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When Hulu’s Dopesick Season 1 Episode 4, “Pseudo-Addiction,” opens, Dr. Samuel Finnix (Michael Keaton) learns about the dangers of OxyContin firsthand. Betsy Mallum (Kaitlyn Dever) struggles with her addiction to the drug. Plus the manufacturer, Purdue Pharma, continues to skirt around allegations as the series explores more of Beth Macy’s nonfiction book about America’s opioid epidemic. 

[Spoiler alert: This article contains spoilers from Dopesick Season 1 Episode 4 ‘Pseudo-Addiction.’ ]

Dopesick Episode 4 Betsy Mullam and Walt looking at OxyContin
‘Dopesick’ Kaitlyn Dever and Nicholas Logan | Gene Page/Hulu

‘Dopesick’ Episode 4 opens one year later

Hulu’s Dopesick Episode 4 begins in 1997, one year after the release of OxyContin. The opening scene is devastating. Teens start crushing up and snorting the Purdue Pharma drug around a bonfire. Chase (Benjamin Perkinson) insists that Elizabeth Ann (Alayna Hester) snort OxyContin. When another teen, Ryder, lies unmoving on the ground, his friends take him home and leave him on the ground despite Elizabeth’s objections. The episode doesn’t return to the teens, but viewers guess he died from an overdose or complication of snorting the OxyContin.

Meanwhile, Betsy works at a local gas station in Finch Creek, Virginia, and sells OxyContin on the side. When her ex-girlfriend, Grace Pell (Cleopatra Coleman), returns to town, Grace tells her about Eureka Springs. After the sighting, Betsy agrees to go to Florida with her drug dealer, Walt (Nicholas Logan), to get more OxyContin. When the doctor examines her, he insinuates that he could “work something out” if she doesn’t have the money for the drugs.

Richard Sackler finds a new ‘expert’ to help him peddle OxyContin

In Dopesick Episode 4, Richard Sackler (Michael Stuhlbarg) has a discussion with his father, Raymond Sackler (Lawrence Arancio). The older man worries that Richard should not have put the “less than 1% addictive” label on the OxyContin. Raymond suggests he find a new expert to speak to the doctors about addiction. 

Richard quickly finds a new expert, Dr. David Haddox (Aaron Serotsky), who believes that the OxyContin patients have a “pseudo-addiction.” Haddox thinks that doctors should increase the dosage of pain medication rather than weaning their patients off of it. Purdue Pharma pushes a new pamphlet on their sales representatives. When one of them, Paula Greene (Caitlin Mehner), questions the philosophy, they fire her. Paula insists that Billy Cutler (Will Poulter) knows the dangers of OxyContin, but he denies it.

Dr. Samuel Finnix is addicted to OxyContin in ‘Dopesick’ Episode 4

Back in Finch Creek, Dr. Finnix begins lowering his patient’s doses but keeping their leftover OxyContin for himself. He pops two 80mg pills. Later he tries to quit “cold turkey.”

When Billy meets with Dr. Finnix, the doc asks about the addictiveness of the drug. Billy offers the new theory and pamphlet, but Dr. Finnix insists Billy is selling “poison.” Then the doctor punches Billy in the face and physically throws him out of his office.

Viewers find out the reason for the name of the series, “Dopesick.” It’s the term used to refer to the pain patients feel during withdrawal from the drug. Later, Dr. Finnix buys drugs from a dealer, Walt (Nicholas Logan), who teaches him to snort the pills instead of swallowing them whole. That’s when the doctor hallucinates dancing with his dead wife, Shelly Finnix (Tricia Hawn). 

The 2004 investigation into Purdue Pharma

In Dopesick Episode 4, Rick Mountcastle (Peter Sarsgaard) and John Brownlee (Jake McDorman) see a breakthrough against Purdue Pharma.

Rick calls the New England Journal of Medicine and tracks down Dr. Herschel Jick, who conducted the study saying that less than 1% of OxyContin users become addicted. The study was only a “letter to the editor” about patients confined to a hospital. It was no official study but only an observation. The letter was five sentences long. Dr. Russell Portenoy (Shane Callahan) co-authored an article in PAIN magazine citing the letter as a study. He’s a significant spokesperson for Purdue Pharma. This admission by Dr. Jick greatly helps Rick and John’s case.

The 2000 investigation by Bridget continues to go nowhere

Meanwhile, in 2000, Deputy Director of Diversion, Bridget Mayer (Rosario Dawson), speaks to the FDA. She insists that the drug is dangerous, but the FDA refuses to put any restrictions on it. She arranges a meeting with Purdue Pharma. Bridget suggests that the company limit the number of pharmacies that carry OxyContin and doctors prescribing it. The response from Purdue is the same as the FDA, and they plan to take her concerns “under advisement.” It’s no wonder she wants nothing to do with the case a few short years later.

‘Dopesick’ Episode 4: Betsy Mallum gets sucked back into using OxyContin

Eric Miller runs an intervention about addiction for Betsy with her entire family. Her parents, Diane Mallum (Mare Winningham) and Jerry Mallum (Ray McKinnon), insist they don’t care about anything else; they only want her to get help. Later in the episode, Betsy joins an AA meeting and describes how she went from an OxyContin prescription for her back pain to becoming addicted to the drug. Although she’s two days sober, a sweet AA woman (Elizabeth Becka) sells Betsy more OxyContin in the bathroom. The vicious cycle continues.

How many episodes of ‘Dopesick’ will there be?

At this point in the Hulu series, many viewers want to know how many more episodes of Dopesick they have to look forward to. According to IMDbDopesick has eight total episodes. After episode 4, viewers have four more episodes to watch weekly until the finale on Nov. 17. Dopesick drops to Hulu weekly on Wednesdays at 12:01 EST.