- America is facing an epidemic of addiction to opioids, including heroin and prescription painkillers
- Prescription painkillers are often the gateway to heroin use, as they are cheaper and more readily available
- Doctors have been prescribing opioids excessively, leading to a surplus of pills in circulation
- The pharmaceutical industry, particularly Purdue, played a major role in promoting the use of opioids for all types of pain
- Purdue marketed OxyContin aggressively, even giving out promotional items and producing videos to reassure patients
- The claim that less than 1% of patients become addicted to opioids was based on a non-peer-reviewed letter and is misleading
- The opioid crisis has led to thousands of overdose deaths each year in the US

- The pharmaceutical industry, particularly Purdue, played a major role in the opioid crisis by misleadingly marketing drugs like OxyContin.
- Doctors were influenced by Purdue's message of a quick and easy cure for pain, leading to a significant increase in prescriptions for opioids.
- Evidence started to emerge that opioids were riskier than promised, with increasing abuse and addiction rates.
- Purdue and other companies faced lawsuits and fines for their deceptive marketing practices.
- The CDC issued guidelines to promote safer prescribing practices for opioids, but access to alternative pain treatments remains limited in many areas.
- The pharmaceutical industry continues to profit from opioids, even marketing drugs to combat opioid-related side effects.
- Efforts to address the opioid crisis will require significant investment in treatment programs and increased availability of overdose-reversing drugs like naloxone.

John Oliver discusses the extent and root of the nation’s epidemic of opioid addiction.

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-♪ ♪ -♪ ♪ I would like to talk to you about drugs.

And I know, I know, I already sound like a middle school health teacher about to show you a video like this.

Take a lack of responsibility, the inability to make right choices, add to it ignorance and indifference, and top it off with a desire for escapism and kicks.

The sum total is then conceivably found in the Bennys, the reefer, the pot needle.

Think about it, when was the last time that you saw a pot needle?

But unfortunately, America is now in the midst of a new drug crisis, and it seems that no 1 is safe from it.

Laura, Charlie's owner, who asked us not to use her last name, says Charlie had to be rushed to the vet.

You can't see the suspect throw the drugs over the fence in the video, but that's Charlie.

And what she's eating is a full bag of heroin.

You can't process the fact that your dog ate heroin.

Yeah, and if she can't process it, imagine how it must have felt for her dog when it kicked in.

Even that lighthearted local news story had some chilling context.

Garrett Bishop runs the Bark & Play where it happened.

He says it highlights a much bigger problem.

This whole heroin problem around here is ridiculous.

You know, we find needles, we find everything around here, and it's getting to the point to where I can't let my employees go outside.

Although, honestly, rampant heroin abuse near a doggy daycare center is the first case that McGruff the crime dog is actually qualified to solve.

But the thing is, that is symptomatic of the fact that America is facing an epidemic of addiction to opioids, like heroin and prescription painkillers.

As of 2015, an estimated 2.6 million Americans were addicted to them, and they're now involved in almost 30,000 overdose deaths a year in the U.S.

And the prevalence of this problem astonishes some people.

Just listen to Donald Trump up in New Hampshire.

They said the biggest single problem they have up here is heroin.

And I said, how does heroin work with these beautiful lakes and trees and all of the beautiful?

--HEROIN LAUGHS AND CLAPS --Heroin works basically everywhere because it's heroin.

--HEROIN LAUGHS AND CLAPS --So, So tonight, we're gonna look at 1 of the major causes of this crisis, prescription painkillers, which are chemical cousins of heroin.

Around 75% of heroin users started with a prescription opioids.

Drugs like Oxycontin, Vicodin, and Percocet, which some take recreationally, and others take as prescribed by a doctor.

But however it starts, it can get out of hand fast.

So how many, if we start from this side, have moved from prescription drugs to heroin?

Once people became dependent on painkillers, they said they'd do almost anything to get them.

1 time I was hurting so bad that I ended up punching a 4x4 and breaking all 3 of these fingers and this bone to get pain meds from my doctor.

So you'd hurt yourself in order to go to a doctor?

9 teeth pulled out of my head for prescriptions.

