American Fix: Inside the Opioid Addiction Crisis - and How to End It

By Ryan Hampton

Nearly every American knows someone who has been affected by the opioid crisis. Addiction is a trans-partisan issue that impacts individuals from every walk of life. Millions of Americans, tired of watching their loved ones die while politicians ignore this issue. Where is the solution? Where is the hope? Where's the outrage?

Ryan Hampton is a young man who has made addiction and recovery reform his life's mission. Through the wildly successful non-profit organization Facing Addiction, Hampton has been rocketed to the center of America’s rising recovery movement—quickly emerging as the de facto leader of the national conversation on addiction. He understands firsthand how easy it is to develop a dependency on opioids, and how destructive it can quickly become. Now, he is waging a permanent campaign to change our way of thinking about and addressing addiction in this country.

In American Fix, Hampton describes his personal struggle with addiction, outlines the challenges that the recovery movement currently faces, and offers a concrete, comprehensive plan of action towards making America’s addiction crisis a thing of the past.

• Language: English
• Publisher: Macmillan Publishers
• Release date: Aug 28, 2018
• ISBN: 9781250196279

Ryan Hampton

Ryan Hampton is a national addiction recovery advocate, community organizer, author, and person in long-term recovery. He has worked with multiple nonprofits across the country and served in a staff capacity for various political campaigns. An alumnus of the Clinton White House, Hampton is in recovery from a decade of active opioid use and is a leading voice in America’s rising recovery movement. He is the author of Unsettled and American Fix. He lives in Nevada with his husband, Sean, and their dog, Dollar.

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PREFACE TO THE PAPERBACK EDITION

SEVENTY-SIX BILLION PILLS. SEVENTY-SIX. BILLION. Pills. Between 2006 and 2012, pharmaceutical companies pumped oxycodone and hydrocodone pills into cities, towns, and communities across America—more pills than we could possibly need. A database maintained by the Drug Enforcement Administration (DEA) tracked every one of those pills, which created and then fueled the drug epidemic that has claimed hundreds of thousands of lives. Analysis of the data showed a clear correlation between the astronomical number of pills and the rising number of opioid-related deaths. Since American Fix was first published, more information has come to light in the press and in the justice system. The epidemic is moving fast, and the issues that affect it change rapidly. In spite of new data, we keep stalling out. As much as we know, it seems like the solution is never in sight.

From 2006 to 2012, the epidemic intensified, but that was just the beginning of the nightmare we’re living in now. During that six-year period, heroin, fentanyl, and other opioids started showing up in the headlines. Pill mills proliferated in the state where I grew up, Florida; and elsewhere, pain doctors pushed pills like they were candy. The volume of the pills produced by Big Pharma increased by about 51 percent as time went along, from 8.4 billion in 2006 to 12.6 billion in 2012.¹ Pills were marketed as a cure-all for discomfort of every kind, including depression and dental procedures. Pills were clearly the focus. Morphine, a well-known and well-studied treatment for severe pain, averaged slightly more than $500 million a year during the same period the pills were pushed to market. Pills were more lucrative, easier to distribute, and, most importantly, didn’t carry the stigma of other drugs.

My story, and the stories of millions of other people, are proof that Big Pharma has been cashing in on those pills and getting rich off the people who got hooked on their products. They’ve said that they’re not responsible for the deaths, overdoses, and massive public health crisis that is ravaging our nation. Nothing could be further from the truth.

Big Pharma’s lies put thousands of Americans in the ground, and ruined the lives of millions more. Seventy-six billion pills equals 36 pills a year for every single adult and child in this country; Big Pharma glutted the market with that quantity in six years. One pill is medicine. Seventy-six billion is greed run riot, with total disregard for human life. The devastation caused by those pills can’t be overestimated. Our country will feel the economic impact of the drug epidemic for generations. One in three households is affected by addiction, and over 22 million people in this country suffer from untreated substance use disorder.²

Since American Fix was first printed, the epidemic has continued to pick up speed, crashing through homes and communities like a juggernaut. The death rate is not dropping: in 2017, more than 70,000 Americans died from drug overdoses, with 47,600 of those losses attributable to opioids³—68 percent of all overdose deaths. Furthermore, African American communities and families of color are disproportionately affected: in 2017, the number of opioid-related deaths was 692 in Baltimore. In West Virginia, the state with the highest death rate in the country, 833 people died, most of them members of the black community.⁴

That’s not a coincidence, either. You can’t overdose if you don’t have access to lethal substances. Adding 76 billion pills to the pharmaceutical market definitely created more opportunities for people to misuse—and overuse, putting their lives at risk. Furthermore, the gatekeepers we relied on to keep us safe, including the FDA, pharmacists, and our own family doctors, were not able to protect us. Why? Because they didn’t understand addiction, either. They received their information about opioids from the pharmaceutical companies that were selling them; the companies whose lobbyists supported politicians’ campaigns; the companies who sponsored five-star getaway retreats to teach doctors about the benefits of their products.

