“We have to use the terms pain and pain management,” says Richard Sackler in Dopesick. The quote illustrates how Purdue Pharma used these terms as linguistic warfare and infiltrated the American psyche during the inception of the generation altering drug OxyContin. These terms were used to sell a dangerous narcotic disguised as simple and non-addictive pain medication to the most economically vulnerable segments of America, specifically poor communities in Appalachia.  This is what the show Dopesick is based around.

Hulu’s Dopesick acts as a semi-fictional, all encompassing time capsule of the genesis of the OxyContin epidemic in America.   Throughout the series we are introduced to characters at every level of what turns out to be the trickle down of the OxyContin effect.  There’s Samuel Finnix, the local doctor (Michael Keaton), ambitious DEA agent Bridget Meyer (Rosario Dawson), the head of the Purdue Pharma empire Richard Sackler, (Michael Sthulbarg), Purdue Pharma salesman Billy Cutler (Will Poulter) and prescribed patient turned addict Betsy Mallum,(Kaitlyn Denver). All of these characters’ storylines are interwoven through the late 1990s to the mid 2000s during the origin of the OxyContin epidemic.

During the early episodes we see the Sackler family lay the framework for the creation of OxyContin.  Richard Sackler is the Richard II of the Sackler Empire both in the sense that he’s trying to expand his  pharma empire and is constantly facing power struggles within his own organization.  He is cold and disgustingly distant from the future horrors that he would lay the foundation for.  Seeing the corporate boardrooms and incredibly decadent backrooms where the Sackler family do their dealings creates a setting that’s intimate as well as sinister. One of the main entry points to the market that allowed OxyContin to flourish is the definition of “pain” and “pain management”.  As we see the “Emperors of Pain” (a title given to the Sacklers by Patrick Raden Keefe’ best selling book, Empire of Pain) formulate their marketing strategy like that of the board game Risk, we see the beginning of the trickle down effect, which starts with the regional sales people who would be incentivized to push this evil prescription to their oblivious and vulnerable clients, the doctors.

In one of the first scenes with the salesmen, we see them in an auditorium receiving training about the term “pain” and how they can use that definition to sell more OxyContin. This is when we are introduced to Billy Cutler who sees this as a golden ticket into an untapped market. While what they were selling was obviously OxyContin, it’s hard to fathom an era in America before the horrendous OxyContin epidemic and how the drug was pitched to doctors as a pain relief medication that didn’t have any addictive properties (which was not true) and that it was a safe and measured option for patients’ pain (which turned out not to be true and very misleading since this pill was essentially a narcotic).  During Billy’s time there we see him have an on-and-off casual relationship with an intellectually and sexually intimidating fellow sales woman by the name of Amber Collins played by Hamilton alumna Phillipa Soo.  We see Billy rise through the ranks and as his corporate career ascends so does his bank account from incentives that prioritize moving the prescription drug to patients. We also see him start to hesitate and think twice about the drug he’s peddling and the damaging effects that he starts to hear about through patient and doctor reports.  At this point we see the trickle down effect start to materialize into the destructive epidemic that it would become.

One of these doctors that he peddles this drug to is Samuel Finnix. When we see the doctor initially it’s 1999 and he’s just your average general physician trying to best serve his patients in Appalachian Virginia.  He is also a widower and has a great relationship with the local community.   But then we start to see not only how his clientele but the entire town start to slowly tread into ruin over the introduction of OxyContin to local patients.  The salesman for Purdue Pharma introduces himself to the doctor to sell him on the selling points of using OxyContin like “pain management” and how “addiction almost never happens.”  Being ignorant to the damage that OxyContin could create through his prescriptions, he accepts taking them from the salesman and starts informing his patients of it and we see another level of trickle down from the doctor to the patients.  In the patients is where we see the pill epidemic take over and spread like wildfire over these smaller local communities around Appalachia and the southeastern United States.  

