LAUSR

The early part of my COVID experience coincided with a year in Washington, DC, working for the US Food and Drug Administration. The stresses within the FDA were significant, as were those surrounding the political landscape in DC at the time.Though I tried to focus my down time on activities intended to decrease anxiety levels, I nevertheless found myself transfixed on two miniseries, Dopesick and The Dropout, in part because each dealt with elements of healthcare and healthcare regulation that I could closely identify with. For this editorial, I will focus on Dopesick (Hulu, 2021), based on the 2018 bestseller by Beth Macy.1 As an aside, if you find the miniseries disturbing, you will find the book even more so. The subject has been in the mainstream news for a number of years, so I think many of us are at least familiar with the general story—the manipulation by the pharmaceutical industry that led to the proliferation of opioid prescriptions and the resulting opioid epidemic in America. Pharmaceutical companies promoted “pain as fifth vital sign,” and the ten-point pain scale with smiley faces and frowns that continues to be ubiquitous in doctors’ offices. Professional societies, which advocated for increased opioid use, received funding from the pharmaceutical industry.2 In 2012 alone, over 250 million prescriptions were written for opioids.3,4 From 1999 to 2011, the use of prescription opioids, oxycontin, oxycodone, and hydrocodone, skyrocketed, as did deaths due to opioid-related overdoses.5 Policy changes beginning at individual State levels began to reduce the availability of prescription opioids,resulting in a dramatic increase of the price on the illegal market, and a switch to lower-cost alternatives of heroin and more recently, fentanyl. Overdose deaths have continued to increase year over year, with more than 106 000 in the U.S. in 2021.6 One highly successful tactic employed by the prescription opioid industry was the use of all-expense-paid “pain management” seminars targeting health care professionals and held at luxury resorts.7 The physician played by Michael Keaton in Dopesick, originally reluctant to prescribe opioids, attends such a seminar and meets with highly regarded physicians who reinforce the