Barry Meier on the addictive nature of opioids and narcotics ~
“The fact is that any type of opioid or narcotic, once you begin to take it, your body physically adjusts to it. It’s a very natural process called tolerance, so if you’re getting say a specific level of pain relief from, let’s say, 40 milligrams of the drug, you’re going to soon need more of the drug to get the same level of pain relief, so doctors kept having to ramp up and ramp up their patients’ dosages.”
Brian Wilson Few people have devoted as much time to studying the origins of the opioid crisis as Barry Meier. As the author of “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic” Meier initially explored this as a reporter for the New York Times. His book came out in 2003. Still some 15 years later he found there was much more to the story. This led Meier to revisit his work and update more than a decade of developments in a riveting rewrite.
Barry Meier: In the early going it was quite remarkable, because when I first started on the story I knew nothing about opioids; I knew nothing about pain treatment. I had done some stories about the pharmaceutical industry, and this whole story came to light with the emergence and appearance of the drug OxyContin. OxyContin was very much the seed that launched this whole opioid epidemic, and back in 2001 there was an outbreak of abuse of this new drug OxyContin.
Brian Wilson Where was it coming from?
Barry Meier: Well, the drug was made in Connecticut by a small company named Purdue Pharma, and marketed very aggressively by the company:
Male Speaker 1: I got my life back now. Now I can enjoy every day that I live. I can really enjoy myself.
Female Speaker 1: Since I’ve been on this new pain medication I’ve not missed one day of work and my boss really appreciates that. Lauren is there every day.
Female Speaker 2: Life is wonderful again. I’ve found life again, and it’s worth living now, and I’m so grateful.
Barry Meier: But the abuse was turning up in places like Maine and Appalachia and very rural parts of the United States.
Brian Wilson I have seen maps that suggest there is a huge problem throughout the Appalachians.
Barry Meier: Well, in the early 2000s I would say that was part of the epicenter of the opioid epidemic or what was then basically an opioid crisis, and you had what we would refer to as hot spots, where you had these outbreaks of OxyContin abuse, so I remember when I was starting to report on the story you’d see local newspapers, and I mean small town newspapers in tiny little towns and cities throughout Virginia and West Virginia and Kentucky, Ohio, Western Pennsylvania, there’d be stories about scattered arrests of drug dealers or drug users, and maybe the occasional arrest of a doctor for running a so-called pill mill, essentially like a medical practice where you could come in and say, “Boy, my shoulder hurts me,” or, “My back hurts me, and I heard about this drug called OxyContin. My friend told me it really works great for pain,” and the doctor would write you a prescription for it.
Brian Wilson Were there other ways that it was making its way into the public?
Barry Meier: Essentially OxyContin was a very unique drug. It was a drug that was marketed as a long-acting pain reliever. Most traditional narcotic pain relievers last four hours. OxyContin was promoted as lasting 10-12 hours, but what was remarkable about OxyContin is that it’s manufacturer, Purdue Pharma, was able to get a claim from the FDA that because it was a so-called long-acting drug it was less likely to be abused than shorter acting drugs like Percocet and Vicodin. The sales reps for this company went out to doctors, to pharmacists, to whomever, and were promoting this drug as a drug that couldn’t be abused.
Male Speaker 2: There’s no question that our best strongest pain medicines are the opioids. But these are the same drugs that have a reputation of causing addiction and other terrible things. Now, in fact the rate of addiction amongst pain patients who are treated by doctors is less than 1 percent. They don’t wear out, they go on working, they do not have serious medical side effects. And so these drugs which I repeat are our best strongest pain medications should be used much more than they are for patients in pain.
Barry Meier: It could be abused extremely easily, because it was essentially a pure narcotic. It was supercharged. In the book I describe it as a nuclear weapon compared to traditional pain-killers which were more or less conventional arms.
Brian Wilson If you are truly in need of it, it’s a Godsend.
Barry Meier: It’s a very useful drug. It’s a drug that allows you to sleep through the night, to take less of it than traditional pain killers. It’s not better per se in any other way in that it is long acting, but it’s a useful drug.
Brian Wilson Well, how did this then become a danger?
Barry Meier: It became a danger because it was being promoted as non-addictive, essentially.
Female Speaker 3: Now this medication does not turn you into a zombie. It has turned me into an active person again. And all these pictures I look at myself. I look so heavy and so unhappy. And, now I look completely different. I feel different.
Female Speaker 4: When I started taking OxyContin two months ago it was the first time I had felt normal since my original injury ten years ago.
Barry Meier: Doctors were also being taught at this time or they were being convinced at this time that pain as a condition, as a medical condition, was under-treated, so basically you had this big initiative going on within the medical world to treat pain more aggressively, and you had a drug that doctors were being convinced that they could use to treat pain more aggressively because it was essentially a non-addictive form of a narcotic, so you basically had this perfect storm come together where you had doctors who really wanted to help their patients and do the right thing and treat their pain being told that they could use pain killers more aggressively, and lo and behold they were given a drug that they could use as aggressively as they wanted because it was non-addictive.
