Dopesick: Chapter 3 Summary & Analysis

The story of the OxyContin epidemic doesn’t reach national media until a New York Times article published on February 9, 2001. By the summer, it is clear that the opioid abuse epidemic is spreading out from areas like Virginia and Maine, into the rest of Appalachia, into major East Coast cities, into the Deep South, and even into parts of the Southwest. The parents of those who die from overdoses are some of the first to organize a response. Ed Bisch, from Philadelphia, first learns about OxyContin on the day that his son Eddie dies of an overdose.

The new movement of OxyContin from rural areas into the cities and suburbs resembles the wave of iatrogenic morphine and opium addiction that swept through the nation about a century earlier. Eventually, opioid addiction died out in most places except big cities (where heroin was part of the jazz scene). When, after the Vietnam War, 20 percent of American soldiers came back with signs of heroin dependence, it didn’t lead to an epidemic, largely because there was no heroin network outside of major cities. By the mid-1990s, however, OxyContin changed this by expanding the supply.

Ed Bisch learns that his son Eddie wasn’t alone—that Eddie’s death was in fact the 30th overdose in the region in just the past three months. He starts a message board called OxyKills.com. In 2001, the same year OxyKills.com is founded, OxyContin hits $1 billion in sales for the first time.

Lee Nuss is another parent with a story similar to Bisch. She lost an 18-year-old son named Randy to the opioid epidemic. Though she initially hesitates to reach out because of grief, she eventually connects with Bisch and discovers that they’re from similar areas of Philadelphia. The two of them eventually align with Van Zee and Sister Beth after they read Barry Meier’s 2003 book Pain Killer. Nuss and Bisch launch a grassroots nonprofit to oppose the opioid epidemic, called Relatives Against Purdue Pharma (RAPP).

More memorials flood the OxyKills.com message board. Barbara Van Rooyan’s 24-year-old son Patrick is another victim. Van Rooyan asks Van Zee how OxyContin ever got approved for sale by the FDA. As it turns out, Van Zee receives some documents from Sue Ella about Purdue Pharma, including their application to the FDA for OxyContin’s approval. It turns out that, although Purdue was claiming they had no knowledge of the drug’s potential for abuse until February 2000, the drug’s 1995 FDA application contradicts this.

The FDA’s top examiner noted in 1995 that the drug could be crushed up for a more immediate high and that the company should be cautious in its marketing. Two years later, however, the same examiner was hired as a consultant by Purdue.

Armed with this knowledge, in January 2002, Van Zee goes to testify before an FDA advisory committee. At the meeting, he is outnumbered 19-to-1 by Purdue people, and they try to portray him as a kook. Purdue also falls back on the fact that no clinical studies have been done to look at the long-term risks of opioid abuse. The FDA ends the forum promising to monitor the abuse situation more closely, but many, like Van Rooyan, feel that it’s too little too late. It takes several more years, until 2013, before it comes to light that FDA regulators had been meeting in expensive hotels with Big Pharma executives, who were using a strategy called “enriched enrollment” (weeding out people from studies who don’t respond well to drugs) in order to get approval of their drugs.

Staffers at the FDA get to know Barbara Van Rooyan whether they want to or not. She picks up where Van Zee left off, formally submitting a recall petition for OxyContin to the FDA in 2005.

RAPP gets involved with civil lawsuits against Purdue. Though Purdue wins the cases, the legal bills are adding up. To help rehabilitate its reputation, Purdue hires the consulting firm of former New York City mayor Rudy Giuliani (who was recently popular because of his response to the 9/11 terrorist attacks).

One of the early civil lawsuits that RAPP gets involved with is a wrongful termination case about a former Purdue sales representative. The representative believes she was fired because she refused to sell OxyContin to doctors who were illegally overprescribing it. White has a single lawyer with no staff, in contrast to Purdue’s high-powered team and their consultancy with Rudy Giuliani. Ultimately, the judge rules in favor of Purdue, saying that the former sales rep’s lawyer had not sufficiently proved that Purdue’s tactics were illegal.

Back in western Virginia, John L. Brownlee is a 36-year-old former paratrooper, now an attorney who likes to make a splash in the press. He likes to take risky cases and wants a big win so that he can run for office, and he sees an opportunity with OxyContin lawsuits.

In 2005, Purdue lawyer Howard Udell goes after Barry Meier (author of Pain Killer and a New York Times journalist). Udell gets Meier taken off the opioid beat at the newspaper because, as the author of a book about OxyContin, he has a financial conflict of interest. For the most part, Meier doesn’t write about Purdue in the paper for four years.

Brownlee (along with his office’s fraud investigator, Gregg Wood), keep in communication with Van Zee and RAPP about the latest OxyContin news. Wood in particular is passionate about collecting dirt on Purdue.

Fayne McCauley is a miner in Lee County, Virginia, who injured his shoulder in the 1990s and got prescribed OxyContin. Though McCauley is not the ideal client for a lawsuit against Purdue (since he has admitted to taking other drugs), his case seems promising to an ambitious lawyer from Abingdon who agrees to take up the case. Again, however, a judge rules that there is not enough evidence to rule in McCauley’s favor, suggesting that the risk of addiction was not proven to be high enough to outweigh the benefits of eliminating pain.

Lisa Green, the daughter of McCauley, remembers sending her father to rehab multiple times before he died. Despite her efforts, however, on October 22, 2009, she gets the news that he has died. Though a state trooper tells her that her father died of a heart attack, his head is blown apart, suggesting murder over a bad drug deal.

Despite the 2005 loss in McCauley’s court case, Brownlee continues to stock ammunition against Purdue. Later in 2005, news breaks that a federal grand jury is investigating Purdue, which gets the attention of Van Rooyan, Bisch, and the other RAPP parents. Leading the investigation are the assistant U.S. attorneys Randy Ramseyer and Rick Mountcastle, who are both much less interested in the spotlight than Brownlee but who have a record of sending overprescribing doctors to jail.

By fall 2006, Purdue’s lawyers sense that things may be beginning to change. A memo from federal prosecutors to Brownlee suggests there may be enough evidence to prosecute Purdue with felony charges. But Purdue is able to use its influence to water down the charges, using Giuliani’s influence as well as pressuring the current deputy attorney general, James Comey, to question Brownlee about his tactics. Brownlee personally drives to Washington to lay out his tactics, however, and Comey ultimately lets him go ahead.

Purdue’s boldest move comes in October 2006: they get a senior Justice Department officer to call Brownlee at home and pressure him to give Purdue more time for a plea agreement. Brownlee doesn’t budge, and the company accepts the plea deal. Eight days later, Brownlee and several other attorneys find themselves on a list to be fired (although Brownlee is not ultimately fired)—this seems to be yet another case of Purdue meddling with U.S. attorneys’ offices.

The charges are not as large as what Ramseyer and Mountcastle initially threatened against Purdue, but they represent a mixed success against the company, particularly compared to earlier lawsuit outcomes. The Sacklers realize that a plea deal is preferable to holding a trial in southwest Virginia, which could lead to much harsher penalties.

In May 2007, Brownlee unveils news of the settlement: Purdue has pleaded guilty to falsely advertising the benefits of OxyContin while concealing its potential for abuse. As a result, Purdue will pay $600 million in fines, and top executives will admit to misdemeanor crimes (although without jail time). A sentencing hearing in mid-July will also force these executives to meet the parents of opioid abuse victims. At the press conference, Brownlee’s team shows evidence from their vast collection of Purdue’s wrongdoings—they have so much evidence that they have to rent extra space in a strip mall to store it.