'Dopesick' casts the Sacklers as villains of the opioid crisis. Reality is complex

Editor's note: This story contains quotes and information originally discussed during a Twitter Spaces event hosted by NPR TV critic Eric Deggans and featuring NPR addiction correspondent Brian Mann, Dopesick author Beth Macy, Dopesick series creator Danny Strong and more. Follow us on Twitter, and read more of NPR's addiction coverage here.

For the millions of Americans whose lives have been shattered by the opioid crisis, Hulu's limited series Dopesick provides a cathartic piece of storytelling. For those who haven't been affected by addiction firsthand, the story offers powerful insight into the crisis, portraying the devastation many families feel.

When the Sacklers and their private company, Purdue Pharma, are introduced on-screen (often seen in their eponymously named museum wings or on one of their opulent estates), they're portrayed as the main villains of the story.

The series dramatizes Richard Sackler's long-running efforts to boost sales of OxyContin. Documents made public in recent years show that Purdue Pharma's effort to "turbocharge" opioid prescribing continued long after it was clear to people inside the company that addiction and overdose deaths were surging.

For many viewers around the U.S. who feel Purdue Pharma and its product OxyContin bear an enormous responsibility for the devastation caused by this public health crisis, it's powerful storytelling.

Based on journalist Beth Macy's 2018 book, Dopesick, the limited series tries to show just how hard it is to hold anyone — an individual or a company — accountable for the opioid crisis. And in the real world, it's even less clear if the Sacklers, Purdue Pharma or other players in the pharmaceutical industry may face meaningful consequences for their alleged roles.

While the Sackler family has faced criticism for its role in fueling the opioid crisis, the family denies any wrongdoing. Members of the family who led the company have never been charged with a crime, and it's very likely they never will be.

They're also likely to emerge from this scrutiny with much of their wealth intact, protected by a legal firewall that would prevent people harmed by OxyContin from suing them directly.

"Even the federal bankruptcy judge who approved this deal for the Sacklers described it as a 'bitter' outcome," said NPR addiction correspondent Brian Mann.

"Judge Robert Drain said he felt like the family at the center of this opioid crisis should have paid more. But this is how corporate accountability works right now — and it appears the Sacklers navigated the system, brilliantly."

Did the American justice system blink?

As far back as 2007, the Justice Department saw Purdue Pharma marketing OxyContin in some very dangerous and illegal ways. Department officials fined the company, and Purdue Pharma pleaded guilty to misdemeanor criminal charges.

A felony guilty plea entered by the drug company in 2020 revealed that much of the illegal activity kept happening long after that first Justice Department deal was signed.

Critics say federal regulators were often back on their heels, slow to curb escalating OxyContin sales that fed black markets for pain pills around the United States.

And all this while the government was spending huge amounts of money and resources on the war on drugs every year.

For their part, members of the Sackler family maintain they did nothing wrong as they profited more than $11 billion from opioid sales. They have agreed to contribute more than $4.3 billion to an opioid settlement.

The Justice Department has challenged that deal, arguing it's inappropriate for the Sacklers to receive legal protections from a bankruptcy court without first filing for bankruptcy themselves.

If that deal is confirmed on appeal, the Sacklers would also give up control of Purdue Pharma. But they're expected to walk away from this legal process retaining their status as one of the wealthiest families in the world, with a clean legal slate.

"This family will walk off into the sunset with their wealth," said author Ryan Hampton, who is living in recovery from opioid addiction. "When they're done paying this settlement after nine years, there's a model out there — it shows they'll actually be richer based on their investments and interest rates that they have."

Hampton played an active role negotiating with the Sacklers during Purdue Pharma's bankruptcy. For his book Unsettled, he also investigated how the bankruptcy settlement impacted communities hard hit by the opioid crisis.

"The maneuvering that has taken place with the Sacklers ... is continuing to this day," Hampton said.

"We shouldn't have to trade off corporate accountability for real public health solutions," Hampton added, "and that's what they're making us do right now in the Purdue Pharma bankruptcy."

Hulu's Dopesick, meanwhile, has the freedom to make claims about the Sacklers that legal systems — which citizens usually rely on to assess culpability — have not had.

Changing the narrative by blaming people with addiction

The bankruptcy settlement, if finalized, wouldn't prevent state or federal prosecutors from charging members of the Sackler family with crimes.

But most legal experts tell NPR they don't expect that to happen. Proving criminal misconduct in corporate settings is difficult, especially in highly regulated industries like Big Pharma.

Meanwhile, millions of Americans with addiction to opioids are working their way through the justice system.

Macy, author of the book Dopesick, explained that while Richard Sackler has avoided criminal charges, he famously put the blame for addiction on people with addiction.

"Abusers [of OxyContin] aren't victims," Sackler wrote in a 2001 email made public as part of lawsuits against Purdue Pharma. "They are the victimizers."

Many public health experts say that Sackler's narrative directed attention and accountability away from prescribers and pharmaceutical companies and left many with opioid use disorder stigmatized and abandoned.

"There's so much we need to do, and a lot of it falls right under the umbrella ... of unraveling the war on drugs," Macy said. "We [should] start treating people less like criminals; stop hammering abusers, like Richard Sackler told us to do; and start treating these folks as people with a genuine medical condition, which is what they are."

In the end, dramatizations like Hulu's Dopesick provide a black-and-white moral clarity that may be immensely satisfying to many viewers. But the U.S. justice system has not reached similar clarity for Purdue Pharma, the Sacklers and other Big Pharma companies that earned billions selling prescription opioids as more and more Americans died.

Copyright 2021 NPR. To see more, visit https://www.npr.org.