Dreamland (42 page)

When he got a call from a cell boss, Pedro figured he would be different. He wanted to earn enough to open a bakery. The boss sent him and another young man to the border, and paid for them to cross with a group of migrants. The other kid was headed to Minneapolis to sell. Pedro was sent to Columbus, and from there his boss sent him to another city that was deemed virgin territory.

He was given certain rules. No blacks. His boss feared African Americans. Once a customer brought a black customer along. The boss pulled a gun and told them both to get out and never come back. The kids Pedro sold to were all white, always ready to try out their high school Spanish.

“Hola, amigo. Como estas? Me gusta mucho la cerveza.”

Pedro and his coworkers found a furnished apartment. Pedro didn’t want to stand out, or drive more than he had to. When he wasn’t working, he was in the apartment, playing the Xbox. He made a thousand dollars for a few weeks of work. Then he was arrested and convicted of trafficking.

Authorities shipped him to prison. There he studied for his GED, at twenty-five cents an hour, and passed. He also worked as a prison landscaper and cook, making twenty-three dollars a month. It was enough to afford him a television, a radio, and his own food. By the time he was released, he had made nine hundred dollars—almost what he had made selling heroin.

They sent him to El Paso, where an officer took him to the bridge leading to Ciudad Juárez and told him to start walking.

“Don’t come back,” the officer said.

A month later, back home, Pedro received a letter from the prison. It contained a check for $430, the remainder of what he was owed for working and studying for his GED.

On the day of Operation Black Gold Rush, a year after the arrest of the junkie bailiff in Nashville, hundreds of officers fanned out across fifteen U.S. cities gathering up Sánchez clan heroin crews: 138 people in all, drivers, telephone operators, suppliers, as well as numerous local addicts.

That day, federal court looked like a hospital ward. Junkies were throwing up, sweating, and falling off their benches.

“If we didn’t arrest them they were going to die,” Mabry said.

Marshals rushed doctors to court. Several junkies had arraignment postponed because they weren’t fit to understand the judge.

Like Operation Tar Pit six years before, Black Gold Rush showed the vast expanse of the Xalisco system—in this case operated by just one extended family. Nashville was connected to Ohio, to North and South Carolina, to Indiana, Kentucky, and to several states out west.

Indicted in absentia in Tennessee, Alberto Sánchez—Uncle Beto—remains in Mexico, possibly Guadalajara. As happened after Operation Tar Pit, the Sánchez heroin cells quickly reconstituted. His networks, and those of his family, are believed to encompass most of the state of South Carolina, including Myrtle Beach, where police have six times dismantled the Sánchez heroin cell, only to see it return each time. DEA sources and traffickers themselves tell me Sánchez family cells operate also in Denver, Charlotte, Indianapolis, Salt Lake, Las Vegas, Cincinnati, Columbus, Knoxville, Memphis, Reno, and Portland, Oregon.

Whole new labor pools were becoming available in Nayarit as young men in dead-end jobs signed up for driving stints. Up in America, new, younger, and wealthier customers were emerging everywhere.

It was a good time to be a heroin dealer.

The Criminal Case

Southwest Virginia

Late at night on October 24, 2006, John Brownlee, the U.S. attorney in western Virginia, received a phone call at home.

On the line was Michael J. Elston. Elston worked in the U.S. Department of Justice while Alberto Gonzales was attorney general for President George W. Bush.

Elston said he was calling on behalf of a Purdue Pharma executive.

The investigation Brownlee had approved into Purdue Pharma and its campaign to market OxyContin was then four years old. The case was assigned to the tiny Abingdon, Virginia, office, near Kentucky and West Virginia, a coal-mining region where hundreds of people had died of OxyContin overdoses. The office issued hundreds of subpoenas, scanned stacks of documents into a database, and interviewed dozens of people. By 2006, Brownlee’s staff believed they had evidence that the company had knowingly misbranded OxyContin as virtually nonaddictive.

