Listen now

Related reading

Episode transcript

Elizabeth Vargas:

Beth Macy, Danny Strong, welcome to Heart of the Matter. It’s great to have you. Congratulations on your first Golden Globe win for Dopesick, three nominations. I think more nominations to come as we come out. You guys have got to be thrilled with that.

Danny Strong:

Yeah, it’s very exciting. Whenever you get to this point with a project, the award season, it’s never some guaranteed thing or… It shouldn’t even necessarily be the goal of a project because awards are totally subjective. It’s not like sports where the goal is to win. But at the end of the day, it’s still quite exciting when it happens and it can be a lot of fun if you approach it that way. But it’s also great for the project itself because it just gives it more attention and it keeps the story alive.

Elizabeth Vargas:

Danny, you called this show the trial the Sacklers never had. What did you mean by that and did you have that in mind when you chose to do this?

Danny Strong:

I think in some ways I did have that in mind. When I was researching it in the very early stages, I was appalled, stunned, shocked by what they had done and what they had gotten away with. This was early 2018. This was before Nan Goldin’s protests kept the story alive in a big way. It had the appearance that there were going to be no consequences for them. I found it enraging and terrifying. I just was stunned by the whole thing.

So I thought, “Oh, I could turn this into a crime thriller and lay out everything they’ve done in a pretty damning… ” But also at the time felt compelling, exciting way. I had this vision of the piece pretty early that could really lay out what had happened. I thought that that would be in some ways some kind of… I don’t know if I thought of it as justice, but I just thought the public, A, needed to know. But then I also had read that they were now using these techniques to market OxyContin internationally.

So I viewed the piece originally as a warning to other countries that Purdue Pharma is coming to addict you and to lie to you and to poison you. So that was a very early, early concept for me. It’s like a worldwide warning about this corrupt company. Which is very strange, I’ve never had a project where I thought, “I’m going to make a worldwide warning to people about what this company is doing.” But that was literally a very early idea I had.

Elizabeth Vargas:

You referred to Nan Goldin’s protests. Those are the protests she organized in different art museums, for example, where people would go in and then throw down prescription labels or empty pill bottles of OxyContin, lie down on the floor, and protest because all of these museums, these amazing cultural institutions around the world, had all named wings after the Sackler family. Beth, you wrote this book years ago and you follow many different stories. First of all, your reaction at seeing it brought to life.

Beth Macy:

Oh my gosh! I mean, it was such a thrill to be in the writing room for it. I tell people it was like getting a master’s degree just getting to spend that much time with Danny and the other writers who were so experienced and see how they managed to take this 20 year of story, which was slow simmering and many Americans still aren’t onto, and make it both entertaining and understandable. Because it’s really hard to read, say a Wall Street Journal article, about all the technical aspects of a bankruptcy and understand it.

But our show makes it, what they did, really understandable. So I was thrilled about that. My two goals going in were, one, that we didn’t stereotype Appalachia. Danny and the rest of the room were just so on point with that and the show being authentic. We brought in a consultant from Kentucky named Robert Gipe who read all of our scripts and gave notes. Then, two, this message that this is a treatable disease, but there’s still a huge stigma against buprenorphine and methadone.

So when you see an A-list actor like Michael Keaton being stigmatized for being on methadone and then Suboxone and then him coming out of it and helping others, sounds a little wonky at first, we’re going to get into the weeds on a little bit of medication, but it’s so important. Danny figured out a way to make that entertaining too. To me, that is the biggest takeaway from the show, is people are starting finally to get it.

Elizabeth Vargas:

You’re referring to the medicines that can help people with opioid addiction stay off opioids. We know that sometime those medications, ironically, are far more restricted than OxyContin, which is what got many of these people hooked in the first place.

Beth Macy:

Absolutely. Yeah. Doctors have to take an eight-hour training course, they can only prescribe so many people. If we made the medications as easy to access as dope is, we could really start to see our deaths of despair start declining. But we haven’t done that yet as a country.

Elizabeth Vargas:

Danny, you cast Michael Keaton as Dr. Samuel Finnix, who is a central character in this, a doctor who prescribes OxyContin to a young woman who’s a minor who gets an injury in the mines and is reassured by the sales force repeatedly that it’s not addictive. In fact, we have a clip from the trailer where we talk about how the sales force is sent out to all these doctors, largely in Appalachia by the way, but up and down the East Coast, to reassure them that it’s not addictive.

Dopesick Excerpt:

We’ve begun looking at something that could be big.

OxyContin.

Purdue Pharma, they’ve been marketing the drug as something that’s not addictive when it clearly is.

All your doctors are going to be asking, “How is this even possible?” Your most effective talking point are these magic words”

“Less than 1%.”

“Less than 1%.”

“Less than one…”

“Less than one…”

“… told me less than 1% would become addicted.”

“If OxyContin does what I think it can…”

“It could soon become Purdue’s first billion-dollar drug.”

Purdue continues to lie about the drug safety to doctors, to patients, and the FDA. We have a major case here.

