You asked, we answered: The best from our Reddit Q&A on OxyContin
The drugmaker Purdue Pharma launched OxyContin two decades ago with a bold marketing claim: One dose relieves pain for 12 hours, more than twice as long as generic medications. On the strength of that promise, OxyContin became America’s best-selling painkiller. But our Los Angeles Times investigation found that OxyContin’s stunning success masked a fundamental problem: The drug wears off hours early in many people, exposing them to painful symptoms of withdrawal and an increased risk of addiction.
We hosted a Q&A on Reddit on May 11 and received thousands of questions for reporter Harriet Ryan and editor Matt Lait. Here’s a selection of those questions and answers, lightly edited for length and clarity.
On taking OxyContin
I’m a junior in high school, and I’ve seen Oxy completely take over the lives of so many people I know. How can I best inform my friends and community on the dangers of opiates? It seems like things like Oxy or Percocet or Vicodin are the only options after surgery, so do my friends and I even have options when it comes to painkillers?
Harriet: This is very scary. I think sometimes teens and young adults view prescription pain meds as less dangerous than “street drugs” like meth and cocaine. One guy I talked to said he wouldn’t even try marijuana, but he dove right into OxyContin because it was a pharmaceutical and he thought it was safer.
One recommendation the [Centers for Disease Control and Prevention] recently made that may help address the problem of teen access to painkillers: It urged doctors not to send people home from surgery with a full prescription of pills. The CDC said that only a few days of painkiller are needed and that’s all a doctor should write. Otherwise, they end up unused in medicine cabinets and ripe for pilfering.
As for what you can tell your friends, I think former addicts are the best messengers. Go on YouTube or some of the Reddit message boards, and you’l find people telling their stories and it will break your heart/wake you up.
Are there safer, less addictive alternatives out there, or will effective pain medication always carry that risk?
Harriet: This is a great question. A pain researcher recently told me that this country needs to have a Manhattan Project to develop non-addictive pain meds. The CDC says the best treatment for chronic pain is not opioids but alternatives like NSAIDs, physical therapy, interventional treatments, meditation, etc.
Would you ever take any painkiller, or recommend them to anybody?
Harriet: I would — short-term for acute pain or if I was in hospice. The CDC has said painkillers can be appropriate treatment in those cases.
Would you take OxyContin?
Matt: After doing this research, I personally would avoid taking the drug. If you do so, do so carefully and check in with your doctor.
I badly broke my neck in an on-the-job accident working for the fire department and am now partially, legally disabled. I live every day of my life in severe, intractable pain.
While I regret the fact some folks have abused this medication, journalists such as yourselves have demonized OxyContin to the point that millions of individuals around the world who live in severe pain now have significant difficulty obtaining access to pain medicine so that they can have any possibility of a “real life.”
Do you admit, or deny, that your efforts have made it more difficult for individuals with severe pain to obtain effective treatment?
Harriet: I deny. I am sorry that you suffer chronic pain. There are very few problems that are more challenging, and I recognize the bravery it takes to get up every morning and live when you are in severe pain. But I don't think it is fair to blame journalism for trying to shed light on the very serious problems that have accompanied the broad use of painkillers in this country.
As our story notes, more than 190,000 people have died from overdoses involving these drugs since 1999. Many of them died after years of addiction that stripped them of their dignity and wrecked the lives of their families. It's not only advocacy groups and reporters who have noted the problems with painkiller use. It's the federal government and the CDC. I urge you to read what that agency said two months ago about how doctors should and shouldn’t treat chronic pain.
How we investigated
As far as collecting sources, how did you manage to find people willing to go on the record, and was it difficult finding them to begin with? What was the process like when searching for people to talk?
Harriet: I was surprised at how willing recovering addicts were to speak publicly about their experiences. I think that some feel it’s their mission to get the word out that recovery is possible. We found people by contacting rehabs, support groups, addiction doctors and others and saying, “We want to talk to people who became addicted to OxyContin after being prescribed it for legit pain.“” A bunch of people were recommended. We didn’t tell them about the duration issue. We just said, “What happened?” And again and again, we heard that the drug didn't last.
What was the most weird route to addiction by a patient?
Harriet: The most surprising — and sad — route to addiction to me was teenagers who were given OxyContin for post-surgical pain. In one case, it was for dental surgery. I was shocked that doctors would send teenagers home with a bottle of OxyContin for minor surgeries.
It’s worth noting that the doctors who wrote those prescriptions were going off-label. That’s not the use of the drug the FDA approved.
What was the most alarming discovery you made?
Matt: We were struck by how the company responded to information it received that doctors were prescribing the drug for eight hours rather than 12 for many patients. They held special training sessions to get sales reps to “refocus” doctors on so-called q12h dosing. Records show that company executives were concerned that insurers would stop paying OxyContin’s hefty price if it weren’t a true 12-hour drug. There were other cheaper painkillers on the market that lasted four, six or eight hours.
We were also struck that the company’s solution to the drug not lasting 12 hours in many patients was to prescribe stronger doses, which comes with increased risks to the patients. One of the documents that most surprised us was the one in an FDA petition in which company lawyers acknowledged that eight-hour dosing might be the “optimal” treatment for some patients, but that the company intended to continue marketing it for 12 hours, in part, because of the “competitive advantage.”
