The snowballing opioid crisis in America has been a focal point for many acclaimed movies and TV shows in recent years, from Hulu’s Emmy-winning Dopesick, which tracked the roots of the epidemic both at Purdue Pharma and in the rural communities where their drugs did most damage, to Laura Poitras’ documentary All the Beauty and the Bloodshed, which won the top prize at last year’s Venice Film Festival.
Netflix’s Painkiller is the latest entry in the genre. Based both on Barry Meier’s book, Pain Killer: An Empire Of Deceit And The Origin Of America’s Opioid Epidemic, and on Patrick Radden Keefe’s New Yorker story Empire of Pain, Painkiller explores the combination of elements that allowed the crisis to take such a deep hold: the malfeasance of the Sackler family, which owns Purdue Pharma; the real unmet need of thousands of pain patients; and the systems that repeatedly failed to protect them. Although Painkiller is partially fictionalized and features several composite characters, the horror it depicts is absolutely real. Here’s a primer on the true story behind the series.
The opioid crisis took root in the 1990s.
In 1995, the FDA approved Purdue Pharma’s application for a new drug called OxyContin. At the time, the medical community as a whole was rethinking its approach to pain management; a 1995 editorial in the Journal of Clinical Oncology argued that doctors were systematically under-prescribing pain relief medication, and decried the “numerous barriers…that prevent patients from receiving effective pain treatment.” That sentiment helped to bolster excitement for OxyContin, which was billed by Purdue Pharma as being far less addictive than other opioid medications, and therefore less subject to abuse.
When OxyContin became available the following year, the FDA took the unusual step of including this claim on the drug’s official label, which stated: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” Thanks in large part to this promise, OxyContin soon became a runaway success, with sales rocketing from $44 million in 1996, to almost $1.1 billion in 2000.
It’s also worth noting that FDA examiner Curtis Wright, who oversaw the drug’s approval, left in 1997 to take a lucrative new job at Purdue Pharma. Meanwhile Richard Sackler, who had overseen the marketing push behind OxyContin, became president of the company in 1999. (In Painkiller, he’s played by Matthew Broderick).
During this period, pain had been elevated to “the fifth vital sign” within medicine, with doctors instructed to check all patients’ pain level as a matter of course alongside their temperature, pulse, blood pressure, and respiration rate. Increasingly, the messaging received by both doctors and patients was that pain was a problem that could be entirely eradicated through medication. “Physicians felt like this was being pushed down by pharma [companies], particularly the ones manufacturing opioids,” Dr. Dino Beckett, a West Virginia physician who’s spent years on the front lines of the crisis, told Vox. “You felt like you weren’t adequately treating pain if you weren’t getting this favorable rating from the patient.”
Uzo Aduba in Painkiller.
Amidst snowballing addiction and overdose deaths, regulators sounded the alarm in the spring of 2001.
Despite Purdue’s claim that OxyContin’s extended release formula made it less addictive, it soon became clear that the statistics did not support that conclusion. By the year 2000, areas with high levels of OxyContin prescriptions such as West Virginia, Maine, and eastern Kentucky, were seeing dramatically increased levels of opioid abuse and opioid-related overdoses. Between 1997 and 2003, the number of deaths related to opioid use increased eightfold, a figure that was echoed across other regions where OxyContin had a stronghold, primarily in Appalachian states.
In the spring of 2001, FDA officials met with representatives from Purdue Pharma to develop a “risk management plan” for OxyContin abuse. Shortly after that, the drug’s label was modified to remove the claim that OxyContin was less subject to abuse; it was replaced by a “black box warning,” the highest level of warning that can be attached to a product. But these modifications were too little, too late—by this time, the alarming spike in addiction and deaths had caught the attention of other regulatory bodies. OxyContin soon became the subject of a targeted National Action Plan by the DEA (Drug Enforcement Administration), a first in the agency’s history.
In 2002, the first federal investigation into Purdue Pharma was launched in Virginia, focusing on the company’s marketing practices and its claims regarding the drug’s addictive potential. Ultimately, that investigation ended in 2007 with a plea agreement; Purdue was fined $634.5 million for criminally misbranding OxyContin. It was a muted victory for prosecutors, who had recommended felony charges against Purdue’s top executives which could have resulted in jail time. But the legal fight was only just beginning.
Almost 3,000 lawsuits have been filed against Purdue Pharma in relation to the opioid crisis.
In the fall of 2019, Purdue filed for bankruptcy, having been hit with more than 2,600 federal and state lawsuits. By the time the company was dissolved two years later, that number was close to 3,000.
In October of 2020, the company agreed to plead guilty to criminal charges related to its marketing of OxyContin, admitting that it had defrauded federal health agencies, violated anti-kickback laws, and marketed opioids to doctors whom it suspected were writing illegal prescriptions. The combined penalties of roughly $8.3 billion were the largest ever imposed on a pharmaceutical manufacturer, and concluded a years-long federal investigation into the company.
This settlement was heavily criticized for shielding the Sacklers themselves from any liability, and several states appealed the judge’s ruling. Washington State attorney general Bob Ferguson said that the agreement was “morally and legally bankrupt,” allowing the Sacklers “to walk away as billionaires with a lifetime legal shield.” But in the spring of 2023, an appeals court upheld the original ruling, giving the Sacklers immunity from any civil (but not criminal) litigation relating to Purdue Pharma, in exchange for making payments totaling a combined $6 billion to thousands of plaintiffs in various lawsuits.
Painkiller executive producer Peter Berg told Tudum that the series aims to tell “the origin story of the collision between medicine and money” which allowed the opioid crisis to unfold as it did, highlighting not just the Sacklers’ nefarious marketing tactics, but also how they were aided and abetted by a pharmaceutical industrial complex that’s fixated on profits over people. “You can’t understand the epidemic unless you look at all of the participants,” added executive producer Eric Newman. “The people who did it, the people who let it happen, the people who suffered from it—and the people who blew the whistle on it.”
Emma Dibdin is a freelance writer based in Los Angeles who writes about culture, mental health, and true crime. She loves owls, hates cilantro, and can find the queer subtext in literally anything.