The Strange Story of OxyContin: A Tale of Predictable and Utterly Preventable Catastrophe
The October 27, 2017 edition of The New Yorker carried an article by Patrick Redden Keefe on the Sackler family and the marketing of OxyContin.
You can read that article here:
The following is my own (much shorter) take on the same issue. It recently ran in Still: the Journal, an online magazine of Appalachian literature.
The Strange Story of OxyContin: A Tale of Predictable and Utterly Preventable Catastrophe
In the late afternoon, I stand at the corner of Gest Street and State Avenue in the Cincinnati neighborhood of Lower Price Hill and I watch a young woman stumble out of a car. The driver is Hispanic this time, possibly from Chiapas or Guatemala, but if you watch long enough you might later see her stumble out of the car of a downtown businessman or a construction worker in from Adams County.
She stumbles, I say, and even as she rights herself her body leans leftward like a bow, bent perhaps by the moons of heroin or the pressure of crack cocaine or by the distortions of her labor serving men in the cramped front seats of cars,
She is a small woman, not quite five feet tall, and perilously thin. She has a name tattooed at her neck like a shackle and her teeth are gone clouded and gray and there is something about her so twisted and damaged and childlike and holy that I cannot understand how any man would want to have her.
But the men do have her. Again and again, the men come to her corner. They pull to the curb and they roll down their windows and she leans toward them and speaks to each of them for a moment. Then she gets in the car and they drive off, and in a short time, they return her to the corner once again.
Lower Price Hill is a mostly white Appalachian neighborhood in Cincinnati. It is not a hill at all, but part of the Mill Creek valley, the place where the Mill Creek flows into the Ohio River and where, in the late nineteenth century a number of industries and a collection of working-class tenement buildings came together.
Many of the tenements and most of the industries are gone now and most of the open spaces are full of litter and rubble or, on the hillsides leading up to Price Hill proper, are thickly overgrown with honeysuckle and poplar.
Gentrifiers have given the neighborhood the eye and, apparently, deemed Lower Price Hill not worth the trouble.
Somewhere in the 1950s, the original German and Italian residents moved out as the Appalachians moved in. There are now a growing number of Hispanic and African American neighbors, but it is still a largely Appalachian neighborhood where young people speak a mix of down-home and hip hop and a group of us still holds an annual festival of traditional Appalachian music and culture.
Lower Price Hill was never your quiet, tree-lined neighborhood. From the first, it was a hard-working, hard-drinking community, its environs hit hard by the effluents of the local factories and, since the 6os, the Metropolitan Sewer Division’s Mill Creek plant, an eighty-eight-acre facility that adds its own fecal stench to the tang of volatile organic compounds. Residents concerned over the effects of all these pollutants on themselves and their children put up a stiff fight and things have gotten better in some ways. For example, Queen City Barrel, a company that recycled steel drums, was once the worst of the polluters. They had a plant that covered a full city block. Persistent protests forced action and the company installed technology to capture and burn off most of the fumes. But problems persisted until the plant caught fire one night in a spectacular blaze punctuated by the thud of exploding barrels and the entire complex burned to the ground. The site has been cleared for what is supposed to be an industrial park to bring in jobs for the people of the neighborhood.
It’s been several years now and those acres still stand idle.
The Arthur M. Sackler Wing of the Metropolitan Museum of Art is a beautiful place, a unique place, very stark, not at all cluttered or trafficked. In the Sackler Wing, there is nothing like the fetid air of Lower Price Hill and there are no young women with shackle tattoos.
You approach the Sackler Wing down long, quiet corridors of Asian and Egyptian art far removed from the streets outside. You enter the Sackler Wing through large glass doors and immediately, to the right, you see a huge, slanting wall of glass that sends light cascading onto a large, open room that includes a pair of larger-than-life statues, a reflecting pool with a pod of tall grasses, and toward the rear, the centerpiece of the Arthur M. Sackler Wing, the Temple of Dendur, an intricate and eloquent stone edifice covered with bas relief figures who march in ritual procession along its walls.
The Arthur M. Sackler Wing was created with a ten-million-dollar grant from Dr. Arthur M. Sackler who, as chief executive officer of the Purdue Pharma company developed the mass marketing strategy that turned Valium into a household name and –as a poorly thought-out by-product- a new era of addiction.
Arthur M. Sackler died in 1987, but his legacy lives on, for Purdue Pharma later oversaw the creation, promotion, and mass distribution of the drug OxyContin.
The major innovation of OxyContin was in its time-release mechanism which, had it worked as it was intended to work, would have meant that those suffering from chronic and debilitating pain –cancer patients, for example, or those suffering from mining injuries—could receive a dose of opioid pain relief without the concurrent danger of addiction which has been the curse of all earlier opioid pain relief.
We know now that OxyContin did not work the way it was intended. And we know that the producers of OxyContin knew that from the start and that they ignored the evidence that their claims to OxyContin’s safety could not be supported and we know that they continued to promote and to sell and to collect millions of dollars on the sale of OxyContin as addiction rates soared and the suffering of desperate families was further compounded.
I like to think of the corner of Gest and State in Lower Price Hill as Arthur M. Sackler’s other wing.
Demand for OxyContin ---and addiction to it--- quickly took hold in Appalachian communities, from Maine to Alabama and from there into the urban Appalachian migrant centers like Lower Price Hill. It didn’t help that Purdue Pharma took the aggressive sales strategy that they inherited from Arthur M. Sackler. Oxy became known as “hillbilly heroin.” Communities were transformed as people became desperate for the drug.
Why did Oxy take hold so quickly in the Appalachian community?
I think there are three reasons: First, Purdue Pharma had that aggressive marketing campaign which targeted the region.
Second, high rates of cancer and chronic injury in Appalachian communities mean there is a lot of need for pain killing.
Third, sharing is a strong cultural tradition in the Appalachian community, including drugs. People in need and in “need” can usually find someone to share with them. So, something like Oxy can quickly spread.
If there is a fourth, it would be the perpetual economic and social crisis of Appalachian communities where unemployment is high and chances are few.
So, Oxy had fertile ground. Word got out about the disaster. There were articles in the New York Times and other media. Communities raised hell and supplies of OxyContin grew short. Purdue Pharma, in a desperate attempt to clean up its image, started a drug prevention campaign. But the damage was done. Lives were upturned. As physicians grew more reluctant to prescribe OxyContin, desperate addicts looked for alternatives, including Methadone.
Methadone is another very effective drug when dosed properly and combined with counseling. But addicts in Lower Price Hill and other communities figured out that at least one Methadone center was willing to let them forgo counseling and take more than what they needed to control their cravings. With Methadone, if an addict takes more than what is needed to control cravings, that extra dosage will get that person high. So, addicts cut off from OxyContin had a cheap, legal high and the community faced still more troubles. The OxyContin overdoses became Methadone overdoses.
So, the community raised hell again, this time with the East Indiana Treatment Center, and Methadone got scarce.
And the addicts shifted their tactics again. This time, to heroin. Now, the OxyContin overdoses turned Methadone overdoses have become heroin overdoses.
None of this needed to happen. It would not have happened if greed had not over-ruled common sense. But greed almost always does. And greed at the corporate level almost always escapes serious consequences. The people who made this disaster happen have, in some cases, faced fines and civil suits, but none, to my knowledge, has faced jail time or the loss of a loved one.
None of them, to my knowledge, has a daughter or sister who stumbles in and out of men’s cars, who stalks State Avenue with a marked and bent body, holy and sad, a tattoo like a shackle at her neck.
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