In Purdue focus groups, doctors worried about OxyContin’s addictiveness but yearned for a long-lasting and less-addictive painkiller. The company that produced a nonaddictive painkiller “would dominate the pain management market. And that is exactly what Purdue tried to do,” Brownlee testified later. “[Purdue] marketed and promoted OxyContin as less addictive, less subject to abuse and diversion, and less likely to cause tolerance and withdrawal than other pain medications.”

Despite its ad claims, Purdue provided no study to the FDA, investigators later noted, that supported those claims. The company taught its sales force that oxycodone was harder to extract, and thus abuse, than other drugs—though the company’s own studies showed that wasn’t true. In 1995 tests, the company found that 68 percent of the oxycodone could be extracted when the pill was crushed and liquefied and drawn through cotton into a syringe. In fact, addicts I spoke with said it was easier to extract the drug from an OxyContin pill than from other, milder opiate painkillers, such as Vicodin or Lortab, because OxyContin didn’t include anything but oxycodone, while the others also contained acetaminophen or Tylenol.

The company’s sales staff said in promotional meetings across the United States that OxyContin’s twelve-hour timed-release formula meant there were fewer peaks and troughs in euphoria when compared with immediate-release opiates. This was a crucial point. Intense euphoria followed by an intense crash is what produces the cravings leading to addiction to opiates. If OxyContin didn’t cause these extreme peaks and troughs, then its salespeople could claim to physicians that the pills carried less risk of addiction than short-acting opiates. I spoke with several doctors who said the graphs showing OxyContin’s purportedly mild peaks and troughs of oxycodone in blood plasma were among the most convincing data that Purdue salespeople produced.

But federal investigators later said that these graphs were incorrect and “falsely” exaggerated the difference in euphoric effect between Oxy and its short-acting competitors.

Purdue “phonied up [those] graphs to show a steady level of oxycodone in blood plasmas,” said Paul Hanly, a New York City plaintiff’s attorney, who brought a class action lawsuit against Purdue. “The true graph shows an incredible spike, then
boom
—you go straight to the bottom.”

Purdue supervisors taught salespeople to tell doctors that patients using up to 60 mg of OxyContin could stop abruptly without withdrawal symptoms. However, federal investigators found that company officials knew of a 2001 British study of osteoporosis patients who described suffering withdrawal when they stopped using OxyContin. “Even after receiving this information,” federal investigators wrote, “supervisors and employees decided not to write up the findings because of a concern that it might ‘add to the current negative press’” surrounding OxyContin.

As I was writing this book, I contacted Purdue’s media representatives, requesting an interview with someone at the company about the 2006 criminal case. I inquired about its ad campaign and about how OxyContin was selling lately, among other things. I asked also for interviews with Dr. David Haddox, author of the concept of “pseudoaddiction,” and with Dr. Curtis Wright, who had been part of approving Purdue’s application while he was at the FDA. A company spokesman sent the following:

For more than 30 years, Purdue Pharma has developed opioid medications to alleviate the debilitating pain experienced by millions of people. As leaders in our field, we are acutely aware of the public health risks that can arise from the misuse and abuse of these medications. We’re working with policymakers and health care professionals throughout the country to reduce the risks involving opioids, without compromising the medical care of people suffering from chronic pain.

Purdue is developing innovative technologies to create pain medicines in new forms that include abuse-deterrent properties, making them unattractive to drug abusers. These medicines are designed to provide patients with pain relief when taken as directed, while also deterring abuse by snorting and injection. These new approaches do not prevent abuse, but they are a step in the right direction.

We encourage a transition to abuse-deterrent technologies over time, but it must be accompanied by greater societal efforts to reduce the demand for non-medical use of prescription medications.

