All language subtitles for HBO.The.Crime.of.the.Century.1of2.1080p.WEB.x264.AC3.MVGroup.org

Morning, morning.

Oh, so they're working on him?

They worked on him.

- Oh, really?
- Yeah.

Which unit is it? Upstairs?

- It's up on the top corner.
- On top here?

January 13, 2021.

We'll get started at 0540 hours.

Victim's information:

Date of birth: 9,'97.

Long history of drug use.

The mother called
in at 0306 hours

for medical assistance

for her son, the victim.

She found him in his bedroom.

She said he was
cold to the touch.

Officers and medics
arrived on scene.

The lower half of the body...
The legs... were cold,

but the upper body
was still warm,

so officers and the medics
started performing CPR

for approximately 15 minutes.

See if it works.

It's worked like money

the last several
times I've done it.

In the victim's bedroom,

we found a spoon
with a brown residue

inside of a shoebox

as well as a needle
and several baggies.

So that's positive
off the spoon.

Fentanyl.

Yeah.

Ultimately was
pronounced deceased

0336 hours.

Well, it's gonna be

a beautiful, sunny day today.

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

Narrator: For
thousands of years,

a demand for opioid
has attracted commerce

and crime.

The narcotic comes
from the resin

that oozes from the
bulb of the poppy.

From the reign of King Tut,

the Egyptians were the first
to cultivate vast fields

of the drug,

which they sold throughout
the Mediterranean.

Alexander the Great
expanded the market

by introducing opium to India,

where today it is still
cultivated by hand.

It's known for soothing pain,

but carries the looming
danger of desperate addiction.

During the Inquisition,
Catholic clerics called it

the stuff of the devil,

but its lure and
commercial value

were hard to resist.

By the 16th century,

the resin was rolled
into black pills

called "Stones of Immortality"

and marketed as a pain
killer called laudanum.

During the Industrial
Revolution,

infants were narcotized
with laudanum

by mothers without childcare
who needed to leave home

to work the factories
and the mines.

The smoking of opium expanded
the global market into China,

where millions became addicted.

By the 19th century, the
British East India Company

built vast opium factories,

where the stuff was
rolled into cannonballs

and then shipped off
to Chinese merchants

called the hong.

American dealers
like John Jacob Astor

and FDR's grandfather,
Warren Delano,

cashed in by manufacturing
the stuff in Turkey.

By 1839,

opium was the world's
most traded commodity.

Concerned by addiction
and overdoses,

the Chinese emperor
appointed a drug czar,

who dumped thousands
of cannonballs of opium

into the sea.

In a fury, opium companies
pushed the British government

to start a war with China

to keep the profits flowing.

In time, opium developed
as a prescription drug.

The Merck Company
launched a product

called morphine.

Bayer introduced

a cough suppressant

called heroin.

When addiction rose
to dangerous levels,

the U.S. made heroin illegal,

creating a new
global crime business

dominated by the Italian
mafia and Mexican cartels.

Big pharma turned to
the mass manufacturer

of other opium products
like morphine and oxycodone

and learned how to
mechanize the process.

They created a
demand for narcotics,

addicting millions of
men, women, and children

which, in turn, fueled
the illegal drug trade

from pill mills
to heroin dealers,

to illegal fentanyl factories.

The terrible truth
is that the business

of criminal cartels and
pharmaceutical companies

is connected.

Together, they generate $100
billion of income a year

by cultivating and catering

to a desperate need for opioids.

That business model
has a terrible cost.

Within the last 20 years,

more than 500,000 Americans

have been killed by overdoses.

You know, when I started off

telling the story
of the opium crisis,

I'd never written about

the pharmaceutical
industry before,

but I'd written a lot
about illicit drugs.

I had done some
big stories about

the Sinaloa drug cartel.

I was impressed by the
logistical complexity

and the seriousness with which
they thought about the idea

of innovating product lines.

Like when they first
were really rolling out

methamphetamine in a big way,

they would actually send
free samples to key markets,

and the way they thought
about wholesale distribution,

sort of how far down
the chain they'd go,

bringing the money
back to Mexico,

the way they'd
institutionalized corruption.

So I was looking at cocaine
and methamphetamine,

but increasingly it seemed that

Mexican heroin was making
a comeback in a big way

in the United States.

What creates the market

for this very
dynamic drug cartel,

where they're
thinking all the time

about their different products,
and what should we send,

and, you know, how's pot
doing versus cocaine,

and... no, truly...

And what they realize is, God,
there's all these people now

who want heroin.

It turns out that
that was a population

of hundreds of thousands,
and millions of people

who had been abusing
prescription drugs,

whether they were getting
them from a doctor

or buying them on the street.

And for a variety of reasons,

it was getting harder to obtain,

and they find themselves
buying heroin.

You suddenly had this
huge population of buyers

who'd kind of come
into the market

through the back door.

They'd come in through the world

of illicit pharmaceuticals.

And I started
looking at opioids,

and when you do that,

you pretty quickly stumble
on the Sackler family.

I often say I
approach collecting

as a biologist,

that I want enough data

to be able to draw
valid conclusions.

Art is a passion
pursued with discipline.

Science is a discipline
pursued with passion.

You have to really
pursue the object.

You just don't sit there

and have the
objects come to you.

You want to be a
great collector,

you better think of the fact

that you're gonna
commit yourself

to a real passionate hunt.

Narrator: Arthur
Sackler's passion

as a collector made him famous.

With his brothers,
the Sackler family

chiseled its reputation
for generosity

on the walls of
museums and colleges.

No American family
has profited more

from controlled substances...
From Valium to OxyContin...

Than the Sacklers.

They built a fortune of
more than $14 billion

by becoming some of the world's

most successful drug pushers.

So there are three
Sackler brothers.

They grew up in
Flatbush in Brooklyn.

They had immigrant parents
who'd come from eastern Europe,

and they were kind
of quintessential

hungry sons of immigrants,

early 20th century,
trying to go out there

and make a name for themselves.

All three brothers end up
going to medical school.

And Arthur Sackler, who
was the oldest brother

and kind of the patriarch...

Almost as much a parent
to his younger brothers

as he was an older brother...

Kind of leads the charge,

and he ends up, in the '40s,

at Creedmoor Psychiatric
Hospital in Queens,

which is this vast asylum.

6,000 beds.

And Arthur ends up bringing

his younger brothers
into the fold.

Something he often
did in their lives,

is he brings Raymond
and Mortimer,

his two brothers,
along with him.

And at that time,

there were certain
stubborn medical mysteries

having to do with
mental illness.

There were new innovations,

and one of them was
electroshock therapy.

And the Sackler brothers
end up in a situation

in which they are administering

electroshock therapy
between the three of them

to thousands of
patients at this place.

It struck them as
crude and inhumane,

and the brothers were
kind of repulsed by this.

And so they start trying
to find other solutions

to these mysteries,

and they become convinced
that it's brain chemistry

that is causing things
like schizophrenia,

and that if it's a
chemical problem,

then there's probably
a chemical solution.

So the idea that, you know,

there's no affliction for which

we might not be able
to devise a pill.

So the Sacklers buy

a small pharmaceutical
company in 1952,

a company called
Purdue Frederick.

It was this little concern.

You know, they sold tonics

and kind of
unglamorous products.

Ear wax remover.
That kind of thing.

While his brothers are
running Purdue Frederick,

Arthur Sackler ends
up buying and owning

a medical advertising
company called MacAdams

and in pretty rapid succession,

comes up with a whole series
of revolutionary ideas

that completely
transform the landscape

of how we sell drugs
in this country.

Narrator: Arthur
Sackler was a pioneer

in bringing Madison
Avenue techniques

to the selling of drugs.

But in doing so, he
often crossed the line

from promotion to fraud.

The essential trick
was to hire doctors

and use them as pitchmen
to sell to other doctors.

He even paid a division
head at the FDA

to promote his drugs.

Occasionally, he would
invent expert witnesses.

One of the companies
that he represents

has an ad,

and it just had a
series of business cards

of doctors

from different parts
of the country.

At the time when this ad runs,

there was an
investigative reporter

who decides he wants
to get in touch

with these doctors.

So he writes letters
to all of them.

And the doctors don't exist.

So you see pretty quickly

how this can get
kind of perverted,

and at a certain point,
the idea that the doctor,

who we're raised to think of

as a real kind of
custodian of our health,

can be enlisted in a sham
or just outright invented

in the interest of
selling a product.

I get the impression that
you have a very good time.

- I'm having a ball.

Narrator: In the 1960s,
Sackler became incredibly rich

by expanding the market for
addictive tranquilizers,

convincing doctors and patients

that they needed
Librium and Valium

for everyday anxiety.

When widespread abuse
and addiction followed,

a senate committee investigated.

