Dopesick - Beth Macy Page 0,19
deaths now substantially surpassing those caused by cocaine and heroin.
The next month, the DEA developed a “national action plan” to monitor Purdue, asking the company to limit distribution of the drug, rethink its marketing strategy, and consider reformulating the drug to be abuse-resistant. This marked the first time in the agency’s history that it targeted a specific drug to be policed by its manufacturer to prevent diversion and abuse.
In response, the company announced a ten-point plan to curb abuse, including the distribution of tamper-resistant prescription pads, an educational program aimed at alerting teens to the dangers of prescription drugs, and a $100,000 grant for the creation of a statewide prescription monitoring program, or PMP, to halt doctor-shopping. The company also stopped distributing its most potent form of OxyContin, the 160-milligram pill, and reduced shipments to Mexico in light of reports that the drug was being smuggled back into the United States—sometimes by people making the twenty-three-hour drive from Virginia’s coalfields to the Mexican border or flying with pills taped to their back.
With great fanfare in July 2001, the FDA announced it had worked with Purdue to put a black-box warning on the drug, the strongest type of prescription-drug caution. The goal was to help prevent inappropriate prescriptions, misuse, and diversion.
But a company spokesman downplayed the black box, calling it “more of an exercise in graphic design” and pointing out that legitimate users didn’t experience the high created by abusers who snorted or injected the drug. The real victims, executives said time and again, were their “legitimate patients,” who would be denied OxyContin if its distribution were restricted.
That year, a former Purdue rep remembered, the salesperson attended one of the company’s new seminars on diversion and abuse, meant to educate reps so they could inform authorities about suspected diversion. It was now possible for a rep who called on indiscriminate prescribers to earn as much as $100,000 a quarter in bonus pay alone, the rep told me. “It behooved them to have the pill mills writing high doses,” the rep added. “The [diversion/abuse] seminar was just a cover-their-ass type of thing.”
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“Let’s be clear,” a Purdue Pharma spokesman said in August 2001, in a meeting with Virginia’s attorney general. “The issue is drug abuse, not the drug.” The product shouldn’t be blamed for deaths, because in many cases the victims were also drinking alcohol and taking other drugs.
Van Zee scoffed, telling a Roanoke Times reporter: “To me, that’s like somebody who was shot with a howitzer and a BB gun, and you walk up and say it’s a little hard to tell what killed him. Was it the howitzer that took off half his chest, or was it the BB gun?”
Another set of scales fell from the doctor’s eyes as a distinct possibility flashed before him: No one in federal government would take seriously the concerns of a country doctor until opioid abuse took hold in the cities and suburbs. “If it’s a bunch of poor folks up in the mountains, it doesn’t affect them personally,” he said.
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Purdue had tried in vain to quiet the Appalachian naysayers a few months before, in March 2001, by offering Stallard and other county leaders a $100,000 “grant” they could put toward drug treatment and law enforcement. The offer had come the day after a meeting Van Zee arranged between Purdue executives and concerned family members, including a prominent Pennington Gap banker, the one whose addicted son had already blown through $80,000 of his life savings. If Purdue wouldn’t listen to local doctors and cops, Van Zee reasoned, maybe it would listen to someone whose son’s addiction had nearly depleted his 401(k).
“We are an average family,” the banker said in his appeal to the executives, showing them a picture of his son. The banker had grown up in the Monarch coal camp, putting himself through college one night-school class at a time. Before his son stole from the family to buy black-market OxyContin, he had been a good student and a burly outdoorsman. “Surely you have got enough patriotism to worry about this country?” the banker said. He pointed out that the company must have known Lee County (population twenty-three thousand) had an OxyContin problem before Lee County did, considering that it was sending as many pills to the region as it was to areas five times the size. “I’m sorry your family is having such a problem,” Purdue’s chief executive officer, Michael Friedman, said.
At the meeting’s end, the executives stunned the group when they laid