Dopesick episode 7 recap – “Black Box Warning”

November 10, 2021
Daniel Hart 1
Hulu, Streaming Service, Weekly TV


Dopesick turns the screw even more to bring a horrifying 60 minutes of the preventable tragedy of the opioid epidemic.

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Dopesick turns the screw even more to bring a horrifying 60 minutes of the preventable tragedy of the opioid epidemic.

This recap of Hulu series Dopesick episode 7, “Black Box Warning,” does not contain spoilers.

Read the review of the miniseries.

The more I watch Dopesick, the more I believe it is a horror than a drama. The horror of capitalistic evil within the hands of a few who flex any rule possible at the expense of thousands of deaths. That is horrifying, and it’s even worse that this story is based on true events.

Dopesick episode 7 recap

Episode 7 opens in 1972. The Sackler family attend a congressional hearing. Senator Dodd questions the ethics of their company. The Sackler family argues that their advertising is ethical. In 2002, in another congressional hearing, Senator Dodd pressed the issue of a widely available drug, which increases the likelihood of abuse. An expert states he has never seen an epidemic of drug abuse that is as bad as OxyContin.

Back to the core story, and Betsy is found by her mother among the homeless tents. Her mother is determined to find a way to get her better and wants Betsy to attend a town meeting regarding OxyContin. The meeting has a massive turnout, demonstrating how many people have been impacted by the drug. They agree to sign a petition to attempt to end this epidemic. This whole scenes feels sad — there’s so much hope and collectiveness, but as the viewer you can sense the end of the nightmare is nowhere near.

Samuel is in therapy; his therapist wants him to focus on the positive things that he did, rather than the regrets. Specifically, she wants him to focus on all the babies he has delivered. Samuel is making emotional progress, however his reinstatement to be a licensed doctor is under jeopardy — they want him off methadone first. Samuel tries arguing that methadone is helping his addiction, but his argument does not take him anywhere. He looks into another medication that may help him rid his addiction to opioids.

Richard Sackler learns that the FDA wants to change its warning label on OxyContin. He is surprised because he has brought someone in from the FDA (Curtis Wright) to work for them. Their ex-FDA colleague states they need to work on the wording. Randy speaks to an FDA colleague and learns that Purdue Pharma worked with Curtis Wright before he joined them — it’s suspected that Curtis Wright wrote the warning labels for the pharmaceutical company. The lengths they have gone to keep this drug in the system is alarming.

Billy is irritated at work, so his manager checks on him and tells him he is his best saleman. Afterward, Amber tells Billy that she’s being given the role of regional sales manager in New Orleans and wants Billy to join as her employee and boyfriend. Amber admits she has got attached and has feelings for him. But still, the money side of selling OxyContin has festered her mind, and you can tell Billy is irked by it.

Rick and Randy have made headways in their investigation showing that Purdue Pharma has lied to congress and committed fraud. They make the decision to finally indict them. In 2006, the FDA meet Purdue Pharma regarding changing the warning label. The FDA is considering adding the “Black Box Warning” to their label. Richard Sackler can see the end of the line on this drug and he wants to make a strong response. Richard holds a meeting regarding the label to discuss wording. He’s still persistent in fighting this, knowing the commercials at stake.

Samuel rings Betsy and tells her he is still fighting addiction from opioids. He apologizes for prescribing that drug to her and recommends a medicine to help reduce the addiction. He offers to drive her to a clinic every week to get this medicine to help her combat the addiction. Betsy gets advice from the church, and they do not advise this medication, stating that it is a narcotic, and they feel it is merely a replacement. Betsy tells her mother she doesn’t believe in a “higher power” and she wants to try something new so she can return to who she was. Her mother tells her that when she is better, she wants to cook for her girlfriend — it’s an emotional breakthrough in the mother/daughter relationship.

It’s confirmed; OxyContin is labelled with the “Black Box Warning” but, surprisingly, it states that “addiction is reported to be rare”, and can still be used for moderate pain. There’s also another concession; the FDA has agreed on the wording of “the drug can be used for an extended period of time.” The board is gleeful, knowing that they can market the drug indefinitely. It’s all about money, money, money. It’s sickening to watch Richard and the board to be happy about this.

In a sales meeting, Billy is confused about the “Black Box Warning.” He doesn’t understand how they can triple sales with this new wording, and he’s clearly conflicted by it. Feeling desperate, Billy steals some training tapes as evidence of fraudulent behavior in their sales and marketing techniques.

Bridget meets the FDA and Purdue Pharma again with their findings and research. The data is presented. They prove overdoses are mostly from OxyContin users when reviewing autopsy reports. Purdue Pharma wants to review the data, but Bridget tells them that the study is comprehensive, thorough, and conservative. The FDA expert agrees that the data needs to be reviewed, and raises how the label was given as a “Black Box Warning,” to undermine the research. Bridget is told she should have provided the report before the meeting. Afterward, it’s raised how the FDA and Purdue Pharma do not like her. Her husband raises concerns about her well-being and their relationship due to her work.

Bridget continues to struggle internally and externally with her fight against Purdue Pharma.

The ending

The ending of episode 7 brings tragedy, and one that’s difficult to swallow.

Betsy rings Grace and asks if they can try again (to be a couple) once she is better. Grace says no but that she would love to be friends. Betsy hears a baby in the background (and connects the dots that Grace has moved on) and gets off the phone as quickly as possible. She’s heartbroken, and once again, she finds herself with the same drug dealer; she injects opioids again. She thinks it’s a send-off until she goes on to preventative drugs. The next morning, the sheriff visits her home and delivers the news to her mother — it’s obvious what the news is before he says it. Betsy is dead, and the mother screams in emotional pain.

