A deep dive into a sequence of prominent “pill mill” prosecutions reveals the inside, untold history of America’s overdose crisis.
The PAIN GAME
Producer/Director:
Erica Modugno Dagher
Producer/Creative Director:
Mark Larranaga
Producer/Writer: Amy Bianco
Madeline Miller, defendant (2005)
The PAIN GAME is a hard-hitting, immersive multimedia project that challenges the standard narrative around pain, addiction, and opioids by exposing who has a stake in that narrative and why. In the works since 2004, the project investigates a sequence of high-profile criminal prosecutions of medical professionals for healthcare fraud and illegal prescribing, raising the question of why the U.S. Department of Justice and the Drug Enforcement Administration stood on their heads to convict these individuals while leaving more dubious actors untouched. It also covers various events that weave around the cases, documenting the formation of an embattled community of chronic pain patients and the physicians, attorneys, advocates, experts, and officials who banded together to try to protect them.
Rev. Ronald V. Myers, Sr., M.D., at a pain rally in Washington, D.C., in April of 2004
“It’s a big political game that they’re playing with peoples’ lives. You know, unhealthy people that can’t afford to have their lives be fooled around with like that.”
More than $50 billion dollars have been extracted from the opioid industry in litigation for abatement of the effects of profligate opioid prescribing, and the opioid crisis has been firmly established in the public mind as the biggest product-liability fiasco since the Big Tobacco scandal of the 1990s. So has justice been served? The crisis resolved? The story told? Can we all move on now? Not yet.
Settlement money is now flowing into states and municipalities, some of which are using the payouts to expand harm reduction initiatives and experiment with new ways to treat opioid use disorder. Indeed, a recent report from the Centers for Disease Control and Prevention predicts that fatal overdoses may have declined as much as 24% for the 12-month period ending in September, 2024. But while this is inarguably good news, so far the drop appears to be attributable more to increased access to Narcan and the vagaries of the illicit drug supply than to any lasting expansion of evidence-based addiction treatment.
Healthcare providers generally are not eager to integrate medication assisted treatment for opioid use disorder into their practices, even as evidence for its effectiveness mounts and some federal rules governing it are relaxed.
In large part, this is because they are still working within the same distorted healthcare system — under the watch of the same misguided regulatory regime — from which the problem emerged in the first place. As long as the myriad roots of the opioid crisis remain unaddressed, fatal overdoses are likely to remain unacceptably high.
As long as the myriad roots of the opioid crisis remain unaddressed, fatal overdoses are likely to remain unacceptably high.
Over the past few decades the DEA and federal prosecutors have laid down a trail of precedents through the criminal justice system that allows them to construe the writing of a prescription in good faith for a patient who appears to need it as “drug dealing,” and the routine billing for the appointment in which it occurs as insurance “fraud.” The PAIN GAME follows this winding road through the case law to the doorstep of the civil litigation of the opioid industry, and reveals that it is paved with questionable intentions.
Opioids were indeed too freely prescribed for a time, and many people were harmed. It is understandable that they and their families would seek compensation for their loss from Purdue Pharma and other major players in the opioid industry. But this is approximate justice, and it can yield nothing more than proximate results.
When the innocent are convicted, not only do the guilty get away, but the rule of law becomes a free-for-all where no one knows the rules and everyone is harmed.
Big Pharma is a vast, complex industry operating within an ungainly healthcare system by the grace of a criminal justice system in need of reform. Some opioid manufacturers, distributors, and retailers appear to be guilty of much worse offenses than misleading marketing and dilatory reporting of suspicious orders. At the same time, some companies who have already paid out settlements may not actually have done anything illegal at all.
This imprecision comes at a cost. When the innocent are convicted, not only do the guilty get away, but the rule of law becomes a free-for-all where no one knows the rules and everyone is harmed. It’s a brutal game that has severely distorted the healthcare system, diverted precious resources away from public health and into criminal justice, and driven more than a million Americans to their deaths.
Frank Fisher, M.D., defendant; Siobhan Reynolds, activist; Greg Walter, M.D., defendant, on their way to the sentencing of William Hurwitz, M.D. (2005)
Dana Hacker, friend of Linda Schneider, defendant (2015)
Outside the Albert V. Ryan federal courthouse in Alexandria, Virginia (2005)
Because we have been pursuing this story for so long we’ve seen its characters develop and its action interweave itself, with themes recurring, events rhyming, and conclusions beginning to present themselves
The U.S. Department of Justice building in Washington, D.C. (2004)
Frank McCune, M.D., defendant (2004)
The man in the video above is the late Dr. Frank McCune, whom Erica interviewed during her first shoot for The PAIN GAME, in the spring of 2004. Dr. McCune had recently emerged victorious from a federal criminal fraud suit against the home healthcare business he owned and operated with his wife and adult children in the Mississippi Delta. Five years and $500,000 dollars later he had his freedom, but he had lost just about everything else: the business, his savings, and nearly his marriage. But what bothered him most, he told Erica, was that he didn’t understand why the government had targeted him at all — and with investigators who knew so little about how the healthcare system works that he had to assist them in his own case!
As with Dr McCune’s case, the opioid litigation could prove to be a hollow — and haunting — victory if it leaves too many questions about the overdose crisis unanswered and too many of its story lines obscured by the media’s strenuous adherence to the product-liability narrative. Through The PAIN GAME we will keep pressing this vital issue and excavate its whole twisted history.
Then we can move on.
The opioid litigation could prove to be a hollow — and haunting — victory if it leaves too many questions about the overdose crisis unanswered.
Cynthia Moore, mother of Benjamin Moore, D.O., defendant (2004)