The opioid crisis’s origins explored in beth macy’s dopesick – vox

When 27-year-old Debbie Honaker went to her doctor in Lebanon, Virginia, after a routine gallbladder surgery in the early 2000s, she was prescribed “Oxy tens” — 10 milligrams of OxyContin. At her next visit, it turned into 40s. Then she graduated to Percocet. Soon, she began stealing pills, then buying them from Medicaid patients for $1. “At the end of your journey, you’re not going after drugs to get high; you’re going to keep from being sick,” she says.

Honaker’s story is just one of many in author Beth Macy’s new book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, which chronicles the 20-year history of the opioid epidemic, starting with the dawn of OxyContin in 1996 and ending with grim statistics: more than 42,000 dead from opioid overdoses in 2016 alone and expert predictions that 300,000 will die in the next five years.

It’s the same thing if you look at the other initial hot spots. In Machias, Maine, a logging and fishing community, there were also many people already on painkillers from legitimate injuries due to these manual labor jobs. But in Appalachia, in particular, you had trade deals like NAFTA in ’94, and then China joined the WTO in ’01, and so you saw the furniture and the textile mills closing and the jobs going away — and at the same time, a huge rise in disability.

Now, 57 percent of the men of working age in Lee County are unemployed. As this is happening, this whole notion that we were horribly undertreating pain began being pushed by big pharma. Suddenly you couldn’t go and visit somebody in the hospital where there wasn’t a whiteboard where they would ask you to rate your pain on a scale of 1 to 10, or draw a smiley face or a frowny face.

All these things sort of converged: the joblessness, the rapacious behavior of big pharma, Purdue Pharma in particular. One of the first cops I interviewed said, “Oh, yeah, people were walking down the street with green and orange smudges on their shirt.” Orange was the color of an Oxy 40 mg and green for the Oxy 80 mg. They had held the pills in their mouths to soften up the time-release mechanism coating so they could get the euphoric rush of an entire pill all at once, then wiped the coating off on their shirtsleeves. Hope Reese

That’s changed in more recent years. In the first decade, it was kind of like a Wild West of pharmaceutical sales tactics. Pharmaceutical ads were starting to air on TV. A good friend of mine who is a pharma rep broke it down for me: They would find out what the doctor wanted and they would show up with whatever that was. He was waiting for the doctor, a chain-smoking doctor in Bland, Virginia, and another rep has already beaten him — they were there with a carton of cigarettes with a Celexa sticker on it.

The updated CDC guidelines in 2016 were a great improvement. It was kind of what those parents who initially lost their kids to OxyContin overdose wanted. They wanted the guideline to be that opioids were used sparingly, that doctors try pain relievers like ibuprofen and aspirin before prescribing the highly addictive pills, and that they give most patients only a few days’ supply — that opioid therapy for short-term pain last three days, and very rarely longer than seven. Overall, that’s good, but as soon as the OxyContin and the other pills got harder to get, you saw the drug cartels bringing in heroin.

Marijuana laws started becoming legal in states, and the drug cartels needed to make up their profit [from lost marijuana sales]. The doctors are doing better about not prescribing opioids out the wazoo, but we now have 2.6 million Americans with opioid use disorder. What are we going to do about that? You just can’t flip off a switch and it stops.

What I see on the ground are serious holes in the tapestry of treatment. The Roanoke Times finally did a story on medication-assisted treatment, or MAT, which combines therapy with medications like methadone or Suboxone. In it, they quote Steve Ratliff, adult and family services director for Blue Ridge Behavioral Healthcare, and he doesn’t believe in it. He told the newspaper that they only use buprenorphine if counseling has been attempted first and doesn’t work — and then they give them the option. This is not consistent with state policy, and in my view, it is just wrong.

Abstinence models may be better to treat alcoholism, but not opioids, since opioids, especially those laced with fentanyl, are deadly. [Many fewer people] OD on alcohol [compared to heroin]. What I see on the ground is families that can afford to send their children to rehabs — and most families can’t — end up spending thousands of dollars for treatment that is not what science says is the best way to treat opioid use disorder.

Another long-term consequence that scares the dickens out of me is hepatitis C. There are centers, needle exchange programs, where you come and you turn in your dirty needles. There, you get clean needles and you get to know these people who want to help you and want to help you get you hooked up with social work and counseling and ultimately, when you’re ready, go on to treatment. That’s what’s missing in most of America right now.

I was visiting a needle exchange recovery program in Las Vegas recently that was only located on the outskirts of town. If you’re an addicted person and you’re homeless, you probably live near the downtown in these tunnels underneath the city, so the homeless people who are addicted have to save up their bus fare to go there. And it’s because they didn’t want the tourists to see the addicts.

You see that colors a lot of family dynamics around medication-assisted treatment, and you see them worn out also because of bad behavior by the addicted people whose brains have been taken over by this drug, such as users who steal from their families to fund their next fix, for instance. Too often, the addicted person isn’t seen as someone worthy of evidence-based medical care until people are sitting in the pews at their funeral. Hope Reese