China has pain pill addicts too, but no one’s counting them
‘Addicts struggle in shadows of a system’
WBy Erika Kinetz
The Associated Press, supported by a grant from the Pulitzer Center on Crisis Reporting, is investigating the global spread of opioids and its consequences.
Painkillers
– Editor
u Yi was supposed to die. At age 26, his cancer was spreading. His doctor gave him five years to live and a prescription for OxyContin.
Six years later, he was still alive. And still taking OxyContin. Wu said his doctor told him that OxyContin is not addictive, but when Wu tried to stop, he couldn’t.
“This drug is addictive,” Wu said. “One hundred percent addictive.”
A thousand miles (1,600 km) away, in the ancient trading city of Xi’an, Yin Hao shoved eight pills of Tylox, a combination painkiller that contains the opioid oxycodone, in his mouth. Yin had started taking Tylox after getting injured in a fight six years earlier.
“Do you know how ... much I don’t want to take drugs?” he said. “My mouth says don’t take it, but my body is more honest and figures out a way to get it.”
Both Wu and Yin fell into opioid abuse the same way many Americans did, through a doctor’s prescription. But officially, in China, they don’t exist.
Addicts like Wu and Yin struggle in the shadows of a system that offers few treatment options and fails to count them in official statistics on drug abuse, the Associated Press found, making it difficult to assess abuse risks as China’s consumption of opioid painkillers rises. In a society where shame about drug addiction is strong, many believe that strict controls on painkiller use will protect China from a US-style addiction outbreak.
As the backlash against opioid painkillers drove down US consumption, pharmaceutical companies began chasing profits in places like China, Australia and Europe using the same controversial sales tactics they did in North America. In 2017, more than half the doses of five major opioid painkillers went to countries other than the US and Canada, the first time that has happened since at least 2000, data from the International Narcotics Control Board shows.
Chinese officials have blamed outof-control demand and poor oversight for the US opioid epidemic, discounting the role of Chinese supply. Meanwhile, painkiller addicts in China remain largely invisible and, despite strict regulations, can turn to online black markets for opioids and other prescription drugs. The AP found previously unreported trafficking of OxyContin and Tylox on e-commerce and social media platforms run by China’s largest technology companies.
Only 11,132 cases of medical drug abuse were reported in China in 2016, according to the most recent publicly available national drug abuse surveillance report. But reporting is voluntary and drawn from a small sample of institutions including law enforcement agencies, drug rehabilitation centers and some hospitals.
The China Food and Drug Administration said in the 2016 report that it was trying to do better but for the time being “the nature of medical drug abuse in the population cannot be confirmed.”
Hao Wei, president of the Chinese Association of Drug Abuse Prevention and Treatment, said he believes
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abuse of prescription opioids is limited in China, but added that official data largely overlooks prescription drug abuse.
“What is recorded is the tip of the iceberg,” he said.
China’s National Medical Products Administration and the National Narcotics Control Commission did not respond to requests for comment.
Immobilized
Wu was diagnosed with lymphoma in October 2013.
Cancer transformed Wu from a baby-faced boy to a sallow wraith immobilized on a gurney. Doctors cut chemotherapy short after he developed an infection, he said, and his existence narrowed to a single, searing reality: Pain.
For six months, Wu lay in bed. Strange bulges, filled with pink fluid, appeared on his legs. It felt like his bones were swelling until they were ready to burst.
“At that time, I wanted to commit suicide because it was too painful,” he said. “But I wasn’t able to, because my leg joints and shoulder joints didn’t work.”
Wu said a doctor at Sun Yat-sen University Cancer Center in the southern Chinese city of Guangzhou gave men, women and children with medical experts like general medicine, dermatology, cardiology, diabetes, gynecology, orthopedic, oncology, cancer, physiotherapy, ENT and eye care. Apart from that, we provide services like BMI, BP, Blood Sugar, Cholesterol, ECG & Ultra Sound tests were made available. More than 650 beneficiaries participated and had their consultation. The dedication and hard work put in by the JMC Alumni volunteers and social service volunteers
him his first prescription for OxyContin in 2014, telling him he could take as much as he wanted.
As a late-stage cancer patient, Wu was exactly the kind of person OxyContin was meant to help. And the pills brought him relief. But even as the US death toll from opioid overdoses approached 400,000, no one in China warned Wu about addiction risks, he said, not his doctor or the nurses or the drug company sales representative who visited him at his bedside.
The sales rep told AP she worked for Mundipharma, a Chinese company that is owned by the Sackler family, which also owns Purdue Pharma, the American company whose sales of OxyContin allegedly helped drive the US opioid crisis. She told AP she has left Mundipharma but confirmed she used to visit some patients in the hospital. She refused to discuss further details. Three other former Mundipharma employees also told AP they regularly visited patients in the hospital, sometimes disguising themselves as doctors.
A doctor from Sun Yat-sen University Cancer Center told AP that sales reps are not allowed to visit patients. He said he warns patients about OxyContin’s abuse risks but acknowledged not all doctors do. He spoke on condition helped the participants to avail camp facilities easily.