I've been with like groups of people where they've taken like bats to their wrists.

I mean, how many people do know someone has died of overdose from...

The odds are, right now, you probably know someone who is struggling or who has died from an opioid addiction.

Just 2 months ago, in and around Huntington, West Virginia, 28 overdoses occurred in 1 five-hour span.

And given their risks, it's kind of amazing how freely doctors have prescribed them, because there are a lot in circulation.

We have currently nearly 250 million prescriptions for opioids written every year.

That's enough for every adult in America to have a bottle of pills, and then some.

And those bottles aren't necessarily sitting on a shelf unused, like that bottle of wine that you are saving for a special occasion, but now serves as a reminder that you haven't had a single event in 4 years that was deserving of getting fancy drunk.

Now, these pills are getting used or falling into the hands of others, from those who are already addicted to just bored teenagers.

Because, interestingly, as recently as the early 90s, doctors were excessively wary of prescribing opioids.

Back then, there was a thing called opiophobia.

A lot of healthcare professionals did not want to prescribe opiates at all, because they thought you give the slightest amount, you turn your patients into addicts.

And so, even people with stage 4 cancer weren't being given opiates, they were left to suffer.

Yes, opiophobia, which is not to be confused with Oprah-phobia, which is the irrational fear of screaming talk show hosts giving you a brand new Pontiac sedan.

Now, obviously, that level of under-treating pain was a huge problem in itself.

And to their credit, pain care advocates worked to dispel some dangerous myths.

But in doing so, they made a key mistake, as you will see right at the end of this clip.

Today, the federal government said in a report that about half of all surgery patients suffer needlessly, because doctors and hospitals don't pay enough attention to painkiller.

Health Secretary Louis Sullivan talked about myths.

That elderly patients have a higher tolerance for pain.

How the fuck did we ever think otherwise?

But more importantly, the fact that painkillers are addictive was not a myth.

It's like a book of Greek mythology featuring the stories of Zeus, Sisyphus, Oedipus, and Yanni.

That last 1 is very real, and it cannot be dismissed.

And look, a nuanced discussion between the medical community about the complexities of pain treatment is clearly important.

The problem is, that discussion became dominated by the pharmaceutical industry, who started amplifying the message that opioids should not just be used for acute pain, like that from cancer or surgery, but for all sorts of pain, like arthritis and backaches.

Which makes sense as a motive coming from the pharma industry.

End of life pain care is a narrow business.

It's hard to make a lot of money off of a product exclusively marketed to people who are close to death.

Honestly, I don't know how Fox News even does it.

And within the pharma industry, the loudest voice was Purdue.

In 1996, they released the blockbuster drug, OxyContin.

And they marketed it to doctors aggressively, giving out swag like fishing hats, swing music CDs, bearing the slogan, swing in the right direction with OxyContin, and Oxy-branded stuffed plush toys.

And if you think we didn't get hold of 1 of those, You have clearly never watched this show before.

And I've got to say, Purdue, this is the perfect choice of mascots, because much like a gorilla, OxyContin might seem appealing, but if you're not careful, it will tear your f-ing life apart!

-♪ ♪ -♪ Purdue also distributed inspirational videos like I Got My Life Back, featuring 7 patients whose lives were turned around by the magic of OxyContin.

Since I've been on this new pain medication, I have not missed 1 day of work, and my boss really appreciates that.

Lauren is there every day, so I'm able to be very productive.

And 1 of the things that's really dear to my heart and which I'm especially excited about is just the fact that I'm able to spend time with my grandchildren.

It's amazing just to be able to keep up with them and not have to, always constantly tell them, Grandma can't play now, Grandma can't do this, Grandma's hurting, Grandma's back hurts.

That's genuinely sweet, and it's also a powerful message.

Although I will note, it makes time with your grandkids more fun, could apply to literally any drug.

And then we're gonna stay up all night, and I'm gonna come

up with inventions, and you're gonna write them down.

Other Purdue videos sought to reassure patients who might have been nervous about taking such a strong drug.

Less than 1 percent of patients taking opioids actually become addicted.

