“Dopesick:” Purdue Pharma, FDA to Blame for Opiod Crisis

BIANNA GOLODRYGA: Well, turning now to one of the worst drug epidemics in American history. Hulu’s new scripted drama, “Dopesick,” explored how Purdue Pharma’s highly addicted painkiller, OxyContin, led to a tragic ripple effect on communities throughout the country. Actors Peter Sarsgaard and John Hoogenakker join Hari Sreenivasan to discuss their roles in the project and the urgency of the opioid crisis.

(BEGIN VIDEO CLIP)

HARI SREENIVASAN: Bianna, thanks. Peter Sarsgaard, John Hoogenakker, thanks for joining us. First, I want to ask both of you, when you were looking through the script, when you were preparing for this, what surprised you? Peter, let me start with you.

PETER SARSGAARD, HULU’S “DOPESICK,” ACTOR: You know, I think it was this campaign by Purdue Pharma to really make the people who become addicted seem like the problem, that they were kind of a small percentage of people who were prescribed the drug, that they were prone to it, that they were addicts, that they were less them. And I think that’s also what got me angry.

JOHN HOOGENAKKER, HULU’S “DOPESICK,” ACTOR: I would agree that all of that was concerted and that was it by design and that the idea at the end of the day was just to push opium on the masses, to try to find a way to beef that market up. And I was also disheartened that, you know, we like to put our faith in these governmental entities that are there to protect us. I was disheartened at the breakdown that happened at the governmental level. The FDA that allowed this to make it to market and informed that it made it to market.

SREENIVASAN: We’re going to roll on a clip of a young salesman talking to Michael Keaton’s character for the first time, talking about the phrase less than 1 percent addictive.

(BEGIN VIDEO CLIP)

MICHAEL KEATON, HULU’S “DOPESICK,” ACTOR: I’ve got another patient coming in here in a few minutes. So —

WILL POULTER, HULU’S “DOPESICK,” ACTOR: Of course. I won’t take too much of your time. You’re probably already familiar with our drug, MS Contin. Used to treat severe pain in many patients with cancer.

KEATON: MS Contin is a very good drug.

POULTER: So, what Purdue did is they took the same system, the Contin system, and they produced the opioid for chronic and moderate pain.

KEATON: I would never prescribe a narcotic for moderate pain. There’s a pretty long history down here, pill abuse.

POULTER: Less than 1 percent of people get addicted to OxyContin.

KEATON: That’s not possible.

POULTER: But it is. The FDA actually created a special label to say that it’s less addictive than other opioids, right there.

UNIDENTIFIED MALE: Your most effective talking point is the FDA label. These are your new magic words. Delayed absorption as provided by OxyContin tablets.

POULTER: Delayed absorption as provided by OxyContin tablets.

UNIDENTIFIED MALE: It believed to reduce —

POULTER: — the abused liability of a drug.

KEATON: I’ve never seen a label like this on a class 2 narcotic.

(END VIDEO CLIP)

SREENIVASAN: Peter, as you’re reading through the script and you see the ways that the sales people were, you know, working their doctors, trying to improve the reach of the drug. It almost reads like fiction. Like you couldn’t make this up. This is what was happening on a daily basis.

SARSGAARD: Oh, absolutely. I mean, the incentives put before them were ridiculous and obvious. And I think one of things that I really came out of this thinking was that, you know, this really comes down to a fault in our health care system when you have so few people that have a primary care physician or a healer or whatever it is in your circle that is someone they can rely on and trust that the doctor, you know, is getting his ear pulled more by the salesperson and the government is protecting, you know, big pharma more than it is the individual. And I think consumer level, if the person who is in need, if the person who is in pain, you know, they’re just being left out completely. So, to me, it really comes down to restoring that relationship between the physician and the patient. And finding a place for it in our health care system.

HOOGENAKKER: Totally agree. And we’re kind of in a perfect storm scenario too where doctors, I think, you know, generally are good people, principled people doing who doing the best they can for all of their patients, but we’re in a situation right now where your average doctor gets like, what, 12 or 13 minutes with you when you come in for a check-up. It’s not enough time for them, and I think most health care professionals would echo that. And then, you know, they’re approached by these drug reps who hand them labels that have been approved by the FDA and they have to take it at face value. They have to believe the tests that were submitted by Purdue Pharma through the FDA for the approval process. And again, that gets back to some of the things that just blew us away. I mean, as you read into this and find terms like pseudo addiction, when a patient who is dealing with actual addiction, they come up with the term that turns it into something a little bit warmer and fluffier. It can be dealt with more of the drug.

SREENIVASAN: Yes. You know, what’s fascinating to me is that we were in this climate where there was this national rethinking of pain and it wasn’t really until this series and a little bit of the other research that I am realizing, that wasn’t by coincidence that this whole thing was by design, that we were part of a campaign that we didn’t realize we were part of that was actually serving an end goal.

