All language subtitles for The Crime of the Century - 01x01 - Part 1.WEBRip-ION10.English.C.orig.Addic7ed.com

Morning, morning!

Fire got here and they touched
his upper body and he was warm.

- So they were working on him?
- They worked on him.

Really? Which unit is it? Upstairs?

It's up on the top corner.

January 13th, 2021.
We'll get started at 05:40 hours.

The victim's information,
date of birth 9/97.

Long history of drug use.

The mother called in at 03:06 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 legs were cold,
but the upper body was still warm.

So the officers and medics
started performing CPR

for approximately 15 minutes.

Let's see if it works.

It's worked like money
the last couple of times I've done it.

In the victim's bedroom
we found a spoon

with brown residue
inside of a shoe box,

as well as a needle, several baggies.

So that's positive off the spoon,
fentanyl.

Ultimately was pronounced deceased
at 03:36 hours.

Since 2000, more than
500 000 Americans have died

of opioid overdoses.

Millions of Americans
have become addicted.

Every 25 minutes, a baby is born
with opioid withdrawal.

The US Govt estimates
that the cost of opioid abuse

is over 1 trillion dollars.

We call this "The Opioid Crisis".

But a crisis is something
that just happens.

What if we discovered that the opioid
crisis was caused by businesses

seeking to profit from pain?

What if, behind the crisis,
there was a spectacular crime?

For thousands of years, a demand
for opium 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 is 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 it's 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 painkiller
called Laudanum.

During the Industrial Revolution

infants were narcotized
with Laudanum

by mothers without child care
who needed to leave home

to work in 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,
Warner 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 US made heroin illegal,
creating a new global crime business

dominated by the Italian mafia
and Mexican cartels.

Big pharma turned to the mass
manufacture 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 that 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 a hundred
billion dollars of income a year,

by cultivating and catering
to a desperate need for opioids.

That business model has
a terrible cost.

Within the last twenty years,

more than 500 000 Americans
have been killed by overdoses.

THE CRIME OF THE CENTURY

In today's report we're in the central
territory of the Sinaloa Cartel,

at a clandestine laboratory.

When I started off telling the story
of the opioid 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.

When they first were really rolling out
methamphetamine in a big way,

they would actually send
free samples to key markets.

The way they thought
about wholesale distribution

and 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 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,
how is pot doing versus cocaine...

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,

millions of people who had been
abusing prescription drugs,

whether they were getting them
from a doctor

or buying them on the street.

For a variety of reasons,
it was getting harder to obtain.

And they found themselves
buying heroin.

You suddenly had
this huge population of buyers

who'd kind of come into the market
through the back door,

through the world
of licit pharmaceuticals.

And I started looking at opioids

and when you do that, you pretty
quickly stumble on the Sackler family.

I often say I approach collecting
as a biologist,

that I want enough data to be able
to draw valid conclusions.

Art is a passion,
pursued with discipline.

Science is a discipline pursued
with passion.

You have to really pursue
the object.

You just don't sit there and have
the objects come to you.

You want to be a great collector,

you better think of the fact that
you are going to commit yourself

to a real passionate hunt.

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 dollars

by becoming some of the world's
most successful drug pushers.

There are three Sackler brothers.
They grew up in Flatbush, Brooklyn.

They had immigrant parents
who'd come from Eastern Europe

and they were kind of quintessential
hungry sons of immigrants

from the 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 is the oldest
brother and kind of the patriarch,

almost as much a parent
to his younger brothers,

kind of leads the charge.

He ends up in the 40s at Creedmoor
Psychiatric Hospital in Queens,

which is this vast asylum,
six thousand beds.

And Arthur ends up bringing
his younger brothers into the fold,

something he often did in their lives.

He brings Raymond and Mortimer,
his two brothers, along with him.

And at that time, there were certain,
stubborn medical mysteries

having to do with mental illness.

There were new innovations.

One of them was
electroshock therapy.

And the Sackler brothers end up
in a situation in which

they are administering
electroshock therapy

to thousands of patients at this place.

It struck them as crude
and inhumane.

And the brothers were
kind of repulsed by this.

