How opioids invaded America — and are now tightening their grip

After a breakup in 2008, a cousin gave Ashlee Krichmar, then 20, a Percocet. She’d never much liked them in the past — they made her sick — but that day the college student majoring in business management took the pill.

“It numbed all the emotions I was having at the time, so I didn’t have to feel anything,” Krichmar says.

That was in March. Three months later, she was fully addicted, taking 20 pills a day.

“I felt great when I took them. I was energetic. I felt like I could conquer the whole world. Any insecurities I had were gone,” says the New Jersey native, now 31. “I felt like I could walk into any room and make everyone laugh.”

Over the next three and a half years, she would be in and out of a dozen rehabs. She went to a treatment center in Florida, but all that happened there, she says, was that she got a lot of good leads on people back in New Jersey with good drugs.

In 2011, she called a friend she met at rehab and asked for some “Roxys” as she calls OxyContin. “I can do better than that,” the friend said and injected her with heroin. That night, Krichmar went home with a bag of heroin and some needles. She looked up how to shoot up on YouTube.

In late 2012, she went to rehab again, got clean and opened a sober-living company in Los Angeles that was doing well. She seemed to have her life on track. Until one day, about five years into her sobriety, a friend casually mentioned, “Did you know you can order any drug you want on Craigslist?” She couldn’t get it out of her head. A month later, she was back on pills and had to take a buyout from her own company.

She found out about someone called “The Wizard of Oz” who had connections with Uber and Lyft drivers in the city. Within 15 minutes of texting and PayPaling him, a driver would show up wherever she was with whatever she wanted. She was soon spending between $7,000 and $10,000 a week on pills. When she was confronted by her fiancé after stealing money from him, she resolved to get clean again. “I was so broken,” she says. She’s now been clean for four months and is resolved to remain that way.

Krichmar is just one among millions of people in this country who are addicted to opioids. There is no “typical” person affected by opiate addiction. It cuts across socioeconomics, age, race, ethnicity and geography. Victims are just as likely to have been raised in a loving, stable home as not, writes Harry Nelson in his new book, “The United States of Opioids, A Prescription for Liberating a Nation in Pain” (ForbesBooks), out now.

As a health-care lawyer, Nelson has had a particularly good perspective on the opioid epidemic that’s decimated the country in the past 20 years. He’s represented drug-treatment programs reeling from patient overdoses, doctors who have prescribed opioids and caused overdoses, those who have refused to provide pills to patients, as well as those who have become addicted to pills themselves.

“I have a reputation for being as close to a mental-health therapist as lawyers get,” the LA-based lawyer told The Post. In “The United States of Opioids,” Nelson guides us through the overwhelming issues and roadblocks that formed the epidemic.

In 2017, there were 49,000 opioid deaths in the US, according to the Centers for Disease Control. Twelve million people in this country are addicted to opioids, and the numbers keep increasing. In 2012 alone, American doctors wrote 259 million opioid prescriptions for pain, enough to provide every single person in the country over the age of 18 with his or her own 30 day supply of painkillers, Nelson writes. If nothing changes, a million Americans will have died from opioid-related causes between 2000 and 2025.

“For my own sanity, I needed to put something out there that offered a solution,” Nelson said.

Opiates — anything derived from the poppy plant — are one of the oldest medications in the world. Cultivation goes back 50,000 years, some argue; there is residue of opioids in Neanderthal settlements, Nelson writes.

The poppy plant contains alkaloids that mimic various feel-good chemicals in our brains — dopamine and endorphins — and activates those neurotransmitters, sending out intense waves of pleasure through our reward centers and reducing pain.

But at the same time, they slow the body’s respiratory system, meaning breathing becomes shallow and infrequent, depleting oxygen to the brain. Meanwhile, as one continues to take the drug, tolerance increases and larger amounts are needed to reach the same high. Breathing slows even more, often leading to overdose. On top of that, withdrawal from the drug is immensely difficult, causing nausea, intense cravings, vomiting, depression and insomnia, which means quitting is a nightmare. Even those who want to get clean often can’t make it through the intense withdrawal period.

This is not the first opioid epidemic this country has faced, and the earlier one led directly to the current one, Nelson says. In the early history of this country, opioids were a popular form of medication — laudanum, a combination of opium and alcohol, as well as morphine and heroin were all over-the-counter drugs. Eventually, the government began to realize how many people were addicted to the medicine and placed a tax on it to stop rampant consumption. But prescriptions were still cheaply available and with hundreds of thousands of people addicted to opioids, they turned to doctors to get their fix. As a result, the government soon cracked down on doctors and by the 1930s, more than 25,000 physicians were charged with prescribing opiates. As a result, doctors in this country stopped treating patients for pain altogether, Nelson argues.