And I know it may seem like they are pulling that number out of their ass, but they actually pulled it out of the letters to the editor section of the New England Journal of Medicine.

It wasn't peer-reviewed, and it was only about short-term use of opioids in hospitals.

But it became the main source for that 1 percent claim.

And letters pages are not a solid source for information.

Just this month, a Pennsylvania newspaper published a letter featuring a man's question about Hillary Clinton's fitness for office.

Because, and I quote, -"What if that time of the month comes?" -$6,000.

To which the obvious answer is, 1, she's 68.

But even if doctors started noticing that a lot more than 1 percent of their patients were getting addicted, Purdue had a ready answer, what if they're not?

Because they had doctors on their payroll, like Alan Spanos, who were happy to explain the helpful new concept of pseudo-addiction.

When A patient is looking like a drug addict because they're pursuing pain relief.

So, pseudo-addiction is relief-seeking behavior mistaken as drug addiction.

That is like Chipotle going, have you heard of this fascinating new thing called pseudo-diarrhea?

It looks a lot like diarrhea, but it's not diarrhea.

And Purdue's overall message of a quick, easy cure for pain was very appealing, especially for primary care doctors who might only have 15 minutes to treat a patient.

So it is no wonder that by the year 2000, doctors were writing nearly 6000000 oxycontin prescriptions per year, and its sales were more than even Viagra.

And remember, that was a drug that had the distinct advantage of being sold by Bob Dole, the red-hot, late-'90s It Boy.

------------------------------------------------------------------------------------------------------------------------------------------------------------ Evidence started piling up that it was far riskier than promised, with headlines like, Oxycontin abuse is increasing, and Oxycontin abuse called a plague, or as I'm sure Purdue would call it, a pseudo plague.

And even the stars of Purdue's I Got My Life Back video were not immune from this trend because a later investigation discovered 2 out of the 7 of them died as active opioid abusers and that grandmother you saw earlier became addicted and nearly lost everything.

I lost a lot to keep, behind taking that drug when I did lose my dome.

Had I not lost my medical insurance, as I said, or if I was to go to the mailbox once a month and I would find a bottle of Oxycontin in it, I'd probably still be on it and I'd probably be dead.

Losing her health insurance might have saved her life.

That is an irony so deep, it would vaporize Alanis Morissette into a cloud of f**king steam.

Now, by now, I'm guessing you are pretty angry at Purdue.

So, you may be glad to hear that in 2007, they admitted some responsibility in a lawsuit so big, it actually led to the evening news.

The maker of a hugely popular painkiller has some pain of its own tonight.

The company and its top officers will pay $634 million in fines for lying to the public.

You know they fucked up if they had to pay over $600 million for misleading marketing, because you get a lot of leeway on that.

That's why Dunkin' Donuts has not yet been sued for saying, America runs on Dunkin', when we all know their real slogan should be, sometimes you can't find a Starbucks.

And look, it wasn't just Purdue pushing the envelope.

Cephalon paid a $444 million settlement for over-marketing drugs, and Insys has been investigated for some of its practices surrounding a drug they made containing fentanyl, an opioid which can be a hundred times more powerful than morphine.

Their drug is only approved for cancer patients, but Insys is accused of not just pushing it for non-cancer patients, but even helping convince insurance companies to pay for it.

And to do that, according to 1 ex-employee, they used a particularly shady technique.

If you don't have cancer and break through cancer pain, no insurance company is gonna pay for this medication.

So, if you call up and you tell them that the patient doesn't have cancer, it's automatically denied.

They would always ask, does the patient have cancer?

Except everybody knows, uh-huh means yes.

If you go to thesaurus.com and type in uh-huh, literally the first word that comes up is Yes, followed by options such as absolutely, definitely, unquestionably, and yup.

Look, and at this point, I should say that Purdue and Cephalon's owner told us that those practices were in the past, and Insys has denied wrongdoing and didn't respond to any of our questions, not even with a, -"Nuh-uh." -$$LAUGHTER But at a certain point, the question has to become less, what did we do wrong, and more, what do we do now?

