Wonder pills

Aside from excessive media interest and too many jokes about “hillbilly heroin,” Rush Limbaugh’s problem with OxyContin is surprisingly common. Once touted as a “wonder drug” that would revolutionize the treatment of chronic pain, OxyContin has become a dangerous, often-abused narcotic, and Limbaugh’s media-circus consequences, though perhaps humiliating, have not been the most devastating. Unlike many who got hooked on OxyContin, he’s still alive.

New York Times reporter Barry Meier has followed OxyContin, a timed-release version of the opioid pain killer oxycodone, for years. His wide-ranging new book is many things: an account of a small Virginia town’s loss of innocence, the tragic chronicle of one young woman’s descent from high-school cheerleader to methadone-dependent junkie, a business story about the transformation of a pharmaceutical company into a less-than-ethical marketing machine, and a history of the attempts by America’s doctors to deal with chronic pain.

Oxycodone, a close cousin of morphine, is made from a derivative of the opium poppy called thebaine. Long used in pain treatment, it’s usually mixed with analgesics to produce drugs like Percocet. What makes OxyContin, the oxycodone drug made by Purdue Pharma, unusual is its timed-release coating. It delivers a quick burst of pain relief and then continues to break down over a period of 12 hours. The major benefit is that pain sufferers can get a full night’s sleep—a godsend, for example, to a cancer patient struggling with severe pain.

According to Meier, OxyContin’s problems arose when Purdue Pharma, hoping for a larger share of pain-medication sales, made two claims about the drug. The first was that OxyContin’s timed-release feature made it less prone to abuse—a claim Purdue officials cleared with the Food and Drug Administration by relying on limited studies that indicated abusers would avoid timed-release narcotics in favor of the faster rush offered by traditional painkillers. The second was that it could be used safely for both moderate chronic and short-term pain. Sales reps and company literature touted it to physicians as treatment for everything from surgical pain to fibromyalgia.

Of course, users quickly discovered that moistening the timed-release coating would allow the pill to be crushed and then swallowed, snorted or injected to produce a major high. Some users described the high as infinitely better than what they got from traditional pain killers, because the oxycodone in OxyContin was pure, not diluted with analgesics like aspirin and Tylenol. And, because it was being prescribed freely, there was a lot of OxyContin out there.

Meier notes that this wasn’t much different from similar outbreaks of addiction that followed such pain-killing “wonder drugs” as Dilaudid, which picked up the nickname “drugstore heroin” in the 1920s, except for one thing. The aggressive marketing strategy employed by Purdue Pharma, which included such things as a CD of swing music to entice physicians to prescribe OxyContin for arthritis patients, succeeded beyond their wildest dreams.

Meier addresses the difficulties of balancing drug-abuse prevention with the need to provide relief for the millions of people who suffer from chronic, severe pain, but he makes a compelling case for the necessity of closer regulation of pharmaceutical marketing, as well.

This story is not only well-told, but also newsworthy: In the first week of January, a federal judge ruled that Purdue Pharma deliberately misled federal officials in order to secure patents that protected OxyContin from generic competition. Meier’s book explains this pattern of deception fully, and though it doesn’t excuse drug abuse, by celebrities or anyone else, it makes clear that corporate greed may be the biggest drug pusher of all.