Original subtitles

Today, we're gonna talk about

a medical condition known as breakthrough pain.

We were curious as to why nobody says OxyContin

in a video designed to promote OxyContin.

I'm at a loss for words.

It's just changed my life for the better.

We just did what they wanted.

They said, "Make a PSA," so that's what we shot.

This drug has only been on the market

for three years, and there's already been

a spike in overdoses and crime rates.

Purdue Pharma is doing my people a great service,

so God bless 'em for it.

What happens if someone has breakthrough pain

and they're already at 40 milligrams?

It is time to double the dose again

as I present to you,

the 80 milligram pill.

Whoo!

♪ ♪

Pulse rate, body temperature,

blood pressure, respiration rate.

These are the four vital signs.

They indicate the status

of the body's life‐sustaining functions

and serve as a basic warning to potential health problems

should these indicators be off standard levels.

But I would argue

that if we want to ascertain

the true health of our patients,

then these four vital signs are not enough

because they do not monitor pain.

From pain,

we can instantly determine if a patient is suffering.

And what better indicator

for the status of a patient's health

than the level of their pain?

Therefore, I propose to you here today

in these vaunted halls

that the medical community must make pain

the fifth vital sign.

Well, it looks better. How's it feel?

It feels a lot better.

Good. That's what I wanna hear.

So it's been four weeks.

I wanna taper you off the meds.

See, starting Monday, I want you to...

take one pill a day until the next Monday,

and then we're gonna stop altogether.

Oh, okay. Okay?

Sounds good.

And if you have a problem, you call me.

You know, like you didn't do when you first got injured?

Yeah. You're the boss.

That's right. I'm the boss.

So what's the latest with Eureka Springs?

Oh, we called a realtor.

She's looking for a place for us.

Talk to your folks?

Well, uh, I tried to talk to my mom.

How'd that go?

They'll think I'm going to hell,

so it doesn't really matter what I say.

You think you're going to hell?

No.

I never believed in none of that stuff,

even when I was a kid.

Well, then, as far as that goes,

you got nothing to worry about.

Unless I end up in hell.

Yeah.

Well, yeah, there's that.

What do I do about 'em?

Forgive 'em.

Love 'em.

Be patient with 'em.

You never know. They might surprise you.

Go live your life, Bets.

Sometimes you gotta let it go.

You know what I mean?

♪ ♪

Fuck this shit.

We are getting reports

that doctors have had a lot of success

treating breakthrough pain by doubling the patient's dose,

so this got us thinking that perhaps there's a way

to prevent breakthrough pain before it even begins,

and, uh, this inspired...

Why start someone at 10 milligrams

if they really need to start at 20 milligrams, or even 40?

We don't know the needs of a specific patient

the way their doctor would, so we need to let

physicians and nurses know

they need to individualize the dose.

This is exactly right.

Yeah, I agree.

It's very good, Michael. Very good.

Let's move on it. Great.

Thank you, everyone.

Good work.

Paul, uh, can you stay for a minute?

I wanna look into launching OC in Germany

under a relaxed status.

Germany? Yes.

If we can obtain a relaxed status,

we'd be uncontrolled there.

But German regulators are much stricter than the FDA,

and it's very time‐consuming dealing with them.

They're, you know, German.

Thank you for the geography lesson, Paul.

I'm aware Germany isn't the United States.

Perhaps we should focus on shoring up the U. S.

before we start making foreign moves.

And we'll work on it for months or years,

and it won't go anywhere.

They'll never go for this.

Well, that's what Uncle Mortimer said

when I told him we should create a narcotic

for moderate long‐term pain.

Thank you.

♪ ♪

Danke schoen.

If you can get these country doctors

to individualize the dose,

you get the positive side effect

of individualizing your bonus.

All right.

Purdue also just conducted

an osteoarthritis study‐‐

pass those out for me‐‐ and it says

that if a patient is on 60 milligrams a day or less,

they can stop cold turkey without withdrawals.

Now, you make sure you show that to your doctors.

This drug is just amazing.

All right, now, for a little bit of fun news,

management knows how hard you all have been working.

And, you know, we wanna do a little something

to say thank you, so I am pleased to announce

that Purdue is starting a sales competition

called the Toppers Contest.

The sales rep with the highest grosses

from each region

is gonna get an all‐expense‐paid trip

to Bermuda.

