Pain Killer

Barry Meier’s 2003 book Pain Killer chronicles physician Art Van Zee’s early campaign to challenge OxyContin and press for a version designed to resist abuse. Its significance in the account extends beyond documenting that fight: the book connected bereaved families to Van Zee, helped turn private grief into organized opposition, and supplied a point of reference in later questions about how the drug had reached the market.

Subject and Publication

Pain Killer presented Van Zee’s campaign as a David-and-Goliath struggle: a country doctor in Lee County, Virginia, opposing a powerful pharmaceutical company and seeking to keep OxyContin off the market until it could be reformulated to deter abuse. The book was little known, but its account travelled far beyond the region. In early 2016, a retired nurse told the author that Van Zee had saved her opioid-addicted son’s life, and she described the doctor’s extraordinary availability to patients and families. She had learned about his work through Meier’s book.

Van Zee’s alarm came as OxyContin’s makers approached their first billion dollars in gross sales. The book thus placed a local physician’s warnings alongside the commercial expansion of a blockbuster drug. Its central conflict was not only between one doctor and a company, but between documented risks and a product whose success was rapidly growing.

From Reading to Organizing

The book helped bring together people who had experienced OxyContin’s consequences in their families. Lee Nuss and Ed Bisch, both bereaved parents, read Meier’s account and formed an informal alliance with Van Zee and Sister Beth Davies. Nuss had lost her eighteen-year-old son, Randy, after he took a crushed 80-milligram OxyContin pill obtained from a friend. Bisch had already created an online message board; the new alliance carried that network into public life as Relatives Against Purdue Pharma, or RAPP.

The group’s work gave the book’s account a continuing political afterlife. RAPP members advocated for statewide prescription-monitoring programs so clinicians could check patients’ prescription records, organized school drug-prevention workshops, and protested outside Purdue’s headquarters with large photographs of their dead children. They also challenged chronic-pain patients who credited OxyContin with helping them function or sleep. The book did not itself constitute this campaign, but reading it helped families find one another and connect their losses to a wider dispute over the drug.

That connection recurred in public demonstrations. In 2003, RAPP members travelled from Rhode Island and New Jersey to protest outside a drug-abuse-prevention conference in Orlando because Purdue was exhibiting there. As Ed Bisch read the names of 260 people memorialized on his website, an unidentified woman turned a sprinkler on the protesters; a hotel executive denied responsibility. The episode shows how the movement joined remembrance to confrontation, making the names of the dead visible in settings where the company was promoting its presence.

The Book and the Approval Record

Pain Killer also led bereaved relatives to ask how OxyContin had been approved. After Barbara Van Rooyan’s twenty-four-year-old son, Patrick, died following his first and only OxyContin at a Fourth of July party, she contacted Bisch, who put her in touch with Van Zee. Having read Meier’s book, she asked Van Zee how such a powerful drug had come onto the market.

Van Zee answered by walking her through the U.S. Food and Drug Administration’s 1995 approval, led by examiner Curtis Wright, and showing her the company’s New Drug Application. Sue Ella Kobak had given him a copy as a Christmas present in 2000; he regarded the document as especially valuable. Its review described the risks of crushing the tablets, recorded withdrawal symptoms among some clinical-trial participants, and reported that much of a pill’s oxycodone could be recovered. Those details stood in tension with Purdue’s claim that it had not known of the drug’s abuse problems until February 2000. In this encounter, the book’s broader account opened onto a specific documentary record—and made the approval process part of a grieving mother’s effort to understand her son’s death.

Influence on Reporting and Investigation

The book also became part of the conflict over public scrutiny of Purdue. U.S. Attorney John Brownlee had read Pain Killer and knew about the company’s attempt to pressure Meier after publication. Purdue lawyer Howard Udell complained to Meier’s New York Times editors, alleging that the book gave the journalist a financial interest in continued coverage and asking that he be removed from the beat. Meier later recalled that the effort was intended to suppress news about the company. The paper’s public editor accepted the complaint without knowing, as Meier suspected, that Purdue was already under criminal investigation; apart from two minor exceptions, Meier did not write about the company for the newspaper again for four years.

Brownlee had begun investigating Purdue almost immediately after becoming U.S. attorney, though he did not make the investigation public until 2005. The book did not establish the outcome of that inquiry, but it was part of the knowledge through which Brownlee understood both the allegations against Purdue and the company’s response to reporting. Pain Killer therefore occupies several roles in the account: a history of Van Zee’s early warning, a bridge between families and activists, a route into the FDA approval record, and a contested work of journalism whose publication itself drew pressure from the company it examined.