Dopesick Page 6

  In small towns where residents were used to leaving their doors unlocked, patrol officers were suddenly seeing people pushing stolen lawnmowers, four-wheelers, and even garden tillers down the street. “We called it ‘spot and steal,’” recalled Rev. Clyde Hester, who joined Van Zee and Sue Ella in their Lee Coalition for Health, the grassroots group. “They’d look for things during the day—weed eaters were popular—and then at night they’d come back and pick them up,” he said. To fuel his OxyContin habit, Hester’s own son stole his gun, which the minister later retrieved from a local pawnshop.

  A man in Dryden killed a young man attempting to break into his house to steal his wife’s prescription drugs, which he’d spotted above the kitchen-sink windowsill—down the road from Van Zee’s house. And as metal prices rose, Sheriff Parsons reported thieves stealing everything from copper cemetery vases to wires plucked from a telephone pole that addicted users had chopped down. Parsons even had his stepson arrested for stealing his own personal checks to buy black-market OxyContin. “There is literally not a family in this county that has not been impacted by this drug,” he told me in 2017, a statement I heard in every Appalachian county I visited.

  In early 2001, Van Zee and the Lee County Coalition for Health launched a petition drive asking the FDA to order a recall of the potent painkiller, via a website called recalloxycontinnow.org.

  Drawing deeper lines in the sand between Van Zee and the industry, and also between him and most of his physician peers, the petition received more than ten thousand signatures, most from Lee County and the result of a standing-room-only town-hall forum he organized at the high school in March 2001. “In a place where people barely have money for gas in their cars, by far this was the biggest crowd I’d ever seen gathered in Lee County,” one organizer told me. Eight hundred people attended, some sitting in the auditorium aisles. Roanoke-based U.S. attorney Bob Crouch called OxyContin “the crack of Southwest Virginia,” with Oxy overdose deaths now substantially surpassing those caused by cocaine and heroin.

  The next month, the DEA developed a “national action plan” to monitor Purdue, asking the company to limit distribution of the drug, rethink its marketing strategy, and consider reformulating the drug to be abuse-resistant. This marked the first time in the agency’s history that it targeted a specific drug to be policed by its manufacturer to prevent diversion and abuse.

  In response, the company announced a ten-point plan to curb abuse, including the distribution of tamper-resistant prescription pads, an educational program aimed at alerting teens to the dangers of prescription drugs, and a $100,000 grant for the creation of a statewide prescription monitoring program, or PMP, to halt doctor-shopping. The company also stopped distributing its most potent form of OxyContin, the 160-milligram pill, and reduced shipments to Mexico in light of reports that the drug was being smuggled back into the United States—sometimes by people making the twenty-three-hour drive from Virginia’s coalfields to the Mexican border or flying with pills taped to their back.

  With great fanfare in July 2001, the FDA announced it had worked with Purdue to put a black-box warning on the drug, the strongest type of prescription-drug caution. The goal was to help prevent inappropriate prescriptions, misuse, and diversion.

  But a company spokesman downplayed the black box, calling it “more of an exercise in graphic design” and pointing out that legitimate users didn’t experience the high created by abusers who snorted or injected the drug. The real victims, executives said time and again, were their “legitimate patients,” who would be denied OxyContin if its distribution were restricted.

  That year, a former Purdue rep remembered, the salesperson attended one of the company’s new seminars on diversion and abuse, meant to educate reps so they could inform authorities about suspected diversion. It was now possible for a rep who called on indiscriminate prescribers to earn as much as $100,000 a quarter in bonus pay alone, the rep told me. “It behooved them to have the pill mills writing high doses,” the rep added. “The [diversion/abuse] seminar was just a cover-their-ass type of thing.”

  “Let’s be clear,” a Purdue Pharma spokesman said in August 2001, in a meeting with Virginia’s attorney general. “The issue is drug abuse, not the drug.” The product shouldn’t be blamed for deaths, because in many cases the victims were also drinking alcohol and taking other drugs.