All right, so everybody get out there,

you keep selling,

and someone in this room is gonna end up

with one hell of a tan.

Don't be offended when I tell you,

I would jam a knife into your carotid artery

to win that trip.

Okay. Well, how about this?

We double our dose and we partner up.

So if I win, you're my plus‐one.

And if you win, you take me.

Or I'll go with you if you win.

And if I win, I'll go with someone else.

How about that?

Yeah, I mean, that's not really what I was going for.

Oh, Billy, I think you're a riot,

but I only fuck really hot guys and really rich guys.

And you are neither hot nor rich,

but you are fun.

Sort of sweet when you're not being a fucking douche,

so let's just be friends, okay?

'Cause this one‐sided sexual tension

is getting tired.

I mean, can we be friends who fuck on the trip to Bermuda

if I win the contest?

Well, I'll consider it.

Maybe it's time for an upgrade from that piece of shit.

I just gotta individualize the dose.

This is beautiful, Doc.

Yeah, it's one of my favorite spots.

You know, Drea Price keeps asking me

if you're gonna come to Orlando.

She does?

Yeah.

She sure liked ya.

Huh.

Why don't you come down, take her on a‐‐

take her on a date or something?

A date?

I wouldn't remember what you do on a date.

I don't know what I'd even talk about.

Well, you just talk about, you know‐‐

well, I don't know, actually.

I'm not a expert in these matters, but‐‐

Do you have a girlfriend, or what?

No. No. No?

Well, there's this sales rep, actually, who's hot as hell.

Loves to torture me.

She like you?

Definitely not, no.

But she flirts with me just enough

to keep me going, you know?

Yeah.

Here's an idea.

Maybe you could find a girl who actually likes you.

That sounds awful.

Mmm, boy. Look at this. Mmm.

Doc. Yeah?

I was gonna run something by you.

Would you ever start your patients on a higher dose?

If their pain was especially strong,

would you start 'em at 20 milligrams

instead of, say, 10?

Nah.

If I had 'em on 10 and if I had to,

I'd just bump 'em up.

Right. Why?

No, no reason.

I was just, uh, curious, you know?

How are your patients doing on Oxy?

Good, good.

I'm trying to, uh, you know, taper one off.

She has no pain. Her pain's gone.

You don't need to taper her.

Actually, a new study that I just read said that

if they're taking anything less than 60 milligrams a day,

they can stop without withdrawals.

I'll send it to you.

Nah.

I'd rather have her taper, just to be safe.

Hey, Grace.

I don't think I'm gonna make it tonight.

What the hell are you talking about?

I'm already at the Rattlesnake.

No, I know. I know. I just‐‐

I‐I'm not feeling too great.

Are you sure there's not somethin' going on?

'Cause you're acting really strange.

No. No, Grace.

Nothing's going on. I just‐‐

I'm not feeling great, all right?

Okay. Well, let me know if you need anything.

No. I don't.

All right, fine. Bye. Bye.

♪ ♪

Shit!

Shit! Fuck!

I'd been living with pain for so long,

but then almost overnight, I got my life back.

As shown in Exhibit 1A

of the "I Got My Life Back" promotional video,

Purdue manipulated basic facts of the drug,

claiming it is essentially nonaddictive

when it clearly was.

And these participants involved

were deceived into participating,

being told it was a PSA for pain relief

instead of an advertisement for OxyContin,

and many of them are now addicted or dead from drug use.

So we request access to all internal marketing materials,

research, and testing data

to determine if there are other deceptions

as flagrant as the exhibit currently for the court.

Your Honor, statements made by counsel

in no way even resemble the facts.

My client is aware

there have been addiction issues

in this part of the world,

but blaming Purdue Pharma for this

is like blaming Budweiser for a drunk driver.

It is the fault of the drug abuser

and not of the manufacturer.

The scope of the subpoena is overly broad,

and the information contained in their request is privileged.

Your Honor, if there is no liability, then‐‐

What these local lawyers don't seem to understand

is that there is a national pain movement

that is far bigger than my client and its drugs.

Renowned pain organizations

have not only endorsed my client's medication,

but the general use of increased opioid treatment.

My client should be given a Nobel Prize,

not a subpoena for materials.

I actually tend to agree.

Not on the Nobel Prize part.

