Dopesick

by Beth Macy

  it became standard practice: Soldier’s disease as defined in Gerald Starkey, “The Use and Abuse of Opiates and Amphetamines,” in Patrick Healy and James Manak, eds., Drug Dependence and Abuse Resource Book (Chicago: National District Attorneys Association, 1971), 482–84. While Starkey puts the number of addicted veterans at 400,000, some modern-day historians believe the figure is lower and are more likely to cite Horace Day’s 1868 Opium Habit, which estimated that 80,000 to 100,000 Americans were addicted, as also described in Dillon J. Carroll, “Civil War Veterans and Opiate Addiction in the Gilded Age,” Journal of the Civil War Era, Nov. 22, 2016. David F. Musto puts the 1900 figure at 250,000 in The American Disease: Origins of Narcotic Control (New York: Oxford University Press, 1973), 5.

  The addiction was particularly severe: Carroll, “Civil War Veterans.”

  “Since the close of the war”: “Opium and Its Consumers,” New York Tribune, July 10, 1877.

  “I know persons”: Letter by Dr. W. G. Rogers, Daily Dispatch (Richmond, VA), Jan. 25, 1884.

  It was a safe family drug: David F. Musto, ed., One Hundred Years of Heroin (Westport, CT: Auburn House, 2002), 4.

  it also seemed to strengthen respiration: Ibid.

  Free samples were mailed: David Courtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge, MA: Harvard University Press, 2001), 91, 231.

  “almost criminal”: “Women Victims of Morphine; Physicians Discuss the Danger in the Use of the Drug,” New York Times, Oct. 25, 1895.

  By 1900, more than 250,000 Americans: Musto, The American Disease, 5.

  for eight years you could buy heroin: Some states had regional versions of the Harrison Act before 1914, but that didn’t prevent a person from going the mail-order route, according to historian Nancy D. Campbell; author interview, Oct. 25, 2017.

  then called “vicious”: Author interview, Campbell, Sept. 3, 2017.

  “the American Disease”: Musto, One Hundred Years of Heroin, xvi.

  now reliant on criminal drug networks: The drug had been interdicted on Chinese ships, where it was hidden inside the rinds of oranges and bars of soap and, once, in 1924, in the bodies of dead kittens found in a passenger’s basket, according to “China Again in Grip of Opium and Morphia,” New York Times, Aug. 24, 1924.

  Think of the “Des Moines woman”: Daily State (Richmond, VA), May 3, 1873 (wire report).

  “‘contain nothing injurious to the youngest babe’”: “Secretary Warns Mothers of Doped Medicines,” Evening News (Roanoke, VA), March 1, 1914 (wire reports).

  David Haddox touted OxyContin: “If you take the medicine like it is prescribed, the risk of addiction when taking an opioid is one-half of 1 percent,” said Purdue’s medical director Dr. J. David Haddox, as outlined in Meier, Pain Killer, 45.

  The 1996 introduction of OxyContin coincided: Laurie Tarkan, “New Efforts Against an Old Foe: Pain,” New York Times, Dec. 26, 2000.

  Purdue’s bean counters gushed: All budget plans cited in this book came from internal documents I obtained that were originally subpoenaed for the federal investigation.

  “We have an opportunity…”: Purdue Pharma’s 2000 Budget Plan, 51–52.

  A 2000 New York Times article: Tarkan, “New Efforts Against an Old Foe.”

  No one questioned whether: John Walsh, “The Enduring Mystery of Pain Measurement,” Atlantic, Jan. 10, 2017.

  not only did reliance on pain scales not correlate: Effectiveness of pain scales dissected in Anna Lembke’s Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Baltimore: Johns Hopkins University Press, 2016), 66–67.

  “Every single physician I knew…”: Author interview, Dr. John Burton, March 20, 2017.

  The Press Ganey survey upped the pressure: Author interview, Dr. David Davis, March 16, 2017.

  financial toll of $1 trillion: As reported in Altarum, “Economic Toll of Opioid Crisis in U.S. Exceeded $1 Trillion Since 2001,” Feb. 13, 2018. “An additional $500 billion is estimated through 2020 if current conditions persist,” the health care firm estimated. The White House Council of Economic Advisers calculated the costs at $504 billion in 2015 alone, according to “Council of Economic Advisers Report: The Underestimated Cost of the Opioid Crisis,” Nov. 20, 2017, https://www.whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/.

  only a few voices of dissent: Seddon R. Savage, “Long-Term Opioid Therapy: Assessment of Consequences and Risks,” Journal of Pain and Symptom Management, May 1996: 274. Dennis Turk wrote in that same paper: “Arguments both pro and con are based on small segments of the pain populations with unique psychosocial and behavioral, as well as disease characteristics.”

