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US Opioid crisis

phillm said:
If we must have the death penalty let's start with these...

The Family That Built an Empire of Pain
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A long and sobering read. I worked as a rep for Roche, so was well aware of the tactics used to get doctors to prescribe, the Sacklers' were on a different level though.

Two things leaped out:

If present statistics are any indication, in the time it likely took you to read this article six Americans have fatally overdosed on opioids.

A baby with a physical dependency on opioids is now born every half hour. In places like Huntington, West Virginia, ten per cent of newborns are dependent on opioids.

A massive problem, not just in the US either, tramadol is the UKs oxycontin. Withdrawal is a bastard, I've done it.
 
Sasaferrato said:
Aren't they? Especially the poor bloody babies. Tramadol withdrawal was awful (the first time, the second time I handled it differently), I can only imagine what the babies are going through.
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I don't know anything about addiction in such littl'uns. Can't they just taper them off really slowly?
 
Horrible shit. Much as I loathe the political and corporate shithole the UK has become the USA is like an open sewer of corruption and greed.

There is a lot wrong in the USA (and most countries tbf) but the 'business' of arms and health care are a fucking horror.
 
The bottom line is that any drug that is effective has side effects, and all strong analgesics are addictive.

It is a case of taking the smallest amount of anything that brings pain down to bearable levels. Don't ignore paracetamol, it is an effective analgesic, particularly in conjunction with a small dose of a stronger analgesic.

The holy grail for all pharmaceutical companies is an analgesic that:

Is effective.
Is non addictive.
Is cheap.
Is safe in overdose.
Does not develop tolerance.

Invent that, and your fortune is truly made. :)
 
Sasaferrato said:
The bottom line is that any drug that is effective has side effects, and all strong analgesics are addictive.

It is a case of taking the smallest amount of anything that brings pain down to bearable levels. Don't ignore paracetamol, it is an effective analgesic, particularly in conjunction with a small dose of a stronger analgesic.

The holy grail for all pharmaceutical companies is an analgesic that:

Is effective.
Is non addictive.
Is cheap.
Is safe in overdose.
Does not develop tolerance.

Invent that, and your fortune is truly made. :)
Click to expand...
Co-proxamol was an effective and cheap painkiller, specifically designed for chronic pain. Taken off the market because of a kneejerk reaction to it being used in a number of accidental deaths - even the academics that did the study said it should have had it's classification reviewed, not withdrawn.

People who accidentally and fatally overdosed were a) taking 10 or more at once and b) were obtaining them without a prescription.

Bring back this medicine and a lot of people currently on opioids could potentially transition back to a drug that suited them well, with few side effects and a low addiction potential.
 
equationgirl said:
Co-proxamol was an effective and cheap painkiller, specifically designed for chronic pain. Taken off the market because of a kneejerk reaction to it being used in a number of accidental deaths - even the academics that did the study said it should have had it's classification reviewed, not withdrawn.

People who accidentally and fatally overdosed were a) taking 10 or more at once and b) were obtaining them without a prescription.

Bring back this medicine and a lot of people currently on opioids could potentially transition back to a drug that suited them well, with few side effects and a low addiction potential.
Click to expand...

I succeed in getting the army to stop buying co-proxamol.

The people in the army who died had all taken two tablets, with alcohol. The 'with alcohol' was the important aspect.

Those who had taken an overdose were very difficult to treat, the fatal respiratory depression could only partly be reversed with naloxone.

It was not a 'knee-jerk' reaction, it was a measured response to a dirty medication.

Toxicity[edit]
Overdose is commonly broken into two categories - liver toxicity (from paracetamol poisoning) and dextropropoxyphene overdose.