SARSGAARD: Actually, you think about — you know, I think about this recently as last year going into a hospital and seeing a pain chart, that pain chart that we all know with the faces and 1 through 10. Well, in a subsidiary of Purdue Pharma is responsible for making that pain chart to start the conversation, right, to make the conversation about pain. Well, pain is obviously something that none of us likes to deal with but the primary conversation should be about what the illness is, what the problem is and ways going about fixing with it. And dealing with pain is obviously a discussion you need to have, but it’s not the first one.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: I’ve been living with pain for so long, but then almost overnight, I got my life back.

UNIDENTIFIED MALE: As shown in Exhibit 1A that it got my life back promotional video, Purdue manipulated basic facts of the drug, claiming it is essentially non-addictive when it clearly was and these participants involved were deceived into participating, being told it was a PSA for pain relief instead of an advertisement for OxyContin. And many of them are now addicted or dead from drug use. So, we request access to all internal marketing materials, research and testing data to determine if there are other deceptions as flagrant as the exhibit currently for the court.

UNIDENTIFIED MALE: Your honor, statements made by council in no way even resemble the facts. My client is aware there have been addiction issues in this part of the world. But blaming Purdue Pharma for this is like blaming Budweiser for a drunk driver. It is the fault of the drug abuser and not of the manufacturer. The scope of the subpoena is overly broad and the information contained in their request is privileged.

UNIDENTIFIED MALE: Your Honor, if there is no liability then —

UNIDENTIFIED MALE: What these local lawyers don’t seem to understand is that there is a national pain movement that is far bigger than my client and its drugs. Renowned pain organizations have not only endorsed my clients’ medication but the general use of increased opioid treatment, my client should be given a Nobel prize but not a subpoena for materials.

(END VIDEO CLIP)

SREENIVASAN: What’s interesting in this clip and so many others is how completely outgunned the government resources are in this situation. I mean, you literally see almost a phalanx of lawyers lining up for the pharma company and, you know, and John’s character seems like, you know, boy scouts and Mr. Smith goes to Washington compared to what’s happening.

SARSGAARD: Well, there’s that. There’s the, you know, enormous wealth of the Sackler Family and Purdue Pharma. There’s also the fact that the amount of lobbying that they had done in Washington, D.C. So, they’ve essentially, they’ve got lawmakers behind them, you know. It really is a David and Goliath story. And, you know, I didn’t actually talk to Rick Mountcastle until after we did the film. But it really is incredible what they did and incredible that they believed that they could do it. You know, I mean, it’s really a spectacular story. It’s one of the things that really drew me to it. I rarely get the opportunity to play someone that I’m so enthralled of.

HOOGENAKKER: Yes. It was audacious, even the attempt and then, given the Sackler’s records of fending off prior attempts I think —

SARSGAARD: 60 suits prior, something like that. Yes.

SREENIVASAN: I mean, the — also, a bit revelatory, you know, watching this show is the sort of critical eye placed on the FDA. And on the one hand, you can say how absolutely under resourced they are. And then, on the other hand, you also look at the system structurally, it seems aligned so that the very companies that they are regulating have different hands in creating the rules that are regulating them.

HOOGENAKKER: Yes. I completely agree. And I want to echo something that you just intimated, which is, I believe that the FDA is made up of good, well-intentioned principled individuals. But then when you get an organism that is — that can be this ungangly (ph), it is possible for it to be misused. And we as individuals, I mean, it harkens back to the sort of lobbying paradigm that we have in Congress, that you can come in, you can make a lot of friends, a lot of connections, you can serve one term and then, you can still make a really good income for yourself for the rest of your working days. And the same can be true of the FDA. If you leave and you know how the approval process works, you can shepherd companies that just want to bring drugs to market through that process, which has —

SARSGAARD: And that happened with Purdue. I mean, literally —

HOOGENAKKER: And in fact — yes, and in fact, it was even perhaps a little more questionable than that. If it happened the way that it looks like it happened, an FDA person who worked at the FDA huddled with people from Purdue, and I don’t want to give away too much in the story for people who haven’t seen it. But yes, it is — there is a lot of kind of backroom dealing that can happen.

SREENIVASAN: I want to take a look at another clip here because the real tragedy is the ripple effects that it has on any community that is impacted by this.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: Going after a publicly traded companies are pretty steep hill to climb.

UNIDENTIFIED MALE: They’re not publicly traded. It’s privately owned by a single family, the Sackler Family.

UNIDENTIFIED MALE: Sacklers. Big philanthropists, right?

UNIDENTIFIED MALE: Oh, yes. Yes. They give lots of money to museums and schools. Rich person stuff.

UNIDENTIFIED MALE: Very rich.

UNIDENTIFIED MALE: So, what do you guys got no other U.S. attorney in the country is on to?

UNIDENTIFIED MALE: Well, about four months ago, I was reviewing our case load when I noticed an unusual pattern, almost every case over the last three years, I was related to OxyContin, nearly everyone, the legal drug sales, theft, armed robbery, child abandonment.

