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(upbeat music) - Hi everyone, Steve Adubato.

Many of you who have heard of "Dopesick", you may not know where it originally comes from.

"Dopesick" is this book.

And the young lady you've see on camera is the author.

Beth Macy is the New York Times bestselling author of "Dopesick" and the follow up to "Dopesick".

Beth, you didn't realize I had this here.

This is "Raising Lazarus".

Beth, you honor us by joining us, and thank you so much.

- Thanks for having me, Steve.

- For those who do not know the book or the extraordinary, I watched it on Hulu, the documentary.

Tell folks what, first of all, where's the name "Dopesick" come from?

- "Dopesick" is the word that people with opioid use disorder use to a person to describe the excruciating feelings of withdrawal.

And they all say it's like the worst flu times a thousand.

And I wanted to use that word 'cause it's in your face and at the end of your journey, as somebody says early on in "Dopesick", you're not doing heroin to get high, you're doing it so as not to be "Dopesick".

And so I thought if people can just understand that alone, it will have made a public service.

- Thank you for laying that out for us.

Go back, you were a reporter in Roanoke, Virginia at the time.

When did you start covering this story of the opioid crisis in our country, when?

- It was 2012, I was a reporter at the Roanoke Times, which is close to Appalachia, which is kind of where this all started.

And by that point the epidemic begins in the mid nineties with the introduction of Oxycontin, particularly in Appalachia.

But by the time I picked up the story, it was 2012 and there was this growing cell of heroin users that was in our wealthiest suburb.

So it had gone from rural to cities to, there was basically no zip code in America where it wasn't.

But because using drugs is so stigmatized, the parents who were in on it or had the money to send their kids off to rehab were too ashamed to tell their neighbors about it.

And so for that reason, the epidemic grew sort of unabated because of stigma.

And, Purdue knew that what happened, by the way.

- Since you mentioned Purdue, let's put this out there.

So Beth Macy as a reporter in Roanoke, Virginia, Virginia was one of the first states to go after Purdue and the Sackler family.

Put Purdue, tell folks who Purdue was, and who the Sacklers were and are please.

- Sure I think now that I've spent almost a decade in this, I think of them in the earlier years as a family of pharmaceutical executives and millionaires who wanted to be billionaires.

And when they introduced Oxycontin in 1996, they coaxed the FDA into approving the drug with this very unusual label that allowed them to claim falsely that the drug was virtually non-addictive.

And they took that claim all the way to the bank.

They bought off regulators, they bought off politicians.

And that is really how we came to the point in our nation where we have 7 million people with opioid use disorder.

And it wasn't all Purdue.

The other companies jumped in when they saw how well it was going for Purdue.

- The one thing when I was reading the book, there's so many aspects of this, particularly "Dopesick", "Raising Lazarus" to put it in context, this is about the lawsuits?

- "Raising Lazarus" is about the solutions to the opioid crisis, including the efforts of activists to hold Purdue's feet to the fire.

And so it follows the present court case, which is now about to go to the Supreme Court to where it was when I ended writing the book.

But it was basically parents of the dead and activists, many of them who had experienced addiction themselves saying, no court system, the Sackler family doesn't have the right to tell the parents of the dead that they can't sue the Sacklers in court.

They were basically using a loophole in the bankruptcy system to be shielded from bankruptcy even though they themselves were nowhere near, are nowhere near close to being bankrupt.

They still have most of their wealth.

- Sorry to interrupt and the court said no, they're not gonna do that.

Whatever is decided in terms of a settlement, you will pay it.

- Well, it didn't actually go that way.

They got up to $6 billion.

They were gonna give up the company and it was gonna be turned into sort of a public benefit.

- Put Sackler, they own, operate Purdue.

- They no longer, they gave up the keys to the company and they said, "We will give you $6 billion in exchange for civil immunity from 3000 plus lawsuits."

And so for three years we watched the courts go back and forth, then the Sacklers pull their case into the bankruptcy court.

And because of this special release, which is called a non-consensual third party release, and the legality of which has not yet been settled, they were able to get all the way to agreement with just a few holdouts that would've allowed them protection from further lawsuits.

But the Supreme Court is now hearing the case at the request of the trustee's office, which is the bankruptcy's court watchdog.

I mean, their own court's watchdog is the one saying, "This isn't constitutional.

