Almost everyone realizes we as a country, actually we as a planet, are in the midst of an opiate epidemic. How we got here is a story of both misguided good intentions, and outright deception rooted in greed. The Netflix four part series The Pharmacist explores the beginning of the opiate epidemic in the US by telling one individual’s story while tying into broader events from the country as a whole.
The story centers around Dan Schneider (pictured above, credit: netfilx.com), a pharmacist from the New Orleans working class suburb of St. Bernard Parish. The story starts by exploring the effects of another drug epidemic, crack cocaine in the 80-90’s. Dan’s son, unbeknownst to his family, was using crack and is fatally shot while trying to buy some.
The first part of this four part series deals with the family’s reaction to the murder and the story of how Dan tracks down his son’s killer. Yes, you read that correctly, Dan had to find his son’s killer. The film as a whole is a scathing indictment of the state of incompetence and corruption of The New Orleans Police Department.
The majority of the series deals with the events after the resolution of Dan’s son’s murder. Dan by training is a pharmacist and is witness to the start of a sharp uptick in prescribed opiates that begins in 2000. The drug in particular that was accounting for the uptick was Oxycontin. The film explores the start of the opiate crisis in one small region of the country but ties in concurrent national events allowing the viewer to see how these same events repeated throughout the country to create the epidemic we see today.
One of the most interesting aspects of the film is the role of physicians in this mess. St. Bernard parish was a leader in the country in per capita opioid overdoses during this period. One would assume it was due to a vast change in the prescribing habits of doctors as a whole. This however is not what occurred. In St. Bernard Parish, this was due to one physician. The physician, Dr. Jaqueline Cleggett, was operating what has come to be known as a “pill mill.” Basically she was functioning as a drug dealer but remained harder to stop by federal authorities because of the white coat.
Dr. Cleggett’s former office today. Credit: nola.com
For anyone not familiar with the term pill mill, it refers to a medical clinic most often masquerading as a pain clinic, that dispenses opiate prescriptions (usually along with a form of Valium and Soma). So how do you know if you’re in a pill mill vs. a pain clinic? Pill mill MDs have one trick (standard prescription of large opiate dose with valium, or something like it, and soma) and they aren’t all that interested in you (history and exam likely consist of “hello”) or alternate forms of treatment and diagnosis. So legitimate work ups for pain should include a thorough history and physical, possibly some radiology studies, and the use of therapies in addition to opiates. Prescribed opiates definitely have legitimate uses, but their use has to be very carefully weighed against the exceedingly high risk of addiction.
The film explores the role of physicians in this crisis. Specifically the power of one physician to create an exceedingly large wake of damage. Much of the data for this statement is interestingly provided by Purdue Pharma, the maker of Oxycontin. The amount and quality of data the company had at its disposal was staggering. While DEA agents were stuck going pharmacy to pharmacy and sifting through paper prescriptions to find out exactly what physicians at the time were prescribing somehow Purdue was able to provide its drug reps with weekly updates on exactly which physicians were prescribing how much Oxycontin. This revelation highlights the fact that Perdue is likely sitting on a large bank of prescribing data that tracks the spread of the opiate crisis in detail.
At the end, the series explores what happens to this pill mill. Although Dan is finally able to take down the pill mill the crisis continues unabated. The film finally touches on where we are today, specifically the ongoing litigation of the drug companies. Just recently multiples states refused to accept an $18 billion offer to settle the suits. States specifically want funds to aid in treatment.
Netflix did a good job. Dan did an outstanding job.