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Big Pharma said there's 'no dose too high' to fight pain. But the costs keep mounting

·4 min read
A medicine bottle tipped over, spilling out pink pills
Documentarian Alex Gibney examines the opioid crisis in HBO's "The Crime of the Century." (HBO)

For more than 20 years, Americans have watched the human cost of the opioid crisis as if it were an epidemic without a cause. But what if the crisis had been manufactured through a series of cynical misdeeds involving profit-ravenous pharmaceutical companies, bought-and-paid-for medical professionals and a toothless political and legal system?

You probably wouldn’t be shocked, given all that we now know from numerous class-action lawsuits, interviews with recovering addicts and grieving parents, hard news exposés and yes, lots of documentaries. But Alex Gibney’s gripping two-part docuseries “The Crime of the Century” sheds new light on an ongoing disaster by meticulously tracking the moves of one major kingpin: Purdue Pharma, the drug company that made billions off the addictive and often lethal pain medication OxyContin.

Described by HBO as a “searing indictment of Big Pharma and the political operatives and government regulations that enable overproduction, reckless distribution and abuse of synthetic opiates," the four-hour investigation delivers on that promise by mixing commentary about America's broken healthcare system with the justice-seeking tenor of true crime.

"The Crime of the Century" chronicles the history of pain treatment in the U.S. and how it’s been redefined over the decades, largely by the marketing efforts of the Sackler family, who founded and own Purdue. In particular, “Empire of Pain” author Patrick Radden Keefe, “Pain Killer” writer Barry Meier and an investigative team from the Washington Post add context to Gibney's story of how Purdue brilliantly marketed OxyContin to keep its lethal potential a secret.

Material from Purdue seen in the series shows the shift from looking at pain as an unpleasant side effect to an ailment unto itself: “What is pain? … Pain is whatever the person experiencing the pain says it is,” advises a pleasant voice in an instructional video. It should be treated like the fifth vital sign, and not a symptom, clinicians were told in courses. This new, corporate-backed approach to pain management coincided with the advent in the mid-1990s of OxyContin, which the company claimed was a safe alternative to addictive opioids of the past.

Two paramedics in the back of an ambulance, adjacent to an empty stretcher, with another ambulance parked alongside.
An image from Alex Gibney's documentary "The Crime of the Century." (HBO)

Others interviewed here include a former Purdue Pharma sales representative who worked in rural areas, including the Appalachian mountain region that's been ravaged by the opioid crisis. His pitch included telling doctors there was “no dose too high and that patients can’t get addicted. They took all that fear of opioids away, then turned ’em loose,” he says.

Purdue and its formidable team of doctors and lawyers, Rudy Giuliani included, defended against the deaths related to OxyContin — which together with other prescription and illicit opioids has caused hundreds of thousands of fatal overdoses — by claiming there were two kinds of users: patients who followed doctors' orders and drug abusers.

"The Crime of the Century" makes clear that's not the case. A man whose wife died of an overdose while under the care of a high-profile pain management doctor who was indirectly funded by Purdue speaks about how the couple followed whatever the doctor recommended. But in his grief he kept the list of drugs the pain doctor had her on. When another medical professional reels off the names of each drug and the high dosages for the camera, he's stumped and then horrified.

Through firsthand accounts, old reports and new leaks, "The Crime of the Century" shows how Big Pharma conspired against the American people to make a buck, in blue and red states alike. When Purdue was sued over OxyContin deaths in 2008, for instance, prosecutors characterized the resulting $700 million fine as a parking ticket for the Sackler family, who are worth over $10 billion. And even then Purdue sought alternate ways to continue the heist (see: fentanyl).

The prolific Gibney, who also directed the COVID-response exposé "Totally Under Control," "Going Clear: Scientology and the Prison of Belief" and "Enron: The Smartest Guys in the Room," has a way of playing with words in the titles of his films, but not here. For the magnitude of the human and societal destruction depicted here, "the crime of the century" is the only name that fits.

For the record:
7:10 AM, May. 11, 2021: An earlier version of this story stated that Oxycontin has caused hundreds of thousands of overdose deaths. The CDC attributes that number to all opioids, not just Oxycontin.

This story originally appeared in Los Angeles Times.