Who Profits from YOUR Opiate Addiction Given to you by your doctor!


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Deaths During Opioid-Related Hospital Stays in U.S. Quadrupled

Heroin and other opioids are ravaging communities across America. Deaths from heroin increased 328% between 2010 and 2015, and drug deaths from fentanyl and other synthetic opioids are now seeing a sharp rise as well. More Americans die from drug overdoses than in car crashes, and this increasing trend is driven by Rx painkillers.

A new study released earlier this week confirms that deaths in opioid-related hospital stays in the U.S. have quadrupled between 1993 and 2014, PBS NewsHour reports.

Zirui Song, an assistant professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital, launched the study in 2016 in an effort to gain a better understanding of the patients he treated.

Dr. Song analyzed nearly 385,000 hospital stays involving patients who were admitted for opioid use with data from the National Inpatient Sample of the Healthcare Cost and Utilization Project, a national database compiled by the Agency for Healthcare Research Quality.

His research confirmed that by 2014, four times as many patients died from opioid-related causes while staying in the hospital, rising from 0.43 percent before 2000 to 2.02 percent.

Over the same time period, the study also found that patients admitted to the hospital for opioid use skewed younger — the average age was 39 years old — and were more likely to be Caucasian. The number of black and Hispanic patients admitted to hospitals for opioid or heroin use remained relatively stable.

Dr. Song said his study is intended to raise awareness for the need for better strategies for hospitals when patients are admitted for using opioids, in addition to continuing and improving public health.

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Doctors need to STOP prescribing Opiates and, those who do, need to properly detox their patients so they don’t have to go to Heroin!  Talk to your doctor about this today.


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Breaking Down the Uptick in Adolescent Overdoses

Reuters

The leading cause of death for Americans under 50 is now accidental death by drug overdose. There’s been a significant climb in overdose deaths among those under 18.

When it comes to acknowledging the opioid epidemic, the U.S. has been faced with some harsh realities over the past several months. Perhaps most notable is a recent report from the Centers for Disease Control and Prevention that indicates the leading cause of death for Americans under 50 is now accidental death by drug overdose. The 2016 count of lives lost exceeds 64,000, a 19 percent increase from the previous year’s 52,000. These figures are heartbreaking.

 

Perhaps a more important statistic is that overdose deaths among adolescents (those ages 12 to 17) are up as well, with a strikingly similar 19 percent increase in the past year. This information is significant, and not just because it’s alarming. It also begs a different approach in how to address the problem.

 

Several governmental actions have been taken to curb the effects of this devastating crisis. Many states have adopted Good Samaritan laws, which encourage bystanders to call law enforcement for help if there’s concern for a potential overdose, without fear of prosecution for being involved in illicit activities themselves. There are also federal regulations with heavy sanctions on misguided prescribers who may be buffering their revenues by pumping out scripts for prescription opioids. Plus, there’s the overdose-reversing drug Narcan and subsequent funding for free community trainings, with ease of access through your physician or local pharmacy.

But where is the haste toward prevention?

 

In my 13 years working in the mental health and addictions counseling field, I can list over a dozen adolescent treatment programs (that I was personally acquainted with) that have closed simply due to lack of census. Services were being offered, but few were using them. Some of these programs, responding to an increase of young adults (18- to 26- year-olds) in need of treatment, converted their juvenile programs to fit the business’s needs.

Alongside the trend for more young adults seeking treatment, service providers continued to see further declines in adolescents accessing services. In essence, what we’re seeing is a decrease of identification in teens, and an increase as they transition into adulthood. There’s something horribly wrong with this picture. As a culture, we’re being reactive to a crisis as opposed to placing efforts to be proactive. This, unfortunately, is a making of the tragedy we see on the news each and every day.

