The new Hulu series “Dopesick” tells the story of the prescription opioid epidemic in the United States through the eyes of doctors, users, and the pharmaceutical company owners and sales representatives who recklessly distributed powerful painkillers while downplaying the risk of addiction.
The series is a partly fictionalized account based on a nonfiction book. Both are all-too-real accounts of a deadly tale of greed and addiction that continues today.
“Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” written by journalist Beth Macy and released in 2018, traces the origins of the prescription drug crisis in Appalachia through the stories of ordinary people such as Ronnie Jones, imprisoned for armed heroin distribution, and Jesse Bolstridge, a 19-year-old overdose victim.
Macy’s book, like earlier works “Pain Killer” by Barry Meier and “Empire of Pain” by Patrick Radden Keefe, shows how unethical marketing of OxyContin by the Purdue Pharma drug company directly contributed to a wave of addiction and death that is now well into its second decade, with no signs of a slowdown.
The “Dopesick” television series builds upon Macy’s work but also composites some of its stories.
For example, Dr. Samuel Finnix, the character played by Michael Keaton, is based partly upon Dr. Stephen Loyd — a Tennessee physician who got addicted to prescription opiates, recovered, and now works in the addiction treatment field — but also on other individual stories and incidents.
“The Keaton character in the series is going to experience some of the things that I did,” said Loyd, now chief marketing officer at Nashville-based Cedar Recovery.
The miniseries, as a whole, is “balls-on accurate,” said Loyd.
“It’s exactly what I saw,” Loyd told Healthline. “It’s all real people, and it’s still happening every day.”
The series “accurately portrays the controversy surrounding the OxyContin crisis and the pharmaceutical companies, such as Purdue Pharma, who preyed on everyday people’s pain,” David Dorschu, CEO of Recovery Centers of America at Raritan Bay in South Amboy, New Jersey, told Healthline.
“The show also highlighted the local doctors who genuinely cared about their patients and were trying to do their best to alleviate their suffering,” Dorschu said. “A long-lasting ‘miracle pill’ that relieves acute pain with little potential for abuse or addiction was very attractive and simply too hard to resist.”
Macy’s book focused on the rise of the opioid epidemic in Lee County, Virginia, the state’s westernmost area. It’s coal-mining country and part of Appalachia.
In the Hulu miniseries — created by Danny Strong and co-executive produced by Macy — the story focuses on the fictional town of Finch Creek in the same region.
“The story is really tracking true,” Macy told Healthline.
She notes that many of the characters in the show — from Sister Beth Davies, who runs the Addiction Education Center in downtown Pennington Gap, Virginia, to Purdue Pharma head Richard Sackler — are real people.
The title of the series refers more to the challenge of recovering from an opiate addiction than getting addicted in the first place.
“Dopesick” is a term used by people who use drugs to describe the daunting physical and mental barriers to quitting — the point at which users aren’t taking opiates to get high as much as to avoid the agony of withdrawal.
Macy said people addicted to opiates — some resulting from overprescription by doctors for legitimate injuries and pain — deserve sympathy and help.
“We need to stop thinking of people with a medical condition as criminals,” she said.
“Dopesick” primarily focuses on the late 1990s and 2000s, as Purdue Pharma aggressively marketed OxyContin to doctors and reports began streaming in about the drug’s high potential for addiction and overdose.
However, despite growing awareness of the drug’s lethal potential, law-enforcement crackdowns on “pill mills” run by shady physicians, and efforts to control the distribution of prescription opiates, the opioid epidemic rages on in 2021.
In a 2021 settlement agreement, the Sackler family agreed to pay $4.3 billion to mitigate OxyContin misuse and forfeit ownership of Purdue Pharma.
However, the deal also granted the Sacklers immunity from liability lawsuits.
The family, which made north of $10 billion selling OxyContin, admitted no wrongdoing and offered no apologies to the victims of their drug and its marketing.
“It’s outrageous,” said Macy. “There’s two systems of justice — the guy who was selling weed is in jail, and the Sacklers are not only not going to jail, but even after the settlement, the family will walk away even wealthier than it is now.”
Macy and others hope that “Dopesick” not only shines a light on the origins of the problem but encourages stronger action to prevent and treat opiate addiction.
“Someone recently came up to me and said, ‘Until I read your book, I didn’t think I was part of a huge problem, I just thought I was a f***-up,’” she recalled.
Macy is now working on a sequel to “Dopesick” called “Raising Lazarus,” which tracks the opiate crisis and the people it affects up to the present day. It’s scheduled to be released next year.
Macy said, “the crisis has only gotten worse,” even though control of prescription opiates has improved.
That’s because dealers have upped the available supply of heroin and fentanyl to meet the needs of users.
“The horse is out of the barn, and it’s really hard to go back,” she said.
“It’s important to keep in mind that the opiate epidemic is far from over,” said Dorschu.
In fact, the Centers for Disease Control and Prevention reported this summer that drug overdose deaths increased by 30 percent in 2020 from the previous year.
Macy noted that only about 12 percent of people with opiate addictions can access treatment.
“Most are not getting access to treatment, let alone housing and social support, so they will continue to go out and use to prevent themselves from getting dope sick,” she said. “We can’t just stop with preventing new cases. We have to go back and treat these people who have largely been abandoned.”
The stigma around addiction remains a barrier to treatment, said Macy, noting how Sackler was able to shift blame away from OxyContin’s vast potential for abuse by pointing the finger at users.
“We have in this country a stereotype of an addict as someone who is homeless or lives in a crack house, but ‘Dopesick’ shows us how easy it is for anyone to fall into a pattern of substance abuse,” said Dorschu.
“Addiction does not discriminate. Many people who got hooked on these drugs, such as the teens in the fourth episode, were never actually in pain. They were looking for a quick high. The drug became widely available before its dangers were fully understood, and people started doctor shopping to get their fix,” he added.
And while the war on drugs of the 1980s and 1990s has shifted to focus more on treatment and prevention, there’s still strong resistance in many communities to effective addiction treatment, notably the “medical maintenance” use of methadone and buprenorphine for heroin addiction and needle-exchange programs to help prevent the spread of hepatitis and other diseases among people who use drugs.
“There are still so many barriers put up to treatment, and the response is not really happening to match the extent of the crisis,” Macy said.
Physicians still learn relatively little about addiction, said Loyd, who frequently lectures on the subject at medical schools in Tennessee and has testified in cases against doctors who recklessly prescribed opiates, often with deadly results.
“Dopesick,” Loyd said, puts the problem of the opiate epidemic and its origins into the mainstream, which he hopes can help build support for more and better treatment.
“Most of us know somebody touched by this,” he said.
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