The scope of the request is too wide

as it currently stands.

You need to bring me something more compelling

than a single video for such a broad request.

That video should have been enough.

Hey, we'll find more.

We knew it wasn't gonna be easy.

Hey, good luck in surgery tomorrow.

And I know it's gonna go great.

Thanks. I'll be back in a week.

Hey, you take as much time as you need.

All I need's a week.

♪ ♪

Hey, sweetie.

You did good.

The doctor told me it went really well.

Oh, good. Good.

Hey there. How you feeling?

Oh, a little‐‐ uh, not too good.

Are you in a lot of pain?

Yeah. Yeah. I'm feeling some pain.

How would you describe your pain?

Scale of one to ten?

♪ ♪

Mm, about a thousand. Got it.

We are gonna go ahead

and give you 20 milligrams OxyContin.

It will significantly reduce your level of pain.

Do you have anything besides OxyContin?

Why 20? Why not 10?

It's standard to individualize the dose

for the patient's needs.

I don't want Oxy.

We don't have anything as effective.

It is completely safe.

Just‐‐just give me some Tylenol.

I'm gonna go ahead

and have you guys look at this pamphlet

on painkillers.

They're very safe now.

♪ ♪

Hi, Randy. Surgery went well.

Your margins look clean, but I'll know for sure

once the, uh, pathology comes back.

Right.

How are you feeling?

Patient's refusing OxyContin.

He only wants Tylenol.

It won't be strong enough.

Pain's the new fifth vital sign.

It's the top priority of this hospital.

We manage it.

Do you have a strong non‐opioid?

We could go with 1,200 milligrams of Motrin.

It'll knock the edge off, but it doesn't last 12 hours.

Well, neither does OxyContin.

That'll be fine. He'll do Motrin.

♪ ♪

Jermaine.

Break‐in at a rural pharmacy, officer shot.

Guy took only four bottles of OxyContin and nothing else.

I saw a pain clinic in Kentucky

that looked like a junkie drive‐through.

What were you doing in Kentucky?

It's where I get my hair done.

The fuck, Bridget?

You could get in serious shit for this.

Hey, I'm just making observations

and bringing it to the appropriate authorities.

Look, I get it, okay? I get it.

But what's the next move?

You tell me.

Well, if this were cocaine, you'd try to prevent

the smugglers from bringing the drugs into the country

and target local dealers to bust larger syndicates.

Correct? Correct.

I don't need a sting operation to find the drugs

because I know exactly where they are.

Where? They're in every pharmacy in the country.

So I can't call in the Coast Guard

to protect our borders

because the drugs are already here.

So who do I bring a major case against?

Some dickhead with a truck?

A shithole pain clinic in Kentucky?

I don't know, okay? I don't know.

But something is happening here.

A single prescription drug

is filling up jails in rural areas.

Find me a cartel

and I'll call in the Coast Guard,

but right now, this is a local crime issue.

♪ ♪

Uh, Mr. Wayton?

Bridget Meyer, DEA. We spoke on the phone.

Yeah. Hey.

What's going on?

We're gonna put in a higher counter,

tougher to jump over.

Third break‐in this year,

and all they ever take's the Oxy.

You ever think about not carrying the pills?

Tried, but they told me I'd get sued if I did that.

Who told you that?

That woman from Purdue.

What did the Purdue rep say?

She acted like she was helping me out, you know?

Like she was my good friend offering advice.

She said if I refused to dispense her drug,

that doctors and patients could sue me,

and the lawsuits could put me out of business.

Either way, I'm screwed.

Do you have her name?

♪ ♪

♪ ♪

Fuck. No, no, no.

You've got to get your patients off Vicodin.

I've got one multiple studies from different pain foundations

that show Vicodin is terrible for their liver.

Mm‐hmm.

What‐‐I don't have any change.

Bridget Meyer, DEA. Please exit the car.

I have to call you back.

I'm so sorry about the change thing.

I get hit up in my car a lot.

I'd like to ask you some questions

about break‐ins at pharmacies in the area.

Well, I didn't do it.

I would never risk scratching my new Manolos.

You're not a suspect, ma'am.

Several of the pharmacists complained they were told

they had to carry OxyContin when they didn't want to.

Who told them that? They said you did.

They said you threatened them with lawsuits.

Oh, what?

Oh, you're fucking kidding me.

