Pain: A Political History

5. OxyContin Unleashed

168 FIVE OxyContin Unleashed A good man will seek to take the pain out of things. A foolish man will not even notice it, except in himself . . . William Saroyan, “The Human Comedy” The revelation in 2003 that conservative provocateur Rush Limbaugh had maintained a secret addiction to the painkiller OxyContin carried a deep political irony. This arch critic of liberalism, social indulgence, and big government’s coddling, a man who extended Reagan’s ideas and who had wailed against President Clinton’s “I feel your pain” rhetoric, had treated his own pain liberally and to excess. Many commentators at the time remarked on Limbaugh’s political hypocrisy , casting him as a conservative double standard. Limbaugh had once said about drug users, “Go out and find the ones who are getting away with it, convict them and send them up the river.”1 On its face, the Limbaugh episode was a puzzling contradiction. If excessive “bleeding heart” liberal compassion had produced a crisis of dependency and learned helplessness, then what are we to make of the conservative provocateur ’s long-term addiction to the most famous painkiller of his day? His story conjoins the personal and political in the same way that the saga of many other people in pain had done (Rosie Page, Lorraine Polaski, and so on). Like their travail, his was a testament to the times in which he lived—to the growing gap of relief between the privileged and the poor, and to the post-Reagan years and the world conservative deregulation had created. The surge of painkilling drugs into the market since the 1980s (encouraged by both Reagan-era conservative deregulation and continuing liberalization) had both relieved and damaged society , and by the early years of the new century a new liberal-conservative OXYCONTIN UNLEASHED 169 consensus began to emerge around the need for market surveillance. Limbaugh was a poster image for these developments; so too was OxyContin. The late twentieth-century pharmaceutical market expanded by taking advantage of many features of the American political landscape, exploiting both liberal and conservative pain policies. Private industry promised relief in ways conservatives loved, through direct-to-consumer advertising (DTCA) of drugs; to libertarians, drugs promised better access through the rise of Internet pharmacies; and to liberals, lowering the barriers to regulation promised effective remedies for the undertreated .2 Limbaugh’s addiction shed light on the exuberant drug market that regulatory reform had produced; but OxyContin’s rise also forced both liberals and conservatives to look closely at the world they had made—a marketplace that claimed to solve Americans’ problems far more efficiently and completely than government programs ever could, but one that also had the capacity for great harm. Seen in this light, the Limbaugh case is not a paradoxical story but a coming-to-fruition narrative. By the turn of the twenty-first century, the forces of liberalized access to relief (through medical marijuana and physician-assisted suicide) and the forces of neoconservative deregulation (weakening FDA oversight of industry) had opened the door to innovation in the pain market. Combined , these forces unleashed a new world of relief symbolized by drugs like Bextra, Vioxx, Celebrex, and OxyContin. OxyContin seemed ideally suited for the era—it was an old drug, identical to the Percodan of the 1950s, but now in a time-release formulation for people in too much of a hurry for repeated medication. It also appealed to cancer physicians wary of opioids in end-of-life care. The drugs promised relief without addiction . But, like other business booms of these decades, the drug bubble was also susceptible to profound busts; and many of the era’s new painkillers experienced shattering failures as well as success (measured in pills prescribed, revenues and stock prices, but also in side effects, deaths, and fraud prosecutions).3 By 2010, few of the players involved in the painrelief markets—patients, doctors, drug manufacturers, and regulators— had escaped the controversies that defined the OxyContin era or the policing and increased political scrutiny that marked these times. Limbaugh was just one of many casualties. 170 PAIN In the early years of the pain drug boom—a time that coincided with the introduction of DTCA—people like Limbaugh became avid shoppers . This flowering of consumerism was precisely the kind of development that free-market conservatives had long championed, but it also produced new patterns of excessive consumption. In the OxyContin era...