  Van Zee scoffed, telling a Roanoke Times reporter: “To me, that’s like somebody who was shot with a howitzer and a BB gun, and you walk up and say it’s a little hard to tell what killed him. Was it the howitzer that took off half his chest, or was it the BB gun?”

  Another set of scales fell from the doctor’s eyes as a distinct possibility flashed before him: No one in federal government would take seriously the concerns of a country doctor until opioid abuse took hold in the cities and suburbs. “If it’s a bunch of poor folks up in the mountains, it doesn’t affect them personally,” he said.

  Purdue had tried in vain to quiet the Appalachian naysayers a few months before, in March 2001, by offering Stallard and other county leaders a $100,000 “grant” they could put toward drug treatment and law enforcement. The offer had come the day after a meeting Van Zee arranged between Purdue executives and concerned family members, including a prominent Pennington Gap banker, the one whose addicted son had already blown through $80,000 of his life savings. If Purdue wouldn’t listen to local doctors and cops, Van Zee reasoned, maybe it would listen to someone whose son’s addiction had nearly depleted his 401(k).

  “We are an average family,” the banker said in his appeal to the executives, showing them a picture of his son. The banker had grown up in the Monarch coal camp, putting himself through college one night-school class at a time. Before his son stole from the family to buy black-market OxyContin, he had been a good student and a burly outdoorsman. “Surely you have got enough patriotism to worry about this country?” the banker said. He pointed out that the company must have known Lee County (population twenty-three thousand) had an OxyContin problem before Lee County did, considering that it was sending as many pills to the region as it was to areas five times the size. “I’m sorry your family is having such a problem,” Purdue’s chief executive officer, Michael Friedman, said.

  At the meeting’s end, the executives stunned the group when they laid out an ad they planned to place in the local newspaper, a full-page “open letter” to the people of Lee County. In it, the company contended that Purdue had not targeted its marketing to areas like Appalachia with high disability or Medicaid rates, nor had the company known of the drug’s abuse potential. Purdue Pharma also disputed suggestions that it could quickly or easily reformulate the drug.

  The parent meeting had been a setup. Whereas Van Zee thought the company might finally be willing to make some compromises—“Art…really thought Purdue would feel some empathy” toward the banker, Sue Ella recalled—it was plain now that was not the case. The meeting had been brokered to shove the ad down the group’s throat.

  Sue Ella blew up, telling Haddox: “You have done more to hurt Appalachia than the coal industry has ever thought about doing.”

  Haddox said he resented the implication, and Sue Ella said she didn’t give a damn if he did. “I said, ‘Look, I’m an Appalachian scholar, and my family goes back here forever, and I take tremendous insult,’” she recalled.

  She stormed out with the others, and the newspaper ad never ran.

  The next day Friedman gathered with Richard Stallard and other law enforcement officers at Kathy’s Country Kitchen in the Lee County seat. Sister Beth Davies, the pluckiest of the three nuns who had answered the War on Poverty call, was in attendance.

  So was pharmacist Greg Stewart, a miner’s son whose parents had personally helped build the St. Charles clinic. When Stewart filled OxyContin prescriptions, he begged his customers to lock their medication up. He’d already been the victim of two robbery attempts, including one by the son of a neighboring hair-salon owner who crawled in t
hrough the ceiling vents connecting the salon to Stewart’s store.

  When Purdue Pharma offered to put $100,000 toward expanding the county’s drug treatment and law enforcement efforts, Stewart said he was inclined to accept the donation as partial payback, considering the fortune the company was making off the area’s misery. Van Zee and Sue Ella agreed, and even drafted a letter of acceptance after the meeting. Sue Ella explained that she was initially for accepting the money “because of my experience with the coal companies taking and taking and taking, and all the companies, they sit up north with their inherited wealth and leave nothing behind except broken bodies.”

  But Sister Beth, the five-foot-tall redheaded nun, was having none of it. The executives might be able to intimidate the people up north, where their philanthropy held sway in places like Harvard and Manhattan. But Beth was a formidable New Yorker herself, with a master’s from Columbia. More important, she’d grown up under the tutelage of high-powered nuns who ran hospitals and colleges with a firm hand but a fair eye, and a mother who read a book every day.