An overdose of dextropropoxyphene may lead to various systemic effects. Excessive opioid receptor stimulation is responsible for the CNS depression, respiratory depression, aspiration pneumonia, miosis, and gastrointestinal effects seen in propoxyphene poisoning. It may also account for mood- or thought-altering effects. In the presence of amphetamine, propoxyphene overdose increases CNS stimulation and may cause fatal convulsive seizures.[13]

In addition, both propoxyphene and its metabolite norpropoxyphene have local anesthetic effects at concentrations about 10 times those necessary for opioid effects. Norpropoxyphene is a more potent local anesthetic than propoxyphene, and they are both more potent than lidocaine.[14] Local anesthetic activity appears to be responsible for the arrhythmias and cardiovascular depression seen in propoxyphene poisoning.[15]

Both propoxyphene and norpropoxyphene are potent blockers of cardiac membrane sodium channels, and are more potent than lidocaine, quinidine, and procainamide in this respect.[16] As a result, propoxyphene and norpropoxyphene appear to have the characteristics of a Vaughn-Williams Class Ic antiarrhythmic.

These direct cardiac effects include decreased heart rate (i.e. cardiovascular depression), decreased contractility, and decreased electrical conductivity (i.e., increased PR, AH, HV, and QRS intervals). These effects appear to be due to their local anesthetic activity and are not reversed by naloxone.[14][15][17] Widening of the QRS complex appears to be a result of a quinidine-like effect of propoxyphene, and sodium bicarbonate therapy appears to have a positive direct effect on the QRS dysrhythmia.[18]

Seizures may result from either opioid or local anesthetic effects.[14] Pulmonary edema may result from direct pulmonary toxicity, neurogenic/anoxic effects, or cardiovascular depression.[15]

Balance disorder is possible, with risk of falls from standing height.
 
It was not a dirty medication, as you call it, I was on it with no issues for 10 years. One pain med managed my pain.

Since it was withdrawn, I'm on a variety of pain meds including opioids and pregabalin, all meds with addiction potential. I'd quite happily go back on Co-proxamol.
 
equationgirl said:
It was not a dirty medication, as you call it, I was on it with no issues for 10 years. One pain med managed my pain.

Since it was withdrawn, I'm on a variety of pain meds including opioids and pregabalin, all meds with addiction potential. I'd quite happily go back on Co-proxamol.
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You are not alone on that, IIRC, VP has the same view.

I actually mourned it's passing, it was something I took myself for back pain. We had too many deaths though to keep it, it was dished out like sweeties. Our 'standing order' at Rinteln was for 6 x 5000 every six weeks. We had a 'catchment' of about 15,000 people. The only other thing that we used in such volume, indeed greater volume, was ibuprofen.
 
Total Depravity: The Origins of the Drug Epidemic in Appalachia Laid Bare
If there was something corrupting in the mountains, it was the coal. Coal was at the heart of the opioid epidemic. It was extracted from the land, but also made extractions from those laboring for it. Coal has killed West Virginians in subtle and various ways for well over a century. It bowed them, it crushed them; it took their sinews and their lungs. As late as the 1920s, Appalachian coal miners were still boys, as young as eight, preferred because their hands were small enough to work the seams. If these boys were severely injured or killed, the conveyor belts did not stop. After the whistle blew at the end of the shift, the gore and body parts (traumatic amputations were frequent) would then be collected.

In 1921, a series of armed labor disputes known as the West Virginia coal wars culminated in the Battle of Blair Mountain, where miners with rifles fought pitched battles with Pinkerton agents, the army and the police. Together these combatants fired more than one million rounds at one another. The colored neckerchiefs of the resisting miners originated the term ‘redneck’, and the confrontation means the Second Amendment of the Constitution is locally sacrosanct. In most places, armed defense against government tyranny is a hypothetical. In West Virginia, it is a memory.

Still, the twentieth-century union bosses were accomplices to coal’s murders. Black lung was understood early, and too well, and when mechanized drills were introduced, the coal dust they produced was finer, so inhaled more deeply, and killed men with the same efficiency that made the mines more productive. Appalachian Magazine records that the legendary United Mine Workers of America leader John L. Lewis ‘decided not to raise the black lung issue because it might impede the mechanization that was producing higher productivity and higher wages’. Variations of this inhumane calculation persist.

