United States Project

Right too soon: the Orlando Sentinel on opioid epidemic

August 23, 2017
OxyContin 80 mg pills are shot in the studio on August 1, 2013. (Photo by Liz O. Baylen/Los Angeles Times via Getty Images)

The Orlando Sentinel on October 19, 2003 began a devastating, five-part, front-page series entitled “OxyContin Under Fire: Pain Pill Leaves Death Trail”—thousands of words in articles and sidebars, with more reporting in the weeks and months that followed.

The Sentinel series eerily prefigured today’s opioid epidemic: thousands of lives shattered, broken, and lost as a result of taking oxycodone, some through “accidental addiction” caused by casual overprescribing; others through abuse. In the process, the drug created a law enforcement crisis of illegal trafficking through bogus pain clinics, “pill mills,” and legitimately prescribed drugs diverted for profit and recreational use.

In retrospect, despite the Sentinel’s prescience, journalistic carelessness caused the project to backfire, and thus miss its target. Within days, serious reporting errors in the series emerged, beginning with two innocent “victims” of the drug who turned out to have been drug abusers. An analysis of autopsy reports cited in the articles also was faulty and misleading. A series of corrections followed, effectively undercutting an opportunity to alert the nation to an emerging opioid crisis that would become much worse. The unforced errors gave OxyContin maker Purdue Pharma an opening to attack the Sentinel in a PR campaign ultimately aimed at avoiding a regulatory crackdown and ensuring a bonanza of profits.

“The series was flawed, as the newspaper has acknowledged,” recalls Manning Pynn, former chairman of the editorial board, in an interview with CJR. “The current deadly opioid epidemic, however, serves as a reminder that journalistic flaws don’t always mean that there is no need for concern.”

OxyContin, a powerful and profitable timed-release painkiller whose primary active ingredient is oxycodone, was approved for use by the federal government in 1995, and was an immediate success in the market, hailed as a life-saver by chronic pain sufferers. In 1998, the company removed the warning, “May be habit forming,” but restored it in 2001 after reports of deaths following its use. More than 5,000 physicians attended “pain management seminars” sponsored by Purdue in states like Florida to introduce the drug. Before long, however, drug abusers figured out that crushing and snorting the pills produced a heroin-like high.

Users of the drug “put their faith in their doctors,” the Sentinel reported in 2003, “and ended up dead, or broken.” Further, the series noted that “the highly potent painkiller… has been criticized as being aggressively marketed and eagerly prescribed with only routine oversight from government regulators. Illegal use of the medicine has grown as more patients have become dependent on the drug and a new black market has emerged.”

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To be sure, OxyContin is not the only opioid drug, and it is not the only pill with oxycodone as an active ingredient, but for a time it was the best known and most widely prescribed. Purdue Pharma quickly recognized that transforming the drug from one designed to ease the pain of dying cancer patients to one widely prescribed for chronic back pain would prove to be a financial windfall. Citing material from an investigation by the Florida Attorney General’s office, the Sentinel series’ second installment reported that “documents indicate that Purdue minimized the potential dangers of OxyContin while pushing broader use of the drug, boosting sales from about $50 million in 1996 to nearly $1.5 billion in 2001.”

Despite the Sentinel’s prescience, journalistic carelessness caused the project to backfire, and thus miss its target.

In many ways, the Sentinel series—the product of nine months of reporting and research—was prophetic. In 2016, nearly 60,000 Americans died of drug overdoses, the largest yearly rise in US history, making it the most significant cause of death among those under 50, according to a study compiled by The New York Times. That figure was fueled in large part by growing opioid addiction, which now affects more than two million Americans, according to the newspaper. The Center for Disease Control cites exponentially higher figures for the epidemic’s fatalities: More than 183,000 deaths in the US from overdoses related to prescription opioids from 1999 to 2015. During this period, both overdose deaths and drug sales quadrupled.

The Sentinel’s reporting had an immediate impact. Elected officials convened hearings to investigate oxycodone abuse in both state legislatures and the US Congress. By then, Florida’s state legislature had already enacted draconian drug laws. These included mandatory minimum sentences of 25 years for a first offense for trafficking in oxycodone, and possession with intent to sell, including resale of legally prescribed pills. One recent report found there are an estimated 2,000 inmates in Florida serving time in state prisons for trafficking in opioids—mainly oxycodone and hydrocodone—and most of whom are first-time offenders.

