Pain Killer

PROLOGUE
Book of the Dead

Within a span of thirty-six hours in Philadelphia, nine bodies had been found just blocks away from one another. Five were inside homes. Two were in cars. Two were on the street. The oldest of them was forty-two. The youngest was twenty-four.

They had names but they would soon become statistics, data points consumed by a tidal wave of fatal drug overdoses sweep­ing across the United States. In 2016, 64,000 Americans died from drug overdoses. That number equals the population of cit­ies such as Portland, Maine; Lynchburg, Virginia; and Santa Fe, New Mexico. It was as if, in one year, a plague had entered one of these towns and killed every single inhabitant. On an average day in 2016, 175 people died of an overdose, a rate of seven fa­talities an hour. Nine deaths in thirty-six hours wasn t unusual.

Bodies were piling up too fast in some places for medical ex­aminers and coroners to keep up. Morgues were filled to capac­ity, and corpses had to be stored for days in rented refrigerated tractor-trailers until space became available. Many of the dead were not autopsied. It is standard procedure in a drug-overdose case to conduct an autopsy. But even if medical examiners had had time to autopsy every victim, some stopped themselves from doing so. Professional groups that accredit medical examiners set a limit on the number of autopsies that a doctor can compe­tently perform in a year, and examiners in areas with large num­bers of overdose deaths would have exceeded that number and risked losing their accreditation. As a result, when overdose vic­tims were discovered near hypodermic needles or pill bottles, they went straight to their graves, unexamined. The vast major­ity of these deaths 42,000 of them in 2016 involved opioids, prescription painkillers or illegal drugs derived from compounds either found in the opium poppy or synthesized in a lab.

The opioid crisis has become woven into the fabric of every­day American

Barry Meier was the first journalist to shed a national spotlight on the abuse of OxyContin. He was a member of the New York Times reporting team that won the 2017 Pulitzer Prize for International Reporting. Meier is also a two-time winner of the George Polk Award. His reporting at the Times concentrated on the intersection of business, medicine, and the public s health. During his career, he has exposed the dangers of various drugs and medical products, including a defective heart device and a generation of flawed artificial hips. Meier is the author of A World of Hurt and Missing Man. He lives in New York City with his wife and their daughter.

Prescient . . . a landmark work of investigative journalism. David A. Kessler, former commissioner of the Food and Drug Administration and author of The End of Overeating
 
Fascinating. The New York Times
 
A timely, compelling, important book. The Seattle Times
 
A thriller. Minneapolis Star-Tribune

An absorbing indictment of the modern health-care marketing industry, which, as depicted here, has blurred the line between medical education and shilling. Publishers Weekly