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

by Beth Macy

Up the Shenandoah Valley on the interstate, I pass New Market and think not of the men who fought in the famous 1864 Civil War battle but of the women who grew poppies for the benefit of wounded soldiers, harvesting morphine from the dried juice inside the seed pods.

Three decades later, the German elixir peddlers at Bayer Laboratories would stock America’s drugstores with a brand-new version of that same molecule, a pill marketed as both a cough remedy and a cure for the nation’s soaring morphine epidemic, known as “morphinism,” or soldier’s disease.

Most pain pills lasted only four hours, but OxyContin was supposed to provide steady relief three times as long, giving people in serious pain the miracle of uninterrupted sleep. In an early concession to the potential for its abuse, the makers of OxyContin claimed the slow-release delivery mechanism would frustrate drug abusers chasing a euphoric rush.

Ever since Neolithic humans figured out that the juice nestled inside the head of a poppy could be dried, dehydrated, and smoked for the purposes of getting high or getting well, depending on your point of view, opium had inspired all manner of commerce and conflict.

Friedrich Sertürner had isolated the active ingredient inside the poppy, an alkaloid he named morphium after the Greek god of dreams, Morpheus.

“I consider it my duty to attract attention to the terrible effects of this new substance in order that calamity may be averted,” Sertürner wrote, prophetically, in 1810.

Dr. Alexander Wood, the Scottish inventor of the hypodermic needle, hailed his 1853 creation by swearing that, whereas smoking or swallowing morphine caused addiction, shooting it up would not. No one mentioned Sertürner’s warning decades before.

So when doctors departed from the homes of the injured Civil War veterans they were treating, it became standard practice to leave behind both morphine and hypodermi...

An estimated hundred thousand veterans became addicted, many identifiable not by shirt smudges of orange and green but by the leather bags they carried, containing needles and morphi...

“Since the close of the war, men once wealthy, but impoverished by the rebellion, have taken to eating and drinking opium to drown their sorrows,” lamented an opium dealer in New York.

If they could pitch heroin as a new and nonaddictive substitute for morphine, Dreser and Bayer would both strike it rich. Presenting the drug to the German medical academy the following year, Dreser praised heroin’s sedative and respiration-depressing effects in treating asthma, bronchitis, and tuberculosis. It was a safe family drug, he explained, suitable for baby colic, colds, influenza, joint pain, and other ailments. It not only helped clear a cough, it also seemed to strengthen respiration—and it was a sure cure, Bayer claimed, for alcoholism and morphine abuse.

“I have treated many patients for weeks with heroin, without one observation that it may lead to dependency.” Free samples were mailed to American and European physicians by the thousands, along with testimonials that “addiction can scarce be possible.”

“Many cases of the morphine habit could have been avoided had the family physician not given the drug in the first place,” he said. By 1900, more than 250,000 Americans were addicted to opium-derived painkillers.

called “vicious,” meaning their use rose from the world of vice). Soldier’s disease, in the words of New York City’s commissioner of health, had now become “the American Disease.”

The Harrison Narcotics Act of 1914 severely restricted the sale and possession of heroin and other narcotic drugs, and by 1924 the manufacture of heroin was outlawed, twenty-six years after Bayer’s pill came to market.

The addicted were now termed “junkies,” inner-city users who supported their habit by collecting and selling scrap metal. The “respectable” upper- and middle-class opium and morphine addicts having died out, the remaining addicted were reclassified as criminals, not patients.

The 1996 introduction of OxyContin coincided with the moment in medical history when doctors, hospitals, and accreditation boards were adopting the notion of pain as “the fifth vital sign,” developing new standards for pain assessment and treatment that gave pain equal status with blood pressure, heart rate, respiratory rate, and temperature.

Little did Davis or the other ER docs understand that the routine practice of sending patients home with a two-week supply of oxycodone or hydrocodone would culminate by the year 2017 in a financial toll of $1 trillion as measured in lost productivity and increased health care, social services, education, and law enforcement costs.

The reps tended to be outgoing, on the youngish side of middle-aged, and very good-looking. “They were bubbly, they’d flirt a little bit, and it really would make you feel special. And yet intertwined in all those feelings is the name of a drug, which the rep is repeating over and over while you’re eating this delicious, savory meal. And even if you say you’re not swayed by such things, there is no doubt in my mind that you’re more than likely to prescribe it,” Huff added.