And so they start trying
to find other solutions

to these mysteries
and they become convinced

that it's brain chemistry that is
causing things like schizophrenia

and that if it's
a chemical problem,

then there's probably
a chemical solution.

So the idea that there's no affliction

for which we might not be able
to devise a pill.

So the Sacklers buy a small
pharmaceutical company in 1952.

A company called Purdue Frederick.

It was this little concern.
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 McAdams.

And in pretty rapid succession,

comes up with a whole series
of revolutionary ideas

that completely transform
the landscape of how we sell drugs.

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 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.

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.

PURDUE HEADQUARTERS

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.

That'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 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 nose dive.

So they start thinking, what are
we going to 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,

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 overwhelms your system,

it slowly goes into your bloodstream
over the course of 12 hours.

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

was pretty heavily invested
in OxyContin,

but no one more so
than Raymond's son, Richard Sackler,

who was also a doctor.

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 midnight,
he'd write you back right away.

Very fixated on the success
of this drug.

Sackler launched OxyContin

with one 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 the long term.

But whether it's effective or not
also depends on other factors

such as abuse.

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.

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.

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 semisynthetic
drugs, 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.

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 have really
been interested in that

because you can't really get
a blockbuster drug

if the drug is going to be promoted
for pain at the end of life.

There aren't enough patients
with end of life cancer pain,

and they're not to 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.

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.

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.

This is the first time
I've ever seen this.

This isn't just unethical.
I think this could be illegal

that they allowed Purdue to do this.

If it's illegal it would look as though
both Purdue and Curtis Wright

may have broken the law.
There's no way this should be allowed.

That a drug company
would be involved

in drafting the review
of its application...

This is a document from the medical
officer review of Curtis Wright.

This is part of the FDA approval.

And he's the guy that actually
approved it to be sold,

or allowed you all to sell it
from the FDA?

That's my recollection.

You ultimately hired him
a few years later, didn't you?

We did hire him,
but not after his tenure at the FDA.

We discussed it and agreed

that we should not hire somebody
who had reviewed our product and 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...

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.

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 dollars.

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.

Because it means that your army of
hundreds and hundreds of sales reps

can go out and meet with doctors
and say:

"Doc, it's in the package insert.
the FDA approved this."

With this crucial line about how
the delayed absorption is believed

to reduce the abuse liability...

Believed by Purdue Pharma

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.

Cardiac arrest. Unresponsive.

What motivated me to become
an EMT...

My freshman year
when I was in high school,

I had two classmates
that had overdosed on opioids.

As I was in English class, learning
on grammar and punctuation,

I'm sitting in the front room
of the classroom

and heard two thumps of two
classmates falling out of their desks.

They started foaming at the mouth.

961 Wise,
we are in the area.

Do you have a description
of what the residents look like?

I had an 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. All four
had overdosed on oxycodone.

I work sometimes a hundred hours
plus a week for two jobs,

and the stuff I see 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,
Princeton and Beckley.

And then on down to Bristol
and Wytheville.

And spread like cancer.

Was it always West Virginia for you?

Well, my first eight years was in Ohio,

up around Medina,
right around Cleveland, in a log cabin.

Dad worked at a Chevrolet plant
where they made transmissions,

but he had a midlife crisis,
I guess, in his 40s.

And he got the urge to come home
to West Virginia,

where he and my mom were raised.

About the same time, Take me Home
Country Roads came out, too.

So maybe it had something to do with.

We moved to a place called Sundial,
West Virginia, down in the coalfields.

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.

That paid good money.
How about that, dad?

He said: "No, Mark. 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,

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.

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 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 1998,
signing on to sell OxyContin, primarily.

OxyContin was what they stressed
they wanted sales out of.

It was posed 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 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 them 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 cannot 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.

A hundred and fifty years ago,

doctors believed that pain
was actually good for you,

that when patients experience pain
during a surgical procedure,

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.

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.

We don't think that way
about pain anymore.

Now we think,
oh, my goodness, pain!

I've got to get rid of it immediately.