By the 1980s, a new generation of doctors who weren’t educated about painkillers began prescribing them again.

Enter Big Pharma.

Purdue Pharma, run by Artie Sackler, who paid his way through medical school by writing advertising copy, began in the 1950s to look for distressed pharmaceutical companies that he and his brothers, Mortimer and Raymond, could buy and turn around at a profit.

The Sacklers bought Purdue Pharma in the 1950s, and in 1995 the FDA approved the drug OxyContin, a controlled-dose release of oxycodone. By 1996, Purdue “already had ample evidence that OxyContin was being abused and concealed that information while continuing to market the drug as less addictive than other opioids,” Nelson writes.

The appeal of OxyContin was that patients could take a single dose of the medication every 12 hours and sleep through the night, unlike other drugs on the market that required more frequent doses. But it wasn’t true. The pills didn’t last 12 hours, which meant patients needed more and more of the medicine to maintain their pain. As their tolerance grew, they experienced withdrawal symptoms like nausea, shaking and itchiness.

‘It numbed all the emotions I was having at the time, so I didn’t have to feel anything’

Nelson’s book describes how Purdue had their marketing team create fake scientific charts to convince doctors the drug was less addictive than other products, then they flew doctors around the globe to market their pills. They accused patients of being falsely addicted and even convinced the FDA to include a product insert claiming, without factual basis, that OxyContin was safer than other products because of its delayed absorption mechanism, Nelson writes. Purdue later gave a job to the outgoing FDA examiner who approved the statement.

Their hard work paid off: OxyContin soon became a $1 billion-a-year product for Purdue, and people began dying of overdoses as they took more and more of the drug to get the same effect.

Around 2010, as the government sprang into action by cracking down on physicians who were overprescribing opioids, the supply became much scarcer while demand remained high. Those hooked on the drugs turned to the black market and found a crude version of heroin called “black tar” which was surging on the streets at that time, spiking another wave of overdoses.

Around 2013, fentanyl — a synthetic opioid — arrived on the scene. Fentanyl is made in labs in Mexico by cartels and in China and then sold online. It’s cheap, easy to manufacture, odorless and, with no infrastructure in place to intercept it, drug traffickers began to cut other more expensive drugs with fentanyl to increase profit margins, Nelson writes. Fentanyl is roughly 35 times more powerful than heroin, so overdoses skyrocketed after it flooded the market. In three years, from 2013 to 2016, the death rate from fentanyl alone soared from 1 death per 100,000 to 6 per 100,000 — an almost 90 percent increase year over year.

Even though Purdue Pharma and the Sackler family — which currently have more than 1,800 lawsuits against them at the city, county and state levels — are the villainous face of the opioid epidemic, they aren’t the only problem by far, says Nelson. The government’s failure to police the issue, gaps in physician training, physicians who overprescribe, drug rehabs that are focused only on making profits, drug dealers who import fentanyl and other dangerous street drugs and insurance companies who prefer to cover pills rather than alternate pain-reduction therapies like acupuncture all create the perfect storm of a nation hooked on opioids.

The DEA’s stifling of research into new therapies, such as ibogaine, marijuana and psilocybin, due to their federally illegal status, is another problem.

“We are locked in a system that makes it impossible for critical research to happen,” says Nelson. “We have researchers and scientists who are eager to do research into these alternative medicines, but they are scared of jeopardizing federal funding. Any research into these medicines needs to be approved by the DEA, and getting that approval is so difficult, Nelson says, that many institutions don’t bother.

In the meantime, he argues, we have to eradicate the shame associated with addiction and help those suffering from it, not distance ourselves and blame them for it.

“The opioid epidemic is a symptom of the severe depression, anxiety and isolation Americans struggle within an era of digital communication, rampant consumerism, a profound loss of connection with ourselves and each other, economic insecurity and a lack of purpose in a materialist society,” he claims in his book.

As for Krichmar, she understands the shame people feel about their drug use, which is why she was willing to tell her story.

“There’s nothing for me to be ashamed of,” she says. “I’m not the same person as when I use drugs. I don’t lead a life like that anymore. But I want others to know that I am a prime example of how this drug can affect your life. I had the American dream, and it was still snatched away from me because of the opiates.”

Source: Read Full Article