I had not, before coming to Huntington, ever heard of a ‘coal doctor’ before, but this profession has a long history, rarely an honorable one. Often coal camps were lonely, rough places with few services, and coal doctors were rugged men who travelled long distances to provide medical aid to the workers. They were often chancers, and have retained some of this quality to this day. Not long ago, miners would finish their work and rise to the top of the pit to find a physician, ready to hand pills to any man with pains. As the unions faltered and their protections were stripped away, time spent sick became time unpaid, or an invitation to be laid off. Pain management was no longer just optimum, it was indispensable, and then, naturally, addictive.
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Deaths of Despair (podcast)
June 18, 2020
The warning bell sounded in 2014: a down dip in the ever-rising American lifespan, which was 50 years, on average, in 1900, and up close to 80 years into the 21st century. Then something happened and kept happening – not to the very old-agers, but in mid-life. It was a white-working-guy disease that hit women too, but not everybody – not African-Americans the same way, not college graduates at all. It was a sharp surge in desperate death by suicide, often with alcohol or opioids. “Deaths of Despair,” they are called now, each one a message in a bottle about pain, neglect, work, and well-being in America.
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Oxycontin is a prescription medication.

It may have been the case at the beginning of the advertising campaign, and direct marketing to doctors, that the toxicity and addictive qualities were unknown, but that was not the case for long.

The red flag to any doctor or pharmacy is frequent prescription requests. When people need more and more, something is wrong.

Doctors are not blameless in this, far from it.
 
Wall Street, bribery and an opioid epidemic: the inside story of a disgraced drugmaker
19/06/20 (non-paywalled)
Why were the warning signs around Insys ignored for so long? The FT and PBS series ‘Frontline’ investigate
Deborah Fuller had just heard the sentences that were the closest she would get to justice.

In March 2016, her daughter Sarah died from an overdose of drugs that included Subsys: a tiny yet potent spray containing fentanyl, an opioid 50 to 100 times stronger than morphine. The day before her death, mother and daughter had chatted about her upcoming wedding. Sarah had already bought a garter. Deborah was planning to sew her veil.
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The next morning, Sarah’s fiancé found her dead, keeled over on her face. “It was not a vision I would wish on anyone. We had to have her cremated because there was no way they could have made it so that she was recognisable,” Deborah recalls in an interview.

The former nursing assistant had first become addicted to opioids when she was prescribed them for fibromyalgia and neck and back injuries. After she recovered from the addiction, she visited a new doctor. With an Insys sales representative in the room, she was put back on opioids including Subsys — and within 20 days, her dose of the spray was tripled. Admitted to hospital for hyper-sedation, physicians recommended she stop using the spray — but her doctor continued to prescribe it.
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Now, four years later, executives from Insys, the maker of Subsys, had become the first pharmaceutical bosses to be handed prison time for their role in America’s opioid epidemic. Clutching her speech, the 62-year-old mother from New Jersey stood outside the court in Boston this January and accused John Kapoor, the Insys founder, and his colleagues of a “greed and fraud” that took Sarah away when she was just 32. “They are no different from mobsters,” she said.

Seven of the Insys executives and employees on trial were found guilty of masterminding and participating in a scheme to bribe doctors to prescribe the drug. Kapoor was sentenced to five and a half years on charges that included racketeering conspiracy. Michael Babich, Insys’ former chief executive, and Alec Burlakoff, former vice-president of sales, co-operated with prosecutors and received two and a half, and 26 months, respectively.
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Opioids, Inc. Frontline (video)
Season 2020: Episode 15. 23/06/20
The story of a drug company that pushed opioids by bribing doctors and committing insurance fraud. With the Financial Times, FRONTLINE investigates how Insys Therapeutics profited from a fentanyl-based painkiller 50 times stronger than heroin.
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Coincidentally I only watched a documentary on this guy the night before last. He was obviously primarily in it for the money with little concern about the people at the other end.
He was bribing Dr's. left, right & center. The Salespeople would park outside the "Pain Medication" places in Florida and see how many obvious 'users' were going in there and then target the Dr's.
Fentanyl is some pretty strong stuff. I was talking to my former Dr. about it years ago and he mentioned it was not only being brought into Australia ,which at the time I did realise it would of being, but not in the amounts he was talking about. He said it was becoming a much wanted Opioid because of its strength and the fact a tiny bit mixed into Heroin could double its value (due to its strength) and was becoming a real problem due to OD's and addiction.


