.
Excuse me.
Paula.
Hey, are you, uh, checking into the hotel right now? No, I'm going home.
They just fired me.
What? Are you serious? Why? They said I had inconsistent paperwork.
Oh, my God.
Um, I'm sorry.
Don't be.
No, I'm relieved actually.
They all know.
And you know.
Uh, know what? Okay, Billy.
Individualize the dose.
As opposed to other drugs, opioids are uniquely challenging to stop using because they can change a person's brain chemistry.
But in a desperate effort to end the cycle of dependency, some people try to quit cold turkey, but the results can often be disastrous.
A hydrangea? How'd you know? Oh, you know, I have my ways.
Can I, uh, can I see the doc? Billy, you know he doesn't wanna see you anymore.
Come on, there's gotta be a misunderstanding here.
It's been months.
And Iââyou know, I miss him.
Well, he cleared his appointments today 'cause he's not feeling well.
I was in the bathroom when you walked in.
Thank you, Leah.
Mmâhmm.
It's your favorite pharma rep.
Doc, are you okay? Never better.
Hi, I just, uh, wanted to see how you're doing and, uh, see how you're patients are.
It's been a while.
Have a seat.
Sure.
Let me ask you something, Bill.
Do you ever think that, um, maybe that miracle drug you're selling, it's just, you know, just a tad more addictive than you said? Uh, that's not what we're hearing.
Um, but there is a condition associated with this, um, which IââIââI have some information on.
I can share it with you.
Um.
Pseudo addiction.
Uh, we're seeing some cases, although rare, where they show the symptoms of addiction, but in reality, their underlying pain hasn't been sufficiently addressed.
Uh.
Andââand the solution is simple.
You know, youââyou up the dose, andââand their symptoms, you know, disappear, andââ in time.
Let's have a look.
You sell poison, Billy.
What's that? That's all it says.
You sell poison.
That's what you do.
That's just poison.
No, doc, Iââ Yeah, well, it's what it is.
Yeah, it's poison.
I can talk you through it, doc.
It's a new concept.
It's all in here.
No, no, these are good, hardâworking people.
These are good, hardâworking people, and you have the FDA label thisââ Doc, anything in here that you don't understand, I can talk you through.
All right.
Okay.
Get out.
Get out.
All right.
No! Dr.
Finnix.
Get away.
You need to get going.
Don't ever come back.
Docââdocââ Get out of here.
Doc, please.
Get out of here.
You ever come back on these rounds, I'll fucking kill you.
Yeah, I'll fucking kill you myself.
What's wrong with you? Take the rest of the day off.
Go home.
Hi.
I didn't know you worked here.
Yeah.
What are you doing in town? Oh.
It's been a while.
Oh, I'm just visiting my grandma.
How's Eureka Springs? Oh, it's great.
Um, I really love it there.
I like your belt.
Oh, thanks.
Um, I made it.
I guess I'm crafting now.
You still quilting? Um, I It's good to see you, Bets.
You take care of yourself, okay? Hey.
I wanna go to Florida.
When I go driving, I stay in my lane But getting cut off, it makes me insane I open the glove box, reach inside I'm gonna wreck this fucker's ride Guess I got a bad habit Hey, you want a Xanax? It'll take the edge off.
How much? Jesus, man, it's a gift.
In the Gulf, we used to say, don't make me offer twice.
Okay.
Take this.
It'll make you feel better.
All right, all right.
I didn't know you were a vet.
Yeah, did two tours.
Shit I saw Hey.
Salvation at last.
And your next breath is your last Guess I got a bad habit Of blowin' away Yeah, yeah Got a bad habit Yeah, yeah Told you.
Yeah, yeah Got a bad habit Yeah, yeah And it ain't goin' away Yeah, yeah Yeah, yeahâahâah Yeah, yeah Yeah, yeahâahâah Yeah, yeah So injury or chronic condition? I hurt my back.
Mining incident.
Okay, I'm gonna need to examine you.
Did the nurse give you a gown? Here you go.
Uh, bra too, please.
Okay, lift your arms.
Yes, you are definitely gonna need painkillers.
Strong ones.
OxyContin, 40 milligrams, twice per day.
Unless you have breakthrough pain.
How does that sound? Hey, these prescriptions can really add up.
So if you're in a bind, we might be able to work something out.
It's fââit's fine.
I have cash.
No problem.
Fill this out at the dispensary in the back.
God bless the great state of Florida.
I told you never to call me again.
Hi, yeah, you know, I'mââ I'm sorry, and IââI, uh, do want to apologize forââ for what happened.
I'm going through some stuff, Drea.
Watching you fall asleep in the middle of a restaurant is not my idea of a good time.
Yeah.
It was humiliating.
I know, I know, I'm dealing with a medical condition, and, um, in fact, I was wondering if, you know, possibly you could help me.
Uh, Drea, you don't have samples of OxyContin, do you? No, I don't.
Delete my number.
When this just feels like Spinning plates The brain is rewired to function normally when opioids are present and abnormally when they are not.
And the pain from withdrawal is so overwhelming that a person can feel like they are literally going to die if they don't get more drugs.
And this just feels like What is the term for the pain an addict feels when they're in clinical need of their next fix? It's called dopesick.
You wanted to speak to me? Uh, there's something very strange going on here.
What is it? The Porter/Jick study isn't on the internet.
What? Yeah, I mean, it's referenced all over the place.
TIME magazine, Scientific American.
But IââI mean, I can't find the actual study.
Greg can't find it, either.
He's been on it longer than me.
Do you find any affiliations between Purdue and Jick? Paid speeches, consulting, anything like that? Nothing.
What about Porter? Who's that? It's Jick's assistant.
Jane Porter.
There's 10,000 of them.
So theââthe famous Porter/Jick study that's the North Star of the pain movement to increase opioid use is nowhere to be found? Bingo.
Hey, yeah, we're calling about a Scientific American article you wrote in 1990, "The Tragedy of Needless Pain," in which you referenced an, uh, "extensive study" that claimed less than 1% of opioid users, uh, become addicted.
