Oxycodone Concepts

Pain Killer: An Empire of Deceit and the Origins of America’s Opioid Epidemic

by Barry Meier · 29 Oct 2020

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popular painkillers sold under names such as Percocet, Percodan, and Tylox. The active ingredient in those drugs is a narcotic called oxycodone, and each pill typically contained 5 milligrams of oxycodone mixed with 500 milligrams of an over-the-counter pain reliever such as aspirin or acetaminophen. OxyContin was very different. It

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was pure oxycodone, and the weakest dosage contained 10 milligrams of the narcotic, twice as much as in its predecessors. It was also available in much higher dosages,

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including 20, 40, 80, and 160 milligrams of oxycodone. In terms of pure narcotic firepower, OxyContin was a nuclear weapon. The drug was first marketed in 1996 by a little-known Connecticut company named

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Purdue Pharma. To produce OxyContin, Purdue used a patented time-release formula that allowed the company to pack large amounts of oxycodone into the drug. The tablet’s narcotic payload was released gradually, some reaching the patient’s bloodstream within the first hour, and the remainder over

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Vicodin and Lortab, two popular prescription painkillers that contained hydrocodone, another narcotic. The medical establishment believed then that hydrocodone posed a lower addiction threat than oxycodone, and federal regulations governing hydrocodone-containing drugs were looser, making them easier for doctors to prescribe. But none of these drugs had prepared Davies and

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Administration (FDA) of Stravino’s phone call. That filing read in part: “Physician reports that unidentified patients (children, teenagers and adults) using OxyContin (controlled-release oxycodone hydrochloride) for unknown reasons ‘come to the hospital with overdoses and abscesses because of injections.’ Reportedly, children in the area are ‘crushing, snorting and injecting

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in medicine soon became more widespread than opium. Researchers continued to isolate other chemicals from opium, including thebaine, the starting material in the production of oxycodone, the active ingredient in drugs such as Percocet and OxyContin. It had already become apparent by the mid-nineteenth century that opioids carried a price

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a sign that a physician was running a “pill mill.” States such as New York, which monitored prescriptions for Schedule II narcotics like morphine and oxycodone, had typically adopted the systems in response to outbreaks of prescription-drug abuse. For years, both drug companies and the American Medical Association, the professional

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why it believed that a time-release drug would be less prone to abuse than standard painkillers. The company stated: A controlled-release formulation of oxycodone may have less abuse potential than drugs such as Percodan for several reasons. First, most illicit drug abusers prefer a drug that is rapidly acting

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. The controlled-release formulation will have a longer acting effect without producing an immediate euphoria. In addition, the tablet formulation of the controlled-release oxycodone will be more difficult to dissolve in a solution, hence not desired by the “street” addict, who prefers an injectable solution. Second, the controlled-release

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formulation of oxycodone will not be targeted for patients who might otherwise be treated with codeine [a painkiller with less abuse potential than oxycodone] as has been the case [by some makers of oxycodone-containing drugs like Percodan] in the past. As previously stated

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, this controlled-release formulation of oxycodone will be useful in the treatment of patients with acute or chronic moderate

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drug was particularly acute for so-called “opioid naïve” patients, or those who had not taken narcotics before. The drug’s label also noted that oxycodone-containing painkillers were “common targets for both drug abusers and drug addicts.” But the claim that the FDA allowed Purdue to make for OxyContin trumped

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non-malignant. The release of the results of such a survey would be publicized along with the recent FDA approval of a new controlled-release Oxycodone preparation: OxyContin. This is a classic problem/solution strategy to create a need for the launch of a product such as OxyContin. It’s not

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NX. Like many narcotic painkillers, naloxone was also derived from the opium poppy, but it had an opposite effect to drugs such as heroin or oxycodone. Instead of stimulating “receptors,” or neurotransmitters, in the brain and producing a high, naloxone blocked chemical transmissions at those sites, reversing the impact of a

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other factors can we identify that would explain this kind of regional diversity in the abuse of the drug? 8. Replace OxyContin with Oxy/Nx—oxycodone/naloxone, which would presumably cut down substantially on the amount of abuse of the drug. Art Van Zee, M.D. After glancing at the document

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, Purdue distributed pie charts intended to show that the number of overdose reports involving hydrocodone-containing painkillers like Vicodin was far higher than that involving oxycodone-containing drugs like OxyContin. These statistics, while not false, were misleading, because painkillers that contained hydrocodone were prescribed at three times the rate of those

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that contained oxycodone. At the center of Purdue’s defense was a sheaf of testimonies from satisfied pain patients. Company executives, after careful coaching by communications consultants, insisted

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that the DEA would lower the limit on imports into the United States of thebaine, the opium-derived substance used to make OxyContin and other oxycodone-containing drugs. “We were getting creamed; we were getting killed,” Robin Hogen later told a gathering of corporate communications executives. “It was like being a

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of the Chief Medical Examiner in Maine. This data reports that during 1999 and part of 2000, there were 12 overdose deaths in which oxycodone was identified. Oxycodone was the sole chemical identified in only two cases, one of which was a suicide. • As of this writing, we have only been able

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13, 1996 to December 1, 2000, there were 58 reported “Drug Deaths.” Of these deaths, seven involved oxycodone as one of the agents causing death due to multiple drug toxicity. In no case was oxycodone listed as a single cause of death. We have no information at this point as to whether

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any of these deaths involved OxyContin. • We are attempting to obtain data on the reported deaths in western Virginia involving oxycodone. We were told by one of the medical examiners in The Chief Medical Examiners Office of Virginia that there had been 31, not 28 deaths

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in western Virginia since 1997 involving oxycodone. Unfortunately, the authorities have not complied with our requests for information on the reported deaths. We have asked Attorney General Earley to help us obtain

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also argued that the DEA’s singular focus on OxyContin’s role was misguided because it ignored the fact that forty other prescription drugs contained oxycodone as their active ingredient. “More importantly, there’s little evidence that restricting patients’ access to painkillers will do much to fight drug abuse,” the USA

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, the number of emergency-room reports involving prescription narcotics started to soar. Between 1994 and 2001, DAWN data showed, references in emergency-room reports to oxycodone-containing painkillers such as OxyContin climbed by 350 percent. This rate of growth far outpaced the rise in incidents involving hydrocodone-containing painkillers like Vicodin

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, even though those drugs were prescribed three times more often. In fact, by 2001 the total number of reports mentioning oxycodone-containing painkillers was fast approaching those for hydrocodone-based drugs. It was a tragic marker of Purdue’s success in marketing OxyContin. The company, hoping

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drop the claim that OxyContin’s time-release formulation might reduce its risk of abuse compared to traditional painkillers. Instead, the new label would read, “Oxycodone can be abused in a manner similar to other opioid agonists, legal or illicit.” Purdue also agreed to put a black-box warning on OxyContin

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agency wanted every medical examiner’s report, autopsy report, and police report connected with any drug-overdose death during the previous eighteen months in which oxycodone had turned up in the blood or bodily fluids of the dead. About that same time, OxyContin had attracted the attention of other federal officials

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OxyContin, or about nine prescriptions a day. During Paolino’s time prescribing, five people around Bensalem, four of them teenagers, died of drug overdoses involving oxycodone. The hearing took place at a pivotal time for Purdue. Only a month had passed since the company, following discussions with the FDA, had sent

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the manufacture of pharmaceutical tablets]. These issues need to be resolved. Then Goldman referred directly to the risk posed by OxyContin: “Now that controlled-release oxycodone [OxyContin] has been licensed in Canada, we can expect that it and other controlled-release opioid analgesics will also find their way onto the black

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, she was filing call reports about how Norton’s patients were abusing OxyContin by crushing a tablet with their teeth and then swallowing or snorting oxycodone. (Her notes, written quickly, contained abbreviations, typos, and misspellings.) After one of these visits to Norton, she wrote: SAID PATS [patients] NOT DOING SO WELL

