HBO doc ties corporate/political greed to opioid crisis

Documentarian Alex Gibney opens his latest film “The Crime of the Century” in predawn darkness. (See trailer.) Members of a police narcotics unit wait outside an apartment complex for paramedics to pronounce a victim dead. Once the pronouncement comes, their swabs and mobile chemistry equipment confirm the culprit to be the synthetic opioid fentanyl. They then cart off the cloaked body before any neighbors awake.


We don’t know where this is or, at first, when. The wearing of pandemic masks suggests more recent footage, but the point is dual. First, this could be anywhere in the U.S. since Perdue Pharma launched the opioid crisis 25 years ago with its fraudulent mega-marketing of OxyContin. Second, despite more than a half million U.S. deaths from opioids and 3 million current and former addicts, most Americans remain unaware of the full extent of the crisis and the vast corporate greed and political connivance behind it.


Thus, part of the tragedy is just how much of HBO’s two-part, four-hour documentary will be a revelatory outrage for most viewers. This has been a drug war weakly fought largely against ourselves and with comparatively little media coverage. Even for a reporter like myself who has covered and been personally touched by it, Gibney’s documentary contained more than a few new details about the depth of the crime in the film’s title.


One of my personal associations came eight years ago in an Arizona maternity ward. My wife and I were adopting our first and only child. I learned from Gibney’s documentary that every 25 minutes in the U.S. a baby is born with opioid withdrawal. One of these was our son. We met the birth mother months earlier and tracked her prenatal doctor appointments, which she didn’t always keep. So it was not completely surprising when her delivery-room blood tests came back positive for opioids.


Our infant son spent his first five days of life in a neonatal intensive care unit partly for withdrawal. We visited him every day and knew that the science wasn’t exact about the degree to which opioids could penetrate the blood-brain barrier in utero and affect development. After his release from intensive care, we took our son home, thankful he had at least not experienced the ear-piercing withdrawal screams of other babies or last rites like one neighboring infant.


Our son does have some ongoing educational challenges and will most likely be on medication his entire life. But he is loving and sharp, and like parents everywhere, we are nurturing him every day so he can achieve everything his abilities allow.


PART ONE


My wife and I also know compared to all the tragedy and emotional distress spawned by the 100 billion opioid pills that Big Pharma unleashed on America, our connection to opioids is far from the most heart-wrenching. In “The Crime of the Century,” an EMT tells how he found one family of four that had fatally overdosed together. There was a Utah widower who detailed how after his wife was injured in car accident, she was overprescribed OxyContin, became addicted, successfully rehabbed, but then was overprescribed again by the same doctor until she perished. At the end of Part One, one haunting image showed a run-down opioid house with a black arrow and the word “Hell” spray painted on a broken door.


Part One is largely dedicated to the fraudulent history of Perdue Pharma and the billionaire Sackler family behind it. Gibney also details the original “spectacular crime” in the mid-1990s that led to the Federal Drug Administration approving the company’s powerful opioid OxyContin as a safe, general pain killer and not just for end-of-life cancer patients.


Related tot his, the documentary explosively exposes that Perdue Pharma secretly co-wrote the medical review of own application to the Federal Drug Administration. An FDA medical director named Curtis Wright was expected to independently review and write his recommendation, but instead, he huddled for several days with Perdue officials in a Maryland hotel room to produce the fraudulent recommendation. Later Wright would be hired by Perdue and paid hundreds of thousands of dollars a year.


This fraud led to approval of a single sentence on OxyContin’s label that represented a death sentence for so many. The label stated “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” This claim was allowed even though Perdue provided no evidence for it. This wording would later be strengthened, but the drug was never recalled.


A highpoint of the documentary comes when Gibney’s team presents Dr. Andrew Kolodny with a leaked document proving the hotel room story to. Kolodny is executive director of Physicians for Responsible Opioid Prescribing, and the camera pans up from the paper he’s just been handed to his look of shock as he reads it.


