A World of Pain
The dark side of OxyContin is exposed

By Rob Wiser

It’s known as  “hillbilly heroin”  among the thousands of addicts it has spawned in rural towns across America, where users don’t have access to the real thing.  The pharmaceutical industry has marketed it under a different name:  OxyContin.

The experience its users describe is nearly identical to that of heroin addicts.  The high is euphoric, but addiction sets in quickly—and quitting is sheer torture.  The difference is that until recently, OxyContin has been liberally prescribed by many doctors as the most effective painkiller on the market.  They thought the drug was safe and non-addictive—a lie promulgated by the drug’s manufacturer, which was racking up staggering profits.  As a result, millions of patients seeking pain relief inadvertently became hardcore addicts.   

Since 1995, the year OxyContin was introduced by Stamford, Connecticut-based Purdue Pharma LP, stories like that of Jon Riley Hays, M.D. have become disturbingly common.  Formerly a family practice physician in a small town in Southern Illinois, Hays first tried the drug when one of his patients turned in a bottle containing some leftover pills.  He’d been suffering chronic back pain since a car accident, and the weaker painkillers he’d been prescribed weren’t helping.  Believing it to be safe—the sales representatives told him so—he went ahead and swallowed a tablet. 

“I felt like Superman,”  Hays recounted to the Belleville News-Democrat newspaper.  I could work all day, be happy, go home, play with the kids, do everything that I wanted to do…I just felt like a million bucks.”

Within six weeks, Hays was desperately hooked, stealing pills from patients and scamming pharmacies.  As his body quickly built up tolerance, ingesting the drug orally no longer did the trick;  he began crushing pills, mixing them in a saline solution, and injecting it into his arm.

While trying to hide his addiction from his wife and kids, Hays attempted to wean himself off OxyContin.   "You're bedridden," Hays said of the hellish withdrawal.   "Your bones feel like they're on fire and they're melting flesh."

Hays sought treatment and managed to quit OxyContin, but not before the DEA busted him for obtaining the drug illegally.  In May 2002, a judge sentenced him to 51 months in federal prison.  That same year, OxyContin generated more than $1 billion in sales and filled nearly 6 million prescriptions.

For years it was hailed as a miracle cure for chronic pain, from severe arthritis to terminal cancer.  The drug’s key ingredient is oxycodone, a form of synthetic morphine.  The pills contain a slow-release mechanism that give 12 hours of pleasurable, peaceful sensation throughout the day.  It appeared to deliver the perfect high;  users didn’t experience any loss of control and could go through their work day with no noticeable side effects.  There was no hangover or emotional  “crash”  afterwards.  But like all opiate-based drugs, OxyContin is highly addictive and the body rapidly builds up tolerance to it.  Instead of experiencing the euphoric high, addicts are in constant need of the drug just to stave off the withdrawal pains.  Soon, the amount the doctor prescribes is not enough, and addicts need to obtain it by other means.  Armed robberies occurred at pharmacies, where the robbers demanded only OxyContin.  More common was  “doctor shopping”—addicts constantly seeking out new physicians and exaggerating their ailments in order to receive  prescriptions.  Some went so far as to break their own teeth and visit emergency rooms just to get a fix.  Then there were the recreational users, who’d heard of the heroin-like high in the harmless guise of a pill.  A black market sprang up to meet this demand.  The drug exploded across national news headlines in 2003 when right-wing commentator Rush Limbaugh checked himself into rehab and confessed his addiction to the pills, citing years of chronic back pain.  (Ironically, Limbaugh had often railed against drug-abusers and called for harsher criminal penalties.)

On the outskirts of Southwest Virginia alone, hundreds had died from overdoses.  Police reported surges in fraud, theft and violence as addicts struggled to support their habits.  When the sinister truth about the drug began to emerge, victims and their families filed suit against the pharmaceutical giant that had created it, claiming they were never warned about its dangerous qualities.  This led to one of the largest federal investigations ever launched into a pharmaceutical company.  Last year, The Purdue Frederick Company, Inc.  (a branch of Purdue Pharma),  and three of its top executives pleaded guilty to felony charges that they purposely misbranded the painkiller OxyContin with intent to mislead and defraud.  They were ordered to pay a total of $634.5 million in restitution.  (Most of the money went towards covering losses by government programs that paid for OxyContin prescriptions, and to other state and federal agencies.)  It was one of the largest fines ever imposed on a pharmaceutical company.  U.S. Attorney John Brownlee called the outcome  “one of the worst prescription drug failures in the nation's history.”

The ruling will no doubt force pharmaceutical companies to be more forthright about any potential for abuse and addiction their drugs carry.  But there is another question this landmark legal case raised, which caused much debate when Limbaugh got busted for doctor shopping and admitted his addiction.  Conservative and religious commentators rushed to defend Limbaugh, putting him in a different category than abusers of street drugs  (who are predominantly poor minorities).  In their view, those addicted to street drugs should be harshly punished, while the white-collar professional who gets hooked on pain pills deserves sympathy and treatment.

“From a moral standpoint, there’s a difference between people who go out and seek a high and get addicted, and the millions of Americans dealing with pain who inadvertently get addicted,”  Gary Bauer, president of the conservative organization American Values, told Newsweek.

That argument may sound reasonable until you try to define  “dealing with pain.”   Is physical injury the only pain that justifies seeking out drugs, and excuses addiction?  And doesn’t every addict get hooked inadvertently?  (Show me a heroin or cocaine addict who intended to get hooked.)  The pain that drives many people towards street drugs is emotional.  How do you measure their suffering against the white-collar guy who injured his back, or the elderly woman wracked by arthritis?