  A Staten Island native, Sister Beth had worked in Stamford, Connecticut, Purdue’s hometown, where she ran a Catholic school before moving to Appalachia in 1971. A former student of hers from Connecticut had recently called to apologize, in fact; he was a reporter at the Stamford newspaper, which had been strongly encouraged not to write anything critical of the company, she said.

  In 1996, the same year OxyContin was introduced, Sister Beth had stood up to a crowd of sixty coal miners and executives and their lawyers—all men—to demand the Lone Mountain coal company make reparations for the havoc caused by one of its faulty coal-slurry ponds. A liner had burst, sending wastewater screaming through the village of St. Charles. The water unloosed a boulder that rammed a resident’s house, flooded other homes, scattered coal waste and litter for miles along the Powell River—endangering fish and mussel beds—and generally scared people half to death.

  That event pitted company miners from other camps (forced to defend the company or lose their pay for the day) against local miners whose community had been devastated by the flood. Lone Mountain’s defense, as articulated by one of the outsider miners: The town was already full of litter and “Pamper trees”; therefore, the flooding was simply another “act of nature” unleashed on an already diaper-scarred landscape.

  Health care administrator Tony Lawson remembered the way Sister Beth stood up in that meeting—“this tiny little thin woman who was so angry the paper she was holding with her statement shook in her hands. But she spoke loud and clear to all those men in that audience. She was absolutely the most fearless, bravest person I’ve ever seen.”

  The executives glared, and the hired miners booed, but Sister Beth didn’t waver. Though the coal company eventually paid to clean up the mess—not nearly enough, in the nun’s opinion—the flood of slurry-pond waste was an ominous harbinger for St. Charles.

  If the Purdue executives thought that people like Sue Ella and Sister Beth could be bought, they had not done their homework. Both had stood on the picket lines with strikers and their families for nine life-and-death months in 1989, when the Pittston Coal Company wanted such huge union-contract concessions as reduced pay-in to retired miners’ health insurance and wage cuts. Sister Beth had literally lain on the ground, to block the coal trucks, while Sue Ella stood next to the striking miners with her six-month-old baby in a carrier.

  Over the years, Sue Ella’s and Sister Beth’s lives had been threatened because of their social activism, including once when Beth convinced an illiterate coal miner not to sign away all company liability for a mining accident. (“Greed makes people violent,” she told an interviewer in 1982. “When we stand with the least in the struggle for justice, there’s a price to pay.”)

  The Purdue offer was just another page in an old story. This is what happens when wealthy people think they own you, Sister Beth told her Lee County friends. Since the first piece of coal was chiseled from the first mountainside rock by a large out-of-state corporation, the region had suffered from a pattern of exploitation, she said, ticking off all the mining-company executives who’d flown in over the years and spread their money around trying to buy peace, and then shut down unions, reduced black-lung benefits, and kept other industries out to maintain low labor costs.

  Sister Beth thought about all the firsts she was starting to see at her Addiction Education Center in Pennington Gap, where she and Van Zee were now conferring daily over their mutual patients, among them young women now prostituting themselves for drug money. She thought about the high school senior, a cheerleader, snorting OxyContin in the school library. About the people having their teeth pulled for the sole purpose of eliciting an Oxy prescription from a dentist. About the middle-aged woman who’d ruefully remarked in the middle of being fingerprinted and photographed that she was wearing the same gray sweatpants she’d had on the last time she was arrested for distributing OxyContin. “I’d burn those if I were you,” a sheriff’s deputy quipped.

  But it wasn’t funny to Sister Beth.

  She recalled the first phone call she’d taken about the drug, in the late 1990s. The informant had told the cop. The cop called the pharmacist. The pharmacist called Sister Beth. It was another game of telephone, only this message remained tragically on point:

  “Beth, you wait,” pharmacist Stewart had told her on the phone. “They’re saying it’s nonaddictive, but you mark my words: This is the beginning of a disaster for us.”

