Heart­break­ing Sto­ries of Young Lives Lost

The Borneo Post - Good English - - Front Page - By Su­san Okie

DRUG over­doses killed a record 72,000 Amer­i­cans last year - more than the peak an­nual to­tals from HIV, guns or ve­hi­cle crashes. Com­pared with those long-fa­mil­iar plagues, the ex­plo­sion in drug ad­dic­tion and over­dose deaths in the United States still feels new enough to star­tle us: Af­ter all, it was be­lat­edly de­clared a na­tional emer­gency only last year. As a jour­nal­ist, I re­call writ­ing a com­men­tary al­most a decade ago about the rapid in­crease in over­dose deaths from pre­scrip­tion pain pills, in­clud­ing in ru­ral states like West Vir­ginia and New Mex­ico.

As a physi­cian, I’ve been the re­cip­i­ent of con­flict­ing mes­sages about the op­ti­mal use of opi­oids. I re­mem­ber a na­tional cam­paign in the 1990s aimed at per­suad­ing doc­tors to pre­scribe them more read­ily to peo­ple suf­fer­ing from chronic pain, fol­lowed in re­cent years by strict new guide­lines, black-box warn­ings, pre­scrip­tion-mon­i­tor­ing data­bases and other mea­sures aimed at stem­ming the over­pre­scrib­ing of those same drugs.

But un­til I read “Dopesick” by jour­nal­ist Beth Macy, I didn’t grasp all of the fac­tors that have com­bined to pro­duce the present cri­sis. They in­clude un­scrupu­lous pre­scrip­tion drug pro­mot­ers, greedy or gullible physi­cians, the ad­dic­tive po­ten­tial and high re­sale value of the pain pills them­selves, in­ad­e­quate ac­tion by the Food and Drug Ad­min­is­tra­tion, the short­age and high cost of ef­fec­tive treat­ment pro­grams for ad­dic­tion, and pre­scrip­tion opi­oids’ role in open­ing up new geo­graphic mar­kets for heroin, a cheaper but more dan­ger­ous al­ter­na­tive for the ad­dicted. The big pic­ture is over­whelm­ing and de­mands a vig­or­ous na­tional re­sponse.

A Roanoke-based re­porter, Macy had a front-row seat for the pain pill epi­demic’s march through ru­ral and small-town western Vir­ginia, mov­ing south to north on a path roughly par­al­lel to US High­way 81. In the late 1990s, soon af­ter Pur­due Pharma be­gan an ag­gres­sive na­tional mar­ket­ing cam­paign for its new, long-act­ing painkiller, OxyCon­tin, pa­tients hooked on that drug be­gan show­ing up in clin­ics and emer­gency rooms in ru­ral Amer­ica - in farm­ing and coalmin­ing coun­ties, in eco­nom­i­cally de­pressed Mid­west­ern fac­tory towns, in log­ging and fish­ing com­mu­ni­ties in Maine. Over­dose deaths be­gan to rise. A few alert doc­tors, phar­ma­cists, clinic work­ers and lo­cal health of­fi­cials tried to sound an alarm. Among them was Art Van Zee, a ded­i­cated Vir­ginia coun­try doc­tor who launched a pe­ti­tion drive in 2001 ask­ing the FDA to re­move OxyCon­tin from the mar­ket. Van Zee’s ef­forts were chron­i­cled in “Pain Killer,” a 2003 book by New York Times re­porter Barry Meier, one of the first jour­nal­ists to ag­gres­sively cover the OxyCon­tin story.

Pur­due sales rep­re­sen­ta­tives were urg­ing physi­cians to pre­scribe OxyCon­tin for pa­tients with arthri­tis, low-back in­juries and other com­mon causes of chronic pain, not just for those suf­fer­ing from in­tractable can­cer. The com­pany wooed doc­tors with free meals and gifts, as­sur­ing them that the risk of ad­dic­tion with OxyCon­tin was one-half of one per cent - a mis­lead­ing claim, based on a study of its short-term, su­per­vised use in hos­pi­talised pa­tients. In peo­ple re­ceiv­ing opi­oids for long pe­ri­ods to treat chronic pain, the ac­tual risk may be as high as 56 per cent, ac­cord­ing to a 2007 med­i­cal re­view ar­ti­cle cited by Macy.

Users seek­ing a high quickly fig­ured out how to re­move the pill’s outer coat­ing and crush the in­ner pearl of opi­oid into a pow­der that could be snorted or in­jected. “Oxy” also com­manded a high street price: In a house­hold strapped for cash, it could pay the rent, while an ad­dict could use some of the pro­ceeds from re­sale of the pills to buy heroin to stave off “dopesick­ness,” the jit­ters, body aches, nausea, di­ar­rhoea and other symp­toms of with­drawal. “At the end of your jour­ney, you’re not go­ing af­ter drugs to get high; you’re go­ing to keep from get­ting sick,” Deb­bie Hon­aker, a house­wife un­der­go­ing ad­dic­tion treat­ment, told Macy. In ar­eas where many peo­ple were un­em­ployed or on dis­abil­ity, OxyCon­tin and other opi­oids ini­tially pre­scribed for chronic pain of­fered a tempt­ing in­come source - “the new moon­shine,” Macy calls it. And sell­ing the pills helped re­cruit new users.