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OxyContin, and charged him with fraud as well as murder in connection with the deaths of three of his patients from drug overdoses that involved oxycodone. Prosecutors showed that in 1998 Fisher had written a startling 46 percent of all the prescriptions for OxyContin issued through a California state program for

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low-income patients. That same year, a pharmacy near his office had purchased nearly four times as much OxyContin and other oxycodone-containing painkillers as any other retail drugstore in the United States. The drugstore’s owners denied any wrongdoing, while Fisher maintained that his prescribing practices

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started hearing complaints in 1999 from area pharmacists that Graves was inappropriately prescribing OxyContin, particularly higher-strength tablets that contained 40 or 80 milligrams of oxycodone. He was also concerned that Graves was using a Purdue promotional campaign to give patients free samples of OxyContin. Within the pharmaceutical industry, it is

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the 1,300 separate death reports that medical examiners had sent to the DEA in response to the agency’s request for data on fatal oxycodone-related overdoses. Gauvin discarded 350 reports as not substantial enough for his analysis. He then extracted data from the remaining 950, in order to determine

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how often OxyContin had been the source of the oxycodone found during the autopsies or toxicological examinations of overdose victims. Nagel had suspected that the percentage would be high. But Gauvin’s findings exceeded her

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or police information showed evidence of an OxyContin tablet or prescription in relationship to the body. Another category, “OxyContin likely,” included toxicology tests that detected oxycodone but not aspirin or acetaminophen—the over-the-counter analgesics found in traditional painkillers but not in OxyContin. Some 145 cases, or about 15 percent

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showed that victims also had traces of tranquilizers and antidepressants in their blood. Gauvin knew that doctors frequently prescribed those medications to pain patients taking oxycodone to help them cope with anxiety, and, to him, the finding indicated that patients taking OxyContin were overdosing. Nagel thought the results were so significant

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also be lethal, particularly in the hands of someone who is unaware of how it works. Methadone does not produce a high as quickly as oxycodone and lingers in the body for far longer, making it likely that an inexperienced user, waiting for a quick rush, will take more of it

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and overdose. As the demand for painkillers mounted, manufacturers of pills containing oxycodone or hydrocodone started sending huge quantities to hot spots where OxyContin abuse had been rampant. Mexican drug cartels, recognizing America’s growing appetite for opioids

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2007 and 2012, the three biggest wholesalers of prescription drugs in the United States—McKesson, Cardinal, and AmerisourceBergen—shipped 780,000,000 pain pills containing oxycodone or hydrocodone to West Virginia, a state already rife with opioid addiction, a newspaper there reported. The volume represented a quantity large enough to supply

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.” It was conducted by Dr. Sanford Roth and published in the Archives of Internal Medicine on June 26, 2000, as “Around the Clock, Controlled Release Oxycodone Use in Osteoarthritis.” “Howard, Michael, and Paul agree”: This email, concerning the continuing distribution of the Roth study, was written in August 2003 and was

Dopesick: Dealers, Doctors and the Drug Company That Addicted America

by Beth Macy · 4 Mar 2019 · 441pp · 124,798 words

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

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was set to expire, the company launched OxyContin to fill the void, with the intention of marketing the new drug, a reformulation of the painkiller oxycodone, beyond hospice and end-of-life care. It was a tweak of a compound first developed in 1917, a form of

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oxycodone synthesized from thebaine, an ingredient in the Persian poppy. Famously private, the brothers were better known for their philanthropy than for their drug-developing prowess,

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quicker fix. Little did Davis or the other ER docs understand that the routine practice of sending patients home with a two-week supply of oxycodone or hydrocodone would culminate by the year 2017 in a financial toll of $1 trillion as measured in lost productivity and increased health care, social

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they wished it had never been prescribed for them. Van Zee’s neighbors were dying. The region had now buried forty-three people, dead of oxycodone overdose, since Purdue launched its drug. Addicted users had gone from snorting to routinely injecting the liquefied crushed-up powder with livestock syringes they bought

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, rather than controlled, release of the drug; that withdrawal symptoms had been witnessed in several patients during clinical trials; and that 68 percent of the oxycodone was in fact recoverable from one single, crushed-up pill when liquefied and injected. In a summary of his approval, Wright had even urged caution

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,” one supervisor advised an employee, saying it might “add to the negative press”). Another fact highlighted the claim sales reps made to some doctors that oxycodone was harder to extract from OxyContin for IV use than other pain medications—when Purdue’s own study showed that a drug abuser could recover

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the half dozen high school football and snowboarding injuries that landed him in doctors’ offices and emergency rooms, where he was prescribed opioid painkillers including Oxycodone, Vicodin, and Percocet “thirties,” as he later referred to the 30-milligram pills, his drug of choice. “The boy had so many rounds of stitches

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said. * Christopher was two weeks into his first residential-treatment stay when word reached him that a good friend had fatally overdosed on 30-milligram oxycodone pills and other narcotics. It was Colton Banks, Drenna’s son. “It tore me up pretty good,” Christopher remembered. “Colton was the nicest guy ever

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baby’s head had been resting on her spine throughout her last trimester. When the Lortab ran out, her obstetrician wrote her another script, for oxycodone. Within six weeks of giving birth, Ashlyn said, she was hooked. When her doctor left town after a few months and his replacement refused her

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users have about injecting and, later, the telltale track marks. It meant some would buy counterfeit pills that were sold to them as Xanax or oxycodone but were actually fentanyl. In his earliest days of working undercover drugs, Perkins had gone by the name Woody Call and wore the classic Serpico

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give ’em enough so they can sell it and stay in treatment,” Melton recalled. Buprenorphine is the third-most-diverted opioid in the country, after oxycodone and hydrocodone. * Hope Initiative angels like Jamie Waldrop and Janine Underwood were opposed to buprenorphine because, based on their sons’ experience, it was too easily

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-ray and an exam to rule out a break, the doctor wrote her fifteen-year-old a prescription for a twenty-five-day supply of oxycodone. “I tore it up,” Janine said. She also called clinic official Dr. John Burton, who said of the incident: “This was a provider who was

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.” A come-to-Jesus ensued, with Burton reminding the doctor of the hospital system’s ER policy of no more than three days’ worth of oxycodone or hydrocodone per prescription, sans refills. During the Q&A at the end, Patricia stood in the audience and described Tess’s descent from Cave

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, The Purdue Frederick Company, Inc., et al., 13. 68 percent of the drug: Point No. 20(a.), The Purdue Frederick Company, Inc., et al., 6. oxycodone was harder to extract: Ibid. OxyContin caused less euphoria: Point No. 43, 14, The Purdue Frederick Company, Inc., et al. CHAPTER FOUR. “THE CORPORATION FEELS

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, by Detective P. B. Caldwell: “Based on my training and expertise, the currency [$1,350 found on site in cash] and the extreme shortage of oxycodone would indicate the distribution of these pills.” supposed to be his last hurrah: Author interview, Banks, Dec. 15, 2015, and March 23, 2017. chucking her

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, 198, 208, 245; and prostitution, 56; statistics on, 145; susceptibility to theft, 35 opium, 21–23, 26, 59, 218, 250 Overmountain Recovery, 292–95, 301 oxycodone: and crushing of OxyContin pills, 63, 66, 86, 136; and drug diversion, 214; fentanyl sold as, 201; overdose deaths from, 49; OxyContin as reformulation of

Empire of Pain: The Secret History of the Sackler Dynasty

by Patrick Radden Keefe · 12 Apr 2021 · 712pp · 212,334 words

for other opioids, in order to secure new patents. Decades later, Richard’s cousin Kathe Sackler would claim that it was she who first suggested oxycodone. Kathe was also a medical doctor who had received her degree from NYU in 1984. She was in some respects very similar to Richard:

