TThe origin of America’s opioid crisis, the ridiculously profitable proliferation of addictive painkillers whose abuse killed nearly half a million Americans between 2000 and 2019, arguably boils down to a single sentence. In 1996, the pharmaceutical company Purdue Pharma, then owned and controlled by Mortimer and Raymond Sackler and their heirs, began selling the opioid drug OxyContin. (The family of a third brother, Arthur Sackler, sold their shares before the OxyContin presentation.) The highly addictive drug was designed for people in severe pain, such as cancer patients, but was marketed as a moderate pill for chronic pain sufferers. With a succinct and misleading seal of approval from the Food and Drug Administration: “The delayed absorption provided by OxyContin tablets is believed to reduce liability for drug abuse.”
The stamp was “a phrase that gives rise to the opioid epidemic,” says Patrick Radden Keefe, a New York journalist, author of the book Empire of Pain: The Secret History of the Sackler Dynasty, in the HBO documentary The Crime of the Century. , filmmaker Alex Gibney’s expansive four-hour dive into the morally bankrupt businesses that fueled the crisis. It was also a lie, one that Purdue used as a blanket shield to aggressively market OxyContin to physicians across the country as a safe prescription for chronic pain sufferers. Subsequent claims statements revealed that Purdue Pharma clinical trials were never conducted to show that OxyContin was less addictive or abused than any other opioid. A 2006 memorandum prepared by prosecutors in the Western District of Virginia, undisclosed until August 2019, he found that the FDA approval officer, Dr. Curtis Wright, had a suspiciously “informal in nature” relationship with the company; Wright resigned from the FDA shortly after OxyContin’s approval and, a year later, took a job at Purdue with an annual salary of $ 379,000, roughly triple his previous salary.
“There is no opioid crisis without OxyContin,” Gibney told The Guardian. And there is no OxyContin boom without misleading marketing, which The Crime of the Century uses as a starting point for a critical rethink: what if we thought of opioids in the US not as a passive crisis, but as the outcome. logical of a series of legal situations and ethical crimes. (In October, Purdue Pharma, now bankrupt, pleaded guilty to three federal criminal charges, including turning over misleading information to federal agencies, and agreed to an $ 8 billion settlement; none of the Sackler family members were charged. ).
The word “crisis” conjures up images of natural disasters, inevitable damage: “A flood or a hurricane, and it’s not that terrible, but we couldn’t do anything about it, it was just something that happened,” says Gibney. . But “once you reframe it as a crime, then you start looking: what was the motive for the crime? What was the crime, how was the crime carried out, and who is responsible for the crime? “
“You can find a reason for what happened and try to both take responsibility into account and change the system that made it possible,” says Gibney. In the case of addiction and opioid abuse in the United States, “the crisis was manufactured. It wasn’t something that just happened. “
Crime of the Century delves into the many tentacles of profit incentives, political apathy, and staggeringly insensitive greed that underlie the opioid business, which dumped millions of pills on overwhelmed towns while generating billions of dollars for drug companies. The first two hours trace the rise of OxyContin, which rode the wave of pain, sometimes well-intentioned and supported by Purdue, as the new “fifth vital sign”; and Purdue Pharma’s cynical profit strategy: underestimating the abuse potential of OxyContin, ignoring calls for help from sales reps and doctors in the field about the growing addiction crisis, and cynically pushing the line that OxyContin was even safe. on absurd levels.
The second hour begins where the OxyContin flood ended: the rise of fentanyl, a synthetic opioid 80 to 100 times the strength of morphine that is responsible for tens of thousands of overdose deaths. It focuses on the fraudulent marketing of Insys Therapeutics, whose billionaire founder John Kapoor was convicted in May 2019 of bribing doctors and defrauding insurance companies for his fentanyl drug Subsys, a rare occurrence of individual business owners. facing repercussions.
Both chapters include perspectives on many sides of the crisis, from those who have lost loved ones to opioids to former Purdue sales representative Mark Ross, who sounded the alarm about abuse in his home state of West Virginia as early as 2000. Former prosecutors who investigated Purdue and DEA agent turned opioid crusader Joe Rannazzisi testify about calls for consequences ignored or downplayed, while former Insys representatives Sunshine Lee and Alec Burlakoff, convicted together With Kapoor, they spell out a corporate culture that would produce a rap music video on fentanyl that boasts “I have new patients and I have a lot.”
Gibney is no stranger to prolific corruption, greed, and incompetence, having documented Russian interference in the US elections in last year’s Agents of Chaos, and the failed federal response to the Covid-19 pandemic in Totally Under Control. But it was a process for him to view the opioid business as a less passive crisis than criminal negligence. The “real revelation,” he said, was the 2006 Virginia prosecution memorandum, first extract by the New York Times in 2019, a damning 120-page document built on four years of research and millions of cited documents that essentially featured Purdue’s deceptive marketing strategy. Prosecutors found that the company “trained its sales representatives” to use “false and fraudulent” claims about OxyContin, and recommended filing felony charges against three senior Purdue executives, Michael Friedman, Howard Udell and Paul Goldenheim.
The felony charges never came; Purdue assembled a high-powered legal team, including future Trump adviser Rudy Giuliani, who reportedly convinced the Bush Justice Department to drop the indictment. Purdue pleaded guilty to a felony mislabeling and agreed to pay $ 500 million, a paltry sum compared to his billions in earnings, and a settlement that freed his executives from any charge. The following year, 2007, Purdue reported record earnings, largely attributable to OxyContin.
“You see that the playbook for those crimes, the arguments for those crimes, is repeated over and over again by various other companies,” Gibney said. “Not processing, not holding people to account, leads other people to believe, ‘Well, okay, so there is not much risk for us. If we get caught, we’ll pay a speeding ticket and that’s just the cost of the business. ‘
The history of Purdue Pharma, now the subject of several lawsuits across the country, and the commercialization of fentanyl throughout the 2010s, demonstrate “the danger of uniting a turbocharged and unregulated 21st century capitalism with healthcare.” says Gibney. “The profit motive so dominates everything that it creates a series of terrible incentives that are often adverse to the health of patients.”
“The opioid crisis isn’t the result of a few weak, bad-tempered addicts just getting hooked, and it’s not that bad,” says Gibney. “What happened here is that big companies recklessly distributed dangerous drugs because they were profitable, not because they were good for the nation’s health care.”
A quarter century after oxycontin was introduced to the market, with more than half a million Americans killed by overdoses and many more lives shattered by addiction, the idea of a resolution is, for many, impossible. What many who have endured the opioid tragedy want, according to Keefe in the film, are not financial deals but the truth: the sales plans, the callousness, the known or ignored information, and when.
“That’s what we deserve: the truth about what really happened,” says Gibney. “And once we know the truth, I think we can move forward to reform a system that is badly broken.”
George is Digismak’s reported cum editor with 13 years of experience in Journalism