When we meet Betsy, she is your average resident of Virginia, working the coal mines, drinking around bonfires, and living with her parents.  Due to a work accident that causes her to see Dr. Finnix, he tells her about this new drug that just came on the market that emphasizes pain management called OxyContin.  From the very first prescription we see her steep tumble into addiction.  We slowly see how not only interacting with the physical drug but also slowly descending into the criminal culture around the drug deteriorates her ability to be a functioning member of society. The one scene that hits homes is when, knee deep in her addiction and after having a shouting argument with her parents, her father throws her pills in the sink and she turns into this uncontrollable subhuman cursing and groveling for her pills, a far cry from the normal functioning human she was a few months prior. We see her in and out of rehab, even coming across a special scene where she is offered drugs at an AA meeting while in the bathroom.  We not only see her drug use escalate, we also see how it escalates in Virginia and the rest of the country as well.  With that escalated drug use comes an escalation in crime, and this trickle down of evil begins to affect the judicial and legal system.

We are introduced into two storylines from the legal perspective, one coming from FBI Agent Bridget Meyer, and the other from a pair of agents from the Assistant US Attorney Office, played by Peter Sarsgaard and John Hoogenakker. Bridget navigating the ranks of the DEA while being a woman (especially a black woman) and trying to bring one of the biggest pharmaceutical cases ever is one of the better storylines of the series and Rosario Dawson deserves an Emmy for her portrayal .  The information about the effects of the drug and the criminal activity around the drug starts to spread, like how addicts bite capsules and how more addicts were robbing pharmacies exclusively for OxyContin.  They start to see at the ground level how big of an issue this will be.  We see how the cases take a toll not only on their professional life but also their personal life.  Then we start to see the true magic of the Sackler family: they were so large a company and had so much influence within government they were able to police and regulate themselves instead of having the proper scrutiny placed on the marketing and production of OxyContin.  Even once a pair of AUSA agents finally bring charges to Purdue Pharma and the Sackler family they are restricted to how much they can enforce. In one of the best quotes from the series, the US Attorney tells a pair of agents “this is the furthest justice will let us go”.

During these interwoven storylines we see how much pain and hurt OxyContin causes in all layers of the trickle down of evil.  It is not just the damage the users cause themselves but the collateral damage that happens around them, whether that be crying parents trying to send them to rehab or the decline of their local community.  We see Michael Keaton break his hippocratic oath and fall down the dark dingy road of getting addicted to OxyContin.  We see his character go from prescribing clients to over prescribing himself to feed his addiction.  In a particularly jarring scene he counts up the pieces of OxyContin in his office and while his patient/drug cronie asks how many doses he takes a day he reveals it’s twice the amount of the patient.  To see such a prestigious person in the community descend into a criminal was shocking and showed this drug can affect even the least likely people, including a doctor.  From the perspective of the Purdue Pharma salesman we see him change his perspective on the drug and the fact that he is selling it.  He, just like a lot of the characters in the series, starts to see information trickle in from testimonials about the abuse and addiction cases that were very likely with the use of this drug. We also see the tragic death of Betsy.  Michael Keaton deserves an Emmy for his fall from grace into addiction and how he was able to recalibrate his life and use the wakeup call of getting his medical license revoked while getting caught with OxyContin as a springboard to rehab that would eventually lead to his redemptive future career of helping other addicts and regaining his license.  During the conclusive episodes of the miniseries we see one of the overarching themes of the series playout, namely the Sacklers being able to avoid any type of criminal charges despite being the biggest criminals in this trickle down of evil and causing the most damage. While none of the Sacklers were held to any criminal charges, they were issued a $4.5 billion regulatory fine, the largest of all time.  

At first this seems like a loss. We see the perception of the Sacklers in the court of public opinion turn against them with the fervor of a Salem witch trial.  The viewer is treated to real world news clips of the Sackler family getting their names taken off of the Louvre as donors, many personal friends disassociating with them and even being run out of the Hamptons because of their destructive legacy.  While the Sackler clan are getting their social comeuppance, as a viewer you can’t help but think of Betsy, the patient turned addict who ends up dying in a heroin drug house after her second relapse.  While the Sacklers will be banished as the purveyors and the people responsible for OxyContin, the trickle down of evil affected them the least.