Sackler's promotional campaign.

Sackler would blame the problem

on reckless patients.

In Arthur's case, he said

when asked about the idea
that people became addicted

to drugs like Valium,

"The drug isn't the problem.

The user is the problem."

Arthur Sackler died

before OxyContin
was ever invented,

but Arthur Sackler
created the world

in which Purdue and
the Sackler family

would be very successful.

Their first really big hit

is a pain drug called MS Contin.

MS Contin is morphine,

but they developed a system

that they called contin,
which is short for continuous.

It's essentially a
seal around a pill

so that if you take that pill,

the active chemical in it

will enter your bloodstream
slowly, continuously

over a long period of time.

MS Contin was an
innovative drug.

It was used chiefly in
cancer pain-type situations.

And at a certain point,

the company knew that the patent

on MS Contin...

The company's exclusive
right to produce it...

Was going to be expiring soon.

At the point where you
lose that exclusive right,

you have generic
versions of that drug

and you're just gonna see
your profits nosedive.

So they start thinking,

"Well, what are we gonna
find to replace this?"

They start talking
about oxycodone.

Oxycodone is a very
powerful opioid,

much more powerful
than morphine.

It's also quite addictive,
but they had this notion.

"You know, what if we took

"the contin system
that we created

"for morphine

and used it with oxycodone?"

So rather than it
being a huge dose

that will just
overwhelm your system,

it slowly goes into
your bloodstream

over the course of 12 hours.

Narrator: Controlled-release
oxycodone, or OxyContin,

would be the drug that triggered

what we call the opioid crisis.

But what if we discovered
that the crisis

started with a crime?

Through a set of
secret documents

and never-before-released
depositions,

we found powerful evidence

that Purdue may have hidden
the dangers of OxyContin

in favor of the
profits that would come

from touting its benefits.

Would you state
your name, please?

Richard Sackler.

Everybody who worked
at Purdue Pharma,

I think, was pretty heavily
invested in OxyContin,

but no one more so
than Raymond's son,

Richard Sackler, who
was also a doctor.

That's correct. Yep.

He wants to do things

that are a little
more ambitious.

He's got big visions.

He was working around the clock.

He was incredibly demanding.

He would be micromanaging staff.

If you sent him an email
at, you know, midnight,

he would write you
back right away.

Very fixated on the
success of this drug.

Narrator: Sackler launched
OxyContin with one

of the largest pharmaceutical
marketing campaigns

in history, but oddly,

he kept his own role hidden

and never gave
interviews about the drug

until he was forced to
testify in this deposition

when the state of Kentucky sued

and ultimately
settled with Purdue

for its history of
deceptive marketing.

We had a product

that had tremendous potential.

For 100 years, and even today,

there is no drug

that is more effective

or safer than opioids

for treating pain
over a long term.

But whether it's
effective or not

also depends on other
factors such as abuse.

I mean, you can kill somebody
and take away their pain,

but that certainly wouldn't
be effective, would it?

I don't think that death

would be considered a sign

of efficacy.

- Correct.
- Yes, I mean,

in the extreme,

yes, what you say is correct.

So just because
it takes away pain

doesn't mean it's a
good drug, does it?

No.

Andrew: When we talk about
opioid pain medicines,

you're converting
the natural molecules

that exist in opium

into this stronger version

that gets into the brain faster,

that has a more
rewarding effect.

That's basically
the same process

for making heroin.

So when we talk about drugs
like hydrocodone and oxycodone,

you're talking about drugs
that are semisynthetic,

just like heroin

and that produce effects
that are indistinguishable

from heroin.

These are essentially
heroin pills,

which doesn't mean that doctors
should never prescribe them.

These are good medicines
for easing pain

at the end of life,

for a couple of days
after major surgery

or a serious accident.

But unfortunately, Purdue Pharma

and other opioid makers

started to promote their opioids

for common chronic
pain conditions

where opioids are
much more likely

to harm patients than help them.

narrator: In 1994, Purdue
started its FDA application

for the approval of OxyContin.

Not only did Purdue minimize

the addictive
nature of the drug,

its executives launched a plan,

with the approval of
the Sackler family,

to market the drug to the
widest possible audience.

The risks of OxyContin
might have been acceptable

for some people,

like patients painfully
dying from cancer,

but not for teenagers
with knee pain.

So in its application
to the FDA,

Purdue promoted the
safety of OxyContin.

Had Purdue submitted
an application to FDA

seeking approval of OxyContin

for treating pain at the
end of life from cancer,

the burden would have
been easier for Purdue,

but they never would've
really been interested in that

because you can't really
get a blockbuster drug

if the drug is gonna be promoted

for pain at the end of life.

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

and they're not gonna be on
the product for very long.

You've got to get
that drug prescribed

for common conditions.

But to get FDA
approval to do that,

you need the evidence

that the drug is both
safe and effective

for these common conditions.

Narrator: But Purdue
didn't have any evidence

that the drug was safe,

so the company obtained the help

of a medical officer at FDA.

His name was Curtis Wright.

Working closely with Purdue,

Wright allowed the
company to claim

that OxyContin was
not very addictive

or prone to abuse.

Purdue executives camped
out for three days

in a rented room
near Wright's office

and worked with him to draft

the official FDA
review of OxyContin

in a way that Wright promised
would be promptly approved.

Okay, so this is a document

that was leaked to us

that showed a pretty unusual
amount of interaction

between Purdue officials and
Curtis Wright at the FDA.

Wow, uh...

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

This isn't just unethical.

I-I think this could be illegal,

that they allowed
Purdue to do this.

And if it's illegal,
it would look as though

both Purdue and Curtis Wright
may have broken the law.

There's no way that
this should be allowed,

that a drug company
would be involved

in drafting the review
of its application.

And this is a document

from the medical officer review

of Curtis Wright.

This is part of the approval.

- Part of the FDA approval.
- Right.

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

or, you know, allow you all
to sell it, from the FDA.

That's my recollection.

Y'all ultimately hired
him a few years later,

didn't you?

Um...

We did hire him

but not after his tenure

at the FDA.

Um,

we discussed it and agreed

that we should not hire
somebody who had ju...

Who had reviewed our
product and then left.

And so he went to
another company.

He went there for a
short period of time

and then came to
work for you all.

- I don't remember.
- It was certainly...

It was certainly...

I... my recollection
is a couple of years,

two or three years, but
I don't recall exactly.

The record, I'm certain,
could be produced.

All right, well,
let's take a look

narrator: The record shows
that Wright joined Purdue

just over a year
after leaving the FDA.

In his first year at Purdue,

Wright's compensation was
greater than $370,000.

It was a tidy sum for the
man who had allowed Purdue

to use the OxyContin
package insert

as a marketing tool.

Suggesting that
low-dose patients

wouldn't get addicted,

the insert also claimed,
without any evidence,

that the product was
believed to reduce

abuse liability.

If you're Richard Sackler,

if you're Purdue,

that is a tremendously
helpful thing

to have in the
package insert, right?

Because it means that your army

of hundreds and
hundreds of sales reps

can go out and meet
with doctors and say,

"Look, Doc, it's right
here in the package insert.

The FDA approved this,"

with this crucial line

about how the delayed absorption

is believed to reduce
the abuse liability.

Like, believed by Purdue Pharma,

you know, on a hopeful,
"wishful thinking" kind of day.

It's a phrase that gives
rise to the opioid epidemic.

This was a momentous,

historic mistake by the agency.

- Rescue 45.

In the area.

114.

- This event right here.
- 1-11.

209 Northwest .

What motivated me
to become a EMT,

my freshman year when
I was in high school,

I had two classmates that
had overdosed on opioids

as I was in the English class

learning on grammar
and punctuation.

I was sitting in
the front room...

The classroom...
And heard two thumps

of two classmates falling
out of their desks.

Started foaming at the mouth.

961 Wise. We'll be in the area.

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

I have ran a overdose call

where I had four
overdoses at once.

Me and my coworker walked
into the household,

where we had two 16-year-olds.

One of them was a brother.
The other one was a cousin.

And the parents.

They, all four,
had both overdosed

on oxycodone.

I work

sometimes 100 hours-plus a week

for two jobs, and
the stuff I do see,

it does have a bad mix

with my family life.

There has been times
to where I have

went to a room by myself and

just sit there and
talk to myself,

and basically broke down crying.

I ask myself sometimes

if I want to continue
doing this job.

It's made a hard impact.

They had a terrible
problem down in Lee County,

which was not in my territory,

but it was next door to it.

All that area, that
was the first area

where the abuse exploded,

down around Norton
and Richlands.

It exploded right there
first, from what I could see,

and then moved into Bluefield,

and Princeton, and Beckley,

and then on down to
Bristol and Wytheville.

And it spread like cancer.

