Williamson is a city of 3,000 inhabitants of the North American state of West Virginia. Despite the small size, the municipality consumed a tsunami of opioid pills between 2006 and 2016: according to a report by the US Congress, 20 million units of the drug that causes an epidemic of national proportions and that it goes away turn into a public health problem in the U.S.
The last episode of this crisis came on March 26, when the Purdue drug giant woke up – in one of the many lawsuits surrounding the problem – to pay $ 270 million in the State of Oklahoma , which accused OxyContin's opiate manufacturer of having, through the aggressive marketing of his product, contributed to nourishing the overdose wave that has left thousands of deaths in the state.
In total, officials estimate that between 1999 and 2017 218,000 Americans died for overdose of opioids with a prescription and the small Williamson has become a symbol of the problem.
But how has an inner city been flooded with drugs? How has the current health dimension been affected by the health crisis and has launched a giant pharmaceutical company?
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Millions of medical prescriptions
The influx of pills to Williamson generates an average of more than 6,500 drug units per inhabitant of the city.
Opioids are a class of drugs that are naturally found in poppy, the same thing used to produce heroin. They are prescribed to treat different degrees of pain, since they act faster, stronger and more durable than normal analgesics.
But these are the same characteristics that make opioids not only potentially addictive, but also relatively easy to cause an overdose. In spite of this, they have been widely prescribed to patients in the United States in the last two decades. In the 2012 boom, the number of revenues increased from 225 million or 81.3 per 100 Americans.
Williamson is one of the hundreds of cities, counties or states that have opened processes against the pharmaceutical industry.
Purdue's OxyContin has become the prescribed opioid associated with the greatest number of excessive uses, according to the government agency National Information Center on Biotechnology.
"Williamson earned the nickname" Pilliamson "because of this incredible amount of pills," explains BBC Eric Eyre, a journalist based in West Virginia.
Eyre won the Pulitzer Prize, which reported on the research, producing a series of news on analgesics for sale in West Virginia, one of the poorest states in the United States.
CDC data, the leading US health agency, points out that West Virginia has the highest rate of deaths due to overdose in the country: 57.3 deaths per 100,000 people in 2017, more than twice the national average (21.7).
The county of Mingo, where is Williamson, has the fourth national death rate for overdose.
"High rates of drug mortality are concentrated in mining-centered communities, or those that depend on jobs in the services sector," says Shannon Monnat, assistant professor at the University of Syracuse, who studied # 39 ; impact of the opioid crisis in the American rural zone.
"For many people, labor and family institutions have disintegrated over the past 30 years, and this has left some people with little sense in life. Drugs are a way to avoid emotional pain or the reality of a lack of connection or purpose in life. "
In 2017, a NBC report interviewed Williamson's emergency service, which then said it had an average of 50 cases of overdose per month.
"It's fair to say that everyone in Williamson has to meet someone affected by drug abuse," BBC's Roger May, a city-born photographer, told BBC News.
"He started with mining workers who needed the medication to control their pain, but we quickly started listening to stories from family members who also used medications (opioids), including teens, who steal pills to take the parts. So, a few years later, we saw people being posted on Facebook that someone had an overdose or had died. "
Tip of the iceberg
The numbers that Eric Eyre revealed in his reports for the Charleston Gazette-Mail newspaper showed that the Williamson crisis was just the tip of the iceberg.
The communications obtained by the National Agency for the Execution of Drugs (DEA) show that pharmaceutical distributors sent 780 million tablets of oxycodone and hydrocodone, the most common opioid painkillers in pharmacies in West Virginia between 2007 and 2012.
"There is the case of Kermit, a city of 400 residents in West Virginia, who also received millions of pills, but Williamson became more symbolic due to the volume of medications and the fact that people traveled hundreds of kilometers to buy medications. there, "Eyre adds.
Williamson is close to the West Virginia border with the states of Kentucky and Tennessee.
This geographical location, together with regulation at the time of the influx of drugs, made the city a perfect destination for so-called "pain management clinics", and an increase in medical prescriptions of # 39 ; opioids
People began to line up at 6 in the morning at the pharmacy door to get medication.
A single doctor, Katherine Hoover, opened an office in Williamson in 2002, and in 2010 – when the police conducted an intervention at her clinic – she had already prescribed opioids 333,000 times.
