Dopesick: America’s Opioid Epidemic

Addiction has long affected our nation. According to the National Center for Drug Abuse Statistics, 31.9 million Americans currently use illegal drugs.  ^[1]NCDAS, (2022). Drug Abuse Statistics.National Center for Drug Abuse Statistics Resource.Retrieved June 2, 2022, from https://drugabusestatistics.org/ However, it’s our history with prescription drug misuse and abuse that has become increasingly hard to ignore. I’ve been witness to the devastating effects opioid misuse has on Americans from a variety of different social and economic backgrounds. Even with our current push toward awareness, we still struggle with over-prescription of these highly addictive drugs. ^[2]epidemic: a review of the surgeon’s contribution to it and health policy initiatives. BJU international, 122 (5), 754-759.https://doi.org/10.1111/bju.14446

The popular Hulu mini-series Dopesick has revived the discussion concerning the opioid problem in the U.S. Its burgeoning popularity has led many fans of the show to question how much of this TV drama is real when it comes to addressing America’s opioid crisis, and how much of it is manufactured for good ratings. I’ll touch on the roots of the opioid epidemic in the United States before diving into the reality behind the series.

What Is the Opioid Epidemic?

The opioid crisis started in the 1990s when pharmaceutical companies made a large push to reassure the medical community that patients would not become addicted to their pain relief options. This false reassurance led healthcare providers to continue prescribing opioids at a rapid rate. This phenomenon lent itself to widespread dependency on prescription opioids, and then the abuse of the non-prescription opioids that were a cheaper, deadlier replacement for prescription drugs. It was only then that the full realization of how highly addictive these medications truly were would come to light.

Opioid addiction soon became a snowball effect of drug misuse. over-prescription, and crime. Demographics across the nation, from upper-class suburbanites to middle-class workers, seemed to find themselves unable to cease taking what was advertised as a helpful, non-addictive medication. Drug-related crimes escalated quickly, as did overdoses and deaths related to opioid use.

Attempts to stem the tide would start a battle with big pharma companies that continues to this day. While more medical professionals are careful when it comes to prescribing opioids, they are still a top option for providing pain relief after major surgeries. On the patient side of things, even with the understanding of how addictive opioid drugs are, misuse continues today.

How Are We Combating the Epidemic?

In 2017, the Department of Health and Human Services declared a public health emergency as well as a 5-point strategy to combat the growing crisis.

This strategy involves:

These strategies have helped expand our knowledge and resources when it comes to battling the ongoing opioid crisis. With greater awareness of this growing concern, more focused research has gone into understanding how we got to where we are today. One individual who wanted to seek a better understanding of this crisis is Beth Macy. She would play a role in raising public awareness of this serious concern via her role as a journalist and author.

The Book

Written by Macy in 2018, the book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America is the basis for the Hulu mini-series. This New York Times Best Seller provided an account of America’s opioid epidemic, a national drama that continues to unfold over more than two decades. The book follows the progression of opioid use from the labs and marketing departments of big pharma to small-town doctor offices.

Macy’s nonfiction recounting of the devastation quickly caused by the introduction of OxyContin in 1996 shows how the drug affected communities and individuals of all kinds. Even children have been left victim to the misguided belief that opioids are the only real solution for pain relief following surgical procedures. ^[3]Pruitt, L. C., Swords, D. S., Russell, K. W., Rollins, M. D. Skarda, D. E. (2019). Prescription vs. consumption: opioid overprescription to children after common surgical procedures. Journal of … Continue reading This crisis was and is a real concern for children and adults across the nation. Throughout the book, Macy investigates the many factors that led so many doctors and patients to turn to opioids to provide relief and pain management.

Dopesick: The TV Drama

Beth Macy’s book would go on to inspire the hit Hulu series Dopesick. One major player who pushed for the creation of this adaptation was Danny Strong, a popular name in Hollywood and a man who worked as co-creator, executive producer, writer, and director for this adaptation. Strong has a history of working on productions that are heavily surrounded by controversy. He felt moved and angered when learning more about the opioid crisis, which triggered his passion for this adaptation. He felt it was an opportunity to put the Sackler’s Company on trial in a sense, showing their role in a massive drug epidemic still affecting America today. ^[4]White, C. (2022). The Rise of OxyContin: How Purdue Pharma and the Sackler Family is Responsible for the Epidemic Behind the Pandemic. Dominican University of California, Senior Theses. … Continue reading

Strong was not the only one inspired by the real story behind this serious crisis. Many famous actors, such as Michael Keaton signed on to help get this vital story heard. Michael Keaton plays Sam Finnix, the family doctor for a small Virginia mining town. The series highlights his ongoing commitment to his community, his misguided decision to trust in OxyContin, and the serious repercussions that would come to plague his small community. This would lead him to stand in front of a grand jury to testify concerning his involvement in prescribing several individuals in his community this drug.

