In 1996, a company called Purdue Pharmaceutical launched a new opiate painkiller called OxyContin. At a party celebrating its release to the public, Richard Sackler, a scion of the family that owns the company and its senior vice president of sales, made exuberant predictions about its success. ‘The launch of OxyContin tablets will be followed by a blizzard of prescriptions that will bury the competition,’ he said, according to a lawsuit recently filed against Purdue. ‘The prescription blizzard will be so deep, dense, and white …’
The active ingredient of OxyContin is oxycodone, a semi-synthetic opiate (an ‘opioid’) first synthesised in Germany in 1916. Prior to OxyContin’s launch, oxycodone had been marketed as a painkiller in various pill forms for years, including Percocet (where it is mixed with paracetamol), Percodan (where it is mixed with aspirin) and Roxycodone (where it is dispensed pure in small doses of 15 to 30 milligrams). Other kinds of opiate painkillers, like the hydrocodone-based Vicodin, were also mixed with aspirin and came in small doses. While people did become addicted to these pills, the low doses of opiates they contained made it hard to overdose on them, and the paracetamol and aspirin would cause liver damage if the drugs were taken for a long time.
OxyContin distinguished itself from these medications, and received a patent, on the basis of an extended-release technology, the ‘contin’ of the drug’s suffix. Purdue developed OxyContin not to serve an urgent public health need but because the patent was expiring on its most profitable drug, a time-release morphine pill called MS Contin. Pharmaceutical patents, which last twenty years, allow pharmaceutical companies to maintain a monopoly on a drug and avoid competition from generic manufacturers. When a patent on a popular drug expires, its price can drop by as much as 90 per cent. To maintain monopolies, the industry often makes small adjustments to existing medications in order to patent and market them as new. OxyContin was one such drug.
OxyContin dissolves slowly in the digestive system, titrating the oxycodone into the body. Instead of taking a conventional painkiller like Vicodin or Percocet every few hours, the manufacturers claimed a patient could take OxyContin once in the morning and once at night and experience long-lasting pain relief. The slower-acting nature of OxyContin justified the manufacture of pills that contained much higher quantities of oxycodone than had ever been available in a single dose: up to 80 milligrams at first; 160 milligrams a few years later.
‘It was the cleanest drug I’d ever met,’ the artist Nan Goldin wrote in a column for Artforum describing the addiction she developed to OxyContin after an operation. Goldin writes that she took 40 mg doses and was addicted ‘overnight’. She went from taking three pills a day to as many as 18 of them. Not everyone is partial to the feeling produced by morphine derivatives, but for the people who like it, OxyContin seems to represent an apex. (...)
The horror of a video showing a toddler tugging at her mother’s unconscious form in a supermarket conveys more easily the horror of the corruption, avarice, poverty and stupidity that created the problem in the first place. How this happened – how the number of deaths from opiate overdoses increased by a factor of six in the US between 1999 and 2017 – is the subject of several recent books. Dopesick, by Beth Macy, describes the effects of opiate use in Appalachia, where she worked as a newspaper reporter. Dreamland, by Sam Quinones, describes the rise of a super-efficient network of dealers of Mexican black tar heroin in the US and its effects on one particular town in Ohio. American Overdose, by Chris McGreal, a correspondent for the Guardian, offers a more detailed view of the corruption that enabled the spread of opiates to go unchecked by the healthcare industry, government or law enforcement.
Each of these books devotes chapters to the history of OxyContin, a so-called blockbuster drug whose lamentable success was owed to a confluence of factors particular to the US. They include, but are not limited to: the country’s dysfunctional privatised healthcare system, which makes it possible for addicts to accumulate doctors willing to prescribe painkillers in a way they can’t in the UK; a corrupt regulatory agency beholden to the industry it was tasked with regulating; a punitive legal paradigm that criminalises drug users instead of helping them; an abstinence-only approach to treating drug addiction that impedes evidence-based medication-assisted treatment; corporate greed; a political class that takes marching orders from the lobbyists of said corporations; entrenched poverty, joblessness and hopelessness; and a general epistemological failure when it comes to ideas about what ‘drugs’ are, which psychoactive chemicals are safe and which are dangerous, and what a drug dealer is supposed to look like. These factors converged in such a way as to unleash hundreds of millions of potent pills out into the world in the late 1990s and 2000s, which in turn prepared a consumer market for heroin. Hundreds of thousands of lives have been lost, each one of them a world. (...)