Great piece of serious investigative journalism. Very eye-opening. I was wondering, how were you able to obtain the Purdue documents that were sealed by courts? It seems like there were some smoking guns in there.
Matt: Thanks. As with many investigative pieces, we drew from a variety of sources — some of them confidential. Those sources gave us information with the understanding that they would not be identified. Some of the information, however, was from public sources and files such as previous litigation and regulatory reviews.
I’m fascinated by the nuts and bolts of producing a story like this. What is it like behind the scenes on such an epic, long-term investigation? How much percent of a reporter’s time is focused on this story versus other work demands?
Harriet: Three reporters worked on this investigation (this story and ones that will be published later): Lisa Girion, Scott Glover and me. For the most part, we worked on it full time, although we got pulled off occasionally to work on other stories, e.g., the San Bernardino terrorist attack. Investigative journalism is reading through lots and lots of records, occasionally interrupted by attempts — usually unsuccessful — to get people to talk to you who really don’t want to.
Why investigate a drug that does give many people relief from pain, even though it may not last as long for a good portion, as opposed to something more sinister — doctors who abuse their power or miracle cures who are actively and knowingly causing harm?
Harriet: We did a lengthy series examining the role of the medical establishment — doctors, pharmacists and medical boards — in the prescription drug epidemic. But do I think it’s fair to look at the role of drug companies, too? Yes. And why Purdue Pharma? It makes the best-selling painkiller in the country and the one widely blamed for setting off the epidemic.
Tell us more about OxyContin and Purdue
Did you see whether there were any biological indicators as to what made the drug wear off faster for people? Did things like age, gender or body structure affect how fast the drug wore off?
Harriet: Great question. In general, younger, more active people metabolize faster. I think I mentioned that one pain specialist told us that in his experience, OxyContin wore off early in almost all patients, but that he thought it might last the full 12 hours in one type: very elderly invalids.
Do you know of any state or federal prosecutions, current or contemplated, to hold Purdue accountable for deceiving regulators, doctors and the public on OxyContin?
Harriet: The city of Chicago is currently pursuing a lawsuit against Purdue on a variety of grounds, including the duration issue.
A lot of states — and the federal government — settled claims against Purdue for misrepresenting OxyContin in the mid-2000s. The Justice Department and a bunch of states settled in 2007, and Purdue paid $634 million. Kentucky just settled in December. All of these were before our story.
Are there reasons other than sales/marketing for keeping up the 12-hour dosing schedule? What would be required for doctors to be able to deviate from the manufacturer’s recommendation?
Harriet: Doctors are free to deviate from the product label. That’s called off-label prescribing, and it’s done quite frequently. In our reporting, we found that many pain specialists prescribe OxyContin at eight-hour intervals. They told us this was based on their day-in and day-out experience. They felt confident in rejecting the product label and the advice of Purdue’s sales reps because of their many years of practicing pain management.
OxyContin is widely prescribed by family practice and internists too, and these doctors, who are handling the kitchen sink of medical issues, may not be as comfortable deviating from the product label. Some are worried about using narcotics in general and just want to go “by the book,” and others feel like they will be less susceptible to malpractice suits if they are strictly following the label.
What were the most common illnesses you found doctors prescribing these pills for?
Harriet: OxyContin is prescribed for moderate to severe pain that lasts more than a few days. People take it for a whole range of conditions, including migraines, arthritis, surgical recovery, backaches, bad knees.
Did OxyContin's lawyers threaten you with defamation, along with other legal claims?
Matt: Here’s Purdue’s response to our story and our reply.
Let’s talk about painkillers in America
What is it about the American medical system that makes us much more likely to prescribe painkillers vs. other countries?
Harriet: Some things to consider: Other countries have had painkiller problems, including with OxyContin — Canada, New Zealand, Cyprus, Australia. Secondly, in many places around the globe, there is zero use of painkillers because of poverty. Those places can’t afford morphine drips for terminal cancer patients, let alone brand-name drugs for lumbar pain.
Are there any current legal discussions of the danger of opioids and removing them from pain treatment scenarios?
Harriet: I don’t know about legal, but there’s a sea change underway in the medical community about the use of opioids. Leading health authorities in our country are increasingly skeptical about painkiller use long term.
Earlier this year, the CDC issued guidelines for primary care doctors that discourage them from treating chronic pain with opioid painkillers like OxyContin. The agency said that there’s just no evidence that they work long term to relieve pain, while there’s a wealth of evidence that they cause harm. The guidelines urge particular caution with extended-release medications, like OxyContin, and high-dose prescriptions. To be clear, the guidelines don’t apply to short-term use for acute injuries or to end-of-life care.
How related are the problems with opioid overprescription and the heroin problem on the East Coast? Do you think that increased border security could drive up the price of heroin and make it less of an alternative to OxyContin? What do you think is the best path to solving this problem?
Thank you for doing this. I have been lucky enough to not have any of my friends dead from this, but I know too many people who say they have friends or old classmates who started on Oxy and then switched to heroin and then died. This problem affects so many people. It is so sad.
Harriet: It’s super, super sad. I hope you guys will read our next story, which is about black-market Oxy and how it devastated one community. Personally, I think there’s some amount of society that is going to abuse drugs, whether that’s pharmaceuticals or heroin or meth or crack. And then there’s a segment that could go either way. And the fate of those people depends on how accessible the drugs are. If they are well-controlled, then those people won’t end up using.
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