All language subtitles for Dopesick s01e04 Pseudo Addiction.eng

If fraud was too high a bar,

what would you charge him with?

I'd charge them
with criminal misbranding.

Permission granted to release
requested documents

relating to marketing
and distribution.

[suspenseful music]

They're drowning us
in paperwork.

I'm promoting you.

I'd like you to be
deputy director

of the Diversion Division.

I accept.

The worst thing that a
a parent could hear

is that her kid is,
you know, queer.

It'd kill me if you were, Bets.

I guess you're dead, then.

Do you realize that men
might be dead 'cause of you?

I don't understand
what's happening to me.

If we get Germany
uncontrolled,

it will serve as a gateway
to the rest of Europe.

Please tell me
I'm gonna see you

in Orlando in a few weeks.

SAMUEL: That's why I'm calling.
I was

20 milligrams of OxyContin.

TEEN: Got it.
TEEN: Hey, dude.

TEEN: Hi, how are you doing?
TEEN: What's your in on?

TEEN: 80.
TEEN: Bam.

TEEN: Oh, fuck.
TEEN: Yeah.

TEEN: Cheers to that.

TEEN: Hey, hey,
what you doing, man?

I was just gonna pop it.

TEEN: No, man.
You gotta snort 'em.

Here, I'll show you.

TEEN: What the fuck's your
problem?

TEEN: Elizabeth Ann,
are you in?

It hits way faster.

TEEN: Are you sure, man?
TEEN: Trust me, yeah.

TEEN: 'Cause, we've
popped them normal before.

Did Purdue say it was easy
for someone to bypass

the timerelease coating
on an OxyContin pill?

No, Purdue claimed
the coating

was difficult to get around,
and therefore,

OxyContin would be
unappealing to abusers.

Was the coating difficult
to dissolve?

No, it was very easy.

All you had to do
is dissolve it in saliva

and then scrape it off.

And then the abuser
would have immediate access

to the full 12hour supply.

They just crush it off
then snort it.

TEEN: Yeah!
TEEN: Oh, here we go!

TEEN: Holy shit.
TEEN: Fuck yeah.

I think I'm getting a chubby.
[all laugh]

TEEN: Where's, uh,
where's Elizabeth Ann?

TEEN: Elizabeth Ann?

Hey!
TEEN: What the fuck you doing?

Get your ass over here.

Hey, it's good. Don't worry.

TEEN: Go, you're up next.

TEEN: First time
is the best time.

Yeah!
[laughter]

[Elizabeth sniffing]
Yeah!

TEEN: Oh, shit.
TEEN: Hey, hey!

[tense music]

TEEN: All right, I'm up next,
right?

TEEN: Yeah, you got to see...

[whooping]

[distorted, indistinct chatter]

[Elizabeth screaming]

Oh, my God. Oh, my God.

Don't you fucking die,
Ryder!

TEEN: You're gonna be all
right, don't worry about it.

TEEN: Let's take him
to his mom's house.

TEEN: We can't go
to his mom's house!

Can we take him
to a fucking hospital?

We can't take him
to a hospital.

TEEN: Get him out of there.

ELIZABETH:
What should we do?

Oh, John, don't die, please.

TEEN: Fuck, come on.
ELIZABETH: Please.

What the fuck is that?
They didn't have any ice.

Is that a fish?
TEEN: It's frozen.

It'll wake him up.

♪ ♪

TEEN: Wake up.
ELIZABETH: Why?

Wake the fuck up.

Fuck!

Let's get out of here.

ELIZABETH: No, wait, we can't
leave him here!

TEEN: Come on!
ELIZABETH: We can't leave him!

TEEN: Elizabeth Ann!

Come on!

♪ ♪

[engine roaring]

[heavy metal music
playing on radio]

BETSY:
Here.

What the fuck is this?
These are fucking 10s.

ER doctor was on to me.

Only gave me four days' worth.

God damn it. What the fuck?

I'ma be really sick tomorrow.
WALT: Yeah, and I'm not?

You're the fucking
drug dealer!

Why is this on me?

WALT:
And what about Florida?

We can hit one
of the pain clinics.

BETSY:
That's too far. We'll get fired.

Yeah, well, we got
nowhere else to go

'cause you keep burning up
all the God damned ERs.

I'm not good at this.
They don't believe me.

That's why it's gotta
be Florida, okay?

They don't care down there.

We can get whatever
the fuck we want.

I can't go.

I can't go.

All right,
then get the fuck out.

BETSY: What?
WALT: I said, get the fuck out!

BETSY:
Jesus Christ, Walt.

[engine revving]

Fuck!

SAMUEL:
How about right here?

Oh, yeah.
It'sit'sit's getting worse.

Yeah.

Can't even wake up
without a pill anymore.

SAMUEL: Yeah.
You're taking them twice a day?