With so many pills and so little protection, the American people didn’t stand a chance. As more opioid painkillers hit the market, and were pushed onto unsuspecting people through prescribers who were educated by pharmaceutical reps, more people got addicted—and more of us died.

The data that tracked the 76 billion pills was finally released after The Washington Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, won a year-long legal battle in connection with a lawsuit against drug companies filed by roughly 2,000 cities, counties, and other local jurisdictions and in federal court in Cleveland. The information in that database is a crucial element of the largest civil action specific to the opioid crisis in US history: a massive lawsuit against Big Pharma. Hundreds of groups, from states and counties to tribes, family groups, and others, have taken pharmaceutical companies to court to demand reparations. Finally people are calling for justice. Yet, pharmaceutical companies continue to claim there was no wrongdoing in the ways they chose to market, promote, and push their pills.

The connection is too obvious to miss. More pills equals more deaths. The states that received the highest concentrations of pills per person per year between 2006 and 2012 were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7, and Nevada with 54.7. West Virginia also had the highest opioid death rate during this period.⁵

According to an analysis of the database by The Washington Post, six companies distributed 75 percent of the pills during this period: McKesson Corporation, Walgreens, Cardinal Health, AmerisourceBergen, CVS, and Walmart.… Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.… Purdue Pharma … was ranked fourth among manufacturers with about 3 percent of the market.

Big Pharma opened a Pandora’s Box, unleashing billions of pills on an unsuspecting public. Many of the fatal overdoses are linked, and began with legal medications like oxycodone and hydrocodone. These pills traveled through a well-established pipeline, from manufacturers and distributors to pharmacies in every town and city. They were also sold illegally and diverted to the black market, reaching users who wouldn’t be monitored by medical professionals. Other people died due to addiction-related causes, losing their lives as the result of diversion. Some people were cut off abruptly from prescription painkillers and switched to fentanyl or heroin.

The sickening of America was a calculated attack on communities across the nation. But we are fighting back against pharmaceutical companies’ greed and gatekeepers’ ambivalence. The people who are at the forefront of this fight are ordinary folks: friends, parents, children, and neighbors who are tired of watching their communities suffer and their loved ones die. Many of them are moms. Almost all of them are people who have never mobilized before. They’ve never protested, called their representatives, visited Congress, written a letter to the editor, or participated in the lawmaking process. Because of their involvement, we are making small strides.

When American Fix first went to print in August 2018, the national recovery movement was in its emergence. In the last couple of years, grassroots efforts like the ones I described in the book have pushed recovery into the spotlight. We are making measurable gains that change the outcomes for people who struggle with substance use disorder. Addiction used to mean a death sentence. Now, we’re creating more opportunities for people to access recovery, get healthy, and stay that way.

Every step we take forward, however, represents lost loved ones. Each piece of legislation that is passed plugs a hole in a system that is designed to let people fail, relapse, and die. We can keep filling those gaps, but at best, we’ll just slow the death rate.

One of the stories I’ve told many times in the last couple of years is about my friend Tyler. Tyler was a person in recovery from opioid use. He was doing well and starting to put his life back together. He was not actively using, he participated in a recovery community, and he lived with other community members in a sober living home. That home did not have naloxone on-site to counteract opioid overdoses, nor were staff members trained to help if someone did overdose. When Tyler was found in his room, there was no way to revive him. He lost his life because the people who were supposed to be watching out for him were biased against overdose prevention.

The sober living home’s argument was that the presence of naloxone encouraged people to use, or emboldened them in some way. That couldn’t be further from the truth. Anyone who knows anything about addiction understands that using is not a choice. It is a symptom of a mental illness that is beyond the person’s control. Not having anti-overdose medication in a sober living home full of people in recent recovery from opioid use disorder is like refusing to have lifeboats or life jackets on a yacht. It’s a heartless, thoughtless decision. It cost Tyler his life. If his house had stocked naloxone and trained its employees to use it, he might still be alive today. Instead, he’s a statistic, like so many other people: victims of a system that willfully misunderstands addiction and punishes people for getting sick.

