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The Dope Show

Premiering in 2021, Hulu’s eight-part limited series, Dopesick, chronicles the simultaneous rise of OxyContin and the opioid crisis, and the eventual downfall of Purdue Pharma and the Sackler family.  Based on the book of the same name by Beth Macy, the series is an unflinching look at a medication marketed as a salvation for chronic pain sufferers but which became the ruination of so many.  The title refers to the pain an addict feels while going through withdrawal from the drug.

The story begins with a work injury in a Virginia coal mine.  Fearing collapse, the miners inside panic.  In the confusion, one collides with another (Kaitlyn Dever), knocking her into a mine cart and resulting in immediate excruciating thoracic back pain.  She is eventually given OxyContin by her primary care physician, played by Michael Keaton. Though Keaton’s physician registers his skepticism about OxyContin’s claims to result in addiction in less than 1% of users despite its designation as a Class 2 Narcotic, he prescribes OxyContin as a last resort, and is gratified to see that the effects are favorable…for a while.  

The series details the deceptive practices Purdue Pharma deployed to convince medical professionals and the public at large of OxyContin’s safety, including a unique and wholly inaccurate label from the FDA, approved by an official who would later become a Purdue employee, and seminars touting OxyContin’s patented 12-hour time release of oxycodone, the ostensible basis for the assertion that the drug is non-habit-forming.  The time delay is professed to result in fewer spikes and valleys in the delivery of the pain relief, thus reducing the likelihood of dependency and abuse.  

But as the effectiveness of OxyContin wanes over time, the dosage levels and frequency increase proportionately, a consequence not only endorsed by Purdue Pharma but explicitly used to boost profits.  To combat the contention that OxyContin’s 12-hour release does not work as advertised, Purdue simply invents a spurious new medical diagnosis to account for its failure, “breakthrough pain.” Promotional junkets for doctors and threats of lawsuits against pharmacists who resist carrying OxyContin ensure Purdue’s market dominance, and to counter accusations of the drug’s highly addictive qualities, another phony medical diagnosis is devised, “pseudo-addiction,” for which the recommended treatment is, astonishingly, an escalation in the patient’s dosage.

As dosage availability of OxyContin continually increases, from the original 10 mg tablet to the eventual 160 mg pill, so too do crime rates, overdoses, and deaths. Asked about the patients for whom he prescribed OxyContin via grand jury testimony against Purdue Pharma in the series’ opening moments, Keaton’s despondent physician delivers the most chilling line of dialogue you’ll hear all year: “I can’t believe how many of them are dead now.”