PATIENT:
Yeah, but where does that help?

SAMUEL:
Okay, you're having pain even when you don't take it.

Oh, 100%.
But I want off of this stuff.

SAMUEL:
Yeah.

I'mI'm either
falling asleep all day

or thinking
about the next pill.

Mmhmm, okay.

Well, we're just gonna
taper you off there, buddy.

PATIENT:
Wewe tried that.

Yeah, I know,
we're trying again.

I'm gonna lower your dose

from 80 milligrams
down to 40, okay?

And if you're experiencing
any withdrawal symptoms,

I'll cut that
with some Xanax, okay?

We'll get this right.

How many pills do you have left
in that bottle?

PATIENT:
A few. A few here.

SAMUEL:
Okay, just leave the bottle on the table there,

and, uh, we'll lower
your dose here, buddy.

All right.

We'll get you
feeling better, okay?

It'll be all right.

PATIENT:
Thanks, doc.

[tense music]

♪ ♪

We are so proud
to be honoring

my great brother,
Arthur Sackler,

into the Medical Advertising
Hall of Fame.

[applause]

In many ways, Arthur Sackler
invented medical advertising.

He was the first to realize

it wasn't patients who decided
what drugs they took.

It was their doctors.

Shunned by Madison Avenue
for being Jewish,

he formed his own company
specifically targeting doctors

with articles
from scientific journals

and studies
from medical societies.

Sure, sometimes the societies

and the experts
were financed by Arthur.

[laughter]

JONATHAN: Who do you think
is the bigger asshole?

Uncle Mortimer or Uncle Arthur?

C, all the above.
[Jonathan chuckles]

Not only
changed the way medicine

is marketed in this country;

it changed
the medical industry forever.

[indistinct chatter]

BETH:
Your uncle was good.

RICHARD:
For his time.

Hmm.

This one's missing the zombies

that valium
turned some patients into.

He got away with it.
Barely.

But it made him rich.

Beth, darling, would you
give us a few minutes, please?

Sure.
RAYMOND: Thank you.

You had to do it, didn't you?

Do what?

You had to say
it was nonaddictive.

Dad, even the FDA
Oh, please.

Call notes are starting
to come in that patients

are showing signs of addiction.

Just a few pockets
of West Virginia.

It's cultural.

All those hillbillies do
is get addicted.

And Maine and Kentucky.
All our phase one states.

If it becomes accepted
that more than 1%

become addicted, it's dead.

And one year of strong sales

isn't gonna make up
for the 40 million you spent.

[suspenseful music]

Any suggestions?

Take a page
from Arthur's playbook.

Get an expert
who'll tell doctors

the truth of our wonder drug.

We've got Russell Portenoy.

No, I'm thinking someone
more aggressive,

especially if your 1% claim
is, um, hmm.

What's that medical term?

Fucking bullshit.

Fine.

We'll find
an aggressive expert.

No, thethe osteoarthritis
was truly debilitating,

and nothing seemed to work
until I realized

that the patient
needed something strong enough

to stop the breakthrough pain.

So I started the patient
on methadone,

and she was back to normal
within just a few days.

Methadone?

You said find me aggressive.

He has a theory
called pseudo addiction,

which basically means addiction
doesn't exist.

Who is this guy?

David Haddox.

He went to dental school
but now heads

the Pain Management Department
at Emory.

Aa fitting progression.

MICHAEL:
You wanna meet with him?

God, yes.

So you really feel opioids
are underprescribed?

For decades.

Now, the Porter/Jick study
is exactly right.

Under the proper care,
opioids are totally safe.

II recently read
a theory of yours,

which is why I
I wanted to meet.

DAVID:
Thank you.

Let me guess: pseudo addiction?

Correct.
How'd you come up with

mm, uh.

Where did you discover
pseudo addiction?

Yeah, so I was, um,
so I was, uh, was working

with a 17yearold
leukemia patient

who showed
classic signs of addiction.

And yet we upped
his medication,

and he was fine.

Turns out that
he wasn't addicted at all.

It was that
that underlying pain

hadn't been properly treated.

[inquisitive music]

So pseudo addiction means

that, uh,

addiction symptoms are,
in actuality,

the symptoms of untreated pain?

That's correct.

Yeah, taking away a patient's
medication isn't helping them.

It's torturing them.

What they need
is more medication,

and then these supposed

addiction symptoms
will quickly go away.

So

so do you think all addiction

is, in actuality,
pseudo addiction?

In relation to medication?

Yes.
Huh.

DAVID: I look in those rare
instances when a patient

truly is an addict;

that's not the fault
of the drug or the doctor.

No, the patient was most likely
a drug addict to begin with

due to genetic defects.

What about cigarettes?
[David chuckles]

Addiction or pseudo addiction?

Yeah, smokingsmoking is
definitely pseudo addiction.

It's all in their heads.

