Beth Macy on the Opioid Crisis and Her Book “Dopesick”

MICHEL MARTIN: Beth Macy, welcome. Thank you so much for speaking with us.

BETH MACY, AUTHOR AND JOURNALIST: Thanks for having me.

MARTIN: But it hard now since you’ve been living with the subject for so long. But do you remember when you first heard the word “oxycontin?”

MACY: Yes, I was a reporter in Roanoke, Virginia, and my colleagues were going off and covering rural, western Virginia where they were have spate of overdoses, kids overdosing in the library, coal miners overdosing, farmers losing their farms, murders happening in communities that had never happened and this was in the late 1990s. So that really is how long we’ve been dealing with this crisis. People tend to only think it’s since heroin picked up but it goes back 22 years.

MARTIN: So how did you hear the word? What happened? Did people come back to the office and say that was the craziest thing, you’re not going to believe it. Like how did it — how did it become real to you?

MACY: Yes, yes, one of my colleagues, Lawrence Hammock(ph) covered the crime that was happening in localities in central Appalachia where people had never locked their doors, now they were broken into because people were stealing their Oxycontin. There was a grocery store manager got shot as he was doing the night deposit so people could steal money to get their black market Oxycontin. We had never seen that kind of crime on that scale in these rural communities.

MARTIN: So how did you realize that was the story because it’s almost like it was hiding in plain sight. I mean these terrible things were happening, when did you realize that this was the threat that tied it all together?

MACY: Not until I started working on the book in 2015 actually. I had written a three-part series on heroin landing in the upper middle class suburbs of Hidden Valley, aptly named, outside of my home in Roanoke, Virginia. And even then people didn’t put the connection between the over prescribing of opioids and the introduction of Oxycontin in the late ’90s – mid to late ’90s with the fact that when the pills got hard to get, people were still having to go to heroin now and later to fentanyl because once you’re hooked on the morphine molecule whether it’s Oxycontin, Oxycodone, hydrocodone, or heroin, you have to keep having it in order not to feel dope sick which is what they call this excruciating withdrawal.

MARTIN: Yes, tell me a little bit more about that. What is dope sick?

MACY: Dope sick is what users call the feeling of withdrawal. It is sweating, diarrhea, cramps, vomiting, nausea, restless leg. They all say it’s like the worst flu times 100 and as somebody early in the book says, at the end of your journey, you’re not doing heroin or pills in order to do high, you’re just doing it not to be dope sick.

MARTIN: You know for people who have no experience with this and that’s a dwindling number of people in this country as you make abundantly clear. A lot of people might think what’s the appeal? How did this all start?

MACY: Well three out of four people start with prescribed opiods, whether it’s prescribed to them. Some kids who are experimenting will start out stealing left over pain killers from their parents, grandparents medicine cabinets.

MARTIN: Why? Just for the fun of it? Just for the thrill?

MACY: Yes, I mean when you and I were growing up it was maybe alcohol, maybe marijuana. But now kids are doing pills at parties and if you look at the data, the number of prescribed, diverted pills is just off the hook. Two thirds of college seniors have been offered ADHD medication.

MARTIN: You the fact the thing about your work is you don’t point the number at any one cause or any one thing but you definitely point the finger or lay a lot of responsibility on aggressive marketing tactics by pharmaceutical companies and one in particular which is Purdue Pharmaceuticals which was owned by three brothers, the famously private Sackler family. What exactly did they do to lay the groundwork for this crisis?

MACY: So when Oxycontin came out in 1996 the FDA allowed them to make this sort of nebulous squishy claim that because it had this brand new 12 hour time release mechanism that was supposed to allow Oxycontin to bleed out over 12 hours, it was less likely to be abused or to set people up for addiction and if you go to those communities where it tended to be prescribed a lot – central Appalachia, Machias, Maine, it was really clear that users very quickly figured out an end run around the time release mechanism. They would put the pill in their mouth, let the coating, the time release coating melt off and then they would wash it on their sleeves. So they would go around with like orange from the 40 milligram, green from the 80 milligram stains on their shirts from this and they would get the full euphoric crush of that pill in one fell swoop and that sets people up for addiction and the company said they didn’t know until 2000 that it was being abused. But I mean it took me about a half hour to find the first sop who saw people walking around almost immediately with these orange and green stains on their shirt.