What makes the opioid crisis unique

is that the pills themselves
are so inherently addictive

that if you then add that
to all the business incentives

to over prescribe, you do end up
with this kind of perfect storm

that leads to the crisis
that we have today.

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.

They're hard driving.

And if we're gonna write
a song for these folks,

it's a song that's gotta smoke.

Purdue, are you ready to rock?

I wanna tell you a story
about people,

About a company
called Purdue Frederick.

And they did so good in '96...

I think you're ready to rock right now.

I said, are you ready
to rock right now?

Put your hands together
if you're ready now!

You know you make me want
to sell OxyContin, MS Contin...

In the late 90's, Purdue celebrated
its marketing muscle.

There were 600 sales reps
pitching healthcare providers

all over the country.

Using junkets and parties
to lure doctors to write scripts,

Purdue's pitchmen banked 40 million
dollars a year in bonuses.

At the turn of the century,
OxyContin sales exceeded

1 billion dollars a year,

passing Viagra
as America's most profitable drug.

I was very gladdened to see
that OxyContin was meeting

with such a strong positive reception
by both physicians and patients.

The doctors that we targeted

they called them moneybags
and easy money.

I guess, because in their mind,
once you got them on OxyContin

or another opioid
and they got hooked,

you were going to get
recurring prescriptions

and the monthly bonus checks.

In my first year with Purdue,

I believe I made about 170 000.

Selling MS Contin every day,
Selling OxyContin...

My final year was almost 300 000.

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.

They called it 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 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 it many times
in physicians' offices

and sort of humanized 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 mention the dosages
the they were on...

I'm currently at 1 200 milligrams
of OxyContin.

You know, some physicians,
their mouth would drop open,

and we would explain to them there
was no maximum on the dosage,

that you 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, the one to start with,
and the one to stay with.

What is pain? Pain is suffering.
Pain is soreness.

Throbbing, aching.

Pain is whatever the person
experiencing the pain says it is.

Amazing. Purdue was so generous.

They had videotapes.
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 to an all day long course
on pain.

I didn't have to go to an all day long
course on cardiology or radiology.

The fact is that pain should be treated
as aggressively

as the underlying condition
that causes the pain.

I was taught that pain should
be treated like the fifth vital sign.

When you take blood pressure,
when you take respiratory rate,

when you take heart rate,
temperature,

you should show them this scale
from 1 to 10.

1 is like a tiny little bit of pain

and 10 is the worst pain
you could imagine.

Incorporating pain management into
nursing education at all levels

will produce staff members who are
skilled in pain management.

We were constantly being told that
there was a growing epidemic of pain,

that more and more people
were in pain,

that it was the responsibility
of the doctors to alleviate pain.

There is always something
that can be done to reduce pain.

You needed to, quote unquote,
"get over your opioid phobia".

We doctors were wrong in thinking
that opioids can't be used long term.

No dose is too high
and your patient can't get addicted.

Less than one percent of patients
taking opioids become addicted.

And if you don't use them,
you are a bad doctor.

You want people to suffer.

Take opioids seriously.

So we tried to abate all their fears
that were well founded

that they had acquired
through medical school

and through practicing before
we got to them about opioids.

We took all that away
and then turned them loose.

There was great recognition that we
had millions and millions of Americans

who deserved to have their pain
treated more humanely.

Frankly, that's why
we go to medical school, right?

We're there really to provide relief
of suffering as much as anything.

Only once every generation or two
is there such a dramatic shift

in the way in which we can help
patients in such a large way

that I thought I was at the beginning
of this new frontier.

And that's how I became addicted
to the treatment of pain.

Hello, everyone.
I'm Lynn Webster.

For many people
that experience chronic pain,

it's as malignant as a cancer.

I've 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.

Helping them market or serving
on advisory boards.

He's spoken at hundreds
of medical events.

The problem is not hydrocodone.

The problem is hydrocodone abuse.

I don't think there's anyone
who he wouldn't work for.

My space in lecturing was what
I viewed was more academic.

You were sometimes paid
by pharmaceutical companies?

No, not to speak.

Now, pharmaceutical companies
may hire an educational company

to put together a program.