How would you like to work
for Purdue Pharma?

[inquisitive music]

♪ ♪

RANDY:
Morning, boss.

RICK: Still no update
on the funding?

Well, good morning
to you too, Randy.

How's Jennifer? The kids?

RICK:
Sorry, good morning.

Nailed it.

You know,
it seems pretty darn odd

if these FBI guys
won't grant us

a small amount of resources.

Could just be,
as my son would say,

a dysfunctional government.

Your son's four, Rick.

Feeling a little inadequate
right now.

Good morning, guys.

RANDY: Morning.
What's up?

KAREN: Still haven't heard back
from the Medicaid office,

and Dr. Jick's office finally
called me back and said,

"The doctor's unavailable."

Unavailable? Today?

Nope.
She said unavailable, period.

RECEPTIONIST: Yes, I told you,
Dr. Jick is unavailable.

Well, I've called
multiple times,

and I'd just like
an explanation

as to why Dr. Jick refuses
to speak to me.

RECEPTIONIST:
He said he's very busy,

but I'll leave a message.
Thank you.

Well, this just
got interesting.

JOHN:
So what's the latest?

Well, as you know,

Purdue aggressively
pushed the drug

as nonaddictive
with the phrase

"less than 1% get addicted."

That figure comes from
the Porter/Jick study

that was done
by Dr. Hershel Jick at, uh...

Boston. Boston University.
RICK: Boston University.

JOHN:
Well, let me guess, it's that the fraudulent study

that was secretly funded
by Purdue?

Just like the pain study?
RANDY: Well, that's one theory.

We actually called Dr. Jick
to discuss it with him,

but something
very interesting occurred.

He wouldn't get
on the phone with us.

Well, nothing says suspect

quite like
an unanswered phone call.

If that 1% study
is indeed fraudulent,

it's a home run in proving
criminal misbranding.

Yeah, and if you can find

the highlevel Purdue exec
that oversaw it...

Could indict them for fraud.

Yeah, that's right.
It sounds like a great lead.

Yeah, this case is starting
to take up so much time.

That's right.

RANDY: We need more funding
for prosecutors

for our nonPurdue cases.
JOHN: Yeah, I know, I know.

I mean,
why won't the FBI or the DEA

give us additional funding?

You know, I don't know.

Maybe they're not, uh,
connected to the issue.

You know what you should do,
you should try

the Virginia State Police.

Try Virginia Medicaid
Fraud Unit.

They'll get it.
And you know, the more we find,

the more it opens up
those coffers.

Yeah, but it, it just
it is really difficult

to find anything without
the proper resources.

I mean,
I knew we'd be outspent,

but I did not expect

to not have access
to the most basic things,

like highspeed computers
and scanners.

JOHN:
Look, guys, II get it, trust me.

But we just
keep pushing, all right?

Yeah.
We'll see where it goes, sir.

JOHN:
All right, boys. You can enjoy your lunch.

RICK: Thank you.
JOHN: Keep me posted.

Oh, Randy.
Sir?

Uh, how you doing,
healthwise?

I actually just had
my oneyear scan,

and I am cancerfree.

Yeah, he's good.
JOHN: That's great news.

BRIDGET: OxyContin is becoming
the leading cause

of overdose in the country.

Newspapers are filled
with arrests in rural areas

where crime directly related
to the drug is skyrocketing.

Isn't Diversion
and local authorities

supposed to deal
with these crime issues?

Yes, but what makes this
so overwhelming

for law enforcement
is the sheer ease

with which users
can get access to the drug.

I mean, they are available in
every pharmacy in the country.

What do you feel
is the best approach?

I think
the most effective way

to solve this problem

is to limit the drug's use
for severe pain only.

It is a very strong narcotic
that is being prescribed

for issues such as basic
dental work and even headaches.

If it was no longer allowed
for moderate pain,

then overnight,

millions of pills
will be off the streets.

What about the millions
of legitimate pain patients

that will lose access
to the drug?

If they have severe pain,
they will not lose access.

But this recent practice
of opioid use for moderate pain

is causing a startling new wave
of crime and addiction.

The role of the FDA is
to make sure medicine is safe.

And when this drug
is taken as prescribed,

this medicine is safe.

And I disagree.

CYNTHIA:
Anecdotes about abuse and crime

are not a scientific analysis
of the drug's safety.

They're tales of addicts
abusing pharmaceuticals,

which happens with all opioids.

So until you can prove
the drug itself is dangerous,

I don't see how we can
put restrictions on it.

[tense music]

Okay.

Well, you're not gonna
take action,

then I will call in Purdue,
discuss it with them directly.

I think you should.
I will.

And your warning label
that this drug

is somehow less addictive

is total bullshit.

You should look into
changing that immediately.

BILLY:
Why would you start him on 20 milligrams

when 40 milligrams sounds like
it's gonna be more effective?

