Flip on the news. On any given broadcast these days, some talking head will bring you a story focused on America’s current scourge. This isn’t about the most recent social media head scratcher put forth by Dear Leader, but a real, bona fide and honest-to-God scourge, one that’s sweeping the nation. I’m talkin’ ‘bout the newest, latest and greatest of American Tragedies—The Opioid Epidemic. Every time I hunker down in front of the television and Lester Holt warns of the disturbing story his network is about to lay on me, I want to holler back at the tube: “Where the fuck were you guys fifteen years ago?”
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There was a time when I’d joke that if it wasn’t for alcohol and firearms, I’d be unemployed. It wasn’t long before I came to realize this clever bon mot didn’t provide for me that sharp, short and sweet summation of life as a medico-legal death investigator as concisely as I wanted it to. Sure, it stood on its own and produced a few dry chuckles from those I graced with it, but this was not enough. It’s true that alcohol plays a huge role in providing me with food and shelter. It wouldn’t be unfair to assert ballistic mayhem has done its bit in making Game of Thrones and Boardwalk Empire a part of my life. Without it, I could well have to endure a life of TV entertainment limited to a “basic” package. The problem I had was that my little pet phrase was lacking. It didn’t encompass a full view of my employment. It omitted a very important facet of my career when it came to percentages regarding how I spent my time at work. It truth, it was an aspect of death investigation that provided me with more job security than the consequences of drunkenness or gunplay—combined.
Lengthening this slice of morbid humor to “If it wasn’t for alcohol and firearms and prescription painkillers and all derivatives of opium, I’d be unemployed,” just wouldn’t do. It didn’t “sing.” This from a guy you all know has one dickens of a time “keeping it short.” So, I dropped it altogether. I dropped it well over fifteen years ago. The media had nothing to do with this decision. They were still jerking themselves raw over 9/11 in those days. I was in no danger of being considered passé due to pop-culture oversaturation.
To be truthful, fifteen years ago the number of opioid/opiate overdoses weren’t as overwhelming as they are now. But… the signs were there, and that’s not hindsight. When I first started as an investigator, the types of overdose fatalities reported to us were spread more across the board, so to speak. The pharmacological spectrum of drug use that resulted in fatalities, both intentional and accidental, was more varied and consistent in those days. Opioids, i.e. prescription painkillers concocted in a lab, not a poppy field in Turkey, held a notable but not overwhelming share of this spectrum. Psychotropics – often cocktails of benzodiazepines and tricyclics combined with alcohol– were “popular”. Non-benzo sleep aids like zolpidem and Lunesta, and antipsychotics like quetiapine (Seroquel), clozapine, risperidone also held a notable place. This spectrum also included overdoses that involved gulping down any and every pill available, prescription or OTC (over the counter), with suicidal intent and relying on the theory that too much of anything ought to kill you.
The primary opioid culprits back in those days were the pharmaceutical products of Percodan or Percocet (oxycodone and aspirin and oxycodone acetominophen, respectively) and Vicodin (hydrocodone and acetominophen.) These medications are highly effective, both at relieving pain and killing people. In my first year or so as an investigator, these meds were almost exclusive in opioid fatalities. We’d encounter the occasional morphine or methadone death, and there were folks who either had too little respect for its position of power in the opiate spectrum, or too much regard for the opinion of it as a wimp on that same spectrum, and wound up dead for taking a generous handful of Tylenol 3s (acetaminophen and codeine.) Once in a great while we’d catch an honest-to-god heroin OD, but in the waning 1990s that was a genuine eyebrow raiser. Then along came a medication that was heralded as an answer to the problem of folks abusing their pain medication: Oxycontin.
Oxycontin is just oxycodone; oxycodone with a twist. Big Pharma was tired of being associated with the over-prescription and subsequent abuse of painkillers. Just because they made the shit didn’t mean they were handing it out to anyone who wanted to cop a buzz. They preferred the blame being directed at the middle man. Doctors, on the other hand, had no problem with Big Pharma sharing the heat. When it came to patients who’d been on a regular diet of opioids going on three years after an ankle surgery, and whose next need of medical intervention took place in a morgue, the argument was made, “If this is all you have to offer for pain control, don’t scold us for prescribing it.” Big Pharma’s answer to this was oxycontin. (I heard this from a doctor, a friend of mine who was doing an emergency medicine rotation through his residency. He stated this was more of an ongoing gripe than an any sort of official dialogue between pharmaceutical companies and physicians, though he asserted this had been an ongoing debate for decades.)
Like I said, oxycontin was just oxycodone, “new and improved.” To diminish—if not wholly eradicate—this drug’s appeal as a pharmaceutical joyride, they did some chemical tinkering. It was made “slow/time release” and “buffered.” This resulted in a painkiller that was just as effective when it came to dulling the “ouch”, but eliminated the “aaaahhhh…” associated with the parent medication. Voila! This’ll take care of that abuse/addiction headache. Who’d want to get hooked on a pill that won’t give you a buzz? Problem solved.
A couple years after I became an investigator, this new and improved painkiller started showing up in overdose cases. We weren’t given much info about this stuff. You might find that odd, but, as I’ve learned over the last couple of decades, the medical and pharmaceutical communities aren’t in the habit of handing out updates to medical examiner’s offices. I suppose, after all the testing, studies, cross testing and cross studies and whatever, they don’t expect the latest FDA approved pharmaceutical advance will be sending us any business. (This isn’t the sole bailiwick of pain control. Remember “Fen-Phen”? Pharmaceuticals are equally adept at killing overweight folk as those in pain.)
When the oxycontin started showing up, and at an alarming rate, if I dare use such cliché, we were a little taken aback. We’d heard of this stuff, but that’s about as far as it went. A little research and a few pointed inquiries shed a ton of light on this latest puzzle. The answer was should have been obvious, but we, least of all, hadn’t figured it out.
Stay tuned. I’m about to tell.