[Music] it was the pill that revolutionized the way we live with pain I am as dependent on oxycontin as I am on my glasses to see so out here it was a revolution driven by a marketing campaign that targeted our doctors people who are hurting are desperate because of the lack of anything else to offer them we now spend more than 10 billion dollar a year on treatment with narcotic pain pills I went from spending probably four of seven days in bed to being a mom again and we're spending hundreds of millions more on the
addictions that the pain pills cause I think a huge cat has been LED out of the bag and I don't think it's going to be put back [Music] in good evening I'm lynon McIntyre it's our hidden epidemic pain we're told that that maybe 6 million Canadians suffer from it more than 50 million Americans all the time it costs us billions in Lost productivity all the pills we take to dead in it and now the incalculable costs of a drug addiction epidemic tonight the story of a marketing campaign that helped transform the way we think of
pain and the miraculous pain pill that turned out to be a medical time bomb once a fact of life pain has become another problem to be solved by pills simple pills for simple ailments but for heavyduty pain a heavyduty drug derived from opium one the doctors call an [Music] opioid Oxycontin is the most dramatically successful of the so-called opioids the company that developed it is Purdue Pharma Inc by ingenious marketing puru companies in Canada and the US succeeded in turning this one pain pill into a multi-billion dollar business at that time there were no pain
clinics around pain specialist clinics like we have now come on you get one at a time in 1997 Tammy dagno had never heard of oxy conton it was only introduced in 1996 six she was an insurance broker a happily married mom living near Hamilton Ontario she had chronic back pain she'd been on a narcotic pill called peret a doctor suggested something new a narcotic that released its payload slowly it was a safe narcotic there was little chance she'd get addicted to it and he says we have a new drug that's on the market called oxycoton
it's not as addicting as peret because of the slow release so when you're in pain it'll alleviate that pain but it's not as addicting as per ccoet Vancouver 1997 puu showcased its new drug here at a conference on chronic pain in Canada and the US the drug manufacturers were recruiting health professionals many of them doctors who were paid to spread the good news about Oxycontin to other doctors and now I just have a little point to toothpick and I'm just going to prick you and you tell me if what it feels like so out here
okay that's not too bad okay there it feels do thicker thicker Dr Roman Joy would become one of their most successful Advocates filling a vacuum as he sees it in the lives of people suffering with chronic pain when you look back 15 years ago nobody was talking about pain certainly the universities failed in their obligation to to educate health professionals appropriately nobody was talking about pain and so companies like Purdue stepped in and at least were raising awareness were their motives totally altruistic probably not they had a simple message Oxycontin was a safe narcotic they
would make that claim a mantra in ads like this in the Journal of the Canadian Medical Association in lectures workshops and seminars this assurance the one to start and stay with was convincing Oxycontin could become a friend for life a vital Ally in a war on pain how you doing good thanks see all right it's been uh8 weeks or so right about 8 weeks eight weeks for Dr Joy it was the beginning of a new age in pain treatment a new frontier in which he'd become a Pioneer okay so I'll just leave things as they
were I'll refill things and how fair is the perception that that was driven by pharmaceutical industry I would I would disagree with that I I don't think that's pharmaceutically driven I think that that's an awareness issue that people are aware that pain can be treated and and it should be treated Dr Joy readily admits that he's been paid to speak by many drug companies over the years but Purdue and its new pain medication had special significance for him we estimate based on surveys the Canadian pain Society has done they're probably about six million Canadians suffering
from moderate to severe pain daily or most days of the week well you say okay how's that compared to other things that's a lot that's probably comparable to those with heart disease and cancer and perhaps exceeding those in 2002 Dr Joy edited this handbook it would become the Bible for doctors treating patients for their pain it became part of the curriculum of a major med school it was paid for by puru Pharma the manufacturers of oxy conton puru retained the copyright the manual has 17 chapters on pain treatment including eight by Dr Joy two on
acute pain in its treatment were contributed by the cbc's medical commentator Dr Brian Goldman Dr Goldman has also on occasion been paid by Purdue for talks on opioids and pain he says he's recently modified his views especially on oxicontin but to Skeptics Dr jy's manual was little more than advertising for the drug so I'm going to give you a month prescription Dr Philip Berger a pain specialist at St Michael's Hospital in Toronto how aggressive were they in the marketing of the you can't get much better than getting in the classroom of medical students can't do
