That summer, it became clear that OxyContin abuse had seeped out of the western Virginia and Maine backwoods, creeping up and down the Appalachian range. The news was disseminating, finally, not just to big cities on the East Coast but also into the Deep South and parts of the Southwest. Overdose deaths and OxyContin-fueled crime grabbed headlines from Miami–Dade County to Bridgeport, Connecticut. Across the country, OxyContin was becoming a staple of suburban teenage “pharm parties,” or “pharming,” as the practice of passing random pills around in hats was known (ironically in farming communities).
It would fall, ultimately, to the parents of the dead to organize the first national response, specifically to a thirty-nine-year-old IT worker named Ed Bisch. In February 2001 Bisch had been summoned home to his working-class enclave of Philadelphia after taking a frantic call from his daughter, who’d just found her eighteen-year-old brother passed out and turning blue in the bathroom.
Bisch arrived home to find a pair of emergency workers sitting on his front lawn. His son, Eddie, was a high school senior, a soccer player with decent grades and plans to attend a local culinary school. Eddie had complained of feeling ill recently, but it had not crossed his father’s mind that he was deep into opioid withdrawal. Bisch had suspected Eddie was drinking and maybe smoking pot but hadn’t considered pills. They had plans to fly to Florida for a father-son fishing vacation in just six days.
“I’m sorry,” one of paramedics told Bisch. Eddie was dead.
As friends gathered, Bisch was still in shock and grappling for answers when he asked the first responders what his son had taken.
“Oxy,” one said.
“What the hell’s an Oxy?” Bisch wanted to know.
The first time Ed Bisch heard the word “OxyContin,” his son was dead from it.
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If parents were slow to catch on to the epidemic, experts weren’t any quicker. The movement of OxyContin from the economically straitened hinterlands to the largely more affluent cities and suburbs in the early aughts reminded historian David Courtwright of the iatrogenic wave of opium and morphine addiction that stormed the nation exactly a century before. By the 1920s and 1930s, most of the small-town morphine addicts and Civil War veterans with soldier’s disease had died out, not long after the national crackdown hastened by the Harrison Narcotics Act, which set the scene for drug prohibition and, later, the so-called War on Drugs.
“After the old-time addicts died out, narcotics were unheard of throughout the mid-twentieth century, unless you got cancer,” Courtwright said.
For most of the previous century, opioid addiction was mainly relegated to big northeastern cities, where heroin had long been smuggled in through illicit channels, infiltrating the Harlem jazz scene of the 1940s and the beatnik subculture of the 1950s. The term “hipster,” in fact, drew from the Chinese opium smoker of the 1800s, who’d spent much of his time smoking while reclining on one hip. The hipster counterculture took inspiration from heroin-addicted jazz greats like Charlie Parker and John Coltrane.
But where prescribed painkillers were concerned, the Harrison Act had effectively contained the earlier iatrogenic wave of addiction, and the small-town female morphine addict gave way to the image of the hustling, mainlining male junkie. Progressive doctors championed the carefully restricted use of narcotics and called out heavy prescribers for being behind the times. Pharmacists, too, upped the refill bar so high that in 1955 the heroin-addicted Beat writer and artist William Burroughs called them “sour, puritanical shits,” unlikely to fill even a codeine prescription without checking with the doctor’s office first.
When 20 percent of American soldiers came back from Vietnam with symptoms of heroin dependence, researchers were initially puzzled by the fact that most didn’t go on to become heroin addicts—possibly, some theorized, because they returned to spread-out social networks in rural areas and small towns where heroin didn’t exist. It may have helped, too, that many were detoxed in Vietnam before they came home, with the veterans who continued to struggle with addiction typically being the ones who already had drug problems before serving.
“In the early 1990s, probably ninety percent of the heroin market was still in cities like New York, Chicago, and Detroit,” Courtwright explained. “There was this long-standing urban hierarchy of heroin that completely dominated the illicit opioid market in the United States.” But when doctors started widely prescribing OxyContin for noncancer pain in the late 1990s, it effectively nationalized the supply, making opioids no longer only a big-city story. “So that any doctor in any small town, under the dispensation of a new FDA-approved prescription, could now suddenly provide opioids to people with low back issues and so on. You read a lot about economic depression and loss of morale, and I’m certain that fuels the epidemic.
“But the supply expansion [via OxyContin] came before anything else. And if it hadn’t been for the supply expansion, then this [epidemic] would not have happened,” Courtwright said.
If history was any indication, the moment OxyContin and other opioid pills became too expensive or too cumbersome to get, illegal drug peddlers would step in to fulfill the market demand, just as they had done a century earlier when heroin became illegal. For centuries, dealers of opium, morphine, and heroin understood that an addicted person’s fear of running out—of becoming dopesick—portended one hell of a business model.
The author of several books on the history of drug addiction, Courtwright said he used to tell his students that “what most surprised me in my lifetime were things like the internet, or seeing tattoos on respectable women. But I’ve got to add this to the list of real shockers. I’m sixty-four years old, and I have to admit, I didn’t think I would ever see another massive wave of iatrogenic opiate addiction in my lifetime.”
*
Courtwright wasn’t the only one. Though it took nearly a decade before police, the press, and drug-abuse experts fully understood what was happening, Ed Bisch watched the urbanization of the pill epidemic play out on his front lawn in 2001, as paramedics carried his son’s body away.
He retreated to his computer, where he was shocked to learn that his son’s death had been the region’s thirtieth opioid overdose in the past three months.
How was that possible when he’d only just learned the word? “The internet was still new, and back then it was mostly message boards as opposed to websites,” he said.
Bisch channeled his grief into computer code. Hoping to warn other families, he created his own message board, giving it the bluntest moniker he could think of—OxyKills.com. Within weeks it had morphed into a scrolling database of grief, warnings, and statistics. The website became a clearinghouse for the latest Oxy-related overdose numbers reported by local medical examiners and the DEA. Bisch promoted news stories about OxyContin, such as when the New York Times noted that the drug’s sales in 2001 hit $1 billion, outselling even Viagra.
Parents from Florida to California joined Bisch in memorializing their dead children on his site, which became a running tally of dead athletes and young mothers and former beauty queens, many no more than twenty years old. “I was answering every email, and it was consuming me,” Bisch recalled. “Probably ten deaths a day, sometimes a hundred emails a week.”