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Monthly Archives

May 2019

Trump Declares Commitment to Ending Opioid Crisis ‘Once and for All’

By News, Opioid Crisis
  • ATLANTA — President Trump, after a week devoted to criticizing the Mueller report and investigations by congressional Democrats, turned on Wednesday to a policy matter, vowing to “smash the grip of addiction” caused by the opioid epidemic.

Addressing a conference of health professionals and addiction specialists in Atlanta, Mr. Trump promised to provide more funding for treatment, stronger scrutiny of what he called Big Pharma and tougher interdiction of drugs at the border with Mexico.

“We will never stop until our job is done, and then maybe we’ll have to find something new,” he said. “And I hope that’s going to be soon, but we will succeed.”

Many leading authorities on the opioid crisis have been highly critical of the federal government’s response as far too slow and inadequately funded, starting with the Obama administration, but say there has been some improvement under Mr. Trump.

Andrew Kolodny, a physician and a director of opioid policy research at the Heller School for Social Policy and Management at Brandeis, said Mr. Trump deserved credit for focusing on the problem, and for delivering more funding than President Barack Obama did.

Still, Dr. Kolodny noted, Mr. Trump, despite his often fiery words, has not offered a comprehensive plan.

“When President Trump designated the problem a public health emergency, something bizarre came out of that,” Dr. Kolodny said. “He gets up and states the U.S. is dealing with an emergency, then offers no plan for what we are going to do about this emergency.”

“It’s like pointing to a burning building, saying there is an emergency, then not calling the fire department,” he said.

Emily Walden, whose son died of a drug overdose in 2012, also said that Mr. Trump seemed to be highlighting the issue more than Mr. Obama did.

“I think he’s done more than the previous president, I will say that,” said Ms. Walden, who is now part of a national group to end opioid addiction. She added that she thought there were “some things they aren’t addressing,” and specified the Food and Drug Administration.

Melania Trump, the first lady, traveled with her husband to Atlanta and addressed the conference before he did. She has made opioids one of her signature issues — particularly the toll the crisis takes on babies and mothers — and it is the one public policy initiative that she and the president work on together.

But Mr. Trump did not use his address to focus solely on opioid addiction, instead pivoting to talk about the strength of the economy and a law enforcement crackdown at the southwestern border, with special praise for drug-sniffing dogs.

He also drew a connection between more aggressive interdiction efforts and his long-promised construction of a border wall.

“We’re going to have a wall. It’s going to be a very powerful wall,” he said, adding that it would have a “tremendous impact” on drugs coming into the country, even though most of the illegal drugs get smuggled through legal ports of entry.

In the past 20 years, overdoses caused by prescription opioids have claimed more than 200,000 lives, according to statistics from the Centers for Disease Control and Prevention, with an uptick in recent years in parts of the country where Mr. Trump is popular, like West Virginia and Ohio.

The president declared the opioid crisis a public health emergency in October 2017. By the next October, according to the White House, the Trump administration had raised $6 billion in new funding to address it.

In 2016, President Barack Obama spoke at the same conference. He announced plans to expand drug treatment centers and to use drugs like naloxone that reverse the effects of opioid overdoses. At the time, Mr. Obama said, “This is still an area that’s grossly under-resourced.” He requested $1.1 billion in additional funds to fight opioid addiction.

Mr. Trump’s appearance at the conference comes a day after the Justice Department announced felony drug-trafficking charges against a drug wholesaler, a legal strategy that has until now been reserved for street dealers and cartel bosses. Prosecutors said executives at the company, Rochester Drug Cooperative, ignored signs of illegal distribution and shipped tens of millions of oxycodone pills and fentanyl products to pharmacies they knew were dispensing drugs illegally.

The president also discussed China’s recent decision to ban all of the variants of fentanyl, a promise the Chinese leader, Xi Jinping, made to him last year. The drug has spread across the United States in the past five years and led to thousands of overdose deaths. China’s new rule is effective on May 1, and many hope that could plug gaps that have allowed some Chinese manufacturers to produce variations of the drug that were not technically illegal.

“They’ve agreed that they are going to make it a major crime,” Mr. Trump said.

China’s ban, however, still does not cover all of the precursor chemicals that are used to make fentanyl and its analogues. These chemicals are typically sent to Mexico from China and are used in composing the fentanyl that is used in the United States.

Fentanyl and its analogues became the leading cause of overdose deaths in 2016 and, according to the C.D.C., contributed to more than a third of deaths the agency counted in 2017.