I’ve told Tyler’s story many times. I told it in Congress, in op-eds, every chance I had. That story helped pass a law that adds safety provisions to sober living homes: it was signed into law by President Trump in October 2018 as part of the SUPPORT for Patients and Communities Act, also known as Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. This federal law makes medical treatment for opioid addiction more widely available. For the first time ever, we have ethical standards for recovery homes, with funding to states to implement them. Anyone convicted of patient brokering—when a drug rehab or similar facility pays a third party for bringing a patient to their center—will face federal penalties of up to ten years in prison and a $200,000 fine. People in sober living homes will be treated with dignity. Tyler’s story and this new law will save lives. But it doesn’t change the fact that my friend is dead. He’s never coming back.

The road to recovery is long, and we’ve suffered many losses. Each win seems to come at such a high price. However, we push on, knowing that if we don’t take action, we’ll pay even more. Dedicated advocates have pushed to pass legislation that protects people from patient brokering, a human trafficking practice that moves people across state lines to disreputable rehabs and treatment centers.

In 2018, Senator Elizabeth Warren (D-MA) and the late Rep. Elijah E. Cummings of Maryland introduced the Comprehensive Addiction Resources Emergency (CARE) Act to finally begin treating the devastating crisis like the critical public health emergency it is. The plan would allocate $100 billion toward life-saving resources over the next decade. It gives money to research, medical support, community organizations, and states and counties that have been hit by the crisis. A hundred billion dollars might sound expensive, but compare that with the cost of not dealing with the crisis head-on. President Trump’s Council of Economic Advisers estimated that the opioid crisis cost us more than $500 billion in 2015 alone. In addition, a new study in the journal Medical Care estimates that the federal government lost $26 billion in tax revenue between 2000 and 2016 due to the crisis.⁶ We must make a serious investment and address every aspect of addiction, from the individual who struggles with substance use disorder to the policies signed into law by our elected leaders. Addiction can’t be solved by paperwork: we need real-world solutions.

Media mentions help keep our national focus on the epidemic, but they don’t translate into policy that saves lives. We need more than buzzwords to address this national tragedy. Over a decade into the crisis, the White House finally stated that it was time to start talking about solutions. I disagree: the time to start was years ago, even before the last presidential election. With over 200 deaths a day, every single day that we drag our feet or refuse to take action is a death sentence for people who are desperate for help. It’s not enough to just talk about recovery. We have to do something about it, too.

Slowly doling out media mentions, building a wall, and signing the occasional bill isn’t going to cut it. People are dying, their families are desperate, and our communities are suffering. We need a solution and we need it now. Where that solution comes from, and who suggests it, doesn’t matter. The outcome is what counts. We need a plan, and leaders who are determined to follow through with it. American Fix was a call to action for people who feel the way I do. This is a full-blown crisis, unlike anything our nation has ever seen. We need to get busy, get loud, and stop the deaths.

Since 2018, new adversaries have entered the field. Fentanyl’s arrival into our communities peaked when Trump took office—it is our nation’s deadliest killer, yet little has been done to combat it. Harm reduction measures like supervised consumption sites and batch tests for people who use drugs aren’t supported because of severe stigma and discrimination. Fentanyl, which is sometimes mixed into other substances, is lethal but impossible to detect by taste or smell. It can be pressed into pills of ecstasy or street hydrocodone, mixed into powders, and added to crystals. Any user, whether they’re a one-time weekend partier or a daily maintenance user, risks dying of an overdose they didn’t even see coming. It’s a game of Russian roulette, and they’re losing.

Stigma still plays a major role in contributing to the death toll. We won’t help people because, deep down, our culture tells us their lives aren’t worth saving. The issue isn’t just inadequate funding: the money is there. The real limitation in our fight against addiction is the lack of understanding of how addiction works and of the best ways to help people stay alive so they can get healthy.

