American Overdose: The Opioid Tragedy in Three Acts

by Chris McGreal

Ballantyne concluded that OxyContin supercharged what was already widespread dependence on lower levels of hydrocodone and oxycodone by drawing a new group of people into the “at risk” category. The drug was so powerful that it widened the circle of those vulnerable to addiction to suck in users of Percocet and Vicodin who had not allowed those drugs to take over their lives and who were not immediately at risk of overdose. OxyContin had found a fertile bed to burrow into. “Giving long-acting opiates captured a whole population that wouldn’t have got into trouble with opiates if they hadn’t been prescribed and become dependent on a drug it would never have occurred to them to take,” she said.

The danger was compounded by OxyContin’s failure to live up to its promise of holding pain at bay for twelve hours. For some patients it wore off after eight hours. That caused them to take three pills a day instead of two, greatly increasing their overall dose of narcotic and with it the risk of addiction.

Years of surgery have given Lucas a healthy respect for pain as a tool for recovery. To suppress it was dangerous. But as large doses of opioids became the norm, the surgeon noted an increasing number of incidents of patients struggling to breathe after routine operations and being moved to intensive care. “Narcotic depresses the respiratory center. You don’t breathe well.

Before the commission’s dictum, 0.7 percent of trauma center patients died from “excess administration of pain medicines.” The death toll rose fivefold to 3.6 percent after the commission’s policies kicked in.

The two doctors made no secret of who they blamed for “this preventable cause of death and disability”: the Joint Commission. “It’s about money. Money has influence, and it influenced the Joint Commission,” said Lucas.

The three doctors did not deny that pain was inadequately treated, but their wide experience told them that opioids were not the answer. Van Zee saw the devastation of addiction from overprescribing; Ballantyne recognized the harm caused by ever-escalating doses, Lucas witnessed the dangers of pain management in hospitals. They were not alone. Studies emerged from the United States and Europe backing their conclusions.

“Nearly half a ton of narcotics reached six small mountain counties from 1998 to 2001—the equivalent of three quarters of a pound for every adult who lives there,” the paper reported. That worked out at around two hundred opioid pills per person. “All the drugs were legal, but they didn’t stay that way.”

Opioids proved as hard a blow to mountain communities across eastern Kentucky as the collapse of mining and rise of unemployment, fracturing a society already struggling for survival.

Rogers is a conservative Republican. He voted against gun control and for repeal of Obamacare. He has consistently backed measures to curtail abortion rights and supported a constitutional ban on same-sex marriage. On the whole, Rogers is a friend of big corporations, but for him Purdue Pharma was beyond the pale.

Wolf told the hearing that the FDA’s decisions that day would decide how many more people died and how many families were destroyed. The FDA continued to allow OxyContin to be widely prescribed for moderate pain. “We were ignored,” Congressman Rogers told me. “They just listened to us, smiled, waved good-bye.”

For all that, Rogers thought there was something deeper at work, what he called “a societal thing.” “A lot of that has to do with lack of hope. Despair,” he said.

The War on Poverty did not create jobs, and the region could not unhitch itself from its dependence on coal.

Forty percent of children are not living with parents because of drugs.

Twenty years after the gap started to open up, a white American whose education stopped at high school was six times more likely to die of drugs, alcohol, or suicide than a person who made it through college.

The pills destroyed families and communities on a scale that alcohol and suicide never did. “It’s easy to put a template over it and say these people are full of despair. ‘What is their hope? Who are they?’ But it was a business decision to introduce these drugs to this community. It was somebody figuring out how to have a good quarter and a better year. They made some choices. They decided which people are valuable and which ones are expendable.”

Former officials say a culture developed inside the agency of avoiding conflict with an industry only too ready to let loose the lobbyists on Capitol Hill.