Culture | Pain and gain

America’s opioid tragedy

A journalist maps the networks of cash and complicity behind the crisis

American Overdose: The Opioid Tragedy in Three Acts. By Chris McGreal. PublicAffairs; 304 pages; $27. Faber & Faber; £12.99.

TO CALL WILLIAMSON, West Virginia, a town is to exaggerate. It is a pinprick settlement of 2,800 people in Mingo County—yet over a decade two pharmacies there pumped out 21m pills of addictive opioids. Unscrupulous clinics staffed by negligent doctors issued prescriptions to throngs of patients attracted by the lax procedures. These “pill mills” were an open secret, so much so that the town acquired the nickname “Pilliamson”.

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In “American Overdose” Chris McGreal of the Guardian looks unsparingly at the causes of the opioid crisis that kills tens of thousands of Americans a year. Drug firms such as Purdue Pharma, maker of OxyContin, claimed there was an epidemic of chronic pain—and that it could be treated by non-addictive, long-term opioid use. Pliant researchers provided shoddy science; deferential regulators at the Food and Drug Administration (FDA) bought it. Drug distributors shipped massive quantities of pills to small-town pharmacies without question for years. Dodgy doctors were recruited to sign prescriptions en masse, making more cash than they knew what to do with.

The current hellscape is the result. Americans make up 5% of the global population but consume 30% of the world’s prescription narcotics. More die of drug overdoses than in car accidents. The White House estimates that the addiction epidemic has cost $1 trillion in lost output. Alan Krueger, an economist at Princeton, has found that increased opioid prescription could account for 20% of the decline in male participation in the labour force.

Mr McGreal reports mostly from West Virginia, the worst-hit state. In Huntington, on the border with Ohio, a tenth of babies are born suffering from opioid withdrawal. He probes the networks behind the “pill mills”: the profiteering clinic-owners and complicit professionals who make the carnage possible. With only a few heroic exceptions, those who should have noticed—police and the Drug Enforcement Administration (DEA), as well as distributors and the FDA—were remiss.

The victims are strewn across the state. One is Willis Duncan, who couldn’t quit opioids even after his son and wife died of overdoses. “Me being a dumb-ass hillbilly, I didn’t understand what was going on,” he tells Mr McGreal after finally achieving sobriety four years ago. “They all worked together. The doctors. The pharmacies. They didn’t give a rat’s fuck.” Such uncomplicated fury stands in sharp contrast to the deflections and dissembling of the pharmaceutical companies.

The pessimism extends to today. Purdue Pharma made OxyContin harder to abuse, but by then people had moved on to heroin—which provided the same high for less money—and then fentanyl, an opioid 50 times more powerful. Even after the crisis was belatedly recognised, regulators and Congress have dawdled. The FDA approved Zohydro, a high-dose narcotic, after overruling a committee concerned about its potential for abuse. In 2016 Congress passed a bill hamstringing the DEA’s ability to seize suspicious shipments of opioids from drug distributors. Barack Obama signed it into law.

President Donald Trump would like to be seen to be addressing the calamity. But the epidemic has progressed beyond prescription painkillers—which the government regulates—to illicit substances. Between now and 2025, the number of “deaths of despair” from drug overdoses, alcoholism and suicide is projected to increase by a third.

This article appeared in the Culture section of the print edition under the headline "Pain and gain"

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