Lessons in Addiction from the Opioid Epidemic

By Nathaniel McDonough

Community leaders are not stepping down in the fight against opioid addiction, even though overdose deaths are dropping. 

There were 2,125 opioid-related overdose deaths in 2023, which is 232 fewer than in 2022 when Massachusetts had a record 2,357 fatal opioid overdoses, according to a Department of Public Health report.

The opioid crisis was fueled by Purdue Pharma plans to sell their prescription drug OxyContin in 1996. They manipulated studies to persuade the FDA to sign off on tthe drug and convince doctors to prescribe OxyContin for cases that did not require such heavy opioid prescriptions, according to the United States Department of Justice. 

Senator Patrick O’Connor, a state Senator representing the Norfolk district of Massachusetts has long been a champion for those who are affected by addiction and the opioid epidemic. “This issue was one of the impetuses for me to get involved in government in the first place," he said. 

"I went to school over in London and so when I came back home in 2003, 2004, 2005, people that I had grown up with that had become addicted to prescription drugs and I didn’t understand it because when I went back to London none of those drugs had been approved for the common use that we were prescribing them for here in the US. I remember going to Town Hall when I was 20 and asking what we were doing for the problem of addiction because good local kids who were upstanding began becoming addicted to prescription drugs.” he recalled.

He  also passed a follow up to Governor Baker’s PACT Act, which set the model for the rest of the country to monitor prescriptions to prevent a similar situation from happening in the future. 

He has been asking the community for advice on what needs to be done. "It has been community based and we financially fund a lot of these community organizations through earmarks. We see what is working in our communities and we help give them what they need. We supported South Shore Peer Recovery to the tune of hundreds of thousands of dollars because their model seems to be working. The biggest thing we land on as far as what needs to be done is education.”

He noted that families in the community have shared their stories with him. “We spoke to one person, who lost her son when he was nineteen years old. He was from Duxbury, played basketball, and he got addicted to prescription drugs and regressed to heroine. When he overdosed the people, he was with left him because they were afraid, they would get in trouble,” he said.

In Massachusetts, the Good Samaritan law protects people in these situations.  “His mom has made it her mission to increase the awareness of the Good Samaritan law inside schools, so our schools do a couple assemblies on opioids, so we want the Good Samaritan law to be talked about at those assemblies," he said. 

He said the focus is now on the dealers. "What we want to do, and I filed this bill last session, is go after high level dealers and drug traffickers, and pin specific opioid deaths on the person who brought the drugs in. We are not looking to go after someone who deals drugs to feed their habit, but instead the people who are not addicted and are feeding off of the people who are and benefiting off of their deaths by dealing poison.”

Dan Schneider, the subject of the Netflix documentary “The Pharmacist” began grappling with our country’s treatment of the drug crisis when his son was murdered in Louisiana and law enforcement wrote off the case because to them, he was “just another drug addict”, according to Schneider. 

His documentary chronicles his efforts that led to him solving his son’s case, opposing police corruption, fighting stereotypes of those facing drug addiction, and working relentlessly to shut down a major pill mill. Today, he still works as an advocate for awareness and policy to help those struggling with addiction. He is an advocate for MOUD (Medication for Opioid Use Disorder) drugs,

“I have a little bit of mixed feelings on methadone only because the clinics in general are not properly run and you can potentially even overdose on methadone. But for some people who take it properly it regulates them and if they get some counseling along with… it would do more good," he said. "What I think is much better is another drug which is a half strength opioid, where methadone is a full-strength opioid. This drug called buprenorphine or Suboxone which doctors can write a prescription for. It stops the cravings, and it stops the withdrawals, and they can’t mess up too much with it. In other words, they can’t take too much of it and die. That’s one of the things I really advocate for because, and this is an example I like to use for this, France started using this openly about five years ago and they reduced their overdose deaths by ninety percent. In the past two years we have finally had some decreases in opioid deaths and there’s a bunch of different reasons but one reason they think might be important is they’re starting to use more buprenorphine and of course Narcan. Narcan is a great drug because it gives people a second chance.”

He said the country needs to look at how drugs are coming into the country. “There are two parts of the border. There are parts which are illegal to cross and there are what is called legal ports of entry. What the majority of people in America don’t understand; that is where almost all the fentanyl gets in. What can we do about it? We haven’t invested in trying to stop it. There are thousands and thousands of trucks that come across the border every day and they only have the personnel and equipment to inspect I think about ten percent. Can we completely stop the flow? I say we can’t…. There’s a million ways to get it over the border."

Fighting the epidemic needs a multi-focused approach. "What we really have to do is invest more in treatment and prevention. We should try to reduce the supply… but if we could reduce demand, supply would also go down because the only reason why the stuff gets across is because they can sell it.” Schneider said. 

