A new Netflix TV show about the origins and consequences of the opioid epidemic is coming to the small screen. The show, “Painkiller,” is a fictional story based on real events that transpired around the Sackler family, Purdue Pharma, and the marketing and distribution of their drug, OxyContin. It adds to the growing list of television shows and movies around America’s opioid crisis, including Netflix’s own “The Pharmacist,” Hulu’s “Dopesick,” and HBO’s “The Crime of the Century.”
The opioid crisis has plagued the U.S. for over two decades, starting with prescription opioids in the late 1990s, then heroin and fentanyl in the early 2010s. Nearly 600,000 Americans died from opioid overdose between 1999 to 2021, with over 200,000 of them from prescription opioids like oxycodone and hydrocodone. In 2017, one of the highest years of prescription opioid-related deaths on record, the economic burden of the opioid epidemic — including health care expenses and lost productivity — was estimated to be over $1 trillion.
Court filings show that Purdue, owned by the Sackler family, earned more than $35 billion from the sales of OxyContin, which was approved by the FDA in 1995.
The limited Netflix series, which premieres on Aug. 10, is based on a book written by journalist Barry Meier, titled “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic.” While working at the New York Times, Meier provided groundbreaking coverage of Purdue Pharma and the Sackler family starting in the early 2000s as the opioid epidemic began.
STAT asked Meier about his seminal reporting as the epidemic emerged, the decades-long saga of Purdue Pharma and OxyContin, the upcoming Netflix show based on his book, and what viewers should take away from the show as it relates to the current state of the opioid epidemic.
What is “Painkiller” about and what can people expect if they watch it?
It’s really about the origins of the opioid epidemic and why it happened. But because it’s a dramatic adaptation, it’s told through the experience of characters. It’s an ensemble of actors who are playing out threads of stories, narratives of stories, that weave together and provide you with what I think is an engrossing way of pulling you into the tale. … I think people are going to find it a really exciting, interesting show.
To what extent did your book influence the show’s plot?
I spoke at length with the screenwriters and provided them with a lot of the original material that I had gathered when writing the book. We had lengthy discussions about my experience covering the story, and my views on the story. And so, I think both the book and my experiences and observations informed what they were doing and how they were approaching the story. And there are a number of scenes in the series that reflect things that happened to me while I was working on either the articles for the [New York] Times or the book.
Every show has protagonists and antagonists. Who are the villains in the show and what do they represent?
When I first started writing about this whole episode two decades ago, my initial instinct was, oh, well, this is just about money. This is just about this drug company spreading around money, these doctors pocketing money. I think as journalists, we tend to be driven by the idea that money is the ultimate corruptor. But what I quickly came to realize is that there was another force that was contributing to this whole disaster, and that was the power of ideology. The power of belief.
These are doctors and company executives who think, I am going to become one, incredibly successful, two, incredibly wealthy, and three, change the course of medicine by selling this drug. Because this drug is a miracle, a wonder drug, a gift to patients. And in the process, I’m going to be celebrated as the person who brought this drug to medicine. [Richard Sackler] struck me, from the types of materials that have come out in litigation about him, as the type of person who wanted to see himself become an icon in the medical community. And I think that carries through in a very unfortunate way in how they went about promoting OxyContin.
In your opinion, what’s the biggest failure or injustice that allowed this to happen?
You can look across the board. You had doctors who, because they were on an ideological mission, distorted science in a way that as a layman, I found appalling. You had a company, Purdue Pharma, that hid information from doctors — we learned later on that they knew immediately when the drug came onto the market that it was being abused. You had regulators who didn’t require the company to produce the type of evidence that they should have been required to produce to make this incredible claim about its lack of abusiveness. And then you had all these people that are supposed to be charged with protecting us — lawmakers, policymakers, regulators, law enforcement officials — who were essentially asleep at the switch, or cowardly, because this epidemic just continued to grow and grow.
How did you get started investigating Purdue Pharma and OxyContin?
One of my editors came up to me in 2001 and said, I just got a call from a friend of mine who’s a regulator on a pharmacy board, and he was telling me this crazy story that essentially went like this: There’s a new prescription drug that’s turning up on the street. It’s all over the place. And the thing that’s weird about it is that the representatives of the company that makes it are telling doctors and pharmacists that it’s less prone to abuse. We have no idea what’s going on.
Eventually that tip started a very lengthy trail of reporting that would take me to the towns where the drug was rampant on the streets, into the regulatory system that approved it, and to the activities of Purdue Pharma, which was then marketing it like crazy. They were having junkets for doctors, and having hundreds of doctors on a speaker’s bureau promoting this drug to other physicians. By the time I got very deeply into it, I thought, there’s a bigger story here. There’s a book here about the marketing of this drug, the family behind the drug, and how we treat pain and drug addiction.
