When you hear the phrase “the opioid crisis,” it can sound like it’s referring to a natural disaster with a beginning and an end. But as Alex Gibney’s shattering two-part, four-hour HBO documentary “The Crime of the Century” makes devastatingly clear, the opioid crisis is more than a human tragedy that has claimed half a million lives. It’s part of what America has become. We’re a nation of addicts, fueled by scuzzy alternating currents of pleasure and despair; a nation of corporate malfeasance; of doctors who knowingly trash the credo of “do no harm”; of regulatory agencies that no longer function as they were designed to; of politicians who allow laws to be written for them. “The Crime of the Century” is a saga of addiction that could have been entitled “What We Did for Greed.”
Gibney is our most avid and deep-drilling documentary muckraker, and his message is that the opioid crisis didn’t just happen. It was orchestrated. The first half of the film investigates how Purdue Pharma, in 1996, brought OxyContin onto the market and pushed it like fast food — in a way that was so medically irresponsible it was morally (and maybe legally) indistinguishable from back-alley drug dealing. OxyContin wasn’t the first opiate identical to heroin to be marketed as a narcotic for pain relief. But each pill was embossed with a sealant that allowed the drug to be time-released into the bloodstream, and the Purdue executives used that fact to pretend that the drug was infinitely safer — less prone to abuse — than it was. The FDA official Curtis Wright allowed Purdue officials to literally write the drug’s approval for him (within a year, he was hired by Purdue at a salary of $375,000). The stage was then set for the drug to be prescribed not just for late-stage cancer patients or for those recovering from surgery, but for anyone suffering from any kind of pain.
“Pain relief” sounds like an innocuous phrase out of an old Bayer aspirin commercial, but Gibney captures how the elimination of pain has been elevated, by the pharmaceutical-medical establishment, into a false American cult of wellness. It’s no accident that the Sackler family, owners of Purdue Pharma, advanced this way of thinking. It was more or less invented in the early ’60s by Dr. Arthur Sackler, who brought drugs into the age of advertising with the marketing of Valium. OxyContin was sold as a quality-of-life drug, which is how it hooked thousands. And that marked a paradigm shift: From this point on, you could basically walk into a doctor’s office and ask for pain relief. “The Crime of the Century” is a full-scale vision of how America, addicted to pain relief, embraced the corruption of legalized drug pushing.
Gibney shows us the rise of pain clinics (also known as pill mills) in Florida, which were staffed by doctors who doled out prescriptions to anyone who came in, with the drug options literally presented on a menu. He interviews people like Patrick Radden Keefe, who did groundbreaking reporting on the epidemic and wrote the new book “Empire of Pain: The Secret History of the Sackler Dynasty,” and Art Van Zee, a small-town physician from western Virginia who was one of the first to see his community decimated and wound up testifying before the Senate, where his pleas were shot down by Sen. Chris Dodd of Connecticut (the home base of Purdue). Gibney also talks to Lynn Webster, who became one of the pioneering culprits of the racket in which physicians are paid off in speaking fees, and who used his Lifetree Clinic to distribute voluminous amounts of drugs for pain relief. We follow the tragic case of one of his patients he kept re-addicting, even after she’d gotten off the pills.
The movie shows us how Rudy Giuliani, once he left office, became a pitchman/hatchet man for Purdue, using his prestige as “America’s Mayor” to lend the company credibility. And we see Paul Goldenheim, Purdue’s chief medical officer, testifying before Congress that once Purdue learned that OxyContin was becoming a heartland problem, the company sprung into action — a stance flagrantly contradicted by his own emails. The company had, in fact, conducted its own “spoon-and-shoot” study (demonstrating that the pills could be crushed, mixed with water, and injected like heroin), and by 1998 Purdue executives and members of the Sackler family were well aware that the drug was being sold on the street for $40 a pop as “purple peelers” or hillbilly heroin. The company responded by introducing a 160 milligram pill, prompting one Purdue official to write, “They’re killing themselves with the 80s. Why would we come out with a 160?” The film presents excerpts from a hearing in which Dr. Richard Sackler is grilled, and he is a study in terse-lipped denial.
“The Crime of the Century” does have a hero of sorts: Joe Rannazzisi, the former DEA enforcer who was nudged out by members of Congress bowing to pressure from the pharmaceutical industry. He’s still on the anti-opioids warpath, though now he’s working on a grassroots level; he’s a David fighting the corporate Goliath. Even when federal investigators called Purdue on the carpet, the company was dogged for fines that sounded big in newspaper headlines ($600 million!) but amounted to a small percentage of the billions in profits that Purdue had made from opioids. And the members of the Sackler family were able to evade prosecution.
At the same time, the door had now been kicked open to even greater mass abuse of opioids. The second half of “The Crime of the Century” centers on fentanyl, a synthetic opiate 100 times as powerful as morphine, and how it was sold in spray form and jammed onto the market by Insys Therapeutics, a company that paid off dozens of Congressmen to rewrite the laws to allow it. Gibney tells the story of the company’s founder, John Kapoor, its leading sales rep (a “used-car salesman on steroids” named Alex Burlakoff), and on down to ground level, where we come face to face with a local pusher and one of the young people who died ingesting his product. It’s a rinse-repeat cycle of money, addiction, and death. All brought to you by nice people in lab coats.
“The Crime of the Century” will be shown on HBO in two parts on Monday, May 10, and Tuesday, May 11.