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As the U.S. continues to deal with the fallout from the devastating opioid epidemic that has killed over 500,000 people in the country since 1999, we speak with Academy Award-winning filmmaker Alex Gibney, whose latest documentary, “The Crime of the Century,” looks at the pharmaceutical industry’s methods in promoting and selling the powerful drugs. “I realized that the big problem here was that we had been seeing it as a crisis, like a natural disaster, like a flood or a hurricane, rather than as a series of crimes,” says Gibney. “You had these terrible incentives, where the incentive is not to cure the patient. The incentive is to just make as much money as possible.” The Centers for Disease Control and Prevention says U.S. drug overdose deaths skyrocketed to a record 93,000 last year — a nearly 30% increase. It is the largest one-year increase ever recorded, with overdoses rising in 48 of 50 states.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman. The Centers for Disease Control and Prevention says U.S. drug overdose deaths skyrocketed to a recent 93,000 last year, a nearly 30% increase. That’s the largest one-year increase ever recorded. Overdoses rose in 48 of 50 states. Opioid overdoses accounted for nearly two-thirds of the deaths, driven in part by synthetic opioids like fentanyl, which is 50 times stronger than heroin. Overall, drug overdoses accounted for more deaths in 2020 than car crashes, gun violence and HIV/AIDS combined.
This comes as the nation continues to deal with the fallout from the devastating opioid epidemic that has killed over half a million people in the United States since 1999. Fifteen states recently agreed to abandon their fight to block the bankruptcy plan of Purdue Pharma, the maker of the highly addictive OxyContin. In exchange, Purdue will release tens of millions of documents and pay a settlement expected to reach $4.5 billion. The owners of Purdue, the Sackler family, will agree to cede ownership of Purdue but will not have to admit responsibility for their role in fueling the opioid epidemic. They’ll also be shielded from future opioid lawsuits. Meanwhile, closing arguments will be held next week in a closely watched federal trial in West Virginia against the nation’s three largest drug distributors.
We turn now to a stunning two-part documentary, directed by Alex Gibney, about Big Pharma’s role in driving the opioid crisis. It’s called The Crime of the Century.
GARY BLINN: I came out of the doctor’s, and there was a representative of Purdue. She said, “We have a drug called OxyContin. We pick up all the costs. Just take as much as you need.” I said, “Sounds like a deal.”
ALEX GIBNEY: Within the last 20 years, more than 500,000 Americans have been killed by overdoses. Controlled-release OxyContin would be the drug that triggered the opioid crisis. But what if we discovered that the crisis started with a crime?
DR. ANDREW KOLODNY: When we talk about drugs like oxycodone, you’re talking about drugs that are essentially heroin pills. Opioid makers started to promote their opioids for common chronic pain conditions.
ALEX GIBNEY: Purdue didn’t have any evidence that the drug was safe, so the company obtained the help of a medical officer at FDA.
DR. ANDREW KOLODNY: This is the first time I’ve ever seen this. This isn’t just unethical. I think this could be illegal.
PATRICK RADDEN KEEFE: Hundreds and hundreds of sales reps go out and meet with doctors and say, “The FDA approved this.”
ALEX GIBNEY: Big Pharma celebrated its marketing muscle, using parties to lure doctors to write scripts.
UNIDENTIFIED: This was a new drug cartel. They were drug dealers wearing suits and lab coats.
ALEX GIBNEY: Basically, “Here’s some money. Write some scripts.”
ALEC BURLAKOFF: Yes. I’m looking at this, and I’m going, “Clearly we’re breaking the law.”
PATRICK RADDEN KEEFE: Purdue ends up getting pursued by the authorities. The company lied under oath.
NATHANIEL YEAGER: Ethics did not play a role.
ALEX GIBNEY: The companies took out their checkbooks and paid to keep the evidence hidden.
PAUL PELLETIER: You are basically telling pharmaceutical companies, “You have a green light to do this.”
