OxyContin
DopesickOxyContin was an extended-release oxycodone painkiller whose 1996 launch became a turning point in the book’s account of the opioid crisis. Purdue promoted it as a dependable option for a broad range of pain, while its high-dose tablets and time-release design made it attractive for illicit use as well as legitimate treatment. The consequences appeared early in Virginia’s coalfields, then spread through prescription diversion, changing drug markets, and a public-health response that repeatedly lagged behind the damage.
Formulation and commercial launch
The drug emerged from a corporate effort to replace a profitable product as its patent approached expiration. Purdue Frederick had developed MS Contin, a morphine-derived, end-of-life painkiller, in 1984. By the mid-1990s, MS Contin was generating $170 million in annual sales, but its commercial life was running out. OxyContin, a reformulation of oxycodone, was intended to fill that gap and extend the company’s pain business beyond hospice and end-of-life care. The oxycodone compound itself had been developed in 1917 from thebaine, an ingredient of the Persian poppy.
The company behind the product had a longer history. Mortimer, Raymond, and Arthur Sackler bought Purdue Frederick in 1952, when it had only a few employees and annual sales of $20,000. The brothers had first made their fortunes with over-the-counter products, then expanded internationally and entered pain relief with MS Contin. Purdue Frederick was based in Stamford, Connecticut; Purdue Pharma, its marketing and sales arm, was launched in Delaware. The family was widely known for philanthropy and cultural patronage, a public identity distinct from its pharmaceutical business.
The Food and Drug Administration approved OxyContin in late 1995, and it was introduced in 1996. Its extended-release system was central to the product’s identity and to its commercial pitch: the tablet was supposed to deliver oxycodone over time. But the dosage range was substantially higher than that of standard painkillers. An 80-milligram tablet could sell for $80 on the illicit market, a price that made OxyContin more valuable to sellers than lower-dose alternatives. The same potency that supported the company’s business also gave the drug a strong illicit-market value.
Promotion, medical claims, and changing standards
Purdue promoted OxyContin for chronic pain, not only for cancer or end-of-life care. David Haddox, a pain specialist who became the company’s principal public advocate for the drug, described addiction as exceptionally uncommon when the medicine was taken as prescribed. Purdue’s representatives carried that assurance to doctors and dentists across all fifty states, presenting prescribing OxyContin for a wide variety of conditions as responsible and compassionate care. The conditions named in the campaign ranged from moderate back injuries and wisdom-tooth surgery to bronchitis and temporomandibular joint disorder.
The launch coincided with a broader change in medical practice. Doctors, hospitals, and accreditation bodies were adopting pain as the fifth vital sign, a framework that placed pain assessment alongside blood pressure, heart rate, respiratory rate, and temperature. Formal patient-satisfaction surveys helped make pain treatment consequential for hospitals and clinicians, while reimbursement incentives encouraged more liberal treatment. In 1999, the Joint Commission on Accreditation of Healthcare Organizations approved mandatory standards for assessing and treating pain. These developments did not by themselves explain the epidemic, but they formed an institutional setting in which Purdue’s claims could reinforce expanding opioid use.
The company’s reassurance was especially consequential because the delayed-release mechanism did not prevent all forms of abuse. Within months of the launch, Richard Stallard, an experienced drug detective, was reporting misuse and black-market sales. Users had found ways to defeat the tablet’s time-release design and use its oxycodone more rapidly. Art Van Zee, a physician in the region, doubted Purdue’s claims after hearing about the abuse and seeing its effects among local residents. The early warning was not an abstract concern about future risk: it came from law enforcement and a clinician observing misuse in their own communities.
Early misuse and local consequences
Before OxyContin, Art Van Zee treated only one to three narcotic-dependent patients a year, despite a longstanding, smaller problem of prescription-drug abuse in the region. He began seeing older opioid-dependent patients with abscesses associated with injecting crushed tablets and came to regard the 40- and 80-milligram formulations as a different order of risk from lower-dose painkillers. Parents began calling about young-adult children whose addictions were costing them jobs, homes, marriages, and custody of children. One local banker told Van Zee that his son had used the banker’s credit cards to acquire goods that could be exchanged for OxyContin, consuming $80,000 in savings.
The losses were not confined to younger users or families with few resources. A farmer in his seventies, whose land had been worth $500,000, sold his property within six months to keep his addiction supplied. The account made the drug’s reach legible through a rapid reversal: land and security became resources spent on continued use. For Van Zee, these cases enlarged the meaning of addiction from a familiar, limited clinical problem into a crisis transforming family life and the local economy.
By March 2001, the region had buried forty-three people who died of oxycodone overdoses after Purdue launched the drug. Users were increasingly injecting liquefied crushed tablets, and the Lee County jail held seventy-nine people in cells designed for thirty-four. One prisoner had traded the family mule for four tablets. In nearby Coeburn, a masked robber killed the manager of a Payless Supermarket while attempting to fund another OxyContin purchase. In Clintwood, a man broke into a pharmacy across from the courthouse and sheriff’s department; Richard Stallard later recalled that pill bottles fell from the fleeing man as he ran. These episodes show how dependence, diversion, and crime became entangled in the local account, without reducing the crisis to crime alone.