Michael Tackett reported from Atlanta, and Eileen Sullivan from Washington.

The opioid epidemic: Here’s why our battle against drugs has failed

By News, Opioid Crisis

Courtesy of The Courier Journal by USA Today

 

While opioid drugs have scathed every state, Kentucky’s epidemic has been particularly severe. We rank among the top 10 states in opioid-related overdose deaths.

In 2016, Kentucky’s rate of 23.6 overdose deaths per 100,000 persons was nearly double the national rate. Prior to 2000, the annual toll of lives lost due to illegal drugs was about 18,000 per year — a small number compared with annual tobacco deaths (about 425,000) or alcohol-related deaths (about 85,000). By 2017, annual drug overdose deaths in the U.S. are exceeding 70,000. Given the investment we have made to halt drug abuse in general, opioids in particular, we need to ask ourselves: What are we missing?

The opioid problem is partly caused by actions of the health care industry, particularly drug companies. The industry’s role in the massive increase in deaths is not difficult to infer. During 1997 to 2002, OxyContin prescriptions increased nationwide from 670,000 to 6.2 million. Data from 2015 shows Kentucky physicians provided 97 opioid prescriptions per 100 persons (4.47 million prescriptions) while the average U.S. rate that year was 70 opioid prescriptions per 100 persons.

Opinion: Is it possible to reduce opioid deaths by 40%? UK researchers say yes

The nationwide alarm about opioid abuse rose as the number of deaths accelerated. That alarm led to the health care system better managing opioid pain medications, limiting unnecessary dispensing when less potent drugs, such as ibuprofen, or even drug alternatives such as massage therapy or acupuncture may be adequate to manage pain.

For quite some time, most states have had systems in place (in Kentucky since 2011) to monitor duplicate prescriptions brought to different pharmacies, to detect or control “doctor shopping” or unethical pain clinics that give people large quantities of opioids, knowing that they are being used illicitly. An unintended consequence of limitations on access to prescription pain relievers was a parallel rise in use of heroin and opioid derivatives, such as fentanyl, with even greater overdose risk.

Another growing strategy is the distribution of Narcan (naloxone), to reverse drug overdoses. Experts think Narcan kits should be distributed (with training) across communities and work groups, such as first responders, perhaps even family members of known drug abusers.

In addition to the measures mentioned above, public health is taking a harder look at primary prevention. What could be done to diminish cases of opioid use disorder? How can we intervene earlier? There are a number of innovations beginning to gain traction.  Some communities facilitate disposal of prescription pain drugs no longer needed.  Stockpiles of these drugs in home medicine chests is one of the common ways they land in the hands of youth.

Opioid epidemic: epidemic: We must learn to treat pain without addictive drugs

Economic forces play a role. Adult opioid use increases with economic downturns and unemployment. Part of the reason there is such an infusion of these drugs in Eastern Kentucky and elsewhere in Appalachia is because poverty is rampant and usual solutions (business and economic development) insufficient. For many, drug abuse is an addiction, but concurrent drug selling is subsistence employment.

 Giving people resources to obtain self-sufficiency and a better life is a long-term solution, though easier described than done.

Unfortunately, a history of drug use is frequently a barrier to employment; we should review public policy in this regard. Epidemiologist Angus Deaton coined the phrase “deaths of despair” in reference to declining middle-age life expectancy. He suggests the early mortality trend is born in hopelessness about the future. If that is the case, the nation needs to soul-search about how to provide a comprehensive social safety net that supports the economic needs of those living on or below the poverty line.

In past decades, drug abuse prevention has focused on children and youth, because drug experimentation typically commenced late in middle school, beginning of high school. Although the opioid epidemic does not fit that mold, prevention efforts should still target youth. School-based efforts should be less about curriculum, more about bonding youth to life-affirming attitudes and behaviors and family based strategies to cultivate resilient children.

Community-oriented prevention efforts link to social capital, a measure of community solidarity, the degree to which people have a social network. Social capital means engaging with local government, voting in elections, volunteering with charities and nonprofit agencies, and participating in faith-based communities, fraternal organizations and group recreation. In general, high social capital accompanies low risk for drug abuse. People can enhance social capital, but governments and organizations such as faith-based institutions also can play important roles.

Opinion: Her violent death shattered my preconceptions of opioid overdose

This brings us to a critical issue missing from most discussions about drug abuse prevention: the view that jail is an essential and effective way to manage drug abuse.  The war on drugs has mostly failed. Illicit drugs are more readily available and cheaper now than they were 50 years ago, the opposite of what was intended.