He said more steps need to be taken. “ We have done a pretty good job of slowing [the flow of drugs] down from big manufacturers. Now though, they (Purdue Pharma/ Pharmaceutical Companies) have created so many addicts over the years that these people now are buying street drugs because it’s cheaper and more accessible, but they’re also more dangerous. You can trace it back and big pharma has a lot to do with the people that are dying even today. Now, what can we do to control big pharma further, because if we don’t watch out, they’ll come back at us. We’ve got to stop allowing them to advertise because they are influencing them to take more drugs than they need.”

Schneider said the top three things we need are awareness, education, and treatment. In his area lawsuit money from big pharma has gone towards educational billboards and buprenorphine clinics where OUD patients can receive free treatment. He also said it is imperative that we get into schools and educate children about drugs before they have the chance to try them and become addicted.

David Morgan is another pharmacist who owned multiple pharmacies in Boston during the birth of OxyContin and the beginning of the opioid pandemic. He did not know much about the drug other than that it contained a heavy dose of narcotics, was being widely prescribed and was causing a severe uptick in pharmacy robberies from people who were desperate and addicted. 

He made the decision not to carry the drug and faced severe backlash from Purdue Pharma which resulted in heavy pressure from the Board of Pharmacy. Today he does work for OUD (Opioid Use Disorder) awareness, education, and government policy advocacy. He was one of the presenters of “Prescription Drugs: What You Don’t Know Can Hurt You,", and a member of the Weymouth SAPT (Substance Abuse Prevention Team).

“ Armed robberies on pharmacies went from about zero to about one-hundred and fifty almost overnight and it was all due to OxyContin. It had such a high street value and I read a report on the prescriptions, and they were almost all young kids from Southie and that’s not the usual demographic for pain meds. Usually, its older people and people with cancer, stuff like that. … it was way too concentrated. We had 160 milligram tablets which is equivalent to thirty-two Percocet in one tablet; I said this is crazy! That type of stuff was usually reserved for hospice patients. I’ve never had a doctor call me up and say, ‘hey I need you to give Mrs. Jones thirty-two Percocet.’ So, I made the decision to not sell it and the drug company went ballistic. They said, ‘Oh you have to sell it’ and I said, ‘No I won’t do it’, and I had no idea they would end up killing so many people with their drug. I talked to Oncologists, and they agreed, they were good with Percocet. They said it’s too expensive, it’s too concentrated, the drug should’ve never been brought to the market. As of September 10, 2001, we no longer carried OxyContin. Purdue called the Board of Pharmacy and brought me in front of the board, and they told me you have to carry it. They even got doctors to testify against me. I said I’d close the stores down before I sell it, ,Morgan said.

He said the path to heroin for those who became addicted was clear. “ It started with the prescription drugs, and it took a hold of people, and then when doctors wised up and stopped prescribing it people went to heroin and recently it’s all been Fentanyl. Heroin you have to harvest from a poppy plant and manufacture but Fentanyl is synthetic so you just get the chemicals, and you can make an extremely concentrated opioid. You can smuggle fentanyl so much easier because the effective dose is so small. A tiny amount is the equivalent to a large quantity of heroine. We have to cut down the demand somehow and that starts with education. Everyone should have Narcan. Another thing that is good is I think the younger generation has wised up to the danger of drugs.”

One man, who did not wish to be named, once struggled with addiction, but now is a certified recovery coach for Peer Recovery. He started off as many do using less serious drugs and then tried harder drugs and progressed to intravenous drug use. He has seen addiction from all sides.

 He said the three main factors that contributed to addiction for him were family, experimenting as a young person, and loss of support during hard times. He finally beat addiction for good when he saw his children going down a bad path and wanted to be a good example to them. They are all leading successful lives now as a result, he said.

“ I said to the doctor ‘could my son be an alcoholic?’ and he said, ‘Well how much do you drink?’ and I said, ‘well what’s that got to do with it?’ He said ‘It’s got everything to do with it. If your son sees you drinking and getting high every weekend that’s exactly what he’s going to do.’ From that day I was done and since then I have not picked up a drink or any type of drug. Recovery is real, that’s one thing I always tell people. At the worst I was sticking a needle in my arm, living on meth, and hitch-hiking across the country. That was my first bottom. And my last bottom was having my head down in a pile of coke for four days, not seeing my kids on the weekend, not working, not making rent, lying cheating and stealing to get money, and even that wasn’t enough for me to stop. It was only the love of my children that got me to stop. I didn’t care about me, and that is one of the things that happens in recovery. People learn to hate themselves because they know their behavior is wrong, they just can’t stop… One of my friends came to my house all [messed] up and I said what are you doing? You have three kids, and they need you. He said I want to get high but I’m hoping that it kills me to end this. People get to that point and what makes sense of this in my mind is when you look at the studies of alcohol and marijuana in adolescence where it alters the brain chemistry to the point where they lose their impulse control, and they start craving the endorphin rush from a young age.”

He stressed the importance of equity in access to help, fostering healthy family dynamics, mental health resources, education, and awareness. He said there is a lot of help out there, but the trick is getting someone to listen for long enough to save themselves. He also stressed the importance of drugs like buprenorphine and methadone, but that some people are better suited to different treatments but there is no miracle drug.