By Jane Roberts

Following a nearly 500% increase in prescription opioid-induced overdoses of Americans from 1999 to 2017, according to the National Institute on Drug Abuse, the argument surrounding the regulation of potentially dangerous medications has gained more traction. While many different prescription drugs have acquired notoriety for their highly addictive properties and frequent misuse, including Xanax, Vicodin, and Percocet, one painkiller in particular has recently taken the spotlight: OxyContin.

The increase of prescription opioid overdoses since 1999. Image credit: National Institute on Drug Abuse.

When the drug manufacturer Purdue Pharma released their new opioid OxyContin in 1996, they immediately took an “aggressive” marketing stance, spending $200 million on advertising for these painkillers in 2001 alone. Through commercials, pharmaceutical salesmen, brochures, and physician conferences, the company marketed OxyContin as a solution to the “chronic pain epidemic” in America at the time. 

According to The New York Times, Purdue contended that this opioid was less addictive than others of its kind due to its controlled-release formulation, which made the drug contain more oxycodone than most other opioids but deliver it over a longer period of time. Their promotion proved to be highly successful, and OxyContin generated nearly $1.1 billion in revenue in 2000.

Richard Sackler. Photo credit: ProPublica via Wikimedia Commons.

However, as the opioid crisis worsened at the end of the 20th century, with skyrocketing overdose and crime rates in counties where OxyContin was prescribed frequently, more questions arose surrounding the veracity of Purdue Pharma’s claims. Many drug dealers began faking injuries to acquire OxyContin prescriptions and resell the drug for a profit. Drug abusers also learned to remove the controlled-release coating from the tablets, thus ingesting more oxycodone at once and getting a stronger and longer-lasting high. 

Following many allegations against Purdue Pharma for misrepresenting the risk of addiction of their product, Richard Sackler, its president at the time and a prominent member of the Sackler family, which founded and owned the company, assured both physicians and patients that OxyContin was not to blame for the influx of overdoses. “We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals,” wrote Sackler in a confidential February 2001 internal email. 

One deceptive log-scale graph released by Purdue Pharma to show OxyContin’s “controlled release.” Image credit: Food and Drug Administration (FDA).

The Food and Drug Administration approved OxyContin for sale in 1996, despite the bottle’s label claiming addiction was “very rare” for the product, which was later revised to be more accurate. Furthermore, the FDA had only 39 employees reviewing and verifying advertisements for every pharmaceutical product in 2002, amounting to around 34,000 total promotions. This obvious understaffing caused many misleading OxyContin marketing techniques to be overlooked.

According to the CDC, from 2000 to 2014, the peak of OxyContin consumption and abuse, the United States experienced a 200% increase in the rate of fatal overdoses from opioids, which includes both pain relievers and heroin. An astonishing 65% of the growth in overdose deaths between 1996 and 2017 can be attributed to the launch of Oxycontin, according to The New York Times. Even though Americans make up a mere 5% of the world population, they consume 80% of all opioids produced worldwide. 

Nearly 27 years after OxyContin went on the market, Purdue Pharma finally reached a settlement regarding their involvement in the opioid epidemic. Initially, Purdue tried to put forward a bankruptcy settlement, which would protect individuals like Sackler from facing criminal charges. However, a federal judge rejected this proposal. The new agreement, reached in March 2022, requires the Sackler family to give up ownership of their company, does not protect them from further litigation, and forces them to pay more than $6 billion to benefit communities and individuals harmed by the opioid crisis. 

The Sacklers have continually failed to truly apologize for the damage their drug has caused. “While the families [within Purdue Pharma] have acted lawfully in all respects, they sincerely regret that OxyContin, a prescription medicine that continues to help people suffering from chronic pain, unexpectedly became part of an opioid crisis that has brought grief and loss to far too many families and communities,” wrote the family in a statement.

Dopesick promotional poster. Image credit: Hulu via IMDb.

Despite the Sacklers’ avoidance of the claims against them, Purdue Pharma’s reputation has been significantly tarnished, especially in the wake of Hulu’s 2021 miniseries Dopesick. Based partly on Beth Macy’s nonfiction book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, Dopesick’s eight episodes take viewers through the offices of two local prosecutors from Abingdon, Virginia working with the Drug Enforcement Administration (DEA), the headquarters of Purdue Pharma, and a small Virginia mining community overtaken by opiates, conveying the true damage caused by the opioid crisis and the corruption behind it. 

Much of the show was in fact filmed in Central Virginia, and more specifically, Richmond. Many Sackler Family boardroom scenes were shot in the Virginia Museum of Fine Arts, and other filming locations included Boulevard Burger and Brew and the Canal Walk. One scene at a rehabilitation facility in Dopesick even features the Roslyn Retreat Center, just down the road from Collegiate on River Road. 