Frankie Tack, a drug addiction expert at the University of West Virginia, is part of a group of scholars who believe that rural communities have become good opportunities for business expansion for drug giants.
"I do not think companies have accidentally dumped all these pills in cities like Williamson. It was part of a business model, aimed at communities with higher risk," Tack told the BBC.
"In West Virginia, there are so many cities with people who work manually (which causes pain in the body) and with less access to medical services.
He says he interviewed patients who ingested opioids "without knowing what they were, and even if it was addictive."
"If you take into account this epidemic, you see that the victims were middle-aged people, people who needed pain medications."
But drug manufacturers and distributors have constantly denied these accusations.
But to understand how the epidemic has come to the present, we have to go back two decades.
In the mid-nineties, it was estimated that about 100 million Americans were affected by chronic pain, which led health authorities to demand less regulation in the use of more potent analgesics.
The main argument in favor of this was that patients with chronic pain, from the elderly to the workers who had years of manual labor, would have a better quality of life if they had access to stronger medications .
The discussion evolved to the point that the level of pain was declared the fifth "vital sign" of patients – which means that their measurement and management were considered as important as the monitoring of temperature, blood pressure, respiratory frequency and heart rate. .
Soon opioid medications began to be distributed throughout the country and pharmacists started a career for their market share.
One of these companies is Purdue Pharma. In 1996, the company began selling its flagship, OxyContin. In 2001, it had already generated billions of dollars in opioid sales.
Quickly, however, reports of deaths related to opioids began to increase, increasing the overall rate of deaths due to overdose in the United States, from 16,849 in 1999 to 36,000 in 2007.
The same year, Purdue was fined with more than $ 600 million, after admitting his guilt to mislead the public about the risk of addiction present in OxyContin. It was one of the highest fines applied to a pharmaceutical company in US history.
The health information company IQVIA estimates that OxyContin has generated sales of Purdue with 35,000 million dollars. Investigations show that the drug represented 82% of the company's sales in 2017.
Earlier this month, Purdue announced that it was considering the bankruptcy application, the containment of legal procedures and the negotiation of out-of-court settlements.
The liquidation in Oklahoma would be the first in which the company would respond to a popular jury on the responsibility of the pharmaceutical companies in the American crisis of the opioids. The case was resolved through an extrajudicial request, but the pharmaceutical company is accused in hundreds of other legal claims.
Overdose deaths continue to increase – there have been more than 70,000 cases in 2017. Authorities have included medical prescriptions, but they remain high: 58.7 recipes per 100 Americans.
At the same time, addicts to opioids have used counterfeit drugs or illicit drugs, such as heroin.
Research in Congress
Overdose is now the greatest cause of death among adults under 55 years of age and they kill as much as combined firearms and traffic accidents.
"Before, there have been drug outbreaks in the United States, but they tend to concentrate on" pockets. "This is different: many people become addicted, even when they use opioids properly," says Frankie Tack.
The "tsunami" of Williamson pills was one of the most prominent aspects of a Congressional public hearing last December – about the opiate crisis in West Virginia.
The investigation has caused harsh criticisms not only of the pharmaceutical companies, but also of the anti-drug agency of the DEA.
"Our discovery revealed systemic failures for both the distributors and DEA who contributed – and could not contain – the crisis of opioids in the state," said Greg Hull, the Energy Committee leader and House Trade.
Experts predict that the mountain of judicial proceedings against pharmaceuticals will result in massive extrajudicial settlements, such as those involving the American tobacco industry in the late 1990s – one of the bids exceeded $ 200 billion.
"Cities, counties and states have filed legal claims that demand reparations against public expenditures related to the opiate epidemic," said Nora Engstrom, a law professor at Stanford University. "Some economists estimated that in 2015 the economic cost of this crisis was 504 million dollars, or 2.8 percent of the US GDP."
At the local level, these costs feel stronger. In Mingo County, where Williamson is located, a survey estimated that the opiate crisis cost almost $ 7,000 per inhabitant, whose per capita income is just over $ 20,000.
"Opioids have devastated entire communities in West Virginia and elsewhere in the United States," says Roger May. "The feeling is that some people have taken advantage of".
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