IN EARLY JANUARY, Time magazine became the first major media outlet in America to report on the growing abuse of a prescription synthetic-opioid painkiller named OxyContin. According to the story, the drug was “so popular and addictive” that it was generating “a blizzard of a crime wave” in several “pockets of the nation.” While the article admitted that the medication had been “hailed as a miracle” by legitimate users, it added that OxyContin pills were nicknamed “killers” in some areas because of the rapidly escalating toll of overdose deaths allegedly associated with its illicit use.
The Time piece was only the opening salvo in a sustained journalistic campaign — conducted over the angry protests of pain specialists and their patients — that has, in a few short months, irremediably stained the public image of a medication previously acknowledged as a major breakthrough in the treatment of debilitating chronic pain. Over the past four months, reporting on OxyContin abuse has become a national media craze. Sensational, fear-mongering stories have appeared in hundreds of publications from Newsweek to small-town newspapers in Midwestern hinterlands. pain pills blamed for rash of deaths, the Associated Press proclaimed. the ‘poor man’s heroin,’ U.S. News blared. prescription painkiller gains status as thrill pill, claimed the Indianapolis Star, while the Cincinnati Enquirer called it the ‘heroin of the midwest,’ with the subhead traffickers’ and abusers’ first choice. Just last week, the Boston Herald weighed in with a front-page feature, headlined narco crime wave, about a rash of local drugstore robberies specifically in search of OxyCotin. But none could match the Port St. Lucie News, which called it the “new crack” and touted its “heroin-like high” in the same headline.
Yet experts say no evidence exists that increases in abuse of the drug are outpacing increases in prescriptions for it. In fact, several incidents seem to suggest that the media’s sensational coverage — which informs potential addicts about the new drug and explains how to get and use it — may itself be contributing to an increase in OxyContin abuse. Meanwhile, doctors and legitimate users have been needlessly scared away from an important advance in the treatment of pain.
OXYCONTIN WAS an instant hit with doctors when it was introduced by Purdue Pharma in December 1995. Pain-management specialists hailed the oxycodone-based formulation as a breakthrough in the medical profession’s ongoing effort to control the debilitating effects of chronic pain. As the good news spread, sales of the drug mushroomed, rising from $40 million in 1996 to more than $1 billion last year, outstripping even Viagra.
The drug was a godsend for patients whose pain did not respond to other medications. “Without OxyContin I wouldn’t be able to get out of bed in the morning, much less hold down a full-time job,” says Tracey Jordan of Houston, Texas, who suffers from three degenerative disks in her back. Before going on OxyContin in August 2000, she took a host of other medications, but they “were just too harsh, and didn’t really take care of my pain,” she says.
The media also offered a few glowing accounts of OxyContin’s effectiveness. In a September 1996 article, for example, OxyContin was said to be enjoying “a groundswell of international support” at the annual meeting of the International Association of the Study of Pain (IASP), with members touting it as “an excellent opioid for moderate to severe pain.”
But about 18 months ago — roughly three and a half months after OxyContin’s auspicious debut — some instances of illegal use surfaced in rural Maine. Soon after, the drug’s popularity began to rise in rural Appalachia, especially in parts of western Virginia, eastern Kentucky, West Virginia, and southern Ohio (in and around Cincinnati). If abuse amounts to an epidemic anywhere, it’s here, says pain specialist Shelley Freimark of Ashland, Kentucky: “In this area right now, it is a severe problem.”
That’s because the usual street drugs are not as readily available in these rural outposts, says Phil Fisher, head of the Appalachian Pain Foundation (APF), a group formed last year by pain doctors devoted to educating the medical community and public about the uses and benefits of OxyContin. “This is an isolated area where it’s hard for people to get real street drugs,” he says. “By and large, OxyContin is not a street drug in most places.”
Even when the problems first emerged, the press outside this region largely ignored the development. But that changed on February 6 with “Operation Oxyfest 2001.” More than 100 Kentucky cops fanned out in what were called the largest drug raids in state history. Sweeping a five-county area, they netted 207 dealers and users. Within days, the OxyContin “epidemic” was national news, turning small-town cops into minor celebrities. Detective Roger Hall of the sheriff’s department in Harlan County, Kentucky, had the distinction of being quoted in two separate AP articles carried by scores of papers, despite the lack of expertise suggested by his claim that abusers “will kick a bag of cocaine aside to get to the Oxy” (it’s rare to be addicted to nervous-system depressants like OxyContin and stimulants like cocaine at the same time).
Politicians, naturally, weren’t shy about chasing the free publicity. They convened a series of press conferences and public meetings to take advantage of the heightened media interest. On March 1, Virginia attorney general Mark Earley convened an Oxy-epidemic “summit” attended by high-ranking officials from five states. Not to be outdone by his neighbors, Kentucky governor Paul Patton, who had already proclaimed a “near epidemic” in his own state, announced the creation of a statewide OxyContin task force, made up of officials from 15 separate agencies.
