Quotes from John Temple

problem-solution marketing. They would market and publicize the problem of untreated pain. Then they'd promote the solution: OxyContin.

It didn't mention that the "article" was a letter to the editor, published in 1980, and that its conclusions were based on a simple review of the charts of hospitalized patients, not a scientific study of long-term narcotic use. But the idea was out there, published in a scientific journal: Fewer than 1 percent of pain patients would develop addictions.

Between 1996 and 2002, Purdue funded more than twenty thousand pain-related educational programs, almost ten a day, seven days a week. During the same years, Purdue conducted

A favorite freebie was the heat-sensitive Oxy-Contin mug that bore the words: "The one to start with . . . ." When filled with hot coffee, the rest of the slogan materialized: "The one to stay with.

Purdue doubled its sales force during those years, from 318 to 767 pharmaceutical reps. In the trade, the reps are called detailers, and they're typically good-looking, gregarious, and well-dressed. They remember the names of the clinic receptionists and secretaries and nurses. Purdue expected each drug rep to develop a list of 105 to 140 physicians within a specific sales region and call each one every three or four weeks.

Purdue paid its reps better than most drug-makers paid theirs—by 2001, an average salary of $55,000 and an average bonus of $71,500. Purdue spent a half-billion dollars on the one-on-one sales strategy between 1996 and 2001.

Purdue drilled its reps on two selling points. One, OxyContin was the first narcotic that wouldn't hook patients. And two, fewer than 1 percent of pain-management patients get addicted anyway.

By 2002, six years after its release, Purdue was selling almost $1.5 billion of the drug each year—eight times the volume the company had projected. The single drug represented 80 percent of Purdue's net sales. It was the biggest-selling brand-name controlled substance on the market. The once sleepy drugmaker was now a powerhouse, and it wasn't about to concede that its star product had a major flaw. OxyContin's

But deaths involving prescription narcotics continued to mount, until the trend was impossible to dismiss. Overdose deaths involving prescription opioids quadrupled between 1999 and 2007, from about three thousand to twelve thousand per year. By contrast, cocaine killed about six thousand users in 2007, heroin about two thousand. Prescription narcotics were now killing more Americans than all illegal drugs combined. In

The company was selling an addictive drug that it said would not addict you as long as it was taken as prescribed. Then, when the drug did addict someone, and they began taking too much of it, or hoarding it to take all at once, or trying to obtain multiple prescriptions or early refills—then, that person was no longer taking it as prescribed. That person became one of the outcasts, an addict, and therefore the "safe when taken as prescribed" dictum remained valid.

And the companies developed one new opioid narcotic after another, hailing each as a breakthrough.

Endo, maker of Opana, Percocet, and Percodan, distributed a patient education publication that said withdrawal symptoms and increased tolerance to narcotics are not the same as addiction. "Addicts take opioids for other reasons, such as unbearable emotional problems."* The

In 1993, three years before OxyContin came out, the DEA allowed pharmaceutical companies to manufacture 3,520 kilograms of oxycodone. In 2007, the DEA signed off on the production of seventy thousand kilograms of oxycodone. Almost twenty times the amount manufactured just fourteen years earlier. Twenty times.

And it wasn't just oxycodone. Between 1996 and 2007, the DEA had nearly quadrupled the production of hydrocodone, allowed manufacturers to produce almost ten times the amount of fentanyl, and hiked the quota of hydromorphone by four and a half times. Despite its impact on public health, the quota-setting process was conducted in secret.

Studies have demonstrated that opioids may actually increase pain over the long run and that non-drug treatments are much more effective than opioid therapy. The federal Centers for Disease Control and Prevention has declared that painkiller overdose deaths are an official epidemic.

In 2010, ninety of the top one hundred oxycodone-purchasing doctors in the country lived in Florida. By 2014, the DEA said, the state contained only one. The number of oxycodone pills shipped to Florida dropped from 650 million in 2010 to 313 million in 2013.

the manufacturing companies keep asking the DEA for permission to make more pills, and the DEA keeps granting it.

According to the International Narcotics Control Board, the US had consumed 83 percent of the global supply of oxyco-done in 2007. And 99 percent of the world's hydrocodone. No one believed that the US was in that much more pain than the rest of the world.

Pharmaceuticals were the most profitable industry in the country, and the pharmaceutical lobby was by far the biggest in Washington.*

At $75 per appointment, South Florida Pain was seeing enough patients to pay doctors between $2,000 to $4,000 a day. Plus $1,000 cash a week for the use of their DEA registration number to order drugs.

Turned out the rugged mountains and humid climate of eastern Kentucky were excellent for growing weed. By the 1980s marijuana was believed to be the state's number one cash crop.

It wasn't hard to get urine. Folks back home had taken to selling Mason jars of it at flea markets. Whitney

Four of the doctors at American Pain were among the top nine physician purchasers of oxycodone in the United States, according to the DEA, which meant that together, they were a juggernaut. A

Same went for babies born addicted to drugs. In 2001, sixty-two Kentucky newborns were hospitalized for neonatal abstinence syndrome. The next year, ninety-three. Two years after that, 166. By 2007, 275.