This was not the first journalistic attempt to ring the alarm bells about oxycodone, either nationally or in Florida. Earlier reporting was done by The New York Times , the New York Post , the Louisville Courier-Journal, the Cincinnati Enquirer, the South Florida Sun-Sentinel, the Gainesville Sun, and CBS News. Much of this coverage was sparked by product liability and wrongful death lawsuits, as well as revelations that talk radio host Rush Limbaugh had abused the drug.

The Sentinel’s coverage was more ambitious. At its core was a claim that posed a serious threat to Purdue’s business: Taking OxyContin as prescribed could lead to dependence, addiction, and death. Purdue knew it couldn’t fight that point with facts. But corporate officials made a bet, correctly, that the newspaper’s other mistakes on the series could fatally undermine conclusions likely to prove unfriendly to the company’s bottom line. Purdue, sensing a target of opportunity, launched a ferocious counterattack. The company was joined by outraged readers who had come to depend on the drug for pain relief. The company’s multi-front campaign charged that the series was fatally flawed from the outset, primarily because it conflated the dangers of taking oxycodone as prescribed with abusing the drug, often in combination with other controlled substances.

Corporate officials made a bet, correctly, that the newspaper’s other mistakes on the series could fatally undermine conclusions likely to prove unfriendly to the company’s bottom line.

Here’s what the Sentinel got wrong: In a key statistic, citing data compiled by the Florida Department of Law Enforcement, reporter Doris Bloodsworth wrote that there were 573 deaths in Florida in 2001 and 2002 caused solely by oxycodone, the active ingredient of OxyContin. However, in the wake of complaints by Purdue and others, a re-examination of the data and of autopsy reports found that only a fourth of those deaths were caused solely by oxycodone, and it was not possible to say for certain how many of those fatalities were the result of taking OxyContin as prescribed.

More damaging was the choice of two men featured at the beginning and throughout the series as the primary illustrations of the dangers of OxyContin. The series implied that those oxycodone overdoses—one fatal—were caused by “accidental addiction,” that the victims were innocent patients, having taken OxyContin as prescribed for pain relief. In fact, both men turned out to be drug abusers who used illegal drugs or other prescription painkillers like Vicodin and Xanax in addition to oxycodone, although family members, friends, and physicians quoted in the series made no mention of this.

The backlash was intense, even from others in the media. Slate mocked the Sentinel’s coverage, disparaging as alarmist the “claim that numerous new OxyContin addicts have been created by doctors who cavalierly prescribe the drug. Articles or news segments assert that overdose frequently occurs among the innocent patients of careless doctors.”

Bloodsworth declined to be quoted about her tenure at the paper. She came to journalism late in life, after raising her children and working in jobs with an airline, a community college, and an insurance company. In her 40s, she studied journalism at the University of Central Florida and the University of Florida. After working at several papers as an intern, including The Wall Street Journal, her first full time staff job was at the Sentinel. She began working on the OxyContin story after she was assigned to attend a drug convention in Orlando, and editors up the line recognized its potential impact. They agreed to turn her loose to report the project—alone. This decision was based on other, award-winning, investigative work she had done as an intern and several series for the Sentinel. One, involving the methadone-related death of a jail inmate, was nominated by the newspaper for a Pulitzer Prize.

Several piecemeal corrections followed in the weeks after the series ran, one of which acknowledged that the series “created the misleading impression that most oxycodone overdoses resulted from patients’ taking the drug to relieve pain from medical conditions.” In February of 2004, the Sentinel ran a Page 1 correction, and the Sunday Insight section featured a major, 2,500word investigation of the series written by two senior reporters working over three months, explaining in almost clinical detail what went wrong with the reporting. The newspaper even retained a medical examiner from a neighboring county to review the autopsies.

However, the Insight piece did not constitute a complete retraction. After acknowledging the errors, the Sentinel said, “The records do support the series’ conclusion that oxycodone—available in OxyContin as a long-lasting, powerful narcotic—is involved in a large number of the state’s overdose deaths.”

The premise was correct. It was just the execution that went awry.”

Dan Tracy, one of the two reporters who wrote the examination, recalled recently in an interview with CJR: “The premise was correct. It was just the execution that went awry.” This might have been avoided with more careful reporting and editing, Tracy and others at the paper told CJR, and something as minor as more circumspect wording regarding causes of death.

For all the public introspection, it was never made clear where individual responsibility for the debacle lay. The newspaper described the actions of the reporter and editors up the chain of command, but did not explicitly assign blame for them, leaving a number of questions unanswered. Did the reporter overhype what she had and push for the overall conclusion? Did the editors, as I suspect, push too much—or allow themselves to be pushed—to take the story beyond what the evidence could support? The implication was that it was an institutional, systemic failure, although responsibility seemed to weigh heaviest on Bloodsworth.