As for Samuel, well, he’s waiting for Betsy. He rings the mother and she drops the news that she’s dead. Samuel is in shock. The weight of the news will be crushing. He will feel responsible, but, we know it’s not his fault — this is a pharmaceutical horror show.

What did you think of Hulu’s Dopesick episode 7? Comment below.

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1 thought on “Dopesick episode 7 recap – “Black Box Warning”

  • November 15, 2021 at 12:27 am

    This recent episode was good, however, as someone who worked as an intake coordinator in a drug rehab program, it’s totally inaccurate to depict Suboxone and Methadone in a similar light — the two drugs are nothing alike.

    While turning to methadone to kick a severe addiction is certainly better than trying nothing at all, people do get high off the drug and the withdrawal is just as severe. More often than not, people who are on methadone still have a hard time functioning in their daily lives — like holding down a job, for example — because they’re still feeling doped up from the drug’s effects. The general consensus in addiction treatment research is that methadone is just a temporary band-aid, and a largely ineffective one at that.

    Suboxone, on the other hand, is a partial opioid agonist (methadone is a full opioid agonist), that will bind to the same brain receptors as full opioids do, but does not result in any accompanying high. Suboxone’s partial agonist effects have several benefits: lower abuse potential, lower level of physical dependence (less withdrawal discomfort), a ceiling effect at higher doses, and greater safety in overdose compared with opioid full agonists.

    When administered correctly, Suboxone can essentially stop withdrawal symptoms in its tracks, providing relief to patients and enabling them to come off whatever opiate they’re addicted to, without the debilitating suffering that prevents so many addicts from stopping in the 1st place.
    After 2-4 weeks, the patient, in consultation with a doctor, can then choose to gradually wean off Suboxone — a much easier hurdle, thanks in part to its long half-life, than coming off an opiate like Oxycontin.

    Many people, however, choose to stay on Suboxone for longer, more indefinite periods of time — not only does it help with acute withdrawal, it also provides relief from more long-term withdrawal effects — i.e. “cravings”, anhedonia (an inability to feel pleasure or excitement), chronic depression, anxiety, and other disorders that often follow opiate addiction. These long-term withdrawal effects are a major reason why so many opiate addicts relapse, even after getting through the acute withdrawal phase. Suboxone, which many describe as helping them “feel normal” again, can reduce the risk of relapse.
    In the scene where Betsy talks on the phone with Samuel (an award winning performance by Michael Keaton), it looks like she’s no longer in that acute withdrawal phase, but she’s still clearly experiencing long-term withdrawal that affects her ability to cope with a difficult conversation with an ex girlfriend, making the chances of relapse all that more likely…tragically, in this case.

    In addition to providing relief from long-term withdrawal symptoms, Suboxone can also act as a sort of psychological deterrent — because of its binding properties, ingesting any other opiate drug while on Suboxone can trigger a severely adverse physical reaction. In fact, patients starting Suboxone have to wait until they’ve been off opiates for at least 24 hours and are in the initial phases of withdrawal before they’re given the medication, otherwise they’ll likely have to go to the emergency room.

    One drawback to Suboxone is that for those who’ve been on it long-term and decide to stop, coming off it can be challenging, as is the case with many medications. It’s important to wean off Suboxone as gradually and carefully as possible rather than stop suddenly, and always under the guidance of a doctor, ideally an addiction specialist. While not nearly as severe as withdrawal from full opioids, Suboxone withdrawal can reportedly last a long time, even if the symptoms are much milder and more tolerable.

    Many long-term survivors of opiate addiction resolve to stay on Suboxone indefinitely, for the rest of their lives, if possible, because they do not want to even risk their recovery. They view Suboxone in the same way diabetics view their insulin — the medication is essential to their survival. Those in the medical community who treat addiction and understand it as a disease agree with this comparison.

    The scene in this recent episode when the leader of a recovery support group warned Betsy and her mother that Suboxone was just “trading one addiction for another” was infuriating — I’ve heard that so many times from people who others turn to for help with addiction — people with otherwise good intentions, yet who have no medical background or understanding of how Suboxone works.
    Decisions about Suboxone as a treatment option should be made between a patient and doctor, no one else. Recovery support groups like NA/AA undoubtedly save many lives. But there are some who get a bit too caught up in the organization’s proselytizing rhetoric and dogma — much of which has no scientific or medical basis. They tend to view any kind of “harm reduction” treatment such as Suboxone as “cheating” and not true recovery.

    Long story short, Suboxone has been a game changer in the treatment of opiate addiction. As part of a comprehensive treatment plan that includes counseling, therapy, support groups like NA, etc., it’s been a lifesaver for many who are now in long-term recovery and finally have their lives back. This is especially true for those who tried and were unsuccessful in all their previous attempts to get off opiates and stay off them.

    As the doctor in this recent episode said, studies show that opiate addiction literally changes the brain. Once a person is physically dependent, the brain will do anything to “trick” the user into needing and taking more of the drug — i.e. assaulting the body with “false pain signals”, which despite being “fake” signals, are still very real to the person suffering from them.
    The brain’s physiological and neurological changes resulting from opiate addiction makes it a very powerful and difficult disease to fight. If there exists a medication that helps people survive this deadly disease, then those who need it should have access to it and not be actively discouraged against it.

    p.s. As an interesting aside, there’s several studies (primarily out of Harvard University) showing that Buprenorphine, the active ingredient in Suboxone, may also be effective in treating clinical depression, particularly for cases that are resistant to more common anti-depressant medications such as SSRIs (Effexor, Prozac, etc.).

    Finally, it’s important to note that despite its benefits, Suboxone is still a narcotic, therefore, it does pose certain risks. For those who are “opiate naive” — who don’t take opiates on a regular basis, who have a low tolerance to opiates and no physical dependency on them — there is a risk of abuse and overdose with Suboxone, even in low doses.

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