Free AMERICAN PAIN by John Temple Page B

heart-and-minds campaign worked, beyond even Purdue’s expectations. Within a few years, OxyContin became a major pharmaceutical hit, one of the top-twenty brand-name medications in the United States. By 2002, six years after its release, Purdue was selling almost $1.5 billion of the drug each year—eight times the volume the company had projected. The single drug represented 80 percent of Purdue’s net sales. It was the biggest-selling brand-name controlled substance on the market.
    The once sleepy drugmaker was now a powerhouse, and it wasn’t about to concede that its star product had a major flaw.
    OxyContin’s warning label instructed users not to crush or dissolve the pills because the entire narcotic load would be released at once. In other words, do not powderize the pill . . . unless you want to get ecstatically, euphorically high. Abusers paid attention and realized how ridiculously easy it was to beat the pill’s timed-release formulation. Just crush it, and they’d get the whole thing at once. They could wrap it in foil and grind it between their molars, or take a hammer to it. Still, after ingesting it that way for a time, the knife-edge of joy became just a bit blunted. So abusers would try snorting it to get it to the bloodstream faster, boost the rush. And when that dulled, they could mix the powder with water, draw it into a needle, and shoot it straight into the vessel.
    People began dying with OxyContin in their bloodstreams. At first, around the year 2000, the overdose reports were haphazard and anecdotal, a few dozen deaths tallied by a worried medical examiner in Virginia or a few hundred reported by a DEA researcher. News reports detailed a wave of OxyContin abuse that originated in rural areas with a tradition of pill dependency, such as western Virginia, eastern Maine, and Kentucky.
    Purdue pushed back against the evidence. Just because oxycodone was found in a corpse’s bloodstream didn’t mean it came from an Oxy-Contin pill, company spokesmen said. And if there were other drugs or alcohol involved, as was often the case, how could you definitively blame oxycodone?
    But deaths involving prescription narcotics continued to mount, until the trend was impossible to dismiss. Overdose deaths involving prescription opioids quadrupled between 1999 and 2007, from about three thousand to twelve thousand per year. By contrast, cocaine killed about six thousand users in 2007, heroin about two thousand. Prescription narcotics were now killing more Americans than all illegal drugs combined.
    In fact, while the heroin years of the 1970s and the crack crisis of the 1980s had produced a frenzy of publicity, those outbreaks had barely nudged the overall drug death rate. The unintentional drug overdose death rate had hovered between one and two annual deaths per one hundred thousand citizens during the heydays of those drugs. By 2007, the overdose rate had shot up to about nine deaths per one hundred thousand, almost entirely due to opioid-related deaths. Pills were far deadlier than crack or heroin, but they didn’t create the same national hysteria.
    There was a reason for this lack of outrage. Golbom noticed that almost every story about the increasing devastation quoted a pain management doctor or “expert” from one of the industry fronts like the American Pain Foundation. There was always a paragraph about the “undertreatment of pain,” with the implication that even more opioids were needed to solve the problem. Purdue had created a truth, backed up by a body of seemingly legitimate research and publication, and few seemed to question the underlying premise that OxyContin was an effective drug for chronic pain, safe “when taken as prescribed.”
    It took Golbom time to fully comprehend the implications of Purdue’s strategy, but once he did, he realized its brilliance. The company was selling an addictive drug that it said would not addict you as long as it was taken as prescribed . Then, when