Um, no. No. I tried to help them.

I told them doctors and patients could sue them.

I never said anything about my company.

Well, they took it as a threat from you.

They felt they were being bullied

into carrying a drug they didn't wanna carry.

Well, I'm not surprised they were confused.

They're pretty stupid down here.

That's what happens when you fuck your sister.

Were you instructed to threaten these pharmacies

by your employers?

No.

And I have to go.

I just have a few more questions.

Do I have to answer them by law?

No, you do not.

Then you have

a great day, ma'am.

♪ ♪

♪ ♪

Good to see you. Thank you for having us.

Oh, of course. Nice to see you.

Glad you could come.

Check out Richard.

I didn't know he knew how to smile.

It's a smile of relief he didn't sink the company.

I don't know if I'm happier we have a potential blockbuster

or annoyed he actually pulled it off.

Hmm, I heard everyone at the office hates him.

Mm.

Can't stand him.

You know, he didn't even know what oxycodone was

until I told him,

and now he micromanages everyone

like he's God's gift to medicine.

He's gonna make a toast.

Theresa and I would like to toast

the opening of the Sackler Institute at Cornell

as we make our family

the most philanthropic in America.

Thank you, Mortimer.

I'd also like to toast our host, my son, Richard,

for his tireless work on our latest product, OxyContin.

It's only been out a few months,

and it's already a major breakthrough

in pain management.

So to Richard.

To Richard.

Hi. How are you?

♪ ♪

Your numbers are good,

but they can be even better.

Just keep pushing your doctors to individualize the dose,

and I will keep checking in.

Thank you.

Good Unch.

Good boy. Good boy.

Dad hates it when you bring him into the office.

Then, uh, don't tell him.

Is Unch short for something?

What's going on?

Uh, so...

Uh, Germany isn't gonna work. Why not?

We have to prove OC has minimal abuse liability,

and we‐we can't make that claim.

That's‐that's just negative thinking.

Can't we run another long‐term trial

to get more data?

I wasn't aware there were any long‐term trials.

Dr. Richard,

even if we could get OxyContin designated uncontrolled,

it's highly likely it will be abused in Germany

under that classification

and then be reclassified as controlled.

God damn it, I'm sick

of all these fucking noes!

I want a yes.

Germany isn't like the U. S.

We can't maneuver around their laws.

You're wasting a lot of time on something

that will get revoked.

It's also cultural.

The Germans don't believe in opioids.

They believe suffering is part of healing.

Um, hey, Paul, will give us a minute?

♪ ♪

Richie.

It's going great.

It really is.

The drug has turned a corner.

We're on an upswing.

You and Beth should take a trip.

Relax.

You haven't had a break in years.

Go spend some time with David and girls.

There's no time for a break.

There is no break.

There will never be a break.

Look, I‐I know I can be hard on people,

but can you think of any greater venture

to help humanity

than curing pain?

We need to get this drug into Germany.

Please, John, just...

don't give up so fast.

Okay.

Okay. We'll‐we'll keep trying.

Thank you.

We got lucky with the weather, buddy.

No doubt.

It's just nice to get out and get away from things.

Oh, amen. I could just sit here

and stare at the river, to be honest.

Pretty crazy world, these days there.

Oh, Lord. Lord. Oh, it's a mess.

You know, you read about or heard about

any of these programs

if you think someone's a homosexual,

they‐‐they're gonna pray away the gay?

You ever hear of them?

Oh, yeah. I've heard of that.

Yeah. Why?

I got a friend up in Greensboro.

He's thinking of sending his kid to one.

What, you saying they don't work or something?

It's snake oil business.

I mean, prayer is good,

but it's not gonna do any more or less for that

than it would for anything else.

Well, not to be a Bible thumper, Doc,

but if you had a kid like that

and you believed in the good word,

you'd wanna do something to try to help 'em, wouldn't you?

Yeah, except most all the research says

that's just, you know, how people are born.

It's who they are.

Research, huh. Yeah. Yeah.

I don't know. Maybe.

My cousin's got a kid who's, uh,

maybe that way.

Just, uh, goes against about everything he believes in.

Why don't you tell your cousin

just to‐‐ just think for a minute

about how hard it is on that kid.

♪ ♪

I don't know if he can let it go, Doc.

Sure he can.