I would be contracted then
by an educational company

to put on the program.

So it wouldn't be directly.
It's indirectly, I suppose.

But they had no influence
on the content.

Zero. I would never do that.

Most of my speaking
was about the risk of opioids.

Opioids can be used safer than
they had been used in the past

because it is, frankly, your health.

I think that the definition
of addiction has to be defined.

You have to be exposed to a drug
that's rewarding,

like an opioid in order to develop
the disease of addiction.

But it's not sufficient.

Meaning most people exposed
to an opioid will never develop

an addiction to it, regardless
of how long they are 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.
And 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 in about 1990,
but it's crucial.

In a single case report, the doctors
who wrote that case report said:

"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.

He 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

is 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,

wondering 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?

I've been criticized because I said
the treatment of different...

One option in trying to understand
if it's a pseudoaddiction,

the treatment should be
give more drug.

The idea of pseudoaddiction, that was
talked about in training a fair amount.

The way you need to explain
to the physician is,

it 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 eyes were
glossed over with the mission

to treat untreated pain,

filled right in a gap
of any of your knowledge.

The story seemed to build on itself.

Yeah, that makes sense.
Pseudoaddiction.

Well, looking back on it,
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?

Yes, absolutely. I think that there
was a lot of enthusiasm.

I owned it because I thought
I could just give enough

and my patients
would have a normal life.

I know and all anesthesiologists
know you can give enough opioid

to take away the pain.

The problem is,
will they be awake or alive?

I served a mission for my church.

The 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 gotta get this on the road."

"Go get dad's boat.
We're going to Pineview Dam."

We get up there, she skies a lap,

beaches on the sand and says:
"I'm ready to have the baby."

She wasn't afraid of anything.

This never should have happened.

One day, Carol and my oldest son
were going to Sam's Club

and an 84 year old woman
ran the stop sign

and my son's vehicle T-boned her car.

And she was thrown
into the windshield.

A neurosurgeon rebuilt her neck

with the 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?

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 30-45 minutes later,

she would think, "I've got to take
my medication".

She would take it again.

Numerous times
I found her unconscious

in the strangest of places.

When she'd come out of it,
she would have no knowledge of it.

And so started taking pictures
of when I would find her.

And the only reason I took the pictures

is so that I could show her
because she did not believe me.

We'd end up in the emergency room

and my son John got all of the pills
that Lifetree had prescribed

and we took them out there.

And I remember the physician saying:

"You've got to be kidding me."

And he was able to convince her
to go in the program.

She was able to get off of all
of the pills, all of the patches.

She was in great shape.

She was happy. She was smiling.
She was involved.

And she was on Tylenol.

Then 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:

"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 doctor 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 Carol is not in a good way.

There was always some tension
between the family and my patient.

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.

Opioids can provide more potential
benefit than the potential harm.

10 000 miles from its headquarters
in Connecticut,

Purdue Pharma sough the solution
to a pressing production problem.

The company was so successful
that it was running out of opium.

To find enough supply
for the soaring demand,

Purdue turned to a company famous
for its promise of no more tears.

In just this one moment, your baby
is getting even more than clean.

The scent, the lather,

even the tiny bubbles of a Johnson's
bath, are helping to enhance

the experience.

Johnson & Johnson, they have
this brand that makes people think

of baby shampoo and talcum powder
and wholesome products.

But they are also the kingpin
in the opioid crisis.

Johnson & Johnson
wasn't just selling its own opioids

and promoting them for conditions
where we shouldn't use them,

promoting long-term use,
high-dose use.

Johnson & Johnson
was also supplying Purdue

and all of the other opioid
manufacturers in the United States

with the opium
that was making it possible

for the US to be flooded with opioids.

The traditional way to extract opium
is you lance the poppyhead

and someone goes through the field
scraping off the opium sap.

It's very labor intensive.

In Tasmania, Johnson & Johnson
industrialized 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.

Johnson & Johnson also genetically
altered the nature of the plant

to create a super poppy
that was surging with thebaine,

a narcotic in oxycodone.