Because these drugs are still the most effective solution for certain types of pain.

And many patients need them, so we can't get rid of them, but we have to be much more careful about how they're prescribed.

And to their credit, the CDC issued voluntary guidelines this year, suggesting doctors use non-opioid therapies when possible and, if and when 1 is needed, to start patients with a lower dose and a shorter supply.

A technique that they call, start low and go slow.

Which does sound good, but also sounds like how your creepiest high school friends described cunnilingus.

Look, and while all that sounds great, unfortunately, not all areas of the country have access to alternative pain treatments.

It's easy to say, use some non-opioid alternative, but in a lot of rural areas, patients don't have access to things like physical therapy and mindfulness meditation, and insurance companies won't pay for it.

And that is a big problem, because even in a rural area, alternative pain treatments should be at least as easy to find as waffle houses, which, like heroin, are both hazardous to your health and dangerously addictive.

And to put it mildly, it does not seem that the pharmaceutical industry is expecting any major reversals in opioid sales anytime soon.

In fact, they are now marketing extra drugs to fight 1 of opioid's side effects, constipation.

If you need an opioid to manage your chronic pain, you may be so constipated, It feels like everyone can go except you.

You know painkillers are powerful if people use them despite the side effect being jealous of a dog's butthole.

And that commercial aired during the Super Bowl this year, which means A, it is a big business, and B, I can only assume there was a reverse commercial during the Puppy Bowl featuring a jealous dog and a shitting man.

But we cannot just work to prevent future addicts.

We're going to need to do more to help the millions that already exist, which means more investment in treatment programs, as well as increasing the availability of drugs like naloxone, commonly used in a nasal spray to rescue people from overdoses.

Because, as this Firehouse makes clear, it is a tool that they use with depressing frequency.

So every single firefighter in the Revere Fire Department knows how to use this, has been trained on this.

We tend to have more overdoses than we do...

So, it's a piece of equipment that we can't go without now.

Firefighters might be more likely to use a nasal spray than a hose.

Which is really going to fuck up those hot firefighter calendars.

Because something about an overdose-reversing nasal spray isn't quite as sexy.

It's still sexy, but just not quite as sexy.

Not all opioid addicts will respond to the same treatment, and not all people in pain will find relief from alternative therapies.

This is going to take a massive effort and a significant investment.

It won't be cheap, It won't be quick, and it won't be easy.

And it is hard not to be angry at the drug companies like Purdue, whose promise of cheap, quick, easy pain solutions helped put us in this fucking mess.

Because while they may not be solely responsible, if you were to ask me if they bear significant blame for reckless, greedy behavior which contributed to this massive public health crisis.

I might not say, yes exactly, but I would definitely say, uh-huh.

-♪ Uh-huh, uh-huh ♪ -♪ Uh-huh, uh-huh, uh-huh...


Speaker 0: We'll be right back. -♪ ♪ -♪ ♪ I would like to talk to you about drugs. And I know, I know, I already sound like a middle school health teacher about to show you a video like this.

Speaker 1: The pattern is generally the same. Take a lack of responsibility, the inability to make right choices, add to it ignorance and indifference, and top it off with a desire for escapism and kicks. The sum total is then conceivably found in the Bennys, the reefer, the pot needle.

Speaker 0: Yes, the pot needle. Now... Now, you may laugh, but that film works. Think about it, when was the last time that you saw a pot needle? Exactly.

Exactly. But unfortunately, America is now in the midst of a new drug crisis, and it seems that no 1 is safe from it.

Speaker 2: Laura, Charlie's owner, who asked us not to use her last name, says Charlie had to be rushed to the vet. You can't see the suspect throw the drugs over the fence in the video, but that's Charlie. And what she's eating is a full bag of heroin.

Speaker 3: You can't process the fact that your dog ate heroin.

Speaker 0: Yeah, and if she can't process it, imagine how it must have felt for her dog when it kicked in. Who's a good boy? I'm a good boy. I'm a really good boy. I'm the best boy.

Ah. -♪ But here's the thing. Even that lighthearted local news story had some chilling context.