McGreal, Macy and Quinones all document the rise in the late 1990s of pill mills, where in some instances doctors dispensed as many as 200,000 prescriptions for painkillers over the course of a few years. Complicit with the doctors were pharmacies, drug distribution companies, sales representatives and, of course, Purdue itself, whose executives knew very well they were flooding the market with a highly addictive substance. Young people used to pilfering a Xanax from their parents’ medicine cabinet or sharing out an Adderall prescription at a party were now taking a much more dangerous drug. People who had occasionally taken a stray Percocet or Vicodin from a friend who had had her wisdom teeth taken out had no reason to suspect that OxyContin would affect them differently. A common theme in interviews in these books reveals how little scepticism there is towards pills – many people had no idea what they were taking until they were deep into their habit. A generation raised on televised ‘this is your brain on drugs’ propaganda and pop cultural depictions of addicts had no warning system in place for prescription drugs. It is common in the US for people who would never dabble in cocaine or LSD to take psychoactive pills without shame or suspicion. (...)
Macy is the author of another book, Factory Man (2014), about the effects of globalisation, automation and the decline of coal in Virginia, which once had thriving textile and furniture industries. Dopesick could be read, in part, as a sequel to that book. ‘The federal disability programme was becoming a de facto safety net for the formerly employed,’ she writes, ‘a well-intentioned but ultimately disastrous way of incentivising poor people to stay sick with mental illness and chronic pain.’ In both the Ohio towns Quinones writes about, as well as the Appalachian towns described by Macy, pills became currency. Elderly people or those on disability who received government-funded health insurance through Medicare or Medicaid would get prescriptions for pain pills that were paid for by the government. At a going rate of $1 per milligram on the black market, thousands of dollars could be made from a 30-day OxyContin prescription. ‘Peddling pills was now the modern-day moonshining,’ Macy writes. In small towns where independent commerce had disappeared, addicts would shoplift goods from under the noses of unmotivated, underpaid Walmart employees and trade them for pills. Pill dealers would keep stores of stolen goods, where pills could buy everything from stolen televisions to nappies to laundry detergent – all at a discount. ‘Some large though immeasurable amount of the merchandise supporting addiction, as the opiates settled on heartland America, was mined from the aisles of Walmart, where Main Streets had gone to die,’ Quinones writes. ‘The opiate scourge might never have spread as quickly had these rural areas where it all started possessed a diversity of small retailers, whose owners had invested their lives in their stores, knew the addicts personally, and stood ready to defend against them.’
In 2010, Purdue introduced an ‘abuse deterrent’ to the drug which caused it to congeal when crushed, making snorting or injecting impossible. Conveniently, this also allowed Purdue to renew OxyContin’s patent, which was on the verge of expiring. (Through minor tweaks and reformulations, Purdue has re-patented OxyContin 13 times. Under its original patent the company would have lost exclusive rights to the drug in 2013. Now it maintains them until 2030.) It was in part the 2010 reformulation that provoked many users of OxyContin to try heroin and realise that it could also sate their cravings. By 2010 most of the pill mills had finally been shut down. Heroin was also significantly cheaper, especially for people who had built up tolerance to Oxy and required multiple pills a day to avoid the debilitating symptoms of withdrawal.