Furthermore, the war on drugs has been deeply racist, with a disproportionate impact on African Americans and Hispanics, not because they actually use more drugs, but because they have a greater risk of being arrested and jailed for drug offenses, with less access to legal counsel. They also have less access to drug treatment and health care in general, and in jail leave behind families and neighborhoods less able to absorb their loss to their communities.

Our punitive approach to dealing with drug abusers has made the United States the nation with the highest percentage of prisoners in the world, the majority of whom are incarcerated for drug-related crimes. Reliance on crime-based policies such as incarceration is counterproductive and unsustainable.

A new generation of leaders must imagine a society in which drug addiction is treated as a mental health problem, not a reason to lock up 2 million people. Responding to addicts with jail sentences is ineffective and unjust. We should be seeking evidence-based alternatives to incarceration, grounded in the best science available, with an eye to social justice in all of our plans.

Richard W. Wilson and John Chenault are professors at the University of Louisville. The views expressed are their own and are not meant to be representative of U of L

U.N. agency is accused of helping Purdue Pharma spread opioid epidemic around the world

By News, Opioid Crisis

Courtesy of NBC News

 

Lawmakers say the World Health Organization is helping Purdue wage a “propaganda campaign” about opioids.

 

By Corky Siemaszko

Two members of Congress accused the World Health Organization on Wednesday of helping Purdue Pharma use the same “propaganda campaign” that fueled the opioid epidemic in the United States to expand drug sales internationally.

In a 38-page report titled “Corrupting Influence, Purdue & the Who,”Rep. Katherine Clark, D-Mass., and Rep. Hal Rogers, R-Ky., charged that the WHO has published guidelines for opioid use that parrot Purdue’s claims “that dependence occurs in less than 1 percent of patients, despite no scientific evidence supporting this claim.”

“We believe the similarities between their propaganda campaign in the U.S. and the confusion and deception they have spread through international publications are not a coincidence,” the report states. “We are highly troubled that after igniting the opioid epidemic that cost the United States 50,000 lives in 2017 alone and tens of billions of dollars annually, Purdue is deliberately using the same playbook on an international scale.”

Clark and Rogers called on the WHO to “no longer allow the same companies and the same people who recklessly chose profits over human lives in the United States to inflict the opioid crisis on the rest of the world.”

WHO is an agency of the United Nations that is concerned with international public health and is based in Switzerland.

“We have received the most recent letter from Congress and are reviewing it point by point,” WHO spokesman Christian Lindmeier wrote in an email after NBC News reached out for a response.

Purdue Pharma spokesman Bob Josephson responded in a statement when NBC News reached out for comment.

“Purdue strongly denies the claims in today’s congressional report, which seeks to vilify the company through baseless allegations,” the statement reads. “Purdue Pharma LP is solely based in the United States with no international operations. The company has never violated any applicable rules or guidelines and no formal complaint or enforcement activity has resulted from Purdue’s financial support or relationship with any third party.”

The report from Clark and Rogers appeared a year after they wrote to Margaret Chan, the WHO’s former director general, and urged her to keep an eye on Purdue Pharma, whose best known product is the powerful painkiller OxyContin, and its network of foreign affiliates, Mundipharma.

“The greed and recklessness of one company and its partners helped spark a public health crisis in the United States,” they wrote.

In particular, Clark and Rogers warned that Mundipharma was engaging in “deceptive and dangerous practices.”

Purdue, in a statement, said it is an “industry leader in the development of abuse-deterrent technology.”

Mundipharma said in a statement that the company continues “to take active preventative measures.”

But Clark and Rogers say they never got a response from the WHO.

“When the WHO failed to respond to the letter, we began to question why they would remain silent about such a significant and devastating public health epidemic,” they wrote in the report. “The answers we found are deeply disturbing.”

Lindmeier, however, insisted their records indicate Chan replied to the lawmakers on May 17, 2017.

In their report, the lawmakers said they discovered that the WHO published a document in 2011 called “Ensuring Balance in National Policies on Controlled Substances, Guidance for Availability and Accessibility of Controlled Medicines” that repeats Purdue’s bogus claim that less than 1 percent of patients get hooked on opioids.

“It states: ‘Opioid analgesics, if prescribed in accordance with established dosage requirements, are known to be safe and there is no need to fear accidental death of dependence,’” the report states.

Then in 2012, the WHO published a second document called “Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses.”

