Drug buster

A powerful new book details how a pharmaceutical company's billion dollar "wonder drug" became "hillbilly heroin" for thousands of OxyContin abusers.

Published January 22, 2004 9:59PM (EST)

On February 9, 2001 New York Times investigative reporter Barry Meier wrote an article about the prescription drug OxyContin headlined, "Cancer Painkillers Pose New Abuse Threat." While local papers had reported on the drug's abuse in their communities, Meier's piece was a watershed moment in the story of OxyContin. Over the next 13 months Meier -- who previously covered tobacco industry litigation for the Times -- wrote more than a dozen stories about the government regulation, and patient use and abuse of the drug.

Introduced in 1996, OxyContin was initially marketed as a less addictive drug than other prescription narcotics because of its breakthrough formulation: a slowed-down time release, that supposedly thwarted those looking for a quick jolt. "At its birth," writes Meier, "OxyContin had been a pharmaceutical industry dream, a 'wonder' that heralded a sea change in the treatment of pain." But abusers discovered that by crushing and snorting the drug, they got a high that came on quicker and was more intense than with previously abused prescription drugs, such as Percocet. Initially popular in rural areas, OxyContin was dubbed "hillbilly heroin" and became one of the most highly abused street medications in history, particularly among teenagers looking for a quick and mellow high, one that could be pulled right out of their parents' medicine chests.

Pain Killer: A 'Wonder' Drug's Trail of Addiction and Death is Meier's page-turning expose of OxyContin and America's pain industry. He details how OxyContin went from the almost exclusive domain of cancer patients to a mass-prescribed miracle weapon in a new war on pain; in turn it became a billion-dollar baby for its makers, Purdue Pharma -- and one of the fastest growing drugs of abuse in recent history.

Pain Killer tells a story that goes back decades and spins itself around the globe from young abusers in rural Virginia to the opium poppy growing industry on the island of Tasmania. Meier grounds a complex topic in colorful characters that provide his book with a true narrative. There's Dr. Art Van Zee, a small-town physician who witnesses Oxy savage his community. There's Lindsay Myers, a well-heeled cheerleading teenager who's handed a pill in a friend's car one day and is soon munching the drug like Junior Mints at a matinee. There's Purdue Pharma, a relatively unknown drug company that marketed the drug to doctors with unprecedented aggression. There's the FDA, an agency whose staggering screw-up led to a mislabeling of the drug as less easily abused than other prescription narcotics because of its slow release mechanism. And there are the well-meaning doctors who took the FDA's approval and ran with it.

Salon recently sat down with Meier at a Manhattan cafi to talk about the history of OxyContin, new allegations against the drug's maker Purdue Pharma, and a certain larger than life talk show host who was addicted to Oxy.

You describe the OxyContin epidemic as the "perfect medical storm." What's the Cliff's Notes version of that storm?

Essentially, it's a classic story of what happens when doctors' good intentions and the drug industry's quest for profit force medical practice to run far ahead of scientific fact or reality. The result is often a catastrophe. And that's what happened here.

Why is it that OxyContin abuse hit the teen community hardest?

The old saw within the tobacco industry was that if kids weren't hooked on cigarettes by the time they were 18, you've lost them. Prescription drugs were never marketed to kids, but they are still getting to them. Every generation of kids experiments, but today's teens are messing with a class of drugs that have far greater consequences and potential to addict than when I was a teenager.

The general consensus among addiction specialists is that people who become addicted during their teenage years face a lifetime of risk of continued addiction. At a meeting in early 2000, a New York state drug regulator named John Eadie reported that he was seeing data revealing skyrocketing rates of young people experimenting with prescription narcotics. Eadie said, "Look, we're facing the possibility that we are going to create a new generation of lifelong legal narcotics users and it's unfolding right before us -- and we need urgent action to avoid a calamity." But his warning went unheeded.

Unheeded by whom, exactly?

By everybody. His colleagues. The pharmaceutical companies. The government. You name it.

Why did OxyContin abuse spread so rapidly compared with that of other narcotics like Percocet?

