One company, the Sackler family’s Purdue Pharma, has played a critical role in instigating an epidemic of opioid addiction in the United States that killed 72,000 Americans last year — more people than perished at the peak of the HIV epidemic or died in car wrecks or shootings last year.
Even now — as the failure to recognize opioid addiction as a chronic disease rather than a moral failing, and limits on insurance coverage keep people from long-term treatment — the painkiller industry is spending nine times more on lobbying to fight regulation than is spent by the powerful gun lobby.
Those were some of the striking takeaways from a fast-paced, sharply focused discussion of the opioid crisis presented Aug. 20 at East Hampton’s Guild Hall by the Hamptons Institute, which has been hosting panel discussions there throughout the summer.
It featured journalist Elizabeth Vargas as moderator along with three expert speakers: U.S. Navy Admiral (retired) James “Sandy” Winnefeld Jr., who co-founded Stop the Addiction Fatality Epidemic after his son died at 19 on his fourth day at the University of Denver; Dr. Joseph Garbely, medical director at Caron Treatment Centers; and New Yorker staff writer Patrick Radden Keefe, whose October 2017 article, “Empire of Pain,” threw the spotlight on Purdue Pharma’s role in pushing its invention, oxycodone, as a safe way to treat chronic pain — even after its addictive nature became clear.
Americans tend to talk about the opioid epidemic in its magnitude and complexity as a kind of natural disaster, Mr. Keefe said, but it is “much more man-made.”
Before the oxycodone push, he noted, physicians had been careful to avoid using opioids to treat chronic pain, because they were understood to be highly addictive.
Because doctors seemed reluctant to prescribe it, “one company,” he said, began during the 1990s to push oxycodone “in very slick and suggestive ways” as “not so addictive.” That marketing strategy coincided with a “cultural shift” in the medical profession that allowed for aggressive treatment of chronic pain with oxycodone, Mr. Keefe said.
Purdue’s marketing claim that patients would need only two pills a day, one every 12 hours, “was a recipe for addiction,” Mr. Keefe explained, because withdrawal and the craving for more — a purely physiological process in the brain — begins after eight or nine hours.
There were early signs of trouble, “little pockets of abuse,” he said, but “the company did not react.” Instead, Mr. Keefe said, it denied any problem and blamed “addicts and drug abusers” — and hired “Rudy Giuliani to fight off any regulation” — a comment that elicited moans and groans from the audience.
“We really did think oxycodone was less addictive,” recalled Dr. Garbely. “We were told that by the reps” from Purdue, that “we could safely prescribe it, and we bought it hook, line and sinker.”
Adm. Winnefeld noted that oxycodone costs $1 a milligram, which means the addicted need to spend $240 a day to avoid withdrawal, and that heroin, at $20 per hit, is the much cheaper and readily available alternative.
Ms. Vargas called on the admiral to start the discussion with the story of his son Jonathan. Growing up in a military family that moved frequently, he was likable, athletic, good-looking and seemed well-grounded but in fact he suffered from anxiety and depression, Adm. Winnefeld said. He began self-medicating with marijuana, alcohol and other drugs.
He spent 15 months in an intensive inpatient program in New Haven, Conn., during which he earned certification as an emergency medical technician. “He wanted to help others,” the admiral said. Jonathan planned to become a paramedic firefighter when he entered the University of Denver.
“We dropped him at school and he was amazing, bright-eyed and bushy-tailed,” the admiral recalled. “We lost him on the fourth day of college” to a fentanyl-laced dose of heroin he had bought in Denver.
“We had missed a few signs” of his relapse: he was edgy, sweaty and nervous; “we thought college” was the reason, Adm. Winnefeld said. “Little did we know he had relapsed. We had lost him,” he continued, adding that the family will feel “sadness for the rest of our lives.”
Adm. Winnefeld said his goal now is “to help people avoid this.”
He praised print journalists for accurately depicting the nature of the opioid crisis but blamed “photo-journalism” for seeking out the skinny, tattooed and needle-marked “guy living under an underpass” to depict addiction. But, as he and Dr. Garbely noted repeatedly, opioid addiction strikes everyone — well-off people, educated people, good-looking people like Jonathan Winnefeld — just as easily as it strikes the poor.
Peter Boody is news editor for The Sag Harbor Express.
This article is a part of The East End News Project. Three East End news organizations — the Times Review Media Group newspapers, the Press News Group and The Sag Harbor Express — have joined together with Stony Brook University’s journalism program in a unique collaboration that focuses on the opioid epidemic across the region. If you can help by telling your story, please contact us at [email protected].