KANE: Hey, yo, Teddy.
RILEY: Yo.

BILLY:
Right, that's why you keep titrating 'em up

until all there's left to say
is thank you.

I managed to scrounge up
a couple of Hokies tickets

if you're interested.

You are the hardestworking
nurse in the state.

All right, you deserve
a spa weekend.

Listen, I think win or lose,
we go to the bar.

That'sthat's what
I've been saying.

Individualizing the dose
is everything.

BOTH:
♪ I work ♪

♪ I work, I work ♪

♪ I work, baby ♪

♪ I work, I work ♪

KANE:
♪ I'll get the job done ♪

BOTH:
♪ I work ♪

♪ I work, baby ♪

DAVID:
Which means that most symptoms of addiction

are, in reality,
untreated pain.

And the cure
for pseudo addiction

is that the patient
needs more medication.

MICHAEL:
More than 100,000 physicians,

almost half of all doctors
in the country

will be sent
pseudo addiction pamphlets.

Give one to any doctor
if their patients

show signs of addict
sorry, pseudo addiction.

Questions? Yes.

Last week, I had a doctor
tell me he had two patients

taking way more pills
than he prescribed.

Like, he was very worried

they were addicted
to the medication.

No, no, no, no,
it sounds like

your physician's
actually under prescribing.

No, he's not.

They're already taking
80 milligrams a day.

Look, if I tell them
that they're pseudo addicted

and need to be bumped up
to 160 milligrams,

he'll just kick me
out of his office.

Now that is
a defeatist attitude.

Dr. Haddox is giving us
innovative concepts,

and he deserves respect and
appreciation for his expertise.

Uh, ma'am, if people are
living with unnecessary pain,

and they're being stigmatized

when the solution
is right in front of them

if people are suffering,
they need a higher dose.

[applause]

[upbeat music playing]

Hey, I'm Sandra.

BILLY:
Hey. Billy.

So, um, which territories
do you cover?

Uh, Virginia.
Appalachia mostly.

Wow, lucky you.

Excuse me. Paula.

Hey, are you, uh, checking
into the hotel right now?

No, I'm going home.
They just fired me.

What? Are you serious? Why?

They said I had
inconsistent paperwork.

Oh, my God. Um, I'm sorry.

Don't be.

No, I'm relieved actually.

They all know.

And you know.

[tense music]

Uh, know what?

Okay, Billy.

♪ ♪

[unsettling music]

[Radiohead's
"Spinning Plates"]

♪ ♪

Individualize the dose.

SCIENTIST:
As opposed to other drugs,

opioids are uniquely
challenging to stop using

because they can change
a person's brain chemistry.

But in a desperate effort
to end the cycle of dependency,

some people try to quit
cold turkey,

but the results
can often be disastrous.

A hydrangea? How'd you know?

BILLY:
Oh, you know, I have my ways.

Can I, uh, can I see the doc?

Billy, you know he doesn't
wanna see you anymore.

Come on, there's gotta be
a misunderstanding here.

It's been months.

And Iyou know, I miss him.

Well, he cleared
his appointments today

'cause he's not feeling well.

I was in the bathroom
when you walked in.

Thank you, Leah.
Mmhmm.

[rhythmic knock at door]

BILLY:
It's your favorite pharma rep.

Doc, are you okay?

Never better.

Hi, I just, uh,

wanted to see
how you're doing and, uh,

see how you're patients are.

It's been a while.

Have a seat.
Sure.

Let me ask you
something, Bill.

Do you ever think that, um,

maybe that miracle drug
you're selling,

it's just, you know,

just a tad more addictive
than you said?

Uh, that's not
what we're hearing.

Um, but there is a condition
associated with this,

um, which III have
some information on.

I can share it with you. Um.

Pseudo addiction.

Uh, we're seeing some cases,
although rare,

where they show
the symptoms of addiction,

but in reality,
their underlying pain

hasn't been
sufficiently addressed.

Uh.

Andand the solution
is simple.

You know, youyou up the dose,
andand their symptoms,

you know, disappear, and
in time.

Let's have a look.

[unsettling music]

♪ ♪

You sell poison, Billy.

What's that?
SAMUEL: That's all it says.

You sell poison.
That's what you do.

That's just poison.

BILLY:
No, doc, I

Yeah, well, it's what it is.

Yeah, it's poison.

I can talk you
through it, doc.

It's a new concept.
It's all in here.

No, no, these are good,
hardworking people.

These are good,
hardworking people,

and you have
the FDA label this

Doc, anything in here
that you don't understand,

I can talk you through.

[grunts]

[tense music]

All right. Okay.
SAMUEL: Get out.

Get out.
BILLY: All right.

LEAH:
No! Dr. Finnix.

SAMUEL:
Get away.

You need to get going.
Don't ever come back.

