All Aboard the Oxycontin Express

The Oxycontin Express

The above special is part of Current TV’s vanguard series and examines the legal and illegal market for prescription pills like oxycodone while telling the story of an oxycodone addict and his family in Broward County, Florida, where the Oxycontin Express begins its travel to Appalachia. It focuses on the ease in which people are able to legally purchase large amounts of pharmaceutical drugs there. Overall, I like the special and think it is fairly objective in showing the diversion of pharmaceutical drugs, the toll of addiction, and intentional or not, the shortcomings of law enforcement in drug policy.

Still, the documentary lacks any information about the legitimate uses for these drugs. It almost certainly incites a sense of worry and hysteria in those who haven’t heard much else about this problem. There is no discussion of possible solutions other than the underlying suggestion that increasing law enforcement resources is the only answer. No treatment facilities are explored and no treatment or addiction professionals are interviewed.

The problem

DEA officials say doctors in Broward County wrote prescriptions for more than 6.5 million oxycodone pills from June to December 2008, making it the nation’s top supplier. In under 2 years, 70 pain clinics opened in Broward and Palm counties. These clinics write the prescriptions and some also sell the drugs they prescribe. Because the state has no pill tracking system, patients doctor shop. Doctor shopping refers to patients with a prescription going from pain clinic to pain clinic to get their prescriptions filled and often coming away with thousands of pills because without a tracking system there is no way for a pharmacy to know if scripts have already been filled. Florida’s governor, Charlie Crist, signed a bill earlier this year that would set up a pill tracking system for the state but it won’t take effect until next year.

In Florida, an average of 11 people die every day from prescription drug overdoses. In Kentucky, 877 people died of overdoses last year.

There is a problem with how many pills are being handed out but I’m not convinced that these pain clinics need to be shut down. They provide an alternative to street drug dealing which is more dangerous and leaves money going only to criminals. As the special documents an addict’s attempts to buy the drugs from a pain clinic, he is unable to do so and must go to a friend’s home where he is sold 30 pills from a 70 year old grandmother. So as crooked as these places are painted to be (and I have no doubt some of them are) others are following what rules are in place. And it isn’t until we see the pills leaving the state of Florida where they become significantly valuable. In other states where obtaining the drug is not as easy, pills can be worth 10x what they are bought for in Florida. A bottle of pills bought for $500 can be worth $5,000 in Kentucky. That’s money worth protecting. In the attempt to rid their communities of this diversion, the police focus on arresting small time dealers and addicts, a common short fall of the U.S. war on drugs.

The addicts and the law

You’ll meet Todd, a man whose addiction to oxycodone, which he smokes, persists even after his brother and wife died from overdoses. You’ll briefly meet Terry, another oxy addict who sells small amounts of drugs to support his addiction and as he put it, “do what you gotta do to support your family.” You’ll also meet women incarcerated for selling prescription pills and a young couple who are convinced by police to sell them some medication outside a pharmacy in an undercover bust.

At the end of the day, are Todd and Terry (the man arrested for selling prescription drugs) and all of the women who are incarcerated, really people that belong behind bars? The sheriff of the Greenup says himself that the pill problem isn’t getting any better – despite the fact that jails are overflowing with people convicted of prescription drug offenses. I took notice to the many marijuana posters in the sheriff’s office. The America’s Most Wanted (pot) poster, news articles covering the departments pot busts, and an old dried up pot leaf that likely came from a grow-op bust, show that he has been dedicated to fighting a war on drugs (or at least on marijuana) and not only has the drug problem not gotten better, its become worse. Even a neighboring county’s deputy sheriff was recentlyarrested for distributing oxycontin.

These areas need better treatment and prevention services not just more law enforcement. When you look at Todd’s unsuccessful attempts to quit oxycodone which includes 7 visits to rehab and 15 detoxes, you begin to realize the seriousness of this addiction. I don’t see the problem as being these clinics alone. In fact, I think the legalization of drugs with strict regulations (varying for different substances) is a smart move but isn’t the answer to our addiction problems. It is the answer to taking away funds from criminal enterprises and taking a market that unfortunately isn’t going away and putting into a regulated and controlled system. The problem I see with the prescription drug distribution profiled in this video, is that there is not a pill tracking system. Furthermore, the police are focused on busting small time drug addicts. The couple busted in the special faces a 3 yearmandatory minimum sentence after being convinced to sell some of their drugs to an undercover police officer pretending to be someone in serious pain but unable to get their prescription filled. I think this is ineffective and inhumane, and does little to stop the diversion of drugs. Even the police admit this is just a drop in the bucket and I think it’s a waste of their resources. I also think these arrests just make the problem worse. Now you have addicts who can’t get a job, who will use drugs in jail, who will lose their families, and who will lose their support systems (if they even have any). They just end up more likely to continue using.