Addiction rates, overdoses, and crime are on the rise across the country because of this drug.

Elizabeth Vargas:

That less than 1% addiction rate is a central issue, Danny, in the show. You see the doctor going, “What!” And you see these sales reps out there doing anything they can, flowers, manicures, weekends away at a resort, to get these doctors to prescribe this drug, this painkiller that is much more addictive than what they are promising.

Danny Strong:

Yeah. That claim, less than 1%, that’s the original sin of OxyContin. That is the big why. That is, I think, why we have the opioid crisis, is because they took an addictive narcotic, a highly addictive narcotic, because it’s pure oxycodone, it’s essentially heroin in a pill, and then they aggressively, maniacally marketed it as being essentially non-addictive, and that if it didn’t work good enough, well, all you need to do is double it. And when it starts to not work, well, just double it again.

In doing so, they created a nation of people that were highly addicted to a narcotic. That’s a very simplistic version of how the opioid crisis started. What makes it so terrifying is that a pharmaceutical company would do something so dangerous and so flagrant, but that the pillar, the institutions that are supposed to protect the American public from this kind of deception enabled them, let them get away with it. When finally investigators were onto them, the people that were doing their jobs at one point, the DEA had a very active investigation against them, which is what we cover in the show.

We have these prosecutors bringing a case against them. And those people themselves are stifled by the highest levels of the US government. That’s what made the crisis flourish. There was in 2001, 2002, some of the actions that the DEA was trying to take. Like I said, we literally dramatized these moments. If they had been successful, it could have turned the corner then, which would’ve been five, six years into the drug – long before the overdoses skyrocketed. It was still causing a great deal of harm in these phase one areas and already crime had become rampant and these communities had been transformed, which should have been enough. There was enough information.

That’s one of the things that always stunts me about this story. I remember when I first started researching it and interviewing people, I would say to them, “I don’t understand. OxyContin was famous as being dangerous by 2000, 2001. There were major news stories at that point, and yet, doctors kept describing it even more so over the years. It didn’t slow anything down.” To me, it’s still… I don’t want to call it one of the mysteries of it. I think it’s the power of Purdue’s persuasiveness and marketing, that they were able to push through that.

Elizabeth Vargas:

Well, it’s not just persuasiveness, I mean, and marketing. They got a special FDA label from somebody in the FDA who was overseeing their application. That person a year and a half later leaves the FDA to go to work for Purdue Pharma. You shine a real light, both in the show and Beth in your book, on this revolving door of the regulators then leaving the regulatory agency to go to work for the people they were regulating at a huge salary of half a million dollars, thereabouts, which raises a lot of questions about how closely they were actually doing their job before they went and got the payout.

Danny Strong:

Yeah. The revolving door is a major target of the show because it’s a huge reason why we are where we are with the opioid crisis. You bring up the label, but then there was a label change, which was supposed to solve the problem, but then it only made the problem even worse. So there’s all these elements of it that are maddening, but that also tie into tremendous flaws in the dark side of American capitalism and how companies are able to influence, peddle at the highest levels of the US government. I think this is the ultimate example of the danger of that.

Elizabeth Vargas:

Beth, talk about the fact that there was one particularly shocking scene in the show, and I’ve also read about this, that Purdue Pharma at one point when problems started arising tried to argue that these were faux addictions, that there’s no such thing as addiction, and that in fact if somebody’s having issues with withdrawal, double the dose. I mean, it’s not just counterintuitive, it’s mind-boggling.

Beth Macy:

Well, they found this dentist-

Elizabeth Vargas:

A dentist.

Beth Macy:

… turned pain management expert named Dr. David Haddox, whose story we tell on the show, who had coined this word pseudo-addiction. This was the concept that basically addiction didn’t exist. If you’re exhibiting signs of addiction and you’re a doctor and your patient is showing signs of needing the pills earlier than they’re supposed to and whatnot, the problem isn’t that they’re addicted, the problem is that they’re not getting enough of the opioid. So the answer is… And they came up with all of these basically marketing schemes.

I mean, and they bought people at Ivy League institutions. Russell Portenoy, a very well respected pain management expert, he bought into it too and became one of their paid speakers. Now, in 2012, he recants it and he says, “We were wrong to have done that.” But that was how many years after the drug was out? 15 years. As Danny says, it’s just really shocking at how many levels. As we were working on the show, new information was coming out weekly.

The Massachusetts lawsuit, which was the first to name Sacklers, somebody leaked us a document that helped allow us to create that scene where Curtis Wright at the FDA and Purdue executives actually rent a hotel room and work on the label together. I mean, geez, that’s crazy. I mean, I remember Danny was even rewriting a scene the night before they shot it.

Danny Strong:

Yeah, because new information had come.

Elizabeth Vargas:

Wow!

Danny Strong:

Yeah. It was pretty exciting actually.

Elizabeth Vargas:

So you were adjusting as you were shooting to the facts as they were emerging?