Was it always West
Virginia for you?

Well, my first eight
years was in Ohio,

up around in Medina,

right around Cleveland,
in a log cabin.

Dad worked at a Chevrolet plant

where they made transmissions.

But he had a mid-life
crisis, I guess, in his 40s,

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

where he and my mom were raised.

And it was about the same time.

"Take Me Home, Country
Roads" came out too.

And so maybe that had
something to do with it.

Moved to a place called
Sundial, West Virginia.

Down in the coal fields.

I had four brothers
and one sister.

Dad worked in the mines

till he blew out his
lungs from black lung

and from asthma

from being in belt fires.

Dad wanted me to go to
college. I wanted to go.

I first asked him if I could

go into the mines
like him, you know.

"That paid good money.
How about that, Dad?"

He said, "No, Mark."

He says, "You're so clumsy,

you'll get killed
the first shift."

So I went to college
at Concord University,

down in the southern part of
the state of West Virginia

at Athens

and got a degree to teach

biology and chemistry
in high school.

But the first job that
I got out of college

was a pharmaceutical
job with Mead Johnson

about 1988.

I didn't know much about sales,

and I'm not even...
I wasn't even sure

that I would really stick
with it or liked it,

but I came to be
hired on with Purdue

when I was called
by Mark Radcliffe,

who was my district manager.

He's pretty infamous right now.

He's been in a federal prison.

He called me and said,
"If you work hard,

you'll make tremendous
amounts of money."

Uncapped bonus.

That's what caught my
ear, was uncapped bonus.

There was no cap
on it. No ceiling.

And I thought, "Well,
that's the kind of money

I'd like to make."

I started in April of '98,

signing on to sell
OxyContin primarily.

OxyContin was what they stressed

they wanted sales out of.

It was supposed to me
that it was a veritable

treasure chest of
untapped sales out there

because there were
so many people

that were undertreated for pain,

or they weren't
being treated at all

because physicians
were afraid to use

stronger pain
medications for them,

and they were suffering.

And I could see the mission
being described to me,

and then I signed onto it.

It sounded like a very
honorable thing to do.

Helping patients that
were suffering from pain,

get their relief, and
give 'em their life back.

Today, we essentially
consider pain

in any form to be dangerous,

that the experience of pain

leaves a kind of psychic scar.

The origin of this concept
really comes from Freud,

that when we have traumatic
childhood experiences,

those can influence
the development

of adult psychopathology,

and that that can often happen
on an unconscious level.

You can not be aware

that certain neurotic tendencies

that you have as an adult

have their origins
in some kind of

early traumatic experience.

And that, in and of itself,

was a very modern and new idea.

150 years ago, doctors believed

that pain was
actually good for you,

that when patients
experience pain

during a surgical
procedure, for example,

that that would boost the
cardiovascular response,

that would boost
the immune response,

that it helped with
the healing process,

that there was a
spiritual component.

You know, this whole idea that

what doesn't kill you
makes you stronger.

That was very much ingrained
in medical training

and in the medical
system to the point

that in the mid-1800s,
when anesthesia

was first invented,

some of the most prominent
surgeons in this country

didn't want to adopt
it because they wanted

their patients to feel
pain during procedures

in order to expedite
the healing process.

Like, we don't think that
way about pain anymore.

You know, now we think,
"Oh, my goodness, pain!

Like, I've got to get
rid of it immediately."

But what makes the
opioid crisis unique

is that the pills themselves

are so inherently addictive

that if you then add that

to all of the
business incentives

to overprescribe,

you do end up with this
kind of perfect storm

that leads to the crisis
that we have today.

You know, guys,

you know, as far as the Purdue

Frederick Sales Organization

is concerned,

it's a high-energy sales

organization.

It's one of the best
sales organizations

in the pharmaceutical industry,

and they're hard-driven.

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

it's a song that's gotta smoke.

Okay.

Purdue,
are you ready to rock?

Whoo!

I think they're really
ready to rock right now.

I said, are you ready
to rock right now?

Put your hands together
if you're ready now.

Narrator: In the late '90s,

Purdue celebrated
its marketing muscle.

There were 600 sales reps
pitching healthcare providers

all over the country.

Using parties and junkets

to lure doctors
to write scripts,

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

At the turn of the century,

OxyContin sales exceeded
$1 billion a year,

passing Viagra as America's
most profitable drug.

I was very gladdened

to see that
OxyContin was meeting

with such a strong,
positive reception,

by both physicians and patients.

Ladies, and gentlemen...

The doctors that we targeted,

they called me Moneybags
and Easy Money,

I guess, because in their mind,

once you got them on
OxyContin or a opioid

and they got hooked,

you were going to get
reoccurring prescriptions.

And the monthly bonus checks.

My first year with Purdue,

I believe I made
in the neighborhood

of about 170.170,000.

My final year, it
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.
- Nice to see you as well.

Yeah, they called me Easy Money,

but there wasn't
nothing easy about it

because we had such
a wall to break away.

At least early on, doctors
were afraid of the opiates,

and they didn't believe
in using high doses.

They didn't believe in
using it in non-cancer pain,

so we had to overcome all that.

In this program, these
and other patients,

all of whom have
suffered through years

of varying degrees
of chronic pain,

tell the story of their
long, often frustrating,

always painful search
for adequate treatment.

They had a video called
"I Got My Life Back"

I played many a-times
in physicians' offices,

sort of humanize the idea
of treating pain patients.

Since I've been on this
new pain medication...

I'm more of a partner
to my husband again.

- Now I can go to a movie.
- I'm still alive.

When they mentioned the dosages

that they were on...

I'm currently at
1,200 milligrams

of OxyContin.

You know, some physicians,

their mouth would drop
open and, you know,

we would explain to them that

there was no maximum
on the dosage,

that you could go
with a pure opioid

that had no secondary
product in it

like Tylenol, or
ibuprofen, or aspirin.

This medication does not
turn you into a zombie.

The opioids have given
my life back to me.

The gold nugget was

non-cancer, chronic pain.

OxyContin, it's the
one to start with

and the one to stay with.

What is pain?

Pain is suffering.
Pain is soreness.

Throbbing. Aching.

Pain is whatever the person
experiencing the pain

says it is.

Amazing!

Purdue was so generous.

They had video tapes.

They had manuals.
They had posters.

They disseminated that

to all the hospitals
in the country

who had to educate
their doctors.

It meant that I, a psychiatrist,

had to go an all-day-long
course on pain.

I didn't have to go to
an all-day-long course

on, you know,
cardiology or radiology.

The fact is that
pain should be treated

as aggressively as the
underlying condition

that causes the pain.

I was taught that
pain should be treated

like the fifth vital sign.

When you take blood pressure,

when you take respiratory rate,

when you take heart
rate, temperature,

you should show them

this scale from one to ten.

One is like tiny,
little bit of pain,

and ten is the worst
pain you could imagine.

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 "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 1%

of patients taking opioids

actually become addicted.

"And if you don't use them,

"you are a bad doctor.

You want people to suffer."

- 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 'em

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 had a lot of experience
with Lynn Webster

over the years.

He's unfortunately been one
of the leading educators

across the country

on opioid prescribing,

taking lots of money
from drug companies...

Hundreds of thousands...

Probably more than any
other key opinion leader.

- Thank you.
- Helping them market

or serving on advisory boards.

He's spoken at hundreds

of medical events.

The problem is not hydrocodone.

The problem's hydrocodone abuse.

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

I don't know.

My space in lecturing was

what I viewed was more academic.

But you...

You were sometimes paid
by pharmaceutical firms.

- Not... no, no. Not to speak.
- Oh.

Now, pharmaceutical companies
may hire an educational company

to put together a program.

I would be contracted then
with an educational company

to put on the program,

so it wouldn't be directly.

It's indirectly, I suppose,

but they had no, no
influence on the content.

Zero. I would never do that.

Thank you very much.
Hello, everyone.

Most of my speaking

was about the risk of opioids.

Opioids can be used safer

than they have been
used in the past

because it is,
frankly, your health.

You know, I think that the
definition of addiction,

um, has to be
defined.

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

like an opioid,

in order to develop the
disease of addiction,

but it's not sufficient,

meaning most people
exposed to an opioid

will never develop
an addiction to it,

regardless of how
long they're on it.

A whole generation of doctors

bought into this idea

that it's okay to
use opioids liberally

as long as you're giving them

to a patient in pain,

that somehow there's
a magic halo effect

with that prescription pad,

and your patient
won't get addicted.

And if they look like
they're getting addicted,

they're not really addicted.

They're pseudoaddicted.
Now, what's pseudoaddiction?

Pseudoaddiction is

when a patient is looking
like a drug addict

because they're
pursuing pain relief.

"Pseudoaddiction"
was a made-up word...