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. The drug was already widely available as a painkiller, in mild treatments like Percodan and Percocet. But there was only a small amount of oxycodone in those pills, because in Percodan it was mixed with aspirin and in Percocet it was mixed with acetaminophen, both of which can be toxic

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if a person takes too much of them. If you deployed pure oxycodone using the Contin system, however, it might be possible to administer a larger dose that would filter slowly into the bloodstream, allowing the patient

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late eighties,” he said. According to Richard, it was Bob Kaiko’s idea, not Kathe’s. Indeed, in the 1990 memo, Kaiko had suggested oxycodone, saying that it was “less likely to initially have generic competition.” Though the company had moved to Norwalk, it continued to have a presence in

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took a job at the research center in 1992 and spent the next fifteen years working at the company. He ended up assigned to “the oxycodone project,” as it was then known. The initial efforts at creating a formulation had not been successful, and by the time Wilson arrived, the

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liked him: Kaiko had a great deal of experience treating people with narcotics, and he believed passionately in the therapeutic potential of a controlled-release oxycodone product. Richard Sackler was also a frequent presence, and Wilson liked him, too. Richard could be imperious, but to Wilson it seemed that he

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wanted to be kept in the loop but took no specific interest in the work going on in the trenches: when it came to the oxycodone project, Richard was in the trenches himself. “He worked hard. I think he never slept,” Wilson said. “I wasn’t the only one who

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employees thought he was a pain in the ass, but there was a compulsion in this behavior, a single-minded devotion to making the new oxycodone product a worthy successor to MS Contin. The younger generation of Sacklers were becoming increasingly involved in the company. Richard officially joined the board

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a literature” to support this kind of positioning. They would suggest OxyContin for “the broadest range of use.” Still, they faced one significant hurdle. Oxycodone is roughly twice as potent as morphine, and as a consequence OxyContin would be a much stronger drug than MS Contin. American doctors still tended

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patient/addiction.” At the same time, the memo noted, these surgeons would welcome the idea of a long-acting pain pill that was not morphine. Oxycodone, the former executive pointed out, “didn’t have the stigma.” Different drugs have different “personalities,” Michael Friedman liked to say. When he and Richard

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a very different personality. In their market research, the team at Purdue had realized that many physicians regarded oxycodone as “weaker than morphine,” Friedman said. Oxycodone was less well known, and less well understood, and it had a personality that seemed less threatening and more approachable. From a marketing point

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as addictive. Now, in internal discussions at Purdue headquarters in Norwalk, Richard and his colleagues entertained the notion of a similar marketing strategy. In truth, oxycodone wasn’t weaker than morphine, either. In fact it was roughly twice as potent. The marketing specialists at Purdue didn’t know why, exactly, doctors

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this misapprehension about its being weaker, but it might have been because for most physicians their chief exposure to oxycodone involved the drugs Percocet and Percodan, in which a small dose of oxycodone was combined with acetaminophen or aspirin. Whatever the reason, Richard and his senior executives now devised a cunning

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strategy, which they outlined in a series of emails. If the true personality of oxycodone was misunderstood by America’s doctors, the company would not correct that misunderstanding. Instead, they would exploit it. Like MS Contin, OxyContin could be

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these pain specialists were validating the commercial research and development that Richard and his colleagues were doing at Purdue. “Until last week, our belief that oxycodone in high dose might be a satisfactory alternate to high-dose morphine was supposition,” Richard informed colleagues, excitedly, one day in 1991, when the company

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developing OxyContin. “As recent as this past July, Dr. Kathleen Foley told me that ‘The idea is very promising, but whether one can use oxycodone in high doses for cancer pain is not known because nobody has ever used it.’ ” But Foley had been working with

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oxycodone liquid, administering it in large doses to patients, Richard explained, and “it has performed excellently,” with “no unexpected side effects.” She was giving patients

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should be reserved for more severe pain.” In one 1997 exchange with Richard Sackler, a company official pointed out that many physicians believed, erroneously, that oxycodone was weaker than morphine, when in fact it was twice as strong, and said, “It is important that we be careful not to change

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the pills—even if you just chewed them with your teeth—you could override the controlled-release mechanism and unleash a mammoth hit of pure oxycodone. It did not take much trial and error to make this discovery. In fact, each bottle came with a warning that, in retrospect, doubled

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an inadvertent how-to: “Taking broken, chewed, or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose of oxycodone.” Meier spoke to law enforcement sources who described an active black market in OxyContin. He talked to pharmacists and doctors who testified to the aggressive

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community. “We are in the middle of a real fight,” Richard Sackler declared when the DEA discussed the possibility of tightening the quotas on legal oxycodone that Purdue would have access to. “This is a clear attack on the pain movement. There can be no other interpretation.” Richard’s strategy,

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possibility. But as the prosecutors discovered, the company had studied just that, conducting a so-called spoon and shoot study to determine how much oxycodone someone could get by dissolving one of the pills in liquid. The study found that most of the narcotic payload of OxyContin could be accessed

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in 1999 in which Friedman said, “I mean, we have an OC pill that’s 80 milligrams per pill. Now, that is as much oxycodone as in 16 Percocet tablets…That’s why the addicts want to go after our pills.” Even Purdue’s claims about its own noble contributions

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death was high blood pressure and cardiovascular disease. But he had two opioids in his bloodstream, according to a toxicology report, one of which was oxycodone. Ira had recently been released from a detox center. He had pills in his pocket when he died. Johnny, the construction worker, also struggled

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no longer confined to rural areas. The death of the actor Heath Ledger that January, from an overdose involving a long list of painkillers, including oxycodone, brought a new level of national attention to the problem. Fatality numbers were on the rise, and on Capitol Hill, Senator Joe Biden called

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went in-house, camping out in a conference room at Purdue headquarters. Sales of OxyContin were at an all-time high, but the amount of oxycodone prescribed by American doctors was beginning to flatten. Ed Mahony, Purdue’s chief financial officer, warned the Sacklers that projections now indicated sales of

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with the “OC” that had traditionally adorned each pill but with “OP” instead. The payload in these new pills was precisely the same: pure oxycodone. It was the coating that had been reinvented. As far back as 2001, people at Purdue had been talking about the possibility of a silver

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marquee product from abuse. But another element might have been the fact that some of Purdue’s competitors were also racing to devise a crushproof oxycodone pill. If one of these other companies beat Purdue to market, they could promote their pill as a safer alternative to OxyContin. “Purdue should

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a prescription for OxyContin or other strong opioids. Now, on top of these other challenges, the pills stubbornly refused to deliver the full rush of oxycodone right away. As a consequence, many people simply gave up on OxyContin. In an ideal world, they would have just quit cold turkey, braving

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variety of super poppy that’s been genetically engineered to produce a higher proportion of thebaine, an alkaloid that is the key chemical precursor for oxycodone. At the Westbury facility, the poppies are harvested, then processed into a concentrated extract that is flown to the United States, where the raw

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narcotic material can be processed into oxycodone and other opioids. This is the breadbasket of the opioid boom. Though it is only about the size of West Virginia, Tasmania grows 85

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immune to these pressures and proceeded to soften its position under a steady barrage of industry encouragement. Between 1994 and 2015, the quota of oxycodone that the DEA permitted to be legally manufactured was raised thirty-six times. A subsequent report by the inspector general of the Justice Department criticized

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made it revolutionary—what made the Sacklers so proud of it—was the innovative mechanism that enabled Purdue to pack forty or eighty milligrams of oxycodone into a single pill. Moreover, OxyContin was the drug to “start with and to stay with.” Purdue’s business model was predicated on pain

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Wall Street Journal, when you take into account the dosage strength of each pill, Purdue actually accounted for a market-leading 27 percent of all oxycodone sold. In a separate analysis, ProPublica found that if you adjust for potency, in some states Purdue’s market share of all opioid painkillers—

