Art Van Zee

Art Van Zee is a physician in western Virginia whose close knowledge of patients and community led him to recognize the OxyContin crisis before it was widely acknowledged. He warned Purdue Pharma about misuse, pressed for changes to the drug’s marketing and formulation, and later defended evidence-based addiction treatment. His story connects an individual doctor’s persistence with the broader consequences of institutional indifference: people in his care were not abstractions, but neighbors and friends whose suffering he encountered both in the clinic and in the hospital.

Identity and Background

Tall and slender, Van Zee was the Vanderbilt-educated son of a minister from Nevada. He came to the region in 1976, aged twenty-nine, intending to work in a medically underserved community. The town’s new federally qualified community center, with fees adjusted to patients’ ability to pay, offered a practical version of the accessible health care model he valued. The book presents his decision to practice there as the foundation of a long relationship with the people and institutions of the area, rather than a temporary professional posting.

His work was rooted in a community marked by the legacy of coal mining. Photographs of miners lined the walls of his exam room, and many of the overdose victims he later encountered were descendants of miners. They were also, in many cases, people he knew as friends. That closeness made the emerging epidemic personal, but it also gave him a view of its early signs that distant institutions did not share.

The book sets Van Zee’s dissent alongside a longer history of warnings about opioid danger that went unheeded. It compares his alarm with that of a Richmond physician in 1884 and with the inventor of morphine, who had urged caution in 1810. Van Zee and his colleague Sister Beth Davies were unlikely public sentinels: a country doctor and a former Catholic nun turned drug counselor, whose outsider status obscured the depth and relevance of what they knew. The comparison gives his work a historical frame without suggesting that his warnings were immediately influential; like earlier warnings, they met indifference.

Recognizing the OxyContin Crisis

Before OxyContin, prescription-drug misuse existed in the region, but on a much smaller scale. Van Zee generally treated only one to three patients dependent on narcotics each year. In the early years of the new drug, he noticed a change among some older patients: some were crushing tablets for injection, and injection-related abscesses were appearing. He suspected that the 40- and 80-milligram OxyContin tablets presented a different problem from the 10-milligram Percocet pills some teenagers used recreationally on weekends. The distinction mattered to him because the scale and character of the misuse seemed to be changing, not merely continuing an established local pattern.

The wider signs accumulated quickly. Within two years of OxyContin’s release, 24 percent of juniors at Lee High School reported having tried it, as did 9 percent of the county’s seventh-graders. Van Zee met with worried parents and was also called to the hospital after a teenage girl overdosed. He had immunized her as a baby and remembered where he had first held her in the St. Charles clinic: beside a counter made from materials salvaged from a coal company’s former commissary, where miners had once collected their wages in scrip. The remembered clinic and the later emergency call brought the community’s industrial past into direct contact with a new crisis among its young people.

Van Zee was not the only clinician raising concerns. In 2000, his medical partner, Vince Stravino, filed formal complaints about children crushing, snorting, and injecting OxyContin, and about resulting overdoses and abscesses. Regional public-health official Sue Cantrell also pressed for action. She contacted the public-health commissioner in Richmond in the late 1990s, explaining that the area had experienced substance-abuse problems for years but that this was a more potent drug than the substances involved in the smaller group of cases she had seen in previous decades. Together, these reports show that the warnings arose from repeated observations in clinics and hospitals, not from a single dramatic incident.

Campaign Against Purdue Pharma

Within weeks of recognizing the pattern, Van Zee helped organize public meetings through the Lee Coalition for Health, a grassroots group of ministers, social workers, and other community-minded residents. His wife, a lawyer and former VISTA volunteer, edited and coached him as he prepared letters of complaint to Purdue Pharma. In them he described patterns of injection, frequent overdoses, abscesses, and an increased incidence of hepatitis C. The letters made local clinical experience legible as a public-health warning, even as the company failed to respond in a way that satisfied him.