The product’s reach eventually crossed the boundary between rural communities and affluent suburbs. In the early 2010s, OxyContin was still commonly treated in Roanoke as a coalfields problem, even as the newspaper rarely returned to the subject after covering Purdue executives’ 2007 sentencing hearing. Suburban teenagers obtained pills through social connections and diverted prescriptions, including pills left over after wisdom-tooth surgery or legitimate treatment. At Hidden Valley High School, students called the green 80-milligram tablets Green Goblins. The movement through peer groups made the spread less visible to families and police than a conventional drug market might have been.
Criminal proceedings and the limits of accountability
In May 2007, John Brownlee announced a federal settlement in Roanoke. Purdue pleaded guilty to felony misbranding, admitting that for six years it had marketed OxyContin as less prone to abuse and as having fewer narcotic side effects than immediate-release versions. The company agreed to pay $600 million in fines to resolve federal criminal and civil charges. Purdue executives Paul Goldenheim, Michael Friedman, and Howard Udell also pleaded guilty to misdemeanor versions of the offense; $34.5 million was paid on their behalf by the firm.
The penalties represented about 90 percent of Purdue’s profits from the drug’s launch in 1996 until 2001, when the company removed language claiming that the timed-release mechanism reduced abuse liability. The fine was the eleventh-largest paid by a pharmaceutical firm in the Justice Department’s history. The plea agreement did not require the executives to serve jail time, although a later sentencing hearing was to determine probation and community service. For bereaved families and advocates, the planned hearing offered an opportunity to describe the drug’s effects in court, but the settlement’s scale did not undo the years in which OxyContin had been sold under the disputed assurances.
The consequences also continued through civil litigation. Eight years after the 2007 sentencing, lawsuits against Purdue and other opioid companies were multiplying, with plaintiffs including Everett, Washington; the state of Ohio; Cabell County, West Virginia; and Dickenson County, Virginia. West Virginia and Kentucky had already obtained settlements of $10 million and $24 million, respectively. The legal comparison with tobacco litigation had limits: opioids have legitimate medical uses when correctly prescribed, a distinction companies could use to cast blame on people who diverted or misused their products. Still, the lawsuits treated the burden on communities as more than a series of individual cases and sought to make manufacturers and distributors answer for a public-health crisis.
Reformulation, displacement, and continuing controversy
Purdue introduced an abuse-resistant version of OxyContin in 2010. Users interviewed in the book reported that the reformulated tablets gelled when crushed and could no longer be used in the same ways as the earlier formulation. But the reduction in the usefulness of the pills for illicit consumption did not end demand. Some people who had dealt pills began dealing heroin instead. The reformulation thus marked a material change in the object and a change in the drug market, without serving as a simple solution to addiction or overdose.
The transition is tied to the experience of Jesse Bolstridge and his friend Dennis Painter. When the two were involved in a Washington, D.C., heroin network in late 2012, Jesse still preferred injecting crushed prescription pills; heroin soon became his choice because it was cheaper, stronger, and easier to obtain. Their parents paid for residential treatment in separate facilities, but both returned to use after coming home and reuniting. The book situates this change within a wider national pattern: three-quarters of the people who died in the 2013 heroin wave had begun with a painkiller prescription, and heroin-related deaths that year numbered 8,257, a 39 percent increase over the previous year.
Barbara Van Rooyan had petitioned the Food and Drug Administration to add an opioid blocker to OxyContin and to withdraw approval of the original formulation. Two weeks before Jesse’s death, the agency notified her that it had approved the part of her petition concerning withdrawal of the original product. By then Purdue had already withdrawn it voluntarily, three years after the reformulation reached the market. Van Rooyan believed her petition had helped prompt the change, but later came to suspect that the approaching loss of Purdue’s patent, rather than a new commitment to safety, was the main reason for reformulation. The agency denied her separate request to restrict the drug to severe, acute, or terminal pain and to require other treatments to be explored before chronic use. The belated decision therefore brought recognition without providing the broader prescribing limits she had sought.
The debate over OxyContin also became a debate over the regulatory system and the medical culture surrounding opioids. A month after Jesse’s death, the FDA approved Zohydro ER, a high-potency, long-acting hydrocodone product without an abuse deterrent, despite an expert panel’s 11–2 vote against approval. Critics argued that the agency was approving medicines while also expected to monitor their dangers. Andrew Kolodny contended that Purdue’s most damaging effect was not only the particular misbranding for which it was penalized, but the increased comfort it fostered in the medical community toward opioids as a class.
In 2017, Virginia’s Board of Medicine required doctors to check the state drug-monitoring system each time they prescribed, a measure intended to prevent doctor-shopping. The mandate arrived amid evidence of very high opioid prescribing in rural Virginia. At the same time, state officials were expanding medication-assisted treatment and syringe-exchange efforts. OxyContin’s history therefore ends not with a single verdict or reformulated tablet, but with a continuing institutional response: prescription controls, treatment access, litigation, and disputes over how responsibility should be divided among manufacturers, regulators, clinicians, and the systems that made the drug widely available.
