Documentarians Perri Peltz (Risky Drinking, Remembering the Artist Robert De Niro) and Sascha Weiss (Paycheck to Paycheck) discuss the roots of the worst drug addiction epidemic in United States history -- and why destigmatizing the issue is the first step to nationwide recovery.
HBO: Why did you decide to approach this subject from such a personal perspective?
Perri Peltz: People may be aware there is an opioid overdose epidemic, but what Sascha and I believe has been missing from the dialogue is the humanity of people who are suffering from this disease. Addiction is a brain disease -- and what we tried to do is show those who are suffering are not bad people. These are good people who got swept up in an addiction -- often times, not at their own doing. They were taking the very medication they were prescribed and from there, it grew into a dependence.
HBO: Is there a way to treat pain with opioids with minimal risk to the patient? Or does the medical community have to come up with an alternative solution for treatment?
Perri Peltz: The medical community is aware about prescribing fewer opioids. These are very good medications for treating severe, short-term pain. Where the data says they are not effective is for long-term, chronic pain.
Sascha Weiss: We spoke to a lot of doctors about alternative ways to treat pain without opioids. Pain -- chronic pain, especially -- is really complicated. There are interventions that need to happen in order to figure out how to treat it. There’s physical therapy, behavioral support, acupuncture and yoga, but our current healthcare system can’t really support all of these alternatives. It’s easier to give someone a pill for their chronic pain. A lot of this overprescribing came from doctors wanting to do the best for their patients -- and thinking this was something that can be used long-term. We’ve been working with the National Institute on Drug Abuse and they’re in the process of trying to develop alternative medications for pain as well as studying brain images to better measure pain so it’s not as subjective.
HBO: Let’s talk about the Purdue Pharma marketing campaign. Do you think that, if it weren’t for this campaign, the country wouldn’t be in the middle of this crisis?
Perri Peltz: We can’t blame Purdue Pharma by itself. Many contributors in the ’90s allowed this epidemic to take root. [Back then], there was a feeling in this country that we were undertreating pain. Doctors were on the line if they didn’t treat pain aggressively. But there’s no question the Purdue Pharma campaign contributed in a significant way. When it launched in 1999, after the release of OxyContin in 1996, people hadn’t experienced anything like it. There was this push to tell doctors they had been wrong -- these drugs were not as addictive as they had thought, and that less than 1 percent of patients taking these medications long-term would become addicted. It was a perfect storm.
HBO: The film noted 80 percent of those suffering from opioid addiction don’t receive treatment. Is this because of the stigma associated with addiction or because prescription painkillers are so widely used?
Sascha Weiss: The reason that number is so high is two-fold: There’s the stigma of seeking treatment, then getting access to effective treatment that works for opioid addiction. But the way we treat opioid addiction in this country isn’t very effective. Twelve-step, abstinence-based programs don’t work well for opioid addiction. Medication-assisted treatment works much better.
Perri Peltz: The feeling in most rehabs across the country is, why would you replace one drug with another? Unfortunately, when it comes to opioid addiction, there’s hard evidence that suggests when you take opioid blockers like Methadone, Buprenorphine and Vivitrol, your chances of recovery increase almost three times. But it’s been so stigmatized that the undertreating of addiction has run rampant. We have to do a better job of getting people the right kind of treatment -- otherwise it’s going to be hard to crawl our way out of this mess.
HBO: How did you find the families you spoke with?
Sascha Weiss: We looked to nonprofits and small organizations. The family we spoke to in Illinois we found through an organization called Live for Lali, which a woman named Chelsea Laliberte started after her brother died of an opioid overdose. They focus on access to Naloxone and Narcan, the live-saving emergency antidote. In New Jersey we came across a bereavement group through a local newspaper. In California, we worked with Shatterproof, which is a national organization. The most amazing part about making this film was that so many people wanted to participate.
Perri Peltz: Documentaries like this don’t get made without extraordinarily brave people. In this case, the families who chose to open up their lives and their homes and share the worst possible loss that one can ever experience. They did it with such incredible dignity and humanity -- and because they don’t want other families to struggle and suffer the way they have. In large part, that’s because of the stigma. One family in the film mentioned when a child dies of cancer, everyone comes and gathers around... but when your child dies of an overdose, people don’t want to get near. Choosing to tell their stories was to help eradicating stigma.
HBO: As far as next steps, how do we work to start reversing this situation?
Perri Peltz: Unfortunately, the numbers continue to grow. Looking at the epidemiology of this disease, the real concern is the switch to heroin -- and the heroin supply right now is contaminated with fentanyl. There’s talk about this so-called “lost generation” as we get our prescribing laws in line. But what happens to the millions of people who are already struggling with addiction, who can no longer access opioid pills? Do they all switch to heroin? How many more people do we lose? As Congress looks at the Affordable Care Act, we have to hope people will have access to the treatment they need. Because we need to do better.