Docdoc
SAMUEL: Get out of here.

BILLY: Doc, please.
SAMUEL: Get out of here.

[Billy grunts]

You ever come back
on these rounds,

I'll fucking kill you.

Yeah, I'll fucking kill you
myself.

LEAH:
What's wrong with you?

SAMUEL:
Take the rest of the day off.

Go home.

♪ ♪

[engine revving]

[engine shuts off]
[door thumps open]

[door slams]

Hi.

I didn't know you worked here.

Yeah.

What are you doing in town?

Oh.
BETSY: It's been a while.

Oh, I'm just
visiting my grandma.

How's Eureka Springs?

Oh, it's great.
Um, I really love it there.

I like your belt.

Oh, thanks. Um, I made it.

I guess I'm crafting now.

You still quilting?

Um, I...

[sentimental music]

♪ ♪

It's good to see you, Bets.

You take care
of yourself, okay?

[line trills]

Hey.

I wanna go to Florida.

SINGER:
♪ When I go driving, I stay in my lane ♪

[spirited rock music]

♪ But getting cut off,
it makes me insane ♪

[The Offspring's "Bad Habit"]

♪ I open the glove box,
reach inside ♪

♪ I'm gonna wreck
this fucker's ride ♪

♪ Guess I got a bad habit ♪

Hey, you want a Xanax?

It'll take the edge off.

How much?

Jesus, man, it's a gift.

In the Gulf, we used to say,
don't make me offer twice.

BETSY: Okay.
WALT: Take this.

It'll make you feel better.
BETSY: All right, all right.

I didn't know you were a vet.

Yeah, did two tours.

Shit I saw...

Hey.

Salvation at last.

SINGER:
♪ And your next breath is your last ♪

♪ Guess I got a bad habit ♪

♪ Of blowin' away ♪

♪ Yeah, yeah ♪

♪ Got a bad habit ♪

♪ Yeah, yeah ♪

WALT: Told you.
[Betsy laughs]

SINGER:
♪ Yeah, yeah ♪

♪ Got a bad habit ♪

♪ Yeah, yeah ♪

♪ And it ain't goin' away ♪

♪ Yeah, yeah ♪

♪ Yeah, yeahahah ♪

♪ Yeah, yeah ♪

♪ Yeah, yeahahah ♪

♪ Yeah, yeah ♪

DOCTOR:
So injury or chronic condition?

I hurt my back.
Mining incident.

DOCTOR:
Okay, I'm gonna need to examine you.

Did the nurse give you a gown?

Here you go.

Uh, bra too, please.

Okay, lift your arms.

Yes, you are definitely
gonna need painkillers.

[unsettling music]

Strong ones.

OxyContin, 40 milligrams,
twice per day.

Unless you have
breakthrough pain.

How does that sound?

Hey, these prescriptions
can really add up.

So if you're in a bind,

we might be able
to work something out.

It's fit's fine.
I have cash.

DOCTOR:
No problem.

Fill this out
at the dispensary in the back.

God bless
the great state of Florida.

♪ ♪

DREA:
I told you never to call me again.

SAMUEL:
Hi, yeah, you know, I'm I'm sorry, and II, uh,

do want to apologize for
for what happened.

I'm going
through some stuff, Drea.

Watching you fall asleep
in the middle of a restaurant

is not my idea of a good time.

SAMUEL: Yeah.
DREA: It was humiliating.

I know, I know, I'm dealing
with a medical condition,

and, um, in fact,

I was wondering if, you know,
possibly you could help me.

Uh, Drea, you don't have
samples of OxyContin, do you?

[laughs]
No, I don't.

Delete my number.

♪ ♪

SINGER:
♪ When this just feels like ♪

♪ Spinning plates ♪

SCIENTIST:
The brain is rewired to function normally

when opioids are present

and abnormally
when they are not.

And the pain from withdrawal
is so overwhelming

that a person can feel like
they are literally

going to die
if they don't get more drugs.

SINGER:
♪ And this just feels like ♪

What is the term for the pain
an addict feels

when they're in clinical need
of their next fix?

It's called dopesick.

♪ ♪

RICK:
You wanted to speak to me?

RANDY: Uh, there's something
very strange going on here.

RICK:
What is it?

RANDY: The Porter/Jick study
isn't on the internet.

What?

RANDY:
Yeah, I mean, it's referenced all over the place.

TIME magazine,
Scientific American.

But II mean,
I can't find the actual study.

Greg can't find it, either.
He's been on it longer than me.

Do you find any affiliations
between Purdue and Jick?

Paid speeches, consulting,
anything like that?

Nothing.

What about Porter?
Who's that?

It's Jick's assistant.
Jane Porter.

There's 10,000 of them.

So thethe famous
Porter/Jick study

that's the North Star
of the pain movement

to increase opioid use
is nowhere to be found?

Bingo.