Uh, yeah, Porter/Jick.
What about it? Do you have a copy of that study? Uh, I'm not sure.
Uh, have you tried the Internet? Uh, you know, I sure did.
I might've missed it, though, 'cause I only type with my index fingers, but I hear, uh, JD Salinger did the same thing, so that kind of helps me out in the selfâesteem department.
Yeah.
Any medical school will have it.
It's taught all over the country, but, um, I'm happy to check my notes and call you back.
Oh, you know what? I don't mind holding for you.
Um, my boss has been getting on me about this, and you'd really be helping me out here.
Okay.
I'll do a quick search.
Thank you.
Oh, Mr.
Smarty Pants knows his JD Salinger.
I got it from my book learning, sir.
Thinking of reading Moby Dick next 'cause I love whales and, uh, reading stories about whales and doingââ Hi, um, yeah, it's right here in my notes.
The Porter/Jick study is in a 1980 issue of the New England Journal of Medicine.
Do you know which issue exactly? No, that's all I have here, but good luck, okay? I gotta get going.
Okay, thank you.
All right.
Been through every issue of a weekly publication from 1978 to what, 1994, and we can't find this thing, huh? So we got TIME magazine, Scientific American citing it.
Mmâhmm.
Medical schools all across the country teaching it.
Right.
And yet it appears to be the most famous study that no one has actually ever seen.
Whââwhat's going on? Hi, Betsy.
My name is Eric Miller, and I'm a member of the AA community here in town.
Everyone in this room is here because we're very concerned for your health and your safety.
And we have so many things that we want to say and share with you.
We're all worried about your drug use and think it's time to seek treatment.
Why don't you sit down? You lied to me at the station.
Uh, I came here because your mom asked me to.
we're all really worried about you, Bets.
Your daddy and I don't care about anything other than you getting better.
All that other stuff, Bets, doesn't matter.
Just doesn't matter.
Your friends and family are worried every day that you're going to end up in a hospital or dead or in the back of a police car.
They wanna do everything they can to help you get back to a place of health, of just being okay without drugs.
Will you commit to a program? Pleââplease, Bets.
Please don't walk out that door, honey.
Youââyour mama and me, we justââ we just want our little girl back.
Just the way you are.
I'm sorry.
I can't.
I can't.
Betsy, if you don't do this, your family will be forced to turn their back on you.
Grant! Get in here.
What's up? Guess who's coming to dinner? Purdue Pharma agreed to meet.
Is Richard Sackler gonna join? Doesn't say.
Let's see if they give a fuck about safety or if they're just trying to sell pills.
Uh, look, IââI know you're newest to Diversion, but as a general rule, the pharmas don't really care about safety.
They just push as hard as they can until they get slapped.
Then let's bitch slap the shit out of these motherfuckers.
Good afternoon.
I'm Bridget Meyer, deputy director of Diversion.
I'm Michael Friedman.
Howard Udell and David Haddox.
Pleasure.
Is Richard Sackler coming? Dr.
Sackler had a meeting out of state, but I can assure you, we'll relay every word.
Fine.
Let's get started.
Uh, we'd like to start with a, uh, PowerPoint presentation about the efficacies of OxyContin.
That won't be necessary.
I've seen your promotional materials, and I'm familiar with your talking points.
So let's get right to the issue at hand.
I've brought you here to talk about addiction and abuse.
Since the launch of your drug four years ago, it has gotten out of control.
No, I beg to differ.
Uh, you can beg when I finish.
Now, to be proactive, my staff and I have come up with some practical common sense ideas that we believe could easily be implemented and would really help reduce the widespread abuse of this drug.
We don't believe the drug is being abused, but we'd be happy to hear your ideas if you think it would enhance public safety.
Given the growing incidences of drugstore robberies, it might be useful to reduce the number of pharmacies allowed to dispense.
This would also help with pharmacies that don't want to carry the drug but feel pressured to because of threats of lawsuits.
We'll take it under advisement.
We also thought that you could limit prescribing privileges to doctors with training in pain management.
It seems that GPs are prescribing this for things as frivolous as headaches and toothaches.
The drugs should be limited to pain specialists.
Well, um, that's not only impractical, it would also deny many legitimate pain patients access to the drugs, so.
That's verbatim, the FDA's concern.
Do you have them on speed dial? Excuse me? Whatever friendly situation you have going on over there, I assure you, you do not have here.
I want to restrict access to this drug.
It is being overprescribed and causing patients to become addicted as well as making it too easily available for recreational drug users.
Addiction rates, overdoses, and crime is on the rise across the country because of this drug.
So if you will not take action to curb this problem, then I will.
We'll take that under advisement.
New England Journal of Medicine.
Hi, my name is Rick Mountcastle.
I'm with the US Attorney's office in the Western District of Virginia, and I'm trying to locate a study that you published years ago regarding opioid addiction by a Dr.
Hershel Jick.
Does that ring a bell? Oh, yeah.
We know Dr.
Jick well.
He's been writing us letters for years.
We've published a lot of them.
They're good.
Some people just, you know Wait.
They love to read letters to the Internet.
I'm sorry, uh, you mean, like letters? Yeah, yeah.
He writes a lot of letters.
I found it.
That can't be it.
Oh, my God.
Government calls Dr.
Hershel Jick.
Afternoon, sir.
Dr.
Jick, tell us about your 1980 letter to the editor at the New England Journal of Medicine regarding addiction rates and patients taking opioids.
In the late '70s, I built a database of hospital records, which became known, as it was one of the first.
After reading a newspaper article on addiction, I decided to calculate how many patients in my database showed signs of addiction to narcotic painkillers.
Number was shockingly low, less than 1%.
So I wrote up a letter and sent it to the New England Journal of Medicine.
This letter was based on patients confined to a hospital setting, is that correct? Yes.
Mmâhmm.
Isââso is the likelihood of addiction higher in these same patients if they were not confined to a hospital? That is correct.
It wasn't an official study.