Danny Strong:

Yeah. Beth and I, we have an active investigation all through, not just the writing process, but through the production process where people would pop up or new information would pop up, like she said, or documents would be leaked and we’d continue to interview people sometimes together, sometimes separately. Since she’s a real journalist and I play one on TV, it would be very exciting to me. I’d call Beth, “I got new information,” and we’d talk it out and then that would lead to other people.

Then I’d literally go and write it into the show. There were a few times where it was the day before new information came to light. I remember in one case information came to light after fact and it was too late. We’d already shot the scene and the scene was now inaccurate because of the new information that had come to light. So I literally had to cut the scene out of the show because of it. But that was a good thing, because the goal, we wanted the show to be as accurate as possible. So it was great just the stream of information that just kept coming.

Elizabeth Vargas:

One of the things when you talk about making the show as accurate as possible is your portrayal of people in the grips of opioid addiction. Michael Keaton’s nephew died of a drug overdose. How did he draw upon his own personal experience with a family member? I know that Kaitlyn Dever, who plays a young woman who is also deeply addicted to opioids, and she reports that she really did massive amounts of research and talking to people who had themselves been addicted about what it felt like.

Watching the show, it felt to me like one of the most… I mean, I don’t have any firsthand knowledge of this, but it looked like one of the most accurate depictions based on people I’ve interviewed and what I’ve read of what dope sickness is like. I’ve heard heroin addicts say they will do anything not to be dope sick, and that after a while, you’re not even chasing the high, you’re just chasing, “Please, God, I don’t want to get that sick from the withdrawal.” Talk about how your actors researched that and how you directed them in those scenes to capture that.

Danny Strong:

Well, there’s a combination of factors here. One is as far as that element of what is dopesick and the portrayal of dopesick. But first and foremost, I feel like it starts from Beth’s book, which beautifully captures it in a very vivid, powerful way. From that, we’re able to then get the scripts at a place that feel as hopefully as authentic as we could possibly make it. So there’s the foundation of it, starts there, and then the actors do their own research.

I think Kaitlyn was watching videos on YouTube. I’m not so sure on Michael and the specific things he did. But then we have this advantage, which is they are as talented as actors could be. I mean, they’re literally artists at the highest, highest levels. You may not understand that if you’re just watching. You’re like, “Oh, they’re really good,” or, “Wow! They’re great.” But when all you do is work with actors, and so many of them are so good and so talented, there is something special about when you work with ones that are at the highest level of artistry, like Michael Keaton and Kaitlyn Dever.

Everyone’s in awe of Kaitlyn Dever on set by the way. We all called her little Meryl Streep. At one point, one of the actors, actor who played her dad, Ray McKinnon, who is this incredible veteran character actor, the wonderful writer-director too, very successful writer-director, he turned to me and he said, “I’m sick of getting my ass kicked by this 24-year-old,” because she just would just show up and was just unbelievable every time. Then we had our assistant property master, Hardt Robert, Hardt Bob. He had addiction.

He just had addiction issues in his background and he was incredibly helpful. I called him the MVP because it was our second assistant props would come on and he would just explain things to Kaitlyn and talk things through as far as the mechanics of the needles. It was great. It was like having a true expert there on set. With all of that, most of the time I didn’t have to say much as a director. They would just do their thing and it was almost always really powerful and completely spot on.

Elizabeth Vargas:

It’s unsurprising then that Michael has won already a Golden Globe for his performance. Kaitlyn’s been nominated for a Golden Globe. They’re really both so powerful. You must have been behind the camera a lot of times just with your hand over your mouth going, “Holy cow!”

Danny Strong:

Yeah. Yeah. And by the way, not just them, the whole cast is incredible. But there were some scenes, the scene when Kaitlyn… when her dad throws the pills down the drain.

Elizabeth Vargas:

Oh yeah.

Danny Strong:

In the script, all I had written was, “He throws the pills down the drain and she becomes a rabid animal and start screaming.” Something like that, but I used the words “rabid animal.” And then to see her come to life with it, it was so powerful. I’m not a very emotional person and I almost started crying on set. Then when I was in the editing room putting the scene together, I had to stop and take a break on the first time that me and the editor went through it because I was so upset and… I might get emotional talking about it, just remembering that experience of what she did and the tragedy of it. To me, it epitomizes the tragedy of everything that we’re doing here, is she’s such a good person.

Elizabeth Vargas:

Yeah. You’re so heartbroken. I don’t know. I knew from the beginning that this probably wasn’t going to end well and you just watched with dread as that story unfolded.

Danny Strong:

Yeah. She didn’t deserve this.

Elizabeth Vargas:

No.

Danny Strong:

She had an injury. That’s all. To me, it epitomizes the tragedy of what happened and why we need to tell the story.

Beth Macy:

And also what it does to families. That scene, that was the most powerful scene for me to watch too. I thought immediately of all these real life families that I had interviewed. Tess Henry, who was a major character in the book, Dopesick, being on meth and hitting her mom and the way this addiction can destroy families. That scene, the way she brought the pain of that to life, was just so hard to watch, but also just so spot on. We had a Gallop poll release just a few weeks back showing that a third of American families have opioid crisis in their family. And when you think of that scene of her pounding on those kitchen cabinets and screaming at her dad and burning the quilts, a third of our families have dealt with some level of that. That’s just so powerful.