 

Yes, prevention does exist; however, it’s fragmented at best. Most common prevention efforts take place in the school setting. One of the most frequently used school-based prevention programs has been empirically suggested to be ineffective, and yet the program gets renewed year after year in some states. Some states’ education departments require that school boards employ a specialist to handle substance use and other crises in their students; however, these professionals often occupy several roles within the district, and their time is often stretched too thin. Programming targeting parents to provide information on current trends and concerns regarding substance use are lightly attended. I’ve facilitated many of these workshops myself; in a student population of 1,200, if you can get 20 parents to attend, you’re in luck.

 

One thing is blatantly clear: When we’re not appropriately addressing substance use and addiction in adolescence, we are inundated with young adults literally fighting for their lives shortly thereafter.

I’m not saying that the approach we’re taking to the opioid crisis is wrong. Rather, it’s incomplete. We need to start the conversation about drug use and addiction at an early age. And no, “just say no” isn’t an acceptable means of prevention. “Just say no” is something that we feel more comfortable doing. We can just check it off the list, say that we “had the conversation,” and be done with it. In order to create change, we have to be OK with getting uncomfortable. This is how we’re going to save these kids lives.

Talk to your families about substance use. If you have a family history of addiction, there’s all the more reason to do this – your children may have a predisposition. Go to prevention programs offered in your community. Most, if not all, are free. Bring your kids with you. Talk about the program on the drive home. Have family dinners once in a while. Bring up any pop-culture or media references to overdose deaths, and listen to their reactions. Reach out and call the school your child attends to find out how they address prevention. Acquaint yourself with the personnel who coordinate it. Introduce your child, too. Research other agencies in your community, and participate or volunteer in their events from time to time.

 

There are limitless ways that we can make small impacts in our families and our communities. Stigma usually hold us back. Stigma also adds to this crisis. However, if we’re more active in our prevention efforts, not only will we see a reduction in adolescent overdoses, but over time we will not have an opioid epidemic on our hands.

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CDC Report Finds Overdose Deaths Rose 21 Percent in 2016

A new report released Friday by the Centers for Disease Control and Prevention reveals deaths from drug overdoses in America rose 21 percent last year. That jump is more than the last four years combined. For every 100,000 people, almost 20 died from a drug overdose in 2016, compared to 16.3 the previous year, Bloomberg reported.

The report shows deaths from liver disease, suicide, cancer and HIV have decreased. However, the overall death rate continued to increase. Farida Ahmad, the report’s author and mortality surveillance lead at the CDC says this is because people are dying in larger numbers from other causes, such as drug overdoses, or homicides and firearm-related injuries, both of which also rose last year.

 

The CDC measures 20 causes of death in its report, and although there are slight increases in other categories, Ahmad says drug overdoses show “the most stark increase,” WTKR News reported. Every quarter in 2016 saw an increase in the number of deaths related to drug overdoses.

 

These findings come shortly after President Donald Trump declared the opioid crisis in America a public health emergency. This allows the Trump administration and Department of Health and Human Services to allocate funding and resources to address the crisis under the Public Health Emergency Act. The order lasts for 90 days and can be renewed every 90 days until deemed unnecessary.

 

The president had been heavily criticized over his handling of the epidemic after he announced he would declare the crisis a national emergency but did not. A declaration of national emergency would have allowed for additional funding from the Federal Emergency Management Agency’s Disaster Relief Fund.

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Are You an Addict? Signs of a Prescription Drug Addiction

You just may not know you’re addicted when your drug dealer is your doctor.

Woman is suddenly stricken with sadness

When you’re sick or have suffered from a serious injury, the first few days after a visit to the doctor you rely heavily on the prescribed drug to ease the pain and get you through the day. However, you may reach a point where you feel compelled to continue taking the prescription long after you need it. If you think you or a loved one might have a problem with prescription drugs, there are some red flags you should watch out for.

The Cheat Sheet spoke with some of the country’s top addiction experts to learn more about prescription drug abuse.

There is sudden behavior change

One of the first signs of a prescription drug addiction is an abrupt change in behavior. If you suspect the abuse of prescription medication, take note of unusual behavior you hadn’t observed before.