Speaker 2: Garrett Bishop runs the Bark & Play where it happened. He says it highlights a much bigger problem.

Speaker 4: This whole heroin problem around here is ridiculous. You know, we find needles, we find everything around here, and it's getting to the point to where I can't let my employees go outside.

Speaker 0: Okay, that is terrifying. Although, honestly, rampant heroin abuse near a doggy daycare center is the first case that McGruff the crime dog is actually qualified to solve. But the thing is, that is symptomatic of the fact that America is facing an epidemic of addiction to opioids, like heroin and prescription painkillers. As of 2015, an estimated 2.6 million Americans were addicted to them, and they're now involved in almost 30,000 overdose deaths a year in the U.S. And the prevalence of this problem astonishes some people.

Just listen to Donald Trump up in New Hampshire.

Speaker 5: They said the biggest single problem they have up here is heroin. And I said, how does heroin work with these beautiful lakes and trees and all of the beautiful? It doesn't.

Speaker 0: Yeah, it does, though. It does. --HEROIN LAUGHS AND CLAPS --Heroin works basically everywhere because it's heroin. It's not a cell phone. Heroin has full coverage.

--HEROIN LAUGHS AND CLAPS --So, So tonight, we're gonna look at 1 of the major causes of this crisis, prescription painkillers, which are chemical cousins of heroin. Around 75% of heroin users started with a prescription opioids. Drugs like Oxycontin, Vicodin, and Percocet, which some take recreationally, and others take as prescribed by a doctor. But however it starts, it can get out of hand fast.

Speaker 6: So how many, if we start from this side, have moved from prescription drugs to heroin? Everybody. Heroin's so much more cheaper. Once people became dependent on painkillers, they said they'd do almost anything to get them.

Speaker 7: 1 time I was hurting so bad that I ended up punching a 4x4 and breaking all 3 of these fingers and this bone to get pain meds from my doctor. I do that several times.

Speaker 6: So you'd hurt yourself in order to go to a doctor? Absolutely.

Speaker 7: I had

Speaker 8: 9 teeth pulled out of my head for prescriptions.

Speaker 7: At the time, that's how my...

Speaker 6: To get a prescription? Yeah. I've been with like groups of people where they've taken like bats to their wrists.

Speaker 7: Broke arms? Easily.

Speaker 6: I mean, how many people do know someone has died of overdose from... Everybody.

Speaker 0: This is happening everywhere. The odds are, right now, you probably know someone who is struggling or who has died from an opioid addiction. Some towns have been devastated. Just 2 months ago, in and around Huntington, West Virginia, 28 overdoses occurred in 1 five-hour span. And given their risks, it's kind of amazing how freely doctors have prescribed them, because there are a lot in circulation.

Speaker 9: We have currently nearly 250 million prescriptions for opioids written every year. That's enough for every adult in America to have a bottle of pills, and then some.

Speaker 0: Holy shit! And those bottles aren't necessarily sitting on a shelf unused, like that bottle of wine that you are saving for a special occasion, but now serves as a reminder that you haven't had a single event in 4 years that was deserving of getting fancy drunk. Now, these pills are getting used or falling into the hands of others, from those who are already addicted to just bored teenagers. So how has this happened? Because, interestingly, as recently as the early 90s, doctors were excessively wary of prescribing opioids.

Speaker 10: Back then, there was a thing called opiophobia. A lot of healthcare professionals did not want to prescribe opiates at all, because they thought you give the slightest amount, you turn your patients into addicts. And so, even people with stage 4 cancer weren't being given opiates, they were left to suffer.

Speaker 0: Yes, opiophobia, which is not to be confused with Oprah-phobia, which is the irrational fear of screaming talk show hosts giving you a brand new Pontiac sedan. Oprah, I can't afford the taxes on this. You haven't thought it through. Now, obviously, that level of under-treating pain was a huge problem in itself. And to their credit, pain care advocates worked to dispel some dangerous myths.

But in doing so, they made a key mistake, as you will see right at the end of this clip.

Speaker 11: Today, the federal government said in a report that about half of all surgery patients suffer needlessly, because doctors and hospitals don't pay enough attention to painkiller.