He can just remind himself that his love for his kid

is bigger than anything else in the world.

He sure does love that kid.

Sure does.

♪ ♪

You feeling all right?

Yeah, I'm fine.

Just tired.

Well, you don't have a fever.

Jer, dinner's up.

Mm‐hmm.

Bless us, oh Lord, for these are gifts,

which are boundless, oh Lord. Amen.

So did you catch anything?

Well, a couple of trout. Not worth, uh, keeping, though.

And Finnix? Oh, no.

He wasn't really interested in fishing.

He seemed, uh, more interested

in talking about his friend's gay kid.

And why would he do that?

I don't know. Have to ask him, I guess.

Sure made a big deal about it, though.

Said how research shows people are born that way,

so on, so forth.

That's the, uh, city boy still in him.

He's been here for 40 years.

Well, I guess he ain't a true believer, then, is he?

The worst thing that, uh, a parent could hear is that...

Our kid is, um,

queer or gay or lesbian

or whatever they say now.

It'd kill me if you were, Bets.

It'd absolutely kill me.

Well...

I guess you're dead, then.

You got something to say to me,

or you want old Doc Finnix to say it for you?

I just said it.

Didn't you hear me?

And what about you?

You hear me this time?!

You don't raise your voice

to your mom in my house, you hear me?

You don't have to worry about that,

'cause I'll leave, Dad.

You won't ever have to look at your queer kid ever again.

Well...

I think that's best.

No! Fine.

I'll leave this weekend.

You do that. No, Jer. No.

You don't have to go anywhere.

No, I do.

I'm not wanted here.

No. She doesn't have to leave!

I don't care.

I don't care.

I don't care. I really don't.

Jerry, I don't care.

♪ ♪

♪ ♪

Oh, shit. Oh, shit.

♪ ♪

Did you check the methane monitor?

Betsy, did you check the methane monitor?

Yeah.

Yeah, it's all clear. It's all clear.

♪ ♪

Help!

Did you read the methane monitor?

Of course I did.

How's Eddie?

Go ahead.

They, uh, think he's gonna lose his right arm.

What was the number?

On the readout, before the explosion?

Um...

Was it above a four? No.

When the levels are that high, the machine just shuts down.

And we both know

it sometimes gets disabled,

which is why you're there to check it.

Was dust obscuring the readout?

Just‐‐just tell the truth.

Uh...

there might have been.

♪ ♪

Do you realize that men might be dead 'cause of you?

That it's possible this mine will close?

Do you know how much damage you have done?

I don't understand.

What? What don't you understand?

I don't‐‐

I don't understand what's happening to me.

♪ Who's the man with the master plan?

♪ I'm thinking of a master plan ♪

Gracias. Hey, I want some of that.

Yeah?

Oh, it's really good.

Mmm!

You wanna jump in?

Yeah, I can do that. Hold on. Hold on.

Sorry.

This is fucking great.

Um, it's work. Is that okay? Yeah, go ahead.

No problem. Okay.

Hello?

Hi. Agent Meyer?

This is Mike Wayton from Wayton's Pharmacy.

I don't know if you're still investigating

the guy that broke in here, but they got him.

Oh. Where did they catch him?

In his bathtub.

He was dead from an overdose.

His little girl in the next room.

I tried not to sell that stuff, but those people‐‐

Um... Bridget!

I'm‐‐I'm so sorry. Uh, I‐I gotta go.

Thank you, um...

and I promise you, it is not your fault.

I appreciate that.

♪ ♪

You want some more? No, I'm okay.

♪ ♪

♪ ♪

You, uh, want to stop here, take a look?

Yeah, right here.

♪ ♪

How many kids in your school are on OxyContin?

Maybe half.

♪ ♪

Bridget.

Down here. Oh.

Are you okay? Yeah, I'm fine.

Uh, I know we've only been dating for nine months,

but I have never been with someone

that I respected

and admired and cared for

and loved as much as I love you.

You're my hero,

and I would be so honored

if you would be my‐‐my wife.

Oh, my God.

Yes? Yes!

Yes! I'm sorry. I'm so sorry.

Don't apologize. Here. Wait. Oh, my God!

You think you got it? Wait, I got it. Oh, my God!

Oh, my gosh!

Okay.

You asked to speak to me, sir?

Stay out of Diversion's domain.