Because of its purity. All the previous painkillers were a combination of oxycodone, and either aspirin or acetaminophen. OxyContin is pure oxycodone, so you can take one Oxy and it's like getting heroin that's been stomped on. It's a huge bang for your buck.

Clearly OxyContin has been a boon for many people -- cancer patients and others with long-term pain -- most of who dont ever abuse it.

You see a pattern with painkillers like OxyContin, antidepressants, and other drugs. And that pattern is that drugs that do have value in a specific setting see their use broadened without any scientific basis to justify that taking place. Two recent examples include the broadening use of Ritalin and antidepressants in children. How and why a drug's use expands is a fascinating story. It tells us a lot about the ways that doctors operate, drug companies operate, and what are society's anxieties, demands, and expectations. Treatments become popular without scientific evidence to back their popularity. Why? Because it's in someone's vested interest to make it that way. And it's not simply the vested interest of the drug company at times, it may be the vested interest of the insurance company who doesn't want to pay for what may be a better but more expensive treatment.

What was the tipping point in the Oxy epidemic?

OxyContin is a Schedule II narcotic. That is supposed to be the most tightly controlled, tightly regulated drug you can prescribe. By industry agreement, narcotics manufacturers have agreed not to advertise directly to consumers; rather, they advertise to the medical profession -- to people who are going to write the prescriptions The most significant thing they did was took the most powerful narcotic that was available to a doctor, a drug only previously marketed to cancer specialists and pain specialists -- doctors who really knew how to use and control the use of these drugs -- and marketed it to the average doc on the corner, into the breadbasket of general medicine. Once this drug was in a huge number of doctors' offices if was an easy jump out of those offices and onto the streets and into the hands of teenagers. Feigning pain is simple, and lots of well-meaning doctors got conned.

How did OxyContin move from a medication that doctors prescribed only to the most severely in pain to such a common treatment?

With the exception of a few doctors who are running pill mills, the doctors who are prescribing this drug wanted to help their patients. But now here comes a marketing campaign [from the drug's makers] that says all the stuff you've heard about the dangers of narcotics is a myth; and not only are some of the myths you've heard not true, but this drug is safer than any narcotic you can use because it's a new time-released drug, and the government has allowed us to make this claim that time-released drugs are less prone to abuse than so-called traditional immediate-release drugs. And doctors are also being told you've been ignoring this epidemic of untreated pain. And here's the magical answer -- a drug that is safer to use than every other competing drug on the market. It's a very tempting combination.

One reviewer of your book described Purdue as a "well-intentioned drug company." Do you agree with that?

The measure of any drug company is not how they react when things are going well, but how they react when there's evidence that there's a problem. How quickly do they step up to the plate? The book is fairly clear that, at least from my perspective, Purdue falls dramatically short on that account. Purdue had taken some earlier steps, but I believe that it was only when the spotlight of publicity was on them that they took bigger actions: sending letters to doctors across the country alerting them to the growing abuse of the drug; voluntarily dropping the claim that the drug was less prone to abuse.

It seems inconceivable that Purdue couldn't have anticipated the potential for abuse.

I'd look at the situation with the cigarette companies before them. It took the public a long time and lots of litigation to understand what really happened inside these companies. It's classic in the annals of corporate behavior -- the cigarette companies, asbestos companies, etcetera. At this point in time we don't know anywhere close to the full story as to what happened inside Purdue. This company has hired the best PR teams and legal defense team available, the same companies that defended the cigarette companies. But interestingly, just a few weeks ago a federal judge in New York ruled that Purdue had effectively lied to the government to extend its patent [by claiming that patients didn't need as much of the drug to get an adequate pain-killing effect] and keep generics out of the market. So this house of cards is starting to crumble a little bit. Time has its way of yielding the truth.

Despite the controversy, Pharma is still raking it in.

This is a company that rode this drug like a rocket ship; OxyContin accounts for somewhere between 70-80 percent of its income -- and brings in about 1.5 billion dollars a year. If they lose the patent protection, they go back to being some little backwater drug company without a blockbuster drug, without hope of achieving this dream as enunciated by their president of 'breaking into the top ten pharmaceutical companies in the world sometime in the next decade.' So they're going to do whatever they can to squeeze as much life and profit out of this drug. Many other companies would do exactly the same thing.