“Wow. This is the first time I’ve ever seen this. This isn’t just unethical. I think this could be illegal that they allowed Perdue to do this. If it is illegal, it would look as though both Perdue and Curtis Wright may have broken the law. There is no way this should be allowed that a drug company would be involved in drafting the review of its [own FDA] application,” Kolodny said.


The individual I most identified with was the earnest, principled rural Virginia doctor Art Van Zee. When widespread misuse of OxyContin hit his community like a tsunami, he wrote to the chief medical officer of Perdue. He reported this included 9% of local 7th graders being found to have tried Oxycontin at least once, and 25% of the 11th graders. Perdue’s response struck Van Zee as just a thin effort at marketing, and he later participated in an unsuccessful recall drive of OxyContin.


In 2002, Van Zee testified at a U.S. Senate hearing on opioids. Before and during the hearing, he felt rudely dismissed by then Democratic Senator Christopher Dodd of Connecticut, where Perdue was headquartered. The documentary described Dodd as a proud booster of the company and regular recipient of political donations.


At one point in the hearing Van Zee said, “If you have an abusable drug that is highly available, it’s going to be highly abused,” and Dodd responded by musing whether that was a quaint Appalachian saying. Then instead of blaming the company, Dodd said blame should more rightly fall on the addicts for killing themselves.


PART TWO


This pattern of political apathy and fundraising in the face of vast addiction, death, and corporate lobbying is chronicled even further in Part Two. My own reporting has found that in the last decade the five largest U.S. opioid makers and six largest distributors have pumped $60 million into the American political system. Combatting the power of such political donations motivated my run last cycle for Congress, especially after I discovered my county’s two primary members of Congress had taken nearly $200,000 from the opioid industry over the last decade. This included the incumbent I opposed, Ami Bera, who is a doctor.

In addition, all of these donations to Bera and his Congressional colleague came from opioid companies currently being sued by their county health department to recoup the cost of the public health response. Despite this, I not only couldn’t get any local media outlets to cover the issue, but not one editor or reporter would return my calls or emails, which I dutifully made each time a new local record fine was assessed or a billion-dollar settlement announced somewhere.


The fines and settlements were dutifully covered, but never the newsworthy connection to our Congressional representatives. With the public largely ignorant of this political tolerance, both incumbents were re-elected easily, and both have already accepted new donations from the opioid industry during the first three months of the 2021-22 election cycle.


Back in 2016, these same officials also participated a dispiriting corruption of our federal legislative process. As Part Two chronicled, as the opioid epidemic worsened, the Drug Enforcement Administration started cracking down on opioid companies for failing to report suspicious sales to the black market and suspected drug mills. The DEA could instantly shut down such distribution facilities to compel corrective actions. This enraged Big Pharma, but as the narration pointed out, when they “didn’t like that they were being held accountable... instead of complying, they just decided to change the statute.”


This led Congress to make the red-hot opioid crisis even worse when in April 2016 it unanimously passed a bill that kneecapped the DEA’s ability to shut down egregious distributors. The bill was written by the opioid industry, and once the bill’s egregious defects were exposed by 60 Minutes and The Washington Post 1½ years later, lawmakers interviewed admitted they never read the three-page bill. Many agreed the bill needed to be fixed, but four years later, Congress has yet to do so.


Washington Post reporter Scott Higham was among the few to deeply investigate the opioid crisis. In the documentary, he said of Congress, “People were dying by the tens of thousands, and their representatives were selling them down the river. It was one of the most outrageous things I’ve ever seen in the 35 years I’ve been doing this.”


Part Two also covered how the Justice Department forced into retirement a 29-year veteran DEA investigator who was on the front lines fighting the opioid epidemic. But a shortcoming of the documentary is it doesn’t deeply explore – or shame – many of those above him who capitulated to political pressure and career considerations. It just noted they all refused to answer questions on the subject, including President Obama who signed the bill into law.


Among those avoiding questions is former U.S. Attorney and FBI Chief of Staff Chuck Rosenberg. The documentary briefly flashed his picture, but never identified him. From 2015 to 2017, Rosenberg served as head of the DEA but failed to flag the bill as harmful to the DEA’s work or to protect Americans.