To persuade Tasmanian farmers
to switch from potatoes to poppies,

J&J offered luxury vacations
and awarded prizes,

Mercedes and BMWs
to farmers who could produce

the most potent crop.

Soon, seventy-four thousand acres
of Tasmania were devoted to opium.

J&J lobbied the US government
for unlimited access

to American markets and promoted
its product in a brochure

called Finding Relief.

In the United States, Purdue used
the opioids from Tasmania

to flood the country with OxyContin.

But the pills weren't just for pain.

They were being diverted from doctors
to people looking for a heroin high.

From the mid 90's, 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 into their company
that was pre-exposed

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".

That sentence was pounded in,
I pounded it in doctor's heads.

"Delayed absorption of OxyContin
is believed to reduce"

"the abuse potential".
Over and over and over again.

"Delayed absorption of OxyContin
is believed to reduce"

"the abuse potential".

Nothing gets into these package
inserts that hasn't been reviewed

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 write

a lot of prescriptions for opioids.

We didn't go to a lot of people
who didn't write them.

We went to people who did.

Dr. Frank Sutherland was an osteopath
down in Grundy, Virginia.

Grundy, Virginia,
is a little poduck town, coal town

that's down in a bowl
coming from Richlands.

It's just straight down.

There's a lot of hardworking people
down there,

but there's a lot of people that are
druggies, I guess I 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,
the more and more I went,

that he had patients that looked
like they were rough around the edges

and I would hear conversations,
"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.

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."

Okay, as long as you know
who they are...

I don't want you to prescribe
OxyContin to somebody

who you know is abusing.

But then I had a doctor...
I saw him one time, when I went in,

wiping his nose and doing
this trick coming up from his desk.

He was cutting up OxyContin and
snorting it right off his own desk.

As time 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, then overdosed.

What? Are you kidding me?

I started to hear more and more stories
from nurses that I knew for 15 years.

By the time it got to the end of 99,

I was pretty convinced 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.

It's gonna be a death train coming.

We've got to do something about this.
It's just chaos out here.

I thought that they would least
have the decency to listen

to one of their best reps
with some concerns.

But they did not even want
to entertain a discussion.

"It's not your job to be a policeman."

"Go in there and sell,
you're a salesman."

I was sort of like a canary
in the coalmine.

But nobody was running.
Nobody was leaving.

I was at work one day,
sitting around the newsroom,

and an editor came over to me.

He had gotten a tip from a source
of his that was on a pharmacy board

who told him there was
this new drug, OxyContin.

It had become the hottest drug
on the street

and the number of overdoses
were rising.

And he thought we should be
looking into what was going on.

We started calling around,

speaking to pharmacists,
speaking to doctors,

trying to get an understanding

because prior to this I'd 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 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 a put it on the market?

I'm not aware of any.

And I wondered whether
Purdue knew about that study,

whether they had distributed
that study,

whether they told the FDA
about that study.

I asked them all those questions,
which they refused to answer.

Purdue, when we started speaking
to them,

were adamant that neither the drugs
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.

Beginning with a series of articles
for the New York Times,

Barry Meier began to investigate
possible crimes committed

by Purdue and the Sackler family.

That led to a book called Pain Killer,

which was the first detailed account
of the opioid crisis

and how it had spread
from Maine to Mexico.

It focused on Appalachia, and the
Westernmost sliver of Virginia

that points like a knife between
the heartlands of Kentucky

and Tennessee.

In the town of St. Charles, Barry Meier
discovered a citizens' crusade

to protect local communities
against the assault of OxyContin

led by a doctor named Art Van Zee.

If you're in a small town
and you have a hospital practice

and you're involved in a lot of things,

internal medicine for 44 years,

you do get to do a lot of things
that are meaningful to you.

How many babies do you suspect
you've delivered in that time?

I don't deliver babies.

I've seen a lot young people grow up

and I've been involved with multiple
generations of some families,

in terms of their care.
But we don't deliver babies.

It was 1999, 2000 when OxyContin
really came like a tsunami

into the coalfields.

Nine percent of the seventh graders
had tried OxyContin at least once.

And 25 percent of the 11th graders.

