Dopesick - Beth Macy Page 0,5
was the same iconic small town romanticized in Adriana Trigiani’s novel and film Big Stone Gap, the one based on her idyllic upbringing in the 1970s, when a self-described town spinster with the good looks of Ashley Judd could spend her days wandering western Virginia’s hills and hollows, delivering prescriptions for her family-run pharmacy without a thought of danger.
The year was 1997, a pivotal moment in the history of opioid addiction, and Stallard was about to sound the first muffled alarm. Across central Appalachia’s coal country, people hadn’t yet begun locking their toolsheds and barn doors as a guard against those addicted to OxyContin, looking for anything to steal to fund their next fix.
The region was still referred to as the coalfields, even though coal-mining jobs had long been in steep decline. It had been three decades since President Lyndon Johnson squatted on the porch of a ramshackle house just a few counties west, having a chat with an unemployed sawmiller that led him to launch his War on Poverty, which resulted in bedrock social programs like food stamps, Medicaid, Medicare, and Head Start. But poverty remained very much with the coalfields the day Stallard had his first brush with a new and powerful painkiller. Whereas half the region lived in poverty in 1964 and hunger abounded, it now held national records for obesity, disability rates, and drug diversion, the practice of using and/or selling prescriptions for nonmedical purposes.
If fat was the new skinny, pills were becoming the new coal.
Stallard was sitting in his patrol car in the middle of the day when a familiar face appeared. An informant he’d been working with for years had some fresh intel. At the time, the area’s most commonly diverted opioids were Lortab and Percocet, both of which sold on the streets for $10 a pill. Up until now, the most expensive painkiller of the bunch had been Dilaudid, the brand name for hydromorphone, a morphine derivative that sold on the black market for $40.
The informant leaned into Stallard’s cruiser. “This feller up here’s got this new stuff he’s selling. It’s called Oxy, and he says it’s great,” he said.
“What is it again?” Stallard asked.
“It’s Oxy-compton…something like that.”
Pill users were already misusing it to intensify their high, the informant explained, as well as selling it on the black market. Oxy came in much higher dosages than standard painkillers, and an 80-milligram tablet sold for $80, making its potential for black-market sales much higher than that of Dilaudid and Lortab. The increased potency made the drug a cash cow for the company that manufactured it, too.
The informant had more specifics: Users had already figured out an end run around the pill’s time-release mechanism, a coating stamped with oc and the milligram dosage. They simply popped a tablet in their mouths for a minute or two, until the rubberized coating melted away, then rubbed it off on their shirts. Forty-milligram Oxys left an orange sheen on their shirtsleeves, the 80-milligrams a tinge of green. The remaining tiny pearl of pure oxycodone could be crushed, then snorted or mixed with water and injected.
The euphoria was immediate and intense, with a purity similar to that of heroin. Stallard wondered what was coming next. In the early nineties, Colombian cartels had increased the potency of the heroin they were selling in urban markets to increase their market share—the goal being to attract needle-phobic users who preferred snorting over injecting. But as tolerance to the stronger heroin increased, the snorters overcame their aversion to needles and soon became IV heroin users.
As soon as Stallard got back to the station, he picked up the phone.
The town pharmacist on the other line was incredulous: “Man, we only just got it a month or two ago. And you’re telling me it’s already on the street?”
The pharmacist had read the FDA-approved package insert for OxyContin. Most pain pills lasted only four hours, but OxyContin was supposed to provide steady relief three times as long, giving people in serious pain the miracle of uninterrupted sleep. In an early concession to the potential for its abuse, the makers of OxyContin claimed the slow-release delivery mechanism would frustrate drug abusers chasing a euphoric rush.
Based on Stallard’s news, the pharmacist already doubted the company’s claims: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” If the town’s most experienced drug detective was calling him about it just a couple of months after the drug’s release, and if his neighbors