  The disaster was now in full bloom. And Sue Ella and Sister Beth guessed exactly where it was headed. Even if Big Pharma and the pill-mill doctors could be brought to justice, the morphine molecule was so deadly, its lure so intractable, that those who were already addicted were likely to be ruled by it for the rest of their lives.

  Sister Beth threatened to quit the coalition if anyone accepted Purdue Pharma’s $100,000 grant, and Van Zee’s letter of acceptance was never sent. The grant was nothing more than “blood money,” she said, and the coalition agreed.

  Poff Federal Building, Roanoke, Virginia

  Chapter Three

  Message Board Memorial

  While regional reporters from Boston and Roanoke were unpacking the damage done in their rural outposts, the story of the burgeoning OxyContin epidemic didn’t hit the national media until February 9, 2001, when New York Times reporter Barry Meier and a colleague swooped in just north of Lee County for a front-page story on Operation OxyFest, a nine-month federal investigation that had produced the biggest drug-abuse raid in Kentucky history. “We caught 207” user-dealers, a federal prosecutor told Meier. Most of those arrested were patients who had coaxed pills out of doctors who were either busy, slipshod, or quietly cooperative in overprescribing the drug. “We didn’t catch half of them; that’s how pervasive this thing is.”

  That summer, it became clear that OxyContin abuse had seeped out of the western Virginia and Maine backwoods, creeping up and down the Appalachian range. The news was disseminating, finally, not just to big cities on the East Coast but also into the Deep South and parts of the Southwest. Overdose deaths and OxyContin-fueled crime grabbed headlines from Miami–Dade County to Bridgeport, Connecticut. Across the country, OxyContin was becoming a staple of suburban teenage “pharm parties,” or “pharming,” as the practice of passing random pills around in hats was known (ironically in farming communities).

  It would fall, ultimately, to the parents of the dead to organize the first national response, specifically to a thirty-nine-year-old IT worker named Ed Bisch. In February 2001 Bisch had been summoned home to his working-class enclave of Philadelphia after taking a frantic call from his daughter, who’d just found her eighteen-year-old brother passed out and turning blue in the bathroom.

  Bisch arrived home to find a pair of emergency workers sitting on his front lawn. His son, Eddie, was a high school senior, a soccer player with decent grades and plans to attend a local culinary school. Eddie had complained of feelin
g ill recently, but it had not crossed his father’s mind that he was deep into opioid withdrawal. Bisch had suspected Eddie was drinking and maybe smoking pot but hadn’t considered pills. They had plans to fly to Florida for a father-son fishing vacation in just six days.

  “I’m sorry,” one of paramedics told Bisch. Eddie was dead.

  As friends gathered, Bisch was still in shock and grappling for answers when he asked the first responders what his son had taken.

  “Oxy,” one said.

  “What the hell’s an Oxy?” Bisch wanted to know.

  The first time Ed Bisch heard the word “OxyContin,” his son was dead from it.

  If parents were slow to catch on to the epidemic, experts weren’t any quicker. The movement of OxyContin from the economically straitened hinterlands to the largely more affluent cities and suburbs in the early aughts reminded historian David Courtwright of the iatrogenic wave of opium and morphine addiction that stormed the nation exactly a century before. By the 1920s and 1930s, most of the small-town morphine addicts and Civil War veterans with soldier’s disease had died out, not long after the national crackdown hastened by the Harrison Narcotics Act, which set the scene for drug prohibition and, later, the so-called War on Drugs.

  “After the old-time addicts died out, narcotics were unheard of throughout the mid-twentieth century, unless you got cancer,” Courtwright said.

  For most of the previous century, opioid addiction was mainly relegated to big northeastern cities, where heroin had long been smuggled in through illicit channels, infiltrating the Harlem jazz scene of the 1940s and the beatnik subculture of the 1950s. The term “hipster,” in fact, drew from the Chinese opium smoker of the 1800s, who’d spent much of his time smoking while reclining on one hip. The hipster counterculture took inspiration from heroin-addicted jazz greats like Charlie Parker and John Coltrane.