Danny Strong:

Yeah.

Elizabeth Vargas:

I’m curious about the reaction that you’ve gotten to the series since it came out. You mentioned, Danny, that you got a call from a Congressman a couple days ago. What was that about?

Danny Strong:

Yeah. Congressman was talking about the opioid crisis. A friend of mine who’s a reporter sent me a clip, a screenshot, because he had a Dopesick poster to talk about it. It was fascinating. Then she connected us and he wanted to reach out to me about different programs that he’s working on and different things that he’s trying to do that I want to participate and help in some way. I talked to him about some of the issues that I thought were incredibly important, specifically better access to Suboxone, buprenorphine.

The medication to treat opioid use disorder, we need to get this to more people. It’s very difficult to get access to it. These kinds of conversations at people within the US government, the fact that it’s stirring it is terrific. Now, let’s hope hopefully it can actually have an effect and actually change policy or dictate new policy that could be helpful, Beth’s mission of wanting to destigmatize buprenorphine in her book. When we started talking in our earliest conversations, she said that was so important to her in the show and I loved it.

I just thought, wow, I couldn’t agree more. What a terrific use of our platform in telling the story to help destigmatize the treatment, the cure to this nightmare? It’s not 100%, but it’s the best there is right now and not enough people are getting it.

Elizabeth Vargas:

I mean, Beth, you’ve long been in this since you were researching this book and this book came out, but Danny, you’ve joined her in this, activists of a kind on this issue. You both went to a big rally in Washington, D.C. at the end of 2021 lobbying Congress to allow the Sacklers to be held legally liable for the damage that many feel that they have brought upon the country and now are trying to bring down upon world. Why is that important? I have to imagine, Danny, that this is a pretty unusual thing for you. I mean, Hollywood guys don’t normally do projects and then turn into activists.

Danny Strong:

Yeah. Well, I mean, the piece itself is a piece of activism to a certain extent. So it is a natural extension of what we did in the show. In my case, people just asked me to do things and I couldn’t be more excited to do them. I mean, this rally came up, Ed Bush, who’s one of the great activists on this issue, organized a rally outside the Justice Department to push the Justice Department to pursue criminal charges against the Sacklers.

The fact that that hasn’t happened is a tremendous miscarriage of justice. When you take a bird’s eye view of what occurred here, a very, very, very small group of people, maybe less than 20 people, made billions of dollars off of the devastation that has been brought up on millions of people. And that devastation has all these splintering side effects to communities and just damage and destruction. It’s unbelievable that there have not been criminal charges against them.

So that’s something that we’re pushing right now. I was asked to speak at a rally. Of course, and it seems to me that’s the next step, is the bankruptcy, the fact that that was appealed. So we don’t know what’s going to happen with the bankruptcy at this point, but the Sacklers as of now can be sued in civil liability, but they need to be pursued criminally. That’s the next push and that’s what we’re trying to achieve right now.

Elizabeth Vargas:

In the final episode of this series, your DEA agent played by Rosario Dawson says to the lawyers who have finally successfully pursued legal action resulting in, yes, only misdemeanor charges at the time, but at least the first charges, and Rosario Dawson’s character says at that point of the Sacklers, “They will someday go down.” Do you both believe that to be true?

Danny Strong:

I didn’t believe it when I wrote it.

Elizabeth Vargas:

You didn’t?

Danny Strong:

No. No, I didn’t. I still don’t know if it’s going to happen. I believe they’ve been shamed in a profound way. I think they’re probably viewed as one of the most villainous families of the last 100 years. Maybe-

Elizabeth Vargas:

A member of Congress called them the most evil family in America.

Danny Strong:

Yeah. Yeah, we put it in the show as archival footage right towards the end. For me, there won’t ultimately be justice in this until they’re charged criminally. So when I wrote that, there’s a response to it, which is, I don’t know and we’ll see. I think the answer to that, we’re still finding out. What do you think, Beth?

Beth Macy:

Well, it’s not over until the fat lady sings. I mean, the activists, I sit on this group of activists that I follow for my forthcoming book, Raising Lazarus, and they’ve said that over and over they get really depressed, despondent when things go for Purdue, which they normally do. But then you have this appellate judge in New York say that during the bankruptcy, judge didn’t have a right to give them non-consensual releases, third-party releases. That was a huge win.

Then you had the rally and a lot of people speaking and people like Danny, not just Danny, but former prosecutors. Rick Mountcastle, who was played by Peter Sarsgaard in the show, he’s this quiet, super professional. He’s out there calling for criminal charges. Look, the recidivist criminals, that company pleaded guilty in ’07 and again in 2020 and now it looks like they’re posed to get away with it via this bankruptcy loophole.