We need the Supreme Court to weigh in on it because otherwise what would keep another family of millionaires that wanna be billionaires from introducing a faulty drug knowing that they can get an escape hatch in the bankruptcy system?"

It's very complicated.

- It's complicated, but extraordinarily important.

So one of the aspects of "Dopesick" that really got my attention, I'm sure millions and millions of others, was the role of pharmaceutical sales reps.

In your view, from your research, of those pharmaceutical sales reps disproportionately were women if I'm not mistaken, correct?

- I don't actually know that.

I mean, I don't know if they were mostly women.

They tended to be on the younger side of middle age and very good looking no matter their gender.

- I apologize for that.

- All right.

- Incorrect information.

So do you think most of them knew that what they were pedaling, what they were trying to sell to physicians was so deadly, and when people could no longer get access to the drugs or that those drugs in fact wound up being, they went on the street, a lot of these people got sick, who were addicted, they got addicted to heroin.

- Yeah.

- Do you think they knew that?

- They would show up in their doctor's office with track marks on their arms.

And one sales rep that I interviewed, who was a woman who tried to convince them that this was happening, we're supposed to report it when we think people are abusing our drug, was basically fired.

And there was a lot of pressure to sell, sell, sell, because the bonuses were incredible.

If you talked a doctor into upping the prescription from a 40 milligram to an 80 milligram, they increased your bonus allotments.

So it became, some of these reps in the early days, in the late nineties were earning easily six figures over $300,000, a lot of that just in bonuses alone.

- What about the physicians?

- Yeah, what about the physicians?

- Physicians who signed off?

Do you think most of the physicians who signed those scripts and were sold to by these reps, you think most understood the deadly nature of what they were prescribing again and again and again to people who no longer needed those drugs in terms of an injury or pain?

I'm sorry, go ahead.

- Well, I don't know that most of them did.

I know there were some really bad actors.

So if you were a rep and you had say, two bad actors in your territory, you were set, you barely had to work at all.

- Describe a bad actor.

- A pill mill doctor, somebody who was just prescribing right and left.

Now, I think there were, I don't think they were a majority of the doctors.

The majority of the doctors were fed a bunch of lies about the supposedly safe qualities of Oxycontin and the efficacy.

But if you were paying attention, it was pretty clear to most doctors, especially the Dr. Art Van Zee that I profiled early on in "Dopesick" and he's featured in the show as well, all of a sudden, he had kids he had immunized as babies overdosing in the high school library on Oxycontin.

He had farmers and miners he had treated most of their lives losing their farms, losing their trucks, losing their families, saying, "My God, that drug has ruined my life."

And so.

- He stood up.

- He stood up, he was the first physician really in the nation to call.

And they basically wrote him off as a kook.

And this doctor from Appalachia and he testified before Congress and the FDA and it was very difficult.

And one of my goals going into "Dopesick" was not only to tell his story, but also to say, how is it now in Appalachia?

And how it is, is it took him six weeks just to meet with me because he's so overwhelmed by patients who are addicted now.

- The Sacklers, Richard Sackler is focused on heavily, but there are others involved in the other Sackler family.

That's a weird question.

Do you believe that Richard Sackler was an evil person who knew what he was doing and did it to quote you to become a billionaire from being a millionaire?

He was an evil person?

- I don't know what's in Richard Sacklers heart.

- I know.

- Did he act in evil ways?

- Yeah, I know that in court he was asked in a deposition, no, in a court hearing, he was asked, "Do you think you hold any responsibility?

", no.

He was asked how many people had died.

He said he had no idea.

He was asked if Oxycontin created the opioid crisis, no.

Did his family have any responsibility?

No.

I mean, he has to be evil if he can't see the facts laid out before him.

I think he convinced himself early on that he was going to not only be rich, but be this big man who could cure pain and there isn't a cure for pain, alas.

- Go back to the federal government.

These drugs regulated through the FDA, correct?

- Yes.

- What did they do to get a particularly important FDA regulator official to give them a pass on this?

What did they do for that to happen?

- Yeah, I was leaked a memo as we were finishing up writing the show, and the memo was written by the fraud department of the Department of Justice, and it basically showed, without a doubt how Purdue had manipulated the FDA.

And at one point they even rented a room down the street from the FDA, where Purdue's people met with Curtis Wright, who worked for the FDA, who had ultimately stamp approved on the Oxycontin drug application.

