OxyContin is extremely dangerous, and unless an individual requires immediate relief from extreme pain—say, from a horrific accident, medical procedure, or disease—it’s best avoided. Like its legion of prescription opioid brethren, it is, in effect, heroin in pill form. And yet thanks to the efforts of the Sackler family’s Purdue Pharma and the corporations that followed its lead, OxyContin is now consumed by millions of citizens who are addicted to it, and die from it, just like any other deadly narcotic. No matter Purdue’s protestations to the contrary, this so-called miracle drug has helped spawn a ghastly opioid crisis that from 2000 to 2019 caused 487,842 overdose deaths in America.
And as Alex Gibney’s latest documentary contends, this wasn’t an unfortunate side effect of a vitally needed treatment. It was a deliberate and dastardly crime, carried out in the name of profit.
Gibney’s two-part HBO documentary The Crime of the Century (premiering May 10 and 11) is an evisceration of Big Pharma, which it argues purposefully and aggressively flooded the market with OxyContin—and, later, the even more powerful fentanyl—in order to reap enormous windfalls, all while knowing that its product was hazardous, and certainly not fit for wide-scale mainstream consumption. With a level-headedness that makes its takedown all the more effective, Gibney’s film shines a spotlight on the evolution of Purdue and company’s treacherous conduct, linking physicians, sales representatives, boardroom bigwigs, distributors, pharmacies, and politicians in a contemptible conspiracy of fraud, negligence, malpractice, bribery, and mass killing.
Following a brief history-lesson recap of opioids through the ages, The Crime of the Century fixates its gaze on Purdue Pharma and its renowned Sackler family founders, who are referred to here as “some of the world’s most successful drug pushers.” It was Arthur who made the Sacklers an initial fortune by pioneering Madison Avenue drug advertising in the ’60s for Librium and Valium. He was the architect of a new world order of mass-marketing drugs to consumers, and though he didn’t live to see the advent of OxyContin, which came to fruition during the tenure of his nephew Richard, he was responsible for the environment in which it flourished. And flourish it most certainly did, landing on the scene in 1996 like a bombshell thanks to its delivery of opioid doses via a “Contin” pill-delivery system that allowed the chemicals to enter the bloodstream slowly and continuously over an extended period of time.
OxyContin was developed for people who’d had surgery, or were suffering from cancer, but Purdue knew that there was no real money to be made from those limited customers. Thus, a giant promotional push ensued, not only in the media but with doctors themselves, who were bombarded by sales reps with interconnected lies: that there was a pain epidemic in America that was going untreated; that OxyContin was fit for any type of ailment, major or minor; and that the drug was so safe that it could be taken as much as a patient wanted without any fear of addiction. The fact that these were, per Dr. Andrew Kolodny, “essentially heroin pills” was downplayed, as well as countered by FDA-approved OxyContin package inserts which stated, “Delayed absorption as provided by Oxycontin tablets, is believed to reduce the abuse liability of a drug.”
This was lethal deception, and The Crime of the Century methodically employs talking-head interviews, archival clips, and written documents (as well as narration from Gibney) to lay out how Purdue first concocted an unnecessary market—and attendant culture—for OxyContin, and then inundated the country with it. The method by which it did this was graft and fraud on an enormous scale. That involved incentivizing salespeople to perpetrate crimes and doling out kickbacks to cooperative physicians. And it also entailed paying off politicians with campaign donations—such as Tennessee’s Martha Blackburn and Pennsylvania’s Tom Marino—to pass legislation like 2016’s misleadingly titled “Ensuring Patient Access and Effective Drug Enforcement Act” bill, which neutered the DEA’s ability to stop the flow of OxyContin to pharmacies and “pill mill” clinics that had no qualms about fulfilling hundreds of daily prescriptions, even though such quantities were obvious red flags.
The Crime of the Century’s second installment spends considerable energy on John Kapoor’s Insys Therapeutics, whose despicable efforts to peddle SUBSYS—a fast-acting spray device for fentanyl—included hiring people to pose as doctor’s office employees in order to trick insurance companies into covering the cost of uncalled-for drug prescriptions. It’s a monumental exposé of institutionalized corruption and the scourge of addiction it created. Gibney paints a damning portrait of the big picture, in which virtually everyone on every rung of the pharmaceutical ladder—from Purdue to Cardinal Health to the halls of Washington, where DEA lawyer Linden Barber switched sides to work for his former enemies in a stark example of D.C.’s wretched revolving-door culture—chose to take part in the scheme, because there was insane wealth to be made and, should anyone complain, the blame could always be shifted onto the users themselves.
Wending his way through this scandalous labyrinth, Gibney also highlights how the crackdown on Big Pharma’s OxyContin, fentanyl and other opioid industries has helped push hooked patients to heroin and the black market, thus empowering drug cartels that were happy to fill a supply-chain vacuum. At the same time, he makes sure to deliver stinging montages of men and women overdosing and dying from pharmaceuticals. Those go hand-in-hand with harrowing personal stories of the cost of this war on everyday Americans, be it computer repairman Caleb Lanier of Lubbock, Texas, whose addiction drove him to become a fentanyl dealer, or Salt Lake City’s Roy Bosley, whose wife Carol died from an opioid overdose while under the supervision of Dr. Lynn Webster, a notorious pro-Big Pharma spokesperson who, in The Crime of the Century, makes a series of increasingly weak defenses of his role in spreading the OxyContin gospel.
Gibney’s doc makes clear that, in a multi-billion-dollar industry such as this, fines and settlements—like the ones Purdue Pharma and the Sacklers were hit with—are akin to meaningless parking tickets; the only solution, ultimately, is rigorous, comprehensive regulation. After spending four hours in this morass of individual and corporate avarice and inequity, however, it’s hard to have much hope that any meaningful remedy is on the horizon.