Psychologist Matthew Polacheck, director of outpatient services at the Betty Ford Center in West Los Angeles, said behavioral changes may also be accompanied by cognitive and physical changes. “The first thing we look for is a change in behavior of any kind. [Someone] who never naps comes home and goes to sleep. [Someone] who is passive suddenly becomes more euphoric. More specific behavior includes nodding off, drowsiness, slurred speech, confused thinking, and pupils can also be constricted.”

The drug becomes part of a daily routine

Medications on shelves of medicine cabinet

If you or someone you know can’t seem to go a day without a prescription drug that was meant for short-term use, this is another red flag. Over time, short-term medication should be slowly tapered down until there is no longer a need for it.

Audrey Hope, an addictions specialist at Seasons in Malibu World Class Addiction Treatment, said if there is difficulty in stopping a drug, this should be a cause for concern. “The main sign that you are a prescription drug addict is that you use the drugs every day. You can’t function without them. You rely on them. You need them. You lie to yourself that it is for the ‘pain’ and because ‘the doctor prescribed it.’ You say it is OK to use them,” said Hope.

More of the drug is used than prescribed

Doctor handing pills to a patient

Another sign of trouble is using too much of the prescription and running out of the drug much earlier than expected considering the prescribed amount. Someone desperate for a refill may resort to manipulative behavior to obtain the drug, said Plattor. “Other signs of prescription addiction can include manipulative behaviors such as lying, stealing, using more of the drug than is prescribed, poor decision-making, ‘losing’ prescriptions often, and obtaining a number of prescriptions for the same drug(s) from more than one doctor,” Plattor said.

Misconceptions about prescription drug addiction

man pouring pills into his hand

There are many misunderstandings when it comes to an addiction to prescription drugs. Here are some of the most common ones.

Myth: Pain pills are the only addictive prescription drugs

Pink pills

While pain medications are commonly abused, there are many others that can become addictive. “In addiction treatment, what we see most is opioid abuse. We also see abuse of ADHD medications, such as Adderall or Ritalin. Medications like benzodiazepines can also be substances of abuse. Drugs given for anxiety or depression, especially when given without concurrent psychotherapy, can lead to substance abuse problems,” said Dr. Constance Scharff, the research director of addiction treatment center Cliffside Malibu and author of Ending Addiction for Good.

Myth: I trust my doctor so I don’t need to ask questions

Doctor looking at tablet

Ask questions about your prescription, and don’t just blindly trust your doctor. It’s important to check with your doctor and make sure you understand side effects as well as how much medicine you should take and when to stop. You should also let your physician know if you’re having a hard time stopping your medicine.

Where to get help

Psychologist making notes

If you’re looking for assistance for yourself or a loved one, know there is quality help out there. You can reach out to a support group or consider seeking the services of an inpatient or outpatient detox program. You can start your search online on websites such as VictoryRetreatMontana.com. 

 

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Patients Treated with Naloxone Continue to be at High Risk of Overdose: Study

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A new study finds 10 percent of people saved by the opioid overdose antidote naloxone die within a year of treatment.

“Patients who survive opioid overdoses are by no means ‘out of the woods,’” lead study author Scott Weiner, MD, Director of the Brigham Comprehensive Opioid Response and Education Program at Brigham and Women’s Hospital, said in a news release. “These patients continue to be at high-risk for overdose and should be connected with additional resources such as counseling, treatment and buprenorphine.”

The study, presented at the annual meeting of the American College of Emergency Physicians, found half of patients who died within a year of naloxone treatment died within one month of treatment, Health Day reports.

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President’s Commission on Opioid Crisis Calls for Nationwide System of Drug Courts

 

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President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis released its final report on Wednesday, calling for expanding drug courts into all 94 federal court jurisdictions. The commission also recommended easier access to alternatives to opioids to treat pain, The Washington Post reports.

Drug courts are specialized court programs that target criminal defendants and offenders, juvenile offenders, and parents with pending child welfare cases who have alcohol and other drug dependency problems.

