Dopesick: Dealers, Doctors, and the Drug Company that Addicted America

by Beth Macy

During the first decade of the drug’s existence, the legal system could not prove the makers of OxyContin had broken the law.

Their clients ranged from miners and masonry workers who became addicted following work-related injuries to a factory worker so desperate to stop taking OxyContin that he’d flushed his pills down the toilet, telling his lawyer that trying to explain dopesickness to a nonaddict was “like describing an elephant to a blind man.”

As the Virginia writer John C. Tucker described it in May God Have Mercy: “For a miner who avoids being crippled, burned or buried alive, the usual question is which will give out first—his lungs, his back, or his knees.”

McCauley bought the black-market OxyContin, he told an opposing lawyer from Purdue in a series of depositions, for the same reason a century’s worth of heroin addicts had kept returning to their dealers for more dope: to stave off dopesickness.

It didn’t matter that he’d been treated with lower-strength opioids after losing two fingers to a 1980 coal-mining accident but did not develop a $300-a-day drug habit until 1999, shortly after his first bottle of OxyContin.

Stallard, the Big Stone Gap drug detective, remembered an informant unpacking the life of a Norton patient: “He told us, ‘Dr. Norton wrote prescriptions for Lortab, forty-milligram OxyContins, and eighty-milligram Oxys all in the same visit.’” When Stallard subpoenaed the physician’s records, he saw Norton had prescribed thousands of OxyContin pills in just thirty days.

When McCauley, seventy-five, died four years after his case was tried, police found him in his lime-hauling truck at 4 a.m. in the middle of a pasture—he’d crashed through a fence. Several near-empty bottles of pills, prescribed just two days earlier, were strewn on the seat next to him. A state trooper told McCauley’s daughter and wife that he died of a heart attack, but his daughter believes he was murdered over a bad drug deal. His head was blown apart, she said, as if from a gun.

Jay McCloskey, the U.S. attorney in Maine, had challenged the company’s promotional techniques early on, with some success. He had pushed the company to drop the doctor junkets and the 160-milligram version of its pill, only to leave his post in 2001 to work as a consultant for—wait for it—Purdue Pharma.

Rather than risk more serious charges or a jury trial in western Virginia, where the drug’s problems were by now legend, the company accepted the plea agreement later that night. But Purdue wasn’t quite finished negotiating. Eight days after it accepted the deal, Brownlee was stunned to see his name on a firing list, along with four other U.S. attorneys. Though he wasn’t ultimately fired, the incident provided fresh criticism of then–attorney general Alberto Gonzales, accused of trying to sway the work of U.S. attorneys’ offices.

By the time the negotiations were complete, a Purdue-owned holding company, Purdue Frederick, would plead guilty to a single misbranding felony and the company’s executives to misdemeanor charges of misbranding the drug. In a bit of legal-language parsing, the executives would not stipulate that they’d had direct knowledge of the misbranding, only that “the court may accept these facts in support of their guilty pleas.” In other words, their only crime was that they headed up a firm wherein other people committed crimes.

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. Top executives Paul Goldenheim, Michael Friedman, and Udell would pony up $34.5 million (or, rather, the firm would, on their behalf) and plead guilty to misdemeanor versions of the crime.

The executives would not serve any jail time, per the plea agreement, though it was ultimately up to the judge, at their court appearance, to sign off on the deal and outline the exact terms of their probation and community service.

For added visual effect, Brownlee displayed falsified charts created by Purdue that had claimed “smooth and sustained blood levels” and “fewer peaks and valleys” for patients on OxyContin. The ginned-up graphs were meant to buttress the drugmaker’s claim that OxyContin had less potential for abuse. An adjacent easel featured actual clinical data that the prosecutors had culled from Purdue’s own studies. The real data looked like a map of steep mountains, the faked data like a single gentle slope.

He had even written a poem about one, titled “OxyContin,” published in Annals of Internal Medicine: It might have been easier If OxyContin swallowed the mountains, and took The promises of tens of thousands of young lives Slowly, like ever-encroaching kudzu. Instead, It engulfed us, Gently as napalm Would a school-yard. Mama said As hard as it was to bury Papa after the top fell in the mine up Caney Creek, it was harder yet to find Sis that morning cold and blue, with a needle stuck up her arm. Top of her class, with nothing but promise ahead until hi-jacked by the torment of needle and spoon.

