In 1996, a company called Purdue Pharmaceutical launched a new opiate painkiller called OxyContin. At a party celebrating its release to the public, Richard Sackler, a scion of the family that owns the company and its senior vice president of sales, made exuberant predictions about its success. ‘The launch of OxyContin tablets will be followed by a blizzard of prescriptions that will bury the competition,' he said, according to a lawsuit recently filed against Purdue. ‘The prescription blizzard will be so deep, dense, and white …'
The active ingredient of OxyContin is oxycodone, a semi-synthetic opiate (an ‘opioid') first synthesised in Germany in 1916. Prior to OxyContin's launch, oxycodone had been marketed as a painkiller in various pill forms for years, including Percocet (where it is mixed with paracetamol), Percodan (where it is mixed with aspirin) and Roxycodone (where it is dispensed pure in small doses of 15 to 30 milligrams). Other kinds of opiate painkillers, like the hydrocodone-based Vicodin, were also mixed with aspirin and came in small doses. While people did become addicted to these pills, the low doses of opiates they contained made it hard to overdose on them, and the paracetamol and aspirin would cause liver damage if the drugs were taken for a long time.
OxyContin distinguished itself from these medications, and received a patent, on the basis of an extended-release technology, the ‘contin' of the drug's suffix. Purdue developed OxyContin not to serve an urgent public health need but because the patent was expiring on its most profitable drug, a time-release morphine pill called MS Contin. Pharmaceutical patents, which last twenty years, allow pharmaceutical companies to maintain a monopoly on a drug and avoid competition from generic manufacturers. When a patent on a popular drug expires, its price can drop by as much as 90 per cent. To maintain monopolies, the industry often makes small adjustments to existing medications in order to patent and market them as new. OxyContin was one such drug.
OxyContin dissolves slowly in the digestive system, titrating the oxycodone into the body. Instead of taking a conventional painkiller like Vicodin or Percocet every few hours, the manufacturers claimed a patient could take OxyContin once in the morning and once at night and experience long-lasting pain relief. The slower-acting nature of OxyContin justified the manufacture of pills that contained much higher quantities of oxycodone than had ever been available in a single dose: up to 80 milligrams at first; 160 milligrams a few years later.
‘It was the cleanest drug I'd ever met,' the artist Nan Goldin wrote in a column for Artforum describing the addiction she developed to OxyContin after an operation. Goldin writes that she took 40 mg doses and was addicted ‘overnight'. She went from taking three pills a day to as many as 18 of them. Not everyone is partial to the feeling produced by morphine derivatives, but for the people who like it, OxyContin seems to represent an apex. ‘Oxycodone provides the most glowing and rapturous high I have experienced in my very thorough career as a recreational drug user,' a report on the online drug encyclopedia Erowid begins. The writer, under the pseudonym RighteousDopeFiend, describes the aftermath of snorting an 80 mg OxyContin tablet:
The oxycodone experience is difficult to describe to an opiate virgin. Personally, I feel as if I have suddenly gained all that I want in life and no longer have anything to fear. I am perfectly content both mentally and emotionally. All the tension slips from my body and I feel warm and utterly comfortable, as if I were sitting beside a roaring fire, wrapped in a delicate cashmere blanket, rocking gently back and forth. Communication is pleasant but unnecessary. Under the influence of oxycodone, no companionship is needed. I accept myself and the world just as we are, not begrudgingly, but eagerly, ecstatically even.
Since OxyContin's arrival on the US market in 1996, a widespread increase in opiate use in America has killed more than 400,000 people. Drug overdoses have been the leading cause of accidental death in the United States since 2008, when they surpassed deaths from road accidents. In 2017, more than 49,000 Americans died of opiate-related overdoses.
The epidemic has a narrative, divided into three waves of molecularly similar drugs: first, OxyContin and other prescription pills; then heroin; and now, especially since 2016, an opioid called fentanyl that is more potent in smaller quantities, and therefore easier to smuggle and also more likely to kill. There is also now an established genre of newspaper stories that tell of overflowing morgues in the Rust Belt, of parents overdosing at Little League baseball games, of once safe rural areas overtaken by criminal junkies, of open-air heroin markets in homeless encampments in major cities, of public librarians and Starbucks employees who have learned how to revive an overdosing patron with naloxone.
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