History does repeat itself. Heroin, formulated in 1898 by Bayer Pharmaceutical Company, was hailed as a cure for both morphine and cocaine addiction. In the early 1930’s, hydromorphone (Dilaudid®) was introduced as a safer, less addictive drug alternative to morphine. Back in the 1960s pentazocine (Talwin®) was synthesized by Sterling Drug, Inc. and marketed as a painkiller of morphine magnitude but without its addicting properties. Street addicts soon learned to mix Talwin with pyribenzamine, a sedating antihistamine, to produce a heroin-like effect. On the street, this potent mixture was called “T’s and Blues.” In recent years, Tramadol (Ultram®) — a non-scheduled drug for pain relief — has become a drug associated with addiction. History chronicles attempt after attempt to find an effective non-addicting painkiller. Although many formulations have appeared to fill the void, over time diversion and addiction have blemished the images.

Author Barry Meier describes this chase for the “magic bullet” — a powerful painkiller without the hazards of addiction — as “a march of such substances, each one offered as a safer alternative to the addicting painkiller that preceded it.” One of the latest in this steady march is the formulation of oxycodone into a long acting time-release tablet called OxyContin®. OxyContin is the subject of Meier’s well-written and educational text.

Meier is neither a physician nor a pain expert. He is an award-winning reporter for The New York Times, in which he has published articles about OxyContin and where he specializes in investigating issues related to public health, business, and the law. Relying on reports from those addicted to the drug, those who treat addiction, pain experts, and drug agents and regulators, Meier states his goal as “to examine how and why the problems involving OxyContin had happened from the perspective and experiences of those whose lives the drug had touched.”

Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death tells the story of the development of OxyContin, a drug designed to help millions of people suffering from chronic and debilitating pain. The book also tells the poignant story of lives destroyed by this drug. Meier presents this story from many perspectives. Unfortunately, executives from Purdue Pharma (the pharmaceutical company that produces and markets OxyContin) refused to be interviewed. According to the literature the company disseminates, it produced the medication to give steady-state pain relief. The company, as well as the FDA, believed that the hydrophobic acrylic matrix utilized for the slow release of the narcotic would hinder those trying to abuse the medication. Also, they believed that the steady-state blood level of the medication would be less reinforcing and, therefore, less addicting. They did not understand the mindset and determination of the addict.

The true power of Pain Killer comes from the addicts, their families, and those in the health care community who struggled to get Purdue Pharma and the regulatory agencies, such as the FDA, to take action and prevent the growing epidemic of OxyContin addiction, overdose, and death. The author brings to life their voices in the pages of this book. These voices tell the real story of the heartbreak of addiction. Meier beautifully captures the struggles, the emotions, the successes, and the failures of those who are addicted and those who put themselves on the line to bring the dark side of OxyContin into the light.

The Pain Killer story does not end when the last page of the book has been digested. In January of 2004, the General Accounting Office recommended that the FDA require pharmaceutical companies to identify potential problems with diversion and abuse when first submitting a drug to the FDA for approval. This action is a reaction to highly questionable practices regarding the marketing of OxyContin. For example, Purdue Pharma had released
an unsubstantiated promotional video claiming that less than 1 percent of patients taking the drug would become addicted.

Time spent with this book will give the reader historical perspective on the use and abuse of painkillers. It educates the reader about the processes and competitive nature of bringing a drug such as OxyContin to the marketplace. The human suffering aspects of the book may create strong reaction against OxyContin and Purdue Pharma. Throughout, the reader needs to remember the good that has come from this and similar medications. For the vast majority of those who have used this powerful painkiller, it has allowed them to live a better life. However, a small but significant population of individuals will find a way to abuse any medication with potential for positive mood enhancement.

Cardwell C. Nuckols, PhD, is President of the Cardwell C. Nuckols & Associates, LLC, a national and international training and consulting organization. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

This article is published in Counselor,The Magazine for Addiction Professionals, June 2004, v.5, n.3, pp 75-76.

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