Dealers, Doctors, and the Drug Company that Addicted America
by Beth Macy, 2018
Painful, scary book about the opioid epidemic, which started with the release of Oxycontin by Purdue Pharma in the mid 1990s. This was a drug so powerful and so over-prescribed by doctors in the Appalachian areas, that many were addicted and when Purdue Pharma finally, finally made it abuse resistant, the addicted turned to heroin, which was cheaper and more powerful. The damage was done and we’re still paying for it as families go through the living nightmare of caring for a heroin addict. She tells the history of opioids, Oxycontin, heroin, and tells real-life stories of doctors, policeman, dealers, and addicts. America, we have yet another nearly unsolvable problem created by our greed and inherent dissatisfaction. There is not an easy answer to the problem of addiction; we don’t even know what really works for opioid addiction. Scary, scary, scary.
Here are some interesting quotes from the book:
Dr. John Burton, of Carilion Clinic in western Virginia: “I can remember telling my residents, ‘A patient can’t get hooked on fourteen days worth of [opioid] pills.’ And I was absolutely wrong.”
‘In an Appalachian culture that prides itself on self-reliance and a feisty dose of fatalism, peddling pills was now the modern-day moonshining. Some passed the trade secrets down to their kids because, after all, how else could they afford to eat and pay their bills?’
‘…They’d both lost their teeth. “You get sick and throw up. Or you leave pills in your mouth and it takes the enamel off,” Honaker said. Neither had ever had steady work. “You couldn’t keep a job because you’d steal if you worked at a restaurant,” Street added. “Or you just couldn’t get up and go–you were too sick.”‘
‘Honaker put in: “At the end of your journey, you’re not going after drugs to get high; you’re going to keep from being sick.”‘
‘For most of the previous century, opioid addiction was mainly relegated to big northeastern cities, where heroin had long been smuggled in through illicit channels, infiltrating the Harlem jazz scene of the 1940s and the beatnik subculture of the 1950s. The term “hipster,” in fact, drew from the Chinese opium smoker of the 1800s, who’d spent much of his time smoking while reclining on one hip. The hipster counterculture took inspiration from heroin-addicted jazz greats like Charlie Parker and John Coltrane.’
‘To help burnish its image in the face of so many legal, financial and public-relations problems, Purdue hired former New York mayor and Republican insider Rudy Giuliani and his consulting firm, Giuliani Partners. Just a few months after his lauded response to the 9/11 terrorist attacks, Giuliani’s job was to convince “public officials they could trust Purdue because they could trust him,” as Barry Meier and another writer at the New York Times put it.’
‘On a clear day in May 2007, in the atrium of a downtown Roanoke office building, Brownlee unveiled the news of the settlement: The company and its top executives would plead guilty to their role in a marketing blitz that hyped OxyContin’s strengths while down playing its propensity for addiction and abuse. To resolve the federal criminal and civil misbranding charges, Purdue would pay $600 million in fines and admit that for six years it had fraudulently marketed OxyContin as being less prone to abuse and having fewer narcotic side effects than instant-release versions of the drug–a felony misbranding charge.’
The Sacklers own Purdue Pharma and got extremely rich off of OxyContin – a net worth of $14 billion.
‘And what this patient wanted Bickel to know was no different than what the Lee County farmer meant when he told his doctor how OxyContin had stolen everything from him: Nothing’s more powerful than the morphine molecule, and once it has its hooks in you, nothing matters more.’
‘That same pattern was playing out in the Lee County coalfields, where some parents coaxed their children’s doctors toward ADHD diagnoses, knowing that such behavioral problems could help make them eligible for Social Security disability when they became adults. “Ritalin is a pipeline to disability here,” one Lee County health care manager told me, describing the federal program as a coping mechanism for poverty and workplace uncertainties.
‘A hospital administrator I know from nearby eastern Kentucky recalled a Drug Abuse Resistance Education officer asking her high school classmates what they wanted to be when they grew up.
“A drawer,” one young man said.
“You mean an artist?”
“No, a draw-er.”
Someone who draws disability checks…Well over half of Lee County’s working-age men–a staggering 57.26 percent–didn’t work.’
‘For people who have not ventured recently into rural America, the jaw-dropping and visible decline of work comes as a shocker, an outgrowth of the nation’s widening political and cultural divide.’
‘Drub epidemics unfold “like a vector phenomenon, where you have one individual who seeds that community and then the spread begins,: said Dr. Anna Lembke, an addiction-medicine specialist at the Stanford University School of Medicine and the author of Drug Dealer, MD. People whose parents or grandparents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, with genetics accounting for 50 to 60 percent of that risk, Lembke explained; she noted that the correlation between family history and depression is much lower, 30 percent. Other risk factors for addiction include poverty, unemployment, multigenerational trauma, and access to drugs.’
‘Victoria remembered the first time she tried to crush an abuse-resistant Oxy, folloowing Purdue’s long-awaited reforumlation in 2010, and it worked exactly as Barbary Van Rooyan envisioned it would when she petitioned the FDA, demanding an opioid blocker, or antagonist, be added to the drug: “If you tried to crunch ’em, they’d gel up on you. You couldn’t even snort’em, let alone shoot’em. After that, the pills either went dry or were just too expensive to get. And everybody who used to deal pills starting dealing heroin instead.”
Baltimore has long been a prime staging area for drugs.
Regarding treatment for opioid addicts, MAT (medication assisted treatment) may be the best and it needs to be long term – years and years, with a very gradual weaning and maybe taking a little tiny bit for the rest of their lives.
‘The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid-addicted user eight years–and four to five treatment attempts–to achieve remission for just a single year.’
‘This was Ronnie’s third time in prison. He already knew that one in three black men was destined to end up incarcerated, only to find himself branded as a felon and second-class citizen the moment he got out, blocked from the mainstream economy and propelled into a dystopian loop of jail, joblessness, and back to jail. He knew that drug-involved offenders who represent half the incarcerated population, had a recidivism rate of 75 percent. His own story was a case in point.’
‘Opioids are now on pace to kill as many Americans in a decade as HIV/AIDShas since it began, with leveling-off projections tenuously predicted in a nebulous, far-off future: sometime after 2020. IN past epidemics, as the public perception of risk increased, experimentation declined, and awareness worked its way into the psyche of young people, who came to understand: “Don’t mess with this shit, not even a little bit,” as another public health professor put it. But that message has not yet infiltrated the public conscience.
‘What about the more than 2.6 million Americans who are already addicted? Will the nation simply write them off as expendable “lowlifes,” as Van Zee’s patient still believed?’
‘Ronnie Jones was right again: Shit had not stopped at all, but with continued regional-media cutbacks–the Roanoke Times was down to just a single Roanoke Valley police reporter, and there were now sprawling heroin-ring prosecutions that received zero media attention — the public was left to believe that it had.’
Depressing, scary, ugly world. So, so sad.