The saga of the opioid crisis in this country, the how and why behind the pharmaceutical epidemic that tore through American communities and resulted in the deaths of hundreds of thousands, is a huge narrative. Hulu’s Dopesick, a new limited series based on Beth Macy’s book Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, attempts to dig into all of it, with often moving results. But its vastness eventually becomes its Achilles’ heel.
Created by Danny Strong, who wrote and directed multiple episodes, Dopesick tries to address so many aspects of the rise of OxyContin that it becomes unwieldy at times, exacerbated by its tendency to hopscotch between time periods — a ticker on the screen is constantly reminding us whether it’s 1999, 2003, or some other year. In Dopesick, OxyContin functions like the unspoken protagonist, with all the characters serving as supporting players in its origin story. Individual scenes that focus on those supporting players — particularly those that involve Dr. Samuel Finnix (Michael Keaton), a doctor who works in a small mining town in Virginia, and Betsy Mallum (Kaitlyn Dever), a miner and a patient of Finnix’s who gets hooked on Oxy — often have real impact. But because of the way those scenes are stitched together, that impact sometimes gets muffled by the sprawling fabric of the whole.
The unspoken mission of Dopesick is to piece together the history of OxyContin in a way that shows how many people’s lives were upended by it and how appallingly easy it was for the American system to enable that. That American system certainly includes Purdue Pharma, the company that manufactured Oxy and was owned by the Sackler family, but also the FDA and other government agencies that didn’t do enough to properly regulate it. Within the pages of a script, that journalism-meets-scripted-television approach probably made perfect sense; all the time-jumping is much easier to follow when reading versus watching. But as episodes progress — there are eight total, and seven were provided in advance to critics — whiplash starts to set in as you try to keep track of what’s going on with each of the many story lines that has been established.
And there are many story lines, including the ones that involve Finnix and Betsy as well as a pair of federal prosecutors (Peter Sarsgaard and an especially appealing John Hoogenakker) attempting to make the case that actual crimes were committed during the development of OxyContin; a DEA agent (Rosario Dawson) who is equally determined to get the drug into fewer hands; a Pharma rep (Will Poulter) who is being unwittingly coached in the art of conning doctors to push Oxy on patients; and members of the Sackler family, especially Richard (Michael Stuhlbarg), who are fixated on making a profit without regard to the potential loss of life.
In many of these accounts, a palpable sense of the frustration and tragedy comes through thanks to an incredibly capable cast and an admirable resistance to treating the working-class characters like caricatures instead of human beings. Keaton brings an understated sensitivity to his role as a widower and a committed physician who personally knows all of his patients. Finnix comes across as the kind of doctor everyone in America wants and too few of us actually have: a physician who has known you all your life and makes informed decisions about your health because he actually cares. When Poulter’s Billy, the rep for Purdue Pharma, first suggests that Finnix consider prescribing OxyContin to his many patients suffering from chronic pain, the doctor is skeptical. But Billy has his talking points ready. He says OxyContin is not addictive and doesn’t spike and fall in the bloodstream the way other opioids do. He even has a chart to prove it. (As relentless as Billy is, he’s a benign entity when compared to his fellow Pharma rep Amber — played by Hamilton’s Phillipa Soo — who lacks scruples and quite possibly a soul.)
Finnix starts prescribing Oxy on a modest basis, including to Betsy, a lesbian struggling to come out to her extremely religious parents (Mare Winningham and Ray McKinnon). The medication is effective at first; the back pain caused by her labor in the mines abates. But as soon as Betsy starts taking the stuff, it’s obvious she is going to get addicted. Her journey is really the heart of Dopesick, and while it’s become standard to say this about Dever’s performances, it’s still true: She is just exceptional here, evoking the desperation and powerlessness that comes with addiction and withdrawal without ever succumbing to the clichés that can creep into such portraits. She earns empathy honestly by making Betsy as real and vulnerable as anybody you might pass the next time you run an errand or grab a cup of coffee.
Seeing how Betsy is affected by Oxy makes the tactics used to market it that much more infuriating. Dopesick spends a lot of time going into the details surrounding all that, particularly Purdue Pharma’s use of semantics and outright deceit to hide the addictive nature of its drug. When patients start to find their aches returning after taking the pills for a while, Purdue dubs the experience “breakthrough pain” and encourages doctors to prescribe more. Individualizing the dose is another invented buzzword that gives doctors the flexibility to provide patients with more OxyContin and gives Purdue Pharma more revenue.
While it’s vital to understand some of the machinations behind Purdue Pharma, more time is spent among the Sacklers than is necessary. Stuhlbarg is a fine actor and plays Richard Sackler with an appropriately whispery energy and perpetual frown, but even a well-etched performance can’t overcome the fact that, at least as written, he’s not a particularly dynamic character. Almost every scene with the Sackler family is like a pitch reel that asks, “What if Succession, except boring?”
Stuhlbarg isn’t the only performer let down by Dopesick’s expository instincts. While Dawson makes a convincingly aggressive DEA enforcer, her character often seems to exist as a means to explain aspects of the opioid crisis, particularly with regard to the FDA, that didn’t fit under any other sections of the narrative umbrella.
The subject matter of Dopesick is, sadly, still timely even though most of the events take place more than a decade ago. Last month, a judge in U.S. bankruptcy court approved a settlement that dissolved Purdue Pharma but shielded the Sackler family from the company’s Oxy liability and enabled them to escape further scrutiny in open court for their role in the opioid crisis. That news reinforces the thread in the series that suggests everything about this epidemic — from forcing those responsible to be held accountable to weaning off the pills themselves — is a nearly insurmountable challenge. The callous treatment of the Americans who died, lost loved ones, or became addicted also may help explain why some, particularly in working-class sections of this country, mistrust pharmaceutical companies enough not to get vaccinated against COVID-19. The series itself never tries to connect these two dots, but it’s hard not to see a link there.
For these and other reasons, Dopesick is worth watching. While it bites off more than it can reasonably chew and can be a little heavy-handed at times, when the series breaks your heart, it really shatters it. It argues that attention must be paid to the casualties of the opioid crisis and the conditions that allowed that crisis to take root and that similar mistakes should never be made. It’s impossible to disagree.