It was an observation based on a small group of patients in a highly controlled environment.
That's why the letter was so short.
Yes.
It was five sentences long.
How long would an average scientific study on addiction be? Between 25 and 50 pages.
Which is more than five sentences.
Obviously.
Have you ever worked for Purdue Pharma? No.
Have you ever consulted for them or received money from them? No, I have no affiliation with Purdue Pharma.
Well, are you aware that sales reps at Purdue cite your letter as a scientific study to convince doctors that less than 1% of patients would get addicted to their narcotic OxyContin? No, I'm not.
And are you aware that your fiveâsentence letter is cited as a major study by medical schools all across the country, and in magazine articles from TIME magazine, Scientific American as proof that opioids are safe? I was not aware of that.
Well, I'm gonna tell you what, there is an entire school of thought espousing opioids as being practically nonâaddictive, and your letter is often cited as a major source for this thesis.
This particular letter is very near the bottom of a long list of my published work.
It's simply provides some basic numbers based on a small group of people.
I have no idea how it became so discussed.
I'll tell you how.
So it became the primary source that opioids are nonâaddictive when it was cited in a 1986 article in PAIN magazine, which was highly influential in transforming the perception of opioids from addictive to safe.
And this article was coâauthored by Dr.
Russell Portenoy, who is now a paid spokesperson for Purdue Pharma and one of the chief medical proponents for increased use of opioids and OxyContin in the United States of America.
Halfway home to Abington, baby.
Whoo.
Ah.
I'm all about those small victories.
Aw, what do you mean, small victories? We had a big day.
Sure was.
Maybe it'll help us get more funding? I doubt it.
Rick Mountcastle.
Oh yeah, I remember you, Toby.
How're things at the DEA? Mmâhmm.
Well, it's still early in the case.
We haven't found anything yet.
You know what? I'll tell you whatââ it isn't a good time to talk.
Try you another time? Yeah.
It's all right.
Great, bye.
DEA wants to know how the pharma case is going.
They have zero interest, and right when we land something big, they justââthey call us right outta nowhere? Let's keep this buttoned up.
Just me, you, and Brownlee.
I don't trust anyone on this case.
Even after nine years staying sober, I know I got a disease.
So grateful I can come here every week as a reminder of what I need to do to stay on my path.
Thank you for sharing, Belle, and you're not alone.
Betsy, would you like to speak? Do I have to? You might find it helpful.
This is a very safe space.
Just share from your heart, dear.
We're all here to support you.
Okay, um.
I'm Betsy.
Hi, Betsy.
I was prescribed OxyContin for, uh, a back injury And it worked great at first, but Then it stopped working, and I needed more.
Here you are, sweetheart.
I guessââ I guess I always felt kinda tense and uncomfortable around people.
But taking the pills, it was It was the first time I felt normal.
In maybe my whole life.
And now And now I don't feel anything at all anymore.
All I think about is getting more pills.
And it can get scary.
Aww, everything's gonna be just fine.
Don't you worry.
How long has it been? Two days.
I feel like I'm gonna die.
Oh, honey, it's the worst feeling in the world, but I can help with that.
You can? Mmâhmm.
I got 10s, 20s, and 40s.
It's a dollar a milligram, so if you've got $40, I can give you four 10s right now.
I mean, wouldn't it be nice if all this pain just went away? Yeah.
Here you go.
Thank you so much.
It's gonna be all right, sugar.
Thank you.
I'll see you here next week, all right? Hey.
Hey, Walt.
Doc, how you doing? Ah, good, good.
Hey, sorry, I know it's lateââ Hey, no, you're all good.
Yeah, I'm gonna need some of that 80s if you got 'em, or 40s.
Whatever you got.
Yeah, yeah, you're in luck.
I'm newly replenished.
One second.
Now, hey, put that awayââput that away.
All right.
Okay, okay.
You feed me To the Lions, yeah Doc? Hey.
You got it? All right, I got you.
All right, now, this is two 12 bags.
All right.
All right.
Got you here.
That's good, hey? Thanks, thanks.
That's good.
All right, how're you doing? You all right? Good? I'm good, man.
Sorry, sorry.
I woke you up so late there, man.
You knowââyou know how it is.
Say, doc? Yeah? You don't look good, man.
Huh? No, I'm not.
I'm not.
No, I know, but do yourself a favor, all right? Snort those, crush them up.
Snort 'em.
How do you do that? Put them in your mouth, all right, for about a minute.
And then rub off that coating on the outside, so make a little mark.
All right, crush it up, snort it.
It's gonna hit you way better.
When this just feels like Spinning plates I'm living In Cloud Cuckoo Land Stars shining bright above you Night breezes seem to whisper "I love you" Birds singing in the sycamore trees Dream a little dream of me Say "Nightyânight" and kiss me Just hold me tight and tell me You'll miss me While I'm alone and blue as can be Dream a little dream of me Stars fading But I linger on, dear Still craving your kiss I'm longing To linger till dawn, dear Just saying this Sweet dreams till sunbeams find you Sweet dreams that leave all worries behind you But in your dreams Whatever they be Dream a little dream of me Stars fading But I linger on, dear Still craving your kiss I'm longing To linger till dawn, dear Just saying this Sweet dreams till sunbeams find you Sweet dreams that leave all worries behind you But in your dreams Whatever they be Dream a little dream of me Dream a little dream Of me
Permission granted to release requested documents relating to marketing and distribution.
They're drowning us in paperwork.
I'm promoting you.
I'd like you to be deputy director of the Diversion Division.
I accept.
The worst thing that aââ a parent could hear is that her kid is, you know, queer.
It'd kill me if you were, Bets.
I guess you're dead, then.
Do you realize that men might be dead 'cause of you? I don't understand what's happening to me.
If we get Germany uncontrolled, it will serve as a gateway to the rest of Europe.
Please tell me I'm gonna see you in Orlando in a few weeks.
That's why I'm calling.
I wasââ 20 milligrams of OxyContin.
Got it.
Hey, dude.