LENNY BERNSTEIN: It explains how America got hooked on opioids.
ALEC BURLAKOFF: Doctors willing to be paid to prescribe a drug, those are the people that are going to get you promoted, and eventually put you in prison.
MARK ROSS: The abuse exploded and spread like cancer.
GARY BLINN: When you’re in that much pain and you’re addicted at such a high dose, you’re a trapped rat.
JOSEPH RANNAZZISI: When the companies didn’t like that they were being held accountable, they decided to change the statute.
JONATHAN NOVAK: They should be changing their behaviors, not the rules.
SCOTT HIGHAM: People were dying by the tens of thousands. And their own representatives are basically selling them down the river.
PATRICK RADDEN KEEFE: If you talk to people whose lives have been touched, what does matter to a lot of these people is truth.
AMY GOODMAN: That’s the trailer for Crime of the Century, a two-part documentary available on HBO and HBO Max. The series is directed by the Academy Award-winning documentary filmmaker Alex Gibney, who joins us now. His other films include Enron: The Smartest Guys in the Room, Going Clear: Scientology and the Prison of Belief and the Oscar-winning Taxi to the Dark Side. Alex Gibney joins us from Summit, New Jersey.
Alex, welcome back to Democracy Now! This is a powerful, explosive documentary that describes the Sackler family, Purdue Pharma, as a kind of crime syndicate. Can you go back and talk about, first, why you got interested in this, and then lay out the “crime of the century”?
ALEX GIBNEY: So, Amy, I think this started for me when I had a discussion with a group of investigative journalists at The Washington Post, who collaborated with me on this project, as well as some other journalists, and they sketched out the scope of this opioid crisis over the course of 20 years. And as they talked to me, I realized that the big problem here was that we had been seeing it as a crisis, like a natural disaster, like a flood or a hurricane, rather than as a series of crimes. And the crimes really coalesce around the idea of fraud.
And it was Purdue Pharma that really launched that fraud with a drug called OxyContin, which is time-release oxycodone, which is a terriibly potent opioid. And what they did, initially, was to gain approval by the FDA, and they worked with a man named Curtis Wright, who was at the FDA, and essentially worked with him to write the review of their own application. And they got inserted into the package insert, the paper that comes along with a prescription, you know, basically, two notes: one, that it wasn’t terribly addictive, and, two, because of the time-release mechanism, the Contin system, it wasn’t prone to abuse.
Neither of those things were true, but their salesmen then used those pieces of information to aggressively mount a campaign for greater and greater use of the drug. I mean, this is a powerful and very useful drug for people with end-of-life cancer pain, for example. But they wanted to expand the market rather dramatically, so that it — as the Purdue salespeople would say, it’s the one to start with and the one to stay with, and so that you might be prescribed it for knee pain if you were a high school athlete, you know, that kind of thing. And that’s how the opioid crisis really started: with fraud. And it spread from there.
AMY GOODMAN: And tell us who the Sacklers are and who the men were in the family who began this and understood it’s essential not only to produce the drug but to sell it, and the kind of scheme that they developed, to include drugstores, doctors and on.
ALEX GIBNEY: Well, the Sacklers were, really — the key Sacklers were three brothers, Arthur, Mortimer and Raymond. And at some point in time, they all found themselves at the Creedmoor Psychiatric Facility, and they were actually rather appalled at some of the procedures they were forced to do — orbital lobotomies and electroshock therapy. And they thought, “Well, wouldn’t it be better if we could find a pharmacological solution to some of these maladies?” And so, that was where this started, with a sense of idealism.
But it quickly turned. Arthur Sackler, the eldest brother, developed, at an advertising firm named McAdams, a mechanism of selling drugs like you would sell soap. And he became famous for pushing Librium and Valium. And again, kind of it was the model for what would become the selling mechanism for OxyContin: pitch directly to doctors, sometimes remunerate them for being your pitch person, and use all sorts of Madison Avenue techniques to really pump up the volume.