Another big player based on a real-life individual is Purdue Pharma president Richard Sackler, played by Michael Stuhlberg. He is portrayed as an ambitious, borderline villainous character who is driven to outdo the successes of others in his family. His uncle, Arthur Sackler, pioneered the market strategy for Valium.

The pressure to succeed drives Sackler to push his sales team to get OxyContin as the top prescription medicine choice throughout the nation. The major selling point was that the protective coating around the drug allowed for a timed release. This enabled the company to claim that less than 1% of patients would become addicted. It sounded too good to be true and would prove to be just that, eventually.

The Hulu mini-series outlines the start of the OxyContin opioid addiction crisis. It does so by following different storylines that take place in different periods. It also shows the crisis from several different angles including doctors, patients, prosecutors, law enforcement, manufacturer Purdue Pharma, and the drug’s inventor. The series highlights how quickly what seemed to be a miracle, non-addictive prescription medication would tear communities apart. It didn’t take long for people to discover that crushing the medication could provide an immediate high. Soon, small communities that experienced a peaceful existence were torn apart by crime and desperate desires to get more.

In my opinion, this series offers an authentic portrayal of what happened to many small, working-class communities across the U.S. due to the opioid crisis. However, this leaves the question: how much of this story is true?

Is Dopesick Based on a True Story?

Dopesick is based on a true story but uses both real-life and fictional characters to represent the views and experiences of many. As mentioned, it is largely based on the book written by Beth Macy to provide authenticity. At the time, Macy was considering offers around Hollywood for her best seller, Danny Strong was already setting up his own opioid addiction project at 20th Television.

They decided that by working together, they could better show the true nature of the opioid epidemic. Creating the mini-series involved a lot of extensive research, including interviewing numerous doctors, patients, and other individuals who have been impacted by this crisis—both now and when OxyContin first hit the market. Instead of focusing on the narrow truths of certain real-life people, Strong felt they could share a greater truth by creating characters based on the experiences of many individuals.

For that reason, several characters are fictionalized. Their character arcs are inspired by the real stories of others who experienced addiction, or the repercussions of addiction. This includes the dramatization of Keaton’s character Sam Finnix, the local doctor who soon finds himself and his community addicted to OxyContin. While Sam Finnix is not a real man, he represents the true accounts of many doctors.

The mini-series also takes a strong position when it comes to portraying the Sackler family. They are shown as overly-ambitious, heartless individuals who would rather focus on profit than the growing problem surrounding their medication. The series portrays law enforcement and prosecutors having a difficult time seeking justice due to the pharma company’s financial, legal, and lobbying resources.

When it comes to the real-life Sackler family, they continue to maintain that they did nothing wrong. However, the company itself has had to settle different lawsuits over the years. ^[5] Dyer, O. (2019). Opioid lawsuits target Sackler family members. BMJ: British Medical Journal, 364, l1507. https://doi.org/10.1136/bmj.l1507   In fact, Purdue Pharma and the Sackler family have been sued by almost every state in the union. ^[6]Edgell, C. (2020). It’s Time to Finish What They Started: How Purdue Pharma and the Sackler Family Can Help End the Opioid Epidemic. Penn St. L. Rev., 125, 255. Retrieved June 2, 2022, from … Continue reading In summary, while Dopesick is based on true events and characters shaped by real people, it does streamline the story to make for a more effective TV drama.

Dopesick Review

As a person who has dedicated his life to providing guidance and counseling for addiction, I am often asked for my take on the Hulu hit series Dopesick. I find that the research put into the creation of this series speaks for itself. While the storyline is created through the experiences of many, those experiences are still very real. The opioid epidemic is still an enormous problem today, even after all the countless years, endless research, and compelling evidence that has shown how addictive and over-prescribed this medication can be.

This TV series does a well-rounded job of portraying the many different facets of this issue, and how quick and easy it was for it to get out of hand. Watching this dramatization or reading the work of Beth Macy is a great place to start for those who want to understand more about the opioid epidemic.

As someone who has always held true to the hope of recovery, I am optimistic that as a nation, we will continue to find ways to grow and heal. Addiction can be overcome with proper treatment and support. There is always life after addiction for those who are willing to make a change.

Stay Strong,

Jim

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