Coverage built up to the April 9 issue of Newsweek, whose cover screamed painkillers. Of two related inside articles, one reported on the overall rising tide of prescription-drug abuse; the other, titled “How One Town Got Hooked,” described events in Hazard, Kentucky, the town said to be at the center of the epidemic.
With the raids’ success and the ensuing barrage of press coverage, the idea of an OxyContin epidemic became entrenched in the national consciousness. After the wave of Kentucky stories by the big boys, the major urban newspapers in the East and Midwest assigned reporters to hunt for indications of abuse on their own turf. Unsurprisingly, they found what they were looking for.
MANY OF the media’s “thrill pill” stories have centered on widely disseminated claims that OxyContin has resulted in a shocking number of overdose deaths. Just how many is an open question. The numbers vary from paper to paper, and are unverifiable at best. Some of the published figures appear only once, in a single article, and leave no clue as to their origins. Others are widely used; most papers across the country have claimed that the drug has caused more than 120 deaths, 59 since February 2000 in eastern Kentucky alone. The latter figure originated in early February with public statements from Joseph Famularo, the US attorney for the Eastern District of Kentucky, who used it to justify the eight-month investigation leading to Operation Oxyfest. Virginia attorney general Mark Earley struck next, claiming 32 deaths in southwestern Virginia since 1997, a figure that was later increased to 39 by assistant medical examiner William Massello.
The press responded to these announcements with a flurry of stories. But none of the accounts examined the reliability or meaning of the numbers. “That figure was given to us by local law enforcement,” says Wanda Roberts, Famularo’s spokeswoman, about the 59 alleged Kentucky deaths. That it came from the same police officials who used it to justify Operation Oxyfest does not appear to trouble Roberts, though when asked she declined to confirm the figure as accurate.
Says David W. Jones, executive director of the Kentucky medical examiner’s office, “As far as deaths go, I’ve heard different numbers in different places at different times. I have no idea where these people are getting their facts and figures.” While he stresses that not every drug-related death is necessarily reported to his office, his data show 27 oxycodone-related deaths in the entire state in 2000.
Of course, at first glance, 27 deaths over 12 months in a single state — even in Kentucky, the heart of the purported epidemic — seem like solid evidence of a spike in oxycodone abuse. But when Jones breaks down the numbers further, the situation appears far less grave. Two of the 27 victims, he explains, had ingested both oxycodone and alcohol, which resulted in a fatal interaction. What’s more, 23 others evinced traces of a head-spinning multiplicity of other drugs in their systems, including highly potent prescription painkillers such as Dilaudid, and powerful illegal drugs like heroin. In the final analysis, Jones says, only two of the 27 fatalities were caused by oxycodone alone.
As for Virginia, medical examiner Massello became notably tightlipped when asked for further details about his cases, though he did admit that a “significant number” of victims had taken multiple drugs.
Other jurisdictions report similar findings. In Blair County, Pennsylvania, the county coroner has collected data indicating that of the seven oxycodone-related deaths in her jurisdiction during the last five-plus years, six involved multiple drugs (often including heroin), and one was a suicide.
Moreover, most accounts omit two additional facts: oxycodone is the opioid agent in around 40 separate brand-name prescription medications besides OxyContin; and OxyContin accounts for only about 25 percent of the oxycodone consumed annually. OxyContin is the strongest oxycodone formulation available, but there is absolutely no way of telling, Jones explains, whether an oxycodone-related fatality resulted from OxyContin.
For that matter, not everyone who dies from an oxycodone overdose does so accidentally. Legitimate OxyContin users include many terminally ill patients, some of whom choose to escape further suffering through fatal overdose. Yet such cases are often lumped in with accidental overdoses, making the already inflated numbers appear even greater.
Even when accidental-overdose deaths can be confirmed, they do not point to a vast increase in the overall number of the drug’s abusers. Rather, the evidence of multiple-drug usage implies that a substantial portion of OxyContin abusers are long-standing drug addicts who have switched to OxyContin from other prescription or illegal drugs — or who take OxyContin occasionally as a substitute for their preferred drugs, which may be in short supply in areas like rural Kentucky. “The problem is not particularly the abuse of OxyContin,” says Kentucky state representative Jack Coleman, a legislative expert on prescription-drug abuse and a member of the state’s recently formed OxyContin task force. “It’s with prescription-drug abuse in general.”
His view is echoed by Karla Berkholz, a board member of the American Academy of Family Physicians, who says that “six to seven percent of the American population uses illicit substances, and that number has held pretty steady over time.” The number of oxycodone-related emergency-room visits — a more reliable figure than oxycodone-related overdoses — supports Berkholz’s analysis. Such visits have increased 72 percent, from 3060 in the first half of 1999 to 5261 in the equivalent period in 2000, according to the federal government’s Drug Abuse Warning Network (DAWN). But that’s still tiny compared to ER incidents involving other drugs; for example, over the same time period there were 18 cocaine-related ER visits for every one involving oxycodone.