  Chapter Two. Swag ’n’ Dash

  Interviews: Dr. Steve Huff, Rosemary Hopkins, Ray Kohl, Dr. Sue Cantrell, Dr. Art Van Zee, Sue Ella Kobak, Dr. Vince Stravino, Jan Mosley, Greg Stewart, Dr. Molly O’Dell, Debbie Honaker, Jennifer Ball, Crystal Street, Sister Beth Davies, John Kelly, Doug Clark, Dennis Lee, Emmitt Yeary, Sheriff Gary Parsons, Rev. Clyde Hester, Tony Lawson

  detailed television ads touting specific medical claims: Dylan Scott, “The Untold Story of TV’s First Prescription Drug Ad,” STAT, Dec. 11, 2015, https://www.statnews.com/2015/12/11/untold-story-tvs-first-prescription-drug-ad/.

  companies spent more plying: Chris Adams, “Doctors ‘Dine ’n’ Dash’ in Style, as Drug Firms Pick Up the Tab,” Wall Street Journal, May 14, 2001.

  there were scant industry or federal guidelines: U.S. General Accountability Office report, “OxyContin Abuse and Diversion and Efforts to Address the Problem,” December 2003, 15–17, https://www.gao.gov/new.items/d04110.pdf. Voluntary guidelines regarding drug company marketing and promotion were issued by July 2002 by the Pharmaceutical Research and Manufacturers of America. In April 2003, voluntary guidelines were issued by the Office of Inspector General, U.S. Department of Health and Human Services.

  Purdue handpicked the physicians: Barry Meier, Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death (New York: Rodale Press, 2003), 99–101.

  If a doctor was already prescribing lots of Percocet: Ibid., 103. High-prescriber target was also outlined in Purdue Pharma’s 1996 Budget Plan for OxyContin, 56.

  a term reps use as a predictor: Deciles are based on volume, past prescribing history, managed care mix, and adopter status, and are used as a way of getting reps to prioritize time and resources; author interview, longtime pharmaceutical sales rep, Dec. 18, 2017.

  the more visits that doctor received: Purdue Pharma’s 1999 Budget Plan, 65. Meier, 99–103. GAO report, “OxyContin Abuse and Diversion,” 15–20: “Purdue directed its sales representatives to focus on the physicians in their sales territories who were high opioid prescribers.”

  who often brought along “reminders”: Purdue Pharma’s 1999 Budget Plan, 65.

  the higher the milligrams a doctor prescribed: Author interview, former Purdue Pharma OxyContin sales rep, Jan. 26, 2017.

  family doctors now the largest single group: Paul Tough, “The Alchemy of OxyContin,” New York Times Magazine, July 29, 2001.

  Reps began coming by before holidays: Author interview, pharmaceutical sales rep, July 28, 2016.

  Purdue reps were heavily incentivized: David Armstrong, “Secret Trove Reveals Bold ‘Crusade’ to Make OxyContin a Blockbuster,” STAT, Sept. 22, 2016.

  “We were impressionable young doctors”: Author interview, Dr. Steve Huff, Aug. 7, 2016.

  When he set about trying to coax: Ibid., Sept. 26, 2017.

  “Cadillac high”: Author interview, Rosemary Hopkins, Sept. 23, 2016.

  in nearby Galax, a factory town: Author interview, Ray Kohl, director of tourism for Galax, Aug. 8, 2016.

  Cantrell remembered setting up: Author interview, Dr. Sue Cantrell, March 23, 2016.

  Jobs in coal mining: Brad Plumer, “Here’s Why Central Appalachia’s Coal Industry Is Dying,” Washington Post, Nov. 4, 2013; Nathan Bomey, “Coal’s De
mise Threatens Appalachian Miners, Firms as Production Moves West,” USA Today, April 19, 2016.

  That’s where he met his wife: Author interview, Dr. Art Van Zee, Sept. 3, 2017.

  “‘The best doctor in America’”: Author interview, Dr. Vince Stravino, March 13, 2017.

  Locals often compared Van Zee… to Abraham Lincoln: Author interview, Jan Mosley, June 30, 2016.

  “When his patients are admitted to the ER”: Ibid.

  accompany a patient in cardiac arrest: Author interview, Greg Stewart, Sept. 23, 2016.

  The time when he cracked three ribs: Author interviews, Van Zee and Sue Ella Kobak, March 3 and 4, 2017.

  a physician colleague treated a septuagenarian: Author interview, Stravino.

  “Nobody would listen to her”: Author interview, Dr. Molly O’Dell, March 22, 2016.

  In 1997, the Roanoke-based medical examiner: Rex Bowman, “28 Deaths Linked to Drug—OxyContin Plagues Southwest Virginia,” Richmond Times-Dispatch, Feb. 9, 2001.

