Saige Earley was gone in stages.
To her mother, Ellen, the 22-year-old grew increasingly detached within weeks of returning from the dentist with a fateful prescription for opioid painkillers. The young woman with long dark hair and a broad toothy smile was gone physically a few months later when she walked out on her young son and left Ellen wondering if her daughter was even alive.
Then last September, Saige was gone for good, found dead of a heroin overdose in a toilet stall at Syracuse airport, clutching a plane ticket to drug rehab in California.
“Whether she escaped in her insatiable appetite for books, dancing till exhausted, headphones blaring music, walks upon walks, or the drugs that cut her life so terribly short, she simply needed to run,” Saige’s father, Jason, wrote in a moving and frank obituary. “But she always wanted to return, to make us laugh, to love her baby, to show us this cruel yet fascinating world through her eyes.”
The obituary caught the eye of the New York attorney general’s office as it built a sweeping lawsuit filed against the opioid industry last month. The legal action singled out Saige Earley as the face of “real people” devastated by the worst drug epidemic in American history.
An epidemic fomented in board rooms
The New York lawsuit drew a clear line between the dentist prescribing Saige Earley opioids after he removed her wisdom teeth in the spring of 2017 and the heroin overdose that claimed her life 18 months later. But her reality was messier, and in its own way a deeper indictment of the lengths the drug industry went to blame Saige and other victims of the epidemic for their deaths.
Topping a long list of accused in the New York action is Purdue Pharma, the maker of OxyContin, and those members of the Sackler family who owned and ran the company.
The lawsuit reveals an email written by Dr Richard Sackler, Purdue’s head of marketing who ramped up sales of OxyContin by downplaying the risks of addiction from its high dose of narcotic. As overdoses and deaths escalated, Sackler painted the victims as criminals to blame for their own condition.
“They get themselves addicted over and over again,” he wrote in a 2001 email. “They engage in it with full, criminal intent. Why should they be entitled to our sympathies?”
Sackler has apologised for “using insensitive language” in what he said was his frustration at illegal drug use. But it was more than a passing outburst. Blaming the victims evolved as a central strategy as Purdue and other opioid makers sought to keep the door open to the mass prescribing earning billions of dollars a year even as it fuelled an escalating human tragedy that has claimed about 400,000 lives over the past two decades.
The manufacturers, their lobbyists and well funded industry front organisations played on society’s stigma against those sucked into addiction by powerful narcotic drugs to blame the person, not the pill. Addiction was painted as a lifestyle choice, and those who made it as degenerates.
But for Saige Earley, it was a struggle for survival.
At times she kept a diary. A year after she walked out of the dentist’s office, opioids were testing her will to live.
“I don’t want to overdose and die. That’s not for sure though because it changes all the time. Sometimes I do want to,” she wrote.
When Richard Sackler spoke about “criminal addicts”, Saige was exactly who he had in mind. Her family too. Saige’s mother, Ellen, was buying black market opioid painkillers in the 1990s before much more powerful and addictive OxyContin hit the market. Her father, Jason, was also struggling with substance abuse.
Ellen was able to walk away from the narcotics when she became pregnant with Saige. She taught dance and reckoned her daughter was a natural. The family lived in a roomy wooden house in Cazenovia, a prosperous upstate New York village with a sense of history and well-preserved 19th century architecture. But Saige struggled with mental health issues as a teenager, something Ellen links to a history of bipolar disorder on Jason’s side of the family.
Saige began coming home drunk and then took to marijuana. She skipped school and cut herself. In time, Ellen noticed her daughter developing what she regarded as a less savoury set of friends. The two clashed. Ellen tried to get help but said counsellors put the confrontations down to “mother daughter stuff”.
“I was relating it to my own teenagerhood and thinking I did some crazy things and I was hanging out with some absolutely wrong people, and I survived,” said Ellen. “But I have two other kids that I’m trying to raise by myself and this chaos was too much. We had a year of just chaos.”
By then Ellen and Jason were divorced and she gave Saige an ultimatum: get help or go live with your father. At 17, Saige moved in with Jason. She continued to use alcohol and marijuana, and didn’t speak to her mother much for a couple of years. But then Saige became pregnant and asked to move back home. Ellen agreed.
“I was young when I was pregnant too and I thought I’ll never greet a pregnancy with negativity. So that’s great. She said she was very happy about it but she was young and she knew from my life experience that single parenthood is difficult,” she said.