Addiction is a moving target; as an illness, it doesn’t follow predictable pathways. The federal government has doled out at least $2.4 billion in state grants since 2017, but it was earmarked specifically for opioids. Many people who use opioids also use other substances: an estimated 22 percent of them use methamphetamines as well. Addiction isn’t necessarily substance-specific, which means that when one substance is unavailable, people will gravitate toward something that is. With legislation focusing solely on opioids, other substances like methamphetamines and cocaine reappeared. Naloxone doesn’t help during a cocaine overdose: it only works on opioids. By creating a system that is focused on only one type of substance, we leave the gate open to many others that are just as destructive.

Addiction is a cause that has powerful bipartisan appeal, with almost unanimous support for recovery-related legislation. Recovery brings people together. However, we must do more. We must ensure that people in recovery have a seat at the table: No decisions about us, without us. We must also select leaders and policy makers who have an educated, compassionate, progressive stance on recovery. Asking someone to legislate on addiction when they see people with substance use disorder as second-class citizens and criminals is a recipe for death. How do I know? Because it’s the recipe we’ve used for a hundred years, and all it got us was a public health crisis, a broken criminal justice system, and a population that would rather die than tell anyone they’ve got a problem.

Unless we go deeper than superficial solutions, and get at the causes and conditions of addiction in America, we’ll just keep scratching the surface. And people will continue to die.

One place where we’re seeing the kind of meaningful change American Fix called for is the battle against Purdue Pharma and the Sackler family. Although its products represent a smaller percentage of the FDA’s pill tracking database, Purdue has an unusual part to play in the drug epidemic. The plaintiffs in the massive lawsuit against Big Pharma singled out Purdue because of its creation of OxyContin, a version of oxycodone that went to market in the 1990s. OxyContin was the game-changer in the drug epidemic. The way it was marketed, and who it was marketed to, had deadly consequences.

Furthermore, the Sackler family, who owned Purdue Pharma, made billions of dollars from the sale of these lethal, life-ruining pills. Internal emails disclosed in a 2015 deposition and recently circulated in the press show that Dr. Richard Sackler, the onetime chief executive of Purdue Pharma and a key member of the family that controls the company, made it his personal mission to sell OxyContin to the public. His domineering, aggressive approach centered on pushing pills to people who would create more profit for Purdue as they developed a dependency. Sick people, not corporate greed, would take the blame. In a February 2001 email, Sackler wrote: We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.

The Sacklers’ wealth permeates our culture. Their money supports art institutions, theater companies, and universities. The Sackler name is on buildings and in galleries. The money that was extracted from the bodies of people who were addicted to OxyContin funds operas, art shows, and ballets. For many years, the Sacklers were welcome in polite society, using this blood money to buy prestige and respect. There’s a Sackler Educational Laboratory at the American Museum of Natural History, a Sackler Institute at Columbia University, and a Sackler Wing at the Metropolitan Museum of Art. Family members were photographed in Vogue and known as serious donors on the foundations-and-benefit-dinners circuit.

However, all that changed when recovery activists started calling them out for their part in the epidemic. Nan Goldin, a photographer and iconic artist, spoke out against the Sacklers’ insidious influence with protests in art galleries. Angry protesters occupied Sackler-sponsored spaces, leaving hundreds of empty pill bottles to show that cultural institutions benefit from mass murder.

The protests are working: shaming the Sacklers and the people who benefit from their pharmaceutical profits has caused many institutions to divest. According to STAT News, Yale School of Medicine recently removed a 2014 public affairs story from its site in which a dean called Sackler a ‘steadfast friend of the medical school.’ Other organizations have chosen to remove the Sackler name from their museums and buildings. They’re starting to move away from pharmaceutical cash flows. The Guggenheim Museum, London’s Tate museums and National Portrait Gallery, and other nonprofits are distancing themselves, even though the Sacklers offered them millions of dollars. The Wall Street Journal reported that Hildene Capital Management, a hedge fund, removed the Sacklers from their client list due to an opioid-related tragedy that affected someone close to Hildene. Money talks, but justice talks louder.

Equally important, the Sacklers are feeling the social pinch. They’re finally experiencing consequences for their actions. Once considered one of New York City’s most esteemed, generous dynasties, the Sacklers are finally carrying the burden of their actions as corporate criminals. Now, their name is synonymous with the drug epidemic. The media, the public, and other pharmaceutical moguls are taking note. If courts won’t hold the Sacklers responsible for their roles, the rest of us will.