It only came out about
1990, but it's crucial.

In a single case report.

The doctors who wrote
that case report said,

"Aha, we discovered
that this individual

"who looks like
someone who's addicted

"isn't really addicted.

They are 'pseudoaddicted.'"

Relief-seeking behavior

mistaken as drug addiction.

"They're really in pain,

and you just need to
go up on the dose."

- Hold on for just a moment.
- Let me bring in David Haddox.

One of the authors of
that study was Haddox,

who went on to work
for Purdue Pharma.

Good morning.

And was a lead
spokesperson for them

around more opioid prescribing.

No one's talked
about the patients.

There was never any science

behind the concept
of pseudoaddiction.

This message about
pseudoaddiction

was probably the single
most dangerous message

in this whole campaign

because it's
exactly the opposite

of what a prescriber should do.

A lot of us were,
at that time...

Still today... wonder sometimes

if addiction is
really a behavior.

How do we differentiate
a behavior

that is really somebody
experiencing unrelenting pain,

or they want the drug for
the psychological effect?

You know, I've been
criticized because I said

the treatment of... differen...
I mean, one treat...

One option in
trying to understand

if it's in pseudoaddiction,

the treatment should
be, give more drug.

The idea of pseudoaddiction,

that was talked about in
training a fair amount.

And the way you need to
explain it to a physician

is... was false addiction.

They do look like
they're becoming addicted

or drug-seeking,

and that's a sign you
need to increase the dose.

It made sense when your...

Your eyes are glossed over

with a mission to
treat untreated pain.

It filled right in a gap
of any of your knowledge,

and the story seemed
to build on itself.

And, "Yeah, that makes
sense. Pseudoaddiction."

Well, looking back
on it, you know,

that's pretty
hypocritical and crazy.

You don't think that there was

a great enthusiasm
for higher doses

without being concerned
about the possible downside?

Oh, yes. Absolutely.

I think that there was
a lot of enthusiasm.

I owned it because I thought...

I thought I could
just give enough,

and my patients would
have a normal life.

I know, and all
anesthesiologists know,

you can give enough opioid
to take away the pain.

The problem is,
will they be awake,

or alive?

I served a mission
for my church,

a Church of Jesus Christ
of Latter-day Saints.

After returning
from that mission,

I was a pediatric psychiatrist

at the local hospital,

and Carol was
graduating as a nurse

from Weber State University,

and that's where we met.

With our first child,

the due date had passed,

and she said, "We've got
to get this on the road."

"Go get Dad's boat."

We're going to Pineview Dam.

We get up there.

She skis a lap,
beaches on the sand,

and says, "Okay, I'm
ready to have the baby."

She wasn't afraid of anything.

This never should've 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 a plate and screws.

There was pain associated.

It was being managed very well

by our primary care physician,

but then a neighbor came
to visit Carol one day,

who was suffering from
lower back issues,

and he recommended
that Carol go see.

Lifetree Pain Clinic.

Dr. Lynn Webster,
he ran the clinic.

Why did you name your
clinic "Lifetree"?

Well, I had to
name it something.

I wanted people to feel like

there was some
stability to my clinic.

That's the roots
basically of a tree.

I was hoping it to be

really a strength
for my patients.

Webster prescribed oxycodone.

She was on fentanyl.

She was on amitriptyline.

She was on a hypnotic for sleep.

Her mannerisms, her behavior,

everything changed after she
started going to Lifetree

in a negative way.

She would take the medication,

and then she would get confused.

She would get loopy.

And then, you know, a half
hour, 45 minutes later,

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

She'd take it again.

Numerous times, I
found her unconscious

in the strangest of places.

And then, when she'd
come out of it,

she would have no
knowledge of it.

And so I started taking pictures

of when I would find her.

And the only reason
I took the pictures

is so that I could show her

because she did not believe me.

We'd end up in the
emergency room.

And my son, John,

got all of the pills that
Lifetree had prescribed,

and we took them out there.

And I remember the physician

saying,

"You got to be kidding me.

You got to be kidding me.
You got to be kidding me."

And he was able to convince her

to go in the program.

She was able to get off

of all of the pills,

all of the patches.

She was in great
shape. She was happy.

She was smiling.
She was involved.

And she was on Tylenol.

And the next thing
that I know is that

she informed me that

Dr. Webster wanted to
meet with she and I

to discuss her condition.

So we went down, and
I'll never forget.

He made a statement, and
I'm still baffled by it.

He said, "A chronic
pain sufferer

"cannot be an addict.

"I am her physician.

"I will prescribe
the medications

"that I think she needs,

"and she will be under my care.

And that will be the end of it."

I would often say
to my patients,

when I was giving them
higher doses of opioids,

I'd say,

"Take this medicine
just as I say.

Or you may not wake
up in the morning."

Almost inevitably, these
patients would stop,

and look me in the
eye, and say, "Doc",

"that's okay.

I can't live with
the pain I have."

He gets her back on
all these medications,

and immediately she
was dissociative.

She was lethargic all the time.

But Dr. Webster refused

to listen to the family.

My children, I tried.

We would call up and say,

"We need to get a
message to Dr. Webster

that he... that Carol
is not in a good way."

There was always some
tension between the family

and my patient,

and my effort to
try to find a way

to help her with her pain

within a reasonable framework

of what her family would accept

was a challenge.

He didn't spend really
any time with her

on a monthly basis.

He had PAs that were
doling out medicine.

Webster wasn't
minding the store.

He was traveling
around the country,

and he was promoting
the use of opioids.

It was money.

It was ego.

Whenever we're looking
at providing a treatment,

we're always looking
at the potential risk

versus the potential harm,

and opioids can provide

more potential benefit
than the potential harm.

Narrator: 10,000 miles
from its headquarters

in Connecticut,

Purdue Pharma
sought the solution

to a pressing
production problem.

The company was so successful

that it was running
out of opium.

To find enough supply
for the soaring demand,

Purdue turned to
a company famous

for its promise of
"no more tears."

In just this one moment,

your baby is getting
even more than clean.

The scent, the lather.

Even the tiny bubbles
of a Johnson's bath

are helping to enhance
the experience.

Johnson & Johnson,

They have this brand

that makes people
think of baby shampoo,

and talcum powder, and
wholesome products.

But they are also the
kingpin in the opioid crisis.

Johnson & Johnson wasn't just

selling its own opioids
and promoting them

for conditions where
we shouldn't use them,

promoting long-term use,

high-dose use.

Johnson & Johnson was
also supplying Purdue

and all of the other
opioid manufacturers

in the United States
with the opium

that was making it
possible for the U.S.

to be flooded with opioids.

The traditional way to extract

opium is you lance
the poppy head.

Then someone goes
through the field,

scraping off the opium sap.

And it's very labor-intensive.

But in Tasmania, what
Johnson & Johnson did

was to really
industrialize the process,

creating a product called
concentrate of poppy straw.

They would basically
cut the whole plant

at a certain point
where it's richest

in the alkaloids,

and then process the straw
to get the opium out.

Narrator: Johnson & Johnson
also genetically altered

the nature of the plant

to create a super poppy,

that was surging with thebaine,

a narcotic in oxycodone.

To persuade Tasmanian farmers

to switch from
potatoes to poppies,

J&J offered luxury vacations

and awarded prizes...
Mercedes and BMWs...

To farmers

who could produce
the most potent crop.

Soon, 74,000 acres of
Tasmania were devoted

to opium.

J&J lobbied the U.S. government

for unlimited access
to American markets

and promoted its
product in a brochure

called "Finding Relief."

In the United States, Purdue
used the opioids from Tasmania

to flood the country
with OxyContin.

But the pills weren't
just for pain.

They were being
diverted from doctors

to people looking
for a heroin high.

From the mid-'90s,

the company's sales reps
weren't willing or able

to recognize the abuse that
was happening all around them.

Looking back and
reflecting on it,

what Purdue also did
to their benefit...

And I sincerely think it
was probably a strategy...

Was when they hired people,

they hired representatives
from other companies

that didn't sell opioids.

They didn't like to have people,

from what I've seen,
come in to their company

that was preexposed
to the problems

with abuse diversion
and things like that.

You see what I'm saying?

The number one thing we were
taught about addiction was,

in the package insert, it says,

"Delayed absorption of OxyContin

is believed to reduce
the abuse potential."

That sentence was pounded in.

I pounded it in doctors' heads.

"Delayed absorption of OxyContin

is believed to reduce
the abuse potential."

Over and over and over
and over and over.

"Delayed absorption of OxyContin

is believed to reduce
the abuse potential."

And I would always
let them know it,

you know, "Nothing gets
in these package inserts"

"that hasn't been reviewed,

you know, excruciatingly
by the FDA."

From the inception of

the launch of OxyContin,

we focused our
salesmen's attention

to physicians whose practice...