Hi, how are you doing? What's your in on? Bam.
Oh, fuck.
Yeah.
Cheers to that.
Hey, hey, what you doing, man? I was just gonna pop it.
No, man.
You gotta snort 'em.
Here, I'll show you.
What the fuck's your problem? Elizabeth Ann, are you in? It hits way faster.
Are you sure, man? Trust me, yeah.
'Cause, we've popped them normal before.
Did Purdue say it was easy for someone to bypass the timeârelease coating on an OxyContin pill? No, Purdue claimed the coating was difficult to get around, and therefore, OxyContin would be unappealing to abusers.
Was the coating difficult to dissolve? No, it was very easy.
All you had to do is dissolve it in saliva and then scrape it off.
And then the abuser would have immediate access to the full 12âhour supply.
They just crush it off then snort it.
Yeah! Oh, here we go! Holy shit.
Fuck yeah.
I think I'm getting a chubby.
Where's, uh, where's Elizabeth Ann? Elizabeth Ann? Hey! What the fuck you doing? Get your ass over here.
Hey, it's good.
Don't worry.
Go, you're up next.
First time is the best time.
Yeah! Yeah! Oh, shit.
Hey, hey! All right, I'm up next, right? Yeah, you got to see Oh, my God.
Oh, my God.
Don't you fucking die, Ryder! You're gonna be all right, don't worry about it.
Let's take him to his mom's house.
We can't go to his mom's house! Can we take him to a fucking hospital? We can't take him to a hospital.
Get him out of there.
What should we do? Oh, John, don't die, please.
Fuck, come on.
Please.
What the fuck is that? They didn't have any ice.
Is that a fish? It's frozen.
It'll wake him up.
Wake up.
Why? Wake the fuck up.
Fuck! Let's get out of here.
No, wait, we can't leave him here! Come on! We can't leave him! Elizabeth Ann! Come on! Here.
What the fuck is this? These are fucking 10s.
ER doctor was on to me.
Only gave me four days' worth.
God damn it.
What the fuck? I'ma be really sick tomorrow.
Yeah, and I'm not? You're the fucking drug dealer! Why is this on me? And what about Florida? We can hit one of the pain clinics.
That's too far.
We'll get fired.
Yeah, well, we got nowhere else to go 'cause you keep burning up all the God damned ERs.
I'm not good at this.
They don't believe me.
That's why it's gotta be Florida, okay? They don't care down there.
We can get whatever the fuck we want.
I can't go.
I can't go.
All right, then get the fuck out.
What? I said, get the fuck out! Jesus Christ, Walt.
Fuck! How about right here? Oh, yeah.
It'sââit'sââit's getting worse.
Yeah.
Can't even wake up without a pill anymore.
Yeah.
You're taking them twice a day? Yeah, but where does that help? Okay, you're having pain even when you don't take it.
Oh, 100%.
But I want off of this stuff.
Yeah.
I'mââI'm either falling asleep all day or thinking about the next pill.
Mmâhmm, okay.
Well, we're just gonna taper you off there, buddy.
Weââwe tried that.
Yeah, I know, we're trying again.
I'm gonna lower your dose from 80 milligrams down to 40, okay? And if you're experiencing any withdrawal symptoms, I'll cut that with some Xanax, okay? We'll get this right.
How many pills do you have left in that bottle? A few.
A few here.
Okay, just leave the bottle on the table there, and, uh, we'll lower your dose here, buddy.
All right.
We'll get you feeling better, okay? It'll be all right.
Thanks, doc.
We are so proud to be honoring my great brother, Arthur Sackler, into the Medical Advertising Hall of Fame.
In many ways, Arthur Sackler invented medical advertising.
He was the first to realize it wasn't patients who decided what drugs they took.
It was their doctors.
Shunned by Madison Avenue for being Jewish, he formed his own company specifically targeting doctors with articles from scientific journals and studies from medical societies.
Sure, sometimes the societies and the experts were financed by Arthur.
Who do you think is the bigger asshole? Uncle Mortimer or Uncle Arthur? C, all the above.
Not only changed the way medicine is marketed in this country; it changed the medical industry forever.
Your uncle was good.
For his time.
Hmm.
This one's missing the zombies that valium turned some patients into.
He got away with it.
Barely.
But it made him rich.
Beth, darling, would you give us a few minutes, please? Sure.
Thank you.
You had to do it, didn't you? Do what? You had to say it was nonâaddictive.
Dad, even the FDAââ Oh, please.
Call notes are starting to come in that patients are showing signs of addiction.
Just a few pockets of West Virginia.
It's cultural.
All those hillbillies do is get addicted.
And Maine and Kentucky.
All our phase one states.
If it becomes accepted that more than 1% become addicted, it's dead.
And one year of strong sales isn't gonna make up for the 40 million you spent.
Any suggestions? Take a page from Arthur's playbook.
Get an expert who'll tell doctors the truth of our wonder drug.
We've got Russell Portenoy.
No, I'm thinking someone more aggressive, especially if your 1% claim is, um, hmm.
What's that medical term? Fucking bullshit.
Fine.
We'll find an aggressive expert.
No, theââthe osteoarthritis was truly debilitating, and nothing seemed to work until I realized that the patient needed something strong enough to stop the breakthrough pain.
So I started the patient on methadone, and she was back to normal within just a few days.
Methadone? You said find me aggressive.
He has a theory called pseudo addiction, which basically means addiction doesn't exist.
Who is this guy? David Haddox.
He went to dental school but now heads the Pain Management Department at Emory.
Aââa fitting progression.
You wanna meet with him? God, yes.
So you really feel opioids are underâprescribed? For decades.
Now, the Porter/Jick study is exactly right.
Under the proper care, opioids are totally safe.
IââI recently read a theory of yours, which is why Iââ I wanted to meet.
Thank you.
Let me guess: pseudo addiction? Correct.
How'd you come up withââ mm, uh.
Where did you discover pseudo addiction? Yeah, so I was, um, so I was, uh, was working with a 17âyearâold leukemia patient who showed classic signs of addiction.