much better you know they can hide under the moral cover of objective teaching when in fact the only motive any of these drug companies has I'm not saying it's bad is to make money and you can only make money by selling more drugs Dr Henry chesy of London Ontario was fairly typical what blood pressure is perfect 12280 a few hours of teaching about pain in med school very little knowhow about treatment Dr Joy's handbook was a godsend yes it was a good thing and uh we understood from um the information received from the pharmaceutical Representatives
that it was due to the nature of it being a slow release medication that uh there was it was less addictive uh it was um less chance of it being uh abused and less chance of withdrawal reactions uh if you stop so you started to prescribe it sure did changer in the chair yep people like Kim Westlake suffering from chronic pain suddenly had hope thanks to puru and True Believers like her doctor by 2011 Canada would rank second in the world for opioid prescriptions and second in the world for deaths from overdoses but in the
early days it was all good news I went from spending probably four of seven days in bed 24 hours a day to being up and being a mom again and you felt good felt great it was a common reaction among pain sufferers all over North America and it drove oxycoton sales to unprecedented Heights in the US prescriptions for the drug went from 300,000 in 1996 to 7.1 million in 2001 okay you too Tammy dagnell who lives near Hamilton Ontario was so impressed with her new medication she spread the word to members of her family it's
working for me so of course I'm going to tell my mom there's a new drug on the market it's not as addicting as Percocet so then she got prescribed so that's wonderful I mean it's a narcotic that's hardly addictive at all yeah that's like you've died and gone to heaven absolutely Dr Roman Joy takes pride in the influence he's had on other doctors Financial backing from the medication industry made little difference in what he thinks what I've written about is what I practice I'm I'm at the Forefront I'm at the at the coace so I'm
there week in and week out treating people and what's in that book is what I believe go ahead andard when we come back alarm bells ringing in America and he said this is going to be the worst drug that we've ever seen come into this County [Music] [Music] by 2001 Tammy dagnal was turning to Street dealers to satisfy what had become a serious dependency oxycoton had been the answer to her prayers helped her live a normal life marriage kids a good good job selling Insurance her doctor told her that there was little danger of [Applause]
addiction but by 2001 she was taking dangerous amounts of the narcotic 10 times what would become the recommended maximum for daily use she was hooked your tolerance builds up really fast it's helping your pain but then you get immune to it so then you go to the family doctor and he says well you're going to need more so he put you on the 40 milligram so then you're on that for a month and then you get used to that dose and then he puts you on the 80 well this is the maximum when did you
know that you were addicted oh for sure I knew uh absolute 2001 what was the big light bulb in 2001 try to stop on my own and the sickness was unbearable she didn't know it at the time but what she was going through was a shared experience a crisis building in a part of North America she probably had never heard of Appalachia as desperate as Mississippi and the South and Cape Breton in the north an East Coast economic region defined by lumbering and coal mines poverty and pain it was a region that in the late
1990s hungrily embraced a new and improved cure for pain a narcotic that was user friendly the drug called oxyon and it all happened within a frame of 2 3 years I mean it just kind of blew up Beth Davies is a nun from the of Notre Dam an addiction counselor she's been here since the 70s she first heard the word Oxycontin from the local druggist and he said they're marketing it in such a way telling us that this will be the best thing that we could ever use for pain for patients and it's non addicting
because it's a Time relase drug and we don't have to worry about addiction and this is the best thing you could ever do and we're really encouraging that Lee County Virginia became a Proving Ground for a marketing strategy that would establish Oxycontin as the leading pain control pill in America they got all the data on Physicians prescribing they targeted the top uh tiers that were most liberal prescribers of opioids art vanze was skeptical he's a doctor but you didn't have to be a doctor to know that Nar otics are addictive he thought perdue's drug salesmen
were deliberately playing down the fact that patients could get hooked on oxy conton they knew that was there before it went to Market they knew the potential was there so it had to be a known risk and and concern for them Appalachia was a druggist dream aging population beset by aches and pains from hard work and hard living many of the oldtimers here had union benefits or social assistance that got them drugs for free it was just the best thing out there in the eyes of the doctors and lot of the patients and uh it
