In his new documentary, filmmaker Alex Gibney (“Going Clear”) alleges that the U.S. opioid crisis is not just a crisis but a crime committed by pharmaceutical companies, distributors, pharmacists and doctors all looking for a paycheck. Now that the acclaimed two-part series has landed at HBO, let’s break down its most rewindable moments.
1. The Stats
“Crime of the Century” goes to great lengths to illustrate the human cost of the opioid epidemic but that doesn’t make the data it provides any less staggering. According to the doc, overdose deaths in the U.S. have tripled since 1990, 500,000 of which occurred in the last 20 years. Despite claims from pharmaceutical companies that opioid addictions are “excruciatingly rare,” it’s estimated there are about 240 million active prescriptions nationwide, which divides out to more than one prescription for every adult American.
2. The First Family of Big Pharma
The Sackler family, one of America’s most prolific philanthropic dynasties, made their fortune with Purdue Pharma, the privately held company that developed the prescription painkiller OxyContin. In the 1960s, patriarch Arthur Sackler began applying Madison Avenue advertising techniques to the company’s marketing of Librium and Valium, setting a precedent for the branding of OxyContin during its 1996 launch. Following Arthur’s death, brothers Mortimer and Raymond served on Purdue’s board of directors until their own in 2010 and 2017, respectively. As of 2017, the Sacklers had a collective net worth of $13 billion.
3. The FDA Was In on It
In 1995, Purdue enlisted Dr. Curtis Wright, an employee of the Federal Drug Administration, to help ensure that OxyContin would receive a seal of approval. Notably, Wright’s intervention led to the claims that 1) the drug’s delayed absorption lessened the potential for abuse and 2) it was appropriate for a wide range of ailments, from battling cancer to nursing a bad knee. Neither of these claims had sufficient evidence yet the FDA still approved OxyContin.
4. Purdue Courted Doctors
In order to convince them to push OxyContin on patients, “Crime of the Century” alleges that Purdue courted doctors through parties and junkets. The company also facilitated bribes through its speakers program, which paid doctors to promote the drug to their colleagues at trainings. At the height of the speakers program, it represented roughly $3 million of Purdue’s budget and employed over 600 sales reps in the business of pitching painkillers.
5. This Chart Changed Medicine
Chances are at one time or another a school nurse or physician’s assistant has asked you to describe your pain level using this scale of 1-10 (and animated faces) to determine a course of action. Introduced in the 1990s, implementation of the pain scale coincided with the proliferation of painkillers, shifting the goal of healthcare from treating ailments to managing pain and therefore empowering doctors to fill as many prescriptions as that took.
6. Pharmaceutical Reps Cracked the Insurance Code
Fairly early on, Purdue representatives figured out the exact keywords and phrases to get insurance providers to greenlight Oxycontin prescriptions. Full scripts tailored to each provider’s needs were developed to bypass any algorithms and decision trees.
7. Johnson & Johnson is the “Kingpin” of the Opioid Crisis
Purdue is not the only pharmaceutical giant to blame (and Johnson & Johnson is not only in the business of baby shampoo.) “Crime of the Century” claims that J&J hid behind its wholesome brand as it became what the documentary describes as “the kingpin of the opioid crisis”. In addition to promoting long-term and high-dose use of opioid drugs, the company changed opium itself. J&J encouraged farmers to 1) harvest the substance mechanically instead of by hand and 2) genetically modify the plant to create “super” poppies. Luxury prizes and vacations were offered to farmers that produced the most potent crop.
8. 3 Companies You’ve Never Heard of Own Everything
We’ve discussed the manufacturers and pharmacies but what about the middle men? It turns out that 90% of the U.S. drug distribution market is held by three companies: McKesson, Cardinal Health and Amerisource Bergen. Don’t be fooled by their carefully low profile: McKesson is the fifth-largest company in the United States.
9. Purdue Exec Paul Goldenheim Lied Under Oath
In 2001, Purdue Pharma executive Paul Goldenheim testified to Congress that he had no knowledge of OxyContin addiction and overdose rates until an investigation had begun the year prior. However, emails obtained by the filmmakers showed that Goldenheim and other officials had not only known the dangers of their drug for years but actively concealed them. Emails shown in the documentary reveal that Goldenheim had even requested that colleagues remove all mentions of addiction from their correspondence.
10. That $8 Billion Settlement was B.S.
You perhaps saw the headlines from last year that Purdue Pharma had plead guilty to kickbacks and fraud. You may have even read that the company had promised to pay a hefty $8.3 billion settlement. However, Purdue filed for Chapter 11 bankruptcy in 2019, the company only has about $1 billion to its name. According to “Crime of the Century”, the settlement is merely the illusion of justice and will never be paid. Although, given the human cost of this national crisis, could any price constitute justice?
For the record: A previous version of this story had an incorrect statistic about the U.S. drug market.