And yet we upped his medication, and he was fine.
Turns out that he wasn't addicted at all.
It was that that underlying pain hadn't been properly treated.
So pseudo addiction means that, uh, addiction symptoms are, in actuality, the symptoms of untreated pain? That's correct.
Yeah, taking away a patient's medication isn't helping them.
It's torturing them.
What they need is more medication, and then these supposed addiction symptoms will quickly go away.
Soââ so do you think all addiction is, in actuality, pseudo addiction? In relation to medication? Yes.
Huh.
I look in those rare instances when a patient truly is an addict; that's not the fault of the drug or the doctor.
No, the patient was most likely a drug addict to begin with due to genetic defects.
What about cigarettes? Addiction or pseudo addiction? Yeah, smokingââsmoking is definitely pseudo addiction.
It's all in their heads.
How would you like to work for Purdue Pharma? Morning, boss.
Still no update on the funding? Well, good morning to you too, Randy.
How's Jennifer? The kids? Sorry, good morning.
Nailed it.
You know, it seems pretty darn odd if these FBI guys won't grant us a small amount of resources.
Could just be, as my son would say, a dysfunctional government.
Your son's four, Rick.
Feeling a little inadequate right now.
Good morning, guys.
Morning.
What's up? Still haven't heard back from the Medicaid office, and Dr.
Jick's office finally called me back and said, "The doctor's unavailable.
" Unavailable? Today? Nope.
She said unavailable, period.
Yes, I told you, Dr.
Jick is unavailable.
Well, I've called multiple times, and I'd just like an explanation as to why Dr.
Jick refuses to speak to me.
He said he's very busy, but I'll leave a message.
Thank you.
Well, this just got interesting.
So what's the latest? Well, as you know, Purdue aggressively pushed the drug as nonâaddictive with the phrase "less than 1% get addicted.
" That figure comes from the Porter/Jick study that was done by Dr.
Hershel Jick at, uh Boston.
Boston University.
Boston University.
Well, let me guess, it's that the fraudulent study that was secretly funded by Purdue? Just like the pain study? Well, that's one theory.
We actually called Dr.
Jick to discuss it with him, but something very interesting occurred.
He wouldn't get on the phone with us.
Well, nothing says suspect quite like an unanswered phone call.
If that 1% study is indeed fraudulent, it's a home run in proving criminal misbranding.
Yeah, and if you can find the highâlevel Purdue exec that oversaw it Could indict them for fraud.
Yeah, that's right.
It sounds like a great lead.
Yeah, this case is starting to take up so much time.
That's right.
We need more funding for prosecutors for our nonâPurdue cases.
Yeah, I know, I know.
I mean, why won't the FBI or the DEA give us additional funding? You know, I don't know.
Maybe they're not, uh, connected to the issue.
You know what you should do, you should try the Virginia State Police.
Try Virginia Medicaid Fraud Unit.
They'll get it.
And you know, the more we find, the more it opens up those coffers.
Yeah, but it, it justââ it is really difficult to find anything without the proper resources.
I mean, I knew we'd be outspent, but I did not expect to not have access to the most basic things, like highâspeed computers and scanners.
Look, guys, IââI get it, trust me.
But we just keep pushing, all right? Yeah.
We'll see where it goes, sir.
All right, boys.
You can enjoy your lunch.
Thank you.
Keep me posted.
Oh, Randy.
Sir? Uh, how you doing, healthâwise? I actually just had my oneâyear scan, and I am cancerâfree.
Yeah, he's good.
That's great news.
OxyContin is becoming the leading cause of overdose in the country.
Newspapers are filled with arrests in rural areas where crime directly related to the drug is skyrocketing.
Isn't Diversion and local authorities supposed to deal with these crime issues? Yes, but what makes this so overwhelming for law enforcement is the sheer ease with which users can get access to the drug.
I mean, they are available in every pharmacy in the country.
What do you feel is the best approach? I think the most effective way to solve this problem is to limit the drug's use for severe pain only.
It is a very strong narcotic that is being prescribed for issues such as basic dental work and even headaches.
If it was no longer allowed for moderate pain, then overnight, millions of pills will be off the streets.
What about the millions of legitimate pain patients that will lose access to the drug? If they have severe pain, they will not lose access.
But this recent practice of opioid use for moderate pain is causing a startling new wave of crime and addiction.
The role of the FDA is to make sure medicine is safe.
And when this drug is taken as prescribed, this medicine is safe.
And I disagree.
Anecdotes about abuse and crime are not a scientific analysis of the drug's safety.
They're tales of addicts abusing pharmaceuticals, which happens with all opioids.
So until you can prove the drug itself is dangerous, I don't see how we can put restrictions on it.
Okay.
Well, you're not gonna take action, then I will call in Purdue, discuss it with them directly.
I think you should.
I will.
And your warning label that this drug is somehow less addictive is total bullshit.
You should look into changing that immediately.
Why would you start him on 20 milligrams when 40 milligrams sounds like it's gonna be more effective? Hey, yo, Teddy.
Yo.
Right, that's why you keep titrating 'em up until all there's left to say is thank you.
I managed to scrounge up a couple of Hokies tickets if you're interested.
You are the hardestâworking nurse in the state.
All right, you deserve a spa weekend.
Listen, I think win or lose, we go to the bar.
That'sââthat's what I've been saying.
Individualizing the dose is everything.
I work I work, I work I work, baby I work, I work I'll get the job done I work I work, baby Which means that most symptoms of addiction are, in reality, untreated pain.
And the cure for pseudo addiction is that the patient needs more medication.
More than 100,000 physicians, almost half of all doctors in the country will be sent pseudo addiction pamphlets.
Give one to any doctor if their patients show signs of addictââ sorry, pseudo addiction.
Questions? Yes.
Last week, I had a doctor tell me he had two patients taking way more pills than he prescribed.
Like, he was very worried they were addicted to the medication.
No, no, no, no, it sounds like your physician's actually under prescribing.