was easily obtained you go to the doctor and ask for one I had a lot of people that say you know doctor tried to give them oxycoton for some problem and they'd heard the stories and no I'm not going to take that and still the doctor saying this is the best medication for you two subjects that were living there that both had warant Lee County Sheriff Gary Parsons our real hope is that the courts will get the message instead of giving these folks suspended sentences and slept on the wrist they'll actually get some time Sheriff
Parsons grew up here remembers a recent time when people didn't lock their [Music] doors now he had to deal with a drug rated crime wave all the crime went up larsy crimes went up 150 200% in a year's time before that time I could tell you pretty much everyone in Lee County that was involved in the drug trade or in drug traffic in some way once the prescription thing hit everyone from the old to the young the rich to the poor you had no idea who might be uh using the drug or Distributing it one
of the last to realize what was happening in Lee County was the addiction counselor sister Beth Davies even the pharmacist who first told her about oxycoton was panicking and he said this is going to be the worst drug that we've ever seen come into this County and it's going to cause us more problems than any drug we've ever ever seen before the pills were flooding through the hands of those who really needed them ending up with people who just wanted to get high and they were saying it was just just as good as heroin sister
Beth Davies I've never seen anything it was like somebody lit a fire and a drrive pasture Drive forest and it just went you know right through by 2002 Lee County was up in arms demanding that Purdue get oxy conton off the market company officials finally [Applause] reacted they met with us and at that time they were doing damage control I think they were well aware that there was a problem with their drug and it was becoming addiction but they weren't admitting that to you guys no no they were telling us studies and they had a
they had a front man that was up and doing presentations and telling us uh you know that their drug wasn't the problem but their drug was the problem and American Purdue officials would admit years later that as early as 1995 they had known that many of their claims about oxyc conton including its addictive nature were fraudulent in 2002 they offered Lee County $100,000 to help fix the problem they insisted that they didn't cause sister Beth Davies couldn't believe her ears I was Furious why were you Furious why do you get furious if somebody's trying to
give you a bag of money to bag of money for blood money so that they would be able to go around and tell other people in other communities look what we have done for Lee County by 2002 The Story of Lee County was becoming tragically familiar All Along The Ridge called Appalachia South Carolina rural Maine Atlantic Canada doctors beset on one hand by people desperate for some relief from pain and Drug salesmen offering narcotic medication that would do the trick with hardly any risk we're now witnessing the beginning of another painful epidemic drug addiction she's
still using about four to five and no increase in that no increase in that and some pain specialist Dr Phil Berger of St Michaels Hospital in Toronto breaks she breaks it yeah she breaks it was a so-called Perfect Storm a Confluence of unbelievably aggressive marketing by the pharmaceutical Industries which sell these drugs the inadequacy of Education to medical students and physicians in training and the utter failure of regulatory bodies that colleges of Physicians and surgeons to rein in their membership and provide proper oversight to how their members were prescribing medications all three together produce this
burst of widespread availability of very strong opioid or narcotic medications I just had a undeniable spark in my eye I personally think that I was beautiful in this picture and I car in the World Tammy dagnell didn't think twice when her doctor offered Oxycontin for chronic back pain that started with a car accident it worked she passed the word on to others in her family but it wasn't long before she realized she had a problem worse than pain what was it that made you want to stop I felt that it was interfering with work marriage
and my kids how mood swings you would not off because you were taking so much how much well at that time you don't know what I could take up to 3080s a day 3080s yes and still I was a functioning professional until 2007 when my world came crashing down I wrote an exam an insurance broker's exam that day I had cut it down I was only on 1780s and I passed it with flying colors we're talking about more than a th000 milligrams of OxyContin absolutely and you wrote an exam yep and passed and passed and
felt great yep he's been there through thick and thin but the great feeling wouldn't last long the drug that was a godsend 15 years ago is now a demon she's unable to escape I would do anything to to get that back that I never ever took that pill we got courtroom two as well when we come back Judgment Day for oxyc conton Purdue company's now convicted felon every time someone hears the word oxycotton they're going to have in their mind oh that was a drug that that company was convicted of [Music] this was the downside
