Drug Company Profiteering, Pill Mills and Thousands of Addicts: How Oxycontin Has Spread Through America
I left a very white, very affluent Philadelphia suburb for NYU in 2007. When I go home, Oxys always come up in conversation with friends: Who got really "bad" (and can you believe it was him?!), who started selling, or what new pill-based friendship is the strangest. On one visit, I found pens gutted to be used as straws (to snort pills) and tin foil in my old best friend’s bedroom, to smoke Oxys.
In Glen Mills, Pennsylvania, suburban moms and dads enjoy a short commute to the city and send their kids off to a “Blue Ribbon School of Excellence” to prepare them for the educational institutions to which they aspire. Aside from school and work and partying in big houses, there is not much to do.
Boredom tends to inspire some creative takes on “fun.” Out of my town, for example, came theJackass crew. Their worm snorting and reckless self-injury (shocking their testicles, paper-cutting their eyelids) might not have occurred if they had the resources of a city. When Jackass star Ryan Dunn died in a drunk-driving accident June 20, he crashed his car on Route 322, a road members of my community use regularly.
Drugs are another common way to escape boredom. Pop one pill and working at the local pizza parlor after school might not be such a drag.
Of all the prescription pills people used – Xanax, Klonopin, Percocet, Vicodin, Adderrall, Rittalin, Codeine – OxyContin, the brand name for slow-release oxycodone, is king. The most potent painkiller of its class (opioids like codeine, Percocet and Vicodin), Oxys are what you graduate to. Being hooked on percs wouldn’t make sense. Eventually, as tolerance increases and more pills are needed (not just to get high but to avoid withdrawal) Oxys seem like the way to go.
My generation Y, also called the Echo-Boomers, grew up on pills: anti-depressants, ADHD medication like Ritalin, sleeping pills, anti-anxiety meds. Nearly as commonplace as being on prescriptions was sharing them, whether they were your own, your little brother’s, or something you found in your parents’ medicine cabinet.
At parties, no one said anything but “let me get some” as kids crushed and snorted pills off coffee tables, then blacked out and cruised through the night. Being so out in the open about it was a way to be cool, to establish yourself as a bad-ass, or make friends by sharing.
Pills were not only visible at parties. School was sometimes a comical display of who got too fucked up that morning. Kids would walk aimlessly in the hallway, fall off chairs, fall asleep, and often, be escorted to the nurse’s office and punished or arrested.
Finding the pills for a party or school day was not particularly difficult because there are enough Oxys in circulation for dealers to maintain stock. Some sources (not all) claim opioids have become the most commonly prescribed drug category in the United States. Furthermore, 15 percent to 20 percent of doctor office visits in the United States included the prescription of an opioid, and 4 million Americans per year are prescribed a long-acting opioid. The network to find these pills is strong and loyal because, as OxyContin users know, the withdrawal is so bad addicts will do almost anything to find it. The jocks, the cheerleaders, the shy kids, and the rebels – they were all exchanging connects, drugs and tips to get high. Eventually, many of them started to sell drugs to finance their own addictions, creating another network of unlikely drug dealers.
Most of my peers made it through high school alive but shortly after, that began to change. First, the former principal’s son – a well-liked athlete -- died from an overdose of a cocktail of pills, including OxyContin. "The kids that Tim hung out with in high school were kids we as parents wanted him to hang out with … but they were good kids making bad decisions," said his father, who urged that parents communicate, at a school assembly.
After he died that I learned that he was not the first. Another girl had overdosed on methadone the year before. Unfortunately, they were not the last. Since then, at least two people have died from opioids, and “who's next” is not an uncommon question for debate. It's like a virus or the grim reaper, sneaking around the suburbs at night and picking kids.
A 2008 study by DAWN (Drug Abuse Warning Network) for Philadelphia, Bucks, Montgomery, and Delaware counties shows that, combined, there were 681 deaths due to drug use (the vast majority of which involved opioids) and 45 drug-related suicides. One Bucks Country reporter noted that, for his county, drugs are killing more people a week than the Vietnam War did.
While the rates of overdose are startling, death is not the only deterrent to OxyContin use. Addiction itself can take the fun out of experimentation. While some people so enjoy the drug they do not want to quit, others desperately want to be clean – to return to the life they had before, when they did not have to mess with fate just to make it through the day. But another voice – the voice of addiction – overpowers this will, so that they are caught in an overwhelming battle. The problem is so bad, and so common, that I regularly see the ups and downs on Facebook statuses -- posts like “sometimes I think I can’t make it,” “hardest thing I’ve ever had to do,” “being strong,” “getting clean,” and “finally getting back to my normal self."