  “a little bit unique”: Bowman, “Drug Sparks Crime Surge—Southwest Virginia Hit Hard by Opiate Abuse,” Richmond Times-Dispatch, Oct. 21, 2000. The overdose deaths weren’t reported until Bowman’s report the following February.

  So it happened that in the early 2000s: Author interview, Debbie Honaker, March 16, 2016; follow-up interview, Aug. 8, 2016.

  The Board of Medicine suspended Dr. Dwight Bailey’s: Lindsey Price, “Doctor’s License Suspended Amid Prescription Drug Allegations,” WCYB, Aug. 6, 2014, and confirmed in the Board of Medicine’s License Lookup: https://dhp.virginiainteractive.org/Lookup/Detail/0101031921. “Had he not given her that junk, my sister would still be here,” said Jennifer Ball, who said her sister sought help from Bailey after injuring her back while lifting her handicapped son. She died at forty-one from a heart attack brought on by a combination of blood-pressure medicine, Xanax, and opioids; author interview, Ball, Aug. 5, 2016.

  “It’s our culture now”: Author interview, Crystal Street, March 16, 2016.

  24 percent of Lee High School juniors: Author interview, Van Zee, Sept. 23, 2016.

  Machias, Maine, was a remote town: The population of Washington County in Maine has been in decline for the last three census periods; the median household income is $38,083, according to U.S. Census data from 2010 and 2016. Nearly one in three children in the county lives in poverty, according to Tom Walsh, Bangor Daily News, Feb. 7, 2012.

  The plainspoken sheriff: Donna Gold, “A Prescription for Crime,” Boston Globe, May 21, 2000.

  “That’s us!”: Author interview, Sister Beth Davies, Sept. 23, 2016.

  “The extent and prevalence”: Letter from Van Zee to Dr. J. David Haddox, Aug. 20, 2000. Van Zee’s medical partner, Dr. Vince Stravino, had already filed official complaints about children in the area “crushing, snorting and injecting Oxycontin” and “come to the hospital with overdoses and abscesses because of injections,” according to a Purdue response written by Mayra Ballina, the company’s associate medical director, on May 8, 2000.

  “My fear is that these are sentinel areas”: Letter from Van Zee to Dr. Daniel Spyker, Purdue’s senior medical director, Nov. 23, 2000.

  Forty to 60 percent of addicted opioid users: George E. Woody, “Advances in the Treatment of Opioid Use Disorders,” National Institutes of Health, Jan. 27, 2017: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288680/#ref-1; M. J. Fleury et al., “Remission from Substance Use Disorders: A Systematic Review and Meta-Analysis,” Drug and Alcohol Dependence, Nov. 1, 2016; studies interpreted by Harvard Medical School’s John Kelly, author interview, Aug. 31, 2017.

  “Among the remedies which it has pleased”: Meier, Pain Killer, 42.

  makers of the painkiller Talwin: C. Baum, J. P. Hsu, and R. C. Nelson, “The Impact of the Addition of Naloxone on the Use and Abuse of Pentazocine,” Public Health, July-August 1987: 426–29.

  Unemployed Tazewell miners: Author interview, Doug Clark, Aug. 9, 2016.

  and he seemed intimidating: Author interview, then–Tazewell County prosecutor Dennis Lee, now in private practice, May 2, 2016.

  “There’s just no comparison”: Tom Angleberger, “Panel Discusses OxyContin Problem,” Roanoke Times, Sept. 25, 2000.

  Sales-rep bonuses were growing exponentially: In 2001, the average salary for a Purdue sales rep was $55,000, and the average bonus was $71,500, according to U.S. General Accountability Office report, “OxyContin Abuse and Diversion and Efforts to Address the Problem,” December 2003, https://www.gao.gov/new.items/d04110.pdf.

  “starter coupons”: Ibid., 23. “In 1998 and 1999, each sales representative had 25 coupons that were redeemable for a free 30-day supply.…Approximately 34,000 coupons had been redeemed nationally when the program was terminated in July 2001.”

  The trips were free: Ibid., 22.

  “The doctors started prostituting themselves”: Author interview, Emmitt Yeary, Jan. 24, 2017.

  Purdue had passed out fifteen thousand copies: GAO report, “OxyContin Abuse and Diversion,” 27.

  “pseudo addiction”: Explained in the Purdue Pharma “I Got My Life Back: Patients in Pain Tell Their Story” video, narrated by Dr. Alan Spanos, 1997.

  “go to sleep” before they stopped breathing: Thomas Catan and Evan Perez, “A Pain-Drug Champion Has Second Thoughts,” Wall Street Journal, Dec. 17, 2012.

  The region had now buried forty-three: Laurence Hammack, “Deaths from OxyContin Overdoses on the Rise,” Roanoke Times, Feb. 10, 2001, and author interviews, Van Zee.

  At the Lee County jail: Hammack, “Lee County Is the Epicenter of Abuse,” Roanoke Times, June 10, 2001.