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.

Art Van Zee saw it unfolding, and he was terrified. Within two years of the drug’s release, 24 percent of Lee High School juniors reported trying OxyContin, and so had 9 percent of the county’s seventh-graders.

outlining a hard truth that many Americans still fail to grasp: Opioid addiction is a lifelong and typically relapse-filled disease.

Forty to 60 percent of addicted opioid users can achieve remission with medication-assisted treatment, according to 2017 statistics, but sustained remission can take as long as ten or more years. Meanwhile, about 4 percent of the opioid-addicted die annually of overdose.

The movement of OxyContin from the economically straitened hinterlands to the largely more affluent cities and suburbs in the early aughts reminded historian David Courtwright of the iatrogenic wave of opium and morphine addiction that stormed the nation exactly a century before.

When 20 percent of American soldiers came back from Vietnam with symptoms of heroin dependence, researchers were initially puzzled by the fact that most didn’t go on to become heroin addicts—possibly, some theorized, because they returned to spread-out social networks in rural areas and small towns where heroin didn’t exist.

It would not come to light for nine more years that FDA regulators and Big Pharma executives had been quietly holding private meetings at expensive hotels at least annually since 2002, through a drug-industry-funded nonprofit, an ethical quandary a Milwaukee Journal Sentinel reporter shone the light on in 2013.

After all, not only was Giuliani old pals with the DEA director, but he also had just been named Time magazine’s Person of the Year 2001.

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.”

An assistant prosecutor in the case recalled that Giuliani put on a folksy front but was not intimately involved in the negotiation’s details, possibly because he was pursuing what would prove to be a failed bid for the Republican presidential nomination.

In 2005, Purdue lawyers called then–deputy attorney general James Comey to question Brownlee’s investigatory tactics, and Comey called Brownlee with concerns. The young attorney responded by personally driving to Washington to lay out his strategies. “Brownlee, you are fine.

The Sacklers understood that a federal jury convened in southwest Virginia, a region that had now seen as many as two hundred OxyContin-related deaths, could have awarded far harsher penalties.

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.

Arthur pioneered the idea of showering doctors with favors and funding experts to back drugmakers’ claims in the 1960s. It was his marketing genius that fueled the emergence of pills as a quick fix, his marketing prowess that delivered Valium and Librium, dubbed Mother’s Little Helper by the Rolling Stones, to countless nightstands.

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.”

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.

When I asked him those questions, he pointed to a framed Chinese proverb that he takes inspiration from: “It is better to light one candle than to curse the darkness.”

“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.

Well over half of Lee County’s working-age men—a staggering 57.26 percent—didn’t work. (The trend line was somewhat better among women, around 44 percent.)

If OxyContin was the new moonshine in rural America, disability was the new factory work.

Having dropped out of the workforce entirely, they had numerically vanished from the kind of monthly jobs reports touted by politicians and reporters.

Disability claims nearly doubled from 1996 to 2015. The federal government spent an estimated $192 billion on disability payments in 2017 alone,

had no idea how politically and economically splintered our nation had become. And also how much poorer and sicker and work-starved the already struggling parts of the nation truly were—because we didn’t follow that story.

We were safe in our ignorance, or so we thought—content to stereotype drug addiction as the affliction of jobless hillbillies, a small group of inner-city blacks, and a few misguided suburban kids.

I didn’t understand the connection between rural poverty, disability, and opioid addiction until I learned more about the accidental Bassett Furniture arsonist.

So it went that young people barely flinched at the thought of taking Adderall to get them going in the morning, an opioid painkiller for a sports injury in the afternoon, and a Xanax to help them sleep at night, many of the pills doctor-prescribed.

“In the short term, kids and parents and even teachers may feel better” about Adderall’s ability to enhance memory and attention, Lembke said. “But studies show that over the long term those kids don’t do any better in school than people who don’t receive stimulants.”

“We’re out there once a week at least—fights, drug-related stuff, overdoses in the company parking lot,” the sergeant said. “You ask them if they drug-test, and they say they do, but I doubt they watch ’em, so they can still bring in [clean] urine. As long as they got people coming and going to work, they don’t care.”

They seemed to be somewhat shielded because their economies, while not exactly robust, had maintained a centuries-old agricultural base and were never dominated by a single industry or two like so many smaller Appalachian counties where pill abuse first took root.