As mentioned in previous blogs, despite valiant efforts from multiple regulating bodies as well as awareness campaigns in the United States, the opioid epidemic continues to rage on. The COVID-19 pandemic has in fact seemed to further trigger the opioid crisis as overdose deaths reached a record 91,000 in 2020, a 30% increase over 2019. The Centers for Disease Control and Prevention also predicts that overdose deaths will reach over 100,000 when tabulated for 2021. The availability and prevalence of synthetic opioids such as fentanyl along with cocaine and other methamphetamines have fueled the fire of overdose deaths which began over two decades ago, when the pharmaceutical industry began marketing highly addictive painkillers more aggressively for chronic and more minor painful conditions.
While there have been numerous media campaigns, documentaries and books that have chronicled the genesis and proliferation of the opioid crisis, few have had the broad social appeal and impact as Hulu’s Dopesick, an 8 part mini-series based on Beth Macy’s excellent book of the same title. While the material is dark and weighty, the series does a good job of presenting the early stages of the crisis in an interesting and digestible format, even for the more casual audience members.
Set in the epicenter of the early onset of the crisis, the story follows the impact OxyContin has on coal miners in an Appalachian community. Caught in the middle is the respected town doctor Dr. Samuel Finnix, played by legendary actor Michael Keaton (who also was the executive producer of the series).
Dr. Finnix is coerced in to prescribing OxyContin to his patients with painful conditions under the guise that the drug is much less addictive than other opioids, a marketing campaign without substantive evidence despite being approved by the FDA. The show jumps forward through time periods leading up to an investigation by the US States Attorney’s offices in to Purdue Pharma’s substantially misleading marketing campaigns and mysterious FDA cooperation in approval of the messaging (including of the Purdue hiring of the former FDA official responsible for the approval).
Also important to the story is Purdue’s influence in the medical community to designate pain as the “5th vital sign” and to coin phrases such as “breakthrough pain” and “pseudo-addiction”, all encouraging physicians to write prescriptions for higher doses while further enriching Purdue and the Sackler family. The series in particular puts a special focus on Dr. Richard Sackler, Purdue’s eventual President and leader of this movement toward mass addiction.
While Dopesick is an entertaining introduction to the scourge of the opioid crisis, for those wanting a more in-depth look there are several other avenues and mediums to obtain a broader understanding. Reading Beth Macy’s book for which the series is based is a great start, as is Patrick Raiden Keefe’s Empire of Pain or Ben Westhoff’s Fentanyl Inc. Also highly recommended is Alex Gibney’s HBO documentary The Crime of the Century.
All of these tell the story of the crisis starting with the proliferation from the pharmaceutical companies and their financial incentives to get and keep patients addicted. When the patients then lose their ability to obtain or afford their opioids legally, they turn to illicit manners such as heroin or fentanyl abuse. Also outlined in each is the government’s inability to control the crisis and in many situations, ways they are incentivized for it to continue through political campaign contributions from the pharmaceutical companies.
Where the opioid crisis started and where our current situation stands is an important thing for those in the medical community to understand. For those in the physical therapy community, we have a responsibility to educate our medical colleagues and patients of safer, more effective, and evidence-based methods to control patients’ pain such as exercise, patient education and manual therapy. Hopefully more shows like Dopesick and the books and documentaries mentioned here continue to come along to keep the conversation moving in a positive direction.
For more information on how physical therapy can help you or your injured workers, contact Results Physiotherapy at https://resultspt.com/request-info
