Review: Michael Keaton's opioid drama 'Dopesick' is harrowing, horrifying and a must-watch

We all know the story of the opioid epidemic. Or maybe we just think we do.

Much attention has been devoted to the epidemic of opioid addiction and overdose in the U.S. – nearly 72,000 Americans died of drug overdoses in 2019 – although the focus on where we are now in the battle against the epidemic can obscure how, exactly, we got here.

Hulu's "Dopesick" (first three episodes premiering Wednesday, then streaming weekly, ★★★ out of four) aims to fill in the gaps by tracing the rise of one opioid drug: Purdue Pharma's OxyContin. Inspired by the nonfiction book "Dopesick: Dealers, Doctors, and the Drug Company That Addicted America" by journalist Beth Macy, the miniseries is a fictionalized account of the epidemic, mixing real-life figures with composite characters whose lives were affected, and sometimes destroyed, by opioids.

Created by Danny Strong ("Empire," "Game Change") and starring Michael Keaton, "Dopesick" is a harsh rebuke of Big Pharma, the health care system and the American government's long inaction on opioids. Unrelenting in its tragedy, irony and criticism, the series spans the mid-1990s to the mid-2000s as the crisis intensifies across the nation. A devastating series that sometimes gets preachy and slow, "Dopesick" is a vivid, affecting portrait of an American tragedy that you can't look away from.

The primary subjects in "Dopesick" are the billionaire Sacklers who own Purdue; DEA agent Bridget Meyer (Rosario Dawson), who's obsessed with getting Oxy under control; two U.S. attorneys (Peter Sarsgaard and John Hoogenakker) trying to build a case against Purdue; Appalachian family doctor Samuel Finnix (Keaton) and the Purdue sales rep (Will Poulter) who's hounding him to prescribe Oxy; and one of his young patients, Betsy Mallum (Kaitlyn Dever), a Virginia coal miner who becomes addicted after taking the drug to help with a back injury.

The overarching story is remarkably simple: Purdue introduces OxyContin, falsely claiming that – unlike previous opioids – it isn't very addictive; egged on by aggressive reps, doctors start prescribing it; crime and deaths follow; and law enforcement officers try (but often fail) to do something about it.

"Dopesick" is adept at bridging the line between the personal and the big picture, weaving its intimate stories among colder, broader scenes in corporate offices and on Capitol Hill. When Bridget appeals to unfeeling Purdue reps or defensive FDA employees to help her save addicts and families in danger, the audience knows how great the need is, having already seen Betsy's life devolve into chaos.

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The series unfortunately follows a recent TV trend of out-of-sequence timelines, jumping from the 1990s to the early 2000s to the mid-2000s repeatedly during each episode. In some instances, it serves to emphasize the points the writers are trying to make about the devastation of OxyContin and opioids in general. But in others, it muddles the narrative and becomes more confusing than emphatic. "Dopesick" is far from the only offender (and far from the worst), but more linear storytelling might have worked better here.

The cast is excellent and empathetic, helping ground the series. Keaton is at his best, mastering a character who's a mess of contradictions and transformation. Dever helps prevent her character, a closeted lesbian stuck in a small town, from becoming stereotypical. The true star of the series, however, is Dawson, whose DEA agent is passionate and angry on behalf of the suffering she sees in the world but stymied at nearly every turn in her quest for justice, especially as a woman of color in law enforcement who's often dismissed by her superiors.

"Dopesick," as one might expect, turns its lens onthe most tragic moments, and the grimmest settings, caused by addiction. But even when it isn't showing the death, illness and strife caused by opioids, it is brutal to watch. Scenes set in the sunlight are full of moments when I wanted to scream "don't take that pill!" at the TV, as if it's a predictable horror movie.

But it isn't a horror film with CGI monsters; it's based on a true story where the monsters were hidden behind lawyers, inside innocuous-looking pill bottles and in a disease we didn't understand. There are times when "Dopesick" moralizes its way into after-school special territory, but that can be overlooked for how effective it is at bringing the opioid epidemic – often relayed to the public as a series of statistics – to harrowing life.

If great art reflects life, "Dopesick" is the kind that's meant to force us to stare into that reflection and find something better for the future.