Emboldening and empowering people to take matters into their own hands was always the goal of American Fix. The recovery movement is picking up momentum as more and more of us join the fight. When I was just starting out as a wet-behind-the-ears activist, it seemed that the only people involved were the ones who had experienced addiction themselves, or tragically lost a loved one or family member to the disease. Even people who seemed to be unaffected, like high-profile lobbyists and politicians, eventually disclosed that they, too, were in recovery. The movement now includes people who have first- and secondhand experience with addiction, as well as people who advocate for the cause because it’s the right thing to do. Many leaders only need to see the epidemic up close to understand that they have to take action—even if they’re not personally impacted by the illness. Addiction hurts people, our families, our communities, our neighborhoods, our churches, our workplaces, our economy, and our future. To heal our nation, we need to heal ourselves.

One of the passionate activists I’ve met in this movement is Cheryl Juaire, a parent from Massachusetts who lost her son Corey to an opioid overdose in 2011. However, Cheryl’s story didn’t stop there. Corey’s death was not just an ending. It was a beginning. Suddenly, Cheryl belonged to a group of tens of thousands: mothers who outlived their children, who’d lost their kids to a preventable, highly treatable chronic mental health disorder. Cheryl could have buried her head in the sand. Instead, she chose to honor Corey’s memory by taking up the banner for recovery and joining the recovery movement. She started a parents’ advocacy group called Team Sharing to connect families of loss with one another.

She said, Until I started this group, I didn’t know anybody who had lost a child to addiction. Let alone lost a child. I started the group and I welcome members every single day and listen to their stories. We’re a support group: we understand, we sympathize, we get it. We do a lot of socials together. I heard all the stories, all these parents and what had happened to their kids.

Cheryl had never been an especially political person, but she became a leader. The first parent lawsuit against Purdue Pharma was an aha moment for her. She realized that the parents were all sharing about what had happened, but they were not doing anything. Cheryl reached out to me because she saw that I was very active in recovery, and before we’d even met in person, we agreed to march against Purdue Pharma on August 17, 2018.

The protest was a huge success, and Cheryl has been on fire ever since. Team Sharing has chapters in 13 states, and they’re all working to share the message that it’s time to take action. Any protest might have as many as 100 parents, sharing 300 photos of their children on signs, banners, and leaflets. Cheryl said, I’ll tell you what, I have never seen so many parents want to be involved in this. Although they come in with so much grief, what they end up saying is, ‘My child did not die in vain.’ Right now, we’re trying to get the flags lowered to half-staff for National Overdose Awareness Day. The moms who aren’t capable of going to these rallies, they can write letters or call the governor’s office instead. We all take part. It helps parents feel worthy. Everybody’s different in their grief. When I know a mom has just lost her child from substance use disorder, I’ll get a group of moms and we go to the wake. I say, ‘When you’re ready, give us a call.’ I give my materials but I don’t push it. Those moms are the biggest advocates.

Cheryl read American Fix and connected with its message. As a mother whose child was killed by addiction, she has a powerful perspective on the epidemic. She said, "The parents who have lost a child have the loudest voices. People that aren’t aware of what’s going on in the community—when the parents turn up, we can teach others to have compassion for the problem. When they see our children’s photos, they see that they’re everyone’s children. They could be your kid. They’re not ‘those junkies’ or people who lived under bridges. Our stories touched the people who don’t get it."

Cheryl works with families that have been devastated by the epidemic. Some of those parents lost two children to addiction; others have lost three or four, an entire generation erased by overdoses. Cheryl knows two mothers who killed themselves after losing their kids. She talks openly about the consequences of addiction for families and survivors, and why getting involved has given her purpose. Before Corey’s death, she’d never marched, written an op-ed, given testimony, organized a rally, or run an advocacy group. Now, she’s on the front lines, creating change that will save lives.

She said, We keep speaking up. We keep going. If this is what it takes to get the help and support we need, we’ll do it. We can no longer help our child, but we can help yours. As parents, we’ve had enough. We’re not going to sit back and say, ‘Poor me, this is what happened to me and my child.’ We’re going to try and help yours.

Grassroots groups, parents, and first responders have led the charge for recovery reform. Much like advocacy groups that responded to the AIDS crisis, our recovery activists keep showing up, day after day, to do the work that will save millions of lives. American Fix includes a chapter on change-makers who have risen up and answered the call to action. Although some of those groups no longer exist, their legacy lives on. Whenever one of us falters, two more rise to take their