UNIDENTIFIED MALE: I mean, it has transformed the entire district. Jails are suddenly full, violent crime is running rampant. You know, for the last 200 years, folks around here didn’t even lock their doors. Didn’t even think about it. Now, starting three years ago —

UNIDENTIFIED MALE: Never lock their doors.

UNIDENTIFIED MALE: Single highest source of crime in the entire region.

(END VIDEO CLIP)

SREENIVASAN: You know, what was interesting to me is that when you look at the statistics of what happened to the United States because of the overdoses, half a million people have died and in any other reality, that number you would think would move us toward action. You know, have you been following what’s been happening in the case and what’s — how this has been progressing?

SARSGAARD: Well, yes. I mean, there has been some progress in the case with Purdue. You know, there was a settlement for, John, correct me if I’m wrong, $4.5 billion. Something like that.

HOOGENAKKER: That’s right. Paid over nine years.

SARSGAARD: You know, I have someone very close to me who became addicted. And so, I did this documentary in 2016 where I went to Dayton, Ohio, and Shonda Rhimes and Norman Lear produced it. And just I had like a real need to tell the true story. The kind of ripple effect of death and poverty and sadness caused by this drug is absolutely massive. I saw a jail cell filled. Because in Dayton, they had this policy of taking someone, you know, who is in possession and putting them in a jail cell, I believe it was for 30 days. Kind of enough time for them to just barely dry out. And I saw a jail cell for young women and it was filled with probably — just on a random day, I went there, I think with about 70 young girls. And that is the thing that I really want people to take away is, yes, this is about the Sacklers, this is about, you know, lobbyists and government and — but this is really about the individual and the families and the children that have been affected by this drug. Not just the deaths.

SREENIVASAN: What do you both think it will take for America to pay attention to this? I mean, we’ve had this slow rolling tragedy for a few years now and there have been books about this, there are have been documentaries, there’s this series that you’re both part of. You know, what do you think keeps Americans from paying the necessary amount of attention? Is it where it’s happening? It is who it’s happening to? I mean —

HOOGENAKKER: I’ve been talking to my son who’s 12 years old about how this drug and opioids in general can rewire the brain. There’s a character in the show who falls prey to addiction and then she looks like she’s getting clean and then other things happen and he doesn’t after how gotten clean, it could happen again. And I think that what we’re really, really going for is to put a little bit more empathy into the conversation around addiction that people deal with in this country. We have to start to see people who are dealing with addiction in a more empathetic way. You know, the greater conversation about pain being part of the healing process, that’s a really huge mountain to climb and I have no idea how we get there, but I think that’s part of it too.

SREENIVASAN: Peter, I wonder, also, you had mentioned that this had personally affect you and I want to know whether that guided how you played this character or dedicated yourself to this role.

SARSGAARD: It’s the reason I am interested in telling it. You know, I mean, the turmoil that it causes within a family, and I — you know, I — coming from a family where myself and a few others of us have the means to, you know, help someone through this because if you want to try to get through it, it’s a very expensive proposition and your insurance isn’t really going to cover it if you have insurance. So, that personal connection to it is the drive for me. It makes it possible to play a character, who like in every scene, I am single minded about my purpose. You know, to the detriment of probably my own family at certain points. But like this is a man on a mission and, you know, there are lots of causes, there’s lots of things to worry about and talk about in this world but this one is so — to me, it is to preventable, just because if the government got on the side of the individual instead of the corporation, instead of the pharmaceutical company and pass the Sackler Act, then when they actually put individuals, executives in jail, instead of just fining them, because these are just parking ticket. They sound like big numbers to us, but these are parking tickets. That, I think, will start to put a dent into it. But it’s a matter of the government protecting us, you know.

SREENIVASAN: You know, John, I wonder — this is a spoiler alert for the audience, but when you figured out that the person at the FDA who helped write the rules for how OxyContin could be distributed went to work for Purdue Pharma afterward, what went through your mind?

HOOGENAKKER: We have to — as best as we can, we have to keep stories like this alive. Not just instances like the one you mentioned, Hari, but stories like how the opioid crisis came to be in this country. We have to demonstrate that it’s important to us and we have to push lawmakers to pass things like the Sackler Act. I looked it up this morning and it’s stuck — it’s bouncing around in subcommittees, it’s currently in the anti-trust commercial and administrative loss committee They’re just passing it around. I think it looks good, but I don’t know. Why don’t you have a look at it? No, I think it looks, but I don’t know. Why don’t you? And then, you know, another election happens. The country moves in a different direction and maybe nothing happens. And this is how it goes on and on and on. But we cannot become complacent. It’s very important that when we’re given the opportunity to vote, that we get out and make it happen.

SREENIVASAN: The series is on Hulu, it’s called “Dopesick.” Peter Sarsgaard, John Hoogenakker, thank you both for joining us.

SARSGAARD: Thank you for having us.

HOOGENAKKER: Thank you.