Hey, yeah, we're calling about
a Scientific American article

you wrote in 1990,
"The Tragedy of Needless Pain,"

in which you referenced an,
uh, "extensive study"

that claimed less than 1%
of opioid users,

uh, become addicted.

RONALD:
Uh, yeah, Porter/Jick. What about it?

Do you have a copy
of that study?

RONALD:
Uh, I'm not sure.

Uh, have you tried
the Internet?

[chuckles]
Uh, you know, I sure did.

I might've missed it, though,

'cause I only type
with my index fingers,

but I hear, uh, JD Salinger
did the same thing,

so that kind of helps me out
in the selfesteem department.

RONALD:
[chuckles] Yeah.

Any medical school
will have it.

It's taught all over
the country, but, um,

I'm happy to check my notes
and call you back.

Oh, you know what?
I don't mind holding for you.

Um, my boss has been
getting on me about this,

and you'd really be
helping me out here.

RONALD:
Okay. I'll do a quick search.

Thank you.

Oh, Mr. Smarty Pants
knows his JD Salinger.

I got it
from my book learning, sir.

Thinking of reading
Moby Dick next

'cause I love whales

and, uh, reading stories
about whales and doing

RONALD:
Hi, um, yeah, it's right here in my notes.

The Porter/Jick study
is in a 1980 issue

of the New England
Journal of Medicine.

Do you know
which issue exactly?

RONALD:
No, that's all I have here, but good luck, okay?

I gotta get going.
RANDY: Okay, thank you.

[inquisitive music]

All right.

♪ ♪

Been through every issue
of a weekly publication

from 1978 to what, 1994,

and we can't find
this thing, huh?

So we got TIME magazine,

Scientific American citing it.
RICK: Mmhmm.

Medical schools all across
the country teaching it.

RICK:
Right.

And yet it appears to be
the most famous study

that no one
has actually ever seen.

Whwhat's going on?

ERIC:
Hi, Betsy.

My name is Eric Miller,

and I'm a member of the
AA community here in town.

Everyone in this room is here
because we're very concerned

for your health
and your safety.

And we have so many things
that we want to say

and share with you.

We're all worried
about your drug use

and think it's time
to seek treatment.

Why don't you sit down?

You lied to me
at the station.

Uh, I came here
because your mom asked me to.

we're all really worried
about you, Bets.

Your daddy and I don't care

about anything other than
you getting better.

All that other stuff, Bets,
doesn't matter.

Just doesn't matter.

[sentimental music]

ERIC:
Your friends and family are worried every day

that you're going to end up
in a hospital or dead

or in the back of a police car.

They wanna do everything
they can to help you get back

to a place of health,

of just being okay
without drugs.

Will you commit to a program?

♪ ♪

JERRY:
Pleplease, Bets.

Please don't walk out
that door, honey.

Youyour mama and me,
we just

we just want
our little girl back.

Just the way you are.

I'm sorry.

I can't. I can't.

Betsy, if you don't do this,

your family will be forced
to turn their back on you.

Grant! Get in here.

GRANT: What's up?
Guess who's coming to dinner?

Purdue Pharma agreed to meet.

Is Richard Sackler gonna join?

Doesn't say.

Let's see if they
give a fuck about safety

or if they're just
trying to sell pills.

Uh, look, II know

you're newest to Diversion,
but as a general rule,

the pharmas don't really care
about safety.

They just push as hard as they
can until they get slapped.

Then let's bitch slap
the shit

out of these motherfuckers.

[inquisitive music]

[Bridget snapping fingers]

♪ ♪

[clears throat]

Good afternoon.

I'm Bridget Meyer,
deputy director of Diversion.

I'm Michael Friedman.
Howard Udell and David Haddox.

DAVID:
Pleasure.

Is Richard Sackler coming?

Dr. Sackler had a meeting
out of state,

but I can assure you,
we'll relay every word.

Fine. Let's get started.

Uh, we'd like to start with
a, uh, PowerPoint presentation

about the efficacies
of OxyContin.

That won't be necessary.

I've seen
your promotional materials,

and I'm familiar
with your talking points.

So let's get right
to the issue at hand.

I've brought you here to talk
about addiction and abuse.

Since the launch of your drug
four years ago,

it has gotten out of control.

No, I beg to differ.

Uh, you can beg
when I finish.

Now, to be proactive,
my staff and I have come up

with some practical
common sense ideas

that we believe
could easily be implemented

and would really help reduce

the widespread abuse
of this drug.

We don't believe
the drug is being abused,

but we'd be happy
to hear your ideas

if you think
it would enhance public safety.

Given the growing incidences
of drugstore robberies,

it might be useful to reduce

the number of pharmacies
allowed to dispense.

This would also help
with pharmacies

that don't want
to carry the drug

but feel pressured to
because of threats of lawsuits.

We'll take it
under advisement.