Now, Arthur died before the introduction of OxyContin, but Mortimer and Raymond established Purdue Frederick and Purdue Pharma, two companies that would make and market OxyContin. Raymond’s son, Richard Sackler, is the guy who’s most associated with OxyContin. And he was the guy who developed a strategy to pitch directly to doctors, sometimes hiring doctors for speakers programs, which would effectively cause them to take money to prescribe more and more OxyContin, and also promote the use of OxyContin to doctors all over the country and to kind of convince them that people who took it wouldn’t be at risk of addiction and that it couldn’t be easily abused.
And they came up with a term called — or they became famous for really pushing a term called “pseudoaddiction,” which is to say that you can’t really be addicted to OxyContin, no matter how high up the scale you go in terms of the volume. That’s pseudoaddiction, because it really is just — you know, it’s the pain you’re suffering from, not the need for the drug.
All these things were false, and they knew that, to some extent, their business model depended on bad doctors, pill mills, which were sometimes pharmacies and sometimes doctors purposefully misprescribing this drug, because it held within it — you know, once you could crush it, it held within it such powerful opioid material that you could just then dissolve it into water and either shoot it, or you could just crush it and snort it. You know, as Andrew Kolodny says in the trailer, they were like heroin pills.
AMY GOODMAN: Let me go to video testimony of Dr. Richard Sackler. This is from 2019. The investigative news organization ProPublica published it — Dr. Richard Sackler of Purdue Pharma, the maker of OxyContin, a part of the deposition he gave in 2015, the lawsuit in Kentucky. The company waged a three-year legal battle to keep this video secret. Sackler was questioned by attorney Tyler Thompson.
TYLER THOMPSON: Sitting here today, after all you’ve come to learn as a witness, do you believe Purdue’s conduct in marketing and promoting OxyContin in Kentucky caused any of the prescription drug addiction problems now plaguing the commonwealth?
DR. RICHARD SACKLER: I don’t believe so.
TYLER THOMPSON: Sitting here today, after all you’ve come to learn as a witness, do you believe that Purdue’s conduct in Kentucky has led to an excessive or unnecessary amount of opioids being located throughout the commonwealth of Kentucky?
DR. RICHARD SACKLER: I don’t believe so.
TYLER THOMPSON: Do you believe that any of Purdue’s conduct has led to an increase in people being addicted in the commonwealth of Kentucky?
DR. RICHARD SACKLER: No.
AMY GOODMAN: The significance of this, Alex Gibney, and how rarely we hear the voices of the Sacklers?
ALEX GIBNEY: That is true. And it was a great thing that ProPublica did. And actually, we worked with ProPublica to further release more of that deposition in the documentary. But what’s staggering about that exchange is that you see that Richard Sackler doesn’t evince any sense of sorrow or responsibility at all for the opioid crisis, when it’s quite clear — and don’t just take my word for it, but there were federal investigations into Purdue — it’s quite clear that they bear an enormous responsibility for the deaths that we see, in well over 500,000 people. And the idea that he could simply brush off any sense of responsibility at all is kind of staggering. But then, you know, you see that often with people who allow themselves to rationalize their behavior. A professor of mine once said economic actors aren’t rational, they’re rationalizers. I think that goes in spades for Richard Sackler.
AMY GOODMAN: So, I want to go again back to your documentary, The Crime of the Century. This features Insys salesman Alec Burlakoff talking about the four categories of doctors.
ALEC BURLAKOFF: There’s four categories. It’s blue, yellow, green, red.
Blue is analytical. That means, if you don’t have a scientific, double-blind, placebo-controlled study with a lot of patients that proves your data is right, you’re not getting a sale. What does that mean to me? It means I don’t call on analytical doctors, because I don’t have any studies like that.
