Summary
“The One to Start with, The One to Stay With” is an effective setup and scathing indictment of how and why opioids were marketed to the masses.
This recap of the Netflix series Painkiller Season 1 Episode 1, “The One to Start with, The One to Stay With,” contains spoilers.
“The One to Start with, The One to Stay With” is the first episode of the Netflix series Painkiller. From the beginning, the series strongly criticizes the pharmaceutical industry, specifically Purdue Pharma’s actions in bringing a drug to the marketplace. The episode focuses on the marketing strategies employed for opioids.
Specifically, how macro and micro relationships were manipulated for distribution.
Painkiller Season 1 Episode 1 Recap
Before we start, we should define what opioids are. Per the National Drug Institute of Health, opioids encompass various substances, including illegal drugs like heroin, synthetic opioids like fentanyl, and prescription pain relievers like OxyContin, Vicodin, codeine, morphine, and more.
Who is Richard Sackler?
Richard Sackler is credited with marketing a drug called MS Contin, which eventually became the infamous OxyContin. Initially used solely as a palliative treatment for cancer patients, Sackler rebranded this potent, semi-synthetic opioid for many patients to address moderate to severe pain.
According to the series, Sackler strategically marketed the drug through Purdue Pharma, the family’s only substantial asset following the passing of his uncle, Arthur Sackler. The elder Sackler amassed great wealth by inventing the drug Valium, but his family had to assume his substantial debts after he passed away from a heart attack.
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Thus, the invention of the drug caused the opioid crisis and epidemic in the United States.
Who is Edie Flowers?
Edie Flowers is a former investigator for the United States Attorney’s Office. After specializing in investigating physicians for healthcare fraud, she served as the lead prosecutor in the case against Richard Sackler and Purdue Pharma, the company responsible for the opioid epidemic.
The opening episode shifts between a determined and energetic Flowers in her early years as a prosecutor to a burnt-out version of her who has faced repeated failures in prosecuting Sackler. Now, a new prosecution team wants to debrief her on her previous work, but she is cynical, knowing they will never be able to depose Richard Sackler.
The team surprises her with a videotaped deposition of Sackler answering questions about Purdue Pharma’s actions.
Who is Glen Kryger?
Glen Kryger is a businessman who owns an automobile repair company. He symbolizes the first-hand human impact of the opioid crisis. His business is struggling. Glen’s employees slack off, and Tyler, who we are guessing is Glen’s stepson, is goofing around with a backhoe loader, dismantling engines. When Glen tries to intervene, he falls off the vehicle, injuring his back and suffering ligament damage and broken bones.
While rehabbing and managing pain, he was prescribed Vicodin, a synthetic opioid also known as hydrocodone. Glen Kryger’s story is a familiar one. At the beginning of the episode, a mother shares her son Christopher Trejo’s heartbreaking tale. Christopher was given opioids at 15 and tragically passed away from addiction at 27, alone in a gas station parking lot.
As Vicodin fails to alleviate Glen’s pain, he is prescribed OxyContin due to his high rating of nine or ten on the Wong-Baker Scale.
Painkiller Season 1 Episode 1 Ending Explained
How does Richard Sackler market OxyContin to consumers?
Sackler markets OxyContin as a safe alternative to morphine, commonly used in palliative care and associated with death. During a focus group, when participants were unfamiliar with MS Contin, Richard saw an opportunity to shape OxyContin’s reputation among physicians and market the drug to a broad spectrum of patients.
Sackler shifted the responsibility of managing patient usage to doctors, allowing them to provide instructions on proper use. In Glen’s case, this meant taking OxyContin once in the morning and once at night for uninterrupted sleep. This ties into Sackler’s manipulation of the FDA. Since morphine is for patients with a Wong-Baker Pain scale of severe, Sackler will market MS Contin, now rebranded as OxyContin, to patients with moderate to severe pain.
In turn, Sackler reframes a message that doctors do not care about patients’ pain levels, but we do. The company recruits young, attractive sales reps to market OxyContin to any physician, big or small, who will listen. That’s how Edie initially discovers the overprescription of the drug. She found a small-town physician who prescribed it to 1,098 patients in six months.
The episode ends with Edie asking the doctor, “What is OxyContin?”
Why is Richard talking to his dead Uncle Arthur?
Despite Richard conversing with his deceased Uncle Arthur, he is not delusional or medically afflicted. Arthur represents Richard’s problem-solving approach, embodying the mindset of how his uncle would market OxyContin.
What did you think of Painkiller Season 1 Episode 1? Comment below.
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