of the hoopla over oxy conton the much publicized narcotic payload was too tempting to be left alone by drug abusers here we go I'm going to do uh the water on it there were white spread reports that addicts had learned to crack narcotic pills like Oxycontin to get the full effect in minutes instead of over hours all I can explain it in one word bliss on Vancouver's downtown east side addicts were onto it by 1998 it's already starting to hit [Music] me this is now the unintended leg Legacy of narcotic pain pills 8 the urban
methadone clinic where addicts try to stabilize their sickness this is London Ontario where a dozen years ago hardly anybody needed methadone now a thousand people come here every day like Kim West Lake most of them were hooked on oxycontin they've all tried other ways to stop so they come to methodone treatment because they realize the drugs are killing them and they can't get off them any other way T Dr John Craven is a psychiatrist who runs this Clinic fulltime downstairs he dispenses methadone I'm doing all right upstairs he dispenses hope how are you doing better
now hope to people like Kim Westlake she was started on these medications for the first time by a doctor she was provided it as treatment for a health painful health condition Kim Westlake was taking it for pain but soon discovered that she couldn't do without it there you go and that it was taking more and more to make her feel just normal you weren't grinding it up and snorting it no not you weren't no shooting it up your no you were taking it the way they told you to take it yep yep so you figured
nothing bad can happen that's what I thought okay let me see fix it let me see fix it did you know how addicted you were my my life was built around this pill I had to make sure that if I was going on a business trip if I was going on a holiday if I I was doing anything I had to make sure that I had enough to keep me going and then a few days more worth just in case before I went it was no longer about the pain in your bones it was about
a terror that you were going to be caught without it y because of what would happen because of what would happen the sickness Dr Roman joy runs a network of pain clinics in Ontario he's been an ad for Oxycontin since it first appeared and is philosophical about its downside they start they try that because in their their view rightly or wrongly they perceive it as somehow safer somehow safer because it rightly or wrongly because they've been told that well rightly or wrongly because their parents have been taking it and they say nothing's happened to them
so iess and their parents are taking it because they've been told by doctors and they've been told by a large company that uh the risk of taking this stuff is minimal and the potential benefits are unlimited well unlimited is a bit strong I mean it is especially people who are suffering pain you throw out some hope and it it suddenly becomes magnified in their minds but people who are hurting are desperate because of the lack of anything else to offer them so I mean I wish we could develop a treatment on the pharmacologic side that
didn't have the addictive properties but was also very potent analgesic unfortunately we can't separate those out just yet we're working on it but for his patients like Marty Whittier potential benefits are good enough regardless of the risks nice to see you have a seat thanks how have you been I'm still fighting this H High pain face I'm averaging around 8 and 1/2 spikes to nine 12 years ago Marty had a fairly normal life married with two kids then a water skiing accident AC changed everything all right so just uh I'll see you in 8 weeks
as usual a shattered spine excruciating pain she discovered Dr joy and oxycontin and has been on the medication ever since I am as dependent on oxycontin as I am on my glasses to see I'm habituated to the medication I'm not addicted whever pain exists in in a body addiction physical addiction is impossible I've been taught for Marty Whitaker dependency is just the price she pays for her Mobility it's not the same as addiction a delicate distinction that she entrusts to her pain specialist okay byebye bye bye Dr Roman Joy I have a sick sense about
people I try to through interviewing them get some sense of their character and get some sense about well is this N9 out of 10 sort nine out of 10 or is it or is it is there emotional pain behind it and does that need attention so that's the challenge of assessing patients but doctors in a busy general practice would have little time or training for assessing the complex ailments of a patient like Kim Westlake many had little choice but to rely on the reassurance of a Salesman that Oxycontin was the most effective and the safest
pill available the doctor that was handing this stuff out how do we explain his willingness to give you lethal amounts of this drug as much as I'd like to blame him honestly I believe he just hated to see people suffer I think he was also a bit of a coward in that he was afraid of my reaction if he said no by 2001 in Lee County Virginia people were complaining loudly that the salesman had been grossly understating the dangers of addiction and exaggerating the benefits of opiates that year alone Purdue us spent $200 million to