Speaker 8: Health Secretary Louis Sullivan talked about myths. That pain builds character. Myth, he said. That infants don't feel pain. Another myth.

That elderly patients have a higher tolerance for pain. Or that painkillers are addictive. All myths.

Speaker 0: Okay, okay, okay. First, of course babies feel pain. How the fuck did we ever think otherwise? But more importantly, the fact that painkillers are addictive was not a myth. It's like a book of Greek mythology featuring the stories of Zeus, Sisyphus, Oedipus, and Yanni.

Come on! That last 1 is very real, and it cannot be dismissed. And look, a nuanced discussion between the medical community about the complexities of pain treatment is clearly important. The problem is, that discussion became dominated by the pharmaceutical industry, who started amplifying the message that opioids should not just be used for acute pain, like that from cancer or surgery, but for all sorts of pain, like arthritis and backaches. Which makes sense as a motive coming from the pharma industry.

End of life pain care is a narrow business. It's hard to make a lot of money off of a product exclusively marketed to people who are close to death. Honestly, I don't know how Fox News even does it. I have no idea. It's a mystery.

Volume, I guess, but I don't know. And within the pharma industry, the loudest voice was Purdue. In 1996, they released the blockbuster drug, OxyContin. And they marketed it to doctors aggressively, giving out swag like fishing hats, swing music CDs, bearing the slogan, swing in the right direction with OxyContin, and Oxy-branded stuffed plush toys. And if you think we didn't get hold of 1 of those, You have clearly never watched this show before.

Because yes, here he is. And yes, he is my new best friend. And yes, his name is Harold. And I've got to say, Purdue, this is the perfect choice of mascots, because much like a gorilla, OxyContin might seem appealing, but if you're not careful, it will tear your f-ing life apart! Won't you, Harold?

Yes, he will. -♪ ♪ -♪ Purdue also distributed inspirational videos like I Got My Life Back, featuring 7 patients whose lives were turned around by the magic of OxyContin.

Speaker 12: Since I've been on this new pain medication, I have not missed 1 day of work, and my boss really appreciates that. Lauren is there every day, so I'm able to be very productive. And 1 of the things that's really dear to my heart and which I'm especially excited about is just the fact that I'm able to spend time with my grandchildren. It's amazing just to be able to keep up with them and not have to, always constantly tell them, Grandma can't play now, Grandma can't do this, Grandma's hurting, Grandma's back hurts.

Speaker 0: That's genuinely sweet, and it's also a powerful message. Although I will note, it makes time with your grandkids more fun, could apply to literally any drug. Hey, kids, Grandpa's gonna take

Speaker 6: you to the park. I'm gonna take on the swings. I'm gonna push you real high. And then we're gonna stay up all night, and I'm gonna come

Speaker 0: up with inventions, and you're gonna write them down. And you're gonna write them down fast. We're having quality time! -$20,000. And it wasn't just...

It wasn't just uplifting stories. Other Purdue videos sought to reassure patients who might have been nervous about taking such a strong drug. Less than 1 percent of patients taking opioids actually become addicted. Less than 1 percent. And I know it may seem like they are pulling that number out of their ass, but they actually pulled it out of the letters to the editor section of the New England Journal of Medicine.

Seriously, this is it. That paragraph is The whole thing. It wasn't peer-reviewed, and it was only about short-term use of opioids in hospitals. But it became the main source for that 1 percent claim. And letters pages are not a solid source for information.

Just this month, a Pennsylvania newspaper published a letter featuring a man's question about Hillary Clinton's fitness for office. Because, and I quote, -"What if that time of the month comes?" -$6,000. To which the obvious answer is, 1, she's 68. -$6,000. -$6,000.

And 2, f**k you, maybe. Just a little bit. -$6,000. -$6,000.

Speaker 13: But... But...

Speaker 0: But even if doctors started noticing that a lot more than 1 percent of their patients were getting addicted, Purdue had a ready answer, what if they're not? Because they had doctors on their payroll, like Alan Spanos, who were happy to explain the helpful new concept of pseudo-addiction. I'll let him tell you about it.