What was your reaction to your book flopping in 2003 when it was first published?
Bummed. People write books because they expect other people to read them. And people write books they think are important because they expect people to pay attention to them. I struck out on both those counts. So, it certainly wasn’t what I was hoping for. But then again, this isn’t what I was expecting either — that the same book that was ignored for over a decade would become a foundational book that other people would base their books on. Or that I would become a character in these books, and that it would find yet another life as a basis for a television show.
Did you anticipate the whole saga continuing for over two decades after you first started reporting on it?
I was stunned. I mean, there are certain markers in this story in that, each time events reached that marker I thought, OK, this is over. It’s done, time to move on. One of them was in 2003 when the book came out, and another one was in 2007 when Purdue and three of its top executives plead guilty to criminal charges of the Justice Department. But then in 2017, someone gave me this extraordinary document — the memo written by prosecutors investigating that case in 2007. And those prosecutors had very much wanted to charge the Purdue executives with very serious felonies that would have sent them to jail if they had been convicted. The Justice Department did not support that and basically forced these prosecutors to cut a plea deal that allowed the executives to plead guilty to misdemeanors, which are fairly minor crimes. But this document had a large part of the internal evidence that these prosecutors planned to present to a grand jury to seek the felony charges against the executives — internal Purdue emails, testimonies that people had given — it was this incredibly damning document, and I was stunned by how much these prosecutors had learned. And then completely disheartened by the fact that this case had never gone to trial. I honestly do believe that if it had gone to trial — even if the Purdue executives had gotten off — the information that would have come out during that trial would have awakened doctors to how this company had betrayed their trust in such a profound way. I think it would have totally upset the apple cart and caused doctors to reconsider not only how they were prescribing OxyContin, but their relationships with drug companies in general.
Why do you think that, despite all this evidence, the case never went to trial?
Because in the Bush administration, the top officials in the Justice Department were horrified by the idea that white-collar executives were going to be charged with crimes that could send them to jail. We live in a society where there is a two-tiered system of justice. If you’re poor, or a person without power, you go to jail. If you’re wealthy and can afford the best criminal lawyers, you don’t go to jail. And in this case, there was basically a revolving door between the Justice Department and these top tier corporate defense firms. And they didn’t want to get into the business of prosecuting executives, or pissing off these firms and not being able to land a job with them. It wasn’t until very, very recently that the government started sending drug company executives to jail. At that time, there was no stomach for it. Basically, they were cowards.
Today, Purdue is bankrupt and dissolved for restructuring, and the Sackler family will pay $6 billion toward treating and preventing drug addiction in exchange for immunity. Do you think the story is over now?
Presuming that the Supreme Court doesn’t hear this case, it’s over. The story of Purdue, and the story of the Sacklers, is over. It’s ending in a way that is almost as shocking as it began, which is that finally, after two decades, a large sum of money is being dedicated towards drug addiction treatment. The concept that an incredibly wealthy family was able to spend $6 billion of their money to buy what is essentially an insurance policy is mind boggling as well. So the Sacklers may be gone, but their legacy is one that will live on. Their names have been taken down by museums and medical schools. And they certainly now occupy the position in the annals of history that they never expected to find themselves.
In “Painkiller,” does the Sackler family come across as more or less guilty than it played out in courts?
The Sackler family has never been charged with a crime — it’s important to state that. They also contend that they never did anything wrong. But as I mentioned, when we started our discussion and you asked me about antagonists, when you walk away from the series, you may come to the realization that how we think about that word “antagonist” needs to be broadened. Because people can end up doing bad things for all kinds of reasons and forces. To me, that’s one of the really powerful things about the show. It doesn’t take a simple approach to the story. It makes you understand that all the humans involved are very complex.
When viewers watch this show, what do you hope they will take away from it as it relates to the state of the opioid crisis in the U.S. today?
It’s essential that we pay attention to [the opioid crisis] and understand the forces that set it into motion. Because those forces have always been with us and will always be with us. Throughout my long career as a reporter, I saw them play out time and time again. They might have involved different drugs or different medical devices or different surgical procedures, but the underpinning was always the same. The drugs, say, like OxyContin, whose benefits outweighed its risks for a small number of patients, was marketed to a huge number of patients because the manufacturer wanted to make a huge amount of money. Then doctors got on board, either because they could make money from the marketing of this product, or because they hoped to make their reputation through it. And then regulators and lawmakers and the people that are supposed to watch out for our well-being looked the other way. Then this fire starts to burn, and suddenly it explodes. It happens time and time again. Until we understand how it happens, and how to stop it from happening, we’re going to be in a situation like the opioid epidemic again.