And their practice was to use...

Write a lot of
prescriptions for opioids.

We didn't go to people
who didn't write them.

We went to people who did.

Dr. Frank Sutherland
was a osteopath

down in Grundy, Virginia.

Grundy, Virginia is a little
old Podunk town, coal town

that's down in a bowl
coming from Richlands.

It's just straight down,

swerve-y and curvy,
and you get down there,

and there's a lot of
hardworking people down there,

but there's a lot
of people that, um,

are, um

druggies, I guess
you should say.

I went in to see Frank,
and pretty quickly,

he jumped on the bandwagon,

writing OxyContin
very regularly,

probably seeing
80 patients a day.

I also noticed in
his waiting room

more and more I went, that
he had patients in there

that looked like they were
rough around the edges.

And I would hear conversations,
pick up a tidbit about,

you know, "You need
to ask for this many."

And they was talking
about OxyContin.

I didn't sell opioids before.

I didn't abuse them,

so I didn't know
you could crush it

and snort it.

But obviously, if
you do crush it,

you get away from
the time release,

therefore there's trouble.
You could get the whole dose.

I brought that to
Frank's attention.

He says, "I know who they
are. I know who they are."

You know, I said, "Okay."

"You know, as long as
you know who they are.

"You know, I don't want you
to prescribe... give OxyContin

to somebody you know
that's abusing."

But then I had a doctor that
I actually seen one time.

I went in, and he
was wiping his nose

and doing this trick,
coming up from his desk.

He was cutting up OxyContin

and snorting them
right off his own desk.

As it went on,

you kept hearing more
and more stories.

You had, say, the
nurse in the office

explain to you that her grandson

pulled one out of
the drug cabinet

and snorted it and overdosed.

You know, "What?
Are you kidding me?"

You know, and I start
hearing more and more stories

from nurses that I
knew for 15 years.

And by the time it got to

the end of '99,

I was pretty
convinced that we had

a major problem on our hands.

That's when I started trying
to pass the information

up to the top.

The emails that I sent up
were right to the point.

You know, "There's gonna
be a death train coming."

"We've got to do
something about this.

This is just chaos out
here. I can't believe it."

I thought that they would
at least have the decency

to listen to one
of their best reps

with some concerns,

but they did not even want
to entertain the discussion.

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

"Go in there and sell.
You're a salesman."

You know, I was sort of like
a canary in a coal mine,

but nobody was running,

nobody was leaving.

I was at work one day,

sitting around the newsroom,

and an editor came over to me.

He said, "I've gotten a tip,"

from a source of his that
was on a pharmacy board,

who told him there was
this new drug, OxyContin.

It had become the hottest
drug on the street,

and the number of
overdoses were rising.

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

We started calling around,

speaking to pharmacists,
speaking to doctors,

trying to get an understanding,

because prior to this,
I had never really done

any reporting about
the drug industry.

So all the things
that I was learning

were relatively new to me.

They were also kind of strange
and appalling at the same time.

One of the real
turning points for me

came when I found there
was a study that was done

in the late 1990s,

which showed that

drug addicts were seeking out

long-acting opioids

because they were pure

and because they had
much higher volumes

of the active narcotic

than the shorter-acting drugs.

This seems to
disprove the theory

that long-acting opioids
are less prone to abuse,

but there was no question
that OxyContin was

being promoted as,
like, a safer, better,

more effective, less abusable
form of pain treatment.

- It says here under...
- On page 30,

"OxyContin's wide availability

"may have increased
opportunities

for illicit use."

Did you ever do any studies

on abuse liability for OxyContin

before you all put
it on the market?

I'm not aware of any.

And I wondered whether
Purdue knew about that study,

whether they had
distributed that study,

whether they told the
FDA about that study.

I asked them all
those questions,

which they refused to answer.

Purdue, when we started
speaking to them,

were adamant that
neither the drug

nor their manner of
promoting the drug

had anything to do
with the overdoses.

I became somewhat obsessed

with learning about
what Purdue knew

and when they knew it.

Narrator: Beginning with
a series of articles

for "The New York Times,"

Barry Meier began to
investigate possible crimes

committed by Purdue
and the Sackler family.

That led to a book
called "Pain Killer,"

which was the first
detailed account

of the opioid crisis

and how it had spread
from Maine to Mexico.

It focused on Appalachia

and the westernmost
sliver of Virginia

that points like a knife

between the heartlands of
Kentucky and Tennessee.

In the town of St. Charles,

Barry Meier discovered
a citizens' crusade

to protect local communities

against the assault of OxyContin

led by a doctor

named Art Van Zee.

If you're in a small town,

and you have a
hospital practice,

and you're involved
in a lot of things

in internal medicine
for 44 years,

you do get to do a lot of things

that are meaningful to you

and rewarding.

How many babies do you suspect

you delivered in that time?

Oh, I don't deliver babies.

So I've seen a lot of
young people grow up,

and I've been involved
with multiple generations

of some families, you know,
in terms of their care,

but, yeah... But we
don't deliver babies.

It was 1999, 2000

when OxyContin really
came like a tsunami

into the coal fields.

9% of the seventh graders

had tried OxyContin
at least once

and 25% of the 11th graders.

It's morphine.

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

You're kind of numb.

You're free, and
you're like, "Ah,"

but you're itching.

I was going in after
midnight sometimes

to take care of young
people overdosed

on OxyContin, on respirators.

I was really, in many
ways, unprepared for this.

Where were these
pills coming from?

They're everywhere.

Early on in the reporting,

when we were
tracking down doctors

and tracking down pharmacists,

I spoke to Art by phone,

and we began to chat

quite a bit.

He was increasingly freaked out

by how Purdue was
marketing the drug.

And he would supply me with

materials that he
had sent to Purdue.

Letters and some emails

about what we were seeing.

"Dear Dr. Haddox,
I'm writing you

"as medical director at
Purdue Pharmaceuticals

"to give you
further information.

"Over the last two years,

"we've seen numerous
young people abusing

"and becoming
addicted to OxyContin.

"Frequent overdoses, infections,

"abscesses, Hepatitis C

"related to
intravenous drug abuse.

"About 70% of serious
crimes in the county

"are now drug related.

"Some counties in Maine are
experiencing similar problems.

"These problems
are enormous ones

"for poor rural
areas such as ours

"with minimal resources

"for dealing with hard-core
narcotic addiction.

"I would look forward to
having a dialogue with you

"further about this.

Sincerely, Art Van Zee."

They indicated they
were concerned about it.

Narrator: When Purdue
wrote back to Dr. Van Zee,

the correspondence included
two former FDA officials

who now work for Purdue.

One of them was the man

who had pushed through
the approval of OxyContin,

Curtis Wright.

While the tone was conciliatory,

the message was clear:

Purdue wasn't gonna
fix the problem.

So Van Zee dug in
for a longer battle.

I became more involved,
but, I mean, it was

the whole community that
was becoming more involved.

We had a community-wide
meeting at the high school

to address and speak to

the OxyContin problem.

There was something on
the order of 800 people

that... it was an
overflow crowd.

I mean, you couldn't
get 800 people

in that high school
auditorium for any other thing

except maybe the high school
football state championship

or something like that.

Not too long after
that, we got a call

from Dr. Haddox.

He wanted to know if
he could meet with me.

We've been very actively
educating physicians

and other healthcare
practitioners

on appropriate
selection criteria

to get the right drug
to the right patients.

We met in Duffield, Virginia

at a motel there.

They offered us $100,000

to try to deal with...
To deal with the problem.

And we just felt, you
know, at the time,

that it just kind
of been a setup.

We thought it was more
of a publicity deal

than a real attempt to

deal with the problems.

We started on a petition

to ask the FDA to
recall OxyContin,

that it was causing
an unordinary amount

of harm and suffering,

and that it should be recalled.

Purdue Pharma reportedly
spent $26 million

last year educating doctors as
to the wonders of OxyContin,

but Art Van Zee believes
the drug was overpromoted

and is now being overprescribed.

They've very heavily marketed

to the extent that no other

narcotic has ever been marketed.

Narrator: Dr. Van Zee decided

to take the matter to Congress.

Surely U.S. senators
would be concerned

about a drug epidemic

that was costing tens
of thousands of lives

all over the country.

I was pretty much terrified

about speaking publicly

and speaking before the Senate.

A lot of the Purdue
people were there.

Senator Clinton was there.

And Chris Dodd was there.

Narrator: Chris Dodd was the
senator from Connecticut,

where Purdue Pharma
had its headquarters.

A proud booster of the company,

Dodd asked Dr. Van
Zee why he thought.

Purdue should be
held to account.

I said something
to the effect of,

"In general, the experience is

"is if you got a abusable drug

"that's highly available,

it's gonna be highly abused."