And 18 months later, after it was approved, Curtis Wright went to work for Purdue, tripling his government salary.

- I stepped on you.

- And you almost couldn't make that up.

- I stepped on you, that's the part I'm gonna get to.

Curtis Wright wound up working for the Sacklers at Purdue, tripled the salary of his FDA federal government salary, correct?

- Yes, yes, and as we were working, you know, going through all the documents and the interviews we had when we were writing the show, somebody leaked us this document and it had more details about how they had rented a room, a suite of rooms.

And when you picture the government regulating our health and safety for the betterment of all citizens, you don't picture a private suite of hotel rooms and a doctor, regulator physician who is basically helping them write the new drug application so that it will be approved.

I mean, in what world would anyone think this is ethically correct, but you see over and over in this story they did that.

They hired 3000 doctors, nurses, and pharmacists to become paid speakers for the company because they knew they couldn't appeal directly to patients, but if they could convince the doctors that what they were telling was true, then the doctors would convince the patients.

I mean, it's very diabolical when you look at it.

we're talking to Beth Macy, the author of "Dopesick" and "Raising Lazarus", do you believe most - How do you believe this experience, the film, the books, the research has impacted you as a person?

- Well, I think it's helped me see, I come from a family with four generations of addiction, alcoholism, mainly, it's helped me see that we all have grown up stigmatizing drug users and people with addiction.

The Sacklers took advantage of that stigma.

They took it all the way to the bank.

We all say that addiction is a chronic relapsing disease, but when you see that playing out, especially in the Hulu show, we had one mom reach out to us after the show aired, and she said, "You know, after I saw your show, I called my addicted son for the first time in three years.

It's beginning to put the onus on who the criminals were, not her son, not your cousin who's sitting in a jail at Subway for holding a user amount of heroin but the people who started this crisis and the regulators who let it happen, the politicians who took the Sacklers' money.

There's almost no level of government that isn't also part of this.

- The shame and stigma, which you really just talked about, of those who are addicted, first to Oxycontin opioids and then in many cases to heroin, to what degree do you believe your work and people being hopefully better educated about how this happens to so many who are innocent victims, to what degree do you believe that the shame and stigma for those who are "Dopesick", to use the expression, the coin of expression in the book, how has it changed, if at all?

- I think it's starting to change, but I think that stigma, because we all grew up in the war on drugs, is so like baked into our psyches that it's a really, - Just Say No, I'm sorry, 1984, Nancy Reagan, just say no to drugs.

That was the federal government's campaign.

Just Say No, you say all these years later.

- Yeah, yeah.

- Just Say No.

- And Richard Nixon purposely saying, all drug users are bad people as a way to shore up southern votes because we're gonna disproportionately jail black and brown drug users.

And so it's racist, it's historically racist.

I think the stigma is beginning to shift, but I think physicians who played a big part in this need to take a bigger role in the solution.

And what I'll tell doctors, they don't really love hearing this, but I'll say, "I know you didn't all take a free trip courtesy of Purdue to become a paid speaker, but y'all participated in the system.

You need to participate in helping us get out."

Only seven to 8% of physicians have become certified to prescribe buprenorphine, which is the medication assisted treatment.

That's the gold standard of care.

A lot of doctors still don't want those people in their waiting rooms, but they're all over.

- And "Raising Lazarus, Hope, Justice, and The Future of America's Overdose Crisis."

We're big into public policy, particularly public policy that actually makes a difference as opposed to press conferences, ribbon cuttings and window dressing.

I won't editorialize, but I'll ask this.

Are there any specific government public policies that you believe would help address this crisis?

- I think if we could simply make every health department offer medication assisted treatment and connections to care and offer clean syringes, because we know that most people won't come into a clinic because they've been stigmatized so often before.

But if we began to meet them where they are through this concept of harm reduction, which is clean needles, fentanyl test strips, clean use kits, we know that that becomes a gateway for treatment.

And MAT, medication assisted treatment, becomes the gateway to recovery.

If we simply made medication assisted treatment available to all the people who suffer from this, we would really go a long way to turning the crisis back.

But as of right now, you've got about 10% of folks who can access it.

- Yeah but what is the political rationale for those who are opposed to just the clean needle?

- Yeah.

- Part of it, who say, devil's advocate.

- Yeah.

- Come on, Beth.