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not just oxycodone—was as high as 30 percent. In making the case that they had only ever been bit players, the Sacklers and Purdue pointed a finger

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the generic giant Teva and well ahead of Johnson & Johnson and Endo. Rhodes produced a generic version of MS Contin, but also immediate-release oxycodone, a drug that was widely abused. An article on Purdue’s website, “Common Myths About OxyContin,” complained about the “misperception that all

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oxycodone abuse involves OxyContin,” suggesting that immediate-release oxycodone was also to blame, without acknowledging the awkward fact that the Sacklers happened to produce both drugs. Inside Purdue, staff recognized,

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the safety of its tamper-resistant opioid might ring hollow if the public understood that a related company, Rhodes, was still busy producing immediate-release oxycodone that was not tamper-resistant. In one internal email, a Purdue executive, Todd Baumgartner, discussed the “secretive” manner in which the company sought to

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possibilities: “The Secretive Family Making Billions from the Opioid Crisis,” Esquire, Oct. 16, 2017. Kathe suggested using oxycodone: Kathe Sackler Deposition. According to Kathe: Ibid. a different recollection: RDS 2019 Deposition. Kaiko had suggested oxycodone: Kaiko to Richard Sackler, memorandum, July 16, 1990, cited in Kessler Report. Wilson liked him: Interview

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). A Purdue training manual instructed sales reps to inform physicians that “abuse is less likely with OC because it is more difficult to extract the oxycodone from the controlled-release system.” “care should be taken”: Overall Conclusion to 1995 FDA Review, Curtis Wright, Oct. 1995. Cited in Massachusetts Complaint. had “

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Formulation of OxyContin,” news release, April 5, 2010. permitted a claim: “Purdue Pharma L.P. Statement on FDA Approval of New Label for Reformulated OxyContin® (Oxycodone HCL Controlled-Release) Tablets CII and Citizen Petition Regarding Withdrawal of Original Formulation due to Safety,” April 18, 2013. “the extent to which the new

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LP Citizen Petition, No. FDA-2012-P-0760 (July 13, 2012), arguing that if generic versions of OxyContin were allowed, “abuse of extended release oxycodone could return to the levels experienced prior to the introduction of reformulated OxyContin.” In case there was any uncertainty about the company’s motives, a

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of Washington v. Purdue Pharma, L.P. et al., Sept. 28, 2017. “no longer outweigh” the risks: “Abuse-Deterrent Properties of Purdue’s Reformulated OxyContin (Oxycodone Hydrochloride) Extended-Release Tablets,” Memorandum from Douglas Throckmorton to Janet Woodcock, April 16, 2013; “FDA Bars Generic OxyContin,” New York Times, April 16, 2013. “Purdue

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is gratified”: “Purdue Pharma L.P. Statement on FDA Approval of New Label for Reformulated Oxycontin® (Oxycodone HCL Controlled-Release) Tablets CII and Citizen Petition Regarding Withdrawal of Original Formulation due to Safety.” He demanded “intelligence”: Richard Sackler to Gasdia, Jan. 30

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“Drug Is Harder to Abuse, but Users Persevere,” New York Times, June 15, 2011. a subsequent study: Tara Gomes et al., “Reformulation of Controlled-Release Oxycodone and Pharmacy Dispensing Patterns near the US-Canada Border,” Open Med, Nov. 13, 2012. maintains that it alerted authorities: Robert Josephson, email, Oct. 19, 2017

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Robert Josephson statement to New Yorker, Oct. 19, 2017. to some who worked at Purdue: New York Complaint. Rhodes Pharmaceuticals: “RI Is Home to Major Oxycodone Manufacturer and Marketing—State Is Suing Parent Company,” GoLocal Prov, Sept. 11, 2018. uncovered by the Financial Times: New York Complaint; “Billionaire Sackler Family Owns

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“landing pad”: “How Purdue’s ‘One-Two’ Punch Fuelled the Market for Opioids,” Financial Times, Sept. 10, 2018. seventh-largest opioid manufacturer: Ibid. immediate-release oxycodone: Deposition of Richard J. Fanelli, In re National Prescription Opiate Litigation, MDL No. 2804, U.S. District Court for the Northern District of Ohio, Dec

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’ could cause problems if investigations of the opioid crisis expanded.” Delaware Complaint. “their own ‘beach type’ folding chairs”: “Pain Doctor Who Prescribed Large Amounts of Oxycodone Pleads Guilty to Fraud,” Boston Globe, March 15, 2017; Department of Justice, “Physician Sentenced to Prison for False Billing Scheme,” press release, Feb. 6,

American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic

by John Temple · 28 Sep 2015 · 308pp · 96,604 words

throughout the car.” It wasn’t good news, but, hey, add it to the list of administrative headaches that came with running the biggest oxycodone clinic in the country. Headaches like the upstart pain clinic that was getting ready to open in Jacksonville. Those crooks were trying to steal Derik

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regularly used cocaine. And like cocaine before it, the illicit painkiller trade was dominated by one state: Florida. But the similarities between cocaine and oxycodone ended there. Oxycodone wasn’t created in Colombian jungle laboratories or smuggled in suitcases or on thirty-foot “go-fast” speedboats. It was manufactured in pharmaceutical plants

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simply displayed the goods: an amber prescription bottle, dozens of little blue pills tumbling out. Florida pumped millions upon millions of doses of those narcotics—oxycodone, mostly—northward, not through a major criminal organization like the cartels of Mexico, but via thousands of individuals who streamed up and down Interstate 75

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Kentucky. Cops and reporters called these clinics “pill mills,” and American Pain was the king of them all. Its doctors distributed massive quantities of oxycodone to hundreds of customers a day. The clinic had already moved three times in less than two years; its current location was a ten-thousand

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Overstreet had told Chris to order generic versions of Roxicodone instead of the better-known but more expensive OxyContin. They were basically the same drug—oxycodone—but Overstreet also believed OxyContin prescriptions were more closely monitored than the generics. Plus, a lot of recreational users seemed to prefer roxies, especially the

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with flecks of spit when they finally reached the customer window. Or just standing there in a stupid opiate haze, drawling in that distinctive guttural oxycodone register, as if the drug had dulled their voice boxes along with everything else. Derik called them zombies. Dumb and slow, but you had

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optimization expert to make sure that South Florida Pain’s website popped up early in pain clinic searches. When people searched keywords like “pain medication,” “oxycodone,” or “pain clinic,” a link to South Florida Pain’s website came up on the first page, often within the top five links. The

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had Mallinckrodt-made “blues” in stock. For patients, this meant one-stop shopping and no hassling with pharmacists who might question the flood of oxycodone scrips pouring out of South Florida Pain. But as the number of patients grew, it became harder to keep the dispensary stocked all the time

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d read medical texts and histories of past temperance movements. He’d delved deep into obscure corners of the Federal Register to find statistics about oxycodone production. He’d searched newspaper archives for information about pharmaceutical companies. He couldn’t believe he hadn’t figured out sooner what was going on

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’s a sticky yellow residue, opium contains the elemental ingredients for the vast array of illegal and legal opioid narcotics made today, from heroin to oxycodone. Opioids subdue pain. They work beautifully, blocking electrical and chemical signals before they can leap the synapse from one nerve cell to the next.