  “stacking ’em on the floor”: Author interview, Lee County sheriff Gary Parsons, March 3, 2017.

  one of the prisoners had bought four OxyContin tablets: Rex Bowman, “Prescription for Crime,” Time, March 21, 2005.

  While attempting to make a night deposit: Harless Rose was sentenced to life in prison for murdering the thirty-five-year-old store manager, Timothy Hughes; author interview, Richard Stallard, March 3, 2017; and “Life Term Imposed in Wise Slaying,” Richmond Times-Dispatch, March 31, 2003 (wire reports).

  a man made the bold move: Billy Gene Lawson fired a shot at two young men trying to get his wife’s pills, shooting twenty-six-year-old Shannon Fleenor in the back of the head. Lawson was charged with second-degree murder, but a jury of twelve county residents voted to acquit; author interview, Stallard.

  “‘spot and steal’”: Author interview, Rev. Clyde Hester, March 3, 2017.

  petition drive asking the FDA: Originally at recalloxycontinnow.org, but the website is no longer live.

  “In a place where people barely have money”: Author interview, Stravino.

  “the crack of Southwest Virginia”: Hammack, “Deaths from OxyContin Overdoses on the Rise.”

  marked the first time in the agency’s history: GAO report, “OxyContin Abuse and Diversion,” 36. Laurence Hammack, “OxyContin,” Roanoke Times, June 10, 2001.

  ten-point plan to curb abuse: Ibid.

  pills taped to their back: Author interview, Stallard.

  black-box warning on the drug: Reuters Health, “Purdue Pharma’s OxyContin to Get Black Box Warning,” July 25, 2001.

  It was now possible for a rep: Author interviews, former Purdue sales reps, Jan. 26 and Nov. 1, 2017.

  “The issue is drug abuse, not the drug”: Laurence Hammack, “Seeing OxyContin Abuse Firsthand Pushes St. Charles Doctor’s Petition,” Roanoke Times, Nov. 25, 2001.

  “We are an average family”: Meier, Pain Killer, 138; author interview with banker, name withheld by request, Jan. 12, 2017.

  “‘tremendous insult’”: Author interview, Kobak, March 3, 2017.

  the newspaper ad never ran: Meier, Pain Killer, 140.

  The next day Friedman gathered with: Author interview, Stewart, Sept. 23, 2016; banker interview (name withheld by request), Jan. 12, 2017; and Meier, Pain Killer, 140–42 .

  “except broken bodies”:
Author interview, Kobak.

  executives might be able to intimidate the people: Author interview, Sister Beth Davies, Aug. 10, 2016. “Beth, my hands are tied,” she remembered her former student telling her, apologetically.

  Sister Beth had stood up to a crowd: Greg Edwards, “Plant Moves to Clean Up Spill,” Roanoke Times, Oct. 31, 1996.

  That event pitted company miners: Author interview via email, Sister Beth Davies, Feb. 3, 2017.

  “She was absolutely the most fearless”: Author interview, Tony Lawson, Jan. 30, 2017.

  “Greed makes people violent”: “A Connecticut Yankee Meets Ol’ King Coal,” excerpted from John G. Deedy, The New Nuns: Serving Where the Spirit Leads (Chicago: Fides/Claretian, 1982), in Salt, September 1982.

  all the mining-company executives who’d flown in: Author interview, Davies, Sept. 22, 2016.

  she was wearing the same gray sweatpants: Hammack, “Lee County Is the Epicenter of Abuse.”

  Chapter Three. Message Board Memorial

  Interviews: Dr. Steve Huff, Ed Bisch, David Courtwright, Eric Wish, Nancy D. Campbell, Lee Nuss, Barbara Van Rooyan, Dr. Art Van Zee, Dr. Steve Gelfand, Richard Ausness, Laurence Hammack, Barry Meier, Lisa Nina McCauley Green, Lt. Richard Stallard, Randy Ramseyer, John Brownlee

  New York Times reporter Barry Meier and a colleague: Francis X. Clines with Barry Meier, “Cancer Painkillers Pose New Abuse Threat,” New York Times, Feb. 9, 2001.

  The news was disseminating, finally: Paul Tough, “The Alchemy of OxyContin,” New York Times Magazine, July 29, 2001. The extent of the spread of the drug was also chronicled early on by Seamus McGraw, “The Most Dangerous Drug to Hit Small-Town America Since Crack Cocaine?,” Spin, July 2001.

  “pharming”: Author interview, Dr. Steve Huff, Sept. 27, 2017.

  his son was dead from it: Author interview, Ed Bisch, Jan. 26, 2017.

  “After the old-time addicts died out”: Author interview, David Courtwright, July 21, 2016.

  hipster counterculture: Courtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge, MA: Harvard University Press, 2001), 148–52.