As Richard Sackler once said, “I can get any Congressman or Senator on the phone that I want.” We have got to put a stop to all these things that allow a regular court system for those people who get ensnared and then for billionaires who get to leave with all their money. Money is power. They wished the nation bad, they shouldn’t get to keep all their power.

Elizabeth Vargas:

Right. I mean, for those who haven’t connected all the dots or read Beth’s amazing book or Patrick Radden Keefe’s amazing book, Empire of Pain, we know from internal emails that have been released through discovery process that the Sacklers knew that there were issues with the addictive properties of this drug, hid the fact that there were addictive properties of this drug, sent orders and sales reps out to aggressively market higher doses of this drug.

Then when the drug took off and little warning bells were ringing everywhere, began to withdraw billions of dollars and place that money in offshore accounts where it is now unreachable, until the point where we get to 2020 when Purdue Pharma has been basically emptied out, the coffers emptied out, Purdue Pharma declares bankruptcy, and the Sacklers have all their money in offshore accounts and there we are. Purdue Pharma declared bankruptcy, but not the Sackler family, which is still asking for all liability, ultimate liability from any and all legal action against them.

Danny Strong:

That was beautifully summed up, by the way.

Beth Macy:

It was. I heard Richard Sackler tell the court in… Gosh! I think it was May. He was asked, “Does Purdue Pharma feel responsible?” “No.” “Does your family feel responsible?” “No.” “Was OxyContin the cause?” “No.”

Elizabeth Vargas:

Well, and then in the Congressional hearings when Kathe Sackler says, “I wouldn’t do anything differently.” I mean, zero remorse.

Danny Strong:

Well, that’s why I put that in the show.

Elizabeth Vargas:

Yeah. It’s astonishing that they’re, “I wouldn’t do anything differently even knowing everything I know now.”

Danny Strong:

That Congressional testimony, I believe, occurred right before we started shooting. I was watching it, and when she said that, I started screaming at my computer a lot of profanities, which Beth would not be surprised by. I was like, “Oh, I’m going to put that in our archival at the end of the show,” because I was so impacted by that. But I think that what that sums up is the Sacklers and how they’ve treated this whole situation from the get go, is they don’t care, there’s so much dishonesty.

It’s really just about making as much money as they possibly can. I guess there’s an element of it which I have never completely understood, is because they were so wealthy before OxyContin even existed. I mean, these were very, very wealthy people, their names were on all these buildings long before-

Elizabeth Vargas:

They didn’t have to do this, in other words.

Danny Strong:

They didn’t have to do it. If you even gave them the benefit of the doubt, which is by 2000, 2001, that’s when they started to understand that it was addictive or how dangerous it was when all the news reports started coming out… If they had changed course then, maybe you could give them some sort of benefit of the doubt, which I don’t believe is the case. I believe they knew exactly what they were doing from the get go.

But in 2007 when the case ended, which is the case we dramatized, the US attorney’s case in the western district of Virginia, they pled guilty. The company pled guilty to felony misbranding, a major case was made against them. Their key executives pled guilty to misdemeanors, they were very lucky to have gotten that deal. So how does Purdue change its ways post that deal? They had made their case. The opposite. They double down, they triple down, they sell even harder. They triple their sales within two years. To me, that’s when you see that, you think, “Oh, are they sociopaths?”

This is sociopathic behavior to have this major case brought against you, all of this evidence of addiction, death, destruction of communities, and instead of once a settlement is made reforming your ways, you do the opposite, you sell even harder. I remember when I read that Richard Sackler was cornering sales reps post the settlement and saying, “Sell, sell, sell, you’ve got to be pushing even harder,” To me, that’s when I thought, “Oh, there’s a villainy here. There’s an evilness here that is as dark as I think we’ve encountered. This is a small group of people making all this money off of all this death.”

Elizabeth Vargas:

You have lots of scenes in the show involving the Sackler family members. How did you imagine that dialogue? I’m just curious. I mean, obviously you had to create it in your own head because you don’t have somebody in the corner with a transcription machine.

Danny Strong:

Yeah. Yeah, no, it’s the challenge of this piece, is writing those scenes. There’s a technique I use because I’ve done a number of nonfiction movies at this point. There’s a technique I use, which is that the scene itself may be a fictional scene, it may not have happened. However, what they say in the scene, the things they’re saying are true. So it’s not a verbatim transcript of what was said, but the dialogue that’s being discussed are true facts so that the scene itself is a conduit to get true information out. That’s a technique I use over and over.

Elizabeth Vargas:

Did you rely on things like the emails, all those emails that were released? Beth, I see you’re nodding.

Danny Strong:

Yeah.

Beth Macy:

Yeah.

Elizabeth Vargas:

You must have relied on those to have a peak at least into what could have been or undoubtedly was happening.

Danny Strong:

Yeah. The emails were really helpful. There’d also been a number of things reported at this point. So you took that record of things that have been reported, that have come out all the way back to Barry Meier’s book, Pain Killer. There was some real interesting tidbits because he was reporting in real time. Then just other things come out. If it just had been the story of the Sackler family, which was what was pitched to me originally, one of the reasons why I didn’t do it is because I thought I would have to fictionalize too much in order to pull that off.

