Pain Killer

An Empire of Deceit and the Origin of America's Opioid Epidemic

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On Sale 2018-05-29

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The origin story of the opioid epidemic: From a Pulitzer Prize–winning New York Times reporter comes an inside story of corporate greed and government negligence.

Between 1999 and 2017, an estimated 250,000 Americans died from overdoses involving prescription painkillers, a plague ignited by Purdue Pharma’s aggressive marketing of OxyContin. Families, working class and wealthy, have been torn apart, businesses destroyed, and public officials pushed to the brink.

In Pain Killer, Pulitzer Prize–winning New York Times reporter Barry Meier exposes the roots of the most pressing health epidemic of the twenty-first century. Powerful narcotic painkillers, or opioids, were once used as drugs of last resort for pain sufferers. Purdue turned OxyContin into a billion-dollar blockbuster by launching an unprecedented marketing campaign claiming that the drug’s long-acting formulation made it safer to use than traditional painkillers for many types of pain. That illusion was quickly shattered as drug abusers learned that crushing an Oxy could release its narcotic payload all at once. Even in its prescribed form, Oxy proved fiercely addictive. As OxyContin’s use and abuse grew, Purdue concealed what it knew from regulators, doctors, and patients.

Here are the people who profited from the crisis and those who paid the price, those who plotted in boardrooms and those who tried to sound alarm bells. A country doctor in rural Virginia, Art Van Zee, took on Purdue and warned officials about OxyContin abuse. An ebullient high school cheerleader, Lindsey Myers, was reduced to stealing from her parents to feed her escalating Oxy habit. A hard-charging DEA official, Laura Nagel, tried to hold Purdue executives to account. The drugmaker’s owners, Raymond and Mortimer Sackler, whose names adorn museums worldwide, made enormous fortunes from the commercial success of OxyContin.

In this updated edition of Pain Killer, Barry Meier breaks new ground in his decades-long investigation into the opioid epidemic. He takes readers inside Purdue to show how long the company withheld information about the abuse of OxyContin and gives a shocking account of the Justice Department’s failure to alter the trajectory of the opioid epidemic and protect thousands of lives. Equal parts crime thriller, medical detective story, and business exposé, Pain Killer is a hard-hitting look at how a supposed wonder drug became the gateway drug to a national tragedy.

Praise for Pain Killer

“Fascinating.”The New York Times

“A timely, compelling, important book.”The Seattle Times

Under the Cover

An excerpt from Pain Killer

Prologue The Book of the Dead Dr. Fredric Hellman had long kept his own book of the dead. Slightly oversized and covered in blue cloth, it was the type of ledger that a bookkeeper might use to tabulate and balance accounts. In it, the medical examiner recorded every unexplained, mysterious, or violent death he worked on. He had small, meticulous handwriting, and every case entered into the book was accorded its own line. Running down the columns were identification numbers, dates, ages, sexes, autopsy findings, laboratory test results, and, finally, the cause of death. Hellman liked having all this data in one book because it helped him spot patterns. Toward the end of 2000 he noticed a new one emerging from death's steady background noise. In the small county south of Philadelphia where Hellman worked, a drug called oxycodone was turning up in the blood and urine of overdose victims. The oddly named chemical was actually legal. It was a painkilling narcotic long used as the active ingredient in a variety of prescription medications sold under names such as Percocet, Percodan, and Tylox. Hellman wasn't a stranger to the drug. He typically performed about five hundred autopsies each year, and oxycodone would turn up in two or three. This year, though, was different. In just one month it had been found during four autopsies. By the time Hellman closed his ledger on 2000, the painkiller had been detected in connection with fifteen deaths, sometimes at toxic dosages, more frequently in combination with alcohol and other prescription drugs. A state medical examiner in Roanoke, Virginia, some 360 miles to the south, was seeing the same thing. Dr. William Massello's encounters with oxycodone, much like Hellman's, had once been limited. But in 1999, the painkiller had figured in eleven autopsies. From there, the numbers had shot up like the line on a fever chart: the body count rose to sixteen in 2000 and to forty in 2001. It wasn't just the death toll that was mounting. Linda Sullivan noticed that the faces of the dead were changing. Sullivan helped run a testing lab that did work for medical examiners throughout Florida. She had long associated high oxycodone levels at death with older patients who had been given the drug to help ease their suffering from painful diseases such as cancer. But during the summer of 2000, many of those dying in Florida with the drug in their system were in their early twenties, an age group not generally associated with terminal illness or severe pain. Sullivan called medical examiners to ask a series of probing questions. Had investigators found prescriptions for painkillers containing oxycodone at the death scenes? Were doctors treating the overdose victims for pain? Time after time she got the same response: no. Soon others started asking similar questions. Over time their ranks would grow to include drug company executives, physicians, pharmacists, lawmakers, pain patients, cops, drug abusers, and kids just looking for a thrill. Together they formed an army of unknowing volunteers, each playing his or her part in a massive and unplanned public health experiment. It was an experiment that involved one of the most potentially addicting narcotics ever legally sold. Its brand name was OxyContin. At its birth, OxyContin had been a pharmaceutical industry dream, a "wonder" that heralded a sea change in the treatment of pain. For more than a decade, a determined band of medical specialists had carefully laid the groundwork for the painkiller's appearance by waging a campaign to draw attention to pain-mankind's oldest and most persistent medical enemy. Outdated fears about the potential of narcotics to cause abuse, these pain warriors declared, were causing millions of patients to suffer unnecessarily. OxyContin was the answer to their pleas; it promised not only a better approach to pain relief, but a safer one as well. Soon, the drug's producer made the painkiller the centerpiece of the biggest and most aggressive marketing campaign for a powerful narcotic in modern pharmaceutical history. Within just a few years of its launch in 1996, OxyContin was a blockbuster, with annual sales of more than a billion dollars. For a time it must have appeared that all the right stars had come into alignment. The fight against pain had intensified and was seemingly being won. Vast profits and careers were being made. But the era of OxyContin also set into motion forces that were far from celestial. In fact, they had already gathered to form a perfect medical storm.

- About the author -

Barry Meier is a Pulitzer Prize-nominated investigative reporter for the New York Times and a 2002 recipient of a George Polk Award for outstanding journalism. He lives in New York City with his wife and daughter.

More from Barry Meier

Pain Killer

An Empire of Deceit and the Origin of America's Opioid Epidemic

Pain Killer

— Published by Random House —