And he kind of mused about,

"Is that a little
Appalachian saying?"

Or something like that.

Narrator: Dodd defended
Purdue by suggesting

that the real problem was
drug addicts in rural areas.

"Instead of blaming the company,

why not blame the addicts
for killing themselves?"

It was a grim talking point,

and it mirrored
Purdue's perspective

that OxyContin was not
responsible for addiction,

made in a meeting with Dodd

before the hearing.

Van Zee was unprepared
for the firestorm

of Purdue's corporate campaign.

I thought this is like that
huge wildfire at Yellowstone,

where we're sitting on one side

of the fire line
with squirt guns

and a lot of press
gathered around,

and then, on the back end,

they're dropping the napalm.

Narrator: Soon
after the hearing,

Purdue rewarded Dodd

with a campaign contribution
that was 10 times larger

than what Purdue gave
to any other politician.

Art Van Zee returned
to western Virginia,

and the rest of the country
went about its business,

but the opioid crisis
did not go away.

It got worse.

By the end of 2002,

non-medical opioid use
in the U.S. increased

by 2.5 million Americans.

Addictions rates soared,

and so did overdoses.

As these stories
start filtering out

from across the country,

there was a bit of
a bunker mentality,

I think, at the company,

a siege mentality,

a sense that they needed to
protect this product of theirs,

which was bringing them
billions of dollars

at that time.

Richard Sackler, he's angry,

and you can feel the
anger in these emails.

He says, quote,

"We have to hammer
on the abusers

"in every way possible.

"They are the culprits
and the problem.

They are reckless criminals."

Yeah, yeah.

Well, the first
response I had to that:

There's only one reckless
criminal in this situation,

and it's Purdue Pharma.

They had no morals.

They had no ethics about 'em.

In Richard Sackler's mind,
and this is a framework

that you then see
throughout the company,

and over the decades,
even today...

They argue that, "Drug abusers
would be abusing drugs"

"no matter what."

You know, if it
wasn't OxyContin,

"it would be something else.

"And legitimate pain patients
who take the drug as prescribed

don't get addicted."

You know, this idea being that

you're dealing with
two separate species,

well, that's not
how it really is.

You know, patients who misuse

and get addicted to opioids

are legitimate pain patients.

Far from apologizing,

Purdue Pharma is fighting back,

saying its only intent
is to get relief

to the 50 million
Americans in pain.

But with the growing
number of doctors saying

they're afraid to
prescribe OxyContin

and at least two major
supermarket chains

refusing to carry it
for fear of robbery,

Purdue Pharma found itself
in need of a PR miracle,

so it went out and hired one.

Well, we've been
working with Purdue

for about four months now.

Seen here in a
company-provided news release,

former New York City
Mayor Rudy Giuliani,

has agreed to lend his
considerable credibility

to the drug maker's battle

to save its bestseller.

They hire Rudy Giuliani.

This is right after he leaves
government in New York.

He's America's mayor

and becomes kind
of a hatchet man

for Purdue.

This should be
available to people

so that they can
have not just a life,

but a quality of life.

It's astonishing.

The real fervor with
which they pursued

and advanced this idea that,

"We're out here fighting for
the legitimate pain patients.

"For access.

"Access to the thing
that I am selling

and making billions of dollars."

Purdue ends up getting
pursued by the authorities.

There's a federal
prosecutor in Virginia

who goes after them.

The investigation was conducted

by a very small office.

The United States
Attorney's Office

for the Western
District of Virginia,

in Abingdon, Virginia,

which is a beautiful,
little historic town

in the foothills of
the Appalachians.

Well, good afternoon, and
thank you all for being here.

We had a problem.
We had death rates.

We had reports from
medical examiners.

We had crime rates going up

in certain parts
of our community.

We had an explosion

of OxyContin availability

in our community.

And so, all of those things

led us to believe that

we needed to take a look

at this issue.

Narrator: In 2001,
John Brownlee was

the U.S. attorney
in western Virginia.

With a small team
of investigators,

Brownlee began to look into
claims of OxyContin abuse

in Appalachia

and if Purdue and
the Sackler family

knew what was happening.

They spent years gathering
documents from Purdue,

bringing people
before grand juries,

really doing a very
extensive investigation.

It just kept going
and going and going.

Once you had these
millions of records,

these investigators and lawyers

pieced together a case.

And then, when you
put it all together,

it equals a crime.

We at Purdue are very distressed

that OxyContin,

which as you've heard is
providing so much relief

to so many people,

is being abused as well,

and we deeply regret
the tragic consequences

the have resulted from the
misuse of this medicine.

Narrator: Just as Brownlee was
beginning his investigation,

Purdue's chief medical
officer was testifying

before Congress.

He was responding to an outcry

over an article in
"The Boston Globe"

about widespread
OxyContin abuse in Maine.

Everybody was taken by
surprise, what happened.

We launched OxyContin in 1996,

and for the first four
years on the market,

we did not hear of any
particular problem.

In February of 2000,

was the first time
we became aware

that something
different was going on.

In February of 2000,

we got a copy of a letter

that then-U.S. Attorney
Jay McCloskey of Maine

sent to physicians in Maine,

warning them of
problems of OxyContin

that were occurring in
certain communities.

And since that time,

I am proud of our response.

As an executive of this company,

I am very proud to be
working for this company.

Nobody has taken the
kind of initiative

for a problem that is not
just an OxyContin problem.

This is a problem of drug abuse.

This is a problem of
prescription drug abuse,

and OxyContin is now clearly,

squarely in the midst
of that problem.

We've been advocates of
proper pain management.

That testimony by Goldenheim,

his sense of shock
and effrontery

you know, at the idea that
it was only in early 2000

when the company discovered

that the product
was being abused

and they immediately
sprung into action

and took it seriously,

and then to contrast that
with his own emails...

Years of his own emails...

In which it becomes clear

that that's all lies.

He knew. The company knew.

They knew that OxyContin
was being abused.

They discussed it.
They looked into it.

They saw it as a problem.

Literally there's a moment
where Goldenheim says

he wants to remove any
discussions about addiction

from email

because it's too sensitive.

It's clear Goldenheim
lied under oath

in testimony to Congress.

Narrator: It was also clear
to federal prosecutors.

They were discovering,
through witnesses

and the company's own emails,

that starting in 1996,

all the top Purdue
executives and the Sacklers

knew that their
time-release opioids,

MS Contin and OxyContin,

were easily and widely abused.

The company conducted its
own spoon and shoot study,

which revealed that addicts
could crush the pills,

add water,

and then shoot the
drugs with a needle.

In 1998,

key Sackler board members
and Purdue executives

were well-informed
about the street traffic

for their drugs.

30-milligram MS Contin pills
were selling for $40 a pop.

They were known
as purple peelers

because users looking
for a heroin high

would just peel off the
time-release coating.

The same went for OxyContin.

While you were still at Purdue,

do you recall hearing
any information

about OxyContin being
abused in West Virginia?

Sure.

And when was the earliest you
recalled hearing about it?

Maybe a couple years
after its launch.

Would that be 1988?

- '97.
- All right.

And what did you hear?

That it was called
hillbilly heroin

in Appalachia.

What was the source
of that information,

if you recall?

Just gossip throughout
the company.

Narrator: Sales reps
routinely warned Purdue

about abuse of the drug,

but the company
didn't urge caution.

Instead, Purdue encouraged reps

to push higher and
higher doses to doctors.

That alarmed one
Purdue official,

who sent a note about a
new 160-milligram pill

to the company's
chief legal officer.

"They're killing
themselves with the 80s.

Why would we come
out with a 160?"

There are actually
instances of reps

being aware that
there are patients

who are being prescribed just

unheard of, superhuman,

"enough to kill an elephant"
quantities of OxyContin

and apparently being
all right with that.

Narrator: In Naples, Florida,

prosecutors discovered
a plan by Purdue

to use a patient
as a poster child

for high doses of OxyContin.

The man's name was Gary Blinn.

A former heroin addict with
a high tolerance for opioids,

he told me he was
looking for relief

from crippling back pain

when he stumbled on a doctor
named Stephen Montaldi.

So I found Steve Montaldi.

We started with
steroid injections,

and he knew how
severe the case was,

and so he hit me
with the morphine.

I came out of the
office one day,

and there was a very attractive
young lady out there.

Asked if she could talk to me.

I said, "Sure."

She introduced herself.
"I'm Stephanie Cauffman.

"And I'm a
representative of Purdue.

"And we have a drug
called OxyContin.

"And we'd like to offer you a...

"A deal, a trial.

"You know, we pick
up all the costs

if you'd consider
switching to our drugs."

She said, "There's
a special formula.

"You just take as
much as you need.

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

And chances of overdosing
are very slim."

You know, so no money.

