China has pain pill addicts too

Wu Yi (pictured) was supposed to die. At age 26, his cancer was spreading. His doctor gave him five years to live and a prescription for OxyContin. Six years later, he was still alive. And still taking OxyContin. Wu said his doctor told him that OxyContin is not addictive, but when Wu tried to stop, he couldn't. "This drug is addictive,'' Wu said. "One hundred percent addictive."

A thousand miles (1,600 km) away, in the ancient trading city of Xi'an, Yin Hao shoved eight pills of Tylox, a combination painkiller that contains the opioid oxycodone, in his mouth. Yin had started taking Tylox after getting injured in a fight six years earlier. "Do you know how much I don't want to take drugs?'' he said. "My mouth says don't take it, but my body is more honest and figures out a way to get it.'' Both Wu and Yin fell into opioid abuse the same way many Americans did, through a doctor's prescription. But officially, in China, they don't exist.

Addicts like Wu and Yin struggle in the shadows of a system that offers few treatment options and fails to count them in official statistics on drug abuse, the Associated Press found, making it difficult to assess abuse risks as China's consumption of opioid painkillers rises. In a society where shame about drug addiction is strong, many believe that strict controls on painkiller use will protect China from a U.S.-style addiction outbreak.

As the backlash against opioid painkillers drove down US consumption, pharmaceutical companies began chasing profits in places like China, Australia and Europe using the same controversial sales tactics they did in North America. In 2017, more than half the doses of five major opioid painkillers went to countries other than the US and Canada, the first time that has happened since at least 2000, data from the International Narcotics Control Board shows. Chinese officials have blamed out-of-control demand and poor oversight for the US opioid epidemic, discounting the role of Chinese supply. Meanwhile, painkiller addicts in China remain largely invisible and, despite strict regulations, can turn to online black markets for opioids and other prescription drugs. The AP found previously unreported trafficking of OxyContin and Tylox on e-commerce and social media platforms run by China's largest technology companies.

Only 11,132 cases of medical drug abuse were reported in China in 2016, according to the most recent publicly available national drug abuse surveillance report. But reporting is voluntary and drawn from a small sample of institutions including law enforcement agencies, drug rehabilitation centers and some hospitals. The China Food and Drug Administration said in the 2016 report that it was trying to do better but for the time being "the nature of medical drug abuse in the population cannot be confirmed.''

People eat at an outdoor night market in Xi'an, northwestern China's Shaanxi Province, similar to one at which Yin Hao, who also goes by Yin Qiang, was injured during a fight. Yin Hao, who also goes by Yin Qiang, struggled to remember life before pain pills. He thought back to when was 21 years old, strong and wiry, working at a nightclub. He had knock-off Burberry sheets, a mortgage in his name, and a girl he planned to marry. Then one night in 2013, he and his friends got into a fight with some older, richer guys, and someone drove a pickaxe into his waist. The hospital sent him home with four boxes of Tylox, a combination of acetaminophen and oxycodone, the active ingredient in OxyContin. Tylox is manufactured by SpecGx, a subsidiary of Mallinckrodt, which has faced lawsuits in the U.S. accusing it of helping stoke the opioid abuse crisis. Mallickrodt has denied the allegations. Yin said his doctor didn't tell him the medicine could be addictive.

A listing using bogus product photos from a vendor offering OxyContin pills for sale on Xianyu, Alibaba's online second-hand marketplace, is seen on a smartphone in Shanghai, China. Yin opened dozens of accounts with online pharmacies to buy Tylox. Many didn't require a prescription. Once he wrote a three-character Chinese profanity on a piece of paper and uploaded a photo of that instead of a prescription. The pills came anyway, he said. He figured pharmacies wanted the sale almost as much as he wanted the drugs. His excessive consumption didn't trigger any alarms. Yin lost 60 pounds. He wondered if his kidneys would fail and was convinced Tylox had changed the color of his eyes. ``My nerves are a mess, my bones are misplaced and I have become lazy, irritable, extreme,'' he said. ``Experts say that if you take this medicine because of pain, it's not addictive. This is rubbish.''

The longer Wu took the pills, the less effective they were, he said. Wu started taking OxyContin with a half bottle of strong Chinese liquor, which he had delivered secretly to his house. He also noticed the package insert for OxyContin says not to chew it, which releases the active ingredient, oxycodone, all at once rather than over time. Chewing the pills made them hit with more intensity. "As long as you try chewing it once, there's no way for you not to chew it the next time,'' he said.

Yin had vowed dozens of times to quit Tylox. He tried ice baths, saunas, and Russian vodka. Yin said he hoped his story would be a warning to others. If he could make a single vulnerable person understand the consequences of taking this drug, it would be one thing in his life he didn't regret. ``I used to be afraid of ghosts, but now I think this is more terrible than ghosts,'' he said.