Front Burner - Alex Gibney: Big Pharma created the opioid crisis

Episode Date: May 17, 2021

Award-winning filmmaker Alex Gibney’s scathing new documentary, The Crime of the Century, looks into how Big Pharma created and profited from the opioid crisis.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. When it comes to understanding the severity of Canada's opioid crisis, the numbers, well, they speak for themselves. According to the federal government, there have been more than 9,000 apparent opioid-related deaths in Canada since just 2016. This is a national issue,

but it hits really hard in British Columbia. It's been five years since an overdose crisis public health emergency was declared in the province, and since then things have only gotten worse. Last year was the deadliest year ever for drug overdoses in BC, with more than 1,700 deaths. That's almost five deaths a day. So how did we get here? And who is responsible? Those are the questions at the core of Alex Gibney's new two-part HBO documentary, The Crime of the Century. It's the director's latest project and a scathing look at how Big Pharma created and profited from the opioid crisis. I'm Jamie Poisson, and Alex Gibney joins me now. Hi, Alex.

Thanks so much for making the time to speak with me today. Delighted. So I'm hoping you'll take us inside your really damning documentary that recontextualizes the opioid crisis as a crime committed by pharmaceutical companies, doctors, pharmacists, distributors, not something that just happened. And we're going to be talking a lot about Purdue Pharma today, which created OxyContin, and the family that owns the company, the Sacklers. And can you tell me about who Arthur Sackler is and how he changed the pharmaceutical industry? So Arthur Sackler is a guy who was a doctor. He became intensely interested in psychiatry. He was at the Creedmoor, famous sort of psychological hospital in New York, and was faced with the prospect of actually doing lobotomies on patients and also a lot of electroshock therapy. And he found it very dispiriting. He thought it was barbaric and wondered if there wasn't a better

way, if there wasn't a way through chemicals, through pills, through pharmaceuticals, that you could actually address some of the same maladies that they were trying to so brutally address with pre-orbital lobotomies and electroshock therapy. So that put him down the road. But what really made his fortune was his association with an advertising firm where he learned, well, he invented really a lot of the mechanics of promoting drugs. And one of the things that's instructive in terms of the OxyContin story is that he found a way, particularly with Valium, of radically expanding the market for the drug so that his advertising mechanism was a way of saying, look, some people take this because

they're intensely, intensely depressed, but we found it can be good for a lot of different kinds of people, maybe everybody. And Valium it can be good for a lot of different kinds of people, maybe everybody. Right. And, you know, Valium became one of those drugs. There's a famous movie in which Jill Kleberg, you know, asks for a Valium in a department store and like 50 people, you know, rush out with bottles of Valium to give her one because everyone's taking it. And he really pushed the envelope, though, in sometimes unethical ways. And he would try to sell these drugs to doctors and sometimes would hire or invent doctors

to promote these drugs who didn't exist. You see pretty quickly how this can get kind of perverted. And at a certain point, the idea that the doctor, who we're raised to think of as a real kind of perverted. And at a certain point, the idea that the doctor who were raised to think of as a real kind of custodian of our health can be enlisted in a sham or just outright invented in the interests of selling a product. And so he crossed a lot of ethical lines in terms of promoting this stuff. So it was kind of the precursor to some of what was done later with his nephew, Richard Sackler, at Purdue Pharma. And so knowing that context, I want to now zoom forward to 1996

when Arthur is gone. But as you mentioned, there are other Sacklers sort of in charge of Purdue Pharma at this point. And this is the year that OxyContin is invented. And how was this drug different from other pain medications or opioids? Well, OxyContin is in its pure form Oxycodone, which is a narcotic. It's an opioid about twice as powerful as morphine. But the contin part is a time release mechanism. And Purdue Pharma had a drug prior to OxyContin called MS-Contin, which was basically time

release morphine. The patent on that was running out. So they decided to try a drug called OxyContin, which was more powerful, but also had this time release mechanism. And that's what they went out to the market with. Now, OxyContin was a pretty good drug for end-of-life cancer patients who were suffering excruciating pain, but were not going to live long enough to really find that addiction was going to be a problem. But in the case of OxyContin, what Purdue ended up doing was to say, well, look, it's good for those people, but it's also good for a lot of other maladies and pain. So they suggested that it was time to expand the market, because after all, that would be far more profitable. Right. And not dissimilar to what

Arthur Sackler did with Valium, as you just described. Can you take me through how they did that? They did it a couple of ways. One kind of shocking thing, which we discovered by perusing some leaked documents that hadn't surfaced before, was that they actually gamed the system with the FDA, the Federal Drug Administration. There was a medical examiner who was examining the application for OxyContin, a guy named Curtis Wright. And apparently he spent three days with members of the Purdue Pharma Company, and they were helping him to write the medical review of their own application, which is kind of a shocking thing. Shocking.