As the market for opiates expanded, heroin dealers stepped in to supplement the pharmaceutical supply. Of all the books available about the epidemic, Dreamland is by far the best account of how heroin dealers quickly came to understand the market opened up for them by prescription opiate painkillers. Quinones was a reporter for the LA Times when he first wrote about a network of heroin dealers who came from a small city in Mexico called Xalisco, in the state of Nayarit, where a sticky kind of heroin known as black tar is made from poppies that grow in the hills. The Xalisco boys, as Quinones calls them, were no Medellin cartel. They ran efficient, low-profile businesses, averse to violence and with a premium placed on customer service.
by Emily Witt, LRB | Read more:
The active ingredient of OxyContin is oxycodone, a semi-synthetic opiate (an ‘opioid’) first synthesised in Germany in 1916. Prior to OxyContin’s launch, oxycodone had been marketed as a painkiller in various pill forms for years, including Percocet (where it is mixed with paracetamol), Percodan (where it is mixed with aspirin) and Roxycodone (where it is dispensed pure in small doses of 15 to 30 milligrams). Other kinds of opiate painkillers, like the hydrocodone-based Vicodin, were also mixed with aspirin and came in small doses. While people did become addicted to these pills, the low doses of opiates they contained made it hard to overdose on them, and the paracetamol and aspirin would cause liver damage if the drugs were taken for a long time.
OxyContin distinguished itself from these medications, and received a patent, on the basis of an extended-release technology, the ‘contin’ of the drug’s suffix. Purdue developed OxyContin not to serve an urgent public health need but because the patent was expiring on its most profitable drug, a time-release morphine pill called MS Contin. Pharmaceutical patents, which last twenty years, allow pharmaceutical companies to maintain a monopoly on a drug and avoid competition from generic manufacturers. When a patent on a popular drug expires, its price can drop by as much as 90 per cent. To maintain monopolies, the industry often makes small adjustments to existing medications in order to patent and market them as new. OxyContin was one such drug.OxyContin dissolves slowly in the digestive system, titrating the oxycodone into the body. Instead of taking a conventional painkiller like Vicodin or Percocet every few hours, the manufacturers claimed a patient could take OxyContin once in the morning and once at night and experience long-lasting pain relief. The slower-acting nature of OxyContin justified the manufacture of pills that contained much higher quantities of oxycodone than had ever been available in a single dose: up to 80 milligrams at first; 160 milligrams a few years later.
‘It was the cleanest drug I’d ever met,’ the artist Nan Goldin wrote in a column for Artforum describing the addiction she developed to OxyContin after an operation. Goldin writes that she took 40 mg doses and was addicted ‘overnight’. She went from taking three pills a day to as many as 18 of them. Not everyone is partial to the feeling produced by morphine derivatives, but for the people who like it, OxyContin seems to represent an apex. (...)
The horror of a video showing a toddler tugging at her mother’s unconscious form in a supermarket conveys more easily the horror of the corruption, avarice, poverty and stupidity that created the problem in the first place. How this happened – how the number of deaths from opiate overdoses increased by a factor of six in the US between 1999 and 2017 – is the subject of several recent books. Dopesick, by Beth Macy, describes the effects of opiate use in Appalachia, where she worked as a newspaper reporter. Dreamland, by Sam Quinones, describes the rise of a super-efficient network of dealers of Mexican black tar heroin in the US and its effects on one particular town in Ohio. American Overdose, by Chris McGreal, a correspondent for the Guardian, offers a more detailed view of the corruption that enabled the spread of opiates to go unchecked by the healthcare industry, government or law enforcement.
Each of these books devotes chapters to the history of OxyContin, a so-called blockbuster drug whose lamentable success was owed to a confluence of factors particular to the US. They include, but are not limited to: the country’s dysfunctional privatised healthcare system, which makes it possible for addicts to accumulate doctors willing to prescribe painkillers in a way they can’t in the UK; a corrupt regulatory agency beholden to the industry it was tasked with regulating; a punitive legal paradigm that criminalises drug users instead of helping them; an abstinence-only approach to treating drug addiction that impedes evidence-based medication-assisted treatment; corporate greed; a political class that takes marching orders from the lobbyists of said corporations; entrenched poverty, joblessness and hopelessness; and a general epistemological failure when it comes to ideas about what ‘drugs’ are, which psychoactive chemicals are safe and which are dangerous, and what a drug dealer is supposed to look like. These factors converged in such a way as to unleash hundreds of millions of potent pills out into the world in the late 1990s and 2000s, which in turn prepared a consumer market for heroin. Hundreds of thousands of lives have been lost, each one of them a world. (...)
