The warning signs of what would become a deadly opioid epidemic emerged in early 2001. That’s when the state employee health plan in West Virginia noticed a surge in deaths attributed to oxycodone, the active ingredient in the painkiller OxyContin, reports STAT. They decided that OxyContin prescriptions would require prior authorization. It was a way to ensure that only people who genuinely needed the painkiller could get it and that people abusing opioids could not. Purdue Pharma, the manufacturer of OxyContin, thwarted the state’s plan by paying a middleman, known as a pharmacy benefits manager, to prevent insurers from limiting prescriptions of the drug.
The financial quid pro quo between the painkiller maker and the middleman, Merck Medco, came to light in court records unsealed by a state judge at the request of STAT. “We were screaming at the wall,” said Tom Susman, who headed the state’s public employee insurance agency in the early 2000s and led the push to limit OxyContin prescribing. “We saw it coming,” he said of the opioid epidemic, which now causes 28,000 U.S. overdose deaths a year. “Now to see the aftermath is the most frustrating thing I have ever seen.” Overprescribing of OxyContin and other opioid painkillers is blamed for helping to plant the seeds for the current crisis. West Virginia has been hit harder than any other state: It has the nation’s highest per capita drug overdose death rate, more than double the national average. It also has one of the highest rates of painkiller prescribing.