The 7th Annual Alexander Awards: The Best Tox Reading of 2016

 Alexander Gettler

Alexander Gettler

When TPR began giving out the annual Alexander Awards for best long-form writing in the field of toxicology, the eligibility criteria included the requirement that “entries must be fully and freely accessible” on the web. After 2016 — a remarkably truth-impaired year scarred by fake news and unchallenged mendacity — supporting aggressive, unbiased, fearless journalism appears to us to be a civic duty. A number of our selections this year come from sources such as the New York Times and Los Angeles Times that have much of their content behind a paywall. Often they allow access to a certain number of free articles each month, but after that limit easy accessibility to subscribers.

Of course, it’s usually possible to cheat by doing a Google search for the title of the article — most often the link will lead directly to the desired piece. But these institutions are more important now than ever, and deserve financial backing from readers. TPR subscribes online to the New York TimesWashington PostLos Angeles TimesBoston GlobeWall Street Journal, and Milwaukee Journal-Sentinel. All of these publications have had superb coverage of toxicology, the pharmaceutical industry, and the opioid catastrophe over the last several years.

The Alexander Awards was inspired by David Brooks’ Sidney awards, a yearly compilation of that New York Times columnist’s pick of the best essays of the year. Brooks’ picks appeared in two columns this week and can be found here and here.

The Alexander Awards are issued in honor of Alexander Gettler (1883 – 1968,) New York City’s chief toxicologist in the early twentieth century whose work helped establish the field of forensic toxicology.

Going through the last year’s essays and reporting in the field of toxicology was a somewhat grim business — so many of the pieces dealt with lives lost and ruined by the opioid crisis. In the news of 2016, the number of deaths and overdoses from OxyContin and heroin was surpassed by those attributed to fentanyl, carfentanil, and U-47700. the Wall Street Journal recently published a heartbreaking compilation of pictures and short biographies of people — mostly young, in their teens, 20s, and 30s — who overdosed and died from opioid overdose in recent years. An amazing number of them started on the road to addiction when they were prescribed opioid analgesics by often minor injuries.

In a well-reported article, the Los Angeles Times traced how black-market OxyContin imported from Los Angeles devastated the Seattle suburb of Everett, Washington. In another superbly detailed long piece entitled “Dope Sick,” the essential health news website STAT exhaustively examines the story of DJ Shanks, a 21-year-old man in Toledo Ohio of overdosed from fentanyl despite all the efforts of his family and friends and multiple attempts to detox. The article includes an amazing video showing Mr. Shanks terminal event as he passes out face down in tray of donuts in his workplace after snorting fentanyl (he thought it was heroin), while fellow workers go about their jobs not realizing or ignoring the fact that something is terribly wrong:

The DJ Shanks story involves the death of just one individual, but multiply that by 300,00, the number of American who have died from opioid overdose since that late 1990s.

In May, the Los Angeles Times published probably the finest investigative piece of medical journalism I’ve ever read. The title was: “‘You Want a Description of Hell?’ OxyContin’s 12-hour Problem.” In this explosive and masterfully written article by Harriet Ryan, Lisa Girton and Scott Glover, the authors amass an overwhelming amount of supportive evidence of back their claim that in the majority of patients the duration of OxyContin’s analgesic effect is far short of the advertised 12 hours, and that this discrepancy may bear a large part of the blame for the current crisis of opioid-related overdoses and deaths. TPR discussed this must-read article when it was first published. But every health-care provider should read the original.

There were good articles in 2016 about drugs other than opioids. In the New York Times Magazine, Casey Schwartz described her experience getting hooked on Adderall, first at college as an aid for studying, then simply to socialize in Los Angeles where Adderall was the “currency” of friendship. Schwartz points out that the effects of Adderall nicely match the age of the internet, an era when distracted attention is the norm. In the end Schwartz was able to recover from her addiction to Adderall, but doing so was remarkably difficult.

Speaking of drugs that are a perfect match for their time, Ariel Levy’s New Yorker piece “The Drug of Choice for the Age of Kale” writes about how the South American shamanistic ritual ayahuasca — a ceremony centered around the psychedelic tryptamine DMT, is spreading to hip areas in the U.S. such as Brooklyn and the San Francisco Bay area. My guess is that Levy’s description of her experience with ayahuasca — involving vomiting and confronting one’s darkest thoughts — will not appeal to many readers.

Finally, just yesterday the Washington Post published a story about potential medical uses for cannabidiol (CBD,) a non-psychoactive component of cannabis that has shown promise as treatment for a number of conditions, especially some forms of epilepsy. Unfortunately, CBD, like THC itself, is still classified as a Schedule I drug, making it difficult to perform research on its therapeutic possibilities.



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