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In the mid 1980s, the World Health Organization began encouraging doctors to use opioids to treat cancer patients for pain. In 1995, national medical advocacy groups, many of which took money from the pharmaceutical companies, began advising doctors to use the drugs for non-cancer patients as well.
In 2001, the recommendation was codified by the Joint Commission on Accreditation of Healthcare Organizations "to ensure that patients receive appropriate pain treatment." Doctors were required to treat pain as a disease rather than as a signal of another condition. In addition, the government approved use of these drugs for "moderate to severe pain," which vastly broadened the potential market. Those two changes had enormous consequences. "Pain was no longer considered a symptom but a condition requiring treatment," according to the grand jury report, which was released by Suffolk County District Attorney Thomas Spota in April.
Meanwhile, the drug companies began aggressively marketing pain pills as less addictive. They also claimed the pills made pain sufferers more functional. Spota's report described this as a "disgraceful history of careless marketing of opioids."
The DEA approved issuing 25,000 kilos of hydrocodone in 2002. In 2012, the number climbed to 59,000 kilos. Similarly, the amount of oxycodone pills increased from 34,000 kilos in 2002 to 98,000 in 2012. (While the two drugs are chemically similar—both are semisynthetic opioids—oxycodone is generally considered the more powerful.)
As sales of the drug shot up, the number of unintentional overdoses per 100,000 people tripled. Eventually, opioids replaced Tylenol and aspirin as commonly prescribed pain relievers by doctors. Doctors became afraid of "under-prescribing" pain medication. The fact that the drug was so widely prescribed gave people a false sense of security about the likelihood of addiction. A range of celebrities became enraptured with the drugs, leading to reports of addiction and health problems: the late singer Michael Jackson, radio host Rush Limbaugh, Friends star Matthew Perry, singer Courtney Love, and the late actor Heath Ledger.
"The convergence of these factors became the foundation for the rapid increase in opioid abuse," the Spota report says. "Thus was created the epidemic."
Concerns surrounding use of these drugs actually started years ago. Back in 2007, for example, then state Attorney General Andrew Cuomo won $7 million from Purdue Pharma, the makers of OxyContin, as part of a $160 million settlement with the feds on allegations that the company misrepresented the dangers of the drug.
But things didn't get any better. In Suffolk County from 1996 to 2011, the number of people in drug court programs for heroin rose 425 percent, but those in programs for opioid abuse rose 1,100 percent. People in treatment for cocaine use declined by 13 percent. Drug overdose became the leading cause of accidental death in New York State, with prescription-pill overdoses a big part of that.
Although the pain-management community touted the benefits of opioids, other experts told the grand jury that there was no agreement that the use of these opioid painkillers is effective for the treatment of chronic non-cancer pain. Some studies suggest that the drugs actually hurt the patient's ability to function.
In cities and towns across the state, pill abuse has driven up crime. For example, Massena, New York, a town of 13,000 souls near the Canadian border, saw pill abuse triple the rate of violent crime, according to the town's police chief. As with the crack epidemic, babies born addicted to drugs have once again increased.
Over 10 years, pill-related DWI arrests quadrupled. In 2011, half of those arrests involved not alcohol, but painkillers. Last year, 174 people fatally overdosed on pills in Suffolk County. Arrests for the sale of painkillers went up by a factor of eight, while treatment for painkiller addiction in New York State grew by 300 percent.
The head of the New York State Board of Pharmacy told the grand jury: "Improper prescribing is not a defense for what we are seeing. The numbers are just too staggeringly high. There is not that much chronic pain."
A Suffolk County nurse practitioner who'd been arrested for three counts of possession of forged prescriptions told the grand jury that she started with a mild prescription for Percocet to help her get over a childbirth. Her tolerance increased, and she started taking more. Her doctor sent her to a "pain-management specialist," who radically increased her dosage. She got pregnant again and used the drug through her term. After the birth, her doctor prescribed oxycodone again for pain. She soon increased the dosage, and when she ran out, she started writing her own prescriptions, using the names of relatives.
As she told the grand jury, she "already had a prescription pad with the hospital name on it and a stamper with my DEA number. So, basically, I would just write the prescription under somebody else's name, and then I would bring it to the pharmacy and fill it."
Her husband found her pills, and that led her to attempt suicide. But even though she had two young children and a husband and had surrendered her DEA license, she continued to write false prescriptions.
"At first, I thought that I would go there and they would tell me, 'I'm sorry, we cannot fill this prescription; you do not have a DEA number,'" she told investigators. "Surprisingly enough, my number was still in the system. . . . So they filled it. . . . No one ever said a word. . . . I don't know if they trusted me or just didn't care."