It's morphine.
It's like on a morphine high.

You're kind of numb, you're free,
but you're itching.

I was going in after midnight
to take care of young people

overdosed on OxyContin,
on respirators.

I was really in many ways
unprepared for this.

Where are these pills coming from?

They're everywhere.

Early on in the reporting when
we were tracking down doctors

and pharmacists,
I spoke to Art by phone.

And we began to chat quite a bit.

He was freaked out by how
Purdue was marketing the drug.

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 have seen
numerous young people abusing

and becoming addicted
to OxyContin,

frequent overdoses, infections,
abscesses,

Hepatitis C related to intravenous
drug abuse.

About 70 percent of serious crimes
in the county are now drug-related.

Some counties in Maine are
experiencing similar problems.

These problems are enormous
for poor, rural areas such as ours,

with minimal resources for dealing
with hardcore narcotic addiction.

I would look forward to having
a dialog with you further about this.

Sincerely, Art Van Zee.

They indicated
they were concerned about it.

When Purdue wrote back
to Dr. Van Zee,

the correspondence included
two former FDA officials

who now worked 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 going to fix the problem.

So Van Zee dug in
for a longer battle.

I became more involved.

It was the whole community that was
becoming more involved

and 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.

You couldn't get 800 people in that
high school auditorium

for any other thing

except maybe the high school
football state championship.

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
about appropriate selection criteria

to get the right drug
to the right patients.

We met in Duffield, Virginia,
at a motel there.

They offered us a hundred thousand
dollars to try to deal with the problem.

And we just felt, at the time,
that it just kind of been a setup.

We thought it was more
a publicity deal

than a real attempt
to deal with the problems.

We started a petition to ask the FDA
to recall OxyContin.

It was causing an inordinate
amount of harm and suffering

and it should be recalled.

Purdue Pharma reportedly spent
26 million dollars 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's ever been marketed.

Dr. Van Zee decided to take
the matter to Congress.

Surely US 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.

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'd said something to the effect
of, in general,

the experience is as if you got it an
abusable drug that's highly available,

it's going to be highly abused.

And he kind of mused about,

"is that some little Appalachian
saying" or something like that.

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 was 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.

Soon after the hearing,
Purdue rewarded Dodd

with a campaign contribution

that was ten 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 US
increased by 2.5 million Americans.

Addiction 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
the abusers in every way possible.

They are the culprits and the problem.

They are reckless criminals.

There's only one reckless criminal
in this situation,

and it's Purdue Pharma.
They had no morals.

They had no ethics about them.

In Richard Sackler's mind...

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.

If it wasn't OxyContin,
it would be something else.

And legitimate pain patients
who take the drug as prescribed

don't get addicted.

This idea being that you're dealing
with two separate species.

That's not how it really is.

Patients who misuse and get addicted
to opioids are legitimate pain patients.

Far from apologizing,
Purdue Pharma is fighting back,

saying it's only intent is to get relief
to the 50 million Americans in pain.

But with a 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.

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 drugmaker's battle

to save its best seller.

They hired 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,

a beautiful little historic town
in the foothills of the Appalachians.

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.

In 2001, John Brownlee was the
US 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
piece together a case.

And then when you put it all together,
it equals a crime.

We at Purdue are very distressed
that OxyContin,

which as you've heard is providing
so much relief to so many people,

is being abused as well.

And we deeply regret
the tragic consequences

that have resulted from the misuse
of this medicine.

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
by 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 US Attorney
Jay McCloskey of Maine

sent to physicians in Maine
warning them of problems

with OxyContin that were occurring
in certain communities.

And since that time,
I am proud of our response.

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,
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
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.

There's a moment where Goldenheim
says he wants to remove discussions

about addiction from email
because it's too sensitive.

It's clear Goldenheim lied,
under oath,

in testimony to Congress.

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 mg Ms Contin pills were selling
for 40 dollars a pop.

They were known as purple peelers,

because users looking
for a heroin high

could 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 recall hearing about it?

Maybe a couple of years
after its launch.

- Could that be 1998?
- '97.

Alright. 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.