You made a presentation, and we listened.

But in no way did this give you the right

to start an independent investigation.

I understand, sir.

And I immediately gave everything I uncovered

to Diversion, but I believe we must pursue.

Why?

Agent Spellman told me

that the reason we can't pursue an OxyContin case

is that there is no cartel to go after.

The drug is here legally

and opioids are now widely accepted

in the medical community.

But I believe I found the cartel.

Oh, you have? Yes, sir.

I even have their address.

201 Tresser Boulevard, Stamford, Connecticut.

That's the main headquarters of Purdue Pharma.

They are the makers of OxyContin,

and they are the cartel, sir.

They are lying to doctors and patients

about the dangers of the drug, and they are forcing pharmacies

to carry it with threats of lawsuits if they don't.

And the FDA is an unwitting coconspirator

because they issued Purdue a warning label

that gives them cover to say that the drug is less addictive

than other opioids when it's clearly not.

Could the FDA be colluding with Purdue?

It's possible.

The individual who approved this highly unusual wording

on the warning label now works for Purdue.

Really? Yes, sir.

Curtis Wright. We need to act now.

We have to go after Purdue Pharma now, sir.

Right now.

How attached are you to your service pistol?

Why do you ask?

Diversion agents aren't allowed to carry firearms.

Are you transferring me?

No.

No, I'm promoting you.

I'd like you to be deputy director

of the diversion division.

They need someone with balls over there.

I accept.

Congratulations, Bridget.

I believe you're now the highest ranking woman

in the DEA.

Thank you.

Oh, hey, Doc.

This is Rick Mountcastle, U. S. Attorney's office.

See, uh, we wanna ask you a few questions

about a case that we're working on.

Sure.

So Randy described a scenario in which his nurse

was quite forceful about him taking OxyContin.

Is that standard?

What do you mean?

I mean, is there some sort of hospital policy

to push OxyContin?

The hospital can now get sued if the patient felt

that we didn't manage their pain properly.

Or they can write us a bad review online,

which would cause the staff to be rebuked by management.

Nurses have been fired over online reviews.

Is that just this hospital?

No. All across the country.

Internet has really changed things.

Online reviews have caused a shift

in national opioid prescribing?

♪ ♪

How are you feeling?

I'm a little better.

I appreciate it, Doc. Thank you.

All right. Well, I'll check back in.

The older nurses hate it.

All the opioids.

I wanted to show you this.

Pain societies have infiltrated the hospital rooms,

and they love their pamphlets.

I never heard that phrase before today,

and now it's everywhere I look.

Thank you all for coming.

I'm Roger Thurby from the Appalachian Pain Foundation.

We're here tonight to discuss opioids in our community.

We know they've been getting a lot of attention lately

and there's been some folks struggling with addiction,

so we decided to gather experts on the situation

and discuss it publicly.

First, I'd like to turn the microphone over

to Ms. Barbara Mullins, who's on the editorial board

of the "Journal of Pain."

Thank y'all for having me here tonight.

Opioid abuse is certainly growing,

but it's important to distinguish between abusers

and legitimate pain patients who need these medicines.

So is this a consensus?

Pills aren't the issue, it's the addicts abusing them?

Absolutely, but I also think it's important

the pharmaceutical industry does a better job

working with law enforcement

to keep these products out of the hands of abusers.

They have some responsibility here too.

Uh, my sciatica was so bad

I couldn't even get up in the morning.

And right when I finally get back to normal,

I'm terrified my drugs are gonna be pulled

'cause of these junkies.

Absolutely not, ma'am.

We are doing everything in our power

to make sure you get your medication.

Yes, sir, in the back. Hi.

Um, I've been hearing from some folks

the real problem is, OxyContin is

much more addictive than its maker claims.

Is there any truth to that? No, it's a misconception.

Vicodin is actually being abused

at a much higher rate of its total sales.

That's right. Much higher.

And actually, Vicodin is potentially bad for your liver.

I personally wouldn't use it.

I wouldn't either.

It has addictive qualities,

whereas less than 1% of people become addicted to OxyContin.

Hey. How you feeling? I'm good. I'm good.

How y'all doing? Good. We missed ya.

Hey, the guys are in the conference room.

Get in here and talk to these maniacs.

Pain Society has been pushing them for years,

and once pain became accepted as the fifth vital sign, yeah,

J‐Co went from anti‐opioid to pro‐opioid.

