The opioid crisis and the crimes that paid

Oxycodone was marketed in the US as the first opioid that was not addictive. There was no clinical data to support the claim, writes Jack the Insider. Picture: AFP

In the calendar year March 2020 to March 2021, the US experienced 100,306 unintentional drug overdose deaths, a rise of 29 per cent from 2019.

The long term cause of what amounts to an epidemic of overdose fatalities can be traced back to the over prescription of Oxycodone, a drug that was manufactured by a family owned company, Purdue Pharma and marketed in the US as the first opioid that was not addictive or more precisely nine times less addictive than other available opioids.

There was no clinical data to support the claim. It was a smoke and mirrors exercise that fooled doctors and led to addiction across all demographics – age, gender, ethnicity – from a 75-year-old woman with a bad back to the teenager who’d suffered a knee injury playing high school football.

Readers may have seen or heard of Dopesick, a miniseries currently being streamed on Disney+, starring Michael Keaton which weaves personal stories of addiction with Purdue’s duplicity. It’s a slick drama well told but it does miss what is the big story – the gross negligence of Purdue Pharma gave rise to opportunism from transnational crime syndicates.

The over prescription of Oxycodone in the US (Oxycontin in Australia) led to the intervention of the world’s biggest crime syndicates quick to cash in on the millions of Americans who had become dependent on opioids and Oxycodone in particular.

After his first escape from a Mexican prison in 2001, Sinaloa cartel boss, Joaquin ‘El Chapo’ Guzman, scanned his sales charts of illicit substances to find cocaine and methamphetamine were more or less where they had been in the previous year but sales of heroin, where it had established a niche market almost as an exotic product, were going through the roof.

Guzman understood the link between the overuse of opioids like Oxycodone and heroin. He set about boosting production of Sinaloa heroin, firstly by purchasing poppy from places like Myanmar and Afghanistan and then by establishing crops and processing plants in Sinaloa province where ultimately poppy was processed into heroin entirely in Mexico.

Before long Sinaloa heroin was being offered as free samples by street gangs aligned with the cartel in Chicago.

Other crime gangs followed suit. The Calabrian Mafia, ‘Ndrangheta, created processing plants in Guyana in South America and distributed heroin using the old trafficking routes through the Caribbean. The drug was distributed along US eastern seaboard networks that had fallen into disuse as the might of their Sicilian-based counterparts, La Cosa Nostra, had waned under the weight of multiple RICO prosecutions.

Heroin was intentionally marketed and sold at a price that was cheaper than Oxycodone. Before long, the 75-year-old white woman with the bad back and the high school student with the injured knee, both hooked on opioids, were buying heroin.

The 2019 national survey on drug use and health in the US reported that 9.7 million Americans aged 12 or more misused prescription painkillers with 750,000 using heroin.

Long story short, America became addicted to opioids and deaths by unintentional overdose began their climb. It can all be attributed to Purdue Pharma’s lies.

Since then, the nature of the addiction has changed and the drug of greatest concern is the synthetic opioid, Fentanyl. As a synthetic it is not prone to the seasonal ebbs and flows of crop production.

A lot of the black market fentanyl is said to be produced in Guangzhou Province in China but with the right precursors it can be manufactured anywhere. It is distributed into the US by transnational crime syndicates.

Black market fentanyl has become so ubiquitous that it is found in other recreational drugs either deliberately or by contamination during the production and packaging process. The big push from US federal and state governments in the last 12 months is to hand out strips so that drug users can determine for themselves the presence of fentanyl in the drugs they buy.

Some public health experts remain firm that users are unaware of the presence of fentanyl in drugs they purchase, and this is certainly true in many cases while others argue that recreational users welcome the dual hit of upper and downer – what drug users in the 1980s used to refer to as ‘speed balling’. It’s extraordinarily dangerous and too often more than the human body can withstand.

There are no easy solutions. Saying ‘no’ to drugs in this environment is a childish fantasy. The criminal justice system is of no use. Charging someone with possession of a $5 dose of heroin or fentanyl which addicts might take five times a day would choke courts and overpopulate prisons in a country that already has more people incarcerated per capita than any other country on Earth.

Many of the addicts are military veterans from faraway places like Afghanistan and Iraq. They often suffered physical injury in the service of their nation and by way of pain management got on the treadmill.

Experts in public health and harm minimisation are left to hand out clean needles and establish temporary accommodation in tent cities for homeless addicts. Certainly not enough money is spent on rehabilitation, but the problem is now too vast to deal with on a one-on-one counselling and management basis. Swapping heroin or fentanyl addiction with methadone merely exchanges one form of dependency with another. New York City has just announced it will establish injection centres where at least some users are more likely to avoid death by overdose but only while on the premises.

It is often said Australia follows the US in lock step, perhaps a decade behind. Social problems that beset the US can be seen coming our way. It’s not the case here so much and that can in part be explained by the fact that the drug that started it all, Oxycodone was marketed in Australia as a pain management tool without the deceit that the drug had limited prospects of dependency.

That’s not to say that Australia doesn’t have its fair share of problems. In 2020, the Pennington Institute identified 1556 unintentional drug induced deaths in Australia with almost two-thirds (900) attributed to opioid overdoses in the calendar year 2018. Overdose deaths were more prevalent in regional Australia than in the big cities. Indigenous Australians were almost three times more likely to die of drug overdose compared to the non-Aboriginal population.

In what amounts to a refutation of our perceptions of drug users, 40 per cent of overdose deaths occurred in people aged 50 or more with just under ten per cent of deaths occurring in people aged under 30. Two thirds of overdose deaths occurred among Australians aged 40 or more.

Alcohol combined with opioids and other drugs plays a significant role in drug overdose deaths.

We know that there is more heroin coming into the country based on seizures by law enforcement. Rehabilitation centres, too, are reporting increased admissions due to opioid dependency.

In my discussions with law enforcement, they speak of the prevalence of crystal meth and the crime sprees that often occur in a user’s wake. Cocaine possession charges have climbed steeply in Melbourne and Sydney in the last five years. But dig further and they will tell you the biggest problem Australia faces is the rise of black market fentanyl.

We’re not immune to the same social degradation the US faces but its extent has been diminished here generally by better regulation and I’d argue, a superior health system.

What happened to the company that started all the misery and death? Well, no one from Purdue Pharma went to jail. While ‘El Chapo’ is cooling his heels in a US federal prison with a life sentence, a few Purdue execs faced the courts and walked away with fines. The company itself has been dissolved.

In September, the owners of Purdue Pharma, the Sackler family, agreed to forfeit $6.3 billion of their personal wealth. The settlement controversially limits the Sackler’s liability beyond that. $6.3 billion might sound like a lot of money but US cities have spent billions more on harm minimisation programs to deal with a problem that Perdue Pharma kicked off more than two decades ago. The Sackler family will continue to be one of the wealthiest families in the US.

Who said crime doesn’t pay?