We know too well the extent of the opioid crisis in West Virginia. Users started with prescription drugs and when law enforcement and the medical community clamped down on that, addicts moved on to heroin and fentanyl.
West Virginia now has the highest overdose rate per capita in the country, as law enforcement and health officials struggle to keep up.
But where did it all begin and why does the problem seem worse here than many other states?
STAT News, a digital news division of the Boston Globe that covers health and medicine, did a lengthy investigation in West Virginia. Reporter David Armstrong traced the origins of the opioid epidemic to 20 years ago when Purdue Pharma introduced OxyContin.
Armstrong reports that Purdue Pharma took the unusual step of aggressively marketing the drug as an effective pain reliever, but downplayed the risk of addiction. The drug maker made payments to pharmacy benefit managers to keep copays low and make the drug available without prior authorization from insurance companies.
As OxyContin flooded into West Virginia, the state’s Public Employee Insurance Agency began to detect a problem. “In early 2001, the pharmacy director for the state employee health plan noticed coroners listing oxycodone (the active ingredient in OxyContin) as the cause of death for some plan members,” STAT reports.
However, Tom Susman, who was the head of PEIA at the time, said their concerns were ignored. “No one outside the agency wanted to listen,” Susman said. “We felt like we were talking to a wall when we brought the matter up to legislators and other government leaders at the time.”
STAT uncovered documents showing Purdue Pharma worked diligently to overcome any objections to their strategy. “In a memo listing the 2001 goals of Purdue’s West Virginia sales team, the first listed item under Medicaid is ‘Stop any preauthorization efforts for OxyContin’.”
Darrell McGraw, West Virginia’s Attorney General at the time, did pick up on the disturbing trend and sued the drug maker over its hard-driving marketing tactics. In 2004, Eric Holder, who would later become U.S. Attorney General, helped negotiate a settlement with the state on behalf of Purdue Pharma, where West Virginia was paid $10 million dollars (nearly a third of which went to attorneys’ fees).
That may have seemed like a lot of money at the time, but in hindsight it is a drop in the bucket considering the long-term costs associated with fighting the drug problem in West Virginia. One of the main issues in this year’s race for Governor has been how to confront the drug crisis and where to find the money for more treatment.
Eventually, Purdue Pharma paid a bigger price. In 2007 the company and three former executives pleaded guilty to criminal charges of misleading the medical community and the public about the drug, agreeing to $600 million in fines and other payments. West Virginia was not part of that settlement.
Could the opioid crisis in West Virginia have been prevented if Purdue Pharma had marketed OxyContin responsibly or if state officials would have listened to warnings from PEIA? That’s impossible to say, but the evidence suggests we are now battling a worse drug problem because of what happened.
Susman finds the situation disheartening. “Looking back, it’s one of the most depressing things to come out of my government service that we saw what was happening and no one wanted to listen.”