Emily Gerber (‘15), an actor and writer based in Richmond, was cast in Dopesick to portray a secretary in the District Attorney’s office. When asked about the filming process of the series and what she learned surrounding the mismarketing of OxyContin, she replied, “It was clear that the directors… and cast were working to tell a very specific message. Purdue Pharma heavily downplayed and twisted the effects of OxyContin, which resulted in an epidemic that has impacted millions of people. I think the show resonated with a lot of people when it came out. Several of the cast shared their own personal stories with the opioid crisis, too, which I think spoke to how personal this project was to many of the people involved.” 

The release of Macy’s book, the series Dopesick, and press coverage of the epidemic and the legal battles against Purdue have helped bring much awareness to these issues currently plaguing America and the rest of the world. Through deeply personal narratives of real people who struggled with opioid addiction and others who lost loved ones due to the epidemic, the true anguish continually being caused by these drugs has gained more recognition. 

Not only are consistent drug abusers falling victim to opioids, but so are high-achieving high school students, physicians, and people with no genetic history of addiction. In a hearing before the 116th Congress investigating the role of Purdue Pharma and the Sackler Family in the opioid epidemic, Congresswoman Carol D. Miller (R-WV) reflected, “In 2018, there were over 46,000 opioid-related overdose deaths in the United States. In that same year, we lost over 700 West Virginians to opioid-related overdoses. I know these faces, the victims, their families. They’re the person you’re standing next to in the line at the grocery store. It’s the person who’s sitting next to you on the pew in church. They are your neighbors and your friends.” 

In an article in Yale Medicine, one young woman named Cristin recounts her struggle with opioid addiction, which led her to inspire others experiencing the same hardships. At only 18, she was in a car accident that left her with chronic back pain, and her doctor prescribed her OxyContin to relieve some of the pain after encouragement from her parents, both of whom were nurses. She took the drug for a year, strictly following her physician’s instructions and dosage recommendation. However, her doctor then suddenly stopped prescribing it to her, claiming that she had been taking the medication for too long. As a result, Cristin was subjected to intense withdrawal symptoms, and spent the majority of her 20’s addicted to heroin to try and ease that pain. 

In 2006, Cristin was encouraged to start taking methadone, which has proven to be very effective in preventing patient relapses. After switching from this drug to other preventatives like buprenorphine, she finally found what works best for her. Today, Cristin works as a mobile phlebotomist, drawing blood from patients who need testing done, and she shares her story with the patients she meets at rehab centers she visits to inspire their recovery.

Because opioids trigger the release of endorphins, creating an impermanent sense of well-being and pain relief, they are highly addictive, and users may continue ingesting more oxycodone than medically necessary in an effort to maintain that high. For some users, their limited access to synthetic narcotics may open the floodgates to illegally acquired substances like heroin or cocaine. According to the National Institute of Drug Abuse, 80% of heroin users initiated their addiction with the misuse of prescription opioids.

Fentanyl use data in the US. Image credit: Center for Disease Control and Prevention (CDC).

Furthermore, there has been a recent increase in fentanyl-related overdoses, according to the CDC. This drug was previously used strictly in medicine to manage severe pain— oftentimes after a surgery— given that it’s about 100 times more potent than morphine. 

Upper School math teacher Glenn Laferriere was in a mountain biking accident last year, and I asked him about his experience being treated for his injuries. He explained, “The paramedics wanted to calm me down quickly, because my shoulder was injured so badly, so they gave me a small dose of fentanyl while we waited for the helicopter to arrive. Once I got it, I felt no pain. They told me it was 50 times stronger than morphine, which is what they used to give people during World War II when they were shot. When I finally read about it later, I realized how scary it was; they don’t have to give it very often, and they can only give the tiniest bit, or else you might overdose.”

However, illicitly manufactured fentanyl is sometimes added to other drugs to increase their efficiency and lower prices, many times without the knowledge of the consumer, as it’s impossible to detect without laboratory testing. In 2021, over 67,000 people died from fentanyl overdoses and poisonings, a 26% increase from the previous year. 

During these times, it’s especially important not to pin the blame on those affected by opioids. Addiction is a disease; it completely rewires one’s brain, and the capability of 21st century medicine, especially oxycodone, is not to be underestimated. 

The sad reality of today is that these numbers will likely only increase in the years to come unless significant changes are made. As written by the Alabama Department of Mental Health, “The opioid crisis recognizes no neighborhood, no race, and no class. It is neither limited to backstreets in urban settings nor isolated in rural communities.”

 Featured image credit: Michael Tam via flickr.