You were one of the first people to write about Oxy abuse. Overall, how did the media handle the story?

The media by and large did very well. Local papers in Virginia, Maine, and places like that were reporting on this story very aggressively in 2000 and I'm proud of what the Times did on the story. It was after our first major story appeared in 2001 that the FDA contacted the company and began inquiring about the problem; And the DEA also stepped up its efforts to police the abuse and proper prescribing of the drug. We certainly wanted this drug to keep getting to the people who legitimately needed it, but without this attention, what do you think would have happened? You think this company would have voluntarily taken this label off? Would the FDA have done anything? They would have done nothing. They approved this label on the basis of zero scientific information -- it's a scandal. As this story plays out more and more, there are probably still going to be more shocks that come down the line.

Art Van Zee, a small-time doctor in rural Virginia, is sort of your Erin Brockovich figure, one of the first physicians to report the problem. But ultimately, he's still frustrated by Purdue's and the government's lack of responsiveness.

Art was swimming against the tide. He took a draconian position: that the drug should be taken off the market. That's understandable given the chaos he was seeing all around him -- teenagers and young people in his town were having their lives destroyed by abuse of this drug. And he had very few allies. The medical profession wasn't his ally. The pharmaceutical industry certainly wasn't his ally. The FDA was not going to be his ally. The real question is why there are so few doctors like Art Van Zee? Why weren't there other doctors in these affected areas who were also out beating the drum? Art represents the best of what you want your community doctor to be.

Sadly, he's kind of a relic.

We live in a time where doctors aren't engaged in their communities. The house call doesn't exist, except in impoverished places. The reason why there weren't more Art Van Zees [raising the issue of OxyContin abuse] is because there weren't that many doctors who feel a responsibility to the public health of the place they live. But Art Van Zee was seeing a lifetime of work being destroyed right in front of him.

The drug had a huge burst of publicity when Rush Limbaugh publicly admitted he was addicted to OxyContin and checked himself into rehab. How does the celebrity factor change the story?

The celebrity addiction thing is kind of like a soap bubble that blows up quickly and doesn't leave much of a trace -- they come, they go, they come, they go, and there's no real change that results from it. Rush Limbaugh could be different, depending on what he chooses to do. In the past he's been outspoken about having people sent to jail for illegally using drugs. I don't see any purpose in having people sent to jail for what is seen by at least a good portion of the medical community to be a medical problem, the problem of addiction.

Thousands of more people die of Advil-related problems per year than OxyContin. Why not go after the Ibuprofen industry?

You don't have 18-year-olds dying of Advil overdoses. I'm not discounting that Advil or Tylenol is involved in deaths. Anyone can walk into a drugstore and buy Advil and self-medicate with it; OxyContin is doctor prescribed. You're talking about two very different types of problems. To try to draw an analogy between them as Purdue has done and narcotics advocates have done is misleading and does not do justice to either problem.

What about the argument that there's going to be a certain amount of abuse with any new drug?

A lot of people have the view that there's acceptable collateral damage -- and it's a very unfortunate view. We know that substance abuse exists in 8 to 12 percent in society. So somewhere around 10 percent of the people walking into a doctor's office for treatment may turn around and abuse the drug they're being given: that's a frightening situation.

A lot of the people abusing these drugs are kids -- they enter the world of addiction through youthful experimentation. I'd hardly define them as criminals. If we see these kids as acceptable collateral damage of treating medical conditions then we're in a problematic situation as a society because there are many drugs like OxyContin coming down the pipeline. If we don't set up safeguards to prevent them from spilling over into the hands of people who abuse them or even just youthfully experiment with them, it's going to be a tragic situation.

And the solution is...?

The psychological landscape has to change. Everytime we've had a problem with prescription narcotics -- either in not giving them to people who needed them or giving too many of them out and having them wind up in the hands of people who shouldn't have them -- the issue has been seen in black and white. Yet these drugs have good stuff about them, and real bad stuff about them as well. The medical profession can't have the attitude that there will always be people who are going to misuse them.

By Larry Smith

Larry Smith has written about his and other people's lives for ESPN magazine, the New York Times, Teen People, and other publications.

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