“Saige asked if she could move back in because here’s a safe place. There is no drinking or drugging. She was absolutely sober for the entire pregnancy. She found a new focus.”
Ellen describes the birth as “whacky” because it took a while for Saige to realise she was in labour and they only made it to the hospital with minutes to spare.
Saige was clean for a while after her son Julian was born but was still troubled and was drawn back to alcohol. Months later she wrote about it in her diary.
“When I picked up that first drink after having my son I did not think I was chasing alcohol over loving Julian. I really figured I could just drink some nights to relieve stress like other people do. Like other moms do all the time. 1 turned to 3 turned to every single night,” she wrote.
Still, Ellen said Saige largely kept it together and was focussed on her baby.
Then came the dentist. Saige’s wisdom teeth were impacted and causing pain. Ellen thought it was contributing to her daughter’s general unhappiness and encouraged her to have them removed. But she advised against having all four teeth extracted at once because it would be so painful.
The dentist said the insurance company would only pay for Saige to have the teeth removed in one sitting. He said it would be fine. He would give her painkillers to take home.
By the time Saige went to the dentist two years ago, the extent of the opioid crisis was beyond doubt. The Centers for Disease Control and Prevention (CDC) established the close link between the sharp rise in opioid prescribing and increasing overdose deaths more than a decade ago. In 2012 alone, doctors and dentists wrote 255m opioid prescriptions – enough to supply every American adult with a month of pills.
But even as the epidemic revealed itself, the drugmakers worked hard to keep the door to mass prescribing open.
In 2005, Burt Rosen, a vice-president of government affairs at Purdue Pharma and the company’s chief lobbyist in Washington, co-founded the Pain Care Forum (PCF) with other opioid manufacturers. The forum spent close to three-quarters of a billion dollars over the following decade pushing opioid friendly policies, writing legislation, and funding elected officials across the country.
The PCF exploited the longstanding stigma against those who become addicted to opioids, particularly heroin, to tell congressional briefings and Food and Drug Administration hearings that there must be no curbs on prescribing because the people Sackler portrayed as criminals should not be allowed to deprive “legitimate patients” of desperately needed opioids.
Very often though, they were one and the same. People like Saige Earley who began on a prescription and ended up buying on the black market to feed their addiction.
The PCF claimed opioids were safe for those who took them as prescribed and had no history of addiction. To Congress and the FDA, the industry painted a picture of doctors closely interrogating their patients about their vulnerability to addiction and monitoring for evidence of dependence. But most primary care physicians had little training in using narcotics for pain relief, and the drugmakers were instrumental in shaping a medical policy in which hospitals and insurance companies pressured doctors and dentists to default to opioids.
Dr Russell Portenoy, the Purdue-funded pain specialist who led the way in breaking down the medical profession’s decades-long caution about prescribing narcotics, recently said in a court deposition that drug manufacturers deliberately “understated the risks of opioids, particularly the risk of abuse, addiction and overdose” to boost sales. Opioid makers even told doctors that it was safe to ratchet up doses without risk of addiction.
Saige’s history of addiction, and that of her parents, should have been a red flag to any medical professional prescribing opioids. But Ellen said her daughter was not asked if she might be vulnerable. Instead she was sent home with a week’s worth of the opioid hydrocodone – “hydros” – with a refill for another week. There would be no monitoring.
Ellen saw that the drugs would be pushing against an open door with Saige.
“I felt awful because she was an adult. In the middle of the night I was thinking how can I switch those pills so that she wouldn’t know, so that she wouldn’t feel like I was trying to control the situation?” she said.
Ellen gave her daughter the drugs and cautioned her. Saige shrugged it off.
‘And then she was gone’
The CDC warns that opioid painkillers can get a grip on a person in as little as five days.
“I had oral surgery, under anesthetic felt great,” Saige told her diary. “Then got some dumb hydros that I really thought nothing of and like without a second thought I had abused them and was looking for more pain pills. Huge consequence for this.”
On the back of her history of other addictions, Saige rapidly fell into dependence on opioids. When the prescription ran out, she found a new set of friends to supply her with pills. Within a few weeks she hooked up with a man with a long history of heroin use.
“And then she was gone,” said Ellen.