No, he's not.
They're already taking 80 milligrams a day.
Look, if I tell them that they're pseudo addicted and need to be bumped up to 160 milligrams, he'll just kick me out of his office.
Now that is a defeatist attitude.
Dr.
Haddox is giving us innovative concepts, and he deserves respect and appreciation for his expertise.
Uh, ma'am, if people are living with unnecessary pain, and they're being stigmatized when the solution is right in front of themââ if people are suffering, they need a higher dose.
Hey, I'm Sandra.
Hey.
Billy.
So, um, which territories do you cover? Uh, Virginia.
Appalachia mostly.
Wow, lucky you.
Excuse me.
Paula.
Hey, are you, uh, checking into the hotel right now? No, I'm going home.
They just fired me.
What? Are you serious? Why? They said I had inconsistent paperwork.
Oh, my God.
Um, I'm sorry.
Don't be.
No, I'm relieved actually.
They all know.
And you know.
Uh, know what? Okay, Billy.
Individualize the dose.
As opposed to other drugs, opioids are uniquely challenging to stop using because they can change a person's brain chemistry.
But in a desperate effort to end the cycle of dependency, some people try to quit cold turkey, but the results can often be disastrous.
A hydrangea? How'd you know? Oh, you know, I have my ways.
Can I, uh, can I see the doc? Billy, you know he doesn't wanna see you anymore.
Come on, there's gotta be a misunderstanding here.
It's been months.
And Iââyou know, I miss him.
Well, he cleared his appointments today 'cause he's not feeling well.
I was in the bathroom when you walked in.
Thank you, Leah.
Mmâhmm.
It's your favorite pharma rep.
Doc, are you okay? Never better.
Hi, I just, uh, wanted to see how you're doing and, uh, see how you're patients are.
It's been a while.
Have a seat.
Sure.
Let me ask you something, Bill.
Do you ever think that, um, maybe that miracle drug you're selling, it's just, you know, just a tad more addictive than you said? Uh, that's not what we're hearing.
Um, but there is a condition associated with this, um, which IââIââI have some information on.
I can share it with you.
Um.
Pseudo addiction.
Uh, we're seeing some cases, although rare, where they show the symptoms of addiction, but in reality, their underlying pain hasn't been sufficiently addressed.
Uh.
Andââand the solution is simple.
You know, youââyou up the dose, andââand their symptoms, you know, disappear, andââ in time.
Let's have a look.
You sell poison, Billy.
What's that? That's all it says.
You sell poison.
That's what you do.
That's just poison.
No, doc, Iââ Yeah, well, it's what it is.
Yeah, it's poison.
I can talk you through it, doc.
It's a new concept.
It's all in here.
No, no, these are good, hardâworking people.
These are good, hardâworking people, and you have the FDA label thisââ Doc, anything in here that you don't understand, I can talk you through.
All right.
Okay.
Get out.
Get out.
All right.
No! Dr.
Finnix.
Get away.
You need to get going.
Don't ever come back.
Docââdocââ Get out of here.
Doc, please.
Get out of here.
You ever come back on these rounds, I'll fucking kill you.
Yeah, I'll fucking kill you myself.
What's wrong with you? Take the rest of the day off.
Go home.
Hi.
I didn't know you worked here.
Yeah.
What are you doing in town? Oh.
It's been a while.
Oh, I'm just visiting my grandma.
How's Eureka Springs? Oh, it's great.
Um, I really love it there.
I like your belt.
Oh, thanks.
Um, I made it.
I guess I'm crafting now.
You still quilting? Um, I It's good to see you, Bets.
You take care of yourself, okay? Hey.
I wanna go to Florida.
When I go driving, I stay in my lane But getting cut off, it makes me insane I open the glove box, reach inside I'm gonna wreck this fucker's ride Guess I got a bad habit Hey, you want a Xanax? It'll take the edge off.
How much? Jesus, man, it's a gift.
In the Gulf, we used to say, don't make me offer twice.
Okay.
Take this.
It'll make you feel better.
All right, all right.
I didn't know you were a vet.
Yeah, did two tours.
Shit I saw Hey.
Salvation at last.
And your next breath is your last Guess I got a bad habit Of blowin' away Yeah, yeah Got a bad habit Yeah, yeah Told you.
Yeah, yeah Got a bad habit Yeah, yeah And it ain't goin' away Yeah, yeah Yeah, yeahâahâah Yeah, yeah Yeah, yeahâahâah Yeah, yeah So injury or chronic condition? I hurt my back.
Mining incident.
Okay, I'm gonna need to examine you.
Did the nurse give you a gown? Here you go.
Uh, bra too, please.
Okay, lift your arms.
Yes, you are definitely gonna need painkillers.
Strong ones.
OxyContin, 40 milligrams, twice per day.
Unless you have breakthrough pain.
How does that sound? Hey, these prescriptions can really add up.
So if you're in a bind, we might be able to work something out.
It's fââit's fine.
I have cash.
No problem.
Fill this out at the dispensary in the back.
God bless the great state of Florida.
I told you never to call me again.
Hi, yeah, you know, I'mââ I'm sorry, and IââI, uh, do want to apologize forââ for what happened.
I'm going through some stuff, Drea.
Watching you fall asleep in the middle of a restaurant is not my idea of a good time.
Yeah.
It was humiliating.
I know, I know, I'm dealing with a medical condition, and, um, in fact, I was wondering if, you know, possibly you could help me.
Uh, Drea, you don't have samples of OxyContin, do you? No, I don't.
Delete my number.
When this just feels like Spinning plates The brain is rewired to function normally when opioids are present and abnormally when they are not.
And the pain from withdrawal is so overwhelming that a person can feel like they are literally going to die if they don't get more drugs.
And this just feels like What is the term for the pain an addict feels when they're in clinical need of their next fix? It's called dopesick.
You wanted to speak to me? Uh, there's something very strange going on here.
What is it? The Porter/Jick study isn't on the internet.
What? Yeah, I mean, it's referenced all over the place.
