Chapter 6
St. Louis, Missouri, 2008
The route between the pill mills of South Florida and the Appalachian and Ohio River valley regions went by many nicknames, none more fitting than the “Blue Highway.” As 2008 drew to a close, Purdue Pharma’s OxyContin tablets were no longer the most highly sought-after prescription painkillers being doled out by doctors, pill mills, and pharmacies and winding up on the streets. A generic pill manufactured by a company that most Americans had never heard of—Mallinckrodt—was becoming the opioid of choice on the black market.
Powder blue in color and stamped with the company’s trademark “M” logo, the pills packed a euphoric punch. Containing 30 milligrams of oxycodone, each pill was the equivalent to a hit of heroin. Drug users and dealers simply called them “blues.” Unlike OxyContin, blues didn’t need to be crushed to neutralize the time-release formula Purdue had so successfully pioneered as a marketing tool during the previous decade. The delay device had been designed to provide continuous pain relief. But one popped blue, on the other hand, brought an instant rush of pure oxycodone. It was enough to sustain four hours of opioid bliss, leaving users relaxed, happy, and feeling no pain—before the sickening pangs returned and they needed to take another and then another to stave off the ravages of withdrawal.
With the internet pharmacies decimated by the DEA and Congress, pill mills acting under the guise of pain management clinics—many of them set up in the seemingly endless strip malls of Palm Beach, Broward, and Dade counties in South Florida—quickly took their place. On one street in Broward County alone, there were thirty-one pain clinics. Drug users and dealers hopped from one location to the next, shopping for doctors who would sell them painkillers in exchange for a few hundred dollars. On the street, each thirty-count bottle of oxycodone 30mg pills went for $900. Florida lacked a prescription drug monitoring system, enabling the pill seekers to obtain and fill multiple prescriptions. South Florida became an opioid wonderland. Billboards along I-75 and I-95 advertised the pain clinics with toll-free numbers and promises of easy access to prescription narcotics. “Walk-Ins Welcome,” read signs outside.
Drug dealers organized buying trips to South Florida from Huntington, West Virginia, Portsmouth, Ohio, and other towns reeling from opioid overdoses and deaths. They piled into cars, vans, and buses, bringing back bottles filled with Mallinckrodt’s pills and other favored brands of oxycodone and hydrocodone. Some eschewed the rigors of the road and took in-and-out flights to Fort Lauderdale. The route became known as the “Oxy Express.”
Founded in 1867 in St. Louis, Mallinckrodt started out as the world’s leading supplier of chemicals for the emerging photography industry. The company went on to score a series of scientific breakthroughs—inventing contrast chemicals for X-rays; providing purified uranium oxide for the Manhattan Project and enabling the U.S. government to create the world’s first self-sustaining nuclear chain reaction. It also worked in the drug trade. In 1898, Mallinckrodt entered the lucrative opioid business, creating chemicals for the production of morphine and codeine.
The company became a generous benefactor for the renowned Washington University in St. Louis. The medical school’s radiology institute is named after Mallinckrodt. So is the building that houses the student union and the performing arts center. Two members of the family, Edward Mallinckrodt Sr. and Edward Mallinckrodt Jr., were on the board of trustees of the university.
By 2008, Mallinckrodt was manufacturing more painkillers than any other company in the United States. That year, it produced 4.3 billion doses, many of them the 30mg blues. Mallinckrodt executives maintained that they had no way of determining where the pills went after they left their factory in Hobart, New York, seventy miles west of Albany. They said their customers—the drug distribution companies—knew where the pills wound up. They insisted they couldn’t follow the path of the pills from their factory to the retail pharmacies.
Mallinckrodt capitalized on the market Purdue had once dominated by churning out generic versions of oxycodone in what was becoming an increasingly competitive arena. That year Actavis in New Jersey produced 3.6 billion pills. Following the federal fine and convictions, Purdue tried to remain competitive. It reformulated its blockbuster OxyContin, but its numbers were dwarfed by those of its competitors.
Mallinckrodt made more than ten times as many pills as Purdue in 2008, yet it hadn’t received nearly the same public attention and scorn. Members of the Sackler family, who controlled Purdue Pharma, were becoming pariahs. Their name would later be stripped from the wings of some of the world’s most iconic institutions, including the Louvre in Paris, the Serpentine Gallery in London, and New York’s Metropolitan Museum of Art.
The Mallinckrodt name had no such negative connotation. That was about to change.