Drug buster

A powerful new book details how a pharmaceutical company's billion dollar "wonder drug" became "hillbilly heroin" for thousands of OxyContin abusers.

By Larry Smith

Jan 22, 2004 |

On February 9, 2001 New York Times investigative reporter Barry Meier wrote an article about the prescription drug OxyContin headlined, "Cancer Painkillers Pose New Abuse Threat." While local papers had reported on the drug's abuse in their communities, Meier's piece was a watershed moment in the story of OxyContin. Over the next 13 months Meier -- who previously covered tobacco industry litigation for the Times -- wrote more than a dozen stories about the government regulation, and patient use and abuse of the drug.

Introduced in 1996, OxyContin was initially marketed as a less addictive drug than other prescription narcotics because of its breakthrough formulation: a slowed-down time release, that supposedly thwarted those looking for a quick jolt. "At its birth," writes Meier, "OxyContin had been a pharmaceutical industry dream, a 'wonder' that heralded a sea change in the treatment of pain." But abusers discovered that by crushing and snorting the drug, they got a high that came on quicker and was more intense than with previously abused prescription drugs, such as Percocet. Initially popular in rural areas, OxyContin was dubbed "hillbilly heroin" and became one of the most highly abused street medications in history, particularly among teenagers looking for a quick and mellow high, one that could be pulled right out of their parents' medicine chests.

Pain Killer: A 'Wonder' Drug's Trail of Addiction and Death is Meier's page-turning expose of OxyContin and America's pain industry. He details how OxyContin went from the almost exclusive domain of cancer patients to a mass-prescribed miracle weapon in a new war on pain; in turn it became a billion-dollar baby for its makers, Purdue Pharma -- and one of the fastest growing drugs of abuse in recent history.

Pain Killer tells a story that goes back decades and spins itself around the globe from young abusers in rural Virginia to the opium poppy growing industry on the island of Tasmania. Meier grounds a complex topic in colorful characters that provide his book with a true narrative. There's Dr. Art Van Zee, a small-town physician who witnesses Oxy savage his community. There's Lindsay Myers, a well-heeled cheerleading teenager who's handed a pill in a friend's car one day and is soon munching the drug like Junior Mints at a matinee. There's Purdue Pharma, a relatively unknown drug company that marketed the drug to doctors with unprecedented aggression. There's the FDA, an agency whose staggering screw-up led to a mislabeling of the drug as less easily abused than other prescription narcotics because of its slow release mechanism. And there are the well-meaning doctors who took the FDA's approval and ran with it.

Salon recently sat down with Meier at a Manhattan cafi to talk about the history of OxyContin, new allegations against the drug's maker Purdue Pharma, and a certain larger than life talk show host who was addicted to Oxy.

You describe the OxyContin epidemic as the "perfect medical storm." What's the Cliff's Notes version of that storm?

Essentially, it's a classic story of what happens when doctors' good intentions and the drug industry's quest for profit force medical practice to run far ahead of scientific fact or reality. The result is often a catastrophe. And that's what happened here.

Why is it that OxyContin abuse hit the teen community hardest?

The old saw within the tobacco industry was that if kids weren't hooked on cigarettes by the time they were 18, you've lost them. Prescription drugs were never marketed to kids, but they are still getting to them. Every generation of kids experiments, but today's teens are messing with a class of drugs that have far greater consequences and potential to addict than when I was a teenager.

The general consensus among addiction specialists is that people who become addicted during their teenage years face a lifetime of risk of continued addiction. At a meeting in early 2000, a New York state drug regulator named John Eadie reported that he was seeing data revealing skyrocketing rates of young people experimenting with prescription narcotics. Eadie said, "Look, we're facing the possibility that we are going to create a new generation of lifelong legal narcotics users and it's unfolding right before us -- and we need urgent action to avoid a calamity." But his warning went unheeded.

Unheeded by whom, exactly?

By everybody. His colleagues. The pharmaceutical companies. The government. You name it.

Why did OxyContin abuse spread so rapidly compared with that of other narcotics like Percocet?

Because of its purity. All the previous painkillers were a combination of oxycodone, and either aspirin or acetaminophen. OxyContin is pure oxycodone, so you can take one Oxy and it's like getting heroin that's been stomped on. It's a huge bang for your buck.

Clearly OxyContin has been a boon for many people -- cancer patients and others with long-term pain -- most of who dont ever abuse it.

You see a pattern with painkillers like OxyContin, antidepressants, and other drugs. And that pattern is that drugs that do have value in a specific setting see their use broadened without any scientific basis to justify that taking place. Two recent examples include the broadening use of Ritalin and antidepressants in children. How and why a drug's use expands is a fascinating story. It tells us a lot about the ways that doctors operate, drug companies operate, and what are society's anxieties, demands, and expectations. Treatments become popular without scientific evidence to back their popularity. Why? Because it's in someone's vested interest to make it that way. And it's not simply the vested interest of the drug company at times, it may be the vested interest of the insurance company who doesn't want to pay for what may be a better but more expensive treatment.

Next Page: Lots of well-meaning doctors got conned.

• View blog reactions