What makes quitting so hard is how good Oxys, and other opioids, feel. “These drugs are just amazing. For some, it’s a sense of intoxication. For some, it’s a sense of peace. For some, it washes away the pain of existence,” said Scott Kellogg of the New York State Psychological Association. “For some, it’s a sexual experience. The metaphor is always that it’s better than sex – it has some orgasmic quality.”
OxyContin’s euphoric effects vary depending how the drug is taken. When swallowed, active ingredients are time-released, and the high is less intense. When crushed, however, all time-release properties are obsolete so that when snorted, smoked, or shot up, Oxys (at much higher doses than immediate-release oxycodone) flood the body with a rush of warmth and confidence. Called a “miracle drug” by manufacturer Purdue Pharma, OxyContin is a physical and psychological pain eraser. It works by activating the mu-opioid receptor, “hijacking” the body’s natural painkilling system to release much higher levels of endorphins and block out the pain.
At first, Kellogg explained, people use the drugs to feel good. The body so enjoys this intoxication that it craves it. Then it needs it at increasingly higher doses, until users are so sick with days of fatigue, irritability, nausea, pain, diarrhea and vomiting they cannot imagine how to stop. At this point, people are not using to feel good, but to avoid terrible sickness. Withdrawal from opiates has often been called “a living hell.” Kellogg described the withdrawal as “a dramatically painful experience that can last up to five days.”
Both pain patients and abusers of OxyContin fear withdrawal. Many people who use, or have used, note that anyone suffering from that kind of “dope sickness” would do whatever it takes to escape. Even the head of the DEA would be on his hands and knees, begging for heroin.
Heroin, not OxyContin, because often serious Oxy addicts will turn to heroin to keep up their high. “For practical purposes, it’s the same thing,” said Kellogg. Unlike other painkillers like Vicodin, OxyContin and heroin are both derivative of poppy.
OxyContin and heroin have withdrawal symptoms with intense physical effects. Bill Twillman of the American Academy of Pain Management described opioid withdrawal as “the worst flu you ever had times two,” and that might be an understatement.
The horrific withdrawal, combined with Oxys’ high cost, can also drive users to heroin. OxyContin, synthetic heroin, has a street value of $40 for an 80 mg. pill. Heroin, on the other hand, costs about $10 a hit. When people are sick and broke, switching to heroin becomes somewhat of a no-brainer. But while heroin causes fewer deaths in the U.S. than OxyContin (maybe because more people use Oxys), its shifting purity makes users sensitive to overdoses, and the tendency for addicts to use it intravenously presents a wealth of new issues, like hepatitis C and HIV.
A National Epidemic?
Glen Mills is not the only town affected by what has been called “the OxyContin epidemic.” Reports of widespread OxyContin (and subsequent heroin) use have surfaced in many suburbs, including those in Chicago and New York.
Its high profitability helps to spread OxyContin use. Addicts’ overwhelming need for more Oxys makes the black market worth millions of dollars. What’s more, these pills are as costly as they are deadly. Widespread use and availability, matched with difficulty quitting, allows the numbers of users and deaths to skyrocket. A study by Drug Abuse Warning Network shows that visits to the emergency department caused by non-medical use of opioids from 2004 to 2008 increased by 111 percent. Prescription drug overdoses are now the second leading cause of accidental death behind traffic crashes, and painkillers are the top narcotic leading to death.
While death and use is on the rise nationwide, Appalachia has been so hard hit by OxyContin that it has given the pill a new name: Hillbilly Heroin. According to the 2010 National Drug Intelligence Center (NDIC) National Drug Threat Survey (NDTS), 25 of the 43 law enforcement respondents in the Appalachia High Intensity Drug Trafficking Areas identify controlled prescription drugs, of which oxycodone is most popular, as the greatest threat to their regions.
“Readily available and abused at high levels,” controlled prescription drugs also result in a wealth of crime, from hustling to burglaries. Law enforcement officers estimate that 90 percent of all property crimes committed in several West Virginia counties stem from OxyContin abuse alone.