TIME magazine, Scientific American.
But IââI mean, I can't find the actual study.
Greg can't find it, either.
He's been on it longer than me.
Do you find any affiliations between Purdue and Jick? Paid speeches, consulting, anything like that? Nothing.
What about Porter? Who's that? It's Jick's assistant.
Jane Porter.
There's 10,000 of them.
So theââthe famous Porter/Jick study that's the North Star of the pain movement to increase opioid use is nowhere to be found? Bingo.
Hey, yeah, we're calling about a Scientific American article you wrote in 1990, "The Tragedy of Needless Pain," in which you referenced an, uh, "extensive study" that claimed less than 1% of opioid users, uh, become addicted.
Uh, yeah, Porter/Jick.
What about it? Do you have a copy of that study? Uh, I'm not sure.
Uh, have you tried the Internet? Uh, you know, I sure did.
I might've missed it, though, 'cause I only type with my index fingers, but I hear, uh, JD Salinger did the same thing, so that kind of helps me out in the selfâesteem department.
Yeah.
Any medical school will have it.
It's taught all over the country, but, um, I'm happy to check my notes and call you back.
Oh, you know what? I don't mind holding for you.
Um, my boss has been getting on me about this, and you'd really be helping me out here.
Okay.
I'll do a quick search.
Thank you.
Oh, Mr.
Smarty Pants knows his JD Salinger.
I got it from my book learning, sir.
Thinking of reading Moby Dick next 'cause I love whales and, uh, reading stories about whales and doingââ Hi, um, yeah, it's right here in my notes.
The Porter/Jick study is in a 1980 issue of the New England Journal of Medicine.
Do you know which issue exactly? No, that's all I have here, but good luck, okay? I gotta get going.
Okay, thank you.
All right.
Been through every issue of a weekly publication from 1978 to what, 1994, and we can't find this thing, huh? So we got TIME magazine, Scientific American citing it.
Mmâhmm.
Medical schools all across the country teaching it.
Right.
And yet it appears to be the most famous study that no one has actually ever seen.
Whââwhat's going on? Hi, Betsy.
My name is Eric Miller, and I'm a member of the AA community here in town.
Everyone in this room is here because we're very concerned for your health and your safety.
And we have so many things that we want to say and share with you.
We're all worried about your drug use and think it's time to seek treatment.
Why don't you sit down? You lied to me at the station.
Uh, I came here because your mom asked me to.
we're all really worried about you, Bets.
Your daddy and I don't care about anything other than you getting better.
All that other stuff, Bets, doesn't matter.
Just doesn't matter.
Your friends and family are worried every day that you're going to end up in a hospital or dead or in the back of a police car.
They wanna do everything they can to help you get back to a place of health, of just being okay without drugs.
Will you commit to a program? Pleââplease, Bets.
Please don't walk out that door, honey.
Youââyour mama and me, we justââ we just want our little girl back.
Just the way you are.
I'm sorry.
I can't.
I can't.
Betsy, if you don't do this, your family will be forced to turn their back on you.
Grant! Get in here.
What's up? Guess who's coming to dinner? Purdue Pharma agreed to meet.
Is Richard Sackler gonna join? Doesn't say.
Let's see if they give a fuck about safety or if they're just trying to sell pills.
Uh, look, IââI know you're newest to Diversion, but as a general rule, the pharmas don't really care about safety.
They just push as hard as they can until they get slapped.
Then let's bitch slap the shit out of these motherfuckers.
Good afternoon.
I'm Bridget Meyer, deputy director of Diversion.
I'm Michael Friedman.
Howard Udell and David Haddox.
Pleasure.
Is Richard Sackler coming? Dr.
Sackler had a meeting out of state, but I can assure you, we'll relay every word.
Fine.
Let's get started.
Uh, we'd like to start with a, uh, PowerPoint presentation about the efficacies of OxyContin.
That won't be necessary.
I've seen your promotional materials, and I'm familiar with your talking points.
So let's get right to the issue at hand.
I've brought you here to talk about addiction and abuse.
Since the launch of your drug four years ago, it has gotten out of control.
No, I beg to differ.
Uh, you can beg when I finish.
Now, to be proactive, my staff and I have come up with some practical common sense ideas that we believe could easily be implemented and would really help reduce the widespread abuse of this drug.
We don't believe the drug is being abused, but we'd be happy to hear your ideas if you think it would enhance public safety.
Given the growing incidences of drugstore robberies, it might be useful to reduce the number of pharmacies allowed to dispense.
This would also help with pharmacies that don't want to carry the drug but feel pressured to because of threats of lawsuits.
We'll take it under advisement.
We also thought that you could limit prescribing privileges to doctors with training in pain management.
It seems that GPs are prescribing this for things as frivolous as headaches and toothaches.
The drugs should be limited to pain specialists.
Well, um, that's not only impractical, it would also deny many legitimate pain patients access to the drugs, so.
That's verbatim, the FDA's concern.
Do you have them on speed dial? Excuse me? Whatever friendly situation you have going on over there, I assure you, you do not have here.
I want to restrict access to this drug.
It is being overprescribed and causing patients to become addicted as well as making it too easily available for recreational drug users.
Addiction rates, overdoses, and crime is on the rise across the country because of this drug.
So if you will not take action to curb this problem, then I will.
We'll take that under advisement.
New England Journal of Medicine.
Hi, my name is Rick Mountcastle.
I'm with the US Attorney's office in the Western District of Virginia, and I'm trying to locate a study that you published years ago regarding opioid addiction by a Dr.
Hershel Jick.
Does that ring a bell? Oh, yeah.
We know Dr.
Jick well.
He's been writing us letters for years.
We've published a lot of them.
They're good.
Some people just, you know Wait.
They love to read letters to the Internet.
I'm sorry, uh, you mean, like letters? Yeah, yeah.
He writes a lot of letters.
I found it.
That can't be it.
Oh, my God.
Government calls Dr.
Hershel Jick.
Afternoon, sir.