Speaker 14: Pseudo-addiction is... When A patient is looking like a drug addict because they're pursuing pain relief. So, pseudo-addiction is relief-seeking behavior mistaken as drug addiction.

Speaker 0: Wow, that is so convenient! That is like Chipotle going, have you heard of this fascinating new thing called pseudo-diarrhea? It looks a lot like diarrhea, but it's not diarrhea. And the cure may actually be more tacos. And Purdue's overall message of a quick, easy cure for pain was very appealing, especially for primary care doctors who might only have 15 minutes to treat a patient.

So it is no wonder that by the year 2000, doctors were writing nearly 6000000 oxycontin prescriptions per year, and its sales were more than even Viagra. And remember, that was a drug that had the distinct advantage of being sold by Bob Dole, the red-hot, late-'90s It Boy. ------------------------------------------------------------------------------------------------------------------------------------------------------------ Evidence started piling up that it was far riskier than promised, with headlines like, Oxycontin abuse is increasing, and Oxycontin abuse called a plague, or as I'm sure Purdue would call it, a pseudo plague. And even the stars of Purdue's I Got My Life Back video were not immune from this trend because a later investigation discovered 2 out of the 7 of them died as active opioid abusers and that grandmother you saw earlier became addicted and nearly lost everything.

Speaker 13: I lost my house. Oh, yeah, I've lost cars, I've lost... I lost a lot. A lot. I lost a lot to keep, behind taking that drug when I did lose my dome.

Mm-hm. Had I not lost my medical insurance, as I said, or if I was to go to the mailbox once a month and I would find a bottle of Oxycontin in it, I'd probably still be on it and I'd probably be dead.

Speaker 0: Think about that. Losing her health insurance might have saved her life. That is an irony so deep, it would vaporize Alanis Morissette into a cloud of f**king steam. Now, by now, I'm guessing you are pretty angry at Purdue. So, you may be glad to hear that in 2007, they admitted some responsibility in a lawsuit so big, it actually led to the evening news.

Speaker 15: Good evening. The maker of a hugely popular painkiller has some pain of its own tonight. The company and its top officers will pay $634 million in fines for lying to the public.

Speaker 0: Wow. You know they fucked up if they had to pay over $600 million for misleading marketing, because you get a lot of leeway on that. That's why Dunkin' Donuts has not yet been sued for saying, America runs on Dunkin', when we all know their real slogan should be, sometimes you can't find a Starbucks. And look, it wasn't just Purdue pushing the envelope. Cephalon paid a $444 million settlement for over-marketing drugs, and Insys has been investigated for some of its practices surrounding a drug they made containing fentanyl, an opioid which can be a hundred times more powerful than morphine.

Their drug is only approved for cancer patients, but Insys is accused of not just pushing it for non-cancer patients, but even helping convince insurance companies to pay for it. And to do that, according to 1 ex-employee, they used a particularly shady technique.

Speaker 16: If you don't have cancer and break through cancer pain, no insurance company is gonna pay for this medication. So, if you call up and you tell them that the patient doesn't have cancer, it's automatically denied.

Speaker 13: So Instead, what were you doing?

Speaker 16: They would always ask, does the patient have cancer? Uh-huh. That's what we would say.

Speaker 13: So you'd do, uh-huh. You'd say yes.

Speaker 16: But I'm not saying yes, right? I would just say, uh-huh.

Speaker 13: Isn't that a yes?

Speaker 16: Well, that's what they did think. But I wasn't blatantly saying yes.

Speaker 0: Oh, my God! Except everybody knows, uh-huh means yes. If you go to thesaurus.com and type in uh-huh, literally the first word that comes up is Yes, followed by options such as absolutely, definitely, unquestionably, and yup. And... And...

Look, and at this point, I should say that Purdue and Cephalon's owner told us that those practices were in the past, and Insys has denied wrongdoing and didn't respond to any of our questions, not even with a, -"Nuh-uh." -$$LAUGHTER But at a certain point, the question has to become less, what did we do wrong, and more, what do we do now? Because these drugs are still the most effective solution for certain types of pain. And many patients need them, so we can't get rid of them, but we have to be much more careful about how they're prescribed. And to their credit, the CDC issued voluntary guidelines this year, suggesting doctors use non-opioid therapies when possible and, if and when 1 is needed, to start patients with a lower dose and a shorter supply. A technique that they call, start low and go slow.