We also thought that

you could limit
prescribing privileges

to doctors with training
in pain management.

It seems that GPs
are prescribing this for things

as frivolous as headaches
and toothaches.

The drugs should be limited
to pain specialists.

Well, um,
that's not only impractical,

it would also deny many
legitimate pain patients

access to the drugs, so.

That's verbatim,
the FDA's concern.

Do you have them on speed dial?

[tense music]

Excuse me?

Whatever friendly situation
you have going on over there,

I assure you,
you do not have here.

I want to restrict access
to this drug.

It is being overprescribed

and causing patients
to become addicted

as well as making it
too easily available

for recreational drug users.

Addiction rates, overdoses,
and crime is on the rise

across the country
because of this drug.

So if you will not take action
to curb this problem,

then I will.

♪ ♪

We'll take that
under advisement.

[indistinct chatter]

[suspenseful music]

♪ ♪

RECEPTIONIST: New England
Journal of Medicine.

Hi, my name
is Rick Mountcastle.

I'm with the
US Attorney's office

in the Western District
of Virginia,

and I'm trying to locate
a study

that you published years ago

regarding opioid addiction
by a Dr. Hershel Jick.

Does that ring a bell?

RECEPTIONIST: Oh, yeah.
We know Dr. Jick well.

He's been writing us letters
for years.

We've published a lot of them.
They're good.

Some people just, you know...
Wait.

RECEPTIONIST:
They love to read letters to the Internet.

I'm sorry, uh,
you mean, like letters?

RECEPTIONIST:
Yeah, yeah. He writes a lot of letters.

♪ ♪

RICK:
I found it.

That can't be it.

Oh, my God.

Government calls
Dr. Hershel Jick.

Afternoon, sir.

Dr. Jick, tell us about
your 1980 letter to the editor

at the New England
Journal of Medicine

regarding addiction rates
and patients taking opioids.

In the late '70s, I built
a database of hospital records,

which became known,
as it was one of the first.

After reading a newspaper
article on addiction,

I decided to calculate how
many patients in my database

showed signs of addiction
to narcotic painkillers.

Number was shockingly low,
less than 1%.

So I wrote up a letter

and sent it to the New England
Journal of Medicine.

This letter was based
on patients

confined to a hospital setting,
is that correct?

Yes.
Mmhmm.

Isso is the likelihood
of addiction

higher in these same patients

if they were not confined
to a hospital?

HERSHEL:
That is correct. It wasn't an official study.

It was an observation based on
a small group of patients

in a highly
controlled environment.

That's why the letter
was so short.

Yes.
It was five sentences long.

♪ ♪

How long would an average
scientific study

on addiction be?

Between 25 and 50 pages.

Which is more
than five sentences.

HERSHEL:
Obviously.

Have you ever worked
for Purdue Pharma?

No.

RICK:
Have you ever consulted for them

or received money from them?

No, I have no affiliation
with Purdue Pharma.

Well, are you aware
that sales reps at Purdue

cite your letter
as a scientific study

to convince doctors
that less than 1% of patients

would get addicted
to their narcotic OxyContin?

No, I'm not.

And are you aware that your
fivesentence letter is cited

as a major study by medical
schools all across the country,

and in magazine articles
from TIME magazine,

Scientific American as proof
that opioids are safe?

I was not aware of that.

Well, I'm gonna
tell you what,

there is an entire school
of thought espousing opioids

as being
practically nonaddictive,

and your letter is often cited

as a major source
for this thesis.

This particular letter
is very near the bottom

of a long list
of my published work.

It's simply provides
some basic numbers

based on a small group
of people.

I have no idea
how it became so discussed.

I'll tell you how.

So it became the primary source
that opioids are nonaddictive

when it was cited
in a 1986 article

in PAIN magazine,

which was highly influential
in transforming

the perception of opioids
from addictive to safe.

And this article
was coauthored

by Dr. Russell Portenoy,

who is now a paid spokesperson
for Purdue Pharma

and one of the chief
medical proponents

for increased use
of opioids and OxyContin

in the United States
of America.

Halfway home
to Abington, baby.

Whoo. Ah.
[Rick chuckles]

I'm all about
those small victories.

Aw, what do you mean,
small victories?

We had a big day.

[phone ringing]
Sure was.

Maybe it'll
help us get more funding?

I doubt it.

Rick Mountcastle.

Oh yeah, I remember you, Toby.
How're things at the DEA?

[suspenseful music]

Mmhmm.

Well, it's still early
in the case.

We haven't found anything yet.
You know what?

I'll tell you what
it isn't a good time to talk.

Try you another time? Yeah.

It's all right. Great, bye.

DEA wants to know
how the pharma case is going.

[sighs]

They have zero interest,

and right when we land
something big,

they justthey call us
right outta nowhere?

Let's keep this buttoned up.