But by having it one story of maybe six stories, my hope was there’s enough information out there that I could do it in a way where it had integrity, where it was truthful, where it was fair. At the end of the day, those are the things I’m looking to do. I want this to be fair, I want it to be truthful. I don’t want to just slander people and that could open my company that’s financing this up to major lawsuits. There’s a responsibility in doing this type of portrayal. Sometimes it’s a tight rope, sometimes it’s not a tight rope.

I mean, one of the things we had too was a source that Beth found that was inside Purdue Pharma that just gave us tremendous amount of information. Then there were a lot of incredible scoops. Then that information came out in Patrick’s book, Empire of Pain, which unfortunately for us didn’t come out until about two weeks before we wrapped production. I would’ve loved that book, maybe- [crosstalk 00:36:44]

Elizabeth Vargas:

Oh yeah, because that is all about the Sacklers.

Danny Strong:

Yeah, yeah, yeah. But it was clear to Beth and I. It was like, “We know where he got some of this stuff from,” because it was pretty clear from a similar source. I’m kind of going on a bit about this one, but nonetheless, that was the process of putting it all together.

Elizabeth Vargas:

Beth, I’m curious, that source of yours, I’m endlessly fascinated by how the Sacklers sleep at night. Seriously, how do you live with yourself? What did your source tell you about the family and whether or not there were members of the family who did in fact feel uneasy or try to raise objections to what they were doing.

Beth Macy:

Well, I had another source tell me about her. She was a former employee who worked on the executive floor. The secretaries know things, right?

Elizabeth Vargas:

Yeah.

Beth Macy:

Always trust the secretaries. It was like she had just been waiting for somebody to call and ask. But the details about how they dined and how Raymond and Richard would have lunch together and the servant would bring them the dog… We didn’t know about the dog until we talked to her. We were thrilled about that because it actually helped us humanize Richard. One thing we haven’t mentioned yet, and I’m more about the victim side of the story because that’s where my heart lies with this. And Danny’s too. But that’s where I felt like I made my biggest contribution to the show.

We brought in an addictions doctor, who himself had been addicted to OxyContin, one afternoon into the writing room. His name’s Dr. Steve Lloyd. Now, is his character Michael Keaton? No. But he really helped us learn because he had been shopped by patients. He himself had shopped other doctors. He had done all those tricks Michael does to try to get opioids when he is in throes of his diction. Dr. Steve had done that. That was really amazing to have those insights.

But yeah, the Purdue part, I remember early on in the writing room, Danny was like, “Beth, you’re being too literal.” I was like, “How do we know that really happened?” But the trick was, everything was legally fact checked by the lawyers at Disney.

Danny Strong:

[crosstalk 00:39:18]

Beth Macy:

We had multiple sources. I mean, not sources on the quotations exactly of what they said. Some of the quotes actually were word for word. Some of the quotes at the FDA, those came out in documents. We were so lucky to have gotten people to talk to us, people to leak us documents, people to come into the writing room. I mean, really a group effort. And Danny just had this way of making the dialogue really saying and tell a great story.

Danny Strong:

Thanks, Beth. There was one email in particular that for me, it was a gold mine. It was an email that Richard Sackler’s son, David Sackler, had written to his mom in which he poured his heart out to her and went into family history and the challenges of his father. I just got so much insight from this particular email. And you could- [crosstalk 00:40:22]

Elizabeth Vargas:

What insight? Like what?

Danny Strong:

Well, he talked about his dad and how difficult his dad is and how his dad never appreciates anything that he does. And this dad comes across, this is Richard Sackler, so emotionally distant. Talked about how his dad, Raymond Sackler, controlled Richard with money and was able to control him. You get through this whole email that is probably the most heartfelt, compassionate thing I’ve ever seen from a Sackler times a hundred. Then at the very end of the email, you realize he’s just trying to get money from his mom for a bigger apartment.

Elizabeth Vargas:

Okay.

Danny Strong:

Literally, he pours his heart out, and then all of a sudden, we’re back on brand with the Sacklers again. But it was extremely helpful of him just going through the family history and his father. But you asked how they could sleep at night. From what I’ve gotten from different sources, including an email like this, is… because Richard Sackler really does feel like he was the kingpin of all of this, is that he has a personality disorder. He’s been described as on the spectrum, he has been described as having a lack of empathy. Someone told me that there were people in the family that have referred to him as a sociopath.

Elizabeth Vargas:

Wow!

Danny Strong:

I don’t know if that’s true or not. Maybe that’s just their perception of him. To me, maybe that’s how we have the opioid crisis, is a personality disorder of one individual, could be in some ways a genesis of all of this deception.

Beth Macy:

Coupled at the same time with the government’s inability to regulate. We even go into detail because people are like, “How did the FDA do that?” Well, it’s because 65% of the FDA’s regulatory budget is paid for by industry going back to Ronald Reagan and deregulation. I mean, we’ve got to put up better regulatory stops to this so that a sociopath can’t help spawn an epidemic that’s decreasing Americans’ life expectancy.