Which does sound good, but also sounds like how your creepiest high school friends described cunnilingus. Dude, start low, go slow. And afterwards, take her to Friendly's. Chicks love root beer floats, dude. They love them, dude.

Low and slow. Low and slow, dude. Low and slow. Look, and while all that sounds great, unfortunately, not all areas of the country have access to alternative pain treatments.

Speaker 3: It's easy to say, use some non-opioid alternative, but in a lot of rural areas, patients don't have access to things like physical therapy and mindfulness meditation, and insurance companies won't pay for it.

Speaker 0: And that is a big problem, because even in a rural area, alternative pain treatments should be at least as easy to find as waffle houses, which, like heroin, are both hazardous to your health and dangerously addictive. And to put it mildly, it does not seem that the pharmaceutical industry is expecting any major reversals in opioid sales anytime soon. In fact, they are now marketing extra drugs to fight 1 of opioid's side effects, constipation. ♪♪

Speaker 17: If you need an opioid to manage your chronic pain, you may be so constipated, It feels like everyone can go except you. -...go, go, go!

Speaker 0: -...go, go, go! You know painkillers are powerful if people use them despite the side effect being jealous of a dog's butthole. And that commercial aired during the Super Bowl this year, which means A, it is a big business, and B, I can only assume there was a reverse commercial during the Puppy Bowl featuring a jealous dog and a shitting man. But we cannot just work to prevent future addicts. We're going to need to do more to help the millions that already exist, which means more investment in treatment programs, as well as increasing the availability of drugs like naloxone, commonly used in a nasal spray to rescue people from overdoses.

Because, as this Firehouse makes clear, it is a tool that they use with depressing frequency.

Speaker 13: So every single firefighter in the Revere Fire Department knows how to use this, has been trained on this.

Speaker 0: Yes.

Speaker 13: And has used it.

Speaker 18: Yes. From the chief down. We tend to have more overdoses than we do...

Speaker 0: Fires.

Speaker 18: Fires. So, it's a piece of equipment that we can't go without now. Just like we have the hose.

Speaker 0: It's true. Firefighters might be more likely to use a nasal spray than a hose. Which is really going to fuck up those hot firefighter calendars. Because something about an overdose-reversing nasal spray isn't quite as sexy. It's still sexy, but just not quite as sexy.

It is still sexy, though. Just not quite, but still... And that's not the point. The point is... There is no 1 simple answer here.

Not all opioid addicts will respond to the same treatment, and not all people in pain will find relief from alternative therapies. This is going to take a massive effort and a significant investment. It won't be cheap, It won't be quick, and it won't be easy. And it is hard not to be angry at the drug companies like Purdue, whose promise of cheap, quick, easy pain solutions helped put us in this fucking mess. Because while they may not be solely responsible, if you were to ask me if they bear significant blame for reckless, greedy behavior which contributed to this massive public health crisis.

I might not say, yes exactly, but I would definitely say, uh-huh. -♪ Uh-huh, uh-huh ♪ -♪ Uh-huh, uh-huh, uh-huh... ♪

 What concessions does Oliver make to potential counterarguments?

List two key behaviors engaged in by pharmaceutical companies, especially Purdue and INSYS, that greatly contributed to the heroine/opioid addiction crisis.  List one of the key reasons non-opioid treatments for pain (e.g., physical therapy, meditation) aren't used more often.

Does the humor in this clip help or hurt Oliver’s, speaker 1, arguments?

Oliver relates prescription painkillers to heroin and argues that prescription painkillers are a “major cause” of heroin abuse. Do you agree with this connection? Does Oliver transition between these ideas well?

What is “pseudoaddiction”? Does this example of a medical theory help Oliver’s arguments?

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Opioids: Last Week Tonight with John Oliver (HBO)