“This guideline uses the marketing term coined by the opioid industry and utilized often by Purdue: ‘opiophobia,’” the report states. “Opiophobia is how the opioid industry defines a physician’s ‘unreasonable fear’ of prescribing opioids.”

The WHO guideline claimed that there is no maximum dosage of opioids like OxyContin for children despite the fact that U.S. public health agencies have found that “fatal overdoses skyrocket in adult patients who are prescribed above 90 morphine milligram equivalents (MME) per day.”

“The web of influence we uncovered paints a picture of a public health organization that has been manipulated by the opioid industry,” Clark said on her website. “The WHO appears to be lending the opioid industry its voice and credibility, and as a result, a trusted public health organization is trafficking dangerous misinformation that could lead to a global opioid epidemic.”

“The WHO must take action now to right the ship and protect patients around the world, especially children, from the dangers associated with chronic opioid use,” Rogers said in a statement on his website.

Purdue Pharma faces some 1,600 lawsuits that accuse it of promoting OxyContin while downplaying the drug’s addictive properties.

In March, it settled with the Oklahoma attorney general for $270 million about two months before the scheduled start of a televised trial in the opioid-ravaged state.

Last year, Massachusetts named eight members of the Sackler family, the principal owners of the company, in a complaint that accused Purdue of spinning a “web of illegal deceit” to boost profits.

Purdue, which has repeatedly denied the allegations, has generated sales of more than $35 billion since OxyContin made its debut in 1995, according to Forbes.

THE UNSEEN VICTIMS OF THE OPIOID CRISIS ARE STARTING TO REBEL

By News, Opioid Crisis, Uncategorized
Courtesy of WIRED Magazine 

APRIL GROVE DOYLE, a 40-year-old single mom with metastatic breast cancer, pulled her car to the side of the road. Her face was flushed and her eyes puffy from crying, but she looked into the phone mounted on her dashboard and pressed the record button.

“So, I’m just leaving my pharmacy,” she said, taking a breath to steady herself. “I’m not, I’m not—I’m frustrated, and that’s why I’m crying. I get pain pills, maybe every two, three months, OK? I can make one monthly prescription of pain pills last two or three months because I don’t really take it unless I absolutely need it. And when you have metastatic cancer in your bones, you need it. Because sometimes the pain is so much you can’t even function. And I just want to function.”

After another deep breath, Doyle explained: The pharmacist at her local Rite Aid pharmacy in Visalia, California, had berated her for her history of opioid prescriptions, then told her to come back later. She left without the refill, feeling that she was being treated like a criminal.

Like millions of other chronic pain patients around the country, Doyle is the collateral damage of the opioid abuse epidemic. About 17,000 people die each year in the US from a prescription opioid overdose. Fifty million Americans suffer from chronic pain—one-fifth of the adult population—including 20 million who have what’s called high-impact chronic pain, or pain that frequently limits their daily life.

The campaign to keep opioids away from people who abuse them has ended up punishing the people who use them legitimately—even torturing them to the point of suicide. Now they are pushing back, mobilizing as best they can into a burgeoning movement. “Don’t Punish Pain” rallies are taking place in cities nationwide on May 22, and pain patients are organizing a protest at the Centers for Disease Control and Prevention in Atlanta on June 21.

Doyle posted her video to her Facebook page, The C Life, and by the time she got back to her office after her lunch break, her phone began to bing with notifications. The video has since been viewed about 330,000 times; many of the 1,400 comments came from people with similar experiences. After her post went viral, Rite Aid filled her prescription—and apologized.

“This is not right,” Doyle says. “These medications were created for the very problems we’re having, and yet we’re not being allowed access to them.”

TWENTY YEARS AGO, easing pain was the mission and opioids were the method. Pain became known as “the fifth vital sign,” as important as blood pressure, temperature, heart rate, and respiratory rate, and hospitals and clinics routinely asked patients to rate their pain. In 1999 the Oregon Board of Medicine even declared that “clearly documented undertreatment of pain” was “a violation equal to overtreatment.”At pain clinics, the best results came from offering a range of treatments, including physical therapy and cognitive behavioral therapy. But insurance was more likely to pay for the simpler pharmaceutical path. In 2017 doctors in the US wrote 199 million prescriptions for opioids, or 58.7 scripts for every 100 persons. That is actually a decline from the peak of 255 million opioid prescriptions, in 2012.

