Pacific Standard magazine published a piece online yesterday tracing the history of OxyContin, and the rise of opiate addiction in the United States. We've reported here that opiate abuse has killed more than 3,000 people in Michigan alone since 2005. A growing number of those deaths can be attributed to heroin overdoses. Heroin is one kind of opiate. But it's worth remembering how this epidemic started. It started with prescription drug companies chasing profits.
The Pacific Standard piece looks at one company in particular, Purdue Pharma, which was fined more than $600 million by the federal government for misleading doctors about the risks of its profitable pain-killer OxyContin. OxyContin started as a serious pain reliever for people fighting cancer. But Purdue marketed the drug heavily to primary care physicians, even handing out coupons for free pills. Soon, Pacific Standard writes, people across America were using the drug for all kinds of pain, from back aches to tooth aches:
What followed was not all that surprising. Many grew addicted to the opioids, and when the prescriptions ran out, they turned to heroin because of its availability and relatively low cost. The Mexican drug cartels saw this trend and promptly began growing their opium plants, which they consciously made purer and less expensive. And those cartels targeted the suburbs, where those introductory OxyContin prescriptions were being filled—and where the money was.
I reported this summer on the rise of heroin use that's claimed the lives of many young people in Michigan towns like Fraser and Grandville. I also traveled to Gloucester, Massachusetts. The story was the same everywhere: Before getting hooked on heroin, people experimented with prescription opioids such as OxyContin and Vicodin. Pacific Standard reports 4 out of 5 heroin users started that way.
For our radio documentary, The Hidden Epidemic, I spoke to William Morrone, a doctor in the thumb area who treats addiction. He told me it wasn't just the drug companies pushing dangerous prescription opiates. The whole medical establishment was in on it:
He traces the start of the opiate epidemic to a single policy put in place by what was then called the Joint Commission on Hospital Accreditation around 2000. JCAHO pushed hospitals and doctors to start tracking patients’ pain levels as a “fifth vital sign.” You may be aware of when this happened. Doctors and nurses started asking patients to rate their pain on a scale from 1 to 10. The hospitals expected those numbers to go down. Morrone says the problem is doctors didn’t actually get trained on dealing with chronic pain. But they did have access to strong new pain-reliever -Oxycontin and Vicodin. Prescriptions for these drugs shot up like crazy. “We’re talking about a problem where certified medical doctors are actually killing people,” I said to Morrone. His response: “We’re talking about certified medical doctors are maximizing their profits and are not in tune with the ethical and moral standards, ‘At first, do no harm.’”
Michigan is just now coming to grips with how to address the epidemic unleashed more than a decade ago by this shift in pain treatment. Last month, a state task force released recommendations on how to stop the epidemic, and how to help the thousands of people who are already addicted. But addiction treatment isn't cheap. It's still not clear how Michigan and many other states will pay for it.
When I was in Gloucester, Mass. to hear how leaders there are addressing the opiate epidemic, I did hear one idea for how to pay for treatment: Make the prescription companies pay. Gloucester police chief Leonard Campanello told me he and others in Massachusetts have already started making the case:
“We have the anticipation that entities that are involved in this, insurance companies and pharmaceuticals, will step up and clean up the mess they’ve made,” he says. “We’ve made comparisons, pharmaceuticals, to the Exxon Valdez. There was a mess created. And, no one starts with a needle in their hand. We want to bring them to the table, because we think they’re part of the solution. And the solution is, not only clean up the mess you made, but you got to wipe down every penguin that got oil on it, and in this case, every person that started out with a prescribed drug from a doctor, and ended up with a needle in their arm.”
There's really not any dispute about how the opiate epidemic started. The Pacific Standard piece lays out the history fairly well, though you can read a similar story in medical journals and in government reports. The rise of opiate addiction came out of the rise in prescriptions for pain relief. It came out of the rise in marketing for opiate pain relievers such as OxyContin and Vicodin. It came from the medical establishment and from pharmaceutical companies, some of whom made billions. And thousands of people died because of it. More are dying every day.