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 160 mg 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 unheard of,

superhuman, enough to kill an elephant,
quantities of OxyContin

and apparently being alright
with that.

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 was looking for relief
from crippling back pain

when he stumbled on a doctor
named Stephen Montaldi.

So I found Steve Montaldi.
He started with steroid injections.

He knew how severe the case was
and he treated me with the morphine.

I came out of the office one day

and there was a very attractive
young lady out there

asking if she could talk to me.
I said, sure.

She introduced herself.
"I'm Stephanie Cauffman,"

"and I am a representative of Purdue"

"and we have a drug
called OxyContin."

"We'd like to offer you a deal,
a trial."

"We'd cover all the costs
if you consider switching to our drug."

She said there's a special formula.

"You just take as much as you need."

"You can keep on going up
until you get enough pain relief."

"And chances of overdosing
are very slim."

No money.

They were going to pay for everything.
I said sounds like a deal.

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 that she was
willing to give you the drugs for free?

Because it was a trial from Purdue,
excuse me.

They were testing it.

They started me with maybe
8 or 10 twice a day.

160s, the highest dose.

That wasn't working,
so they just kept on raising it.

12 two times a day. 15.
That wasn't doing it.

So we went up to 20.

And I said this still isn't doing it.
So he made a phone call,

he told me it was to the doctors
at Purdue

and they said "give him more".

So that's when we got up
to the 25 twice a day.

That's 50 pills a day.

It would almost take me 15 minutes
just to eat them all.

It was like sitting down
to a bowl of cheerios.

I was starting to feel a little toxic,

like my body was telling me
that we weren't doing well.

But I mean,
what could I do but take more?

You know what I'm saying?

When you're in that much pain and
you're addicted to such a high dose,

no matter what it is,

you're a trapped rat.

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 for being a guinea pig
or an example.

Their plan didn't start off with
here's what we're going to do with him.

When they saw

that I was functioning
on higher doses,

I believe they thought they could just
give me as many as I wanted.

They knew that was the goal,
to keep on adding more.

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,

was she punished? Was she fired?
What happened to her?

She was promoted.

She got moved up to headquarters.

And they gave her a new position
training other sales reps.

Our objective in communicating
with doctors

through trained sales representatives,
literature and educational programs

is to educate them about
the proper use of OxyContin.

Somewhere there in the middle
of my career I got a subpoena

in the mail from the federal
prosecuting attorney from Abingdon.

And I needed to be there at this time
and be ready to testify

in front of the grand jury.

That floored me.

That scared me,
that ran a chill down my spine.

They wanted information concerning
Dr. Frank Sutherland

and how he was overprescribing
OxyContin.

I called Howard Udell,
the lead counsel for Purdue Pharma

and he listened to me
and he chuckled

when I said I needed
some representation.

He said: "You're on your own.
That shouldn't be any problem."

I said: "Are you kidding me?"

"I'm being subpoenaed by the federal
government over OxyContin"

"and you're not gonna send
anybody down?"

"No, you'll be alright." Click.

In addition to Mark Ross,
Stephanie Cauffman

and Gary Blinn, scores of doctors,
patients, and sales reps

were called before the grand jury.

That testimony,
plus internal Purdue documents

became 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.

A hundred 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,

and the fraudulent scheme
and conduct articulated in this matter

has 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 it was committed effectively.

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.

One last question.
one last answer.

Led by former US Attorneys
Mary Jo White and Rudolph Guiliani.

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 would take responsibility
for trading a guilty plea

in exchange burying 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 have 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 going
to know this was a righteous case

that we really should have prosecuted.

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 dollar 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
of misbranding OxyContin

and collectively paid 34.5 million
dollars in penalties.

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 continue to do so as I speak."

While waiting for the bus to take them
to the corporate jet,

the Purdue executives and their
lawyers expressed no remorse

and denied any personal responsibility.

None of them would spend
a day in prison.

Purdue paid the executives' fines
and legal costs

and gave two of them bonuses

to compensate them
for the pain they had suffered.

Do you believe Purdue's marketing
was overly aggressive?

No.