Appalachian Oxy use exposes not only the street level crime associated with OxyContin, it also reveals a bigger trend in OxyContin trafficking – pill mills. In Current TV’s documentary series "Vanguard," reporters exposed “The OxyContin Express,” a flight from West Virginia to Florida, where pain management clinics, commonly referred to as “pill mills,” handed out hundreds of pills per patient, many of whom took their pills back home to sell. Prisons were stocked full of people locked away for selling drugs to support their own habits. As the show noted, all the pain is in Appalachia, while all the profit is in Florida.
A Trail of Corruption
As prescriptions to OxyContin and abuse of the drug rise, it becomes clear that there is far too much of the drug available on the black market. Obviously, something has gone awfully wrong in the pharmaceutical supply system.
In a study on OxyContin patients, researchers at the Albert Einstein College of Medicine and the Montefiore Medical Center revealed that part of the problem with OxyContin is lack of regulation by prescribers. Researchers determined that 8 percent of patients were urine tested (to see if they were drug addicts looking for a fix or non-users looking for cash), and less than half of the patients had regular meetings with their doctors to check on signs and symptoms of addiction. Shockingly, more than one quarter of patients were receiving multiple early refills, suggesting that tolerance (and addiction) had them using at a higher rate, or selling them quicker than they could re-stock.
Pill mills, some of which call themselves "pain management centers," are doctors’ offices that hand out powerful narcotics at a much higher rate than for strictly medical reasons. Like drug dealers, they require “patients” to pay in cash and usually do not perform physical exams or require evidence of injury. They treat pain with pills only, and they often give patients the option to choose their own medicines before directing them to “their” (conspiring) pharmacy. In some cases, doctors operating pill mills have been imprisoned for trafficking narcotics.
“If you live or work close to an OxyContin mill…99 percent of everybody that you see going in there is either an addict or a criminal,” said Assistant Scioto County, Ohio Prosecutor Joe Hale in a suit against OxyContin’s manufacturers. “If they are not an addict — if they don’t need that prescription just to get by every day — then they are going in there out of greed, because they know that they can pay some doctor $400 to write a prescription. They can take it up to Columbus, walk out with a bottle of pills, and in a matter of days they can turn it into $3,000, $4,000, $5000 — and who couldn’t use that?”
While doctors, dealers and addicts are locked-up for OxyContin, Purdue Pharma, the manufacturer, evades responsibility for the collateral damage caused by its product.
Devastation in Appalachia is so costly that several Appalachian and Southern states, including Kentucky, Mississippi, Louisiana, Virginia, and West Virginia have sued Purdue Pharma. Purdue has knocked down nearly every one of the more than 1,000 suits that have been filed against it.
With Rudy Giuliani on its side ( Giuliani Partners was an external adviser to the company since 2002), clearly Purdue has enough money and legal clout to avoid legal responsibility for its money-making, addiction-fueling product.
Alongside legal tools, Purdue Pharma, the only manufacturers of slow-release Oxycodone (which includes higher doses than fast-acting), used marketing to maintain its stronghold on Oxys and Oxy addicts. By advertising OxyContin in mainstream media, Purdue increased demand for its product, leading to large amounts of OxyContin in circulation.
“There’s just so much of it available,” said Twillman, “because they did a really good job of marketing it.”
In fact, they did too good a job.
In May 2007, Purdue Pharma and company chief executive officer Michael Friedman, general counsel Howard Udell and former chief medical officer Paul Goldenheim each pleaded guilty to a misdemeanor count of misbranding the drug, thereby misleading doctors and patients by claiming OxyContin is less likely to be abused (and addicting) than traditional narcotics. Effectively, Purdue Pharma synthesized legal heroin and advertised it to the masses as safer than other painkillers.
These “misbranding” misdemeanor offenses occurred between 1995, when the FDA approved OxyContin for sale, and 2001, when Purdue faced regular, public criticism and cut the “reduced-risk” marketing. During those years, OxyContin made Purdue Pharma $2.8 billion in profits. As Purdue championed the safety of its drug and watched the money pile up, the DEA said the number of deaths related to OxyContin rose 400 percent, and the annual number of OxyContin prescriptions increased nearly 20-fold.
In the end, Purdue Pharma paid more than $600 million to 26 states and the District of Columbia. No one at the company faced jail time.
“The damage to the public from these white-collared drug pushers surely exceeds the collective damage done by traditional street drug pushers,” said Dr. Sidney Wolfe, the director of the health research group at Public Citizen, at the time of the trial.