In 2005, the federal prosecutors in Abingdon, Virginia, who were preparing the case against Purdue subpoenaed Dr. Hershel Jick up at Boston University. A deputy sheriff delivered the papers. Dr. Jick ignored the subpoena at first. He was too busy to be bothered. Then a federal prosecutor called. They needed him to testify before a grand jury, she said, something to the effect, Dr. Jick later remembered, of a drug company using his 1980 letter to the
New England Journal of Medicine
as proof that their drugs weren’t addictive. Hershel Jick was perplexed. He had no idea what she was talking about. What did all this have to do with him?

“I told them I wouldn’t go,” he told me. “But they threatened to put me in jail, so I schlepped on down there. They had me on the stand asking me irrelevant and obtuse questions for two hours.”

Dr. Jick then returned to Boston and with that he exited our story, his tiny letter to the editor in the back pages of the
New England Journal of Medicine
having helped ignite, quite unintentionally, a revolution in American medicine.

In Abingdon, the case against Purdue proceeded. John Brownlee filed criminal charges against the pharmaceutical company. He set October 25 as a deadline for Purdue to accept a plea agreement. In the plea, the company would admit to one felony count of false branding of OxyContin, or face further charges. In later testimony before the U.S. Senate Judiciary Committee, Brownlee said Michael Elston asked him during his phone call to slow the case, postpone the plea agreement. Elston later said he was calling on behalf of a superior, who in turn received a call from a Purdue defense attorney asking for more time for the company.

Brownlee thought about the request. It was a delicate matter. His political career showed promise. He was being mentioned as a potential candidate for state attorney general, even governor. Still, he saw no reason to postpone the long and complicated case. That afternoon, he had received approval from DOJ higher-ups to proceed with it. He said he told Elston to “go away.” Brownlee signed the plea agreement with Purdue the next morning. Eight days later, his name showed up on a list compiled by Elston of federal prosecutors recommended to be fired.

Nine were fired. In the end, John Brownlee was not one of them. But, he testified the next year, he believed his inclusion on the list was retaliation for not delaying the Purdue settlement. The Purdue episode lingered amid the Bush administration controversy in which top attorney general officials were accused of political meddling in the work of their far-flung prosecutors and recommending some be fired for not complying with what were perceived as political orders. Elston later resigned. An attorney for Elston told the
Washington Post
later that there was no connection between the phone call that night and Brownlee’s name appearing on the list of prosecutors recommended to be fired.

John Brownlee spent another year as the U.S. attorney from western Virginia. In 2008, he resigned to seek the Republican nomination for state attorney general and lost in the primary. Talk of a future gubernatorial bid wilted. His political career stalled. He is now in private practice.

However, Purdue Pharma pleaded guilty to a felony count of “misbranding” OxyContin. To avoid federal prison sentences for its executives, the company paid a $634.5 million fine, among the largest in the history of the pharmaceutical industry at the time. Three executives—CEO Michael Friedman, General Counsel Howard Udell, and the by-then-departed chief medical officer, Dr. Paul Goldenheim—paid $34.5 million of that. Each pleaded guilty to a single misdemeanor of misbranding the drug. They were also placed on probation for three years and ordered to perform four hundred hours of community service.

In July 2007, the Purdue executives appeared in federal court for sentencing. Lee Nuss, the mother of a Florida man who died of an OxyContin overdose, rose to speak.

“You are,” she told them, “nothing more than a large corporate drug cartel.”

About this time, over in southern Ohio, Dr. Phillip Prior had left private family practice to devote himself full-time to his specialty in addiction medicine at the Veterans Administration hospital in the town of Chillicothe. Prior was one of the few addiction specialists in southern Ohio, and this made him something akin to a battlefield medic.

The area around Chillicothe had seen drug problems before, but they’d never involved opiates. Not long after the Purdue campaign hit full swing, however, Chillicothe and the surrounding towns began seeing patients addicted to OxyContin. Many of them used hundreds of milligrams a day as their tolerance grew. Newly liberal prescribing put Oxys everywhere. Pill mills sprouted like fungus. Soon, opiate pills were the party drug for small-town kids who in another era might have been building bonfires and getting drunk.