Hey, Gregg! Hey.

Conversation sounded like a barrel of laughs.

Mind if I grab a sarsaparilla and join y'all?

Brother, when you said one week,

you really meant it.

Randy, how are you feeling?

I think I just might be in the clear.

Everything's negative.

That's wonderful news.

So what have we got on these pain foundations?

Totally legit, right?

Just a bunch of straight shooters.

Yeah. Humanitarians of the year.

Uh, started with the Appalachian Pain Foundation.

Pulled their tax returns, and you were spot‐on, Rick.

In 2000, they got a $20,000 grant from Purdue Pharma

to literally start their organization.

What tipped you off?

When they were pushing OxyContin

and trashing Vicodin.

Subtle.

Did you find Purdue connections

with other pain societies?

Gentlemen, it is time to buckle up.

The American Pain Society claims

to be an independent medical group

representing physician pain specialists,

but it receives a sizable portion of its funding

from the drug industry,

including significant grants from Purdue Pharma,

who are one of the biggest beneficiaries

of the society's successful effort

to make pain the fifth vital sign.

Purdue also spent heavily

to subsidize the American Academy of Pain Medicine

and, in 1997,

spent $500,000 to underwrite the work of a joint committee

formed by these two groups, which issued a report

urging the broader use of powerful narcotics.

Now, Purdue also contributed generously

to patient advocacy groups,

like the National Foundation for the Treatment of Pain

and the American Chronic Pain Association,

but in effect, they helped fund

an entire network of pain groups

that represented themselves as independent,

but all heavily promoted the use of opioids.

Uh, permission to approach the bench, Your Honor?

Now, you might recognize this pain chart,

as, uh, it's in hospital rooms and doctor's offices

all across the country.

It's from the organization Partners Against Pain,

which is ostensibly an educational alliance

dedicated to the treatment of pain,

but, in fact,

it is fully funded and run by Purdue Pharma.

It is 100% Purdue‐owned.

In effect, it's Purdue's shadow company,

which has infiltrated

hospital rooms and doctor's offices

as a stealth tool to prompt pain discussions

between doctors, nurses, and patients

with the goal of prescribing more opioids‐‐

Objection. Conjecture.

Purdue has never hidden its relationship

with Partners Against Pain.

Then why not put Purdue Pharma on these pain charts

instead of a different company name?

Your Honor, th‐‐

Proceed.

Partners Against Pain also has a website

masquerading as a patient advocacy group

to guide pain sufferers to specialists,

but every specialist that it sends you to

is a doctor with a very high rate of prescribing OxyContin.

So pain societies partially or fully funded

by Purdue Pharma and other pharmaceutical companies

are de facto propaganda divisions for big pharma.

The deception is so effective that some sales reps at Purdue

thought they were using independent data

when they were quoting studies from the American Pain Society

with slogans like, "Pain is the fifth vital sign."

And, of course, the solution for pain

is always, always an increased use of opioids.

And it's an increase so high in the last five years

it's at levels not seen

since the run‐up to the Harrison Narcotics Tax Act...

of 1914.

Thank you, Your Honor.

♪ ♪

Permission granted to release requested documents

relating to marketing, research, and distribution.

All right.

Go get 'em, Boss.

I know you all are dying to know the results

of the Toppers Contest.

All right, but before I name the winner,

I just have to say

what an incredible quarter you had.

"Individualize the Dose" got a huge number of doctors

to start at 20 milligrams, and some at even 40!

You guys fucking rock!

All right, but there can only be one winner.

And this quarter, it is...

Todd Brunward.

Fuck yeah! Come on!

All right. All right.

Todd, Todd sold

$767,000 worth of OxyContin,

one of the highest in the nation.

Todd, come up here.

Tell everybody how you did it.

Um, well, you know, it was all hustle

and determination.

Yeah, I went to every doctor on my IMS sheet

and, uh, told them what we got here.

He's such a liar. He didn't hustle shit.

What do you mean? He has a whale.

One doctor running a pill mill.

What's a pill mill?

It's a doctor who overprescribes like crazy.

It's a total gold mine if you can land one.

Todd works a few hours a month,

then plays video games and smokes pot all day.

It is so unfair that he wins with a pill mill.

Yeah.