They were gonna
pay for everything.

I said, "Sounds like a deal."

Narrator: Stephanie Cauffman
was the Purdue sales rep

for Southwest Florida.

She would also enter into
a sexual relationship

with Blinn's doctor, Montaldi.

She knew my history.

She was prepped.

Why did Stephanie
say she was willing

to give you the drugs for free?

Because it was a trial
from Purdue... excuse me.

You know, it was a...

They were testing it.

They started me with

maybe eight or ten, twice a day.

160. It's the highest dose.

And that wasn't working,

so they just kept on raising it.

12, two times a day. Then 15.

It wasn't doing it,
so we went up to 20.

And I said, "This
still isn't doing it."

So he made the phone call.

He told me it was to
the doctors at Purdue.

And they said, you
know, "Give him more."

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

Twice a day.

50 pills a day.

It would almost
take me 15 minutes

just to eat them all.

You know, it was like sitting
down to a bowl of Cheerios.

You know?

I was starting to
feel a little toxic,

like my body was telling me that

we're not doing well.

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

You know what I'm
saying? I mean...

When you're in that
much pain and...

And you're addicted to
that... Such a high dose,

no matter what it is,

I mean,

you're a trapped rat.

Narrator: Blinn was
taking the equivalent

of 200 hits of heroin a day.

He kept the prescription
bottle for 20 years

because he thought
something was not right.

I knew I was being used.

My doses were...

Were for being a guinea
pig or an example.

I think their plan
didn't start off like,

"Here's what we're
gonna do with this guy."

When they saw that I...

I was, uh,

you know, functioning
taking the higher doses,

I believe they thought
they could just,

you know, "Okay, give
him as many as he wants."

You know, they knew
that was a goal,

to keep on adding more.

Narrator: When
Montaldi left town,

he kept prescribing
high dosages for Blinn

without reviewing his condition.

Cauffman herself would
deliver the drugs to Blinn.

Even though the pills were free,

Cauffman got a bonus
for the high doses.

More important, Purdue
used Blinn's prescription

as a marketing tool to
prove to other doctors

that no dose of
OxyContin was too high.

That seems kind
of over the line,

but for somebody like
Cauffman, you know,

was she punished?

Was she fired? What
happened to her?

She was promoted.

She...

She was promoted. She, um...

She got moved up
to headquarters,

and they gave her a new position

training other sales reps.

Our objective in
communicating with doctors

through trained sales
representatives,

literature, and
educational programs

is to educate them about
the proper use of OxyContin.

Somewhere there in the
middle of my career,

I got a subpoena in the mail

from the federal
prosecuting attorney

from Abingdon, Virginia,

and I needed to be
there at this time

and be ready to testify
in front of a grand jury.

That floored me. That scared me.

It run a chill down my spine.

They wanted information

concerning Dr. Frank Sutherland

and how he was
overprescribing OxyContin.

When I called Howard Udell,

the lead counsel
for Purdue Pharma,

he listened to me,
and he chuckled

when I said I needed
some representation.

He said, "You're on your own."

Said, "That shouldn't
be any problem."

I said, "Are you kidding me?"

"You know, I'm being subpoenaed

"by the federal government

over OxyContin, and you're
not gonna send anybody down?"

"Well, no. No,
you'll be all right."

Click.

Narrator: In addition
to Mark Ross,

Stephanie Cauffman, Gary Blinn,

and scores of doctors,
patients, and sales reps

were called before
Brownlee's grand jury.

That testimony, plus
internal Purdue documents,

became a part of a
120-page prosecution memo.

While it's still a secret
government document,

we managed to obtain a copy.

It makes a powerful case for a
nationwide criminal conspiracy

that included fraud, pill mills,

doctors trading drugs for sex,
false statements to Congress,

and attempts to
target key officials

of the Bush Administration.

It argues that the FDA was used

to falsely and fraudulently
market OxyContin

and that key executives
and the Sacklers

helped conceal the abuse

and addictive
nature of the drug.

In 2006, Brownlee sent the memo

to the Department of Justice

for final review.

100-page or more pros'
memos are fairly rare.

It had an incredible
amount of detail.

I thought that it was
an overwhelming case

of criminal liability

by the company, and
by the individuals.

I'll read you

what my deputy said to us

about this evidence
in this case.

"Perhaps no case
in history rivals

"the burden placed on
public health and safety

"as that articulated
by our line prosecutors

"in western district
of Virginia.

"OxyContin abuse has
significantly impacted

"the lives of
millions of Americans

"in the fraudulent scheme
and conduct articulated

"in this matter

as a direct correlation
to that threat."

So that was front
and center for us

and for the prosecutors.

The charges were wire
fraud, mail fraud,

and misbranding.

There were money
laundering charges as well

and conspiracy, of course,

because this was

a very complex fact pattern

that many people
were involved in,

making sure that this crime

both was committed and
was committed effectively.

Narrator: It looked like
there might finally be justice

for the damage done,

but when Purdue heard that
some of its executives

might go to prison,

the company mounted an
influence campaign...

Yeah, one last question.

All right. One last answer.

Narrator: Led by former U.S.
Attorney's Mary Jo White

and Rudolph Giuliani.

- Thank you very much.
- Mr. Mayor?

Narrator: They
went over the heads

of Brownlee's prosecutors

to Alice Fisher, the head
of the Criminal Division,

and to Fisher's
boss, Paul McNulty.

One of them bowed to
political pressure

and agreed not to put
the executives on trial.

When questioned
about the decision,

neither one would
take responsibility

for trading a guilty plea

in exchange for bearing
the most damning evidence

against Purdue.

Based upon what I had seen,

I was mortified.

There could be no
rhyme or reason

that you would've
squashed the prosecutors

from prosecuting
these executives

to the full extent of the law

and to prosecute the company
to the full extent of the law,

because that's what the
Department of Justice

missionized us to do.

Lots of times, why you
prosecute these cases

is to get out in
the public milieu

exactly what was going on.

Even if we lose,

the public is gonna know
this was a righteous case

that we really
should've prosecuted.

Narrator: The
Department of Justice

manufactured a press release

to make the deal look tough.

The company, as an institution,

pled guilty to a felony

and paid a $600 million fine.

Also, Purdue's chief
executive officer

Michael Friedman,

general counsel Howard Udell,

and former chief medical
officer Paul Goldenheim,

pleaded guilty to a
misdemeanor charge

in misbranding OxyContin

and collectively paid
$34.5 million in penalties.

Narrator: It was the
illusion of justice.

At the courthouse, the
parents of children

who had died of overdoses
showed up to be heard.

Some had a chance
to speak directly

to the Purdue executives

about the children
they had lost.

Said one mother, "You
created this drug.

"You pushed it.
You lied about it.

"You killed my son
and so many others,

and continued to
do so as I speak."

While waiting for the bus

to take them to
the corporate jet,

the Purdue executives
and their lawyers

expressed no remorse

and denied any personal
responsibility.

None of them would
spend a day in prison.

Purdue paid the executives'
fines and legal costs

and gave two of them
bonuses to compensate them

for the pain they had suffered.

Do you believe
Purdue's marketing

was overly aggressive?

No.

Yeah. Do you believe
Purdue's marketing

was appropriate?

I believe so.

When the deal was announced,

Purdue represented it
as a shocking verdict

that was extremely
onerous for them

and hugely damaging
to the reputation

of the executives.

Was that your view
inside the department?

No, I think the general view
inside the department is,

they paid the speeding ticket.

You know, what happens
to the company is,

you know, it's something
we just didn't look into.

Purdue Pharma, up until 2006,

they made about $9 billion

marketing OxyContin.

$9 billion.

They paid somewhere
in the neighborhood

of $600-to
$700-million as a fine.

Why would anyone not
repeat that conduct?

If the worst that could
happen is you have to give,

what I would say, is a
miniscule amount of that...

Of those profits
to the government?

You can keep doing business
the way you've been doing it.

You are basically telling
pharmaceutical companies,

"You have a green
light to do this."

Yes.

After the settlement,

Purdue doesn't pull
the emergency brake.

They don't recall the drug.

Instead, they double
down. They keep selling.

And the Sacklers start wondering

how they can keep
sales increasing.

And there's two answers.

One is, "We want to
sell bigger doses,

and we want people
on them for longer."

To say as explicitly
as the Sacklers said,

in the face of
the opioid crisis,

"How do we keep
this show going?"

You know, it was
breathtakingly cynical.

Do you know how much the
Sackler family has made

off the sale of OxyContin?

I don't know.

But fair to say it's
over a billion dollars?

It would be fair
to say that, yes.

Do you know if it's
over $10 billion?

I don't think so.

Do you know if it's
over $5 billion?

- I don't know.
- All right.