“It was very quick. Her personality changed. Up until that point, even with the pain from the wisdom teeth, she had a lot of patience with Julian. She was working. But then she was just miserable, consistently miserable. She didn’t want to be around us. The baby all of a sudden became really difficult for her. ‘Can you just take him? I can’t deal with it’.”
Saige walked out of her mother’s house on Independence Day 2017, three months after the visit to the dentist. Julian was 16 months old.
“We had our big July 4th party and then she left with this man and left the baby here,” said Ellen.
Desperate to at least know her daughter was alive, each night Ellen checked Saige’s cell phone billing for evidence she was sending text messages.
“Then the texts stopped. No nothing. No activity on her phone. It was terrifying,” she said.
Ellen has been able to reconstruct only a part of the picture of the life Saige was living at that moment.
“There was some really bad stuff involving sex trafficking. She wound up in Poughkeepsie, New York. She called her best friend who called me and said ‘I can’t really understand what she’s saying. She’s being kept by some guy’,” said Ellen. “There was something really bad that happened and it was fast.”
Saige’s father, Jason, finally tracked her down and got her into rehab in Florida that October. She made it through the initial programme and into a halfway house. Six months later, Saige went out drinking.
“Came home to halfway black out drunk and got kicked out,” she told her diary. “I had spent the night in the hospital and was sober and couldve gotten into 1/2way but instead I continued drinking and drugging for a week til I ran out of resources.”
A month later, she was back in rehab.
In his emails, Richard Sackler said that it was necessary “to hammer on the abusers in every way possible. They are the culprits and the problem”.
Sackler was angry that OxyContin was getting the blame for rising overdoses – “This vilification is shit” – and claimed that it was “factually untrue … that addicts don’t want to be addicted”.
For Saige, it was not nearly so straightforward. A single page of her diary lays bare her struggle to resist being sucked back into using opioids. In rehab in Florida, she wrote: “I’ve accomplished a lot. I’ve changed a lot”.
But a few lines later, she is resisting the drag of the past.
“I feel like going back to the same people, places, things… at this point… I’ll relapse on old behaviors and thought patterns which will lead to a relapse on drugs,” she wrote.
She writes about how she “just really wanted to get high” and the pull of just one more fix “against medical advice”, or AMA.
“Monday I ran into dirty Mike and was like triggered af (as fuck) whatever that means but like I was seriously considering AMAing right then and there.”
Saige was also struggling with life without Julian.
“I miss my baby boy so much. My soul literally aches for him. It’s like a missing limb. But more important. Like missing an organ. Like my body can’t function without him. I can’t function without him. Yet here I am. Living life, without Julian. Happy a lot of the time,” she told her diary.
Finally in August 2018, Saige said she had a handle on her addiction and wanted to come home. Ellen wasn’t sure it was a good idea. She thought her daughter needed more time under the direct oversight of rehab but it would mean Julian would have his mother back and so she agreed.
In Cazenovia, Saige joined Alcoholics Anonymous and recorded her daily struggle.
“Showered, got dressed. Stayed sober. There’s so much more I need to be doing and I could have done today but thinking about how much I failed does absolutely nothing. So Im trying to focus on the good I did accomplish. Loving my son, being here for him. Meetings every night,” she recorded in the diary.
For the first time in years, Ellen and Saige took a holiday together – to Myrtle Beach with their children.
“It was the greatest vacation I think any of us have ever had. We had a lot of fun. Came back and within five days she was gone,” said Ellen.
While she was away, one of Saige’s friends overdosed and died. On her return she went to the “calling hours” to view the body. As the evening wore on, and Saige failed to return home, her mother grew anxious. Ellen shot Saige a text. However hard it is, she said, focus on Julian. You have him and he needs you.
Days later, Saige contacted friends from rehab in Florida who helped get her into a recovery programme in California. A friend in Syracuse bought the plane ticket.
With it, he gifted her a bag of heroin. A last hit before she made another attempt to get clean.
On 16 September 2018, Ellen opened the door to a policeman she happened to know.
“I had just sat down. Saige and I were watching Shameless together. There was a new episode on and I almost picked up the phone to text her and say you’re missing the new Shameless and we got a knock on the door,” she said.
“He said you need to sit down. I knew what was coming. I didn’t want to know but I knew. He said, we believe that we have Saige at the airport and she isn’t alive anymore.”
Chris McGreal is the author of American Overdose, The Opioid Tragedy in Three Acts