The commission made more than 50 recommendations, including requiring doctors and others who prescribe opioids to demonstrate they have received training in safely providing the drugs before they can renew their licenses to handle controlled substances with the Drug Enforcement Administration.

Providers should be required to check prescription drug monitoring databases to ensure patients aren’t “doctor shopping” for prescription drugs, the commission said. In some states, use of the databases is voluntary, the article notes.

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The tide is FINALLY turning: Big Pharma billionaire ARRESTED, charged with CONSPIRACY & BRIBERY OF DOCTORS!

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I almost never thought I’d see the day when a Big Pharma founder and owner was finally arrested for running a criminal drug cartel, but that day has arrived.

“Federal authorities arrested the billionaire founder and owner of Insys Therapeutics Thursday on charges of bribing doctors and pain clinics into prescribing the company’s fentanyl product to their patients,” reports the Daily Caller News Foundation, one of the best sources of real journalism in America today.

Addictive drugs that include opioids, we now know, are claiming over 64,000 lives a year in the United States alone.

From the DCNF:

The Department of Justice (DOJ) charged John Kapoor, 74, and seven other current and former executives at the pharmaceutical company with racketeering for a leading a national conspiracy through bribery and fraud to coerce the illegal distribution of the company’s fentanyl spray, which is intended for use as a pain killer by cancer patients. The company’s stock prices fell more than 20 percent following the arrests, according to the New York Post.

Kapoor stepped down as the company’s CEO in January amid ongoing federal probes into their Subsys product, a pain-relieving spray that contains fentanyl, a highly-addictive synthetic opioid. Fentanyl is more than 50 times stronger than morphine, and ingesting just two milligrams is enough to cause an adult to fatally overdose.

The series of arrests came just hours after President Donald Trump officially declared the country’s opioid epidemic a national emergency. Drug overdoses led to 64,070 deaths in 2016, which is more than the amount of American lives lost in the entire Vietnam War.

As the opioid crisis has developed, more and more states have begun holding doctors and opioid manufacturers accountable for over-prescribing and over-producing the highly-addictive painkillers.

“We will be bringing some major lawsuits against people and companies that are hurting our people,” Trump said Thursday. He also spoke about a program similar to Nancy Reagan’s “Just Say No” initiative.

“More than 20,000 Americans died of synthetic opioid overdoses last year, and millions are addicted to opioids. And yet some medical professionals would rather take advantage of the addicts than try to help them,” Attorney General Jeff Sessions said in a statement. “This Justice Department will not tolerate this.  We will hold accountable anyone – from street dealers to corporate executives — who illegally contributes to this nationwide epidemic.  And under the leadership of President Trump, we are fully committed to defeating this threat to the American people.

President Trump is bringing the war to Big Pharma’s doorstep

Under President Trump, who continues to fight to end the drug cartels and health care monopolies that are destroying this nation, we may see more and more drug companies finally facing the legal scrutiny they deserve for engaging in the mass medical murder of Americans with dangerous, deadly drugs.

And then there’s the question of vaccines, the autism cover-up and the criminal racket run by the CDC, Big Pharma and the lying mainstream media. When that medical fraud and corruption scandal blows sky-high, we may see dozens of pharmaceutical officials going to prison.

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Opioid Crisis Spurs Change at Medical Schools

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Medical schools are responding to the nationwide opioid epidemic by changing the way they train future doctors.

Over the past 15 years, many U.S. medical schools have begun offering lessons, courses and clinical rotations in drug addiction treatment and pain management, experts say, and some schools have added these topics to their required curriculum.

Faculty at schools that require all students to learn about addiction and pain say their goal is to ensure that graduates understand the differences between situations where an opioid prescription is an appropriate treatment for a pain condition and when it isn’t the best option.

Recent medical school graduates who received this training say it has helped them make decisions about whether to prescribe an opioid drug.

