“Dopesick” and the Opioid Epidemic

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If you haven’t taken the time to watch the Hulu original series Dopesick, you are missing out. Not only does this show include incredible actors such as Micheal Keaton and Rosario Dawson, it takes on the task of showing just how the pharmaceutical companies are responsible for the opioid epidemic in America.

The opioid epidemic continues to be a major crisis that the United States is struggling with. How did this epidemic arise? By exploring the history of the opioid epidemic, we can better understand opioid addiction and how to treat it. And this show is a great way to learn while being entertained.

Substance use disorders are complex and involve many moving parts. Drug problems are rooted in both personal and circumstantial issues like world affairs and drug accessibility and stigmatization. An article published in the Pharmacy Times stated that “several factors initiated the opioid pandemic and propelled its growth.”


The series Dopesick starts off by showing the executives at the Purdue Pharmaceutical company wanting to increase profits by creating a long lasting pill to help with the supposed epidemic of pain that America faces. This supposed pain pill, they claimed (inaccurately so) that less than 1 percent would become addicted even though it would be labeled for long term use. Opioids are often associated with pain management. In 1995, the American Pain Society introduced pain as the fifth vital sign, increasing physicians’ obligation to help regulate pain in patients during appointments. In the same year, Purdue Pharma launched oxycodone (OxyContin) on the market, “employing marketing campaigns that emphasized the benefits that extended pain relief provided while downplaying the implications.” The drug probably seemed miraculous at the time because of its ability to alleviate pain just by ingestion. Because of the excitement generated by the introduction of these new pain-relieving medications, most pharmaceutical companies producing them were able to minimize risk factors in their marketing. Several companies, including “Purdue, as well as Allergan, Endo International, and Teva Pharmaceutical Industries Ltd, also downplayed the serious risk and likelihood of addiction that occurs with their opioids.”


The personal level aspect of the epidemic that Dopesick confronts is set in a small mining town in Appalachia. A town of which Michael Keaton plays the town doctor, Dr. Samuel Finnix. The reps from Purdue, educated and brainwashed with false stats concerning the addictive qualities of OxyContin, focused on this region for its rollout of the drug. Dr. Finnix, hesitant at first, eventually decides to try the drug on his patients based on the deceptive tactics of the drug reps. As a result of this lack of transparency, many of the people in this small town, under the care of Dr. Finnix end up addicted and/or dead. Even more concerning is that nationwide, by 2012 physicians across the country had written over 259 million opioid prescriptions, which is “enough for every adult in the country to have a bottle of pills.” The large number of prescriptions issued without detailed information about side effects, and “advertising and false information concerning extended-release opioids’ addictive properties,” are only two of the reasons why the epidemic has continued to spiral. Eventually, the hidden truth about the potential harm of these drugs was addressed.


Intending to protect public health, the FDA discovered that most major drug distributors were complicit in the distribution of unregulated narcotics. The US Food and Drug Administration (FDA) is responsible for protecting public health by “ensuring the safety, efficacy, and security of human and veterinary drugs.” A Wall Street Journal article entitled “Drugmakers Go on Trial Over Opioid Epidemic” revealed how drug distributors shipped loads of opioid drugs to retail pharmacies across the country “neither questioning nor reporting them to the Drug Enforcement Administration.” How did they get away with this? This distribution was made possible because “chain retailers operated within loopholes of the law to dispense opioids to an unwitting public.” Another article published in The New York Times entitled “Big Pharmacy Chains Also Fed the Opioid Epidemic, Court Filing Says” discussed the tactics that pharmacy chains relied on to distribute opioids. Some of these tactics included “providing seminars on pain management and safety, self-policing opioid orders without oversight, and using workarounds to evade hard limits on purchasing.”


Fortunately, over the past few years, public awareness about the dangers of opioid use has substantially increased. Public understanding of the risk of opioid overdose has resulted in education and access to naloxone, a drug used to treat a narcotic overdose in an emergency situation that is “designed to rapidly reverse opioid overdose.” Before 2012, only six states had laws that expanded access to naloxone or lowered criminal repercussions for drug use. Within five years, 46 states and the District of Columbia had issued laws that protect people who help individuals that overdosed or first responders who administer naloxone. Additionally, 46 states have laws that allow pharmacists to distribute naloxone to third parties or first responders from a prescription or standing order. In the years since, naloxone has become more widely available, thanks to an FDA-approved nasal spray formulation for untrained use in a setting without the need for medical assistance. This nasal formulation was popularized in April 2019 and is typically the preferred method of administration.


The series of Dopesick ends with Purdue Pharma being found to have violated numerous ethical issues and is dissolved after agreeing to pay 4.5 billion dollars. This was a huge win for the country and for those who have been fighting this fight for decades. It is hopeful that with this finding and the FDA approval encapsulates an “all-hands-on-deck approach with statistical models suggesting that 21% of opioid overdose deaths can be averted.” While there are efforts in place to reduce preventable deaths from overdose, they still occur daily. The takeaway from this data is that there are steps we can each take to prevent overdose deaths and help end the opioid epidemic. By studying the data we can learn and advocate for awareness of opioid issues and settle the stigma surrounding drug use and addiction. If you haven’t watched Dopesick, I highly recommend you do. It will both educate and infuriate you.

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