The prescription painkiller epidemic is really a story of two epidemics. On the one hand, the Centers for Disease Control and Prevention report that "From 1999 to 2015, more than 183,000 people have died in the US from overdoses related to prescription opioids." On the other, the National Institutes of Health say, "Pain affects more Americans than diabetes, heart disease, and cancer combined." William Hurwitz—perhaps America's most famous pain management doctor convicted of drug dealing—stands at the intersection of these two epidemics. Hurwitz, a graduate of Stanford Medical School who served in the Peace Corps, gained national fame in the '90s and early 2000s for his willingness to prescribe high doses of narcotic painkillers to patients with intractable pain. Confronted during a 60 Minutes segment about the eye-popping numbers of pills he prescribed, he calmly replied, "Dose is irrelevant. The right dose is whatever works that produces tolerable side effects." Law enforcement officials disagreed. After two of his patients died and others were suspected of selling their pills, Hurwitz was charged, tried, and convicted of narcotics distribution in federal court in Virginia. At a press conference marking the event, the head of the Drug Enforcement Administration held up a bag filled with pills and said, "Dr. Hurwitz was no different from a cocaine or heroin dealer peddling poison on the street corner."
A decade later—and after Hurwitz's first conviction was overturned, he was re-convicted on lesser charges, and then released from prison after less than five years—the debate over his legacy still rages. In her new film, Dr. Feelgood: Dealer or Healer?, director Eve Marson introduces viewers to, among other people, the husband of a deceased patient who calls Hurwitz a "demon" and another former patient who says Hurwitz and his prescriptions gave her her life back.
In a conversation about the film, which makes its streaming debut today at Amazon, iTunes, and other digital platforms, Marson shares some thoughts on the complexities of Hurwitz's story.
Why did you want to focus on this particular case?
The testimonies here contradict each other so sharply. And it's not like many other cases that at least I had read about where doctors are arrested or charged with overprescribing and it's clear that [those doctors] were up to no good; it's clear that they were making money hand over fist, or they had a sort of malicious agenda. When I read about Dr. Hurwitz's case, whatever ended up happening, I think it's clear that he did not set out with greed or malicious intentions. So that's immediately interesting to me.
And his case is also of interest to me because he was practicing at a very particular moment in the history of opioids. He was a pain specialist just at the time when Purdue and other pharmaceutical companies began aggressively pushing these drugs—OxyContin, specifically. And we saw a huge rise in the number of prescriptions that doctors were giving out and this was sort of the accepted standard of care at that time. And then certain patients [of Hurwitz's] who became large-scale drug dealers were really among the first to be running these pills up and down the Eastern seaboard. And…this is the exact time when you're seeing the recreational use and abuse of these pills start to balloon.
It's been almost ten years since the start of Hurwitz's second trial. Do we see it more clearly as a result of that time?
I think today everything looks different with the perspective of time and hindsight. And the science has changed. When these pills first came out, Purdue and these companies were saying the risk of addiction was as low as one percent. Now, today, studies say that risk of addiction is as high as thirty to fifty percent of people who use [the medications.] That's a very different take on it.
And as a result the training for doctors has changed so much that now doctors are encouraged not to prescribe as widely. And many doctors, because of the legal actions and because of the numbers of addiction, are terrified to prescribe these drugs at all. So the landscape and the attitudes towards these pills has changed dramatically.
The film repeatedly tells the stories of these chronic pain patients, and shows them on camera. How important was it to you to get their stories on the record?
Very important. Because I think there's so much talk in the media about "greedy pharmaceutical companies," and talk that stigmatizes people who use these pills as addicts or degenerates, which is all part of the story. But I think people don't often stop to think about chronic pain, and how detrimental it can be. I was shocked to learn that one in three Americans suffer from chronic pain, which is a very high number.
One woman in the film couldn't get out of bed for five years. And because she couldn't get any medication that would resolve her pain, she ended up having to have a fairly traumatic brain surgery to try to take it away, which also didn't work. So if you imagine you're living a life where you can't get out of bed in the morning because you're in so much pain, and someone tells you, "Well, here's a pill that can make you function again and get back to enjoying your life. And, by the way, you're going to become physically dependent on it and even perhaps addicted to it." That's an option you might take if you're really suffering. And I think it's important for people to consider that perspective.
That line between dealer and healer can get really blurry. If someone came up to you now and said, "Eve, where is the line between legitimate medicine and drug dealing?" what would you say?
That's a tough question. I would say that it requires sort of a human touch, or a case by case touch. I don't think a doctor can treat every patient the same or trust every patient who walks in the door…That's where got Dr. Hurwitz in trouble.
Any physician presumably wants to help their patients and relieve suffering, and that's a noble pursuit, to be a healer. But there has to be some consideration for how addictive these pills are, how profitable they are to sell on the streets, and a just human judgment on the person you're giving them to that perhaps limits how much you want to give that certain person. And, also, as the film points out, there still isn't a test for pain, which would make all of this a lot easier.
Absolutely. Dr. Hurwitz's former nurse in the film said if there were a pain meter that could just tell if the patient is really in pain or not, it would be super simple. All doctors have to go on is a patient walks in, and a doctor will say, "Tell me how much pain you're in on a scale of one to ten." Which is not a very precise measurement, right? Because maybe my idea of a ten is different from your idea of a ten. Or maybe I'm lying, because I feel like it.
And to further complicate things, you show one guy in the film who appears to be both a legitimate pain patient and, by his own admission, someone who was breaking the law and selling his pills.
Exactly. And I think we see that story a lot, where people come in, they start with these pills in a legitimate way, in an accident, or you have a certain pain. And then little by little, you discover that these pills are not only fixing the pain, maybe they're making me feel a little better than even just normal. Or maybe you're seeing that, "Wow, I could sell five [pills] on the side and pay my rent for the month." And one thing can lead to another.
That's another thing that I think the film showed me, and hopefully shows the audience, is just how that addiction can really take control over a person. So, rather than stigmatize someone and say that they shouldn't be be using or they should "get it together," I think we really have to think about [the fact that] the pills are very powerful, and if you fall victim to that addiction, it takes over your life in such a way where several of the characters in the film describe it where the only thing you're thinking about is, "Where am I going to get my next fix?"
At the end the film, you show a frame onscreen that says "prescription opioids kill more Americans each year than HIV or homicide, and more than heroin and cocaine combined." That's serious stuff.
Absolutely. And in no way is the film trying to minimize the damage that this epidemic has had across the country. And that became important to me as well. The more we got into the film and the more we researched that, [you see that] whatever Dr. Hurwitz's intentions are, there's no denying that the epidemic has been and still is a disaster, particularly when you consider the effects it's had now on the rise of heroin abuse in just staggering numbers.