Van Zee’s requests to Purdue Pharma were specific. He urged the company to stop aggressively marketing OxyContin for noncancer pain and to reformulate the drug so it would be less susceptible to abuse. As a precedent, he pointed to the reformulation of the painkiller Talwin in 1982, when its manufacturers added naloxone, an opioid antagonist, and diversion and misuse promptly declined. His argument joined a criticism of promotion to a proposed technical intervention: reducing risk required addressing both how the drug was sold and how it could be misused.

By March 2001, Van Zee had grown frustrated with repeated letter writing. He had heard patients express deep regret that OxyContin had ever been prescribed to them. The book’s account emphasizes the distance between that experience and the institutional response: the doctor could see the harm in the lives of people he treated, but his accumulated observations did not by themselves compel action. In a letter to Purdue’s senior medical director in November 2000, he warned that Lee County might be a sentinel area, comparable to places where the early spread of HIV had first become visible. He did not then know that the OxyContin epidemic would give way to a heroin epidemic and that injection-related HIV and hepatitis C would become part of its consequences.

Clinical Practice and Medication-Assisted Treatment

Van Zee’s advocacy continued beyond his campaign against Purdue Pharma. He acknowledged that some Suboxone providers in rural America had lax practices that contributed to diversion and misuse. But he argued that those cases should not define buprenorphine treatment as a whole. In his view, policy should encourage more physicians to enter addiction medicine and expand medication-assisted treatment through nonprofit settings such as health departments, community service boards, and federally qualified health centers. Salaried doctors in these institutions, he reasoned, would have less incentive to overprescribe than providers whose practices depended more directly on prescribing volume.

He also challenged the expectation that people with opioid addiction should succeed in drug court without access to Suboxone. From the legal system, he observed, police and judges tended to see trafficking or families disrupted by a parent injecting Suboxone; they were less likely to see patients who were progressing through college, earning graduate degrees, finding work, regaining custody of their children, or maintaining years without drug use. The contrast was central to his defense of treatment: visible cases of diversion were real, but they did not describe all patients taking medication responsibly.

One case at his St. Charles clinic made the stakes concrete. A patient arrived on her sixteenth birthday and learned that she had contracted hepatitis C after injecting black-market Subutex. Van Zee did not use the case to dismiss medication treatment; instead, it illustrated the dangers of an illicit market and the need for safe, accessible care. His position resisted two simplifications at once: that buprenorphine was harmless under any circumstances, and that its misuse invalidated its value as treatment.

Care, Relationships, and Continuing Concern

The book also shows how Van Zee’s reputation rested on acts of care that extended beyond scheduled appointments. In early 2016, a retired nurse whose opioid-addicted son was about thirty credited him with saving her son’s life. She described a doctor who came to the emergency room to see his patients regardless of the hour and who had once visited her home at two in the morning to pronounce her father dead. Her account offers a measure of why his public warnings carried weight locally: they came from a physician whose responsibilities did not end at the clinic door.

That work did not make Van Zee confident that the treatment system was secure. He worried about complaints from law enforcement concerning buprenorphine and understood that addiction could appear to officials chiefly through trafficking, family disruption, or criminal charges. He also feared that the loss of his own ability to practice would leave patients without care. He told the book’s narrator that when jogging on winding roads, he feared being hit by an intoxicated driver—not principally because he might die, but because his patients would then have nowhere to go. The concern brings his character into focus: even his fear of personal harm was framed through the continuity of care his community depended on.

Van Zee’s significance therefore lies both in what he saw early and in how he interpreted what he saw. His warnings linked prescribing and marketing practices to local patterns of misuse; his later advocacy distinguished responsible treatment from diversion without denying that diversion occurred. Against a public narrative that could reduce addiction to crime or individual failure, he insisted on the evidence of patients’ lives and on the obligations of medicine. The book presents him as a sentinel whose expertise came from sustained proximity—to a rural community, to patients whose histories he knew, and to consequences that institutions were slow to recognize.