Original subtitles

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.