A deep dive into a sequence of prominent “pill mill” prosecutions reveals the inside, untold history of America’s overdose crisis.

Producer/Director: Erica Modugno Dagher

Producer/Creative Director: Mark Larranaga

Producer/Writer: Amy Bianco

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.

—Madeline Miller, PG interview

The PAIN GAME is a hard-hitting, immersive documentary film project that challenges much of 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 series investigates a sequence of high-profile criminal prosecutions of healthcare providers for 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 defendants while leaving more dubious actors untouched. It also covers various other events that weave around the cases, documenting the formation of an embattled community of chronic pain patients and the advocates, attorneys, experts, and officials who banded together to try to protect them.

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 is firmly established in the public mind as the the biggest product liability fiasco since the Big Tobacco scandal of the 1990s. So, has justice been served? Has the crisis been resolved, the story told? Not yet. Whatever settlement money is earmarked to treat opioid use disorder will be put to work in the same distorted healthcare system — under the watch of the same misguided regulatory regime — from which the problem emerged in the first place. The myriad roots of the opioid crisis have not been honestly assessed — let alone addressed — and so the dramatic annual rise in fatal overdoses continues unabated.

Over the past few decades the Drug Enforcement Administration 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." Pill mills do exist, and opioids were too freely prescribed for a time; but The PAIN GAME shows how this activity flourished in a medical, legal, and commercial environment that was created not as much by the push to treat chronic pain with opioids as by the pushback against it. 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 half a million Americans to their deaths.

The Backstory

“What happened?” It seems like an obvious place to start, but rarely do journalists ask the question with a truly open mind. 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 massive 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 20 years ago.

Erica’s entry to the pain community was provided by a political science professor at the University of Northern Florida, Ronald T. Libby, Ph.D., who shared with her a working manuscript of a book that was 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. He 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." 

Recognizing that Prof. Libby was onto something important, Erica proceeded to investigate some of those stories herself. Working independently, she began field producing, directing, and interviewing subjects across the country. Prof. Libby introduced Erica to the key players in the community, and the trust Prof. Libby had earned among them was extended to Erica. She was quickly 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. The PAIN GAME couldn’t be filmed today, looking backwards.

Our writer, Amy Bianco, came to the project that would evolve into The PAIN GAME when she caught up with her college classmate Sean Greenwood in New York City in the fateful year 1996, while she was working in the book publishing industry. Sean had been completely sidelined since graduation with an unrelenting headache that 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. 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 job. 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.

Amy and Erica first crossed paths in Topeka, Kansas, when Siobhan came under federal criminal investigation for her advocacy on behalf of a physician in Wichita, and Erica was covering her case. After Siobhan’s tragic death in 2011 (in a private plane crash), Amy dropped the book project and joined forces with Erica on the film project. Using her skills as a trade science book editor, Amy has recruited an advisory panel of top-notch medical, legal, and policy experts to support The PAIN GAME. This is likely the most comprehensive history of the overdose crisis that will ever appear, and we are making sure it is accurate.