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

and hugely damaging
to the reputation of the executives.

Was that your view inside
the department?

The general view inside
the department

is they paid a speeding ticket.

Does this jeopardize
the company's financial standing?

What happens to the company is
something we just didn't look into.

Purdue Pharma, up until 2006,

they made about nine billion
dollars marketing OxyContin.

Nine 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 minuscule
amount 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 fight to do this.

- The drug remains available?
- Yes.

After the settlement, Purdue doesn't
pull the emergency brake.

They don't recall the drug.
Instead, they keep selling it.

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,

is 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
ten billion dollars?

I don't think so.

- Is it over five billion dollars?
- I don't know.

The Sackler family is worth
over ten billion dollars,

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 Modem,

boast collections bearing
the Sackler name.

An article on the family's
real estate holdings showcased

sprawling estates with vast grounds,

pools and tennis courts

and a New York City townhouse likely
worth more than fifty million dollars.

The Sacklers bought the Caribbean
luxury getaway of Amanyara

and scores of opulent hotels.

They collected a portfolio
of seventeen ski resorts,

many in states scarred
by the opioid crisis.

The family moved billions
out of the company,

as the money from OxyContin
kept rolling in.

After the 2007 settlement,
Purdue's revenues soared

to a company record
of three billion dollars 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 a hundred 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?

Can you hear me?
Are you coming out of it?

For more than twenty years,

Americans have watched the human
cost of the opioid crisis

as if it were an epidemic
without a cause.

But what if we had seen early on
the evidence

that the crisis was manufactured
by a series of cynical crimes?

More than a decade passed
before that evidence began to surface

in leaks of the prosecution memo
that had been buried

when the government failed
to bring Purdue to trial.

Reading the prosecution memo was
like an incredible slap in the face.

The tragedy of this episode
really does relate

to how this case was resolved.

Because by burying
the prosecution memo,

the Justice Department effectively
agreed to bury critical information

that doctors, public health officials,

and patients needed to know
about the dangers of opioids.

It was the day before Thanksgiving.

I got home around three
to four o'clock 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 and 11 o'clock
that morning.

We sued Lynn Webster
and Lifetree.

And before it was settled,

there is what's called
a DOPL hearing,

which 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?
- 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.

What are you to do?

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

then 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 mg tablets
of Amitriptyline,

30 40 mg tablets of Celexa,

224 30 mg tablets of Oxycodone,

112 10/325 mg of Percocet,
60 1 mg tablets of Requip,

60 1 mg of Xanax. Sorry.

60 4 mg tablets of Zanaflex,
a muscle relaxer.

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 think, contact
the state medical board

and report that prescriber,

because they are clearly
putting that patient's life at risk.

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.

It was pretty frightening to my staff.
And the office was full of...

And guns?

They didn't have guns drawn, no.
But they had guns.

They were obvious. I felt...

I was on a wonderful career path

of feeling like at the end of the game
I'd feel proud

that I was able to be in this profession
and I could help people.

I still feel that way,

but that event
has forever tarnished me.

Webster was also tarnished
by the evidence.

Records showed a pattern
of prescribing

unusually high amounts of opioids

as well as confirmations
of a number of patient deaths.

There were as many as 100 overdose
deaths at your clinic,

or they were suspecting
that there were.

Would that have been a large number
relative to your patient population?

Well, I think so.

I think...

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.

Many people who use these drugs
for the wrong reason,

and I'm sure I had some
in my practice,

are at risk of overdosing.

Plus, I also have people who die
of old age, cancer.

I don't know what that number means.

That to me sounds like
mass manslaughter.

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.

The DEA sought to prosecute
Webster and Lifetree

for the illegal distribution
of controlled substances

and possible manslaughter.

I wanted to know if we can ask
you a couple of questions?

I've got an appointment.

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?
- No.

- You don't want to answer?
- No.

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 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.

But we didn't learn.
Starting in 2013,

a powerful synthetic opioid surged
in popularity.

Fentanyl.

It was a hundred 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.

To be continued

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,

What a tragedy, 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.

The victims of your crime
can never be made whole,

But 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.