Van Zee

Lawyers for the executives argued that the shame of criminal charges was punishment enough. They reiterated, over and over, that the men—the top corporate executives who had directed the company’s legal, financial, and pharmaceutical divisions—had personally done nothing wrong.

The problem was so widespread that Super Bowl ads now targeted relievers of opioid-caused constipation. “Purdue had a laxative they marketed, too,” Ramseyer said, of Senokot. In fact, according to the rep-call notes subpoenaed for the case, OxyContin and Senokot were routinely recommended hand in hand. “So they got you on both ends!” Ramseyer said.

What in fact was the addiction rate among those prescribed opioids for chronic nonmalignant pain? More recent studies—not letters to the editor penned in 1980—put the figure as high as 56 percent.

“But you can’t put a corporation in jail; you just take their money, and it’s not really their money anyway. “The corporation feels no pain.”

Though the executives were placed on probation for three years and ordered to perform four hundred hours of community service in a drug abuse or drug treatment program, Van Zee and Sister Beth were furious that the Purdue fine would not be allocated to provide drug treatment in the medically underserved region. “This little county was left with nothing, even though we’ve been disproportionately impacted” by the drug, Sister Beth said.

The $634.5 million fine was instead divided among law enforcement, state, and federal Medicaid programs (to reimburse it for claims resulting from the misbranding); to create Virginia’s Prescription Monitoring Program; and to settle $130 million in civil claims.

Many anti-opioid activists were mad, too, that technically it was Purdue Frederick, Purdue Pharma’s holding company, that was banned from participating in the federal insurance programs Medicaid, Medicare, and Tricare as part of its five-year probation—rather than Purdue Pharma itself, which was still permitted to participate, and therefore to continue selling OxyContin.

“It’s very typical for these companies to have an entity that is a shell company, basically, set up to plead guilty to the crime, rather than the actual corporate entity taking the fall,” Meier said.

Asked nearly a decade later about the aftermath of the Purdue Pharma settlement on the communities his court covers, Judge Jones told me: “Opioid addiction continues to be, frankly, a terrible concern.…It’s rare that I don’t have a case today involving substance abuse.”

If the Sacklers’ lieutenants had legitimately not known about the flood of pills unleashed by sales reps toting around bad data and free shrubbery twenty-five rungs down the corporate ladder from them, maybe it was because they had not cared to look.

Friends of overdosing users commonly chuck them into the bathtub and try to revive them with ice or cold water, to avoid having to call 911, which could draw police to the scene, along with criminal charges. One police officer I know showed up to an overdose call to find an unconscious man on the floor, a frozen fish on his neck, a frozen bottle of soda shoved into his pants, ice all over the floor—and the user’s friends long gone from the scene.

Who needs enemies when you have friends that let you overdose?

“The opioid epidemic is an urban story, a suburban story, and a rural story,” said Dr. Jennifer Wells, a Roanoke addiction specialist who has patients from each of these demographics, including one mom with five kids in a countryside trailer and no running water who somehow manages to make it to her group therapy meetings every week.

America!

“Roanoke is just big enough where all the stories meet.”

Before the weathermen incident, heroin had been the domain of police and court reporters in Roanoke, widely believed to be an inner-city (read: black) drug. “In the ’80s and ’90s, maybe a few dozen people were doing heroin here,” said Don Wolthuis, the assistant U.S. attorney who became one of the federal government’s top heroin prosecutors in the state’s western half.

It was common knowledge back then, among the handful of mostly African-American heroin users and dealers in Roanoke, “that you don’t sell heroin to white people because they’ll turn you in,” as Wolthuis put it.

“Herr-on is my girlfriend,” one of his patients told him, adopting the street pronunciation for the drug popular among African-American users. He’d come to Bickel’s lab with track marks on his neck—all his other veins were spent.

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. Not love. Not family. Not sex. Not shelter. The only relationship that matters is between you and the drug.

