Original subtitles

[TV static drones]

[bright tone]

[indistinct chatter]

- 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?

[tense music]

- 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.

- [sniffles]

- 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.

[machine whirring]

- So that's positive off the spoon.

Fentanyl.

Yeah.

[machine beeps]

- Ultimately was pronounced deceased

0336 hours.

[over radio] Well, it's gonna be

a beautiful, sunny day today.

And we can expect much more of the same...

[whistle blows, people shouting]

♪ ♪

[bird cawing]

[singer vocalizing irregularly]

[insects buzzing]

[singers vocalizing]

[train rattling]

♪ ♪

[music fades, wind howls gently]

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.

[dramatic music]

♪ ♪

[reporter speaking Spanish]

- 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.

[soft, unsettling music]

[bells tolling]

♪ ♪

- 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.

[funky music]

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 ♪

[music fades]

[meandering music]

♪ ♪

- 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.

[soft indistinct chatter, door clangs]

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.

[solemn music]

♪ ♪

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.

[pensive music]

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. [chuckles]

[somber music]

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.

[foreboding music]

♪ ♪

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.

[birds chirping]

[soft, unsettling music]

♪ ♪

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.

[elusive music]

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.

[thunder rumbling]

[sirens wailing]

[device buzzing] - Rescue 45.

In the [unintelligible] area.

114.

- This event right here. - 1-11.

209 Northwest [unintelligible].

- 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.

[melancholy country music]

♪ ♪

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.

[John Denver's "Take Me Home, Country Roads" playing]

- ♪ 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.

- [chuckles]

- 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.

[compelling music]

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.

[TV static drones, buzzes]

- 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.

[feedback squeals] Okay.

[electric guitar music]

♪ ♪

[scattered cheering] Purdue, are you ready to rock?

[uproarious cheers and applause]

- Whoo!

[poignant organ music playing]

♪ 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?

[crowd cheering]

Put your hands together if you're ready now.

["Shout" tune plays]

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.

- [incredulously] 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.

- [echoing] 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.

- [echoing] 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.

- [echoing] There is always something that can be done

to reduce pain.

- You needed to "Get over your opioid phobia."

- [echoing] 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."

- [echoing] 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."

- [echoing] Take opioids seriously.

[soft ominous music]

- 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.

[thoughtful string music]

♪ ♪

- 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.

[laughing] 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. [chuckles]

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.

[eerie music]

- 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?

[soft music]

♪ ♪

[car horn honking]

[bell tolling]

- 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.

[music fades]

This never should've happened.

[crashing]

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"?

- [chuckles]

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.

[disquieting string music]

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.

[indistinct TV chatter]

♪ ♪

[birds singing]

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.

[soft music]

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.

[tense music]

♪ ♪

[singers vocalizing]

♪ ♪

[insects buzzing]

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."

[uplifting music]

- 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.

[dramatic music]

♪ ♪

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."

[train horn blares]

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.

[ominous music]

- 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.

♪ ♪

[lights clicking, humming]

[footsteps approaching]

- 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.

[melancholy music]

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.

[page flips]

♪ ♪

- 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.

[gentle country music]

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.

[ambient country music]

♪ ♪

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.

[indistinct chatter]

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.

[camera shutters clicking]

- 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.

[tense music]

♪ ♪

- 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.

[foreboding music]

♪ ♪

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.

160. 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-- [laughs incredulously]

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.

[soft dramatic music]

♪ ♪

- 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."

[solemn music]

♪ ♪

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.

[melancholy music]

♪ ♪

- 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.

[singers vocalizing]

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.

[soft dramatic music]

♪ ♪

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.

[soft dramatic music concludes]

[dog whines]

- 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.

[solemn music]

♪ ♪

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.

[eerie music]

♪ ♪

- 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 ♪ [unintelligible]

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.

[electronic hip-hop music]

- ♪ Yo, oh, you think you're bad? ♪

♪ Well, I'm the baddest, I was created in a lab ♪

♪ With the latest tactics ♪

[music fades]

[gentle music]

♪ ♪

- 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."

[singer vocalizing]

♪ ♪

♪ ♪

[bright tone]

ALEC BURLAKOFF: 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.

SCOTT HIGHAM: This was a new drug cartel

that was being established in the United States.

DAVID LAZARUS: What they would do is bribe doctors

to write as many scripts as we possibly can.

SCOTT: People were dying by the tens of thousands,

and their own representatives

-are selling them down the river. -Lights.

-(SIREN WAILS) -OFFICER: 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.

♪ (DRAMATIC OUTRO PLAYS) ♪