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companies developed and released an ever-expanding lineup of narcotics of different strains and mixtures and strengths. Vicodin, a mix of hydrocodone and acetaminophen. Percocet, oxycodone and acetaminophen. Fentanyl, usually administered through a skin patch. MS Contin, a long-acting morphine formulation. Sometimes researchers thought they’d found one that didn

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would expire soon, which meant that cheaper generic versions would soon be eating into its market share. The company was developing a new drug, an oxycodone pill it would call OxyContin. Like MS Contin, OxyContin was a controlled-release pill. Swallowed, the dose broke down slowly in the digestive system,

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out over twelve hours. This meant Purdue could pack much more oxyco-done into each pill. Percocets contained doses of 5 or 10 milligrams of oxycodone. By contrast, OxyContin came in doses of 10 milligrams, 15 milligrams, 20 milligrams, 30 milligrams, 40 milligrams, 80 milligrams, and even the whopping 160-

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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

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the dirtiest of street junkies. Whereas, “pain pills” had been systematically sanitized in the public’s mind. Even in the flood of news stories about oxycodone deaths, reporters and experts referred to prescription narcotics as if they were, at worst, a gateway to the hard stuff. As a pharmacist, Golbom could

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legal. Two, it was pharmaceutical-grade—you knew exactly what was in it, unlike a bag of heroin bought on the street. Other than that, oxycodone addiction and heroin addiction were the same thing. Nevertheless, Purdue had inflated the market for opioids, and other pharmaceutical companies rushed to meet the demand

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gone after Purdue, and the Centers for Disease Control and Prevention had published report after report on painkiller deaths. Lawmakers held hearings and railed about oxycodone crime and addiction in their districts. The DEA stepped up its investigations of doctors whose patients had died after receiving huge prescriptions. On the other

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important and least recognized duties is to decide how much of each controlled substance can be manufactured. If the DEA decides that the amount of oxycodone being made exceeds the “medical, scientific, research, and industrial needs of the United States,” it can reduce the drug’s production, simply cut it

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twenty times the amount manufactured just fourteen years earlier. Twenty times. Less than four tons compared to seventy-seven tons. And it wasn’t just oxycodone. Between 1996 and 2007, the DEA had nearly quadrupled the production of hydrocodone, allowed manufacturers to produce almost ten times the amount of fentanyl, and

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New patients were supposed to have clean urine, unless they said they had been prescribed something already. Return patients were supposed to be positive for oxycodone, but not illegal drugs like ecstasy or cocaine or marijuana. Patients also were required to fill out numerous pages of paperwork before seeing a doctor

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for a long time. They wanted the clinic’s dispensing logs. They told him they were inspecting South Florida Pain because of the quantities of oxycodone that had been ordered in the doctors’ names. Another pair wanted to audit the pharmacy, examine purchasing records and inventories to make sure the pills

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up a report. Stacy’s toxicology report came back a few weeks after his death. The medical examiner found that Stacy had died from “acute oxycodone and alprazolam intoxication.” Trace amounts of hydrocodone and marijuana were also detected in his system. Sheriff Peters didn’t take it any further than that

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other intensive treatments. OxyContin appeared in 1996, and its purity and strength was like nothing eastern Kentucky had ever witnessed. Stocking pharmacy shelves with pure oxycodone pills in the mountains was like throwing dry timber on a smoldering ground fire—the whole forest blew up. OxyContin didn’t spread like weed

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Dr. Cadet. So Shelby and Lisa began asking questions then and there. The women asked why the doctor had given Stacy so much oxycodone. That amount of oxycodone was dangerous. The man with the ponytail said: People build up a tolerance to these medications. Shelby said: But he’d never been

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and pains vanished. They made him feel like he could do backflips. Derik’s body generally had a number of pharmaceutical chemicals running through it. Oxycodone, for nights out. Anabolic steroids, of course, to keep the machine in prime condition. Adderall, to gun the engine—taking three at once was

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to him, which suited Derik fine. Almost all the doctors wrote Derik or other employees prescriptions at different points.* Jacobo Dreszer wrote Derik scrips for oxycodone 30s. Roni Dreszer wrote him for Adderall and amphetamines, sometimes just because the young doctor didn’t want the drugs in his own name; Derik

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’s prescription drug overdose death rate had risen to eleven a day, topping cocaine’s. Florida doctors and pharmacists were distributing almost twice as many oxycodone pills as the next-highest state, Pennsylvania.* All the federal agencies now agreed; something had to be done. Turner’s partner on the Kentucky

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from one run were enough to sponsor a carful of mules. The pipeline inspired its own lingo. For self-evident reasons, the junkies called the oxycodone 30-milligram pills made by Mallinckrodt “blues,” and the traffickers began calling I-75 “The Blue Highway.” State police staked out the Tennessee-Kentucky border

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drug runners that the flight was nicknamed “The Oxy Express.” Observers found it interesting that the Allegiant planes were the same powder blue as the oxycodone pills. Police in the states between Kentucky and Florida began to figure it out. If a multi-passenger car with Kentucky tags was heading north

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ran support groups and conducted educational presentations in schools. Pete Jackson, a biologist in Illinois, whose eighteen-year-old daughter died after taking a single oxycodone pill in 2006, founded Advocates for the Reform of Prescription Opioids, dedicated to ensuring that regulations surrounding prescription narcotics made scientific sense. Tina Reed, a

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The next five months, Tina watched her son spiral. She confronted his doctor, who refused to stop writing him prescriptions. Her son was caught snorting oxycodone again, and the family staged an intervention. He agreed to go to detox, but didn’t follow through. High at work, he accidentally cut off

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part of two fingers, which made it even easier for him to get oxycodone. Tina researched oxycodone and wrote letters about his doctor to the state board of medicine. Her son went to a detox program, then relapsed a few weeks

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Carmel Cafiero featured her on Channel 7. She talked to the White House’s drug czar when he came to Broward to learn about the oxycodone trade. Tina pushed state lawmakers to create a drug database that would prevent patients from doctor shopping. Thirty-two states had databases that tracked prescriptions

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drugs on the patients, tweaking the treatments as needed and seeking alternative solutions whenever possible. Mechanically stamping out prescription after prescription for high doses of oxycodone wasn’t practicing medicine. Investigations were usually triggered by complaints, typically from distraught relatives of pill seekers. Compared to many criminal defendants, doctors often

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through trial and error, created a template for a new industry. Chris George’s personal history and characteristics made him perfectly suited to conquer the oxycodone game. He was capable of straddling two worlds. He looked plausible in a business suit, was good at making calls about zoning bylaws and small

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find jobs or earn board certification. And some doctors who simply wanted an easy job and easy money. The third loophole that led to the oxycodone rush was that Florida law allowed doctors to sell narcotics themselves, no pharmacist needed. Pain clinics that charged for appointments and drugs could make a

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force eventually interviewed a number of these offenders about what they’d seen inside the clinic. A Boston drug trafficker was arrested with three thousand oxycodone pills from American Pain hidden in his jockstrap. The man told investigators he’d seen Dr. Beau Boshers, who hadn’t physically examined him

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the document. Boshers took his blood pressure but didn’t otherwise touch Lopez. The doctor jotted swift notes on the pages, wrote prescriptions for 120 oxycodone 30-milligram pills, plus some 15-milligram pills and Xanax. Lopez filled the oxy prescriptions at American Pain, but the pharmacy was out of Xanax

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his appointment times shrank and prescription amounts grew. The first time he was in Boshers’s office for thirteen minutes and received 120 30-milligram oxycodone pills. In August, he spent seven minutes in Boshers’s office and left with 150 pills. September, five minutes and 180 pills. October, four

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raid, the doctors of South Florida Pain and American Pain wrote 66,871 prescriptions for various medications. Ninety-six percent of the prescriptions were for oxycodone or alprazolam. More than 80 percent of the patients were from out of state.* The five American Pain doctors under investigation wrote prescriptions for fourteen

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the suffering and be a threat to the public.” The DEA also went after wholesalers, shutting down two distributors that had supplied American Pain with oxycodone: Sunrise Wholesale from Florida and Harvard Drug Group from Michigan. Sunrise surrendered its DEA license. Harvard, one of the ten largest wholesalers of generic