Market and promote just oxy conton sales of oxycoton soord by the middle of the decade the drug was earning Purdue Pharma over a billion dollars a year Dr art vanz this is like a Yellowstone fire where there are bunch of people on the North side with skirt guns trying to put the fire out and in the backside they're dropping Napal on the back side of the fire in 2002 he went to Washington and complained to a congressional committee about the hard cell tactics about salesman getting rich on bonuses overstating claims for benefits and understating risks
when you could take a seconde medical student and have him read those and he could realize that they didn't have anything to do with what the real risk of iatrogenic addiction was for using opioids for chronic non-cancer pain it was not factual it hardly mattered the critics were being drowned out by a massive lobbying camp campaign it would be 2007 before the accumulated outrage in places like Lee County finally struck Home Federal prosecutors in Virginia laid criminal charges accusing Purdue and three top officers of lying in their marketing the trial in Abington Virginia attracted national
attention we got court room 2 as well for overflow but few people were more gratified than the addiction counselor sister Beth Davies many of those who had lost children had lost family members were able to go before the judge and tell this story in front of the officials from Purdue my grandson at 6 years old came home and found her dead in her bed and I will never forgive how would you D my fredman or Paul goldenheim for that they are murderers in the end the company was fined $600 million while three top company officials
would be told to pay $35 million for what the judge called a campaign of deliberate deception Purdue company's now convicted felon every time someone hears the word oxycotton they're going to have in their mind oh that was a drug that that company was convicted of the Abington criminal convictions were a moral victory for the activists who had watched the addiction tragedy unfold for most of 10 years they were a setback for the company Executives who had stonewalled them for much of that time but by 2007 those fraudulent claims and marketing strategies so scathingly denounced in
court had firmly established narcotics as a key part of a vast pain management industry if 2007 was a bad year for Purdue it was a disaster for Tammy dagel who had staked her life on Purdue's assurance that oxy conton was low risk for addiction by then she just couldn't get enough of it she had a good job as an insurance broker but was spending all her income on the drug blew her retirement savings then her husband savings then became a thief 2007 was the peak of my addiction family I stole from my company that I
was working for because I had exhausted everything else you stole take me through it I had to tell my husband I lost my job I have a police officer that's standing in the front door and he says to me he says if you don't tell him I'm going to tell him I'll give you three days to tell him police officer left I took himo back and I told him what I did and it shocked the hell out of him when we come back the price we pay for the pain of opiate addiction you're not a
Believer anymore I'm not a Believer anymore [Music] in 2007 there was a feeling of vindication in Appalachia when a court finded Purdue more than $600 million for deception the judge declared he'd have sent Purdue Executives to jail if he'd had the [Music] option in London under onario Dr Henry chesy had been prescribing opiates for years after the Virginia decision he noticed Canadian drug salesman now trying to control the Fallout the pharmaceutical representatives were adamant that Purdue USA has nothing to do with Purdue Canada so anything that happened down there that's just um you know Americans
are very litigious you know it's probably just a frivolous lawsuit uh and so it has nothing to do with Purdue Canada but Purdue Canada was selling Oxycontin with astonishing success and There Were Striking similarities to the American approach the focus on doctors and pain research in 2006 pju donated $200,000 to a new pain clinic which is associated with the med school here at Western University in London they recruited doctors who instructed trainee doctors on the benefits of opiates like oxycon among those Advocates Dr Roman Joy he was prominent on the Purdue speaking circuit he prepared
a major teaching manual for doctors and Med students learning about pain it was paid for by Purdue how badly was your faith in Purdue shaken when they were charged criminally in the states and then convicted and fined significant amount not much at all quite frankly because that was in America it was now 10 years ago I think that that no 19 2007 but based on stuff that happened 10 years ago it's a different regulatory environment different laws different ways of operating and so I just uh and I can always remember going to American pain meetings