McGreal, Macy and Quinones all document the rise in the late 1990s of pill mills, where in some instances doctors dispensed as many as 200,000 prescriptions for painkillers over the course of a few years. Complicit with the doctors were pharmacies, drug distribution companies, sales representatives and, of course, Purdue itself, whose executives knew very well they were flooding the market with a highly addictive substance. Young people used to pilfering a Xanax from their parents’ medicine cabinet or sharing out an Adderall prescription at a party were now taking a much more dangerous drug. People who had occasionally taken a stray Percocet or Vicodin from a friend who had had her wisdom teeth taken out had no reason to suspect that OxyContin would affect them differently. A common theme in interviews in these books reveals how little scepticism there is towards pills – many people had no idea what they were taking until they were deep into their habit. A generation raised on televised ‘this is your brain on drugs’ propaganda and pop cultural depictions of addicts had no warning system in place for prescription drugs. It is common in the US for people who would never dabble in cocaine or LSD to take psychoactive pills without shame or suspicion. (...)
Macy is the author of another book, Factory Man (2014), about the effects of globalisation, automation and the decline of coal in Virginia, which once had thriving textile and furniture industries. Dopesick could be read, in part, as a sequel to that book. ‘The federal disability programme was becoming a de facto safety net for the formerly employed,’ she writes, ‘a well-intentioned but ultimately disastrous way of incentivising poor people to stay sick with mental illness and chronic pain.’ In both the Ohio towns Quinones writes about, as well as the Appalachian towns described by Macy, pills became currency. Elderly people or those on disability who received government-funded health insurance through Medicare or Medicaid would get prescriptions for pain pills that were paid for by the government. At a going rate of $1 per milligram on the black market, thousands of dollars could be made from a 30-day OxyContin prescription. ‘Peddling pills was now the modern-day moonshining,’ Macy writes. In small towns where independent commerce had disappeared, addicts would shoplift goods from under the noses of unmotivated, underpaid Walmart employees and trade them for pills. Pill dealers would keep stores of stolen goods, where pills could buy everything from stolen televisions to nappies to laundry detergent – all at a discount. ‘Some large though immeasurable amount of the merchandise supporting addiction, as the opiates settled on heartland America, was mined from the aisles of Walmart, where Main Streets had gone to die,’ Quinones writes. ‘The opiate scourge might never have spread as quickly had these rural areas where it all started possessed a diversity of small retailers, whose owners had invested their lives in their stores, knew the addicts personally, and stood ready to defend against them.’
In 2010, Purdue introduced an ‘abuse deterrent’ to the drug which caused it to congeal when crushed, making snorting or injecting impossible. Conveniently, this also allowed Purdue to renew OxyContin’s patent, which was on the verge of expiring. (Through minor tweaks and reformulations, Purdue has re-patented OxyContin 13 times. Under its original patent the company would have lost exclusive rights to the drug in 2013. Now it maintains them until 2030.) It was in part the 2010 reformulation that provoked many users of OxyContin to try heroin and realise that it could also sate their cravings. By 2010 most of the pill mills had finally been shut down. Heroin was also significantly cheaper, especially for people who had built up tolerance to Oxy and required multiple pills a day to avoid the debilitating symptoms of withdrawal.
As the market for opiates expanded, heroin dealers stepped in to supplement the pharmaceutical supply. Of all the books available about the epidemic, Dreamland is by far the best account of how heroin dealers quickly came to understand the market opened up for them by prescription opiate painkillers. Quinones was a reporter for the LA Times when he first wrote about a network of heroin dealers who came from a small city in Mexico called Xalisco, in the state of Nayarit, where a sticky kind of heroin known as black tar is made from poppies that grow in the hills. The Xalisco boys, as Quinones calls them, were no Medellin cartel. They ran efficient, low-profile businesses, averse to violence and with a premium placed on customer service.
by Emily Witt, LRB | Read more:
