48 Quotes by Sam Quinones

Man's decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior

When your kid’s dying from a brain tumor or leukemia, the whole community shows up. They bring casseroles. They pray for you. They send you cards. When your kid’s on heroin, you don’t hear from anybody, until they die. Then everybody comes and they don’t know what to say.

Opiate use in medicine had been destigmatized by crusading doctors. But destigmatizing the new opiate addiction had no prestigious crusaders. That task fell to parents of dead kids and a few individuals with a flair for guerrilla political action...

But Arthur Sackler is important to this story because he founded modern pharmaceutical advertising and, in the words of John Kallir, showed the industry “that amazing things can be achieved with direct selling and intensive direct advertising.” Years later, Purdue would put those strategies to use marketing its new opiate painkiller OxyContin.

Through all this, patients were getting used to demanding drugs for treatment. They did not, however, have to accept the idea that they might, say, eat better and exercise more, and that this might help them lose weight and feel better. Doctors, of course, couldn’t insist. As the defenestration of the physician’s authority and clinical experience was under way, patients didn’t have to take accountability for their own behavior.

After more than a decade in which chronic pain was treated with highly addictive medicine, there still was no attempt to bring the studies of pain and addiction together. Specialists in pain and in addiction operated in different worlds.

Overdose deaths involving opiates rose from ten a day in 1999 to one every half hour by 2012. Abuse of prescription painkillers was behind 488,000 emergency room visits in 2011, almost triple the number of seven years before.

Every patient who was prescribed the drug stood a chance of soon needing it every day. These people were willing to pay cash. They never missed an appointment. If diagnosis wasn’t your concern, a clinic was a low-overhead operation: a rented building, a few waiting rooms, some office staff. And bouncers. These clinics did require bouncers.

The Press Ganey patient surveys, it turned out, had an unintended effect in this context. It was to subtly pressure doctors to write unnecessary scripts for opiates. A doctor reluctant to write them was more likely to get a poor patient evaluation. Too many bad scores and a hospital began asking questions.