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How the Nation’s Opioid Epidemic Is Morphing — and Growing

The nation’s opioid epidemic shows no signs of abating—and in fact may be headed in a far more dangerous direction.

That’s the conclusion of journalist David Armstrong, who has been chronicling the scourge this year for STAT, a new health and medicine website. Armstrong has written about how heroin and, increasingly, fentanyl have overtaken narcotic painkillers as the drugs of choice for addicts — presenting new challenges for law enforcement and health professionals.

In the past few months, Armstrong has told the story of two best friends in Ohio who became addicted to heroin and what happened when one of them died in 2015 after taking drugs supplied by the other. He’s also written about an eerie photo released by an Ohio police department showing a little boy strapped into his car seat while two adults in the front seat are passed out from overdoses.

Armstrong’s news organization, STAT, has also gone back in time to understand the roots of the epidemic. It filed motions to unseal court records from the 1990s and 2000s to learn more about how drug companies marketed their painkillers and got Americans hooked. The news organization won a motion in Kentucky to unseal court records, a decision that’s under appeal by Purdue Pharma, the maker of OxyContin. STAT had more success in West Virginia, where it obtained records showing how Abbott Laboratories helped Purdue market OxyContin to doctors — including giving one doctor a box full of donuts shaped to spell out “OxyContin.”

Joe Amon/The Denver Post via Getty Images

We talked to Armstrong last week. Highlights are below, edited for length and clarity.

It’s not a surprise to anybody in this country that we're facing an epidemic of opioid overdoses and that the problem seems to be getting worse over time. What makes you as a reporter interested in covering a story that perhaps some people feel that they already know?

The reason we thought it was important to cover the opioid crisis is really twofold. One, as you mentioned, STAT is a new publication and we're focused on medicine, health and science, and to my way of thinking, in terms of a public health issue, at this moment in this country, there's nothing more pressing than the opioid crisis. So, from that standpoint, I felt it was important that we cover this and sort of put our stake in the ground.

The other thing that really troubled me about this and piqued my interest in doing more was the rise of fentanyl. You know, fentanyl is so potent and is really adding to the death toll in a way that we haven't seen, and I wanted to know more about that. I wanted to know what was going on, and part of that is learning more about how we got here in addition to what's going on now.

Is the emergence of fentanyl related to efforts to crack down on prescription painkillers?

That's part of it. In areas where we've seen restrictions on prescribers and very aggressive prescription monitoring programs, there's no question that some people who are abusing opioid painkillers or prescription painkillers transition to heroin. But drug dealers and cartels are pretty smart, pretty cynical, and what they saw was a rise in the use of opioids and they realized that they could initially produce heroin cheaper and supply that sort of same population with a similar high, similar drug at a lower cost. So those two things sort of happened in parallel tracks, even though we did have people switching from one to the other. And now with fentanyl, we're just seeing more of the same, except it's just more profitable for drug dealers.

You wrote a piece that was really compelling about two best friends, from Ohio actually, teenagers DJ Shanks and Justin Laycock, and their relationship and their bonding over drugs, and I found it really compelling. How did you get turned on to this story and why did you decide that this was a story that needed to be written?

DJ and Justin, best friends since kindergarten, grew up to have an addiction problem together, but they were heroin users, and it also started with prescription painkillers. They were using Vicodin. They accidentally used heroin laced with fentanyl. Justin brought the drug to DJ who was working at a Tim Horton's doughnut shop at the time, and he snorted it and he died on the job. One of the more compelling aspects of that story is what happened to Justin. He wasn't his drug dealer. He was helping out a friend, he thought, because DJ told him he was “dope sick” and needed something. So Justin brought it to him, didn't charge him. He paid for it, and he was arrested. He was charged with a crime, a drug charge crime, but that carried a mandatory prison sentence. The thing that really caught me on this story was that to get help, Justin had to plead guilty to a higher charge of manslaughter, because that would allow the judge to put him in a treatment program as part of his probation after his prison sentence, and he wants to get sober. He hates being an addict. I thought that was really kind of an indictment of where we are in terms of treatment in this country.

What is the wrongdoing here? Who is falling down on the job here and what needs to be fixed as far as the problem that is repeating itself across the country?

For starters, we've done, as a country and the U.S. government, a poor job of eliminating the source of the drugs, which is primarily China. Now some of that's out of our control, of course, but it hasn't been as much of a priority as it should be. In fairness, you know the problem is so difficult to solve because we have multiple laboratories in China and some other countries in Asia that are sending this product to criminal syndicates in Canada, to Mexican cartels. So then there's numerous people with laboratories that can translate this drug into pill form or put it into heroin, and it's so multifaceted. There's so many organizations doing it that it's almost like whack-a-mole.

In 2007, we had a similar outbreak of fentanyl overdoses. Well it was one lab in Mexico that was producing it and the DEA and the Mexican government uncovered it, they shut the lab down, the problem went away. That's not going to happen this time.

Listen to this podcast on iTunes, SoundCloud or Stitcher. And see more of Armstrong's reporting for STAT here.

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