Rosenberg is known to regular viewers of MSNBC as the straight-arrow, emotionless boy scout who lectured regularly on the ethical failings of President Trump and his administration. He also hosts his own MSNBC podcast called “The Oath” in which he interviews “fascinating men and women who took an oath to support and defend our Constitution and our nation.”

Rosenberg’s emergence as the clucking conscience of good government and as a paid pundit and national speaker is part of a larger problem in corporate media. They regularly pay individuals involved in great political misjudgment or ethical violations as paid political experts. This includes former Chicago Mayor Rahm Emanuel and New Jersey Governor Chris Christie on ABC, MSNBC 11th Hour host Brian Williams, political consultant Steve Schmidt (of Sarah Palin fame) and historians and columnists accused of plagiarism (Doris Kearns Goodwin, Mike Barnicle).


And just as no local media outlets would ask my campaign opponent about his continued acceptance of donations from the opioid industry, no media outlets to my knowledge have asked Rosenberg during his numerous TV appearances about his role undermining the DEA enforcement power as the opioid death toll skyrocketed.


GOOD BUT NOT PERFECT


Gibney’s acclaimed past documentaries include “Going Clear: Scientology and the Prison of Belief” and “Enron: The Smartest Guys in the Room.” “The Crime of its Century” deserves to be ranked close to those, but it has its small flaws. Gibney’s work excels at visual storytelling to avoid the old parade of talking heads and maintain viewer attention. But sometimes this style is distractingly almost too entertaining for subject matter as tragic as the opioid crisis.


For example, Gibney employed several popular songs to jazz up some sections. This included Billy Joel’s “My Life” in a Part Two montage. And in Part One, I was chagrined to find my knee bouncing along infectiously to Curtis Mayfield’s 1972 slow funk classic describe the Sackler family – “Want some coke? Have some weed. You know me... I’m your doctor... I’m your pusherman.” Not the best way to digest tragic details.


The film, especially in Part Two, also seems to stretch its material to last a full four hours. This included a lengthy examination of Insys Therapeutics. Some of it was appropriate as the CEO and some employees of the Phoenix-based company would serve time for using many of the same reckless marketing techniques pioneered by Perdue personnel. But Gibney lingers too long on some of this, including way too much time dedicated to a crazy music hype video Insys’ sales force created for itself.


Such time would have been better dedicated to exploring multiple questions left unanswered by the lengthy doc. These include:

  • Can former FDA director Curtis Wright and others at Perdue still be prosecuted for the documentary’s revelation they secretly collaborated in that hotel room on the review of the OxyContin application? Or has statutes of limitations run out?

  • What happened to all the doctors and pharmacists who took bribes or turned their practices into pill mills? How many were prosecuted or delicensed? How many may remain in practice?

  • Where were the American Medical and American Pharmacist associations in all this? Did they speak up for patients and the Hippocratic Oath? Or were they mute?

  • What about the unassertive coverage of the opioid crisis by corporate media outlets? Might this have been influenced by the major ad budgets of Big Pharma – a consideration that does not affect HBO?

  • And perhaps most importantly, where do the current heads of the FDA, Congress and the Biden Administration stand about finally recalling these drugs? After all, the opioid crisis is not over.

Gibney’s film also leaves out the most recent legislative travesty. Thanks to a special “net operating loss” tax break the GOP slipped into the Covid CARES bill last year, American taxpayers are required to subsidize billions of dollars of the opioid industry’s most recent fines and settlements. Congress with Democratis now in control could quickly close this loophole, but this has yet to happen.


In February, about 120 Democratic members of Congress wrote Congressional leadership urging inclusion of this fix in Biden’s “American Rescue Plan” Covid bill. Neither of my area’s two main members of Congress signed this request, nor did either of California’s two senators. And ultimately no amendment or repeal of the tax break was included in the final bill, which may provides continuing evidence of the incredibly strength of Big Pharma across party lines.


But these shortcomings do not erase the quality of the rest of the documentary. Nor does it dilute the useful visibility it’s giving to so many sins of commission and omission effected in pursuit of corporate profit and political self-gain.


Many of which shamelessly remain ongoing.


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