Pain and greed. How the American opioid crisis was manufactured

A psychiatrist who turned out to be an advertising genius and the drugs that have addicted millions of U.S. citizens. The fifth wave of the opioid crisis

The sidewalk is littered with garbage, feces, and used syringes. Ravaged, unconscious people moving like zombies. This is not a new version of "Night of the Living Dead," but the reality in the centers of some American cities. Reports from the Centers for Disease Control and Prevention indicate that the number of deaths due to overdoses and drug addiction in the U.S. has exceeded one million over the past 25 years.

After the wave of lethal popularity of fentanyl - stronger than heroin -in recent years, when it looked like there would be no worse scourge, a new drug emerged: xylazine, commonly known as "Tranq". The animal sedative is part of a new mixture distributed by dealers. The "zombie cocktail" xylazine combined with fentanyl or other opioids now accounts for one-third of overdose deaths. According to Anne Milgram of DEA (U.S. Drug Enforcement Administration), more than 100,000 Americans died from synthetic drug use in 2022, 70 percent from fentanyl. The lethal dose is only 2 milligrams.

"Tranq" is doubly dangerous. That’s because it blocks the action of the antidote given to heroin or fentanyl overdoses, namely naloxone (this drug has been used by paramedics in the U.S. for several years). As if that were not enough, a side effect of this mixture is the scourge of amputations, which has been highlighted in recent months by drug addiction support organizations. Xylazine causes limb necrosis for reasons that remain unexplored.

The term "epidemic" is used to describe the magnitude of the opioid crisis that has rocked American society for three decades now. The next wave, the fifth, starring a new drug, is just spilling over into more states and cities. It manifests itself in the images of "zombies" that have appeared on American streets and in the reports from DAE (Drug Enforcement Administration) that came out of Philadelphia earlier this year. In the spring, similar images surfaced on social media from cities on the East Coast, including New York, and later from California.

Fentanyl, unlike heroin, is not made from opium poppies but from chemical components. Until recently, a dose cost $10, but now (in combination with xylazine for a stronger and longer effect) dealers sell it for as little as $5. That's cheap, considering that in the U.S. the government-set minimum wage is $7.25 an hour.

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The current crisis was caused not only by the drug cartels, but primarily by the actions of U.S. pharmaceutical companies. It began with the desire to effectively eliminate pain. Only since the 19th century have we been able to silence the nociceptors responsible for the sensation of pain. Before that, there were practically no effective methods of pain relief in Europe. The herbs and traditional substances known to our ancestors were not very effective. For centuries, before the Napoleonic wars, even amputations on the battlefield were performed at best under the influence of alcohol and operations without any anaesthesia.

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Although opium, obtained from the seed of the poppy, was known in ancient Greece, it was not until contact with the Orient that it became more widely used and popular as a painkiller in the Western world. In the first decade of the 19th century, the German Friedrich Sertuerner isolated the first of the alkaloids, morphine, from opium.

The invention of the syringe in 1853 was a breakthrough that greatly accelerated the use of drugs in medicine. Shortly after the Civil War, a problem emerged in the United States - morphine addiction among veterans. When another German, Felix Hoffmann, synthesised heroin in 1897, it became a widely used "non-addictive morphine substitute," as its manufacturer Bayer advertised, as well as a cough medicine (also given to children).

     For a long time, heroin was a legal drug that was only targeted by criminal organisations over time. It was not until 1924 that the need to regulate access to this drug was recognised in the United States.

Antianxiety drugs, psychotropics, and tranquilising drugs, such as Valium became a real hit in the growing postwar pharmaceutical market. The first was mephenesin, a preparation that relaxed the bodies of animals but maintained their consciousness. It was soon found to work in humans as well, and it was marketed under the trade name Miltown. This rather primitive antidepressant became a hit among American housewives in the 1950s: 36 million prescriptions were written in 1957 alone. However, it proved to be addictive.

Pharmaceutical companies were relentless in bringing more 'life-enhancing' substances to the market. Valium, based on diazepam, was introduced and was a huge success. The Rolling Stones sang about the yellow pill, the inseparable companion of every housewife in their 1966 song 'Mother's Little Helper': "A mother today needs something to calm her down / And although she's not really sick, there's a little yellow pill". Behind the success of Valium (produced in communist Poland under the name ‘Relanium’) was a clever advertising method developed by the McAdams advertising agency in New York. Born in 1913 to Jewish immigrants from Galicia, New Yorker Arthur M. Sackler was a psychiatrist by training, but he did better as a drug promotion specialist. He encouraged the formation of patient organizations that called for stronger painkillers to be approved. In the 1960s, he founded Medical Tribune magazine, which reached 600,000 readers. Its audience, however, was not to be the ordinary "pill eaters," but those who prescribed them, i.e., physicians. The magazine was a combination of a guide for medical professionals and an advertising brochure for drug manufacturers. Thanks to this magazine, Valium became the best-selling drug in history, and Sackler soon bought his own company, Perdue Pharma.