Shouldn't he report a doctor for something like that?

He'd probably get fired if he reported him.

So Purdue want whales?

Oh, sure.

You don't wanna shut a whale down.

You wanna reel it in.

♪ ♪

Sam. Hey.

Oh!

Oh, I can't tell you how happy I am to see you.

It's been way too long. Way too long.

Yeah, you look wonderful.

Oh, come on. What'd you do?

I sometimes think about you all holed up in that house

and it just breaks my heart.

It's not what Shelly would want.

Well, it's her fault.

She's the one that dragged me down to the mountains.

Yeah, but she knew you'd follow her.

Yeah, she did.

Do you ever regret it? Regret what?

Spending all those years in Appalachia?

Top of your class at Duke, a fellowship at Johns Hopkins.

It's pretty heady stuff.

Yeah. That's pretty good. Yeah.

No.

I like it down there.

Yeah, I mean, it's not exactly the life I had planned,

but it's been good.

It's good.

Until your sister left.

I miss her too.

But you got a lot of years still.

Uh, yeah.

That's kinda...

kinda why I wanted to come up here

and visit with you, Barbara.

Uh...

You know, this whole idea

of, uh, dating again,

I mean, it's really, you know, odd just saying dating.

But...

I don't know.

First of all, it makes me feel...

guilty.

Like I'm doing wrong by Shelly, you know?

What, did you meet someone?

I don't know.

Maybe.

Aww.

Sam, if you spend the rest of your life

locked away in that house,

you will be doing a great disservice

to that spitfire you married.

♪ ♪

But is it really okay?

You're using your pain as an excuse not to live.

But it's time to start living again.

♪ ♪

Hello? Hey.

Well, be still my heart.

Is this my knight in shining armor?

Oh, well, yeah, I guess.

Please tell me I'm gonna see you in Orlando

in a few weeks.

Yeah, well, uh,

actually, that's why I'm calling.

I, you know, wanted to know if, uh, you still wanted me to.

Well, of course, I do. Well, good. Good.

Yes, and you're gonna make another speech,

and you're gonna get paid for it this time.

Bring your swim trunks.

Oh, all right.

Well, I don't know if‐‐ not sure I got any,

but I'll, uh‐‐I'll swing by and pick some up.

Hey, can you‐‐ I'm gonna call you‐‐

call you a little later.

I gotta take this call here.

Yes. All right. See you Wednesday.

All right. Looking forward to it.

Hello?

Dr. Finnix, where are you?

I'm in D.C. I'm visiting Shelly's sister.

Well, you gotta come back.

There was an explosion at the mine.

How‐‐how bad?

Everyone's alive,

but a bunch are at the hospital.

Betsy Mallum is in bad shape.

Okay. All right. I'm on my way.

♪ ♪

Morning. Morning.

Big truck for just a couple boxes.

♪ ♪

They're drowning us in paperwork.

This isn't half of it.

Oh, Lord.

It's gonna take us over a year

just to catalog all this.

And they'll keep selling pills the entire time.

♪ ♪

So we've been talking to the German regulators,

and we just keep hitting a brick wall.

Why did you have to pick

the hardest country in the world

to get a drug uncontrolled?

Follow me.

I'm, uh, sorry to bother you, but would you mind giving me

a few minutes alone with my brother?

The reason why I want to get relaxed status in Germany

is precisely because

they do have the strictest regulations in Europe.

If we get Germany uncontrolled,

even if the status is eventually revoked,

it will serve as a gateway to the rest of Europe,

which will then open us up to the majority of global markets.

No one in the history of this family

will ever come close

to accomplishing what we're gonna do.

We're going to cure the world of its pain.

So unfortunately, the x‐rays show

you've got four broken ribs.

Yeah. I saw it there.

Thank you very much, Doc.

Uh, Dr. Finnix, please don't rush.

This is a real injury. I know.

I know, yeah.

I'm just in a little bit of a hurry here.

On a scale of one to ten, how would you rate your pain?

What is that?

I don't have my, uh‐‐ my readers.

It's a pain assessment chart.

Oh, I've never seen one of those.

I don't know.

Five, six. Call it a five. I don't know.

All right.

I'm gonna start you at 20 milligrams of OxyContin.

20?

I usually start my patients at, uh, 10.

Well, I like to individualize the dose.

♪ ♪