The more pills handed out, the more cases of addiction; the more cases of addiction, the more illegal street trafficking of the drugs; the more illegal street trafficking, the more snorting and injecting of the crushed pills; the more snorting and injecting, the more overdoses; the more overdoses, the more deaths.
The result of this chain is that about 15,000 Americans are dying every year from prescription pill overdoses — triple the rate of a decade ago, according to the US’ Centers for Disease Control and Prevention, which have declared the problem an epidemic. The death toll exceeds that caused by heroin and cocaine combined, and has become the No. 1 killer in 17 states, surpassing even car crashes.
Apart from the sheer scale of the crisis, the profile of victims is striking. Unlike the crack-cocaine epidemic of the 1980s and early 1990s that wreaked havoc specifically among younger African Americans, those who succumb to a prescription pill overdose are likely to be white, male and middle-aged.
The other factor that sets this disaster apart is its source. Track the supply of Percocet, OxyContin, Vicodin, Opana, or several other opioid painkillers involved in overdoses, and you will eventually arrive not at a Mexican or Colombian drug cartel or an international smuggling ring, as might be the case with heroin or cocaine, but at a doctor.
“It started as a genuine attempt by doctors to help those who needed it,” Geni’s physician, David Caraway, said. “There was a rationale to treating pain aggressively with opioids, but 10 years down the line, we have come to understand the consequences.”
Caraway points out that in the late 1990s, the Joint Commission on Accreditation of Healthcare Organizations, a private body that provides guidelines for hospitals, launched an initiative that encouraged doctors to wage war on pain wherever they found it. It focused on opiate derivatives, drugs that work by modulating pain messages as they pass up the spine to the brain. For years, opioids had been regarded as a drug of last resort, suitable only for the most severe cases. Now, the emphasis began to shift towards prescribing them for chronic pain.
At approximately the same time, drug companies, led by Purdue Pharma, the manufacturer of the leading opioid painkiller OxyContin, embarked on a massive marketing push. In 2001, Purdue Pharma spent US$200 million promoting OxyContin. Primary care physicians were specifically targeted and their patients induced to try out the drug with 30-day free trial periods.
Concerns about potential addiction were assuaged in promotional videos that claimed the incidence of addiction was less than 1 percent. Sales grew and grew to about US$3 billion for OxyContin in 2010.
Caraway knows intimately the outcome of what he describes as this “perfect brew” of official encouragement and “big pharma” marketing. He is a specialist in pain management and vice president of the professional body that represents such experts, the American Society of Interventional Pain Physicians. He also works at a pain management center, the Center for Pain Relief Tristate, right at the heart of the painkiller epidemic, in the small town of Huntington, which sits at the intersection of three states straddling the Appalachian mountains: West Virginia, Kentucky and Ohio.