"BOSTON—John N. Kapoor, a former billionaire who founded opioid maker Insys Therapeutics Inc., was sentenced to 5½ years in prison for his role in a racketeering conspiracy to illegally boost sales of his company's prescription fentanyl drug.Jan 23, 2020"
tinyurl.com

Founder of Opioid Maker Sentenced to 5½ Years in Prison

The sentencing of John N. Kapoor, founder of Insys Therapeutics, caps the fall of a former pharmaceutical industry highflier along with the company and several fellow officials.
tinyurl.com tinyurl.com
 
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The New Fight to Hold Purdue Pharma and the Sacklers Accountable for the Opioid Crisis
July 29 2020
When news first broke last September that Purdue Pharma was filing for bankruptcy, many victims of the deadly opioid crisis, for which the company holds immense responsibility, believed there was reason to celebrate. The demise of the privately owned pharmaceutical corporation, the creator of OxyContin, had been the goal of activists, victims, and their families for well over a decade. For those familiar with the vagaries of bankruptcy law, however, it was immediately clear that the Chapter 11 filing was just the latest move by Purdue executives and its owners, members of the Sackler family, to evade justice and dodge accountability.
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In filing for voluntary bankruptcy, Purdue was able to shield itself from the 2,600 federal and state lawsuits it was facing for its role flooding the U.S. with prescription opioids, contributing to the deaths of over 450,000 people since 1999. Purdue executives and members of the Sackler family were accused, in case after case, of misleading doctors and patients about the addictive nature of OxyContin, while amassing a multibillion-dollar fortune.
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The bankruptcy filing invoked an automatic stay of civil litigation against the company. And while the billionaire Sacklers are by no means facing personal bankruptcy, they too have been granted a stay of litigation. If they get their way in court, as they are likely to do, the bankruptcy settlement could shield the Sackler family from all future claims — and influence whether they are subject to criminal liability, too. The full extent of Purdue’s — and the various Sacklers’ — malfeasance in knowingly creating a mass market in addiction could remain hidden in sealed documents.
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"contributing to the deaths of over 450,000 people since 1999"! Justice delayed is justice denied.
 
FFS

theintercept.com

The New Fight to Hold Purdue Pharma and the Sacklers Accountable for the Opioid Crisis

With bankruptcy, advocates fear that Purdue and the Sackler family will be shielded from accountability for OxyContin’s role in the opioid crisis
theintercept.com theintercept.com

The bankruptcy filing invoked an automatic stay of civil litigation against the company. And while the billionaire Sacklers are by no means facing personal bankruptcy, they too have been granted a stay of litigation. If they get their way in court, as they are likely to do, the bankruptcy settlement could shield the Sackler family from all future claims — and influence whether they are subject to criminal liability, too. The full extent of Purdue’s — and the various Sacklers’ — malfeasance in knowingly creating a mass market in addiction could remain hidden in sealed documents....
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Badgers said:
Horrible shit. Much as I loathe the political and corporate shithole the UK has become the USA is like an open sewer of corruption and greed.

There is a lot wrong in the USA (and most countries tbf) but the 'business' of arms and health care are a fucking horror.
Click to expand...

Its difficult to know what to do to the Sacklers of the world. Killing one person to get their wallet doesn't compare to greed on this scale, with no care whatsoever to the mass death that results. Even if the system were functioning fairly, there really isn't a way for the law to adequately prosecute this level of depravity. We need something on the level of the Nuremberg trials for some of these schemes.
 
Oxy maker Purdue Pharma “pleaded guilty Tuesday to three criminal charges, formally admitting its role in an opioid epidemic that has contributed to hundreds of thousands of deaths over the past two decades.”

