The drug dealers in suits and coats

DRUGS / From Big Pharma to Big Government, Alex Gibney explores the causes of the American opioid epidemic.

Alex Gibney is fast becoming America’s foremost cinematic chronicler of high-level malfeasance so batshit insane as to be hysterical were it not downright lethal. And with his latest, the two-part, nearly four hour, The Crime of the Century for HBO (presented in association with The Washington Post) he turns his lens on an easy, though long slippery, target: Big Pharma. It’s an interesting decision, to say the least. At a time when corporate brands like Pfizer, Moderna, and Johnson & Johnson (the «kingpin in the opioid crisis», according to the doc, having industrialised the poppy cultivation process in Tasmania, right down to genetically altering the plant for increased potency) are rightly being hailed as lifesaving Covid-19 vaccine heroes on these shores, Gibney delivers a sprawling and devastating counter-narrative. One that intricately traces how an entire drug industry has, for decades, evaded accountability for the opioid-related deaths of half a million. Indeed, it’s enough to make one wonder if the shots-in-arms success, like «vaccine diplomacy», will ultimately prove to have disturbing, reputation-laundering side effects as well in the years to come.

The Crime of the Century, a film by Alex Gibney
The Crime of the Century, a film by Alex Gibney

Blame the user

But first a look to the past – specifically to the psychiatrist/visionary marketer who started it all, Arthur Sackler. Gibney takes us on a quick journey back in time, long before the Sackler name became synonymous with the rarified world of philanthropy, with museum collections and prestigious universities (not to mention an 8 billion USD settlement). Born in Brooklyn in 1913, Arthur and his two younger brothers Raymond and Mortimer, also psychiatrists, purchased a little outfit called Purdue-Frederick in 1952. Which eventually became the behemoth Purdue Pharma. Which, in turn, birthed the scourge OxyContin. How we got from point A to what Gibney terms in VO a «manufactured crisis» had everything to do with Arthur’s dark genius for smoke and mirrors promotion. From the start the ambitious MD notoriously blurred lines. (One of his early print campaigns featured a series of business cards – belonging to doctors that a dogged reporter discovered didn’t actually exist.) Big brother Sackler also pioneered the «blame the user» ethos that exists within the company to this very day.

an entire drug industry has, for decades, evaded accountability for the opioid-related deaths of half a million.

But like with the treatment he gave to the Trump administration in Totally Under Control, Gibney makes the case that outsized personalities can only get as far as government enablers will allow. And fortunately for Purdue, supply has always met demand. (Which could be said for the director as well, as Gibney’s able to secure interviews with everyone from investigative journalists to medical professionals, DEA agents to Pharma sales reps, as well as various other whistleblowers and insiders. And then there’s the leaked documents, and even a damning 2015 lawsuit deposition of Richard Sackler, Raymond’s kid and the face of the embattled family empire.) We learn that Purdue worked hand in hand with an FDA official to get its wonder drug Oxycontin approved – the same FDA official who a little over a year later was hired by the company at a salary close to 400K. Its sales reps were rewarded handsomely for overcoming physician skepticism, for soberly proselytising the gibberish of «pseudoaddiction» (as in a patient only seems addicted. Luckily there’s a cure for that – increase the dose!) Even paid Purdue mouthpiece Dr. Lynn Webster, who founded the troubled Lifetree Pain Clinic, appears high on his own talking point supply, tone deafly describing being «addicted» to helping those in pain. With friends like these, who needs regulation?

The Crime of the Century, a film by Alex Gibney
The Crime of the Century, a film by Alex Gibney

Illusion of Justice

Indeed, between a Purdue sales rep catching a doctor snorting oxy off his desk back in the late 90s (though emails showed Purdue leadership became aware of its product proving addictive in ’96 – and then lied under oath about it to Congress), to the company hiring none other than «America’s Mayor» turned Borat joke Rudy Giuliani to handle crisis management, it seems the inmates had likely been running the asylum all along. Though perhaps crazy like a fox is the apter metaphor, as no executive ever went to jail for any wrongdoing (and one even nabbed a bonus for «suffering» after the company did its multimillion-dollar fine faux penance. A «speeding ticket» in the words of one fraud investigator). Guess the company learned its lesson alright – it pays to pay campaign contributions to a powerbroker like the former Democratic Senator Chris Dodd. («Our policies are basically created by the manufacturers», notes one government lawyer.) And the wheels of the «illusion of justice» continue to grind on.

So by the time we get to part two – and the meteoric rise of fentanyl – Big Pharma has devolved into a bunch of «drug dealers wearing suits and lab coats,» according to a Washington Post reporter. Enter guys like the founder of Insys, John Kapoor, to put the Purdue playbook on steroids. Boiler room bottom feeder to Arthur Sackler’s veneer of high society respectability, Kapoor takes full advantage of the drug industry infrastructure – from pop-up clinics and «go-to-CVS’s,» to paying «speaker fees» (i.e., bribes) to willing WIFM («What’s in it for me?») doctors. On a zealous quest to «expand the definition of pain» (and expand profits from his fentanyl-based Subsys), Kapoor hires sales reps who get access to patient records, and then call and lie to the insurance companies – lies specifically crafted to each company in order to milk the greatest payout. And all the while the three big middlemen distributors (alas, drug companies still can’t ship directly to pharmacies) ignore the blazing bright red flags. Perhaps because folks like former Deputy AG in the Clinton administration Jamie Gorelick (better known in recent years as one of Jared Kushner’s lawyers) was pushing hard on the brakes. (Gorelick left government to become a lobbyist for Cardinal – one of the big three.) Add in Insys’s hip hop promo videos (the «I love titration» rhyme is pretty genius), the wonderfully colourful Alec Burlakoff, vice-president of sales at Insys, and his hiree Sunrise Lee, an exotic dancer that climbed the Insys ranks to become the regional sales manager for the mid-Atlantic region, and one thing about this muddled mess becomes crystal clear. Scorsese alone could do justice to this century’s perfect crime.

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Lauren Wissot
Lauren Wissot
A US-based film critic and journalist, filmmaker and programmer.

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