The drop in opioid prescriptions might be a sign that the crackdown on abusive use is working. It also might reflect the plight of chronic pain patients who suddenly find it hard to get the prescriptions they’ve been using to help them get through the day.

One in four cancer patients have had trouble getting their pain medication because a pharmacist refused to fill the prescription, even though the drug was in stock, according to a survey by the American Cancer Society Cancer Action Network. Thirty percent said they couldn’t get the pain meds their doctor prescribed because their insurance wouldn’t cover the costs.

Suicides are rising among people with chronic pain, according to a 2018 analysis of National Violent Death Reporting System data. Halting opioids suddenly also can lead to cardiovascular problems, including heart attacks, according to Michael Schatman, director of research and network development at Boston Pain Care and editor in chief of the Journal of Pain Research.

“Pain patients have been abused,” says Schatman, who advocates for a middle ground on the use of opioids. “I believe that it’s genocide of people with chronic pain.”

WENDY SINCLAIR, WHO has chronic pain from a 2014 car accident, is organizing the “Don’t Punish Pain” rally in Salem, Oregon. It isn’t easy for people with chronic pain to stand on a sidewalk holding signs and waving at motorists. Instead, many of them will sit in chairs or wheelchairs, sharing their stories with people walking by. “We don’t have a lot of healthy people advocating for us, so we have to do it ourselves,” she says.Claudia Merandi, a retired court reporter with severe Crohn’s disease who lives in East Providence, Rhode Island, started the rallies in 2017 with some Facebook posts among friends. Today, her Don’t Punish Pain Rally Facebook page has 10,000 followers, and she has rally coordinators for 44 cities. If someone can’t get to the rally site, she encourages them to sit outside their local pharmacy with a sign instead.

It is a new civil-rights issue, she says: “When you take away a person’s right to live a humane life, what else would it be?”

Perhaps the most powerful support comes from pain experts. In March, a group called Health Professionals for Patients in Pain wrote to the Centers for Disease Control and Prevention, urging the agency to respond to the “widespread misapplication” of its 2016 Guideline for Prescribing Opioids for Chronic Pain. Patients were being forced to taper off opioids and were subjected to unnecessary suffering, they said. The letter was signed by more than 300 health professionals, including three former US drug czars.

On April 9, the Food and Drug Administration warned that suddenly decreasing dosage or halting opioids in patients who are dependent on them could lead to “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.” The next day, the CDC director clarified that the agency’s guideline, which recommends against high doses of opioids, applies to the initiation of opioid treatment and not to patients who have been stable in long-term treatment.

Yet chronic pain patients say many doctors have already stopped prescribing opioids. They fear scrutiny from the Drug Enforcement Administration, state medical boards, or even their own health institutions. Authorities want to shut down “pill mills” that fuel the overdose crisis by providing opioids inappropriately, but those same enforcement efforts can affect doctors who prescribe high doses to chronic pain patients. Oregon, for example, wanted to shift patients from opioids to alternative pain treatment, such as acupuncture, massage, and cognitive behavioral therapy. In 2016, the state required Medicaid patients with back and spine conditions to taper off of opioids.

Then this spring, the Health Evidence Review Commission, which guides reimbursement decisions, considered new limits: Patients with certain chronic pain conditions would gain coverage for alternative treatments under Medicaid, but would have to taper off opioids, even if they have been stable on their doses for many years.

Sean Mackey, chief of the Division of Pain Medicine at Stanford University, was initially reluctant to enter the fray over opioids. “I prefer to avoid this space because there is so much emotional rhetoric and anger and attacks flying both ways,” he says. “I just want to focus on pain, the research and clinical care of people in pain.” But he felt compelled to speak out against what he calls “a social experiment on a large part of the most vulnerable population.”

Mackey wrote a letter warning that forced tapering poses significant harm without any evidence of safety or effectiveness. It was co-signed by more than 100 pain and addiction experts and patient advocates. “People of good conscience need to step up and say ‘No, this is wrong,’” he says.

On May 16, after an independent review found little evidence to support the alternative treatments or the tapering, HERC backed off of the proposal. It stopped requiring people with back and neck pain to taper off opioids and decided to revisit that coverage issue next winter.

This other opioid crisis of pain remains overshadowed by the still-rising number of overdose deaths, most of them involving illegal opioids. Johnna Magers of Indianapolis, organizer of the June protest outside CDC, wants people to think about the lives that are threatened by the loss of access to opioids. “The rest of America better wake up,” she says. “Because you are one accident away from being a chronic pain patient.”