Opioids are the leading cause of preventable deaths in the United States, speaker Mike Hugo said in a public presentation at the Bromfield School last week. His March 5 talk dealt with both opioids and vaping, and it was chock-full of unsettling facts. But perhaps the most shocking thing about the talk was that fewer than a dozen people came to hear it.
Hugo is a former lawyer with a 35-year career litigating cases on environmental and pharmaceutical issues. He serves on the executive board of the Massachusetts Association of Health Boards and on his local board of health in Framingham. The Harvard Board of Health and the schools sponsored his presentation.
Mike Hugo speaks to parents and community members about opioids and vaping March 5 at Bromfield. (Photo by Lisa Aciukewicz)
Nationally, about 200 people a day died from drug overdoses in 2017, according to the Center for Disease Control, with the majority of those deaths caused by opioids. Figures from the Massachusetts Department of Health show that Worcester County had 264 overdose deaths in 2017, the last year for which complete figures were available. Harvard has had at least two overdose-related deaths in the past six years.
Asked about the extent of an opioid problem in Harvard, Police Chief Ed Denmark said his department was not seeing the types of petty crime most often associated with drug addiction, such as housebreaks, thefts from cars, and other forms of small-scale larceny. But he added that neighboring communities like Ayer and Shirley were seeing an increase in nonfatal overdoses.
Profitable poison
“Our nation fell prey to an industrial profit motive,” Hugo charged, speaking of the drug manufacturer Purdue Pharma and its owners, the Sackler family. The family’s fortune skyrocketed after 1996, when Purdue began marketing the opioid OxyContin, which Forbes has described as “morphine in a pill.” Forbes recently estimated the Sackler family’s net worth at $13 billion.
By 2005, Hugo said, more people were experimenting with “oxy” than with marijuana.
Student athletes face a particular risk, Hugo said, because they may receive too big a supply of painkillers for a sports-related injury such as a broken toe. And a person can become addicted after as few as five pills, he said.
Jason Cotting, co-director of the Harvard Ambulance Service, said Harvard has had “relatively few” overdose emergency calls when compared with many Massachusetts towns. He said a very rough estimate would put the number in the single digits or low double digits per year. The Harvard Ambulance Service categorizes drug overdoses with other medical emergencies such as heart attacks, rather than tracking overdoses in a separate category, he explained.
Cotting, who attended Hugo’s presentation, said the talk could have offered a little more practical information for families who are concerned about a member who might be at risk from opioid use. Cotting said he would encourage anyone with such concerns to carry the overdose antidote naloxone (brand names Narcan and Evzio). Nalaxone is an easy-to-administer nasal spray and requires only brief, simple training, he said. Anyone can get a naloxone rescue kit, either with a doctor’s prescription or direct from a pharmacy without a prescription, under a statewide standing order.
The vaping connection
In his presentation, Hugo connected nicotine addiction with opioids, saying Purdue Pharma aimed its early marketing campaigns for OxyContin at states with the highest rates of tobacco use, such as Maine, Ohio, and West Virginia. Purdue used the information on tobacco, he said, to target a population that was already vulnerable to addiction.
In similar selective marketing, Hugo said, tobacco companies are targeting kids in high school or even younger as the prime customers for vaping. “Who else would smoke something that tastes like cotton candy?” he asked. And indeed, use of e-cigarettes is nine times higher among people under 18 than among adults, according to Hugo.
Vaping products are packaged to look just like candy in wrapping and design, he said, showing a slide in which Snickers bars and vapes were virtually indistinguishable at a glance, all in their bright, appealing wrappers.
The brand JUUL, which makes up about half the e-cigarette market share, delivers nicotine in a cartridge or pod about the same size as a flash drive. Each pod contains about 20 cigarettes’ worth of nicotine—or about 200 puffs. The high levels of nicotine, Hugo said, make the product at least as addictive as regular cigarettes.
The U.S. surgeon general’s website on e-cigarettes says young people become addicted more readily than adults, because younger brains build synapses more quickly than older brains do. The site also notes that nicotine addiction primes the brain for addiction to other drugs.
Besides nicotine, e-cigarettes contain a range of other chemicals including propylene glycol (also sometimes used as antifreeze) and diacetyl, which has been shown to cause the irreversible lung damage known as popcorn lung.
Last June Massachusetts Attorney General Maura Healey filed suit against 16 officers and directors of Purdue Pharma, including members of the Sackler family. Her office’s announcement noted that the company had sold 70 million doses of OxyContin and other opioids here since 2008, generating $500 million for the company. The suit charges that Purdue misled doctors and patients by claiming these drugs were even safer than ibuprofen or acetaminophen. Healey’s office also sent cease-and-desist orders last July to three websites that sold vaping products without making an adequate effort to verify that buyers were 21 or older.