Then you have your yellow. That’s your amiable doctor. They want to be friends with everybody. They want everybody to love them, which means, if you’re selling a drug and there’s five other competitors, they just go in a rotation. This one gets Subsys, this one gets Lazanda, this one gets Abstral, and then we go back around. Guess what. They’re out, because they’re just sharing the wealth.
So, now you’ve got your green, which is kind of like your earthy type of doctor, like God forbid you do a lunch and not recycle. You’ll never go back there again.
But then you’ve got your reds. Reds are your businessmen. They own their practice. They run their practice. They manage their books. They see a crazy number of patients. It’s all about efficiency. In fact, when you, as the rep, walk in there, they run to you with a pen to sign, and they’re running away at the same time, because they don’t have time to talk with you, because they’re treating patients, making money. And if he’s a red and he’s a businessman, I’ve got to show him the WIFM. What is the WIFM? W-I-F-M. What’s in it for me? That’s all they’re thinking: What’s in it for me? “Buddy, will you stop talking about the freaking drug? Will you stop talking about saving the patient? Will you stop talking about the science? And will you please tell me what’s in it for me? Because you’re wasting my time.” Those are the reds. Those are the doctors you want to find. And those are the doctors you want to move in, live, eat and breathe with.
AMY GOODMAN: Perhaps the best argument for Medicare for All I’ve seen.
ALEX GIBNEY: Absolutely, 100%.
AMY GOODMAN: But, Alex Gibney, if you can talk about who Alec Burlakoff is, what Insys is? You know, you start with Purdue Pharma, the prototype of all of this, and expand to other drug companies.
ALEX GIBNEY: Well, Insys is a company that was selling a product called Subsys, which was a spray, where you would spray fentanyl in small quantities underneath your tongue, and it would help to alleviate pain. But Alec Burlakoff was a salesman. Actually, he was rather high up at Insys in terms of sales. And they’re using the playbook that Purdue kind of initiated, but taking it to a great extreme, so that it’s all about the money. And it’s all about trying to find either corrupt, money-hungry or other doctors who — that becomes your business model, to look to those people to compensate them for being “speakers” to promote your drug. But really, when it came to Insys, they actually had a return-on-investment flowchart, so that if you got $40,000 from Insys as a “speaker,” you had to prescribe at least two times that amount, or they’d cut you off.
AMY GOODMAN: And explain “as a speaker,” that you put air quotes around.
ALEX GIBNEY: Well, in other words, you know, it’s legal to pay doctors to speak on behalf of your drug, but in this case — so, in other words, to go out and talk to other doctors about how great this drug is. The problem was that they weren’t really speaking. I mean, they would just pay them money, and they would go and have a dinner, and maybe they’d talk to a couple of people. But it was really a quid pro quo. It was just a bribe. “We’ll give you $40,000, provided you prescribe $80,000 of Insys.” And they would encourage them also to up the dose, to titrate up. And because the more you increase the dose, the more money that Insys is making.
I mean, it’s just a — you know, you see in Alec Burlakoff exactly the argument for Medicare for All, because you have these terrible incentives, where the incentive is not to cure the patient. The incentive is to just make as much money as possible. And I can’t recall there was anything in the Hippocratic Oath that had anything to do with supply and demand, but by the time you get to Insys, you know, riffing on the Purdue formula, it’s all about the money.
AMY GOODMAN: So, I want to go to another clip from The Crime of the Century. This is Gary Blinn talking about how he was given 50 OxyContin pills a day.
GARY BLINN: It was a trial from Purdue — excuse me. You know, it was a — they were testing it. They started me with maybe eight or 10, twice a day — 160s, the highest dose. And that wasn’t working, so then he just kept on raising it, 12 two times a day, and then 15. That wasn’t do it, so we went up to 20. And I said, “This still isn’t doing it.” So he made the phone call. He told me it was to the doctors at Purdue. And they said, you know, “Give him more.” So, that’s when we got up to the 25, twice a day, 50 pills a day. It would almost take me 15 minutes just to eat them all. You know, it was like sitting down to a bowl of Cheerios. I was starting to feel a little toxic, like my body was telling me that we’re not doing well. But, I mean, what can I do but take more? You know what I’m saying? I mean, when you’re in that much pain and you’re addicted to that, such a high dose, no matter what it is, I mean, you’re a trapped rat.