Yes. Purdue and Curtis Wright may have broken the law. There's no way this should be allowed, that a drug company would be involved in drafting the review of its application. in drafting the review of its application. And what came out of it were some information in the package insert, the paperwork that goes along with the medication, basically to say that the time-release mechanism guards against abuse and also to suggest that if you take OxyContin because of its time-release formula, if you stop cold turkey, you won't have any ill effects.

Both of those things were untrue, but they managed to get them into the package insert. And that was a marketing tool that they were able to use effectively with doctors to say what became their slogan, the one to start with and the one to stay with. And the idea is that these drugs could not be abused and no dose was too high. Those were dangerous messages to be sending to the marketplace. So how else does Purdue Pharma go about making this drug ubiquitous? They target doctors within the context of a broad campaign that's being waged during this period to reinvent the idea of pain, that pain for many people was becoming the fifth vital sign. A whole generation of doctors bought into this idea that it's okay to use opioids liberally as long as you're giving them to a patient in pain.

Nothing was more important than curing pain. So within that context, they're going around to doctors and saying, you're under treating pain, radically under treating pain. Not only that, but we've got this drug that's really going to help you. And furthermore, people who use this drug can't get addicted. They can only get pseudo addicted. There's this new nonsensical phrase that came up called pseudo addiction. And the idea was that if you start feeling effects that might be akin to addiction, it just means that you're not getting enough pain medication. It means that pain isn't being properly treated. So you increase the dose. So actually, the campaign was, if you feel like you're getting addicted, don't worry, just increase the dose.

Not something that I would recommend for, say, a heroin addict. So that was a problem. And talking about that culture, your documentary really zooms in on this sort of intense Gordon Gekko greed culture at Purdue. There's this bizarre scene from a company event where employees are going nuts over like rock songs about selling Oxycontin to everybody. Purdue, are you ready to rock? OxyContin to everybody. Purdue, are you ready to rock? Can you give me a sense of just how much money was on the table here for the company and by extension for the Sacklers?

Yeah, billions and billions of dollars. I mean, during the late 90s, I believe late 90s, early 2000s, they passed Viagra as the best-selling drug. And you're right. We actually were able to uncover some videotape of company sales events, you know, complete with a rock band. And there was a lot of concern at these sales events for the patient. You know, you didn't hear a lot about, oh, my God, isn't it great how much we're doing for the patient? It was all about selling and all about the money was going to be made. Put your hands together if you're ready now.

You know you make me want to sell OxyContin. And it was like, we're going to sell OxyContin, sell MS-Contin. And everybody's, you know, bumping and grinding at the party. It's a wild thing to watch. Through the back half of the 90s and the early 2000s, the overprescription of this addictive drug, it spirals out of control, right? Can you paint that picture for me? What did it look like in the United States? Well, you're beginning to see communities that are just ravaged by it. It's happening because people who are taking prescription opioids get addicted and then need more.

And if they can't get more for their doctor, they're turning to heroin. It's also happening because Purdue's claims about the abusability of the drug were just false. So people who wanted to just get high were taking the drugs and crushing them, thereby defeating the time release mechanism. And because there was such a potent dose in there, they could get incredibly high. And so it became the drug of choice. In fact, Purdue reps themselves referred to it as hillbilly heroin. And communities, and we talked to one doctor in the west of Virginia, who realized that an enormous proportions of teenagers and community members were becoming addicted and overdoses were rising dramatically. It was really a serious problem.

I was sitting in the front room of the classroom and heard two thumps of two classmates falling out of their desks. Started foaming at the mouth. That doctor, I believe you're talking about Dr. Art Van Zee? Yes. Yeah. I know that he took these concerns to the government, to Congress. And what happened? Well, he was given a rather skeptical reception by Senator Chris Dodd, who's known as a liberal senator. But Senator Chris Dodd was also the senator from Connecticut, which is the

home state of the headquarters of Purdue Pharma. And prior to the hearing at which Dr. Van Zee testified, you know, Senator Dodd had been given a number of Purdue talking points by the Purdue executives, which he then effectively repeated in congressional hearings. And not too long after Art Van Zee's appearance and Senator Dodd's rather dismissive reaction, you know, Senator Dodd received, I believe it was the highest campaign contribution he'd received that year. How is Purdue responding to all of this publicly? in the state of Maine, where a U.S. attorney named Jay McCloskey came out with a report that said terrible things are happening, and they're all happening around this drug OxyContin, and we're very, very concerned. And this was coming right around the same time as Dr. Bansi and others were

raising concerns in Western Virginia. And there were a number of congressional hearings, and Purdue executives appear before them. And what the Purdue executives say is we are shocked to learn that OxyContin is being abused. We had no idea. And then the other thing they began to do is to say, well, look, of course, addiction is a problem. But the real problem is not the drug. It's the addict. It's a little bit like what the NRA says about weapons. And so there are, of course, bad people out there. We call them addicts. And that can't be the