Just last week, Kentucky law enforcement arrested more than 300 people in the largest prescription drug bust that the state has ever seen. Those arrested are accused of creating a “pipeline” for pharmaceutical diversion, doing exactly what is shown in the Current TV special. That is a huge bust but it’s unlikely to have any long lasting effect.

I have to say I found it ironic as Mariana van Zeller, the narrator of this special, lights up a cigarette outside one of the pain clinics. Nicotine is one of the most addictive drugs in the world, right up there with opioid addiction and the drug kills far more people than oxy’s ever will, even with the Oxycontin Express. But no one is suggesting she belongs in prison, nor should they be. Hulu has a blog interview about the special with Mariana van Zeller who is originally from Portugal. Some irony here as well. Portugal decriminalized the use of all drugs and since then has seen a reduction in drug addiction, overdose deaths, HIV rates, drug use/abuse, and an increase in those who seek treatment for their addictions – all outcomes the U.S. could only dream of obtaining.

So if we can’t get rid of the drugs all together, what can be done? Ponder the question: What is so wrong about allowing drug addicts to buy drugs?

Harm reduction.

Harm reduction information is so incredibly important to these areas. Abstinence is absolutely the best way to go if you want to avoid all of the possible harms associated with drug use; there is no surer way to steer clear of addiction or overdose. But just like with sex education, the abstinence only messaging isn’t working. These communities need improved information on the harms associated with prescription drug abuse including dosage guidelines and accurate descriptions on dangerous drug combinations.

Good Samaritan policies could likely save the lives of many people in states like Kentucky, especially young people. If young people are going to be severely punished for calling 911 when a friend overdoses, you can expect it to be unlikely that they will make such a life saving call. Instead you have needless situations like this:

Karen Shay, a dentist in Morehead, Ky., also knows too well the cost and pain of prescription drug abuse. Two years ago, her 19-year-old daughter, Sarah, died from an overdose after partying with friends, who dropped her body off at a hospital and drove away.

What’s the government’s response to all this? To his credit, the new director of the ONDCP, Gil Kerlikowske has admitted that America’s largest drug problem is pharmaceutical abuse. Under the reign of Drug Czar John Walters, you would have heard marijuana was the real threat. The House Appropriations Committee also reduced the National Youth Anti-Drug Media Campaign’s yearly funding by 71% from $70 million to $20 million – a smart move considering that the focus of the ads has been almost entirely on marijuana use among youth and that they have been shown to be ineffective and even counterproductive. I’m not opposed to having PSA’s on the dangers of drug abuse. They seem to have helped in reducing tobacco use among young people and we didn’t have to arrest a single person to do so. If the ONDCP’s ads on prescription drug abuse are realistic and evidence based, they could help to steer young people away from abusing and even using drugs like oxycodone. If harm reduction information is made accessible than those who do choose to use may make smarter choices about their use.

There needs to be acceptance that such a problem will never go away completely and that drug free communities, and countries, and schools are simply impossible to achieve. The prime example of this; America can’t even keep drugs out of our prisons. This is not a problem we can arrest our way out of and it’s a problem that will likely come and go in waves.

Here is an excerpt from a report by the Human Rights Coalition on New York’s prison system and drug treatment services. Drugs can’t be kept out of the prisons and if you’re an addict who gets caught using, you’ll end up in solitary confinement (the box) and be denied treatment even if it is available.

Meet Nathan. He was identified as needing drug treatment when he entered the New York state prison system with a 16-year sentence. But because prisoners close to their release date get treatment first, Nathan faced the possibility of years in prison without help for his drug problem. When he continued using drugs in prison, he was sentenced to the box, though no violent or other disruptive behavior was involved. With each relapse, he received harsher punishment. When we interviewed Nathan, eight years after he entered prison, he was serving a 34-month sentence in the box — 14 months for one drug-related incident and 20 months for another. He had never received any drug treatment. In New York, prison officials say that three of four inmates need substance abuse treatment. Treatment programs are filled to capacity. As inmates wait months, even years, for treatment, many are caught in a Catch-22: at high risk of relapse, but punished and denied access to treatment if they do.

Is there a solution? I think there are combinations of solutions; incremental changes that can be made to rework this system of pill distribution. But I don’t think locking more people up and ignoring treatment resources while funding futile law enforcement attempts is going to get us anywhere. This special has done a great job at shedding light on the situation but I wish they hadn’t almost exclusively interviewed police and politicians as experts on how to fix it.

It has been ingrained into our minds, and you can see this in the Current TV special, that drug addicts are considered bad people and the only way to deal with them is to get tough on drugs. Just look at Todd. His brother dies from an overdose. His wife dies from an overdose. He’s pretty much lost everything. Yet he still uses the same drug and is stuck In the Realm of Hungry Ghosts. And there are countless others who are brothers, sisters, moms and dads and they’re addicted to all sorts of drugs, to gambling, to sex, to food. Where should they be sent? The box?