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of anonymity because he was not authorized to talk with foreign media.
In a statement to AP, Mundipharma denied that sales staff visit patients and said it has checks and balances in place to “ensure strict compliance with medical protocols, laws and regulations.”
Sun Yat-sen University Cancer Center did not respond to requests for comment.
Struggled
Yin Hao, who also goes by Yin Qiang, struggled to remember life before pain pills. He thought back to when was 21 years old, strong and wiry, working at a nightclub. He had knock-off Burberry sheets, a mortgage in his name, and a girl he planned to marry.
Then one night in 2013, he and his friends got into a fight with some older, richer guys, and someone drove a pickaxe into his waist.
The hospital sent him home with four boxes of Tylox, a combination of acetaminophen and oxycodone, the active ingredient in OxyContin. Tylox is manufactured by SpecGx, a subsidiary of Mallinckrodt, which has faced lawsuits in the US accusing it of helping stoke the opioid abuse crisis.
Mallickrodt has denied the allegations. Yin said his doctor didn’t tell him the medicine could be addictive. Within six months, he was taking 30 pills a day.
Yin needed more and more pills to function. He opened dozens of accounts with online pharmacies to buy Tylox. Many didn’t require a prescription. Once he wrote a three-character Chinese profanity on a piece of paper and uploaded a photo of that instead of a prescription. The pills came anyway, he said. He figured pharmacies wanted the sale almost as much as he wanted the drugs. His excessive consumption didn’t trigger any alarms.
Yin lost 60 pounds. He wondered if his kidneys would fail and was convinced Tylox had changed the color of his eyes. “My nerves are a mess, my bones are misplaced and I have become lazy, irritable, extreme,” he said. “Experts say that if you take this medicine because of pain, it’s not addictive. This is rubbish.”
In early 2016, a doctor told Wu the cancer had come back. He signed an organ donation form, and posted it on social media with a message: “Although I don’t know when the journey of life will end, when that moment comes, I will leave behind a bunch of flowers, roses that blossom from my body.”
The proximity of death clarified Wu’s ambition. He had dropped out of school at fifteen and hustled to start a catering business, which collapsed when he got sick.
Now, Wu dreamed of leaving his parents’ home in Yangjiang, a coastal city in southern Guangdong province, and moving to Shenzhen, China’s dazzling southern boom town, to make music.
“If people don’t let me make music, I will die with everlasting regret, he said.”
Wu taught himself composition and piano from videos posted online at Bilibili, a video-sharing platform.
By 2018, Wu’s cancer was in remission and he could walk with a crutch. The pain was under control, but he kept taking OxyContin. “Once you take that drug, I’ve said it, it’s just like going home,” he said. “There’s a sense of belonging and safety.”
But the longer Wu took the pills, the less effective they were, he said. Wu started taking OxyContin with a half bottle of strong Chinese liquor, which he had delivered secretly to his house.
He also noticed the package insert for OxyContin says not to chew it, which releases the active ingredient, oxycodone, all at once rather than over time. Chewing the pills made them hit with more intensity. “As long as you try chewing it once, there’s no way for you not to chew it the next time,” he said.
Hypnosis
Yin had vowed dozens of times to quit Tylox. He tried ice baths, saunas, and Russian vodka. He took a fistful of an antipsychotic that made him feel like his heart had stopped. He went to hypnosis and consulted cheap doctors online.
Yin said he’d gone to hospitals for help, but doctors around Panjin, the town in northeastern China where he lived with his grandparents, didn’t seem to know what withdrawal was. Some told him to go to a psychiatric hospital; others prescribed more Tylox, he said.
He moved to South Korea for a fresh start, but said he got deported after fighting with a policeman.
Once he rented a hotel room in the northeastern city of Dalian, shackled his leg to the radiator and threw the key out the window, he said. He binged on horror movies and cigarettes to distract himself and spent a few sweaty, aching hours alone, writhing in a bed that felt like it was made of fire. Then he broke the lock on his shackles, ran to a pharmacy and bought more Tylox.
On March 6, Yin woke up at 6 am determined to go cold turkey. It hurt to chew. He soaked biscuits in water and gummed them; a little while later, they were diarrhea.
“If I fail and go back to taking the medicine, I will fall apart,” he said on his sixth day of sobriety.
Yin said he hoped his story would be a warning to others. If he could make a single vulnerable person understand the consequences of taking this drug, it would be one thing in his life he didn’t regret.
“I used to be afraid of ghosts, but now I think this is more terrible than ghosts,” he said.
Wu’s family had poured out all their meager fortune to pay his medical bills. He said health insurance had covered roughly 30 to 60 percent of the cost, depending on where he got treatment. To pay the rest, the family sold their house in August 2014. His parents, who planted orange trees before he got sick, picked up short-term jobs, like cleaning restaurants.
As 2018 rolled into 2019, Wu was still spending 1,500 yuan ($215) a month on OxyContin. His parents told him he was poisoning himself and started locking up his pills. (AP)