MARTIN: So many people tried to sound the alarm. People tried to call the company and say, “Hey, this is actually more dangerous than you’re saying.”

MACY: Right Dr. Art. Van Zee who practices in a sliding scale clinic in central Appalachia was one of the first to call them on the phone and he said, “I know you said the drug isn’t addictive or addiction is exquisitely rare, but we’ve got high schoolers O.D.-ing(ph) in the Lee High library, kids I immunized as babies. We’ve got farmers losing everything to this drug; it is addictive. And he wrote them a letter in 2000 and was very pression. He said my fear is that these distressed communities that are now seeing crime like they have never seen before, overdose deaths like we’ve never seen before are the sentinel areas much like San Francisco and New York were in the early days of HIV.

MARTIN: Why were the areas that you write about – places that you live central Appalachia, why were they so vulnerable I guess would be the word?

MACY: So many things, it was kind of the perfect storm. The coal mines were shutting down. The factories, textile mills and furniture factories were going to China or Mexico so people had this desperate need to pay their bills and so when Oxycontin came out people figured that they could also sell them on the black market for thousands of dollars especially if they had Medicaid card they could buy them for a dollar or two and make a lot of money. But the other thing that was happening was the (inaudible) of this vital sign movement. The hospitals were now being judged on how they treated a person’s pain. You’ve seen the smiley face charts when you visit somebody at the hospital. There was this movement being much of fueled by lobbying and pharma dollars to say we’ve been under treating pain.

MARTIN: But then people tried to sound the alarm, what happened?

MACY: Sometimes the company would send people to make sort of peace offerings, grants were offered. Art Van Zee and this coalition he started, they turned down a $100 thousand grant that Purdue wanted to do to the community because they thought it was just accepting blood money as they called it. A lot of teenagers were overdosing on Oxycontin and as it became known, they sort of got organized, the parents. They called themselves relatives against Purdue Phara and they started feeding information to this nascent federal investigation that was happening out of Virginia, out of the area I’m based from and in 2007 the company had pled guilty to criminal misbranding and the three top executives pled guilty to a misdemeanor version of that charge but nobody went to jail.

MARTIN: The numbers are just so staggering that it’s hard to kind of wrap your head around them. I mean drug overdoses have now surpassed heart disease as the number one killer of Americans under the age of 50; 72,000 Americans overdosed last year alone, and this after some of the interventions that you spoke about. This after the drug company was taken to court multiple times. Most people assume that the purpose of the government is to keep people safe, to keep its citizens safe. What was the government’s role in all of this?

MACY: Right. So what the government did was basically nothing. It – it seemed to look the other way and if you go back to political campaigns and lobbying from pharmaceutical companies, they spent eight times what the gun lobbyist spent on political campaigns and lobbying between ’06 and 2015, almost $1 billion and that’s what we need to be looking at. These people in Congress now are allegedly grilling the opioid makers and distributors but you look up – some of them are taking money from the opioid makers and distributors. I don’t know if you saw Eric Eyre’s reporting out of Charleston, West Virginia, but he found a little tiny town in Kermit, West Virginia, with 400 and some people that a pharmaceutical distributor was sending 9 million pills. I mean where’s the oversight there?

MARTIN: Was there a point at which this could have been stopped?

MACY: Oh, Dr. Van Zee talks about that all the time and so do some of the early parents who I’m still in touch with; those early Relatives Against Purdue Pharma. If somebody would have went to jail, if they would have taken it off the market when Van Zee said look I’ve got kids O.D.-ing in the high school library. He wanted them to take it off the market, to reformulate it to be abuse-resistant like the makers of Talwin had done a number of years earlier and that worked. And they didn’t do that.

MARTIN: I guess one point which they were meeting with some of the parents – were meeting with representatives of the pharmaceutical company and one of the dads had a picture of his son and he said to one of the executives, I’m paraphrasing here, aren’t you enough of a patriot to care about…

MACY: To care about…

MARTIN: … this. Aren’t you enough of a patriot to want to change something so this doesn’t keep happening? Why wouldn’t the company change it?