Elizabeth Vargas:

No, I think that’s a definite, powerful, and to be honest, depressing takeaway from the show and from your book, is that it’s not just the FDA, it’s not just the DEA, it’s not just the Justice Department, it’s not just the White House, it’s everything. It’s whack-a-mole. I can’t fix all these different people and agencies that are actively trying to thwart a well-intentioned, authentic investigation into this painkiller, its addictive properties, its marketing, false as it may be, and the consequences.

I mean, it takes years and years and years and you feel authentically and very strongly the frustration of your two attorneys trying so hard and having doors slammed in their faces everywhere they go, literally everywhere they go.

Danny Strong:

Yeah. I think the one area where there hasn’t been a sufficient reckoning and we’re dealing with those ramifications right now with the vaccine is the FDA and with what Curtis Wright had done and with what other people had done to not stop it over the years, which we dramatize in the show. Curtis Wright, for your listeners, is the medical review officer that gave the label the wording that said it was less addictive than other opioids, and then went to go work for Purdue 18 months later.

I think there needs to be a reckoning into the FDA because I believe that that is one of the reasons why there is vaccine hesitancy, that there is a huge group of people that do not trust the FDA because of this, that either themselves became addicted, had friends that become addicted, had family members that become addicted, that died, that lost years of their lives over a drug that they were told by the government was safe. And now you’re telling me this vaccine is safe?

And by the way, I am very pro-vaccine and I think it’s a miracle and unbelievable. But I do think that that is where a lot of this comes from because of their own firsthand experience, because there were no ramifications.

Elizabeth Vargas:

No, they’re all in it together. It’s very, very clear. Just hint that, hey, in a year, we’ll triple your salary if you come work for us, if you just give us this fabulous label that allows us to market this drug that’s basically, as you described it, heroin in a pill, as being somehow less addictive than… Like a Tylenol when it comes to addictive properties.

Danny Strong:

Yeah. Yeah, no, absolutely. Look, I think there needs to be criminal charges placed against the Sacklers. But I also think that there needs to be a criminal investigation into Curtis Wright and into those actions at the FDA in 1995, 1996 so that that won’t happen again.

Elizabeth Vargas:

Right. Well, hold your breath, Danny, until that happens.

Danny Strong:

Well, the criminal investigation to the Sacklers were… That rally, I think, might have had some effects. I think the show has had effects. Beth was talking about the despondency of so many of the activists over the years. There was a phrase that I would constantly use, which is the Sacklers always win. Even when they lose, they always win. The original bankruptcy ruling that Drain had put out, that was a perfect example of the Sacklers always win.

When that was overruled in the appellate court, I thought, “Oh my gosh! This is the first time I’ve seen them lose in a way that could be existential for them, could be catastrophic for them.” So we’ll see if that continues. But there definitely, I think, we’ve seen a turn. The Met took down their name. We had sources that told us that the show was a huge part of that. People that make those decisions were getting pressured by family members of friends that were horrified by what they had seen in the show.

Then we just saw their name came down, I think, yesterday in the Serpentine Gallery in London. So it’s quite exciting to see that there’s actually some effect here and if a criminal investigation and charges could be brought… I’m not saying throw them in jail, they deserve a fair trial, but charges need to be brought. The case is very clear what these people did. Until that happens, I think we won’t truly have justice on this issue.

Elizabeth Vargas:

Right. The Sacklers have been named in many, many lawsuits. But under that original deal, none of that could proceed. By the way, under the original deal, they would not only get that immunity from any and all legal action, but they would manage to keep their $11 billion in profits that they made while paying just four and a half billion dollars to all the states. Not surprisingly, there’s even among people who are also activists on this issue, there’s differences.

I mean, just this week, I saw… I think yesterday, an op ed written by a mother who had lost two of her three sons to drug overdoses arguing that this should stand, that we need this money now. The desperation for those funds that Purdue was willing to pay into this settlement is so high that I wonder if the coalition is beginning to fracture in places. After this united front of Purdue must pay, now people are starting to say, “Well, okay, let’s just take what we can get instead of fighting further, longer, harder for the ultimate goal down the line.” Does that concern you at all?

Beth Macy:

It does, but there isn’t enough money in the whole Purdue universe to turn back the opioid crisis, which is why the government really needs… It’s been estimated it’s going to take 120 billion to turn it round. So four and a half, that’s not going to touch it. Now, the distributor case, that’s up to about 26 billion. That could do some real good. The average victim payout in the Purdue settlement-

Elizabeth Vargas:

Small.

Beth Macy:

… is $5,000.

Elizabeth Vargas:

It’s unbelievable.

