In the third episode of the Hulu miniseries Dopesick, Randy Ramseyer, an assistant U.S. attorney in Virginia who is investigating Purdue Pharma's marketing of OxyContin, undergoes prostate cancer surgery. Although he tells a nurse his postoperative pain is off the charts, he refuses to take the OxyContin she offers, saying he wants nothing but Tylenol.
Ramseyer later describes that incident as a narrow escape from the clutches of pharmacological slavery. "I very easily could've become addicted to Oxy," he says. "And it wouldn't have been the disease that killed me; it would've been my medication. I got lucky."
The implication is that opioids are not an appropriate treatment even for severe postsurgical pain. Ramseyer's decision and his justification for it illustrate how Dopesick, ostensibly about the misdeeds of one unscrupulous pharmaceutical company, promotes pernicious misconceptions about opioids, addiction, and pain treatment.
A 2021 review of the evidence in the journal Frontiers in Pain Research concluded that "the prevalence of opioid use disorder associated with prescription opioids is likely < 3%." Dopesick, which is based on a 2018 book of the same name by journalist Beth Macy, presents that uncommon outcome as if it were typical. We never see a single patient whose life was, on balance, improved by prescription opioids. The resulting impression is that patients who take opioids for pain generally regret it.
Because OxyContin is not qualitatively different from other opioid analgesics, Dopesick's indictment of it amounts to an indictment of the whole drug category, which the show portrays as unacceptably dangerous in nearly every context, with the possible exception of dying cancer patients. Dopesick's creators seem to think everyone else, no matter how life-impairing his pain, should follow former Attorney General Jeff Sessions' cruel prescription: "take some aspirin" and "tough it out."
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