Of­ten pre­scribed in too-large quan­ti­ties, left­over pain pills in bath­room cab­i­nets be­came tar­gets for thieves or bounty that a teenager could swipe to pass around at a pill party. Within a few years, high school foot­ball stars and col­lege-bound stu­dents from up­scale neigh­bor­hoods were join­ing the ranks of the ad­dicted.

The stunned, griev­ing par­ents of some of the teenagers who died of OxyCon­tin over­doses be­came im­pas­sioned ac­tivists. Their voices are among the most pow­er­ful in Macy’s book. Ed Bisch and Lee Nuss, who each lost a son, founded a non­profit or­gan­i­sa­tion, Rel­a­tives Against Pur­due Pharma, whose mem­bers lob­bied leg­is­la­tors, spon­sored school work­shops and demon­strated with posters of their dead chil­dren out­side the com­pany’s cor­po­rate head­quar­ters. In 2007, John L. Brown­lee, a young US at­tor­ney, set­tled a land­mark fed­eral case against Pur­due in a plea agree­ment un­der which the com­pany ad­mit­ted to fraud­u­lently mar­ket­ing OxyCon­tin for six years, claim­ing that it was less prone to abuse than quick-re­lease ver­sions of the drug. It had even fal­si­fied sci­en­tific charts to but­tress that claim. Three top ex­ec­u­tives pleaded guilty to mis­de­meanours, and Pur­due paid $600 mil­lion in fines. At a rally be­fore the sen­tenc­ing, be­reaved fam­ily mem­bers read from a 50-page list of the names of the dead.

But by then, the multi-year pro­mo­tion and sup­ply­ing of OxyCon­tin and other pre­scrip­tion opi­ates to phar­ma­cies all over Amer­ica had ig­nited the pain pill epi­demic, and there was no stop­ping it. “In the early 1990s, prob­a­bly ninety per­cent of the heroin mar­ket was still in cities like New York, Chicago and Detroit,” his­to­rian David Cour­tright told Macy. But by the first decade of the new cen­tury, “any doc­tor in any small town, un­der the dis­pen­sa­tion of a new FDAap­proved pre­scrip­tion, could sud­denly pro­vide opi­oids to peo­ple with low back is­sues” or other types of chronic pain. The symp­toms and con­se­quences of both ad­dic­tions are much the same, although heroin is more dan­ger­ous be­cause of its po­ten­tial for con­tam­i­na­tion or adul­ter­ation, in­clud­ing the re­cent lac­ing of heroin with a much more po­tent nar­cotic, fen­tanyl.

In Roanoke and other Vir­ginia towns, as Macy learned, pain pill ad­dicts read­ily switched to heroin as a cheaper al­ter­na­tive, and teenagers who’d used the pills were eas­ily per­suaded to try it. “I did my first bag of heroin be­fore I drank my first bot­tle of beer,” re­called Spencer Mumpower, who, as a young ad­dict and heroin dealer, went to jail af­ter sell­ing a friend the drug that caused his over­dose death. Lo­cal “mules” would make day trips to Bal­ti­more or Hager­stown, Mary­land, to bring back a sup­ply of heroin to sell. Even­tu­ally, scent­ing an un­tapped mar­ket, more-ex­pe­ri­enced deal­ers moved into ru­ral Vir­ginia from big cities in the North­east, set up sales net­works and be­gan un­der­selling the com­pe­ti­tion.

This ex­haus­tively re­ported book in­cludes many heart­break­ing ex­am­ples of young lives lost to drugs, some­times so sud­denly that par­ents had been un­aware of the prob­lem, some­times af­ter re­peated ef­forts to help a child get clean in re­ha­bil­i­ta­tion fa­cil­i­ties or treat­ment pro­grammes. Although Macy’s sto­ries are set in Vir­ginia, they could hap­pen any­where in the United States. Most com­pelling are the char­ac­ters she was able to fol­low over time, like Mumpower, who re­cov­ered from ad­dic­tion in prison and a halfway house, trained him­self in mixed mar­tial arts, and was clean at the time of the book’s publi­ca­tion. An­other of her sub­jects, high school ath­lete and hon­our stu­dent Tess Henry, be­came ad­dicted to pills and then heroin, was jailed for deal­ing, and took heroin or Subox­one (a syn­thetic opi­oid used to treat ad­dic­tion) through­out a preg­nancy. Born healthy, her son was taken from her, and Tess’ strug­gles to stay off drugs and be­come a fit mother pro­vide a mov­ing coun­ter­point to Macy’s dis­cus­sion of the con­tro­ver­sies that roil our na­tional de­bate over ad­dic­tion treat­ment.

Macy ar­gues per­sua­sively that med­i­ca­tionas­sisted treat­ment, in which an ad­dict re­ceives a daily main­te­nance dose of Subox­one (which com­bines an opi­ate, buprenor­phine and an­other drug, nalox­one), of­fers a bet­ter chance of last­ing re­cov­ery from drug ad­dic­tion than reg­i­mens that re­quire ad­dicts to quit drugs cold turkey. “All stud­ies - ev­ery sin­gle one of them - show su­pe­rior out­comes when pa­tients are treated” with main­te­nance med­i­ca­tions, said Nora Volkow, di­rec­tor of the Na­tional In­sti­tute on Drug Abuse. – Wash­ing­ton Post.

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