AMY GOODMAN: That’s Gary Blinn talking about how he was given, what, 50 pills of OxyContin a day. Alex Gibney’s two-part documentary, The Crime of the Century, he’s interviewed in. So, Alex, explain why he was chosen. What was special about him?
ALEX GIBNEY: Well, that he had such a high tolerance for the medication. I mean, it was not only 50 pills a day; it was 50 160-milligram tablets a day. Most people would be dead from that dose. But he had been a former heroin addict. He had a very high tolerance.
And he was approached by a Purdue salesperson, who said, “Hey, we can give you some free samples. Wouldn’t that be great? I know you’ve got back pain.” And he said, “Sure.” And so, they gave him free samples.
As it turned out, the Purdue sales rep was also — you know, had a sexual relationship with the doctor who was prescribing these pills, and was prescribing them without even examining the patient. But what Purdue did with — or, what this sales rep did with Gary Blinn was to use him as a marketing tool, to go to other doctors and say, “Look, look, this guy is taking 50 160-milligram tablets a day. It just shows you, no dose is too high. Titrate up. Keep prescribing more and more.”
Now, you may be asking, “OK, surely, when Purdue discovered the behavior of this sales rep, she must have been viewed as a bad apple and harshly punished.” To the contrary, she was promoted to a position in sales training. So, it gives you some idea about just how aggressively and how fraudulently Purdue was marketing its drug.
AMY GOODMAN: How does this connect to the 93,000 people who died in 2020 alone of opioid addiction?
ALEX GIBNEY: We have to be careful here and say that it doesn’t necessarily connect directly, but there is a trace, there is a trail. And part of what happens here is that Purdue and other companies, by overprescribing OxyContin, and also allowing for massive abuse, created an enormous demand. And for some of those people, when they either couldn’t afford the drugs, insurance wouldn’t pay for them anymore, or when prescribing tendencies changed, they had a real problem. So they sought out a substitute, which was heroin. And when that became too expensive, they sought out a new drug called fentanyl.
And fentanyl is — as you pointed out earlier, is an extremely potent drug, 50 times more powerful than heroin. And one character in our film goes through that process, a guy named Caleb Lanier from Texas. And he ended up becoming a fentanyl dealer, because he could pay for his own habit by selling it. But fentanyl is an extraordinarily dangerous drug, because it’s very difficult to monitor the dosage. You don’t know really how much you’re getting. And so, fentanyl began to be imported, first from China, sometimes just by mail. There would be websites in China that would say, “Hey, America, you want some fentanyl? Here it is.” And it would come, and they’d sell it. Now a lot of it comes up from Mexico. And we look at a task force, in the film, that’s trying to stanch that.
So I think you have to see the 90,000 dead in the past year as a kind of legacy of this enormous demand that was created initially by the pharmaceutical firms. And, of course, you have companies like Insys, who are also overprescribing a drug like fentanyl, you know, as a technical matter. Now, Insys is one of the very few companies that was successfully prosecuted and a number of their executives sent to jail. But that gives you some sense of the three-part structure of this crime, and also the blurry line between licit pharmaceutical sales and, essentially, cartel sales. They’re not so very different.
AMY GOODMAN: In December, members of the Sackler family refused to apologize when House lawmakers grilled them over their role in fueling the opioid epidemic. This is Massachusetts Congressmember Ayanna Pressley addressing David Sackler.