An explanation is not an excuse. In addition to the lengthy correction, there was an internal shake-up at the paper. Bloodsworth, who was also dealing with severe health crises involving two family members, resigned. More than a decade later, the episode still weighs on her. But, citing “the distance of time and lack of access to my reporting materials,” she declined to discuss her opioid reporting with CJR, other than to say that “I am proud of my work at the Orlando Sentinel.” She survived the debacle, first working for Bloomberg News, then starting several small companies, and working as a communications specialist for a Central Florida municipality.

Sentinel Editor Tim Franklin had the good fortune to be appointed editor of the Baltimore Sun in December of 2003, before the full force of the blowback hit. Other editors associated with the series—who did not agree to requests for interviews—saw their careers effectively short-circuited. Two mid-level editors who worked on the series were “reassigned” to other editing tasks. Seven months later, Managing Editor Elaine Kramer, who had been a candidate to succeed Franklin, left the paper amid newsroom speculation that the OxyContin series had been one reason for her departure.

Whatever the causes for the reporting errors, they undermined and thus obscured the fact that Bloodsworth and the Sentinel were right on the headline points: Taking oxycodone as prescribed, and not in conjunction with other drugs, has led to addiction and, ultimately, death. It’s a point Purdue would later acknowledge in court. And over time, a law enforcement nightmare resulted. In fact, read today, the series accurately raised the prospect of an “opioid epidemic.”

For journalists, veterans as well as neophytes, the Sentinel’s OxyContin series is a cautionary tale—in the extreme. Its failure effectively took the wind out of the sails of any significant regulatory efforts to examine the potential damage of oxycodone, when used as prescribed. Legislative plans to establish a computerized database for the state of Florida, to block duplicative “doctor shopping,” which were already languishing, were delayed for years. It would be nearly four years before another shoe dropped.

On May 10, 2007, three of Purdue Pharma’s top executives—the president, corporate counsel and chief medical officer—pleaded guilty to misleading the public about OxyContin’s addiction risk. The trio agreed to pay a staggering $635.5 million in fines. Two days earlier, the corporation agreed to pay nearly $20 million to 26 states and the District of Columbia for encouraging doctors to overprescribe the drug.

In a press release, US Attorney John Brownlee said that Purdue Pharma had been brought to justice for having “unleashed a highly abusable, addictive, and potentially dangerous drug on an unsuspecting and unknowing public.”

Federal officials said that internal company documents showed that Purdue Pharma knew, even before the drug was introduced, that doctors would recognize its addictive potential and so developed a “fraudulent marketing campaign,” according to The New York Times.

Larger questions linger. What if Bloodsworth and the Sentinel’s editorial team had scrutinized the oxycodone-related autopsy reports and statistics more carefully? What if they had been more scrupulous in their choices of anecdotal examples used to illustrate the problem? More to the point, how many fewer deaths and accidental addictions might have resulted?

“Those are very good questions,” says Franklin, the former editor, who is now senior associate dean at Northwestern University’s Medill School of Journalism. “And I have thought about that question myself over the past few months” as the media has been saturated with articles about the opioid epidemic.

A cover package in the June AARP Bulletin carried the headline: “Special Report: THE OPIOID MENACE! HOW AMERICA’S ADDICTION TO PAINKILLERS AFFECTS YOU.” Inside, the articles began, “We are in the midst of our nation’s deadliest drug epidemic ever.” It’s a scourge that recently attracted attention from President Trump, who on August 10 declared that, “The opioid crisis is an emergency. And I am saying officially right now: It is an emergency, it’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.”

The Sentinel series and the aftermath, Franklin says, “Was a painful experience for everyone involved, not only because of the corrections, but because of some of the larger points in that series ended up getting lost as a result. I wouldn’t presume to say that the opioid epidemic could have been avoided, but had those mistakes not happened, the public’s consciousness might have been raised further—and earlier.”

No one is more aware of that harsh judgement than those responsible for it. One former editor, who declined to be identified despite the passage of time, said the episode haunts him to this day. “It will follow me to the grave.”

CJR’s health care reporting is sponsored in part by a grant from the Commonwealth Fund.

Mark I. Pinsky is a former religion writer at the Orlando Sentinel and the author, most recently, of Met Her on the Mountain: A Forty-Year Quest to Solve the Appalachian Cold-Case Murder of Nancy Morgan (John Blair).