What you're talking about promotes drug use, we're against drug use.

- Right, it's counterintuitive for sure.

And you have to do your research.

You have to go maybe three steps before you learn that people who go to needle excuses are five times more likely to enter treatment.

When you see that, when you see that most of the people are dying are totally without any system of care, you realize we have to go to them where they are.

So that's why I start the new book in a McDonald's parking lot next to a dumpster.

- I'm sorry, I interrupted you.

I stepped on you again, what's the new book?

- The new book, "Raising Lazarus" is mostly about harm reduction.

It begins with.

- I thought you started a whole new book.

- No, no, no, no, no, no, no.

- "Raising Lazarus", go ahead.

- Yeah, "Raising Lazarus" begins next to a McDonald's dumpster in a parking lot with a nurse practitioner reaching out to an addicted person who shows up high.

He's crying, he says, "I'm gonna die if I don't get off the needle."

And he says, "Well, let's get you better."

He's going to call him in a discount prescription for buprenorphine.

But he tells 'em, most importantly, "You can get better."

Most of these folks think they can't, most of Americans think they can't, and two, don't disappear.

So even if you return to relapse, and this is really the crux of harm reduction, even if you're still using, keep coming back.

"And if you can't come back, 'cause your car broke down, text me and I'll come to you."

So it's this idea of meeting people where they are without judgment and with love.

- In terms of solutions, or even if it's not a solution, it makes the situation not as bad and hopefully better.

How confident are you that the folks at the FDA and the federal government learned from the experiences?

What was the guy's name who worked at the FDA and then went over to work for the Sacklers?

What was his name?

- Curtis Wright.

- The lessons of Curtis Wright for the feds for the FDA is.

- End the revolving door.

I mean, you saw this play out later when there was a law knee-capping the DEA from going after suspicious pill mills.

- The drug enforcement agency.

- Yeah, going after suspicious orders.

This is back when they were sending millions of pills to tiny little towns in West Virginia.

And that law was basically written by a former person who had worked in pharma at the DEA.

And so the, if we ended the revolving door, a lot of these ethics lapses would stop.

- Final question, did you ever expect "Dopesick" to become a cultural, social, I hate using the word entertainment, but, - Must.

- No, no.

Never.

- You never expected it?

- No and I was thrilled because I said, "If we can get a message out that doesn't stereotype Appalachia, which most television shows do," - Describe Appalachia, Appalachia's been described for me, it's, "Oh, that's where people who are white and poor live in Virginia."

Yeah, but it's so what?

Come on, that's such a stereotype.

- Such a stereotype, - Go ahead please.

- But if we can do an entertaining show in which we don't stereotype Appalachia, and we make this really important message of getting treatment to people so that when you see an A-list actor like Michael Keaton struggle to get on buprenorphine, struggle to get on methadone, and then once he does, he becomes a helper in his community, that is so powerful, and that can happen.

I've seen it happen, I've seen miracles right and left, but they're just nowhere near reaching the scale of the scale of the crisis.

- Real quick, Appalachia, is it southeast?

Southeast Ohio, where is it exactly?

- Southeast Ohio, Southwest Virginia, parts of Kentucky.

Appalachia actually goes all the way up to Maine, Maine and Georgia, the Appalachian Mountains.

But it was these little tiny towns where a lot of the jobs gone away that Purdue sent their reps with this notion that this drug is safe to use.

And they knew that people who were poor and struggling to pay their bills, they could earn a side hustle by getting their doctor to prescribe them Oxycontin and they could take half and sell the rest.

At one point, it was an 80 milligram pill was selling for $80 on the street.

- Hey, Beth, I just wanna say thank you.

I've been broadcasting for a long time and we broke every rule in terms of time and that's because of you.

I blame you for that, for being compelling and interesting and just causing us to wanna understand this crisis better.

And thank you so much for your work, and we wish you all the best, thank you, Beth, - Thank you so much.

- I'm Steve Adubato, way more importantly, that's Beth Macy.

We'll see you next time.

- [Narrator] One-On-One with Steve Adubato has been a production of the Caucus Educational Corporation.

Funding has been provided by Kean University.

Newark Board of Education.

PSEG Foundation.

The Russell Berrie Foundation.

Robert Wood Johnson Foundation.

The Healthcare Foundation of New Jersey.

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And by The New Jersey Economic Development Authority.

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