SO WHY has OxyContin abuse received so much media attention? One reason flows from the start of the war on drugs in the early 1980s, when the media signed on as full partners in the government’s effort to demonize drug use and stigmatize users. “The media presented the drug problem as a war of the holy people against the depraved people, and unfortunately we haven’t gone far past that moralizing tone,” says media critic Norman Solomon.
This attitude has sometimes primed reporters to jump the gun on drug stories. At the beginning of the last decade, for example, the media were temporarily fixated on “ice,” a smokable form of speed, which a slew of articles and television reports touted as “the crack of the ’90s.” But ice never really caught on — it was apparently too expensive and difficult to manufacture. The OxyContin story fits right in with this sensational coverage. June Dahl, professor of pharmacology at the University of Wisconsin Medical School and president of the American Alliance of Cancer Pain Initiatives, likens the current spate of “ultimately exaggerated” OxyContin stories to the 1930s-era film Reefer Madness, with its laughably over-the-top rendering of the evils of marijuana use.
Racism, too, may explain why OxyContin receives more media attention than such drugs as heroin. The public perceives heroin and crack as ghetto drugs abused by poor people of color, while prescription-drug abuse is primarily a white, middle-class phenomenon. Whites account for about 60 percent of heroin-related ER visits, according to DAWN. But 87 percent of oxycodone-related ER patients are white, more than for any other significantly abused drug.
UNFORTUNATELY, THE media’s wrongheaded anti-OxyContin zeal is more than just a cultural oddity. It is dangerous. Although levels of OxyContin abuse do appear to be rising in some urban areas, particularly in the East and Midwest, that growth seems to follow, rather than precede, heavy attention from major metropolitan dailies. This prompts suspicion that the overblown reports themselves are largely responsible for the rise.
The Cleveland Plain Dealer took its first stab at the OxyContin story on February 10. The article, headlined abuse of prescription painkiller spreading: overdoses are believed to have killed dozens, opened by recounting a pharmacy hold-up in the area. Within two months, two copycat pharmacy hold-ups had occurred. The first took place February 16: as in the story, a masked man wielding a firearm demanded the store’s entire supply of the drug and escaped with more than 1100 pills of various doses. A second pharmacy, in the Cleveland suburbs, was robbed April 22; again, the robber zeroed in on the OxyContin. New users also began to approach dealers. “I never heard of the stuff until about a month ago, when one of my customers asked me about it,” one Cleveland heroin dealer said in mid April. “He showed me an article in the paper that talked about how everyone wanted to get hold of this shit, so I did a little checking and found some available.”
Perhaps worst of all, the victims are not just new abusers but the thousands of potential legitimate users who need OxyContin for pain relief. Media coverage of the drug has provoked anger and derision from growing numbers of specialists in chronic-pain management, a field long ignored or underemphasized by most physicians. “Historically, there have been a lot of inaccurate preconceptions and oversensitivity about opioid analgesics and other narcotics, which has kept them from being used as much as they should,” says Dahl. The OxyContin scare has sent chronic-pain treatment reeling backward into ignorance and fear.
As a result of the media flurry, the Drug Enforcement Agency (DEA) has taken action against Purdue Pharma, the makers of OxyContin. The agency had never before fixed its sights on a single prescription drug, but in May it began pressuring Purdue to cease marketing OxyContin to general practitioners, who make up the vast majority of doctors. So far Purdue has resisted the DEA effort, much to the relief of pain experts. “It’s a ridiculous idea,” snorts Barry Cole of the American Academy of Pain Management. “There are only 7000 pain doctors in the entire country, not nearly enough to treat everyone who needs this medication.” However, Purdue has temporarily halted shipments of 160-milligram pills, introduced two years ago to treat terminal cancer patients.
In addition to pressuring the manufacturer, the DEA has publicly announced a crackdown on physicians who “over-prescribe” OxyContin. One doctor in Virginia recently reported that 30 minutes after a visit from a Purdue sales representative, local DEA agents descended on his office to ask what the salesman had told him and whether he intended to prescribe the drug to any of his patients.
In light of such developments, more and more doctors hesitate to prescribe OxyContin. One doctor in St. Charles, Virginia, has even begun a petition drive to pressure Purdue into withdrawing the drug from the market.
“Doctors are afraid that they’ll be prosecuted for prescribing OxyContin, or that they’re somehow being duped and the drugs they prescribe will end up on the street,” says Phil Fisher. And patients are frightened as well. “I’m treating two little old preacher’s wives,” Fisher says. “Both are afraid of getting addicted, and one is sure someone’s going to break into her home to get her supply of the drug.”
This story was originally published on Alternet.org.