concern of a very good drug. So it was blame the victim and also pretend that they were completely unaware of the problems of their drug. You address this in your documentary, these prosecutors in Western Virginia that took a run at Purdue around 2006. And what ended up happening with that criminal probe? Yeah, so these were US attorneys in Western Virginia, who engaged in a very thorough investigation of Purdue to see if they were fraudulently marketing the drug, that is to say, of Purdue to see if they were fraudulently marketing the drug, that is to say, trying to sell it under false pretenses all over the country because they were terribly concerned with the amount of addiction and overdoses. They developed over the course of a three to four year investigation,

a 120 page prosecution memo, which they submitted to their superiors at the Department of Justice in Washington. And they all agreed that the Purdue executives should be prosecuted for felonies, which would carry significant jail terms. But Purdue then used its political firepower, hiring former U.S. attorneys like Mary Jo White and now famous Rudy Giuliani, to lobby for a different kind of a treatment. The higher-ups of the Department of Justice decided to cut a deal with Purdue. And that meant that three Purdue executives would plead guilty to misdemeanors, which meant they would do no jail time. Purdue would plead guilty as a company, as an abstract entity to a felony. And Purdue would pay a fine of about $600 million, which seems like a lot of money, but pales in comparison. But here's the most important thing. All of the evidence, or all of

the most damning evidence that had been uncovered by the prosecutors would be buried and remain buried until very recently when we revealed some of it in this film. A sense of why that happened, why it was buried in the first place? You know, I think that the reason they got a deal was they were able to bring political muscle to bear. Part of this old story, the crime of the century, is about how damaging money can be in a democracy where there are no checks and balances on campaign contributions and somehow a decision was made not to prosecute. And that had terrible consequences

because years after that, Purdue made its most profitable years. And not only that, but many, many, many other companies, seeing that Purdue effectively paid a speeding ticket for a serious violation, entered the market and also began to sell powerful opioids to an ever-growing market. I'm going to go. Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples.

Can you tell me about the rise of fentanyl in those succeeding years in particular? So fentanyl is a synthetic opioid, which is 50 times more powerful than heroin. You know, fentanyl is a drug that also has pharmaceutical applications. And in the film, we look at one company that has a fentanyl spray, you spray it underneath your tongue, and you get that opioid effect. But fentanyl also plays another role in the sense that one of the issues in this whole story is the way in which licit pharmaceuticals and the market for illicit pharmaceuticals begin to merge. And, you know, sometimes in the course of people getting addicted to prescription OxyContin or by

abusing OxyContin, they then realize it's too expensive and they go for a cheaper alternative, which is heroin. Then heroin becomes too expensive. So they go for an even cheaper alternative, which is fentanyl. And fentanyl for some years was available via FedEx from China. You could just order it online and have it sent. And because it was so powerful, you could not only feed your habit, but you could make a lot of money selling it. The danger of fentanyl is that it's so powerful that in the black market, nobody knows what kind of dose they're getting.

And so overdoses are extremely common. Over half a million Americans have died of opioid overdoses. As I mentioned at the top of the show, the damage done here in Canada is catastrophic as well. And I want to talk about where we are with accountability for these deaths and for so many ruined lives now in 2021, starting with Purdue and the Sackler family? What kind of accountability have they faced? None. I mean, except for some accountability now that's starting to happen in the court of public opinion. I mean, Purdue has paid fines. But as recently as 2020, just just before the presidential election, there was another deal announced with the Department of Justice where Purdue, the company, pled guilty to yet more felonies. But no executives would see any jail time.

A huge fine was announced, $8 billion. But weirdly, because the Sacklers, the family that owned Purdue, were pulling out billions and billions of dollars from 2006 until 2020, Purdue itself had to go bankrupt. So how is Purdue going to pay that $8 billion fine? In order to help undo the damage done by OxyContin, Purdue Pharma is now going to sell more OxyContin. Wow. You know, some of the big pharmaceutical distributors really haven't paid much of any of a price. They've been fined a few hundred million dollars. But there are now these this multi-district litigation, which is being centered in Cleveland, but it represents the attempts by towns and counties and states all over the United States to try to sue some of these pharmaceutical companies to get some

compensation, some financial compensation for the damage done, overdoses, drug treatment, and law enforcement, and so forth and so on. Okay, Alex Gibney, thank you so much for this. Thank you. All right. So before we go today, an update on the ongoing military sexual misconduct crisis and another blow to military leadership credibility. On Friday, it was released that Danny Fortin, Major General in Charge of National Vaccine Logistics at the Public Health Agency of Canada, has stepped down related to a military investigation into a sexual misconduct allegation. We'll be watching this evolving story. Front Burner has a standing request to speak with Defense Minister Harjit Sajjan. He has yet to be made available to us. That's all for today. I'm Jamie Poisson. Thanks so much for listening

to Front Burner. Back tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.