“I felt more comfortable and confident in myself, knowing not only when to say no but also when to say yes,” says Dr. Kevin O’Day, a 2016 graduate from the University of Massachusetts School of Medicine who is now an internal medicine resident at the university.

Regarding the lectures on addiction and pain he’s received as a student at the University of Pennsylvania’s Perelman School of Medicine, Nadir Bilici said via email, “It has been useful to understand the challenges that patients with drug addiction face beyond receiving clinical treatment; we have learned how various socio-politico-economic factors go into making and breaking communities of addiction.”

Experts say that it’s important for aspiring doctors to learn how to avoid either overprescribing or underprescribing opioid medications, since this comes up in most areas of medicine, including surgery and primary care.

“Nobody wants the patient to suffer because their pain was undermanaged,” says Dr. Karen Sibert, an anesthesiologist and associate clinical professor with the David Geffen School of Medicine at the University of California—Los Angeles.

Sibert says most medical schools have bolstered the amount of training they provide on opioid alternatives, including intravenous versions of non-narcotic pain medicines and medical procedures that numb portions of the body where pain is present.

 Experts say it’s critical for all aspiring doctors to learn how to safely manage the pain of patients who suffer from either chronic or acute pain. They say it’s also important for future physicians to understand that people with chronic pain often visit doctors without any obvious symptoms besides a declaration that they feel pain.

“They don’t look sick like someone with acute pain,” says Dr. Daniel Alford, professor of medicine at the Boston University School of Medicine. “When you have acute pain, your heart rate goes up, your blood pressure goes up, you look terrible, but with chronic pain, you can look like anyone else but you have this terrible chronic pain.”

Because there are not visible signs of chronic pain, Alford says, doctors are often skeptical of whether patients who claim to feel chronic pain are feeling pain at all.

Learning how to interview and counsel patients who express pain is a key skill to learn during medical school, experts say, and this can be cultivated through clinical simulations. Some of these simulations show students how to reject a request for an opioid prescription from someone who is misusing the drug.

 One key sign that a medical school provides solid training in pain and addiction medicine, according to experts, is if it offers the opportunity to listen to panels of patients who have suffered from either a pain condition or drug addiction. Another positive sign is if the school offers field trips to addiction treatment centers or addiction self-help group meetings, or if it has pain management specialists on its faculty.
Because of the prevalence of opioid misuse, experts emphasize that medical students need to learn how to recognize when a patient suffers from an opioid addiction, suppress opioid withdrawal symptoms and treat an opioid overdose. They say it’s not important whether a school’s lessons about pain and addiction medicine are taught in stand-alone courses as long as these topics are taught.

“I don’t really think you can look for a specific course,” says Dr. Melissa Fischer, associate dean for undergraduate medical education at the University of Massachusetts. “Just because somebody has a pain management course doesn’t mean they’re doing something better or differently than somebody that doesn’t have a course with that name.”

However, Fischer says it’s important to attend a medical school that addresses opioid addiction somewhere in its curriculum, because this kind of common addiction is a quickly progressing and frequently fatal.

“One of the issues with opioid misuse as a chronic disease is that most chronic diseases kill people slowly and silently, but opioid use disorder does not,” she says. “It kills people quickly and when they’re young.”

Dr. Mishka Terplan, associate director of addiction medicine and professor at the Virginia Commonwealth University School of Medicine, says the opioid crisis has led to vital reforms at medical schools. “The future of medicine is going to look very different in very good ways as a consequence of the tragedy that we’re living through,” he says.

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Big Pharma Plays Every Dirty Trick in the Book to Transform Teens and Adults Into Opioid-Zombified Addicts

Prescription Drug AddictionOver a 40-year career, Philadelphia attorney Daniel Berger has obtained millions in settlements for investors and consumers hurt by a rogues’ gallery of corporate wrongdoers from Exxon to R.J. Reynolds Tobacco. But when it comes to what America’s prescription drug makers have done to drive one of the ghastliest addiction crises in the country’s history, he confesses amazement.