Dr.
Jick, tell us about your 1980 letter to the editor at the New England Journal of Medicine regarding addiction rates and patients taking opioids.
In the late '70s, I built a database of hospital records, which became known, as it was one of the first.
After reading a newspaper article on addiction, I decided to calculate how many patients in my database showed signs of addiction to narcotic painkillers.
Number was shockingly low, less than 1%.
So I wrote up a letter and sent it to the New England Journal of Medicine.
This letter was based on patients confined to a hospital setting, is that correct? Yes.
Mmâhmm.
Isââso is the likelihood of addiction higher in these same patients if they were not confined to a hospital? That is correct.
It wasn't an official study.
It was an observation based on a small group of patients in a highly controlled environment.
That's why the letter was so short.
Yes.
It was five sentences long.
How long would an average scientific study on addiction be? Between 25 and 50 pages.
Which is more than five sentences.
Obviously.
Have you ever worked for Purdue Pharma? No.
Have you ever consulted for them or received money from them? No, I have no affiliation with Purdue Pharma.
Well, are you aware that sales reps at Purdue cite your letter as a scientific study to convince doctors that less than 1% of patients would get addicted to their narcotic OxyContin? No, I'm not.
And are you aware that your fiveâsentence letter is cited as a major study by medical schools all across the country, and in magazine articles from TIME magazine, Scientific American as proof that opioids are safe? I was not aware of that.
Well, I'm gonna tell you what, there is an entire school of thought espousing opioids as being practically nonâaddictive, and your letter is often cited as a major source for this thesis.
This particular letter is very near the bottom of a long list of my published work.
It's simply provides some basic numbers based on a small group of people.
I have no idea how it became so discussed.
I'll tell you how.
So it became the primary source that opioids are nonâaddictive when it was cited in a 1986 article in PAIN magazine, which was highly influential in transforming the perception of opioids from addictive to safe.
And this article was coâauthored by Dr.
Russell Portenoy, who is now a paid spokesperson for Purdue Pharma and one of the chief medical proponents for increased use of opioids and OxyContin in the United States of America.
Halfway home to Abington, baby.
Whoo.
Ah.
I'm all about those small victories.
Aw, what do you mean, small victories? We had a big day.
Sure was.
Maybe it'll help us get more funding? I doubt it.
Rick Mountcastle.
Oh yeah, I remember you, Toby.
How're things at the DEA? Mmâhmm.
Well, it's still early in the case.
We haven't found anything yet.
You know what? I'll tell you whatââ it isn't a good time to talk.
Try you another time? Yeah.
It's all right.
Great, bye.
DEA wants to know how the pharma case is going.
They have zero interest, and right when we land something big, they justââthey call us right outta nowhere? Let's keep this buttoned up.
Just me, you, and Brownlee.
I don't trust anyone on this case.
Even after nine years staying sober, I know I got a disease.
So grateful I can come here every week as a reminder of what I need to do to stay on my path.
Thank you for sharing, Belle, and you're not alone.
Betsy, would you like to speak? Do I have to? You might find it helpful.
This is a very safe space.
Just share from your heart, dear.
We're all here to support you.
Okay, um.
I'm Betsy.
Hi, Betsy.
I was prescribed OxyContin for, uh, a back injury And it worked great at first, but Then it stopped working, and I needed more.
Here you are, sweetheart.
I guessââ I guess I always felt kinda tense and uncomfortable around people.
But taking the pills, it was It was the first time I felt normal.
In maybe my whole life.
And now And now I don't feel anything at all anymore.
All I think about is getting more pills.
And it can get scary.
Aww, everything's gonna be just fine.
Don't you worry.
How long has it been? Two days.
I feel like I'm gonna die.
Oh, honey, it's the worst feeling in the world, but I can help with that.
You can? Mmâhmm.
I got 10s, 20s, and 40s.
It's a dollar a milligram, so if you've got $40, I can give you four 10s right now.
I mean, wouldn't it be nice if all this pain just went away? Yeah.
Here you go.
Thank you so much.
It's gonna be all right, sugar.
Thank you.
I'll see you here next week, all right? Hey.
Hey, Walt.
Doc, how you doing? Ah, good, good.
Hey, sorry, I know it's lateââ Hey, no, you're all good.
Yeah, I'm gonna need some of that 80s if you got 'em, or 40s.
Whatever you got.
Yeah, yeah, you're in luck.
I'm newly replenished.
One second.
Now, hey, put that awayââput that away.
All right.
Okay, okay.
You feed me To the Lions, yeah Doc? Hey.
You got it? All right, I got you.
All right, now, this is two 12 bags.
All right.
All right.
Got you here.
That's good, hey? Thanks, thanks.
That's good.
All right, how're you doing? You all right? Good? I'm good, man.
Sorry, sorry.
I woke you up so late there, man.
You knowââyou know how it is.
Say, doc? Yeah? You don't look good, man.
Huh? No, I'm not.
I'm not.
No, I know, but do yourself a favor, all right? Snort those, crush them up.
Snort 'em.
How do you do that? Put them in your mouth, all right, for about a minute.
And then rub off that coating on the outside, so make a little mark.
All right, crush it up, snort it.
It's gonna hit you way better.
When this just feels like Spinning plates I'm living In Cloud Cuckoo Land Stars shining bright above you Night breezes seem to whisper "I love you" Birds singing in the sycamore trees Dream a little dream of me Say "Nightyânight" and kiss me Just hold me tight and tell me You'll miss me While I'm alone and blue as can be Dream a little dream of me Stars fading But I linger on, dear Still craving your kiss I'm longing To linger till dawn, dear Just saying this Sweet dreams till sunbeams find you Sweet dreams that leave all worries behind you But in your dreams Whatever they be Dream a little dream of me Stars fading But I linger on, dear Still craving your kiss I'm longing To linger till dawn, dear Just saying this Sweet dreams till sunbeams find you Sweet dreams that leave all worries behind you But in your dreams Whatever they be Dream a little dream of me Dream a little dream Of me