'Dopesick' Writer, Producer Talks W.Va. Opioid Crisis

Dopesick is a new series streaming on Hulu. Penned by author Beth Macy, it details the rise of prescription opioids, namely Oxycontin, and the wreckage it has caused across the nation.

The show takes viewers to board meetings of the wealthy Sackler family, who mislead doctors and patients into believing the drug was less than 1 percent addictive. The series plays out like a crime drama, as a pair of assistant U.S. Attorneys from Virginia and a Drug Enforcement Administration agent push to prosecute the drug manufacturer Purdue Pharma.

The show also tells the story of small town doctors who bought into Purdue’s claims and had to face the guilt that they prescribed Oxycontin to patients who would become addicted or even die. That story is based in Appalachia.

“They sent the most [drug sales] reps into those regions with data about every single prescriber,” said Macy, who helped create the show and wrote the book it is based on.

Macy followed the real life story while reporting for The Roanoke Times. She will be speaking in Charleston this Sunday with Kentucky author Robert Gipe. The event is set for 2 p.m. at Taylor Books.

Appalachia Health News Reporter June Leffler spoke with Macy ahead of her Charleston appearance.

June Leffler: While working on this series with people that are not from Appalachia, when did you say “Okay, this is really what we should do, because this is how I think we should portray the region?” 

Beth Macy: I’m from Roanoke, Virginia, which is about a quarter of a million people in the Roanoke Valley. And it’s very different from a small town in far southwest Virginia, like the fictional Finch Creek, which is basically Pennington gap in Lee County. And that’s where some of the first people fought back against Purdue and you see them portrayed. I wanted to make sure that the people in the writers room got to meet these people.

Danny Strong, the showrunner, and I interviewed Sister Beth Davies, the drug counselor who fights back. We interviewed Dr. Art Van Zee, the doctor from St. Charles, Virginia, who fights back and is the first to call Purdue on the phone and say, “Hey, this drug is way more addictive than less than 1%.” We got Robert Gipe who’s a novelist from Eastern Kentucky. His trio of illustrated novels and plays are all around the opioid epidemic. We got him in the room to make sure the dialogue was right, and to really help us portray the small town aspect that I wasn’t as familiar with.

One other thing we did, we brought in a doctor from Tennessee, who at the time was Tennessee’s drug czar, and he himself was a doctor who was shopped by numerous patients, he was targeted by reps, he himself got addicted. And now he is a treatment innovator. We brought him into the room for four hours one day, and just had him tell his story, and it was a very powerful session. One other thing. Danny had two veteran screenwriters who grew up in rural areas, one in Arkansas, and the other in Montana. And another writer was somebody who himself had opioid use disorder.

Leffler: And you also made a point of filming in Virginia.

Macy: It ultimately wasn’t up to me. It was up to Danny and the higher ups at Disney and Hulu. But before he went to look at locations in North Carolina and Georgia, I just made this plea that I felt like if there was any sort of secondary economic benefit to be had that Virginia deserved to have it. Because southwest Virginia was one of the areas that was really targeted hard at the beginning.

Danny also just thought it was beautiful. And Richmond was a place that they could turn into various locations, including Stamford, Connecticut, New York City, as well as Clifton Forge which is a small town. That is where the Finch Creek scenes were shot. That is a really beautiful, mountainous town that has experienced high rates of opioid use disorder. And the people in the town really appreciated us filming there.

Leffler: The Sackler family has been taken to task for its role in the opioid crisis through lawsuits. How do you feel about the Sackler bankruptcy and the settlement?

Macy: The Sacklers are giving up the company, and they’re giving up $4.5 billion of their wealth, but by the time they pay it out over nine years, many experts believe that they’ll be just as rich if not richer than they are right now. Nobody’s going to jail. Nobody’s admitting that they did anything wrong. In fact, when asked in court recently, Richard Sackler had no idea how many people had died from opioids. And I tell you, if you are one of the family members of all those folks who died (more than a half a million) you’re not very happy with that statement. And a lot of people think the Department of Justice should go after the Sacklers criminally, and I quite agree.

Leffler: You don’t see that justice has been served in this case. And I am wondering about your take on what could happen with this $5 billion settlement. Local governments and state governments say they want to put it into addiction recovery services. How optimistic are you that that money will go to the right places?

Macy: Well, I’m pretty discouraged in places in Appalachia, to be honest. I’m very discouraged by the fact that West Virginia has basically outlawed needle exchanges at a time when Charleston, West Virginia, has the most concerning HIV rate in the nation. So we need that money to go to groups that are employing evidence-based practices. We know that people who visit needle exchanges for sterile needles are five times more likely to enter treatment. We know needle exchange also helps with reduced drug use. We have decades of studies of this going back to HIV.

We have to have people on the ground being listened to for their expertise. I’m thinking of the group SOAR who is doing wonderful work in Charleston, and whose operations have been very much criticized. These are people risking arrest, to help the least of us. And I think they need our support, because they’re doing the work that not a lot of people want to do.

We continue to have a really high treatment gap in the nation, 88 percent, which means that only 12 percent of people with an addiction have received access to care in the past year. That’s embarrassing. Frankly, we can do better, we know how to do better.

We need more walk-in clinics. Huntington, West Virginia, has a great treatment model called PROACT. And they work closely with the homeless shelter to make sure that anybody can walk in and get services. We need to be doing that more than turning people away, because anything that gets people into care is going to be one step towards them not dying of this lethal fentanyl that seems to be everywhere on the streets these days.

Leffler: Your book and this series I think hopes to destigmatize those that fell prey to addiction because they were targeted by legal drug pushers. Now that people are dying of illegal street drugs, what stigma remains that needs to be addressed?

Macy: Families have been hurt by this. They’ve been hurt by their loved ones’ behavior in many cases. And a lot of that behavior is because they fear being dopesick, the excruciating withdrawal symptoms. But by not offering them care, by treating them basically as criminals or lepers in some cases, they wouldn’t be committing these behaviors if we offered the medical care, and didn’t criminalize all of their activities.

I know people in my own community of Roanoke who have died of end stage endocarditis, because they couldn’t bear to go back to the hospital where they were treated so poorly, and so stigmatized, so they die at home alone. That’s a story that repeats itself in all kinds of communities.

So I’m hoping the viewer of the show will come away with a newfound knowledge of this 25-year-old story and question Richard Sackler’s language. Richard Sackler said these people are criminals. These abusers are the problem, we should hammer the abusers. So when we stigmatize people with opioid use disorder, we’re following Richard Sackler’s playbook, and he doesn’t deserve anyone to follow his playbook.

Leffler: People in Appalachia are aware of this story, and they see it all around them. I’m wondering, how have your Appalachian readers and viewers responded to you? 

Macy: Already strangers will reach out to me through my author page on Facebook. And whether it’s a family member of someone who died or is still recovering, or maybe a nurse at the hospital who was targeted over and over, there’s a lot of lightbulb moments going on. Some say they didn’t realize that the start of it was Oxycontin. And then there’s also just this sense of, ‘Wow, I’m seeing my story on the screen.’ To feel seen and to feel listened to can be very healing for people. Some people won’t watch the show, because it’s too triggering for them. It’s a dark show, but it’s also exciting. You know, there’s the legal thriller aspect of it, the true crime aspect. That in some ways gives you a break from just the addiction story. But the addiction story is where my heart is. And it’s where I think viewers will learn the most frankly and come away with just a newfound understanding.

Recovery from addiction is possible. For help, please call the free and confidential treatment referral hotline (1-800-662-HELP) or visit findtreatment.gov.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.