REP. AYANNA PRESSLEY: We do not need another failed war on drugs. What we need is a reckoning and accountability for drug companies who put profits over people and rob us of lives and freedom of our loved ones. You have created a nationwide epidemic. Four hundred and fifty thousand people have died. Let me be clear: People struggling with addiction are not criminals. Your family and Purdue Pharma, you are the criminals. You are the ones who disregard your duties to society, and you should be ashamed of yourselves.
AMY GOODMAN: So, Alex Gibney, in fact, while you talk about Insys, people there were jailed. The Sackler family — and this goes to the recently settled lawsuit, and I’m wondering if you could comment on this — 15 states recently abandoning their fight to block the bankruptcy plan of Purdue Pharma, the maker of OxyContin; in exchange, Purdue releasing tens of millions of documents, paying a settlement expected to reach $4.5 billion, but the Sackler family agreeing to cede ownership of Purdue but will not have to admit responsibility.
ALEX GIBNEY: Yeah, it’s really — that settlement was designed to sound good, like, “Oh my gosh, $4.5 billion, that’s a lot of money.” It is a lot of money. But the Sacklers have about $11 billion. And that $4.5 billion gets paid over nine years. So, if you’re taking in at least 5% on your money, it’s really not affecting the principal at all.
But I think the larger thing here goes to a failure of accountability. You know, Purdue was investigated by the federal government back in 2006, and indeed found guilty. But that investigation, which was a very robust investigation, really laid out the roadmap for how Purdue did what it did. And the attorneys were arguing for very extensive felony convictions. Ultimately, Purdue used its muscle to go above those attorneys and have the charges knocked way back to misdemeanors and a fine. And most importantly — and this gets to the current episode — they were able to seal all the records relating to the prosecution. So the most important evidence was buried, which meant that all of us, the public, couldn’t see what had really happened, in order to be able to stop it.
The one bit of good news in this settlement — and there’s not much good news in it, because they’re not really being held financially accountable or criminally accountable — but the one bit of good news is that a huge treasure trove of documents will be released. And so, at least to prevent the next episode from happening again, we can study those documents and see exactly how it was that Purdue did what it did.
AMY GOODMAN: And people shouldn’t forget that the Sacklers sponsor so much of the arts, not only in New York, where we are, but around the country. You have Sackler galleries at all the major art installations, which now are deciding what to do about this.
ALEX GIBNEY: That’s correct. But, you know, one thing I would like to point out, as much as we talk about the Sacklers — and it’s very important to talk about them and Purdue — we shouldn’t be naive and think that that was the only company that was making extraordinary profits out of the opioid crisis and indeed didn’t know better. I mean, you know, three huge companies, which are distributors of drugs — Cardinal Health, AmerisourceBergen and McKesson — they knew very well that their pills, their opioid pills, were being diverted in ways that were causing massive addiction, but they didn’t do anything about it. And indeed, they ended up influencing Congress to pass a law which made them even less accountable, because they used the power of the revolving door to rig the rules. Johnson & Johnson, you know, famous for baby shampoo, was one of the biggest manufacturers of a potent kind of opioid, produced in Tasmania, that actually supplied Purdue Pharma with all the oxycodone that they needed in order to be able to market their drug. They wouldn’t have been able to do it without Johnson & Johnson. So, there is a pretty big and robust —
AMY GOODMAN: And they paid a settlement, Johnson & Johnson, of $230 million over its role in fueling the opioid crisis?
ALEX GIBNEY: Yes, they did.
AMY GOODMAN: But, of course, with all these companies, we’re talking about profits of billions.
ALEX GIBNEY: That’s correct. And also, in many cases, we’re talking about burying the evidence. In other words, the deal is almost always — and this is something we’ve got to look at as a country — the deal is almost always we’ll pay a fine, we won’t admit responsibility, and, most important of all, the evidence will never be seen.
AMY GOODMAN: Well, we want to thank you for being with us, Alex, Alex Gibney, Oscar-winning filmmaker. His latest film, the two-part HBO documentary titled The Crime of the Century, which traces the origins of the opioid epidemic and those who enabled it.