Into the fight

One of my first assignments as a young journalist was a story on how a small-town police department was combatting the illegal drug trade. On a cold January morning, I accompanied the police chief of a Middle Tennessee town as he trekked across the parking lot at the town’s sewage treatment plant. Climbing the steps alongside the concrete tank, he dumped a 3-gallon bucket of pills — almost all of them OxyContin, he explained — into the wastewater inside the tank.

That was 2003, and I had not a clue what OxyContin was. I suppose I drove to the police station that morning believing that we would be talking about marijuana, cocaine, heroin . . . anything but pain medications. The concept of opioid abuse was entirely new to me, as it was to much of America. But, introduced seven years earlier as a long-release form of oxycodone, OxyContin was already at the forefront of a new frontier in this nation’s long-running drug war.

Four years later, the makers of OxyContin, Purdue Pharma and the company’s top executives, pleaded guilty to criminal charges and admitted that they misled regulators, doctors and patients about the drug’s potential for abuse and addiction. The company paid more than $600 million in fines and settlements.

Last week, Scott County, Tenn., became the latest government entity to file a lawsuit against Purdue Pharma (and other pharmaceuticals), alleging that the drugmakers deliberately and repeatedly violated state and federal laws by widely and falsely promoting opioids as safe and necessary while concealing the drugs’ true risks.

Even as the battle targeting the makers of opioids grows — the attorney general for the 8th Judicial District, which includes Scott County has also filed a lawsuit — a pushback has began.

The latest example is a Reason article criticizing the crackdown on opioid abuse. It challenges the narrative — that “deceptive marketing encouraged reckless prescribing, which led to widespread addiction among patients and record numbers of opioid-related fatalities” — and claims that pain treatment isn’t actually the source for America’s addiction and overdose deaths that are related to prescription drugs.

The article makes a lot of claims and cites a lot of statistics, but in rural America — the front line of this fight — the author’s words seem hollow and empty.

For one, the author — Jacob Sullum — claims that opioids aren’t highly-addictive for those who take them for legitimate purposes. And of course we all know someone who has been on opioid pain-relievers at some point who didn’t become addicted (I’m one of them, as are many millions of others). Yet, as someone who has written countless stories about the drug abuse crisis, I can’t tell you how many times I’ve heard a story start like this: “It started with an injury…”

Just before Christmas, I had a long conversation in the hallway of our local hospital with a recovering — perhaps “recovered” is the better word — drug abuser. She was thanking me for our newspaper’s accommodation of a dialogue that drug addicts are real people who need help, not trash to be tossed aside and forgotten. And, with tears in her eyes, she recounted her own story. And, like so many others, “it started with an injury.”

This person is one of the lucky ones. She was eventually able to overcome her abuse, get clean, and now has a job as a respiratory therapist.

The unlucky ones are those who lose their job, their kids and, sometimes, their lives before they’re able to sober up.

The author also claims that opioids aren’t being over-prescribed by citing data from a 2014 survey that found 54% of those who abuse opioids get them from free from relatives or friends, another 16% buy them from relatives or friends, 4% buy them from strangers, 6% get them from various other sources (such as theft or from online pharmacies), and 20% get them from prescriptions written for them. The implication is that only one out of five opioid abusers get their drugs directly from a physician. But what about the other 70% who are given the drugs by someone else who has gotten them from a physician? If a patient has narcotics to sell or give away, narcotics are being over-prescribed.

One can always make the argument that poverty-stricken towns in America’s Rust Belt and throughout Appalachia would’ve turned to addiction using some other means as manufacturing jobs declined, as the author argues.

You can also make the argument that the author is talking out of his rear-end.

In Scott County — where attorneys have just waded into the fray with a lawsuit against Big Pharma — the abuse crisis far predates the downturn in manufacturing. Like most of Appalachia, this community’s economic heyday, if there was such a thing, came during the coal and oil boom of the 1960s and 1970s. When the wells went bust and the seams of coal played out, joblessness soared in the 1980s. By 1987, more than one out of every four Scott Countians were unemployed. Manufacturing slowly replaced the extrication of natural resources as the primary economic driver, and by the late ’90s, as the nation recovered from the recession that sank President George H.W. Bush’s prospects of a second term, the local economy was as good as it ever was. It wasn’t until the late ’00s, as the Great Recession tightened its grip on the global economy, that the U.S.’s manufacturing losses finally began to hit home.

The opioid epidemic became worse during that time, as unemployment soared to 23%. But it started well before. Remember, it was in 2003 — when times were still relatively good — that this young, naive reporter followed a police chief and his bucket of OxyContins up the steel steps of a wastewater treatment tank.

