Alex Gibney Talks New Opioid Crisis Doc and Dangers of a “System That’s Enthralled With Money”

One of the final shots of The Crime of the Century, the new two-part documentary series on America’s opioid crisis helmed by Alex Gibney, depicts a graveyard with a view of Purdue Pharma’s headquarters in Stamford, Connecticut. It’s a compact visual metaphor for one of the film’s main arguments: that by aggressively working to expand the audience for its blockbuster drug OxyContin and ignoring mounting evidence of its abuse, Purdue helped to fuel a crisis that killed nearly 500,000 people between 1999 and 2019.

The film, whose first part debuts on Monday on HBO, traces how the rise in prescriptions of opioids like OxyContin for pain led to abuse of both prescription and non-prescription drugs and fueled illicit sales of heroin and fentanyl. The initial idea behind the film, says Gibney (Going Clear: Scientology and the Prison of Belief, Enron: The Smartest Guys in the Room), arose from a meeting with a Washington Post investigative team that had worked on related reporting (WaPo is now presenting the film in association with Storied Media Group). Gibney came to the conclusion that he wanted to redefine the opioid crisis as a series of “interlocking crimes” and not a “natural event.” If the crisis were treated as a crime, “then there are people to be held to account, and also there’s a way of fixing things so the crimes don’t happen again,” he adds.

In arguing that case, The Crime of the Century cites some previously unreported primary sources, including a damning 120-page Department of Justice prosecution memo on Purdue and a video deposition featuring Richard Sackler. The film also introduces audiences to a motley host of characters involved in the crisis at multiple levels including Alec Burlakoff, the fast-talking former vp of sales at Insys Therapeutics, which bribed doctors to prescribe its fast-acting form of fentanyl, and Caleb Lanier, a Texas father of three who began distributing fentanyl after using opioids to handle his pain from a car accident.

The Hollywood Reporter spoke with Gibney about the parallels between the U.S. response to the opioid crisis and the COVID-19 pandemic, the influence of pharmaceutical money in Congress and how the crisis is in part due to “turbo-charged 21st-century capitalism combined with healthcare.”

Can you explain the title of the film and why you decided to call it The Crime of the Century?

It just seemed that big. I mean, 500,000 people dead. And when I say the “century,” I mean the 21st century, so I didn’t have to deal with a number of other crimes previous. And also this is very much a crime of this century. In other words, Purdue launches OxyContin in the late ’90s but most of the damage done from opioids is in the 2000s, so it seemed appropriate — both the enormity of it and the timing.

How did you find the process of getting these characters like Alec Burlakoff, Sunrise Lee or Caleb Lanier to speak with you, especially when they were implicated in some kind of wrongdoing?

In the case of Alec Burlakoff, he had already been convicted and that was key, so we went through the prosecution team and they gave us permission to talk to him, provided that he would give permission. I wrote Alec a long letter and suggested that it would be useful to other people to hear from his experience, and he agreed, much to his credit. Because I think one of the great things about Alec in the film, what he describes is despicable, but he’s also a very engaging character and a larger-than-life character, something out of Glengarry Glen Ross, something like that. What was great about him was that he was willing to take me back to the time when he was in the middle of it. It’s almost like he transforms himself into that character that he was at that moment. So Alec, what he did was terrible, but I appreciated how honest he was about his role.

The truth is I think most people want to tell their story and they want to tell it very often the way they want to tell it. The critical thing is to convince them that you’re going to listen and that you’re really going to listen to their story and portray them in a way that is honest to what they’re telling you. Even if that sometimes means putting them in a context where they sometimes don’t look so good. Because at the end of the day, I feel it’s really important to allow folks I interview to express themselves in the way they want to express themselves, but they have to know they’re within the context of a bigger story where their story may not always be the most credible one.

You were able to obtain some never-before-seen documentation, interviews and videos, including Department of Justice documents and Richard Sackler’s 2015 deposition for the Kentucky v. Purdue Pharma lawsuit. What new light does this material bring to the issue of the opioid crisis?

Well the charging document, this 120-page prosecution memo, gave a level of detail that was really jaw-dropping that enables us to see exactly how this worked, these plans for flooding the country with OxyContin, how they worked in the field and the result of that is a character like Garry Blinn. Garry Blinn we never would have discovered if we hadn’t found his name in the prosecution memo and we sought him out and he agreed to come on board. Some of the videos are really illuminating, whether it be the Insys video — which has been broadcast before — or the Purdue video of their ’97 sales conference, which is really jaw dropping, where they’re singing rock-n-roll songs about selling OxyContin. And it’s clear that in that jamboree that they’re conducting, there’s very few skits being done about good patient outcomes; it’s all about making gobs and gobs of money by selling OxyContin, that they were going to surpass Viagra as America’s most profitable drug.

And then in the case of the deposition, with the help of ProPublica, who originally obtained the full thing, we were able to get access to all of the deposition from Richard Sackler. He’s a character who really hid behind the scenes, he gave very few interviews but you can really get to a sense of how his mind works and how unrepentant he is and how he doesn’t seem to have any regrets. There’s a kind of weird arrogance about it as well as sort of a tone-deafness that is really important to hear. One of the people who asks him, “Well, Just because the drug is potent doesn’t necessarily mean it’s effective. I mean, if people die, that doesn’t necessarily mean it’s a good thing right?” He says, “Yes, I suppose death is not a sign of efficacy” and he sort of chuckles to himself. You think, dude, this is in the middle of an opioid crisis. So it’s a kind of chilling moment that shows you the lack of human concern for the devastation that was wrought by these drugs.

