"Painkiller" is a textbook example of a show clearly meant to sway public perceptions on a critical public health issue — even if that means lying to viewers along the way.
You cannot trust what Hollywood says about science. From health care to agriculture and space travel, the examples of inaccuracies in movies and TV are nearly endless. Sometimes these errors are minor embellishments designed to heighten the drama of a story. In other cases, the mistakes betray a deep understanding of the subject and a willingness to mislead the audience.
The new Netflix six-part miniseries Painkiller is a textbook example of a show meant to sway public perceptions on an important public health issue, the opioid epidemic, even if that means lying to viewers along the way.
If you’ve seen Erin Brockovich, you’ve seen Painkiller. There’s the obligatory nefarious corporation run by greedy executives who covered up the deadly effects of their product, unsuspecting victims who used that product, and a scrappy protagonist who blew the lid off the conspiracy.
It’s an admittedly entertaining story, but it's being told at the expense of the tens of thousands of people killed each year by illicit drugs and prohibitionist opioid regulations. Netflix should be embarrassed.
A grain of truth
In broad strokes, Painkiller correctly highlighted Purdue’s reckless marketing of OxyContin, its prescription opioid introduced in 1996. As Reason’s Jacob Sullum reported in 2020, the company’s malfeasance included
“... promoting wider use of OxyContin even when executives knew the legitimate market was saturated, encouraging prescriptions by paying kickbacks to physicians, and disregarding obvious red flags indicating that some distributors, pharmacists, and doctors were doling out pills without regard to medical need.”
However, that’s the extent of Painkiller’s accuracy. Like its loathsome predecessor Dopesick, the Netflix series lays blame for the opioid crisis almost exclusively on Purdue, its sales force of tenacious, attractive young women, and a legion of greedy, gullible doctors who couldn’t resist their feminine charms. Painkiller executive producer Alex Gibney seems to really believe this outlandish story, summarizing the show’s central thesis like this:
“The crisis wasn't something that just happened … It was something that was … manufactured by companies looking to make an egregious profit. I realized that this opioid crisis I've been hearing so much about … was really a crime.”
This is a lie, plain and simple. Writing in the Yale Law and Policy Review in February, epidemiologist and Reason Foundation drug policy analyst Jacob Rich explained why:
“Although OxyContin was introduced in 1996 and Purdue Pharma’s marketing campaign subsequently increased its market share within the industry of pain relievers that contain oxycodone, only 9.0% of all nonmedical opioid users in 2001 reported ever using OxyContin during their lifetime … Overall, it is not clear that nonmedical opioid use has significantly changed since 1990.” [my emphasis]
Equally damning to Painkiller’s premise is the fact that “Today’s nonmedical opioid users are not yesterday’s patients,” as ACSH advisor Dr. Jeff Singer explained in this 2019 review article:
“In a 2007 study of more than 27,000 OxyContin addicts who entered rehab between 2001 and 2004, [researchers] found that 78% said the drug was never prescribed for them for any medical reason, 86% took the pills to get ‘high’ or get a ‘buzz,’ and 78% had a history of prior treatment for a substance abuse disorder.” [my emphasis]
The makers of Painkiller seemed to be aware of this data because they framed it as a flimsy industry talking point worthy of dismissal. In multiple scenes, Purdue’s lawyers and supermodel sales reps claim that the rate of OxyContin abuse is “less than one percent,” based on an infamous 1980 letter published in the New England Journal of Medicine.
Rich noted that the pharmaceutical industry “incautiously” misinterpreted this letter and the “not especially rigorous” study it was based on. But Painkiller’s implication that Big Pharma shills minimized the abuse liability of their potent opioids without evidence is false.
Multiple studies published before and after OxyContin was commercialized showed that patients prescribed oxycodone could use it without developing an addiction. The relatively few who did had histories of drug or alcohol abuse. Here’s one such paper from 1986; here’s a review of 67 studies published in 2008. Additional research published between 2010 and 2018 reached the same conclusion.
So alongside Purdue, let’s add the Cochrane Collaboration, research published in the British Medical Journal, and officials from the National Institute on Drug Abuse and the Office of National Drug Control Policy to the list of sources that have cited the insignificant addiction risk posed by opioids prescribed to patients who need them.
Real people telling a “fictionalized” story
Although many of the show’s characters never actually existed, one of the most disingenuous parts of Painkiller is the beginning of each episode that involves real people who have suffered a terrible loss; the mother or father of an addict who was killed by drug abuse appears on screen and reads the following disclaimer:
“This story is based on real events. However, certain names, characters, instances, events, occasions and dialogue have been fictionalized for dramatic purposes. What hasn’t been fictionalized is [the story of my child who was killed by opioid addiction …]”
Devious. It’s both a superficial defense of Painkiller’s overall accuracy and a shameless excuse for the lies that permeate each episode—including the glaring omissions. Not once did any character in Painkiller mention “fentanyl.” This highly potent opioid and its analogs are widely and illegally available across the US and have been responsible for most overdose deaths for over a decade. By the way, overdose deaths have doubled since 2010, even though opioid prescribing has plummeted over the same period; that tragic fact goes conveniently unmentioned as well.
And at no point did the show probe the myriad causes of drug abuse or the difference between physical dependence and addiction. Maddeningly, the miniseries completely ignored legitimate pain patients who have been left to suffer without treatment thanks to America's inane restrictions on opioid prescribing. Many of these individuals have committed suicide to end their anguish.
Apparently, these are details unworthy of your consideration. All you need to know, dear Painkiller viewer, is that Big Bad Pharma sells pills that turn patients with back injuries and broken bones into junkies—shame on the makers of this prohibitionist agitprop.