OxyContin: “Industrial-Scale Delivery of Death”
Opioids came to my attention a few years ago when a report came out that New York State doctors had written more than 24 million prescriptions for opioids the previous year. Unstated in the story, but obvious to me, was that there are only 19 million people in the state, total. Doctors were flooding the state with narcotics. That can’t be right. Chris McGreal’s American Overdose details how very wrong it was and continues to be. It’s capitalism, greed and amorality at their finest.
Opioids are narcotics. The big three, Vicodin, Percocet and OxyContin are the most prescribed. A movement began in the 1980s to free up narcotics for any kind of pain relief at all. Doctors began prescribing them for the slightest pain, on the basis that they hadn’t been doing enough to relieve pain in general. And, incredibly, that opioids weren’t really addictive after all.
The story of OxyContin and the opiate crisis is the story of one family’s quest to provide unfettered freedom for narcotics in the USA. The Sacklers, with a long history of hustle and living just over the edge of legitimacy, built an empire in Purdue Pharma, making narcotics available to all, addicting them for life, shortened though it would be. Chris McGreal investigates the players, the history and the fallout in the thorough, gripping and excellent American Overdose. He spoke to all the key players and plugged in all the missing parts. The timeline at the end is invaluable — for some Congressional hearing that will never take place. At some point, this has to stop.
“OxyContin was not the result of good science or laboratory experiment. OxyContin was the child of marketers and bottom-line financial decision-making,” says John Brownlee, then a southwestern Virginia federal prosecutor. He considers Purdue Pharma a criminal enterprise.
In 1999, deaths from legal drugs overtook deaths from illegal drugs, and have not looked back. Deaths are increasing 18% a year, and the average age of death keeps declining. It’s the number one cause of death for those under 50. Ironically, the old and dying are the only group where opioids are not increasing the death rate. Mass prescribing was driving the epidemic. Addicts ravaged savings, relatives, homes — anything — to keep renewing prescriptions. The pain of withdrawal is that fearsome. Death can come suddenly in an instant, or drag out over days of agony. Even the most drug averse can find themselves hooked without knowing it.
American Overdose is a litany of failures. McGreal has chapters focused on doctors, on the police, on politicians, on drug distributors, and of course, on the manufacturers. Each is as bad as the next. It is astonishing how deeply criminal it was, and how little was done to stop it. Those who tried were squashed like bugs. Judges and police were purchased. Doctors became Mafiosi. Roadkill in this story are the children of addicts. Hundreds of thousands across the country have fallen into state care, because their parents were incapacitated, imprisoned or dead from opioids. Babies of addicted mothers are born addicted.
The relentless pressure from big pharma had the desired effect. Uniquely in America, doctors all over the country firmly believe that narcotics are necessary and appropriate for any kind of pain, for any age of person, in any kind of need. They believe that OxyContin is not addictive, because someone declared the resurgence of pain as the drug wears off is proof there is no addiction. And of course, they believe they need no educating on narcotics and that no one can tell them what to do. They’re doctors, after all. The result is a nationwide epidemic, where overdose deaths have bypassed illegal drugs, alcohol, auto collisions and gunshot fatalities. The grand total long ago eclipsed the number of deaths in the Vietnam war, and it is the only area of mortality that is skyrocketing. By itself, it has lowered the life expectancy of Americans.
Through it all, Purdue Pharma continued to lie. Its training video for doctors states there is “no evidence that addiction is a significant when persons are given opioids for pain control.” It got the Food and Drug Administration to label OxyContin as actually reducing the risk of addiction. Its reps guilted doctors into prescribing more because their competitors were. It bribed them with pizza and swag. It paid some of them for papers or speeches. It produced millions of pills to saturate small localities where people would drive for hours to get instant prescriptions, only fillable at co-opted pharmacies that would not report them.
-Doctors could make $20,000 a day writing scrips. They did them in advance, so receptionists could just fill in a name. No checkup necessary. Just $150-$250. Cash.
-Florida permits doctors to both prescribe and sell narcotics, saving a step in spreading narcotics to all. So hundreds of dispensaries popped up to take advantage of the flood of cash. By the end of the 2000s, Florida was number one in opioid prescriptions.
-As for Washington, its first act to tame the epidemic was to pass a law in 2016 handcuffing the Drug Enforcement Agency, basically preventing it from enforcing existing narcotics laws on distributors.
The Mexican drug cartels are entrepreneurial enough to know a good thing when they see one, and promoted heroin as a far cheaper substitute for OxyContin. Then an artificial opioid, Fentanyl, solved the import problem. Fentanyl is 50 times as powerful per gram, so far less of it has to be made or shipped or delivered. Fentanyl has overtaken heroin and OxyContin in the death race, but heroin and OxyContin are not fading either. A single badly mixed Fentanyl pill can kill by itself, without all the agony of addiction.
In 2018, Purdue Pharma finally said it would no longer promote OxyContin to doctors, and laid off all its sales staff. But the snowball is still rolling down the hill. The Centers for Disease Control estimates it will take another 15 years for the OxyContin epidemic to run its course. Purdue Pharma is all but guaranteed billions of dollars annually until that time. The current estimate of opioid addicts in the USA is at least two million.
McGreal ends with the whistleblowers finally making some progress. They are nibbling away at the edifice of prescription narcotics. A law here, a prosecution there, a help service, a publicity campaign. Incredibly, there is still a narcotics lobby working Washington for all its worth. Because it’s worth billions.
David Wineberg
(American Overdose, Chris McGreal, November 2018)