Scott County, like so many other Appalachian communities, had never had a serious drug problem prior to the surge in opioid abuse. Sure, there was a drug problem in the ’80s and ’90s. Where wasn’t there a drug problem back then? It’s just that it paled in comparison to the current problem. Homegrown marijuana was one of Scott County’s leading crops in the ’70s and ’80s. Cocaine and heroin were available. They were expensive, but so are narcotics. Even meth, as rampant as it became, didn’t challenge the supremacy that opioids soon realized.

It’s not hard to pin the rise in the drug epidemic on that 1996 release of a slow-release form of oxycodone that was considered revolutionary in the pharmaceutical industry.

Purdue Pharma launched an aggressive marketing campaign for OxyContin, the likes of which the drug industry had never seen. Because its new drug was a time-release drug, Purdue contended, it posed a lower threat for abuse or addiction than the traditional painkillers that came before it, like Vicodin and Percocet.

Of course, once drug abusers discovered that crushing and snorting or injecting an OxyContin produced a high every bit as powerful as heroin, it was over. But that still didn’t explain why OxyContin was so easily available.

That only happened because its makers deceived so many physicians, and OxyContin flooded small communities like Scott County, and Livingston — that Middle Tennessee town where I started working in 2003 — and scores of others throughout Appalachia.

Here we are in 2018, and community leaders are still rueing the day that Purdue Pharma’s top executives initiated their greed-fueled campaign to have an increased number of patients prescribed an increased number of pain pills.

Scott County’s unemployment rate in 2018 is near historic lows. It was 3.9 percent at last count. That sounds good on its surface. And, yet, only 7,640 people in a county of more than 23,000 are working. Fewer than 8,000 are in the work force.

Compare that with 2001, the last time unemployment was this low. There were more than 9,000 in the work force, and there were almost 8,500 who were working.

It’s substantial when you put percentages to it. There are 10% fewer people gainfully employed in Scott County today than in 2001. The work force is smaller today than it was in the mid 1980s, when the population was just over 19,000.

One of the driving factors is the drug abuse crisis. Between 2000 and 2010, we lost a lot of workers. That just happens to coincide with the time that OxyContin and other opioids were flooding the community and addiction was skyrocketing.

Loss of manufacturing isn’t as much an issue as journalists like Jacob Sullum would have us believe. Factories are practically begging for workers. Both Takahata Precision of Tennessee, which manufactures precision-molded plastic parts for the auto industry, and Tennier Industries, which manufactures sleep systems and parkas for the U.S. military, have half-page ads in this week’s local newspaper, recruiting new workers. Container Technologies Industries, which makes nuclear waste containers, and Great Dane Trailers are also seeking workers.

In fact, virtually every manufacturing operation in Scott County is currently hiring. But there aren’t workers to fill the jobs. The chief reason, according to human resource managers, is willing workers who can’t pass a drug test.

It has gotten bad enough that S.T.A.N.D., the Oneida non-profit that uses federal grant dollars to combat the drug problem through advocacy and education, is encouraging factories to implement a new program: rather than rejecting potential new hires who test positive for drugs, define those who can’t pass a drug test but who aren’t a threat to themselves, their coworkers or to production, and give them an opportunity to “get clean” while on the job.

“Some people are junkies and you don’t want the junkies,” S.T.A.N.D. executive director Trent Coffey told me yesterday. “But take the ones that are casual users, and maybe they aren’t clean today but they can start work and stay clean. And if you test them for six weeks and they’re still clean, then for six months and they’re still clean, you can back off (the testing).”

In a separate conversation on Thursday, I spoke with Oneida pharmacist Terry Roark, who says there’s plenty of blame to go around for America’s current crisis — “from the manufacturers to the wholesales to the physicians to the pharmacies to the patients,” Roark said. “There’s blame for everyone. What the solution is, I don’t know. But we talk about this on a daily basis.”

Roark’s pharmacy has twice been burglarized in the last couple of years. He’s had to install a cage across his front doors, which is closed at night. Another local pharmacist consulted Roark after his own store was burglarized last week, seeking to install a similar security measure. Roark laments the necessity of placing cages across business entrances. “What does it say to visitors in our town?” he asked. But it’s the new reality.

“Every burglary we ever had, had been for cash,” he said, adding that he never dreamed there would come a day when thieves entered his store and headed straight for his dispensary cabinet instead of the cash drawer.

That, too, is the new reality…a reality created by a generation of drug-abusers whose primary fix isn’t heroin or cocaine but opioids. And it started with Big Pharma’s push to convince us we needed more of them in the 1990s.

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