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the DEA to revise its oversight methods.* Spooked, many other drug wholesalers immediately stopped selling to Florida pain clinics. By July 2010, the amount of oxycodone doses purchased by Florida doctors had fallen from more than eight million per month to around one million. Out of prospects and almost out of

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by cash, check, or credit card, instead of insurance. Despite the furor, few people paid attention in 2010 when another DEA-approved hike in the oxycodone manufacturing quota took effect, boosting the output from 94,000 kilograms to 105,500 kilograms. This was more than twice the total manufactured in 2005

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fight against personal-injury claims. •The Federal Register and the Drug Enforcement Administration Office of Diversion Control website, www.deadiversion.usdoj.gov, contained information about oxycodone manufacturing quotas over the years. •The excellent story by Guy Taylor, “Mills Making the Pills,” published in the St. Petersburg Times on October 30,

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a month. •The 2008 Annual Report of the International Narcotics Control Board provided the statistics about the percentages of the global supply of hydrocodone and oxycodone that are consumed in the United States. •The 2004 book The Truth About the Drug Companies, by Marcia Angell, provided information about the pharmaceutical

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who opened pain clinics. •A GAO report from August 2011 entitled “Prescription Drug Control” provided the statistic that Florida doctors were purchasing nine times more oxycodone than the other forty-nine states combined. •A USA Today story on February 24, 2011, entitled “Florida Raids Target Sellers of Pain Pills” contained

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Businessweek and the Sun-Sentinel and a 2013 DEA presentation entitled “Prescription Drug Trafficking and Abuse Trends” provided details about the DEA’s shutdown of oxycodone wholesalers. •The Florida Department of Health Annual Report 2009–10 provided information about the number of pain clinics that registered with the state. •The

Dreamland: The True Tale of America's Opiate Epidemic

by Sam Quinones · 20 Apr 2015 · 433pp · 129,636 words

cells begin expanding beyond San Fernando Valley to cities across western United States. Their pizza-delivery-style system evolves. 1996: Purdue releases OxyContin, timed-released oxycodone, marketed largely for chronic-pain patients. 1996: Dr. David Procter’s clinic in South Shore, Kentucky, is presumed the nation’s first pill mill. 1996

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particular. 2014: The FDA approves Zohydro, a timed-release hydrocodone painkiller with no abuse deterrent. It also approves Purdue’s Targiniq ER, combining timed-release oxycodone with naloxone, the opiate-overdose antidote. PREFACE: Portsmouth, Ohio In 1929, three decades into what were the great years for the blue-collar town of

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priming the market, those overdoses stayed down. Purdue OxyContin is a simple pill. It contains only one drug: oxycodone, a painkiller that Germans synthesized in 1916 from thebaine, an opium derivative. Molecularly, oxycodone is similar to heroin. OxyContin riffed off an earlier Purdue product: MS Contin. MS Contin was Purdue’s first

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. Purdue marketed it to cancer patients and people just out of surgery, and MS Contin apparently served them well. Likewise, OxyContin contains large doses of oxycodone—40 and 80 mg typically—wrapped in a timed-release formula that slowly sends the drug into the body over several hours. It has legitimate

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decades. If a nonaddictive drug couldn’t be found, perhaps a new method for administering opiates would lead to less addiction. OxyContin theoretically parsed out oxycodone in a way that did not cause the intense highs and lows that caused addiction. This was an exciting possibility. All that testing at the

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1995, the FDA approved OxyContin for 10, 20, and 40 mg pills. Later, it added 80 and 160 mg pills. Despite the high doses of oxycodone loaded into each pill, the FDA bought the idea that by creating fewer surges of euphoria and depression OxyContin would be less addictive—the Holy

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last. The FDA approved a unique warning label for OxyContin. It allowed Purdue to claim that OxyContin had a lower potential for abuse than other oxycodone products because its timed-release formula allowed for a delay in absorbing the drug. “No other manufacturer of a Schedule II narcotic ever got the

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suffered badly. Purdue urged doctors to believe that Oxy was the drug to “start with and stay with.” The doctors needn’t worry because the oxycodone was released slowly over many hours. Thus, OxyContin did not create the steep highs and lows that created cravings. This message went out mostly to

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1 percent of patients ever grew addicted, they said in their presentations. This claim startled Prior because OxyContin contained large doses of the opiate called oxycodone. Prior had attended medical school in the early 1980s, where he had learned opiates were generally to be avoided. He’d remembered a study that

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concluded that daily usage of 30 mg of oxycodone was enough to cause withdrawal. The Purdue sales campaign contradicted “what we had learned in medical school. I was trained that they were dangerous, addictive

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). Purdue held some forty pain-management and speaker-training seminars. The company recruited physicians for its national speakers bureau to talk about the use of oxycodone—and by implication OxyContin—to doctors and nurses at medical conferences and hospitals. These conferences took place in Boca Raton, Florida, and Scottsdale, Arizona, and

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or cocaine on the street started pushing Oxy. Addicts learned to crush it and snort it, or inject it, obtaining all twelve hours’ worth of oxycodone at once. Seniors realized they could subsidize their retirement by selling their prescription Oxys to younger folks. Some of the first Oxy dealers, in fact

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.” The next Monday, Hughes began calling around. His staff told him the drug had started showing up recently, that it contained a large amount of oxycodone, and that users had learned to crush it and snort it. He called colleagues at treatment centers in northern Ohio, describing what Portsmouth was seeing

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the one that ran after that Christmas party. The story talked about a new trend in addiction in southern Ohio and neighboring states: opiates, primarily oxycodone, delivered most prominently in that new pill called OxyContin. About a week after the second story ran, Ed Hughes received a telephone call from a

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easy one. Oxy addicts began by sucking on and dissolving the pills’ timed-release coating. They were left with 40 or 80 mg of pure oxycodone. At first, addicts crushed the pills and snorted the powder. As their tolerance built, they used more. To get a bigger bang from the pill

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the Englishman Robert Twycross once smelled “the fear of addiction” as he stepped from an airplane, that now consumed 83 percent of the world’s oxycodone and fully 99 percent of the world’s hydrocodone (the opiate in Vicodin and Lortab). “Gram for gram,” a group of specialists wrote in the

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million prescriptions a year, as I write), and opiate painkillers the most prescribed class of drugs. U.S. sales of opiate painkillers quadrupled. Sales of oxycodone—the drug in OxyContin, but also sold in smaller-dose generic pills—rose almost ninefold between 1999 and 2010. A rising sea level of opiates

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, timed-release OxyContin arrived—in doses of 40, 80, and, for a while, 160 mg of oxycodone. OxyContin often served as an addict’s bridge between these milder opiate painkillers and heroin. OxyContin contained only oxycodone, and much more of it. When Vicodin or Lortab stopped being enough, when legitimate patients asked

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. Usually, each addict left the clinic with scripts for ninety 80 mg OxyContins—three a day, for a month. The doctor also prescribed 120 generic oxycodone 30 mg pills and 90 Xanax bars. Mary Ann took half of the haul in exchange for driving the addict to the clinic and paying

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. Pills held their value, and that value was printed on each pill. It helped that OxyContin came in 40 and 80 mg pills, and generic oxycodone came in 10, 15, 20, and 30 mg doses—different denominations for ease of use as currency. The pill mills acted as the central banks

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’m looking for a chain saw,’” Mary Ann said. “Then some guy comes by with a chain saw. You buy the chain saw for an oxycodone thirty you paid almost nothing for [thanks to your Medicaid card], and you call the other guy and sell him the chain saw for a

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the pill mills stood people who charged in pills to pee in a cup, promising clean urine as they chugged water. Veteran clients would crumble oxycodone into the purchased urine, because doctors wanted to see that patients had no drug in their system other than what they prescribed. Kids’ urine was