Just me, you, and Brownlee.

I don't trust anyone
on this case.

AA MEMBER: Even after
nine years staying sober,

I know I got a disease.

So grateful I can come here
every week as a reminder

of what I need
to do to stay on my path.

Thank you for sharing, Belle,
and you're not alone.

Betsy, would you
like to speak?

Do I have to?

ERIC:
You might find it helpful.

This is a very safe space.

Just share
from your heart, dear.

We're all here to support you.

Okay, um.

I'm Betsy.

ALL:
Hi, Betsy.

BETSY:
I was prescribed OxyContin

for, uh, a back injury...

And it worked great at first,
but...

Then it stopped working,
and I needed more.

Here you are, sweetheart.

BETSY:
I guess

I guess I always felt
kinda tense

and uncomfortable
around people.

But taking the pills, it was...

It was the first time
I felt normal.

In maybe my whole life.

And now...

And now I don't feel

anything at all anymore.

All I think about
is getting more pills.

And it can get scary.

Aww, everything's
gonna be just fine.

Don't you worry.

How long has it been?

Two days.
I feel like I'm gonna die.

Oh, honey, it's the
worst feeling in the world,

but I can help with that.

You can?
Mmhmm.

I got 10s, 20s, and 40s.

It's a dollar a milligram,
so if you've got $40,

I can give you
four 10s right now.

I mean, wouldn't it be nice if
all this pain just went away?

Yeah.

Here you go.

[unsettling music]

Thank you so much.

It's gonna be
all right, sugar.

Thank you.

I'll see you here next week,
all right?

♪ ♪

WALT: Hey.
Hey, Walt.

WALT:
Doc, how you doing?

Ah, good, good.
Hey, sorry, I know it's late

Hey, no, you're all good.

Yeah, I'm gonna need
some of that 80s

if you got 'em, or 40s.
Whatever you got.

Yeah, yeah, you're in luck.
I'm newly replenished.

One second.

Now, hey,
put that awayput that away.

SAMUEL:
All right. Okay, okay.

SINGER:
♪ You feed me ♪

♪ To the ♪

♪ Lions, yeah ♪

WALT: Doc?
SAMUEL: Hey.

You got it?
WALT: All right, I got you.

All right, now,
this is two 12 bags.

SAMUEL: All right.
WALT: All right.

SAMUEL:
Got you here.

That's good, hey?

Thanks, thanks.
WALT: That's good.

SAMUEL:
All right, how're you doing? You all right? Good?

I'm good, man.
SAMUEL: Sorry, sorry.

I woke you up
so late there, man.

You knowyou know how it is.

Say, doc?
SAMUEL: Yeah?

You don't look good, man.
SAMUEL: Huh?

No, I'm not. I'm not.

No, I know, but do yourself
a favor, all right?

Snort those, crush them up.
Snort 'em.

How do you do that?

Put them in your mouth,
all right,

for about a minute.

And then rub off that coating
on the outside,

so make a little mark.

All right, crush it up,
snort it.

It's gonna hit you way better.

SINGER:
♪ When this just feels like ♪

♪ Spinning plates ♪

♪ ♪

♪ I'm living ♪

♪ In Cloud Cuckoo ♪

♪ Land ♪

♪ ♪

DORIS DAY:
♪ Stars shining bright above you ♪

[Doris Day's
"Dream a Little Dream of Me"]

♪ Night breezes
seem to whisper ♪

♪ "I love you" ♪

♪ Birds singing
in the sycamore trees ♪

♪ Dream a little dream of me ♪

[soft romantic music]

♪ Say "Nightynight"
and kiss me ♪

♪ ♪

♪ Just hold me tight
and tell me ♪

♪ You'll miss me ♪

♪ While I'm alone
and blue as can be ♪

♪ Dream a little dream of me ♪

♪ ♪

♪ Stars fading ♪

♪ But I linger on, dear ♪

♪ Still craving your kiss ♪

♪ ♪

♪ I'm longing ♪

♪ To linger till dawn, dear ♪

♪ Just saying this ♪

♪ Sweet dreams
till sunbeams find you ♪

♪ Sweet dreams that leave
all worries behind you ♪

♪ But in your dreams ♪

♪ Whatever they be ♪

♪ Dream a little dream of me ♪

♪ ♪

♪ Stars fading ♪

♪ But I linger on, dear ♪

♪ Still craving your kiss ♪

♪ I'm longing ♪

♪ To linger till dawn, dear ♪

♪ Just saying this ♪

♪ Sweet dreams
till sunbeams find you ♪

♪ Sweet dreams that leave
all worries behind you ♪

♪ But in your dreams ♪

♪ Whatever they be ♪

♪ Dream a little dream of me ♪

♪ ♪

♪ Dream a little dream ♪

♪ ♪

♪ Of me ♪

♪ ♪

[rooster crows]

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