Drug Company Profiteering, Pill Mills and Thousands of Addicts: How Oxycontin Has Spread Through America | | AlterNet

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Corruption down the line, from Big Pharma to doctors and the war on drugs,

builds a growing epidemic and an addiction-fueled empire.

June 30, 2011  |  

 



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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.â€Â Out of my town, for

example, came the Jackass 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 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,â€

said  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.â€

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.â€Â Kellogg described the withdrawal as “a dramatically painful

experience that can last up to five days.â€

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 and Percocet, OxyContin and

heroin are both derivative of poppy.

OxyContin and heroin have withdrawal symptoms with intense physical

effects. Bill Tillman 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?â€

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 Tillman, “because they did

a really good job of marketing it.â€

In fact, they did too good a job.

In May 2007, Purdue Pharma and company chief executive officer Friedman,

general counsel Udell and former chief medical officer 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... More

at link

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