Narrator: The Sackler family
is worth over $10 billion,

in the neighborhood
of the Mellons

and the Rockefellers.

The world's most famous museums,

including the Museum
of Natural History,

the Smithsonian,
and the Tate Modern,

boast collections
bearing the Sackler name.

An article on the family's
real estate holdings

showcase sprawling estates

with vast grounds,
pools, and tennis courts

and a New York City townhouse

likely worth more
than $50 million.

The Sacklers bought the
Caribbean luxury getaway

of Amanyara

and scores of opulent hotels.

They collected a portfolio
of 17 ski resorts,

many in states scarred
by the opioid crisis.

The family moved billions
out of the company

as the money from
OxyContin kept rolling in.

After the 2007 settlement,

Purdue's revenue soared

to a company record
of $3 billion a year,

the best performance in
the company's history.

Following Purdue's example,

other manufacturers
and distributors

rushed into the opioid market.

They flooded towns and
counties in the United States

with 100 billion pills.

The companies knew exactly
where the pills were going

and that many were not for pain.

Addiction rates soared,
and so did overdoses.

160,000 Americans died

in the seven years after
the Purdue settlement.

What'd she take?

Acknowledge me if
you can hear me.

- Waking up?
- Are you coming out of it?

Narrator: For more
than 20 years,

Americans have
watched the human cost

of the opioid crisis

as if it were an
epidemic without a cause.

Open your eyes.

Narrator: But what if
we had seen early on

the evidence that the
crisis was manufactured

by a series of cynical crimes?

- You're all right.
- You're all right.

Narrator: More than
a decade passed

before that evidence
began to surface,

in leaks of the prosecution memo

that had buried when
the government failed

to bring Purdue to trial.

Reading the prosecution memo

was like an incredible
slap in the face.

The tragedy of this episode

really does relate to how
this case was resolved

because by burying
the prosecution memo,

the Justice Department
effectively agreed

to bury critical information

that doctors,

public health officials,

and patients needed to know

about the dangers of opioids.

It was the day
before Thanksgiving.

I got home

around 3:00 to 4:00
in the afternoon,

and I found Carol in the den,

on the floor,

with her head under
one of the chairs

and a telephone right
by the side of her.

Turned her over,

grabbed the phone,

called 911,

and began CPR.

Based on what I know now,

it appears that she passed away

sometime between 10:00
and 11:00 that morning.

We sued Lynn Webster
and Lifetree.

And before it was settled,

there is what's called
a DOPL hearing...

Which a DOPL stands

for Department of
Professional Licensing...

And Lynn Webster
was in that meeting.

And that's when he asserted
that Carol was suicidal.

He tried to put all
of the responsibility

onto Carol Ann.

He couldn't accept
responsibility of his actions.

I did not have any
direct communication,

other than to look
across the table

and basically tell him that

he killed my wife.

Let me tell you something.

I had several patients
die in my practice.

- At Lifetree?
- At Lifetree, yeah.

And I was very cognizant always

that opioids could
contribute to an overdose.

And I was also cognizant that

without treatment of pain,

then they could commit suicide,

so it's...

What are you to do?

I mean, here's the story

of so many people
with severe pain:

Life is not worth living

unless they have
their pain treated.

You, as a clinician,
are always there

trying to decide,

is the lack of treatment

going to cause more harm

than the treatment?

Every one of my patients,

I had to give that
consideration to.

It's not easy

to make the right
choice all of the time.

In her final monthly
prescription,

one week prior to her
death, she was given

6050-milligram tablets
of amitriptyline,

3040-milligram
tablets of Celexa,

22430-milligram
tablets of oxycodone,

11210/325-milligram
tablets of Percocet,

601-milligram tablets of Requip,

601-milligram tablets of Xanax,

and a... oh, sorry

604-milligram
tablets of Zanaflex.

It's a muscle relaxant.

So if you saw that monthly level

of prescription for a patient,

would that be a rather
significant pain dose?

I think for any patient,

except maybe someone who's
near the very end of life,

if I were to learn

that a physician had
prescribed that regimen

to a patient, I would...

I would, I think, contact
the state medical board

and report that prescriber
because they are clearly

putting that patient's
life at risk.

narrator: In 2009, there were

so many overdose deaths tied
to the Lifetree Pain Clinic

that the medical examiner's
office felt compelled

to report them.

The next year,

the DEA launched a
raid on Lifetree.

They came in with
badges, and, I mean,

pretty frightening to my staff.

- And the office was full...
- Guns?

- They didn't have guns drawn.
- No.

But they had guns.
They were obvious.

I mean, I felt...

I was on a wonderful career path

of feeling like at
the end of the game,

I'd feel proud that I had, um...

I was able to be
in this profession

and I could help people.

I still feel that way,

but, um, that event

has forever tarnished me.

Narrator: Webster was also
tarnished by the evidence.

Records from Lifetree
show a pattern

of prescribing unusually
high amounts of opioids

as well as confirmations of
a number of patient deaths.

There were as many as
100 overdose deaths

at your clinic, or they're
suspecting that there were.

Was... would that have
been a large number

relative to your
patient population?

Well, I think so.

I think that... I
think, uh... I think...

You know, I don't know
what is a large number

or what isn't a large number.

Remember, these are
high-risk patients.

Many of these, not all,

but many of these were
high-risk patients.

Many people who used these drugs

for the wrong reason,

and I'm sure I had some,

in my practice,

are at risk of overdosing.

Plus, I also had people
who die of old age,

cancer.

I don't know what
that number means.

That, to me, sounds
like mass manslaughter.

You know, having two patients
die of opioid treatment,

when you're treating back
pain, is a high number.

Patients shouldn't
die from treatment

for non-life
threatening conditions.

Narrator: The DEA sought to
prosecute Webster and Lifetree

for the illegal distribution
of controlled substances

and possible manslaughter.

I wanted to know if I could
ask you a couple of questions.

We've been trying to reach
out to your team to...

I've got an
appointment right now.

Narrator: But despite an
80-page summary report

containing forensic
details of possible crimes,

the Department of Justice
declined to prosecute,

citing lack of evidence.

Will you answer a
couple questions for us?

No.

You don't want to
answer any questions?

- No.
- Okay.

You know, I think
the criminalization

of trying to treat
people in pain

who are doing the right
thing or attempt to

project a criminal event,

is very chilling.

What happened has happened,
and there's been a lot said

that I think is painful,

and all I could do is fuel,

I think, more pain

if I discussed it anymore.

We're supposed to forgive.

I have tried to forgive Webster.

But at the same time,
we shouldn't forget.

And if we don't
learn from things,

we go nowhere.

narrator: But we didn't learn.

Starting in 2013,

a powerful synthetic opioid
surged in popularity.

Fentanyl.

Narrator: It's 100 times
more powerful than morphine.

Rather than reckoning
with its dangers,

companies sold it
as aggressively

as drug cartels.

But instead of gun-toting
dealers on street corners,

men and women in
suits and lab coats

pushed opioids
with cash bonuses,

PowerPoint presentations,

and pain management jamborees.

Flushed with campaign
cash from big pharma,

Congress would
look the other way,

letting American companies
flaunt bottles of deadly drugs

like parade floats.

This is my poem to Purdue Pharma

called "Death Train."

"When we first met,
I loved what I saw.

"It was a natural fit.

"Together, we had no walls.

"Your mission was my
mission. We were inseparable.

"The extent I would work
for you was incalculable.

"I cut you a path that
was extremely lucrative.

"Maximizing sales
was our imperative.

"But I learned that
you never would listen.

"And if you did, you would
never change your position.

"I tried four separate times

"to warn you of
this death train.

"But despite all my
efforts, they ended in vain.

"You and your strategies
caused massive abuse,

"addiction, and death.

"Oh, what a tragedy.
Oh, what a mess.

"The very fiber
of our communities

"was ripped to sunder

"as you continued to rape,
pillage, and plunder.

"So many families torn apart."

"Teenagers dying
alone in the dark."

"The deeds you've done

"gave you no shame.

"Now you want to blame others.

"You want others
to take the blame.

"Though the victims
of your crime

"can never be made whole,

"Purdue Pharma should give back

"all the money they stole.

"And if need be, the
authorities should squeeze

"all the OxyContin billions

"out of your souls.

"Then the company
should be ripped apart

and thrown deep in a hole."

You
can make a lot of money

getting doctors to
prescribe a medication

to people who don't need
it. And none of it's doable,

unless you break the rules.

This
was a new drug cartel

that was being established
in the United States.

What they
would do is bribe doctors

to write as many scripts
as we possibly can.

People were dying
by the tens of thousands,

and their own representatives

- are selling them down the river.
- Lights.

Get on the ground!

The whole thing is disgusting.
Clearly we're breaking the law.

Back then, did I really care
about being responsible? No.