Millions of Americans are now hooked on drugs which were prescribed for pain

Millions of Americans are now hooked on drugs they or somebody close to them had prescribed for pain, writes Terry Prone
Millions of Americans are now hooked on drugs which were prescribed for pain

IF you happen to be one of the benighted few who has yet to encounter Jack Reacher, you should know that he’s six-and-a-half feet tall at least and has hands the size of hams, which is why us fans refused to go to the movie where Tiny Tom (Cruise) played him.

Once you get to know Reacher, you know nobody other than a young Liam Neeson could play him.

The two downsides to Reacher which you also need to know before you identify with him are, first of all, that he has damn all sense of humour. He has been known to crack a smile, but that’s about the height of it.

The second downside is that Reacher doesn’t stay. Anywhere. It’s not that he’s a freeborn man of the travelling people. It’s just that when he left the US military, wherein he was a military policeman who attained the rank of major, he decided he was never going to settle.

He has no home. He has no property. Well, OK, unlike most of his compatriots, he has a passport, but you’d expect that of a man whose mother was French and who travelled the world as an army brat. He has a passport and a capacity to magic money out of an account somewhere. Other than those two items, zilch.

He travels by Greyhound bus, washes himself a lot but tosses his cheapo clothes into a bin after a couple of days, having picked up more from a Goodwill store. He does not have a phone. Imagine.

What he does have, in every book, is a willing woman — all of them intelligent, brave, beautiful and reasonably happy to bonk and then let him fly free, untrammeled by fidelity. Oh, and a cause. Reacher always has a cause. An adventitious righter of wrongs, he arrives in a town and straightaway a cause presents itself to him, requiring his always principled and inevitably violent response.

His latest outing, entitled The Midnight Line, is set nowhere in particular in Wyoming, a state which, let’s face it, is big enough to contain a whole load of nowhere in particular. The novel ticks all of the boxes that have made this big bad multiple killer beloved of peaceable little old lady readers and others. But this time, it does more. It gives a painful insight into America’s opiate epidemic.

Millions of Americans are now hooked on drugs they or somebody close to them had prescribed for pain. Top of the list, one called Oxycontin. The medication was developed to help patients cope with major post-operative and other pain, and the hope, when they first came out, was that they were non-addictive. Indeed, they were marketed as precisely that.

They were so incredibly effective that a new breed of clinic began popping up all over the US: the Chronic Pain clinic, which offered physio, meditation, living in the moment, and, if all of these failed, Oxy. Everybody was happy. Good folk who had suffered genuine pain for years now had something that would kill off the misery and raise them to a new plane of light, happiness and peace.

When it was suggested that patients on time-release Oxy seemed to get pretty desperate for the next dose two hours before it was due, the makers, Purdue, came up with a rationale that talked of pseudo-dependency. Of course the patients suffering this new syndrome were not addicts. They simply needed their next fix.

Oops, sorry, we meant their next dose.

It was a whole new kind of addict: Hard-working, respectable, decent folk, some of them veterans grievously injured in the course of their duty and whose consequent pain was beautifully managed by Oxy. Wars are the best stimulant for the addiction business. They deliver pain-wracked men and women with money and a long life ahead of them, that life bearable only through the use of laudanum (that would be after America’s Civil War) or morphine (the first and second world wars).

But the great thing, let us remind ourselves, the great thing about Oxy was that, unlike heroin and alcohol, which constituted the main ingredients in laudanum, or morphine, it was not addictive, the claim went, if used properly.

So while Oxy, used properly, was managing pain for hundreds of thousands of patients, Oxy, used improperly, was changing Appalachian life for the worst. Given the level of backwoods deprivation that characterises that area of the US, it’s difficult to imagine any factor making life there much worse, but you have to hand it to Oxy, it managed it.

Young relatives of older patients discovered that a tablet crushed and snorted delivered the most fantastic high, which in time — and it didn’t take much time — turned Oxy into an equal generational addiction. Grandpa took it, Mom took it and young Wilbur took it, albeit in different forms.

Since they had only one prescription serving the three of them, they had to engage in a new sport that took over the Appalachians — doctor shopping. It would take a while and a lot of petrol, but eventually, a determined enough Oxy addict would get enough prescriptions to keep them going and allow a few business deals on the side.

Eventually, the family firm that makes the drug came under pressure because of the deaths their medication was causing. Hundreds of thousands, some authorities suggest. Hundreds of thousands of OD deaths. So the family firm that makes the drug took action. They reformulated the pills in a way that made them impossible to crush and snort.

You can tell this family, the Sacklers, are good at heart, even if you didn’t know about their philanthropic donations to museums like the Louvre. The only problem was that the consumers who had, over time, become addicted to snorted Oxy and who discovered the new version wouldn’t play for them quickly became so desperate that they abandoned the pharmacy where they’d purchased Oxy and went out on the street to buy anything that would deliver the same hit. They found it.

Good old reliable heroin would do it. Right there and then. And tomorrow and tomorrow and tomorrow. That’s why authorities find it difficult to nail down precisely how many deaths can be laid at the door of Oxycontin: because many of those who have died since it was reformulated actually died of heroin, for which Oxy was the gateway drug.

WHAT Lee Child’s new novel does is change many popular notions of drug addiction. The product is not processed in dubious jungle laboratories owned by killer cartels, but in government inspected pharmaceutical plants. The peddlers are not scabby locals, but white-coated doctors. The people behind the whole operation are not Netflix villains, but a family of generous philanthropists.

Donald Trump says he’s going to tackle the opiate epidemic. He could do with a non-fiction Jack Reacher to help him. Because a legally prescribed drug has destroyed a region and more than one generation of Americans.

The Midnight Line by Lee Child is published by Bantam Press

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