Beyond the actions of pharmaceutical companies, the film argues that the lassitude of Congress and its willingness to look the other way given those companies’ major campaign contributions led to the passing of the Ensuring Patient Access and Effective Drug Enforcement Act, at the very least. Do you see the relationship between politicians and pharmaceutical companies changing anytime soon?

I don’t, not until we change the campaign finance laws. And in a funny way, reframing the opioid crisis as a crime is hugely helpful in the sense that you can see the criminals and you can see the crimes and therefore hope to hold them to account, if not in real courts, at least in the court of public opinion. But beyond that I think it really shows the dangers of a system that’s enthralled with money. Until we fix that, we’re going to continue to have huge problems like this. Our healthcare system is broken and we need to fix it. Our political system is broken because it’s suffused by money. And so until we fix those problems, we’re going to continue to have bad outcomes. The Hippocratic Oath does not contain terms like “supply and demand” or “market share,” it’s about “do no harm,” it’s about “look to the good of the patient.” But this turbo-charged 21st-century capitalism combined with healthcare leads to some terrible incentives. And when you have a Congress who is essentially manipulated by powerful forces who are awash in money — that act that you mentioned, it passed by unanimous consent and that was from some representatives and senators who were being very aggressive on the subject of healthcare reform. But I think it passed by unanimous consent because nobody read it and that’s the way the system works. These people in Congress spend so much of their lives raising money, they don’t have time to actually do the business of governing, and that may be the most terrifying thing of all.

Given that you also just released a film about America’s response to the COVID-19 epidemic, Totally Under Control, are there any similarities that you see in the issues with the ways that America responded to the pandemic and the opioid epidemic? Do you see those two health crises intersecting in important ways?

One hundred percent. And I think the same issue applies. In other words, the approach of the Trump administration to the COVID-19 crisis was to pretend it didn’t exist so that it didn’t damage business. Then when there were some attempts to try to deliver PPE and other ameliorative technologies, there were a series of giveaways to the private sector that were designed to maximize profit instead of good patient outcomes. So it’s the same problem. It’s like “Oh, don’t worry, the market will fix everything, just sit back and pretend that the government doesn’t have a role to play and everything will work out fine because big business will rush in and make it happen.” In a way, you have to look at it, like, both the COVID pandemic and the opioid crisis demand a multidisciplinary, coordinated response that deals with everything from medicine to understanding addiction to testing to transmission to masks, all these interrelated issues. And I’ve now conflated or put together stuff from both the opioid crisis with the COVID crisis, but it’s complicated and it demands an integrated response that can’t be met by companies who are focusing not only on their bottom line but also on a particular product. That’s all they care about. They don’t care about the bigger picture. And it’s not their job to care about the bigger picture, that’s the job of government. And so, in both cases, I think government has failed us and they’ve failed us because you’ve given over so much of social policy to the market rather than to a larger, more cohesive understanding of how to run a country for the benefit of our citizens.

Empire of Pain author Patrick Radden Keefe, who you feature in the film, said in a recent interview that while he was writing his book on the Sackler family, which owns Purdue, he received legal threats. Did you or any of the filmmakers involved in this documentary personally deal with any legal threats of your own?

Not so far. We did engage with a lawyer, some PR representatives from the Sackler family and listened to some of their presentations about their point of view but, so far, no legal threats.

What do you hope that viewers take away from this film?

I hope they take away the central notion, which is that this was a crime, it didn’t just happen. It was a series of actions that were consciously taken that caused the deaths of hundreds of thousands of people and those actions are reckless and they deserve to be recognized as crimes. But I think more broadly, and you could probably hear it from my previous answers, I hope viewers will take away from this that coming out of the opioid crisis — and I hope we’re coming out of it even though for the moment it’s getting worse — and coming out of the COVID crisis, that we would have the courage to demand that our representatives do better. And it’s not just “gosh, can we do a little bit better.” We’ve got to change the system and the way it works because it’s not providing good outcomes. I think part of what this film says is to recognize that if you have the wrong incentives, terrible things will happen and many, many people will die and the same thing happened with COVID. We need to demand that we get money out of our healthcare system and we’ve got to get money out of our political system. And we’ve got to demand that we do better to deliver for our citizens.

Anything else you want to add that we didn’t talk about?

The only thing I would say is there’s a pushback that happens often — and this goes to the heart of why I started the story — by the pharmaceutical companies saying, well, if you’re Purdue Pharma, it’s like, “We manufactured OxyContin, what does that have to do with fentanyl?” And I think there you have to look to the market mechanisms and say these companies created a demand that became insatiable and had to be met, and when it couldn’t be met through prescriptions, it was met through the illicit market. And so part of the goal of the film was to show that Mexican drug cartels and the pharmaceutical firms that are pushing opioids are not so very different and in some ways they have the same business model.

This interview has been edited for length and clarity.