‘Dopesick’ tells the devastating tale of America's OxyContin addiction

Journalist Beth Macy’s 2018 book Dopesick offered a devastating and extensive multilayered picture of the history of the opioid crisis in the Appalachian region and its effects on ordinary, often poor and working-class people.

In the hands of writer and creator Danny Strong (The Butler, Hunger Games, Empire), Macy’s non-fiction book has been turned into an ambitious, time-jumping, sprawling piece of hard-hitting social realist drama that gives a human face to the crisis and the many players at all levels of its evolution.

At the top were the Sackler family who, through their company Purdue, manufactured the highly addictive drug OxyContin and allegedly manipulated US federal oversight institutions and regulations to increase their profits. Below them were the increasingly uneasy Purdue sales reps who, in spite of concerns about the drug’s addictive nature, were told to continue aggressively pushing it.

Their dodgy spin-doctoring pulled the wool over the eyes of many small-town doctors who believed the company’s claims that the drug, unlike other opiates, was almost completely non-addictive or else were too enamoured of the incentives they received for prescribing it to worry about the interests of their patients over their own.

At the bottom were the millions of ordinary people who became addicts — many of them first being prescribed the drug for injuries sustained while working in the high-risk environments of the US's industrial and agricultural heartlands and whose rapid dependence on the drugs tore their lives and those of their families apart.

The havoc that opioids were causing to the social fabric of working-class American society didn't go unnoticed by a few dogged prosecutors and federal law-enforcement officials but their efforts to hold the Sacklers and other big pharma opioid pushers accountable and obtain some sort of justice for the victims of their profiteering were continually confounded, until eventually the Sacklers were publicly shamed for their actions and settled with the families of their victims.

Telling such a complicated and decades-long story required Strong and his writers to continually shift the focus of the series between a large cast of characters and across different time periods without necessarily having the luxury to spend too much time explaining everything for the audience. That’s a sacrifice that the show mostly manages to make to its advantage, thanks to a strong cast of empathetically drawn and relatable characters and a terrific cast of actors who keep us engaged with the disparate struggles of their characters.

Michael Stuhlbarg brings an unnerving, dead-eyed hubris to his portrayal of the still-mysterious villain of the story, Richard Sackler who, out of a sense of inferiority and loyalty to his family’s history, is determined to have the drug succeed by any means necessary — even going so far as to spend hours every night phoning sales reps and giving them pep talks to increase their tallies.

One of those sales reps is a brashly self-confident, small-town, average American boy chasing the big money entrepreneurial dream, Billy Cutler (Will Poulter), whose youthful “good old boy” charm  becomes his most powerful weapon in expanding the market for OxyContin into the industrial heartland through his easy relationship with local doctors. One of those doctors is Appalachian GP Dr Samuel Finnix (Michael Keaton) who, though initially incredulous, soon begins to prescribe the drug to his patients and eventually finds himself on the wrong end of the process after suffering his own injury in need of pain-alleviating medication. Brilliantly played by Keaton with a rugged no-nonsense but empathetic sense of purpose, Finnix is on a journey that is one of the more heartbreaking and inspirational of the series.

Among the patients he prescribes the new wonder painkiller to is a young woman named Betsy Mallum (Kaitlyn Dever), a closeted lesbian who has to battle the dogmatic expectations of her family and the sexist environment of the mine where she works and where she suffers a potentially debilitating injury. 

Slowly but depressingly surely all these lives begin to unravel thanks to the greed-fuelled machinations of Sackler and the increasingly easy means of access to his drug.

The only people in any position to put a stop to the rot are two Virginia prosecutors, Rick Mountcastle (Peter Sarsgaard) and Randy Ramseyer (John Hoogenakker), and a federal agent, Bridget Meyer (Rosario Dawson), whose decades-long fight with various higher ups and Sackler protectors will strain their professional and personal lives to their limits.

Ultimately, Dopesick manages to take a wide-ranging, twisting narrative of corporate corruption and its terrible and tragic trickledown effects and create engaging, hard-hitting and emotionally devastating drama that leaves a bitter, angry taste in the mouth long after the conclusion of the story.   

• 'Dopesick' is available on Disney +