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. How much do them run?’ They’d tell you. ‘It’s sixty-nine ninety-nine.’” Keith would pay roughly half that in pills—usually an oxycodone 30—for that circular saw the addict was offering. Of course, prices were subject to a junkie’s desperation. This was pitiless commerce. Mary Ann

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once offered a junkie an oxycodone 15 for a pair of stolen Nike Jordan basketball shoes because the guy was too dope sick to go find another buyer. She bought a

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at Walmart, he had a reasonable expectation that a dealer in town would pay him half the value in pills: an OxyContin 80 and an oxycodone 20. It helped that Walmart employees displayed little love for the store and its famously low wages. Some workers were strung out themselves. Some greeters

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hurting.” With money and addiction urging them on, meanwhile, Floyd County addict-entrepreneurs were like bloodhounds sniffing out shady docs in far-flung places. An oxycodone 30 mg pill cost eight dollars in Florida and could fetch thirty dollars back home. Florida had no prescription monitoring, so any pharmacist would fill

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for doctor visits. The OxyContin Express was the name given to flights from Huntington, West Virginia, to Fort Lauderdale. By 2009, of the top ten oxycodone-prescribing counties in America, nine were in Florida. The other was Scioto County, Ohio, where Portsmouth is located. Broward County had four pain clinics in

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.” But an equally large segment—the X42s—were from narcotic overdoses. Socie began running his computer through its paces, asking about deaths from specific drugs: oxycodone, hydrocodone, heroin, cocaine, morphine, opium. Opiates were present in virtually all the deaths where the drugs were specified. The numbers alarmed Socie. He showed them

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. But even that hid the truth. The use of some opiates actually declined: codeine, for example. The real story was in what skyrocketed. Oxycodone. Dispensed grams of oxycodone—the only drug in OxyContin—rose by almost 1,000 percent in Ohio during those years. They wrote a report revealing once-camouflaged facts

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.” Despite its ad claims, Purdue provided no study to the FDA, investigators later noted, that supported those claims. The company taught its sales force that oxycodone was harder to extract, and thus abuse, than other drugs—though the company’s own studies showed that wasn’t true. In 1995 tests, the

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company found that 68 percent of the oxycodone could be extracted when the pill was crushed and liquefied and drawn through cotton into a syringe. In fact, addicts I spoke with said it

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extract the drug from an OxyContin pill than from other, milder opiate painkillers, such as Vicodin or Lortab, because OxyContin didn’t include anything but oxycodone, while the others also contained acetaminophen or Tylenol. The company’s sales staff said in promotional meetings across the United States that OxyContin’s twelve

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risk of addiction than short-acting opiates. I spoke with several doctors who said the graphs showing OxyContin’s purportedly mild peaks and troughs of oxycodone in blood plasma were among the most convincing data that Purdue salespeople produced. But federal investigators later said that these graphs were incorrect and “falsely

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” exaggerated the difference in euphoric effect between Oxy and its short-acting competitors. Purdue “phonied up [those] graphs to show a steady level of oxycodone in blood plasmas,” said Paul Hanly, a New York City plaintiff’s attorney, who brought a class action lawsuit against Purdue. “The true graph shows

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of coroners had grown up unused to reporting on drug overdoses. The nuances of whether someone died from opiates, and if so, whether that was oxycodone, hydrocodone, methadone, or heroin were sometimes lost. The signature location of this drug scourge, meanwhile, was not the teeming, public crack houses. It was, instead

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more chronic pain than most. Necks, thighs, and ankles ached all season. Medicating injuries to get athletes playing through pain was nothing new. But as oxycodone and hydrocodone became the go-to treatment for chronic pain, organized sports—and football in particular—opened as a virtual gateway to opiate addiction in

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a winning team as the school opened its new stadium. After the games, some of the trainers pulled out a large jar and handed out oxycodone and hydrocodone pills—as many as a dozen to each player. Later in the week, a doctor would write players prescriptions for opiate painkillers, and

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send student aides to the pharmacy to fill them. “I was on pain pills that whole season—hydrocodone or oxycodone. I was given narcotics after every single game and it wasn’t recorded. It was like they were handing out candy,” Bruce told me. One

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, meanwhile, reclassified Vicodin from a Schedule III drug to a more restrictive Schedule II. It also denied approval of a generic timed-release form of oxycodone—a no-name OxyContin. But then it approved Zohydro, a timed-release pill similar to OxyContin, containing as much as 50 mg of hydrocodone per

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own timed-release hydrocodone pill—though this one would include an abuse deterrent. The FDA approved another Purdue drug, Targiniq ER, which combines timed-release oxycodone with naloxone, the opiate-overdose antidote. OxyContin sales, meanwhile, kept rising. Within a few years of the criminal case brought against the company by John

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to need treatment. But with the potency of these drugs, the average age has dropped fifteen years and people get into trouble very quickly with oxycodone, hydrocodone, and heroin.” Nationwide opiate addiction had achieved a few things—albeit at frightening cost. There was the remarkable change of heart regarding prison and

The Best Business Writing 2013

by Dean Starkman · 1 Jan 2013 · 514pp · 152,903 words

Co. and CVS Caremark shops, the two biggest U.S. pharmacies. Both prescription drugs found in her body were made in the United States—the oxycodone in Elizabeth, N.J., by a company being acquired by generic-drug giant Watson Pharmaceuticals Inc., and the methadone in Hobart, N.Y., by Covidien

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pharmacies and distributors. On September 12, the Drug Enforcement Administration revoked the licenses of two Florida CVS stores, which it claims sold excessive amounts of oxycodone without ensuring the pills weren’t diverted to the black market. CVS is fighting the DEA’s order in administrative and federal courts. Two days

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Jupiter, Fla., distribution center, calling it an “imminent threat to public safety.” The DEA’s regulatory action alleges that the facility—the state’s largest oxycodone distributor—“failed to maintain effective controls” of its narcotic painkillers. Walgreen said it is working with regulators and has tightened its procedures. CVS said it

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, is that everyone in the distribution chain is identifiable. The DEA itself controls the supply spigot by setting drug companies’ production quotas for opioids like oxycodone and hydrocodone. For years, opioids were reserved mainly for cancer or terminally ill patients because of fears over their safety and addictiveness. But over the

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an entry from her diary, she had been suffering back and neck pain. Thomas Suits, her employer, prescribed twenty pills of Endocet, a drug containing oxycodone. “I’d never taken opioids before,” Ms. Kinkade wrote in a diary entry. “But I started the med routine and OMG I felt no pain

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. On January 5, 2007, she saw Bruce Kammerman, a family practitioner at a clinic in Stuart, Fla., and came away with a generic blend of oxycodone and acetaminophen. A scan taken a month later showed no problems with her spine, according to the medical report. Through his lawyer, Dr. Kammerman declined

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., charged with drug trafficking, racketeering, and illegally selling controlled substances. The DEA said in a news conference he was prescribing an average of 1,700 oxycodone tablets a day. Dr. Kammerman’s lawyer said his client has done nothing wrong and pleaded not guilty. Ms. Kinkade broke up with her boyfriend

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writing narcotics,” she wrote in her diary. “Nowadays—I’ll just go str8 to pain docs.” During that period, she was prescribed large amounts of oxycodone, her records show, combined with antianxiety drugs and powerful muscle relaxants. Her parents grew increasingly alarmed. “Sometimes you’d be having a conversation with her

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each case, she was released and the charges dropped. She started visiting a pain clinic in Tampa called Doctors Rx Us, where she was prescribed oxycodone, methadone, alprazolam, and gabapentin, an antiseizure medication, according to records her parents collected. Housed in a rundown strip mall, the clinic today is called Palm

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, the DEA launched a probe of the Florida-based operations of Cardinal Health and CVS Caremark. The agency alleged they dispensed “extremely large amounts” of oxycodone with signs that the drugs were “diverted from legitimate channels.” CVS said it has “responded to the DEA’s concerns, including implementing enhancements to our

