The OxyContin Thing

An introduction to The PAIN GAME

Apr 01, 2025

“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.

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.

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."

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." To view a longer excerpt from Prof. Libby's interview visit the Quarter Turn Media website.

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.

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.

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 overarching thesis on the history she was recording; she simply immersed herself in the story with a keen eye and an open mind.

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

Sean would eventually be diagnosed with Ehlers-Danlos syndrome, and I would receive my own EDS diagnosis after illness forced me out of my last in-house publishing position. By the time Sean passed away in 2006, I 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.)

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

Using my skills as a trade science book editor and author, I have adopted a turn-every-page approach to reporting for The PAIN GAME. I have combed through reams of trial transcripts, medical records, and other, less-public documents. In this and other matters, we have been very fortunate to have the assistance of an advisory panel of top-notch medical, legal, and policy experts.

In 2016, Erica and I founded Quarter Turn Media to house the growing PAIN GAME project. In 2023, we were thrilled to be 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, 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/viewers 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.

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. 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 to 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 PAIN GAME videos, in order of appearance:

The PAIN GAME video, November 1, 2005; Myrtle_Beach_11_2005_H: the OxyContin thing.
The PAIN GAME video, June 21, 2004; 021_RTL_06_21_04: nobody’s safe.
The PAIN GAME video, May 1, 2006; 408_Jackson_Cam_B_redigitized: public safety.
The PAIN GAME video, April 13, 2005; 147_Walter_A_roll_redigitized_3: something’s wrong with the system.
The PAIN GAME video, April 18, 2004; 005_04_18_04_redigitized: tell him what your life is like.
The PAIN GAME video; December 15, 2004; Hurwitz_Trial_Siobhan_Millers_outside_court_house6: justice deaf and dumb.