Beth Macy:

The average. Now, that’s not even enough to reimburse for funeral. That’s an insult to parents. I read that piece in the Post yesterday too and I strongly disagree with it. I mean, I respect her and her opinions, but I think most of the activists that I know say it’s not that much money in the whole world of turning back the opioid crisis. It’s certainly not enough to make up for the lost loved ones, so why don’t we have justice? Because as one of our characters in the show says, “If the corporation feels no pain and until we hold them to account for this, this is just going to happen all over again.” It needs to end.

Elizabeth Vargas:

Yeah. Finally, I know that you shot a lot of the show in Virginia in Appalachia. You had, as you said, a consultant from Kentucky come in to make sure you caught this authentically. Sadly, in 2020, 10 states had a more than 40% increase in overdose deaths. And those states include West Virginia, Virginia, Kentucky, Tennessee. The crisis has continued. Years after Beth you wrote this groundbreaking book, and Danny, while you were in those parts of the country bringing the story to life, those deaths were steadily upticking and continue to.

We are setting records now, tragically, in opioid overdoses and deaths in this country. You ended your series with a really poignant monologue from Michael Keaton’s character, Dr. Samuel Finnix, in a recovery meeting talking about pain. I want to play a clip of that.

Dopesick Excerpt – Dr. Samuel Finnix:

Addiction tears apart. It tears apart friendships. It tears apart marriages. It’ll tear apart a family, tear apart a whole community. Part of the reason we relapse is because of pain. There’s some kind of pain that’s in a lot of us, all of us, we just don’t want to feel anymore. And further we fall into addiction, pain says to us, “Hell, it’d be better off just feeling nothing at all.” So we go numb and our souls go numb. Now we’ve got a real problem. Pain is just pain. Not good, not bad, just part of being a human being. And sometimes good can come out of it. And if we’re brave enough and willing to go a little deeper, work our way through it, try to overcome it. Well, we just might find our better selves.

Elizabeth Vargas:

I found it very, very moving. What do you think is the deeper message in that for everybody? Because there was something about that speech she said about pain. You don’t have to be addicted to opioids or have somebody in your life addicted to opioids or any other substance to know pain. We all know pain. As somebody, a friend of mine, once said, “Everybody has something.” It’s a really good speech and a really good life lesson, I think, don’t you?

Danny Strong:

Well, I think it would be arrogant for me to say it was a really good speech since I wrote it. We’ve gone on this journey over these eight hours and I wanted to just say something bigger than Purdue Pharma and their lies. I wanted to say something bigger about what this all means, how this all began. The opening of the show is a monologue about how we have to redefine the nature of pain. And that redefinition of the nature of pain was numbing your pain.

Barry Levinson directed that, the cameras pulling back, right? So I thought when we came to the finale, I want to have a counter argument to that opening speech, that to redefine the nature of pain, you have to numb your pain. And the thesis of the speech was that when you numb your pain, you numb your soul, you numb what it means to be human. But if you could find a way to work through your pain, you could maybe grow from it. Then I shot it, as opposed to point back, we’re now pushing in, and we end close on his face, just about that.

So that was the goal. Look at the end of the day. I’m not a journalist, I’m not a documentary filmmaker. I hope this doesn’t sound pretentious, but I’m an artist. We’re making a piece of art here. So I wanted to tie into the ultimate themes of the piece and to say something and also to say something that I thought was slightly hopeful. It’s a dark show, it’s an upsetting show. I was getting emotional talking about it on this podcast, and I haven’t done an interview, I think, in a month or so.

So I was even surprised about my own… I don’t know if I’m numb to talking about the show, but clearly I’m not. That was the goal of the speech, was I just thought, “This has been a dark journey, painful journey, but what can we learn from the journey?” And that was the ending. You do those sort of things, you just… Because I directed that episode. I shot multiple endings in case it didn’t work. You don’t even know if it’s going to work. So that one point when he walks into the room, the camera pans over to the sign that says the name of his new clinic.

That was my alter ending in case the speech was pretentious or just wasn’t effective for whatever reason. So you just never know at the end of the day what you got. But what I did have was Michael Keaton, so the speech turned out great because he’s so great.

Elizabeth Vargas:

Well, the speech turned out great, and that’s the hallmark of recovery, is you can’t numb your pain, you can’t numb your anxiety, you can’t numb your anger, you can’t numb your resentment. You have to feel it and walk through it and process it and come out the other side.

Danny Strong:

Yeah. When you numb it, you make it worse.

Elizabeth Vargas:

Exactly.

Danny Strong:

And OxyContin is the physical reincarnation of that concept, is that when you use OxyContin to numb your pain, you make the pain worse on multiple different levels. Literally, just the physical pain itself, you’re not treating it. You’re making it most cases long-term, you’re causing more damage to yourself physically. But then if you become addicted, then you’ve now created a whole new set of pain and problems for yourself.

Elizabeth Vargas:

Well, Danny Strong, Beth Macy, thank you so much. Congratulations to you both on this now award-winning show, powerful, and so much in the news it’s a little scary. So, thank you.

Danny Strong:

Thank you for having us.

Contact us

Please use the form below to contact us with any questions or feedback related to Heart of the Matter.