After Arthur's death in 1987, his family introduced another revolutionary painkiller to the market - this was OxyContin.

Today, millions of drug-addicted Americans are patients of a health care system that doctors used to prescribe legal drugs that were supposedly not addictive. Doctors recommended painkillers for teenagers who had sprained their ankle in a basketball game, for their parents who had sprained their spine while gardening, or for grandparents seeking relief for chronic rheumatic pain. OxyContin was used to a similar extent as the European ketonal (a prescription painkiller in Poland until 2017). The Sackler dynasty took advantage of liberal market regulations in the U.S. to not only push the boundaries of pain, but also to make drugs previously reserved for only the most severe cases available to millions of patients.

The heirs of the senior head of the family used his strategy developed in the 1960s. They created a distribution network that targeted physicians directly. At the same time, they convinced the public and institutions (the U.S. Food and Drug Administration - FDA) that OxyContin was not addictive because of its specially patented coating that ensured extended release of the drug. In 1998, Purdue distributed 15,000 copies of a video to physicians promoting the drug and claiming that the revolutionary nature of the drug was that it was impossible to become addicted to the substance.
Arthur Mitchell Sackler (1913-87). Photo: Wikimedia/ Smithsonian's Freer and Sackler Galleries - Flickr: Arthur M. Sackler, CC BY-SA 2.0
Physicians were invited to symposia at luxury resorts and encouraged to give patients their first dose of the drug for free. Purdue developed a patient starter coupon program where customers received a free prescription for a seven- to 30-day>
This strategy proved highly successful, with $1.1 billion worth of OxyContin prescriptions written in 2000. At the same time, so-called 'pill mill' pain management clinics, which were semi-legal and specialized in issuing opioid prescriptions quickly for no legitimate medical reason, were springing up across the United States. The trend in the painkiller market was echoed by other companies. New product lines emerged, including a fentanyl inhalation kit that can be used to inhale the substance.

The Sacklers made it onto the list of richest families in the Forbes ranking - in 2015, their fortune was estimated at $15 billion. At the same time, the family made sure that the name evoked positive associations - with the world of art and science: they supported the activities of universities and museums. Donations to universities such as Harvard, Yale, and even Oxford reached hundreds of millions of dollars, and the Faculty of Medicine at Tel Aviv University, for example, was named after Arthur, Mortimer, and Raymond.

Ultimately, however, it could no longer be concealed that the widespread, highly addictive painkillers had led to a dramatic situation. As a result, the availability of 'legal' opioids declined dramatically, leading to a demand for completely illegal drugs distributed by cartels, particularly the Mexican cartels in Tijuana and Sinaloa, which have multiplied their profits in recent years. This is because fentanyl does not require the importation of poppies from Afghanistan or the Far East, since it is produced only with reagents imported from China.

The story of the Sackler family is now well known - books like Patrick Raden Keefe's 'Empire of Pain' and ‘Pain Killer: An Empire of Deceit and the Origin of America's Opioid Epidemic’ by Pulitzer Prize-winning author Barry Meier. Films include the documentary 'The Crime of the Century' and the series 'Dopesick," starring Michael Keaton as an addicted doctor, and the just-released ‘Painkiller’ which tells the story of the Sacklers and their company.

No one in the Sackler family has ever faced criminal charges. Purdue Pharma was dissolved in 2021, and the family was required to pay $4.5 billion to addiction treatment and prevention programs across the country.

Lawsuits brought by state agencies resulted in settlements with other opioid manufacturers. The lawsuit, which ended in 2022, required a group of companies to pay $26 billion in damages. At the same time, the U.S. Congress Joint Economic Committee released an analysis that finds the opioid epidemic cost the United States a record of nearly $1.5 trillion by>
– written and translated by Cezary Korycki

TVP WEEKLY. Editorial team and jornalists

Main photo: OxyContin tablet. Photo: Charlotte Observer / Zuma Press / Forum
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