'Painkiller' fact vs. fiction: What the Netflix show got right about the opioid crisis, OxyContin, and the Sackler family

In "Painkiller," viewers are introduced to Arthur Sackler (played by Clark Gregg) as the character is lobotomizing a patient. The brutal procedure was a popular psychiatric treatment in the mid-20th century, but it's unclear if Arthur himself regularly performed lobotomies.

In Patrick Radden Keefe's landmark New Yorker article (upon which the Netflix show draws heavily), Keefe reported that all three Sackler brothers — Arthur, Mortimer, and Raymond — worked as doctors at the Creedmoor Psychiatric Center in Queens, New York, together for a time, and were all three interested in pursuing "pharmaceutical alternatives" to familiar psychiatric treatments at the time like electroshock therapy and, ostensibly, lobotomies. Keefe wrote in his book "Empire of Pain: The Secret History of the Sackler Dynasty" that Arthur "hated" electroshock therapy, and the three brothers were also disturbed by lobotomies. 

However, showrunner Peter Berg defended the show's version of events in an interview with Esquire's Jack Holmes. 

Berg told Esquire that Arthur did perform lobotomies. And as Holmes reported, the physician was more interested in "repeat customers" instead of the "one-and-done" nature of lobotomy patients, and eventually began looking into psychiatric medications — much like the show depicts.

The OxyContin plushies feature heavily on "Painkiller," with the cheerful stuffed toys frequently used as a contrast to the addiction and death their namesake drug has wrought on people. 

As Stat News reported in 2016, the plushies were a part of Purdue Pharma's marketing strategy when it came to promoting OxyContin. The company also gave away other "swag" items including branded fishing hats and coffee mugs featuring the OxyContin tagline "The one to start with" which changed to "The one to stay with" when hot liquid was poured into it. 

Stat also notes that Purdue and other drug manufacturers voluntarily agreed to cease this type of promotional swag advertising after the marketing tactics were criticized in a 2003  US Government Accountability Office report. In February 2018, Purdue announced it would stop promoting opioids to doctors.

Heroin and OxyContin are both part of a class of drugs called opioids. 

According to the Drug Enforcement Agency, oxycodone (the generic name for the painkiller) is derived from the poppy plant and causes "similar effects" to that of heroin, fentanyl, and opium.

A report from the National Drug Intelligence Center in 2001 noted that heroin and OxyContin are both "attractive to the same abuser population," and that OxyContin was sometimes referred to as the "poor man's heroin." 

In "Painkiller," Purdue Pharma and Richard Sackler (played by Matthew Broderick) take great interest in Wright after he oversees Oxycontin's FDA application. Wright is initially wary of the drug but eventually signs off, saying that the drug's "delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of the drug."

OxyContin was first approved in December 1995, according to the FDA's website.

According to a 2006 Department of Justice memo proposing an indictment of several key Purdue Pharma executives, Wright advised Purdue Pharma on how to accelerate the approval of Oxycontin while under the employ of the FDA. A year after Wright left the FDA, he took a job at Purdue Pharma with a compensation package of "at least $379,000," according to the DOJ.

While it's clear that OxyContin brought in millions of dollars of revenue for Purdue Pharma, the goings-on at the company's parties and sales conferences haven't been widely reported on. 

It is possible, of course, that Purdue could have hired "OxyContin cheerleaders" for its major events, but the dancers depicted on the show seem more likely to be a metaphor for the corporation's reported greed and excessive spending. 

It may also be a reference to a comment former Sen. Claire McCaskill made in 2018, after releasing the Senate Homeland Security and Governmental Affairs Committee's report on how the country's largest opioid manufacturers, including Purdue Pharma, gave money to patient advocacy groups and professional medical societies.

"I think these groups were cheerleaders … cheerleaders too often for opioids," McCaskill said while releasing the results of the probe, according to The Guardian.

Udell, who died in 2013, was Purdue Pharma's general counsel for more than three decades, according to ABC News.

In his book, Keefe reported that Udell's secretary of over 20 years (referred to by the pseudonym Martha West in Keefe's book) said in court testimony that she "became addicted to OxyContin" while working at Purdue. Before West became addicted, according to Keefe's book, Udell had asked her in 1999 to do online research into the abuse of the drug for an internal memo and also referred her to a pain specialist, who prescribed West OxyContin for back pain.

According to Keefe, West, a recovering alcoholic, was deposed in a 2004 lawsuit against Purdue, and said in her testimony that her OxyContin addiction caused her to try other drugs and start drinking again. She was fired after 21 years at Purdue for "poor work performance."  

A key part of "Painkiller" involves fictional lawyer Edie Flowers (Uzo Aduba), working for the US attorney's office as she tries to bring a lawsuit against Purdue Pharma in the mid-2000s. Despite their best efforts, the office eventually reaches a deal with Purdue, which sees them plead guilty to charges of fraudulent marketing and misbranding of OxyContin.

Part of the reason why the company reached this agreement was because of the efforts of the lawyer they hired — Rudy Giuliani. As Keefe reported, Giuliani originally tried to "scuttle the case." Later, however, Giuliani and the other Purdue lawyers went above lead prosecutor John Brownlee's head to complain to James Comey, who was the deputy attorney general at the time, The Guardian reported. 

Per The Guardian, Giuliani ultimately helped secure an agreement with Brownlee that prevented Purdue from facing additional prosecution over OxyContin and kept the company's senior executives who'd pleaded guilty as individuals — Udell, former medical director Dr. Paul D. Goldenheim, and then-president Michael Friedman — from doing prison time. Instead, Udell, Goldenheim, and Friedman paid a collective $34.5 million in fines, while Purdue was fined $640 million.

By getting Brownlee to agree to prosecute the parent company, Purdue Frederick, rather than Purdue Pharma, Giuliani and his team were also able to prevent a ban against Purdue Pharma doing future business with the federal government, which manages public health programs like Medicaid, Medicare, and the Veterans Administration health system, The Guardian reported. This allowed Purdue to keep selling OxyContin without limitations, despite the guilty plea.

In an earlier statement emailed to Insider regarding "Painkiller," a representative for Purdue Pharma said:

"We have the greatest sympathy and respect for those who have suffered as a result of the opioid crisis, and we are currently focused on concluding our bankruptcy so that urgently needed funds can flow to address the crisis. Under our settlement, Purdue Pharma would cease to exist and Knoa Pharma, a newly formed company with a public-minded mission, would emerge. The settlement would deliver over $10 billion of value for opioid crisis abatement, overdose rescue medicines, and victim compensation."

On August 1o, the Supreme Court temporarily halted Purdue Pharma's planned bankruptcy settlement, which would prevent the Sackler family members from being held personally liable in opioid-related suits.