Lee Nuss of Palm Coast, Florida, was too grief-stricken to reach out to Bisch initially, but her daughter, Monique, called him one night, begging him to talk to her mom. Turned out they had grown up in the same section of Philly, in the same working-class neighborhood of Fishtown, less than a mile apart. And the similarities didn’t end there.
Nuss, too, had lost an eighteen-year-old son, Randy, who died of a single, crushed-up 80-milligram Oxy bought from a friend whose mother wanted him to sell it to pay their rent. “I had no idea he was using pills until this happened,” Nuss said. She told herself that Randy hadn’t been using long, because she still had opioid pills prescribed to her in the wake of dental surgery that were untouched at the time of his death.
The Fishtowners made an informal alliance with Van Zee and Sister Beth after reading Barry Meier’s 2003 book, Pain Killer. If OxyContin nationalized the opioid supply chain, Nuss and Bisch nationalized the opposition to it, launching a grassroots nonprofit called Relatives Against Purdue Pharma (RAPP). It was Ed Bisch’s message board sprung to life, a nonvirtual resistance party that would play out politically and in person over the next decade.
Together the parents-turned-activists would lobby for the creation of statewide prescription monitoring programs, or PMPs, so doctors could check a patient’s prescription records and prevent themselves from being shopped. Members would sponsor drug-prevention workshops in schools and hold signs outside Purdue’s corporate headquarters featuring poster-sized pictures of their dead kids. They would battle—online and at times in person—with chronic-pain patients who praised the drug for allowing them to function and to sleep through the night. Bisch suspected (correctly, in a few cases) that some were “paid advocates,” hired by Purdue to troll his website and post contrary views.
From court cases to medical seminars, RAPP could be counted on to turn up whenever and wherever Purdue was in the news. In 2003, its members traveled from Rhode Island and New Jersey to rally outside a drug-abuse-prevention conference held in Orlando at the Caribe Royale resort—because Purdue was an exhibitor at the conference. The protesters were already battling the rain when Bisch began reading aloud the names of 260 people memorialized on his website—only to have an unidentified woman turn a sprinkler on them. (A hotel executive denied having anything to do with soaking the parents.)
A Purdue Pharma spokesman at the event told an Orlando Sentinel reporter: “We offer our sincere condolences to anyone who has suffered the loss of a loved one from a drug overdose” but insisted that Purdue’s marketing of OxyContin had been “appropriate.”
Raised Catholic and deeply religious, Lee Nuss began wearing a pair of rosary beads for protection at such events. As an added talisman, she carried a tiny bronze urn in which she’d tucked a portion of her son’s remains. (As she explained it to me: “I leave the main urn at home on my mantel. But when I leave the house, I like to have Randy right there with me.”)
The memorials kept flooding the message board. When Barbara Van Rooyan’s twenty-four-year-old son, Patrick, died in 2004—after ingesting his first and only OxyContin, at a Fourth of July party—she reached out to Bisch, who put her in touch with Van Zee. “At the time, I knew very little about the drug, other than Rush Limbaugh had been addicted to it,” she told me.
Van Rooyan, who lived in Folsom, California, had also read about Van Zee’s battle with Purdue in Pain Killer, and she had one central question for the country doctor: “How the hell had such a strong drug come on the market to begin with?”
Van Zee walked her through the FDA’s 1995 approval of the drug, led by its top examiner, Curtis Wright. Van Zee just happened to have a copy of the company’s New Drug Application, or NDA, a document trove that had been a Christmas gift from Sue Ella in 2000. “It was all I wanted that year,” Van Zee told me. Sue Ella admired the way her mild-mannered husband was stifling his hardwired passivity to stand up for the region, yet she increasingly resented the time it took away from their family life. “We used to try to go a day without saying the words ‘addiction’ or ‘OxyContin,’ but we never made it, not once,” she said.
Though Purdue claimed it had no idea of the drug’s abuse problems until February 2000, Wright had signed off on a 1995-filed NDA review that spelled out how crushing the tablets would lead to immediate, rather than controlled, release of the drug; that withdrawal symptoms had been witnessed in several patients during clinical trials; and that 68 percent of the oxycodone was in fact recoverable from one single, crushed-up pill when liquefied and injected.
In a summary of his approval, Wright had even urged caution in the product’s marketing materials: “Care should be taken to limit competitive promotion.” In fact, minimal care had been taken in the drug’s promotion. Wright would go on to work as a consultant for Purdue Pharma two years later.
Van Zee told Van Rooyan, too, about the eight-hour drive to Maryland he’d made in January 2002 to testify before an FDA advisory committee convened to discuss the agency’s role in approving and overseeing the management of narcotics. That meeting pitted Van Zee, wearing his only suit and a Jerry Garcia necktie his mother had given him, against Purdue executives and some of the nation’s top pain-management experts, most of them acknowledging that they were or had been paid speakers for Purdue.
Van Zee found himself outnumbered nineteen to one, a harrowing experience for a loner not accustomed to public speaking.
“I get nervous,” he told me. “It was intimidating, especially in front of my peers, all of whom had big reputations in the field. But this was my responsibility to do, and I did feel like I was speaking truth to power.”
“He practiced and practiced and practiced,” added Sue Ella, who accompanied him on the trip. “I tend to be emotional when I speak, but Art is so careful about saying only what he absolutely knows to be true. His ego is never invested.”
The gist of Van Zee’s opposition, as outlined by one Purdue-funded speaker: “We are allowing the abuse and the ignorance of the few to affect the potential health for the many.…Remember the biggest form of drug abuse today is under treatment, and this is a crime that we can all eradicate.”
The next morning, in a ten-minute conversation with the country’s elder statesman of pain management, Dr. Russell Portenoy, Van Zee asked Portenoy to describe what he believed to be an acceptable level of addiction risk from OxyContin. Given that the “less than 1 percent” figure, trotted out repeatedly from the 1980 medical-journal letter, was out of date and applied only to a hospital setting—rather than in the context of chronic pain treated at home—Van Zee asked Portenoy: Hadn’t that been a meaningless calculator of long-term risk?
He showed Portenoy an OxyContin distribution map, highlighting the overlap between heightened crime and drug abuse in regions like Lee County, where OxyContin was prescribed at a rate 300 to 600 percent above the national average.
“That’s good,” Portenoy responded. The more opioids that were out there, the better to meet the needs of chronic-pain patients.
But what if the risk of addiction is 5 or 6 percent? Van Zee persisted. “What do you consider acceptable collateral damage? If you create fifty thousand patients that are opioid addicts?”