Drugs dont discriminate

Bickel went on to scientifically quantify the indifference of the typical opioid user, comparing the average nonaddicted person’s perception of the future—calculated to be 4.7 years—against an addicted user’s idea of the future, which is just nine days.

the legal and medical structures meant to combat America’s heroin epidemic were woefully disconnected, often at odds with one another, and full of unintended consequences.

By the time Lee was sentenced to eleven years in prison, in 2008, prosecutors had pinned him with bringing a thousand bags of heroin into the region two to three times a week, paying $5,000 for twenty bricks of heroin that his network then sold for $30,000.

Should have give him more

Unlike Ronnie Jones and Clifton Lee, they didn’t aspire to get rich dealing dope. They just wanted to keep from getting dopesick.

Hellish

No one was paying attention to heroin arrests when they only concerned the children of inner-city black families. A 2009 Roanoke Times story suggesting that heroin was now closing in on the illicit use of OxyContin and prescribed fentanyl patches in popularity seemed to draw shrugs, even as one prosecutor publicly warned, “They’re skipping over pot and going straight to heroin.”

Jesse Bolstridge was now in high school and trading his ADHD medication Adderall to classmates who liked the way it allowed them to drink all night without passing out. In exchange, they plied him with painkillers, either bought on the black market or pilfered from their parents’ or grandparents’ medicine cabinets.

No one wants to believe that heroin will ever touch the veins of their children.

His mother believes her son died by suicide, driven by his outsized fear of becoming dopesick. “I wonder, to this day, whether he just couldn’t do it anymore,” she told me.

He shared tips that, in my view, remain among the best prevention advice I’ve seen dispensed to parents of at-risk teens: Rid your medicine cabinets of anything that has codone, indicative of morphine components, in the name. Set rules and hold kids accountable when they break them, even if it means they go to jail. “The problem with me was, the trouble had to outweigh the fun,” he said. Though his mother, Ginger Mumpower, had sent him to fifteen different rehab facilities, for eight years Spencer managed to use and sell drugs before his name ever entered a police blotter.

As his counselor Vinnie Dabney remembered it, “Fifteen rehabs had not convinced Spencer that it was not in his best interests to get high. It took time in jail and a friend dying before he could decide he wanted to change.”

He was happy to school me on drug culture—how he’d once saved his lunch money to buy weed and cocaine, the way he extracted the gel out of a fentanyl pain patch and smoked it, where the best places were to find drug dealers (loitering outside Narcotics Anonymous meetings). Driving by a diabetes-supply pharmacy, he recalled once buying OxyContin off a pharmacy delivery driver. The driver was eventually arrested. “But somehow he had another six hundred or seven hundred pills the next day. That’s a shitload of dope.” he said.

“It’s hard to explain, but some people can manage it. Like if I knew that none was gonna be in till Friday, and it’s Tuesday, and I normally do ten bags a day but I only have thirty left, I would do the math and make sure I had enough to last till Sunday…because you’ll do anything to make sure you’re not dopesick.”

All told, Spencer had already lost twelve friends from Hidden Valley to drug-involved deaths, and every dealer he knew was either dead now or in jail. And he would soon lose several more.

Being fit brought Spencer a feeling of confidence as he left for prison, where he hoped to finish his bachelor’s degree. After his release, he planned to dedicate himself to helping young people with addiction, in memory of Scott Roth.

A sixty-three-year-old nurse was struggling to take care of her infant grandson because her twenty-five-year-old heroin-addicted daughter could not.

As the economists described it, Chinese peasants would better their lot by making chairs in factories, while dislocated American workers would retrain for more fulfilling, advanced jobs. But with ill-designed training for displaced Americans based on a lumbering federal program created in the 1960s, the second part of that equation very rarely came to pass.

Consumers all got cheaper jeans, yes, but what did that matter to the people who had once stitched them if they were now out of work and couldn’t afford new clothes?

The global economy created winners and losers, Bassett Furniture CEO Rob Spilman told me, explaining the dismissal of some eight thousand furniture workers from his payroll. “It was that or perish,” he said. “At the end of the day, we are not a social experiment.”

In rural counties decimated by globalization, automation, and the decline of coal, the invisible hand manifested in soaring crime, food insecurity, and disability claims. In Martinsville and surrounding Henry County, unemployment rates rose to above 20 percent, food st...