What ‘Painkiller’ Omits About the Opioid Crisis
A politician’s job is easiest when there’s a recognizable villain, and there’s nothing like hauling execs in front of a bipartisan panel and racking up the clips for cable news. Painkiller, a new six-episode limited series on Netflix, is the streaming equivalent of a congressional dressing-down: long on pathos, and short on nuance.
The series hammers home the misdeeds of Purdue Pharmaceuticals, as well as the heartache and societal breakdown caused by its onetime “wonder drug,” OxyContin. But like a heavy-handed made-for-TV hearing, Painkiller lays it on too thick. A naïve viewer may come away from the show thinking that the opioid epidemic could be solely attributed to corporate greed, which does little to explore policies that could move the needle on our persistent drug crisis.
Though Painkiller efficiently depicts the main beats of OxyContin’s story—Purdue’s headlong push past traditional guardrails around opioids, aggressive marketing, and power politics—much of the on-screen drama oversimplifies its main characters. A fictional U.S. attorney played by Uzo Aduba, for example, largely serves as a mouthpiece for the showrunners’ anger while delivering monologues of exposition. Former Friday Night Lights star Taylor Kitsch’s character may as well be a stock character from a pickup truck commercial who transforms into an addict writhing on a motel floor. And corporate head Richard Sackler, played by Matthew Broderick, is played as a vacant avatar of avarice. Though his relationship to legacy, family, and reputation could have made for a nuanced story, Painkiller seems content to suggest the pursuit of the almighty dollar (and the wings of museums and college buildings it could purchase) drove him and other Purdue executives to delude others about OxyContin’s addictive potential.
But Purdue Pharma was far from the only 1990s institution sanguine about the potential of opiate-derived prescription medications. Companies like Johnson & Johnson, patient advocacy groups, and the Veterans Health Administration signaled an industry-wide shift to treat pain as the “fifth vital sign” and to convince prescribing physicians to get over their musty old “opiophobia.” Freedom from pain, proclaimed the World Health Organization in 2004, should be a universal human right.
One major question the show leaves unanswered is whether OxyContin was the primary cause of the opioid epidemic, or whether broader trends would have propelled our horrific state of affairs without it. A paper published last year in the Quarterly Journal of Economics suggests that one of the regulatory barriers that kept the opioid crisis from hitting some states as hard in early stages was a relic of New Deal-era efforts to curb the spread of substances like morphine and opium. States like California, for example, required physicians to use a state-issued “triplicate” form when prescribing opioids. Those states—where doctors knew there was a possible paper trail—saw slower growth in opioid-related deaths.
Purdue, and others, attacked those laws as antiquated barriers between doctors and their patients. Even as old paper forms were phased out in favor of electronic medical records, those original triplicate states still had lower rates of OxyContin prescription and lower opioid-related deaths. If other states had similar standards in place, last year’s paper found, they would have had an average of one-third fewer drug overdose deaths.
Moving fast and breaking things can be a welcome tonic in some parts of the economy, but part of the conservative ethos should trust the old and tested. Sometimes bureaucratic guardrails exist for a reason. As economists David Cutler and Edward Glaeser put it, “technological innovation can go badly wrong when consumers, professionals, and regulators underestimate the downsides of new innovations and firms take advantage of this error.” Or, as the Christian apologist G.K. Chesterton might have put it more colloquially, “Don’t take down a fence until you know why it was put up.” One man’s “opiophobia” is, in some cases, a very real respect for the power of a drug that has bedeviled societies for centuries. Exploring the tension between pathbreakers and incrementalists would have been a less tidy, but more interesting, story for Painkiller to tell.
Today, the vast majority of drug-related deaths stem from inadvertent overdoses on potent and highly volatile fentanyl. Illicit drugs have become cheaper over time, and the cartels that produce them operate their supply chain with corporate-like efficiency. With fentanyl, absurd economies of scale make the drug profitable for the cartels. A single dose could be just a few milligrams, meaning that, as the Manhattan Institute’s Charles Fain Lehman has written, producers are willing to write off losing even the majority of their product in attempted border crossings and still make a hefty profit off the rest. Effectively cracking down on cross-border supply makes looking for a needle in 10 haystacks sound easy.
Which means the best policy approach is to expand treatment and, ultimately, seek to reduce demand. One crucial step must be building up the institutions of family and community that can act as some kind of prophylactic. As I have written before, the opioid crisis is largely a crisis of unattached males. From 2010 to 2019, the drug-related death rate among never-married prime-age white men increased some 125 percent, far greater than their married counterparts.
Marital status correlates with income, among other things, and the traits and characteristics of someone who marries are probably associated with more resistance to illicit drug use. But single men may be especially susceptible to opioids because they are drugs of loneliness. As Sam Quinones wrote in 2015’s Dreamland: The True Tale of America’s Opiate Epidemic, still perhaps the best book written on the current drug crisis: “I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often.”
Painkiller wanted to channel The Big Short’s populist rage and sardonic dark humor at the civic disease that has even reversed gains in American life expectancy. Purdue Pharma is an easy villain—the company didn’t direct its sales force to stop promoting opioids to physicians until 2018, and the Sackler family’s legal efforts to preserve the bulk of their fortune are ongoing.
Understanding and addressing the opioid epidemic, however, defies cheap outrage or easy policy answers. An explainer-style melodrama might get more viewers interested in the drug crisis’ origin story, but the focus on one family and one company leaves unanswered broader questions of how to keep future “miracle drugs” from turning into hell on earth for too many families and communities.