MACY: Well they were making a lot of money on that drug. It made over $30 billion now. The Sacklers are on the Fortune 500 list. It’s all about the money in my opinion.

MARTIN: Did you ever have a chance to talk to any of them – any of the principles? I know Arthur Sackler is diseased, but did you ever have a chance to talk to any of the officials and say what about that?

MACY: So I got hold of Howard Udell’s son, Mr. Udell is diseased…

MARTIN: Mr. Udell being?

MACY: He was the head leading counsel for Purdue Pharma and he appeared – he took the 160 milligram off the market. He was behind that and he was trying – or he said he was trying to – they cared about addiction and abuse and I just wanted to see if there was any responsibility because even when they pled guilty to criminal misbranding, they never – they figured out a way never to take responsibility — those three executives. So I asked his son did he think – did he think about that? And there was – it was a lot like the drug dealers. It was like there was no – from what we did to the point where the needle hits the vein and people die, there was no – there were too many connections that people couldn’t make in between and they were – they think they’ve created this wonderful drug and they say they’re very concerned about addiction now and you see their full page ads in the “New York Times” and “Washington Post.”

MARTIN: I mean there are so many people you profile in your book and it’s heartbreakingly hard to keep track so I just want to you to tell me a couple people’s stories. In fact, why don’t you tell me the story of the locket that you’re wearing now?

MACY: Sure – sure this is a locket. It was given to me by a mother that I became very close to. I followed her story and her daughter’s story for two and half years. Her daughter is Tess Henry(ph), she had been a published poet at a young age, had studied French in college and she was over prescribed two 30-day opioid painkillers for a simple case of bronchitis.

MARTIN: For bronchitis? Opioid for bronchitis?

MACY: Cough syrup with codeine and hydrocodone for sore throat pain, 30 days and by the end she had been doing some experimenting with drugs and I watched her over the course of this two and half years just try to access treatment, try to access rehab and this is somebody who is the daughter of a surgeon, a hospital nurse, you know people in the medical system. And what I watched was just the system of medical abandonment I will call it. She would get – she would get in with Buprenorphine-prescribing doctor, that’s medication-assisted treatment that has the best advocacy for staving off overdoses and relapse and then she would lose here Medicaid because she lost custody of her child. She would have a relapse and then eventually she’s living homeless, on the streets until she fell through the cracks and she was murdered last Christmas Eve after failing out of a rehab in Los Vegas that was abstinence only and that’s something I saw over and over again. Hurclean efforts made to send people to treatment but it was really not necessarily the right treatment for them.

MARTIN: There are half a million people who are dead who shouldn’t be dead according to a study from 2015 and we’re talking here about since 1999, half a million people who’ve died because of drug overdoses or conditions related to them who shouldn’t be dead.

MACY: We’ve lost 300,000 people in the last 15 years to drug overdose deaths and we’re going to lose that many in the next five, so it’s a curve going up with no sign of plateauing.

MARTIN: Is anything OK?

MACY: Well we are…

MARTIN: Is there anything that’s going to continue hope?

MACY: Yes, we are starting to see some slight decreases in overdose deaths in some New England states that were early Medicaid expansion states under The Affordable Care Act. So Rhode Island, Vermont, and Massachusetts and what they have in common is they’ve made access to this medication-assisted treatment available to people like Tess(ph) who are living on the streets. We’ve got to just educate people about this because in places where syringe exchanges are places where people can come in and for no money they can get access to treatment and they can get access to HIV and hepatitis C testing and treatment and treatment works. It’s not a cure all, sometimes it take people four, five, six, seven, eight times on trying this drug buprenorphine or methadone to get that or to get their lives together and then they can start seeing success and – but it’s still only 1 in 10 opioid – people with opioid use disorder have access to this. Seventeen states haven’t passed the Medicaid expansion yet.

MARTIN: Beth Macy, thank you so much for talking with us.

MACY: Thank you Michel.