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to a statement he later gave police. She returned to Doctors Rx Us, where Dr. Smith wrote a prescription for ninety tablets of 30 mg oxycodone, according to prescription records. It would be her last. The next day, Ms. Kinkade filled the prescription at a Walgreens in Beverly Hills, Fla. The

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oxycodone would have come from Walgreen’s Jupiter, Fla., distribution center, a company spokesman said. On September 14, the DEA barred that facility from selling controlled

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substances, alleging that it failed to maintain effective controls to stop large amounts of oxycodone from reaching the black market. “When [companies] choose to look the other way, patients suffer and drug dealers prosper,” Mark Trouville, the DEA special agent

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in charge, said at the time. Walgreen said in a statement it is cooperating with the DEA. The oxycodone came from the New Jersey plant of Actavis, a Swiss pharmaceutical company. In April, Actavis was bought by Watson Pharmaceutical in a $5.8 billion

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in his room at a white, low-slung house tucked behind a trailer park. The medical examiner said she died from a drug cocktail including oxycodone, methadone, and methamphetamine. Ms. Kinkade’s physical decline made such an impression on the detective who investigated the case that, two years later, he still

Never Bet Against Occam: Mast Cell Activation Disease and the Modern Epidemics of Chronic Illness and Medical Complexity

by Lawrence B. Afrin M. D., Kendra Neilsen Myles and Kristi Posival · 15 Jan 2016

behaviors, but other than those constitutional findings and diffusely dry skin, I found nothing remarkable on her physical exam. Unsurprisingly, she was on many medications: oxycodone (long and short acting forms), montelukast, tizanidine, potassium, pramipexole, fluconazole, zolpidem, furosemide, venlafaxine, paroxetine, primidone, and albuterol. Curiously, on her allergy list, she noted the

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cancer at 56. There was no known family history of hematologic issues. His medications included pantoprazole, fluticasone, nebivolol, sucralfate, duloxetine, iron sulfate, loratadine, pregabalin, and oxycodone. The only allergic reaction he knew of was a rash to penicillin. Examination found a thin, concerned man with mild systolic and diastolic hypertension. His

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. Allergies include vomiting with clarithromycin, sulfa, and the sulfa-based celecoxib, headaches upon exposure to “blue dyes,” hives upon exposure to norfloxacin, imaging contrast dye, oxycodone, methylsulfonylmethane, codeine, or hydrocodone, and unspecified reaction to metoclopramide. A reaction in July 2012 to CT contrast was quelled with prednisone and diphenhydramine, and she

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. Small wonder, then, that some mast cell disease patients come to be tried on oxcarbazepine long before their mast cell disease is recognized/diagnosed. Oxycodone “Ox´-ee-coh´-dōn.” Oxycodone is a commonly used narcotic, and since many mast cell disease patients suffer pain, many mast cell disease patients come to receive

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oxycodone at some point, which is a dicey proposition considering that in some mast cell disease patients, narcotics serve to trigger acute flares of mast cell

Sickening: How Big Pharma Broke American Health Care and How We Can Repair It

by John Abramson · 15 Dec 2022 · 362pp · 97,473 words

met the challenge. In 1996 — the year its patent on MS Contin expired — Purdue transferred its marketing efforts from morphine to another opiate: semi-synthetic oxycodone, which had been developed in Germany back in 1916. Purdue’s marketing of its new long-acting formulation of

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name OxyContin, claimed several advantages (or created a false impression of these advantages, which it left uncorrected) over other oral narcotics: that oxycodone was a less powerful narcotic than morphine and could therefore be safely used to treat non-cancer-related chronic pain; that using a wax matrix

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to control the release of oxycodone from OxyContin tablets slowed systemic absorption of the active drug, which greatly decreased the risk of abuse, addiction, and withdrawal symptoms; and that OxyContin would

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was a remarkable marketing feat, given that the three claims Purdue had made about the advantages of OxyContin were not true. In the first place, oxycodone is not weaker than morphine; it is actually twice as strong. Second, Purdue had not done any studies to support its claim that the controlled

…

of twice-a-day dosing an advantage; and unlike many other drugs, OxyContin pills were priced in proportion to the dose of the active ingredient, oxycodone, incentivizing drug reps to recommend that doctors increase the dose rather than the frequency of OxyContin. This strategy may have been designed to maximize OxyContin

…

, “Sackler Embraced Plan to Conceal OxyContin’s Strength from Doctors, Sealed Testimony Shows,” ProPublica, February 21, 2019, https://www.propublica.org/article/richard-sackler-oxycontin-oxycodone-strength-conceal-from-doctors-sealed-testimony. less likely than other narcotics: “Purdue Statement in Response to Leak of 2015 Deposition of Dr. Richard Sackler,” https

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him and he would get it done. Willy Delgado got bigger and bigger. He opened restaurants, cigar stores. He developed a nice sideline repurposing leftover oxycodone pills. Then he and his brother reunited with Aida Salazar, who was now running an outfit called Nursing Unlimited with her son Nelson. “I was

…

morphine. And then in 1916, two German chemists took a similar alkaloid to codeine named thebaine, resynthesized it, and came up with something they called oxycodone. Oxycodone never gained the notoriety of its cousins heroin and morphine—until eighty years after its discovery, that is, when it was reimagined by a company

…

named Purdue Pharma. Purdue packaged oxycodone in a high-dose extended-release tablet. The company marketed its invention around the world with more enthusiasm and audacity than anyone had ever marketed

…

at home. It was a good business, but a small one. The Sackler family, which ran Purdue, had grander ambitions. They switched their focus to oxycodone. Typically, oxycodone had been combined with acetaminophen or aspirin. That’s what Percocet and Percodan are, respectively, and that combination made

…

oxycodone harder to abuse, because if you consume too much acetaminophen, you will do serious damage to your liver. Some researchers call this a “governor’s

…

you’ll pay the price.) Purdue’s first innovation was to remove the acetaminophen governor’s switch from oxycodone. Purdue then raised the drug’s dosage. Percocet and Percodan each have 5 milligrams of oxycodone. Purdue decided that its lowest dose pill would have twice that amount. Then Purdue created a special

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three milligrams of morphine (or opium), so its morphine milligram equivalent (MME) is 3. One of the most important opioids in the current epidemic is oxycodone (MME 1.5), which is sold in an extended-release form as OxyContin, manufactured by Purdue Pharmaceutical. OxyContin, known on the street by many names

…

present in 1,999 deaths that year. Before 2011, the increases in deaths were powered by prescription opioids, particularly those based on hydrocodone (Vicodin) and oxycodone (Percocet, OxyContin). In 2011, Purdue Pharmaceutical reformulated OxyContin to make it resistant to abuse. The original formulation had warnings against taking it other than as

…

lives. In any case, by 2011 it was too late to put the genie back in the bottle. Illegal heroin, an almost perfect substitute for oxycodone, quickly picked up the slack; deaths from prescription drugs were replaced by deaths from heroin, and the total of overdose deaths continued its climb. Drug

…

, population 406. Between 2007 and 2012, according to a report by the Energy and Commerce Committee, “drug distributors shipped more than 780 million hydrocodone and oxycodone pills to West Virginia.”32 According to an investigation by the CBS program 60 Minutes and the Washington Post, when the DEA, which is charged

…

, 195, 197, 225 Ornstein, Charles, 283n33, 283n34 outsourcing, 7, 52, 165, 166, 200, 205, 206, 219, 238, 243, 251. See also job loss overeating, 44 oxycodone, 118 OxyContin, 10, 40, 112, 114, 117, 118, 127–28, 129, 259; approved, 247; heroin and, 119 Page, Marianne, 277n15 pain, 3, 72, 76, 82

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