and thinking wow things are really kind of off thee wall big and I didn't see that sort of thing going on here in canadao was having its workshops here having its educational seminars here how are they different oh different more conservative far more conservative whatever the differences in corporate style and legal structure the marketing of oxy conton had phenomenal results in both countries total oxycoton sales in 2010 were $3.5 billion Canadian oxycoton sales in 1998 were a modest $3 million a a little over 10 years later sales in Canada had rocketed to more than $240
million Dr Philip Berger they target doctors with continuing medical education events at upscale restaurants personal meetings for those doctors who agree to meet Drug Company Representatives so-called literature articles from medical literature to all of it to promote and encourage doctors to prescribe their medications they're being spoon fed they're being spoonfed and they're been given dinners and they've been given free materials they're given they're given the same textbook that the medical students were given recently the University of Toronto dropped Dr Joy's textbook on pain management from its medical school curriculum after complaints that it was biased
toward the use of opioids the University of Toronto has pulled your book they have I think that you've been more or less instructed to back away away from what was perceived in there as a company line what does that say about what you've been doing over the last 10 years it says that the University of Toronto basically didn't have the courage to stand up to some outside bullies because doctors the outside voices were doctors but not involved in pain management not knowing anything about pain management frankly and uh that book was reviewed internally by someone
on The Faculty who said you know what it's a good book too bad that produ name is on it get an extract one of the bullies was Dr Philip berer a pain specialist at Toronto's St Mike's Hospital any fever there may well be parts of the book that are useful there are also parts of the book that promote incorrect information on which doctors rely uh deemphasizing diminishing The Addictive potential of long acting opioids critics of Dr Joy's handbook singled out this claim that Oxycontin is less powerful than morphine when in fact it can be twice
as strong they also criticize what could be interpreted as encouragement for overuse of oxy conton so Sam you're feeling well otherwise yes and uh for dror Henry chesy who runs a busy practice in London Ontario Stark evidence of the harm that opiates can cause persuaded him to stop prescribing them he now makes it clear that anyone who wants narcotic medication should go somewhere else you're not a Believer anymore I'm not a Believer anymore after learning about what happened with Oxycontin in the states with the Judgment in Virginia uh against pru that's when I uh started
to realize I have to change my practice uh for my patients there's evidence of a new caution in the med schools and the doctor's offices but there has clearly been a revolutionary change in how we use narcotics to manage pain after 17 years Oxycontin has been replaced by what Purdue promises will be a safer substitute but there are already powerful new narcotic drugs in the pipeline from other companies drugs potentially as easy to abuse as Oxycontin K London Ontario addiction counselor Dr John Craven hello I think a huge cat has been let out of the
bag how are you doing today pretty good and I don't think it's going to be put back in and I I I think there's a lot of interest including people with chronic pain who don't feel it should be put back in how fair is it to accuse you Purdue the whole educational process of having deliberately overstated the potential of the drugs and understated the risks in inherent in taking these drugs it depends on your perspective so if if you're somebody working in an addiction treatment program and all you see are people coming in adct toates
you'll say oh my God these are awful all they do is addict people are you accepting some responsibility as a member of the medical profession well I certainly the medical profession Bears some responsibility but I would put to you how far should we as a society go to protect you from poor decisions and poor Behavior but where does a responsibility end off there poor decision s poor Behavior criminal marketing Behavior by American Drug manufacturers in the end it all comes down to this collateral damage in Ontario alone this year 36,000 people getting by on methadone
at a cost to taxpayers of $200 million a 600% increase since oxycoton hit the drug stores and the streets for Kim Westlake it's a struggle that has already ended for half a dozen of her friends people who have died from a narcotic overdose or suicide do you ever think you might have to live like this forever oh it'll be a struggle every day every day at least Kim Westlake has kicked the oxyc conton head it Tammy dagnell is still stuck with the drug she started 15 years ago every day a choice between the drug dependency
she hates and the chronic pain she cannot stand there's no 30 40-day program that's going to fix me I'm going to need to go for a long time and then I'm going to have to find something that is going to be able to help me with my pain because the same thing keeps happening I come out I last 3 months and I go back on it because I can't handle the pain my husband and my son are peeling me out of bed so I go to the doctor I can't handle it back on it I
[Music] go
