The opioid crisis in the U.S. has never gone away.
Almost every year, more people die of opioid overdoses than in the year before. More than a half-million people have died from prescription painkillers, heroin and illicit fentanyl since 1999. Provisional data from the Centers for Disease Control and Prevention estimates that more than 66,000 people died of an opioid overdose in the U.S. in the 12 months to September 2020, a huge jump from the previous 12 months.
It's not just a crisis destroying communities and plunging countless people into addiction, but is also a crime, says documentary filmmaker Alex Gibney. His new documentary on HBO is called The Crime of the Century.
It's a crime, he says, that was committed by pharmaceutical companies, distributors, pharmacists and doctors, all looking to profit.
Many well-known companies in health care have been involved in manufacturing and distribution of opioids, including Johnson & Johnson, Mallinckrodt, Endo International, Allergan, Teva, McKesson, Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart.
But Purdue Pharma is often singled out for sparking the opioid crisis with its aggressive marketing of its drug OxyContin in the 1990s.
It was "a marketing campaign designed to spread the use of opioids from immediate use after major surgery or end-of-life cancer pain to widespread use for all sorts of pain medications," Gibney says, "on the assertion, which is really nothing more than that by Purdue, that you really can't get addicted."
Members of the Sackler family who own Purdue Pharma have denied wrongdoing and are seeking immunity from future lawsuits in exchange for giving up control of their company and paying a $4.2 billion settlement. They maintain that they have always conducted themselves ethically and legally. Purdue sought Chapter 11 bankruptcy protections in 2019.
Gibney talked with Morning Edition about how the opioid crisis took off over the past 20 years, with the help of lobbyists and doctors, and the role of the Department of Justice.
Dr. Lynn Webster, whom Gibney talks about in the interview, responds to NPR that he or his colleagues have treated thousands of patients over more than 30 years. "Tragically, some patients died not because of treatment, but in spite of it." Webster says millions suffer from chronic pain, which is its own crisis. "For a subset of the chronic pain population, opioids can be effective without incidence of abuse or overdose. Moreover, opioids represent their only hope where no other options exist."
The conversation with Gibney has been edited for clarity and length.
You say Purdue was pushing doctors to expand the definition of pain.
They were pushing doctors to expand the definition of breakthrough pain and definitely pushing doctors to accept the idea that pain was the fifth vital sign — that there was nothing more important than treating patients' pain, even if it was knee pain for an 18-year-old from a sports injury. You know, "OK, have some OxyContin, it'll be fine. And don't worry, you won't get addicted."
That may be morally reprehensible to a lot of people, but was any of that illegal?
Well, it depends. Purdue the company did plead guilty to a felony of misbranding. And there was a rather robust prosecution memo from the Department of Justice, which we were able to obtain a copy of, which actually was prepared to indict a number of Purdue executives for a series of felonies, including fraud, misrepresentation and conspiracy to commit fraud.
You allege that it was essentially covered up, shelved for political reasons?
Yes, we don't know exactly. I mean, we tried very hard to find out exactly how it happened. But we do know that a number of senior prosecutors in the Department of Justice found this 120-page prosecution memo extremely convincing. And so they were shocked and surprised when the Department of Justice itself, after pressure from representatives of Purdue, notably, former U.S. DOJ officials like Mary Jo White and Rudy Giuliani, decided not to prosecute the executives and to work out a deal that essentially held Purdue [the company] criminally responsible. A number of executives pled guilty to misdemeanors. A fine was paid. But most importantly, the key evidence in the prosecution memo was never revealed. It was buried. We contend in the film that hundreds of thousands of lives were lost as a result of that burying of evidence.
I want to get into some of the personal narratives that you tell through this film, specifically of a woman named Carol Bosley who died of an opioid overdose in 2009. Her doctor was a man named Lynn Webster. Can you tell us about him?
Lynn Webster was kind of a key opinion leader. He received speaking fees from a number of key pharmaceutical companies, including Purdue. And he was one of these pain opinion leaders who was trying to preach the gospel of the opioid: the idea that no dose was too high, that pain was really the issue, not addiction. And he ran a pain clinic, the Lifetree Pain Clinic in Salt Lake City.
And one of his patients was a woman named Carol Bosley, who had suffered a terrible neck injury as a result of a car accident. And he was treating her for pain. She became terribly addicted to opioids as a result of prescription of a number of narcotics. Her husband became terribly concerned and she died of an overdose not too long after.
Dr. Webster maintains that he did nothing wrong. All over the country, we should say, doctors were doing this. He wasn't the only one by any stretch of the imagination. He believed that he was helping, didn't he?
I think he did. I think that one of the problems that enters into this equation that's even bigger than the opioid crisis is the problem of economic incentives in medicine. And nowhere is that more evident than in the opioid crisis — where the incentive, whether you internalize it, whether you recognize it consciously or not, is to prescribe more and more and more because you're making more money. But I think that what's disconcerting is that [many] people died of overdoses at Webster's clinic. And so many people were dying that it caused the medical examiner to look into it and ultimately caused the DEA raid on the place.
You also paint the picture of an entire system. We're talking about the doctors, the drug companies, the manufacturers, the salespeople, pharmacies. Has the system that allowed this to happen been dismantled in any way over the past couple of years?
Not at all. I mean, I think that there is now some reticence to prescribe opioids as liberally as doctors had done back in, say, the late '90s, early 2000s. That has changed. And the CDC has issued guidelines which have changed things.
But now one of the big problems is that an enormous demand has been created because you have a lot of people who are addicted. And suddenly now the illicit fentanyl market has entered the country in a way that is becoming ever more dangerous and undergirded by a system that really doesn't have proper attention paid to those who are addicted or an understanding of how supply and demand is working when it comes to these dangerous drugs.
NPR reached out to Purdue Pharma, members of the Sackler family and Dr. Lynn Webster, who denied all of the allegations in the film.
Phil Harrell and H.J. Mai produced and edited the audio interview. James Doubek produced for the web.
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