But the trial did not mark the end of Purdue’s attempts at bogus safety claims. In 2001, when the FDA urged Purdue Pharma to add a more accurate label to OxyContin, Purdue announced it was working on a patent application for a new formula of OxyContin designed to be less likely to lead to abuse and addiction. The result, OxyContin OP, entered the market this year with a special coating so it cannot be crushed and snorted. Addicts, however, have learned to work around this.
On my last visit home, I learned it is possible to cook up Oxys so they can be crushed. Some people even like the new pill better, calling it a “more doped out high” as opposed to the “energetic” Oxy rush. Google “the new OxyContin” and the first results are forums that include more than 100 comments on how to melt away the coating, using a microwave or lighter, and snort or shoot the medication. One comment even recommended a website with videos demonstrating how to successfully crush and snort or shoot the new Oxy.
At the same time, pain patients complain that the new Oxy causes nausea or does not work as well.
Treating Purdue Pharma’s Sick
Stirring up mass hysteria is not a good response to the high rates of Oxy addiction -- but neither should the addiction be downplayed.
Bill Twillman of the American Academy of Pain Management notes that OxyContin addiction is a “problem of our society,” where pills are considered the be-all, end-all of physical and psychological pain. Using, sharing and abusing prescription pills has become so embedded in our culture that addiction to OxyContin, and pills in general, is all too common. Most often, it is not OxyContin alone that causes death, but the pill mixed with alcohol and/or other prescription drugs, particularly Xanax and Klonopin. The bottom line is that prescription pills are quite pervasive. Big Pharma, physicians, street dealers, government, and users themselves all contribute to the wave of OxyContin use and the rising death toll.
Even if the new OxyContin did prevent users from crushing it, the epidemic would not be over. Twillman notes that users put off by the regulation are now turning to Roxicodone and other fast-acting opioids like Oxy IR. So how can we stop, and prevent, what Scott Kellogg called the potential “loss of half a generation”?
Taking OxyContin, or any opioid, deregulates the body’s natural opioid system so that, for some long-term users, the effects can be permanent. According to Kellogg, when addicts stop using these drugs, brain images show the brain starting to look better over time, but the earlier the intervention, the better the chances of a return to baseline.
Many people consider medical treatment like suboxone and methadone, though highly effective, “switching one thing out for another,” and families and friends of addicts often pressure them to go off these medications before they are ready. The result is often relapse. For this reason, combined with potential permanent brain alteration, the “diabetes” model of addiction as a life-long disease that requires a lifetime of treatment can be highly effective, according to Kellogg.
The neurochemistry of some addicts (and of those who most abuse the drug), might never have been “normal” in the first place, Kellogg notes. Thus, faulty brain chemistry sends potential addicts off on a quest for self-medication, and for that reason, prescription pills are attractive – and addicting.
In regard to suppliers, Twillman says pharmaceutical companies must go to the DEA and report how many pills they will manufacture the upcoming year. The DEA, however, is mandated by law to ensure there is enough medication available for the people who need it. OxyContin is obviously overprescribed, and to cut the numbers of pills manufactured as rates of use rise seems like an obvious solution.
However, because opioids work well for many pain patients, Twillman was leery of suggesting legal regulations that require doctors to use alternate pain treatments. Instead, he supports a crackdown on pill mills and guidelines that recommend treatments like acupuncture, chiropractic, local anesthetic patches, and a wealth of other action.
Taking OxyContin off the market would not only endanger pain patients, but addicts as well. Sick from withdrawal, they would increasingly turn to heroin, which could be impure, and therefore dangerous.
To minimize the surplus of Oxy in circulation, several states, including Florida and Ohio, are passing laws to regulate and stop pill mills. Though laws to regulate pill mills may be a step in the right direction, the government’s reaction to prescription pill abuse is fundamentally flawed. Purdue Pharma intentionally misled the public in advertisements designed to boost demand, profit-hungry doctors overprescribed highly addicting drugs, and parents left excess prescriptions in medicine cabinets. Rather than focus on why addicts use (like naturally flawed opioid receptors in the brain), the government focuses on jailing street dealers and addicts who are in dire need of life-long treatment.
At this point, Pandora’s box is open. Oxy addiction is widespread, and regulating the drug will result in higher numbers of heroin use. As was evidenced in Russia’s attempts to crack down on heroin, addicts will do nearly anything, includinginjecting flesh-rotting house-held chemicals, to avoid withdrawal. The time has come to pursue legal action against the real dealers – the manufacturers and the doctors in their pill mills – and apply money from lawsuits against them to treat the sick before the death toll rises and thousands more people face addiction that could change their brain chemistry indefinitely.