Brian Wilson But it is addictive, and it became a problem. Do I have this correct that first of all they want more OxyContin? When they can’t get OxyContin, then they start to turn to other drugs to have the same impact.
Barry Meier: Well, there are a couple of different ways it can play out. The fact is that any type of opioid or narcotic, once you begin to take it, your body physically adjusts to it. It’s a very natural process called tolerance, so if you’re getting say a specific level of pain relief from, let’s say, 40 milligrams of the drug, you’re going to soon need more of the drug to get the same level of pain relief, so doctors kept having to ramp up and ramp up their patients’ dosages.
At a certain point patients who not only needed more of the drug but wanted more of the drug would start going around to other doctors, seeking prescriptions; doing what was called ‘doctor shopping,’ so they would get more of the drug, and then there would be people who would be faining pain and come to doctors and say, ‘Doctor, I have a bad shoulder. I have a bad back. Can you prescribe me some OxyContin,” so the drug eventually would get out onto the street. It was very valuable on the street, so people would use it and then if the supplies of OxyContin started becoming low because there were police activities or some kind of crackdown, people would seek out other drugs, and that could be anything from Methadone to heroin to some other; whatever opioid would be available on the street if someone had a severe opioid addiction, they would seek out whatever was available or whatever was cheaper.
Announcer: You’re listening to Opioids: Hidden Dangers, New Hope. More when we return.
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Brian Wilson Bring us forward to where we are today.
Barry Meier: Well, it’s a long and rather sad and tragic trajectory, because like most journalists you think, “I’ve reported about something. I’ve written a book about something. I’ve solved the problem. It’s all over,” but much to my astonishment the problem just kept growing and growing. The promotion of these drugs kept going and going. The push for doctors to treat more aggressively kept going on, so by the time 2013 rolled around, which is a decade after the book appeared, the number of prescriptions for opioids had grown four-fold. The number of over-dose deaths had increased four-fold, and then by 2013, 2014, we began to see the introduction of these very powerful counterfeit forms of the drug fentanyl on the street, and overdose deaths just started skyrocketing. They were at an extremely stunning, disturbing rate prior to that, but in the last few years the biggest growth in overdose death has come from illegal versions of fentanyl.
Brian Wilson Incredibly powerful.
Barry Meier: Yes. It is. 50, 100 times more powerful than heroin, and the problem is that people will go into immediate respiratory arrest which is how people die from opioids. (silence)
Brian Wilson So, now we have a situation where it’s not just the opioids. It’s the fentanyl, it’s heroin, it’s black-tar heroin in some cases. Tell me about that culture that has moved in to fill the need of addicted people.
Barry Meier: Well, we have a hydra-headed problem. We have the prescription drug problem, we have the illegal drug problem, and in some ways they cross over, but in many ways they’re separate from each other, and I’ve always believed that attacking these problems, you have to deal with them separately. One is a medical problem. The prescription drug problem is very much doctors, insurers, corporations, everyone deciding, “Well, we have people in pain. How do we treat those people in pain?” Then we have the law enforcement side, which I think you were referring to as well, which is how do we deal with all this illegal activity; the people who are bringing in heroin, the people who are bringing in fentanyl?
We’ve had people talking about trade with China. I know that’s one of President Trump’s favorite subjects, but the fact of the matter is that many of these starting chemicals that are used in the production of illegal fentanyl emanate from China, so if we really are serious about dealing with the illegal side of the opioid problem; that is the fentanyl side of the opioid problem, there are actions that our government can take vis a vis China to make sure that those chemicals are not exported to Mexico or this country.
Brian Wilson You’ve become deeply engrossed in this issue. You started back when it was first happening. You’ve re-written the book as you learned that the problem has gotten worse. How has this impacted your life? How has it changed you?
Barry Meier: Well, it’s taught me that you can’t walk away from something. I never thought that I would be re-writing this book again. I never thought that this issue would have to be revisited again. What was so stunning to me when I re-wrote it, I re-wrote it because I came across information showing that the Federal Government had planned to indict three executives of Purdue Pharma, OxyContin’s manufacturer, on very serious criminal charges; charges that would have sent them to jail had they been convicted, and those prosecutions never went forward because higher ups in the justice department prevented them from happening for political reasons, or whatever reasons.
I think as much of an outrage as I felt when I wrote the first book, my sense of outrage went well beyond the drug company to our own government at that point, because it was crystal clear to me that there are two standards of justice now in this country; that had those individuals been street-corner drug dealers they would have been arrested. They may have been sent to jail for the rest of their lives, and because this was a corporation with a lot of money to throw around, with a lot of high-powered defense attorneys, they essentially got to walk. I guess maybe I’ve become a little bit more cynical.
Brian Wilson Well, not so cynical that you gave up. Thank you.
Barry Meier: My pleasure.
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This presentation is underwritten by DisposeRx.