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.

Erica talking to a cab driver in Myrtle Beach, South Carolina, in 2005 

“What happened?” 

It seems like an obvious place to start, but rarely do journalists ask the question with a truly open mind anymore. Rarely do they even try to gain access to defendants who have already been vilified in the press before they’ve had their day in court. Rarely will the various players involved in a controversial issue allow their activities to be documented when there is a vicious blame game raging around them. And very rarely does a filmmaker manage to embed herself at the nexus of such an important story while it is unfolding, as our Director, Erica Modugno Dagher, did more than 20 years ago.

Rarely will the various players involved in a controversial issue allow their activities to be documented when there is a vicious blame game raging around them.

Erica was set on the path she was to follow by a political science professor at the University of Northern Florida named Ronald T. Libby, Ph.D., who shared with her a working manuscript of a book he was writing, eventually published in 2008 as The Criminalization of Medicine: America’s War on Doctors (Praeger Publishers). At the time of his interview with Erica in 2004, Prof. Libby was collecting the stories of physicians who had been criminally prosecuted, primarily by the federal government, and analyzing the cases against them.

Ronald T. Libby, Ph.D. (2004)  (Click here to view a longer excerpt from Erica’s interview with Prof. Libby)

Prof. Libby was overwhelmed by the number of stories he unearthed and the palpable fear he detected among medical professionals around this issue. In case after case, he found that these prosecutions were abusive, and had been grossly misrepresented in the media. Rather than enacting meaningful healthcare reform and a rational drug policy, federal and state governments were scapegoating doctors who were high billers to Medicare and Medicaid for “fraud and abuse,” and vilifying those caring for the poor and disabled as “drug dealers.”

The coverage was (and still is) so uniform that it took great intellectual courage to dive below the surface and find the story running underneath.

By 2004, when Erica began filming the project that would become The PAIN GAME, the media had been saturated for several years with stories of corrupt doctors flooding down-and-out communities with OxyContin. The coverage was (and still is) so uniform that it took great intellectual courage to dive below the surface and find the story running underneath. Working independently — and on her own dime — Erica sought out healthcare professionals who had been characterized by prosecutors as “drug dealers in white coats” to hear their stories first hand as they struggled to make sense of what was happening to them.

Michael D. Jackson, M.D., defendant (2006) 

OxyContin addiction was indeed becoming a serious issue in rural areas; but the high-profile criminal cases against these individuals did not come close to explaining the problem, and they certainly did not make any contribution to solving it. 

It just didn’t add up.

Greg Walter, M.D. defendant (2005) 

Erica imposed no thesis on the history she was recording; she simply immersed herself in the issue with a keen eye and an open mind.

The trust that Prof. Libby had earned within the embattled pain community was extended to Erica. She was invited into defendants’ homes, to their attorneys’ strategy war rooms, various media prep sessions, off-the-radar conferences, meandering cab rides, and countless impromptu gatherings in far-flung hotel rooms — even prowling the halls and meeting rooms of Congress with her camera always running. Erica imposed no thesis on the history she was recording; she simply immersed herself in the issue with a keen eye and an open mind.

Amy has adopted a turn-every-page approach to reporting for The PAIN GAME, combing through reams of trial transcripts, medical records, and other documents

Our Writer, Amy Bianco, came to the project through her college classmate Sean Greenwood in 1996. They had both ended up in New York City, where she was  working in the book publishing industry, and he was seeking expert medical care. Ever since their graduation ten years earlier, Sean had been completely sidelined with an unrelenting headache no one could explain. Tagging along Sean’s grueling medical odyssey, Amy got to know his wife, Siobhan Reynolds, who was fighting to get Sean pain control, and advocating for other chronic pain patients. 

Siobhan Reynolds outside the Albert V. Ryan federal courthouse in Alexandria, Virginia, during the trial of William Hurwitz, M.D. (2004) 

Sean would eventually be diagnosed with Ehlers-Danlos syndrome, and Amy would receive her own EDS diagnosis after illness forced her out of her last in-house publishing position. By the time Sean passed away in 2006, Amy was deep into the medical and legal aspects of chronic pain, helping Siobhan write a book about her work as the founder of Pain Relief Network. (The book was never published.)

Amy and Siobhan at the KSNT-TV studio in Topeka, Kansas (2009) 

Amy and Erica first crossed paths in Topeka, Kansas, in 2009, at a court hearing concerning Siobhan. Siobhan had herself come under federal criminal investigation for her advocacy on behalf of a physician in Wichita, and they were both covering her case. After Siobhan’s untimely death in a private plane crash on Christmas Eve, 2011, Amy dropped the book project and joined Erica on the film project.

Using her skills as a trade science book editor and author, Amy has adopted a turn-every-page approach to reporting for The PAIN GAME, combing through reams of trial transcripts, medical records, and other, less-public documents. In this and other matters, the team has been very fortunate to have the assistance of an advisory panel of top-notch medical, legal, and policy experts. In 2016, Erica and Amy founded Quarter Turn Media to house the sprawling PAIN GAME project. In 2023, they were joined by Mark Larranaga, one of the film industry’s top creative directors and visual effects artists. As a friend of Erica’s in the Los Angeles film community back in the day, Mark had taken an interest in the project from its inception. 

The deep history of the overdose crisis presented here is truly one of the most important stories you’ve never heard.

The PAIN GAME couldn’t be filmed today, looking backward. The story would have disappeared if we hadn’t recorded it. Almost no one who was involved in the pain community in the early years will talk about what really happened now, because the media environment has become so hostile to them. Indeed, most of the accounts of the overdose crisis that have appeared in recent years actively misrepresent its early history. And many of the people we filmed — and whom our readers/views will come to know — have passed on. The deep history of the overdose crisis presented here is truly one of the most important stories you’ve never heard.

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.

We’ve been all over the country in the last two decades or so, and have spoken to hundreds of people from all walks of life. We started at the beginning and worked from the inside out — from inside the pain community, through the healthcare and criminal justice systems, and out to American society at large. The result is an open-ended — yet surprisingly coherent — investigative history. 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. What we’ve documented has turned out be much more than an exploding public-health crisis. In the end, The PAIN GAME portrays the political unraveling of America in recent decades.

The Department of Justice building in Washington D.C.