In a virtual hearing with a federal judge in Newark, New Jersey, the OxyContin maker admitted impeding the U.S. Drug Enforcement Administration’s efforts to combat the addiction crisis. Purdue acknowledged that it had not maintained an effective program to prevent prescription drugs from being diverted to the black market, even though it had told the DEA it did have such a program, and that it provided misleading information to the agency as a way to boost company manufacturing quotas.

It also admitted paying doctors through a speakers program to induce them to write more prescriptions for its painkillers.
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Crikey.

The guilty pleas were entered by Purdue board chairperson Steve Miller on behalf of the company. They were part of a criminal and civil settlement announced last month between the Stamford, Connecticut-based company and the Justice Department.

The deal includes $8.3 billion in penalties and forfeitures, but the company is on the hook for a direct payment to the federal government of only a fraction of that, $225 million. It would pay the smaller amount as long as it executes a settlement moving through federal bankruptcy court with state and local governments and other entities suing it over the toll of the opioid epidemic.

Members of the wealthy Sackler family who own the company have also agreed to pay $225 million to the federal government to settle civil claims. No criminal charges have been filed against family members, although their deal leaves open the possibility of that in the future.
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www.mercurynews.com

OxyContin maker Purdue Pharma pleads guilty in criminal case

Members of the wealthy Sackler family who own the company have also agreed to pay $225 million to the federal government to settle civil claims. No criminal charges have been filed against family m…
www.mercurynews.com www.mercurynews.com
 
McKinsey agrees $573m opioid settlement in US
05/02/21
McKinsey has agreed to pay $573m (£419m) to resolve claims it faced across the US related to its role fuelling America's opioid epidemic.

The consulting firm was under investigation for its work with Purdue Pharma, which aimed to boost sales of the addictive Oxycontin painkiller.

McKinsey maintained that its past work was "lawful" and denied wrongdoing.
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But California Attorney General Xavier Becerra said the firm had been "part of a machine that... destroyed lives".

Prosecutors said McKinsey had worked on strategies to "turbocharge" Oxycontin sales, advising Purdue to increase sales calls to doctors known to be high prescribers and to "subvert" restrictions on higher dosages that authorities wanted to impose.

When officials began to take legal action against Purdue, McKinsey partners discussed deleting documents related to their work with Purdue, which started in 2004 and lasted until 2019 - more than a decade after the company pleaded guilty to misrepresenting Oxycontin's risks, they said.
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"McKinsey's cynical and calculated marketing tactics helped fuel the opioid crisis by helping Purdue Pharma target those doctors they knew would overprescribe opioids," said New York Attorney General Letitia James. "They knew where the money was coming from and zeroed in on it."

Prosecutors said McKinsey also made millions of dollars helping other firms involved in the industry develop similar marketing and sales plans.
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Purdue Pharma Conducted Massive Probe Of The Sacklers, But The Findings Are Secret
NPR. March 19, 2021
According to Purdue Pharma's description of the probe, investigators were given unprecedented access to "over 21 million" internal company documents, including private emails and other correspondence between the company's top executives.

They were also able to take part in depositions when members of the Sackler family were questioned.

Experts said the investigation appears to be the most sweeping effort yet to explore the Sacklers' alleged liability for the opioid epidemic, which has killed roughly 450,000 Americans.
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Drugmakers Go on Trial Over Opioid Epidemic
April 18, 2021
Four drugmakers are slated to go on trial Monday in California over claims they fed the opioid crisis, in a proceeding that could help finalize multibillion-dollar settlements between state and local governments and pharmaceutical companies.

The case is just the second to go to trial out of thousands of similar lawsuits accusing the drug industry of fueling an opioid epidemic that has killed nearly 500,000 people since 1999, according to federal data.
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In the trial set to begin Monday fully by videoconference, four California communities allege that Johnson & Johnson, JNJ 0.44% Teva Pharmaceutical Ltd. TEVA -4.23% , Allergan and Endo International ENDP -5.75% PLC ran misleading marketing campaigns that played down the risks of opioid addiction to boost sales of powerful prescription painkillers.
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