OxyContin continues to devastate Appalachia

Back road beauty of Kentucky belies the tragedy of drug addiction.

WYTHE COUNTY, Va., March 11, 2014 — Prescription drug abuse, specifically opioids, such as OxyContin derived from natural or synthetic forms of opium or morphine, is so prevalent in Appalachia that a new word has been created just to describe these addicts: pillbillies.

A pillbilly is a person addicted to and obsessed with the acquisition and use of opioids, medicines normally prescribed for pain, but widely abused in the Appalachian region. West Virginia and Kentucky are consistently in the top ten for the number of fatal drug overdoses involving painkillers.

But this is by no means an epidemic confined to Appalachia. In 2010 alone, 254 million prescriptions for these drugs were filled in the United States, enough for every adult in America to stay medicated around the clock for a month.

These drugs include codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), morphine, hydromorphone (e.g. Demerol and Dilaudid), propoxyphene (e.g. Darvon and Darvocet) and methadone (e.g. Dolophine and methadose). The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices was four times larger in 2010 than in 1999.

Prescription Drug Overdoses Kill More People Than Car Accidents

The Center for Disease Control and Prevention just released a report stating prescription drugs are now responsible for more overdose related deaths than heroin and cocaine combined. If that is not alarming enough, for the first time in 100 years, overdoses from pharmaceuticals now outrank car accidents as the number one cause of accidental deaths in this country.

All these drugs have potentially lethal consequences, but none have had the devastating effect of OxyContin. When first aggressively marketed by Purdue Pharma as a strong, but non-addictive relief for chronic pain, OxyContin was received as a miracle drug and widely prescribed throughout the Appalachian region.

Now, as the overdose death rates soar and the pill mills, unethical doctors, and pharmaceutical companies rake in record profits, one has to question just how long it will take for the government to wake up and do something about it.

Perhaps the recent arrest of the brother of the current governor of West Virginia for the illegal distribution of oxymorphone will prompt a long overdue increase in the oversight of opiods. But the only likely result will be the broadening realization that no class of people is immune to the abuse of this powerful group of drugs.

The History of OxyContin

To understand the unprecedented abuse of a single pharmaceutical drug, you must delve deeper into the history of the manufacturer of OxyContin, a privately owned company called Purdue Pharma.

Purdue Pharma traces its origins back to a company that sold a sherry-based “medicinal tonic” in Greenwich Village in the early 1900s. The three brothers who bought the company in 1952, Mortimer, Arthur, and Raymond Sackler, all started out as psychiatrists at a mental hospital in Queens in the 1940s, where their insights would later be praised as ground breaking in understanding the biology of psychiatric illnesses.

Meanwhile, the eldest brother Arthur joined a small advertising agency that specialized in marketing pharmaceuticals. Arthur was so successful that in 1997 he was one of the first people named to the Medical Advertising Hall of Fame and is credited by this organization with helping shape pharmaceutical marketing as we know it today.

Arthur’s scientific knowledge and marketing expertise was used to expand the uses of Valium, making it the first $100 million drug. Arthur’s marketing approach was to entice doctors with expensive dinners, lucrative speaking fees, and fancy junkets; an approach so effective the entire industry adopted it.

Further demonstrating his brilliance, Arthur’s research told him pain medicine was the growth area. In 1984 Purdue took a drug for cancer pain, morphine sulfate, added a time release formula, and began marketing it as MS Contin, a drug that generated sales exceeding $475 million over the next decade. All Arthur had to do was figure out a way to make it more available to larger numbers.

OxyContin set up

The truly brilliant stroke came not from a breakthrough in science, but one of marketing. The active ingredient in OxyContin was invented in 1914, but it was largely avoided because of its heroin like addiction. Prior to this, it was reserved for severe chronic pain sufferers like cancer patients.

The stroke of genius came in adding a time-release mechanism that facilitated FDA approval to sell OxyContin in late 1995. This allowed it to be marketed as non-addictive since it gradually released the drug over a twelve-hour period, thus avoiding withdrawal and eliminating the euphoric rush addicts seek.

In 1998, a promotional video for OxyContin claimed the addiction rate at less than 1%. With this fear gone, doctors began prescribing it, and sales soared from $45 million in 1996 to nearly $3.1 billion in 2010.

What the video did not tell the doctors was OxyContin is just a few carbon molecules away from being synthetic heroin, and ten minutes after it hit the market clever addicts would figure a way around the time-released additive to get to that heroin like rush. The result was a legal way to get a very lethal buzz.

You will never hear Purdue Pharma admit they targeted primary care doctors, specifically in rural and poor areas, to market their new wonder pain medication. Poor people on Medicaid are prescribed painkillers at twice the rate of non-Medicaid patients, and are at six times the risk of prescription painkillers overdose. One Washington State study found that 45% of people who died from prescription painkiller overdoses were Medicaid enrollees. Your tax dollars at work America.

As addiction rates began to rise, lawyers and prosecutors alike urged more action in addressing the devastating effects of the drug. The charges were so serious that federal prosecutors formally recommended charging Purdue Pharma and its top three executives with multiple felonies, including conspiracy, mail and wire fraud, money laundering, and misbranding.

Misbranding is when a drug company claims one of its drugs can be used to treat an ailment that has not been government approved. It also involves outright lying by stating a drug can do something it cannot do.

Abbot Laboratories was fined $1.6 billion dollars for misbranding, but this is not the largest fine levied for the offense. Pfizer was fined $2.3 billion dollars in 2010, the third-largest fraud settlement ever.

Big Pharma’s Star Defense Team

In response, Purdue Pharma hired an all star defense team that included Mary Jo White, a former U. S. attorney, and Rudolph Giuliani, a former mayor of New York City and presidential candidate.

Eventually the two sides agreed Purdue Pharma would plead guilty to a single felony count of misbranding. In May, 2007 Purdue agreed to pay a $600.5 million dollar fine, and its top three executives were fined $34.5 million, (Purdue paid the fine for them) and they left Purdue as a result.

But the damage has been done, regardless of how Purdue Pharma repackages OxyContin, and regardless of how hefty the fines levied against the company. OxyContin has left a trail of addiction and destruction unparalleled in the field of pharmaceutical medicine: an addiction level just as devastating as heroin, with all the life destroying, soul stealing effects common place with “traditional” heroin addicts.

OxyContin, or as the media refers to it, “hillbilly heroin,” has become the 21st century black lung of Appalachia. History has taught us black lung was a recognized and accepted consequence of bad practices allowed to continue long past obvious ethical boundaries, just like the continued manufacturing, marketing, and distribution of OxyContin is today.

How many people will these drugs destroy before those elected to protect us do their jobs and address the growing danger of opiods?

This article was first published on Saturday, June 9, 2012.

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I was born and educated in Southwest Virginia, traveled with my job all over America in my twenties and early thirties then came back to the mountains to raise my daughter. I’ve been employed as everything from a quality control technician in industrial construction, to a mail processing plant manager, to postmaster of a small town. I’ve been to forty nine of the fifty states, as well as many other countries. Traveling will always be a passion I indulge, and something I’ll call upon often in my writing. I come from a long line of story tellers, and will shamelessly exploit a family tree resplendent with colorful and unique characters, both past and present. In short my perspective will reflect the pride and familiarity I have of my Appalachian heritage. My stories will be a reflection of the values I believe we hold dearest here, all embellished with a healthy dose of Southern Appalachian flare.