“The Crime of the Century” – Not just this one [MOVIE REVIEW]

OxyContin. Photo courtesy of HBO

OxyContin. Photo courtesy of HBO

HBO’s new two part documentary, directed by the incomparable Alex Gibney, is a deep dive into the opioid crisis and the major contributing players. In association with the Washington Post which has led major investigations into the crisis and the perpetrators, “The Crime of the Century” documents who started it, who spread it, who profited, who investigated, and, sadly, who won the war if not all of the battles.

Part One of “The Crime of the Century” is an introduction to Purdue Pharmaceuticals and the methodology of how they built their business into a 6 billion dollar enterprise. Gibney gives us a short course on its owners, the Sackler family.

It started with three brothers, all physicians. The two eldest were interested in therapeutics, the youngest, Arthur, dreamed of dollar signs. Arthur bought a marketing company and became a pioneer and very wealthy by bringing Madison Avenue to medicine. It is Arthur who dreamed up the use of fake medical experts to tout the benefits of the drugs he represented. He was a Master of Advertising and succeeded beyond his wildest dreams promoting the use of Valium and Librium to an eager audience. He set the stage for the future generation of Sacklers by disavowing the negative effects of those drugs. It was Arthur who was the first to state, “The drug isn’t the problem, the user is the problem.”

His elder brothers, Raymond and Mortimer, bought a factory producing patent medicines like ear wax cleaner. Renaming their company Purdue Pharmaceuticals, they happened upon a gold mine when they came up with an novel painkiller called MS Contin, a so-called slow-release morphine pill.  As the patent was about the expire, the younger generation led by Raymond’s son Richard came up with a patentable replacement, OxyContin, a drug that is based on the oxycodone opioid already present in Percocet.

The manufacture of OxyContin, an opioid approved for use in the mitigation of extreme pain associated with end stage cancer, was the source of the company’s incredible success. And what would make it even more successful? More prescriptions based on a new—their own— definition of “extreme” pain. They enlisted an army of hard charging super salesman to go out and sell doctors on their definition of pain; basically anything that hurt. A key to this story is that the Sacklers of Purdue Pharmaceuticals knew that OxyContin was addictive when used for chronic pain and hid that fact from the FDA with the help of an FDA examiner who later was hired to work for them. What followed was wide-spread abuse of the drug, over-prescribing, and wholesale addiction.

If you have not followed any of the excellent newspaper reportage on Purdue and the Sacklers, then Part One of “The Crime of the Century” will fill you in. It’s not a pretty story of government collusion, medical corruption, and unadulterated greed. There aren’t a lot of laughs. The film footage of Richard Sackler as he is deposed will send chills down your spine.

Commercially grown opium poppies. Photo courtesy of HBO.

It is Part Two that really grabbed my attention and made my blood pressure rise dangerously. Although the saga of the Sacklers continues, it is the prolific use of the doctor network by other drug companies that spreads and deepens the crisis. Like “whack-a-mole,” every time a source of drugs was shut down a new one appeared. Florida became the king of the pop-up drug clinic. Whenever the DEA got close to shuttering an operation someone or something interfered. Lobbyists succeeded in getting laws changed that protected the industry and cooperating politicians were awarded to the tune of millions.

A new major player in the addictive drug market appeared in the guise of a biotech company called Insys founded by Jonathan Kapoor who came up with a fast-acting highly addictive fentanyl drug approved for end stage cancer pain. But Kapoor knew that the doctor network would fuel his profits and he sent an army of salespeople to spread bribes euphemistically called “speaker fees” to those whose prescriptions were in excess of their “fees.” He started the IRC (Insys Reimbursement Company) to trick insurance companies into approving his drug. He enlisted a network of off-site workers, pretending to call from the doctor’s office, to get insurance reimbursement. Depending on the insurance company, they would read from a script of responses necessary to get payment. In other words, fraud.

There are too many bad players to recount. Let it be said that the heroes are all on the losing side, many of whom have lost their livelihoods, and that there are too many villains to track. Much like lobbyists everywhere, it is those who have left the governmental agencies, such as the DEA, who have sold their services to the highest bidders and exploited any weak links in the system. I guess that’s the American way, but it truly makes you want to cry.

So gird your loins and gear up for a rough, but informative and necessary ride. You’ll be older, sadder, and wiser with a great appreciation for those who do their jobs against great odds and limited success.

Part One launches Monday, May 10 on HBO and HBO Max. Part Two will be televised on Tuesday.

 

 

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