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Lingering Pain

Medical school alumnus helped spur a national movement against misused prescription opioids

Photo: Josh Meltzer
Art Van Zee

In late 1999, physician Art Van Zee, MD (MED 鈥�73), began to see increasing numbers of young adult patients struggling with addiction to OxyContin, an opioid-based painkiller. He was working at a community health clinic in St. Charles, Virginia, a small Appalachian coal town where he鈥檇 moved in 1976 after an internal-medicine residency and had close ties to the community.

鈥淭hey were good kids with bright, promising futures, and this was all being hijacked by their development of opioid-use disorder,鈥� said Van Zee, who saw a 鈥渢sunami of opioid addiction鈥� overtake his region. 鈥淚t鈥檚 hard to overstate the tragedy this brought countless individuals and families and communities.鈥�

Van Zee became an activist, among the earliest in the battle to stop the deadly epidemic. He called attention to the addictive dangers of Purdue Pharma鈥檚 OxyContin, beginning with a petition drive in 2001 asking the U.S. Food and Drug Administration (FDA) to take the drug off the market.

He also spoke at FDA meetings, testified before Congress and authored a widely cited 2009 paper in the American Journal of Public Health about the marketing and promotion of OxyContin.

Now, a reckoning is underway that he said is both long overdue and insufficient because it doesn鈥檛 include prison terms. Purdue is in bankruptcy, and its Sackler family owners may pay as much as $6 billion in a legal settlement. They said they acted lawfully. Settlements with other companies also have been reached.

Van Zee鈥檚 work has been highlighted in two books, one of which was turned into last year鈥檚 fictionalized series Dopesick on Hulu.

He recently talked with Think. The conversation has been edited for length.

I thought when people couldn鈥檛 just say, 鈥楾hese are just 鈥榟illbilly鈥� kids dying of overdoses in Appalachia鈥�—when kids started dying in Boston and White Plains and Shaker Heights—that things would be different. But they weren鈥檛. The [FDA] was so influenced by this narrative that the pharmaceutical manufacturers put out about how there was this epidemic of untreated pain—and that opioids were an effective tool for treatment.

In 2003, I started using buprenorphine (Suboxone) in my practice to treat opioid-use disorder. I consider it one of the most effective and meaningful things I have done in more than 45 years as a physician.

They have to use evidence-based medicine to guide spending for prevention and treatment services. One of the things the state should really look at is the use of curriculums in the school system at the elementary and high school levels that have been shown to reduce substance use.

There can never be sufficient justice. With all the lives lost and families fractured, there鈥檚 nothing that can ever make up for that. I have felt it is important that if it鈥檚 effectively shown what the leadership of Purdue knew and when they knew it and what they did [with that information], then there should be jail time. And that has not happened.

My own take is that we should prohibit the pharmaceutical industry from being able to market controlled and abusable drugs. Because if the system isn鈥檛 changed... and they鈥檙e able to do this in the future, it鈥檚 only going to be a matter of time before there鈥檚 a similar issue with a controlled and abusable drug.

— Dan Morrell