“I used to think that there was nothing more reprehensible than what the tobacco industry did in suppressing what it knew about the adverse effects of an addictive and dangerous product,” says Berger. “But I was wrong. The drug makers are worse than Big Tobacco.”

The U.S. prescription drug industry has opened a new frontier in public havoc, manipulating markets and deceptively marketing opioid drugs that are known to addict and even kill. It’s a national emergency that claims 90 lives per day. Berger lays much of the blame at the feet of companies that have played every dirty trick imaginable to convince doctors to overprescribe medication that can transform both teens and adults into zombified junkies.

So how have they gotten away with it?

A Market for Lies

The prescription drug industry is a strange beast, born of perverse thinking about markets and economics, explains Berger. In a normal market, you shop around to find the best price and quality on something you want or need—a toaster, a new car. Businesses then compete to supply what you’re looking for. You’ve got choices: If the price is too high, you refuse to buy, or you wait until the market offers something better. It’s the supposed beauty of supply and demand.

But the prescription drug “market” operates nothing like that. Drug makers game the patent and regulatory systems to create monopolies over every single one of their products. Berger explains that when drug makers get patent approval for brand-name drugs, the patents create market exclusivity for those drugs, which protects them from competition from other brand drugs that treat the same condition as well as from generics. The manufacturers can now exploit their monopoly positions created by the patents by marketing their drugs for conditions for which they never got regulatory approval —and this dramatically increases sales. They can also charge very high prices because when you’re in pain or dying, you’ll pay virtually anything.

Using all these tricks, opioid manufacturers have been able to exploit the public and have created a whole new generation of desperate addicts. They monopolize their products and then, as Berger puts it, “market the hell out of them for unapproved and dangerous uses.”

Opioids are a drug class that includes opium derivatives like heroin (introduced by German drug maker Bayer in 1898), synthetics like fentanyl, and prescription painkillers like oxycodone (brand name: OxyContin). A number of factors are aggravating the addiction crisis: There has been a movement in medicine to treat pain more aggressively, while at the same time wide-ranging economic distress has generated a desire to escape a dismal reality. But a key driving force is doctors who have been wooed by Pharma marketing reps overprescribing for chronic pain.

“For the first time since the years after heroin was invented,” writes investigative journalist Sam Quinones in Dreamland: The True Tale of America’s Opiate Epidemic, “the root of the scourge was not some street gang or drug mafia but doctors and drug companies.”

Doctors were once reluctant to write prescriptions for opioids. The U.S. drug regulator, the Food and Drug Administration, would only approve such drugs for severe cases like cancer patients in chronic agony or certain people in short-term pain after, say, an operation. But representatives of Connecticut-based drug maker Purdue, which released OxyContin in 1996, along with other companies, began to flood doctors’ offices with reports asserting that using the drug for off-label purposes was harmless. Often the targets were primary care physicians with little training in addiction. Have a chronic arthritis case? Give your patient OxyContin. Tell folks to take it every day, for weeks, even years, to treat just about any kind of chronic pain. The upshot was dependence, typically not because people were getting high for fun, but because they were using a legal drug in precisely the way the doctor ordered.

Purdue and others whisked doctors to stylish retreats to push them to prescribe drugs for uses not approved by U.S. regulators—a marketing strategy banned by federal law. They even created fake grassroots organizations to make it seem as though patients were demanding more prescriptions. Pharmaceutical companies like to dodge responsibility for the opioid crisis by blaming dishonest distributors and pointing out that they’re not the ones prescribing or handing out drugs to patients. True enough: They don’t need to, because they’ve done their work hooking you long before the drug is in your hands.

“The marketing is not only fraudulent; it’s incredibly elaborate,” says Berger. “Fake scientific studies promote the lie that opioids are better than other medications for pain. They’ve gone to just about any length. Bribery, you name it. It’s outrageous.”

OxyContin is so addictive it can create physical dependency in a matter of weeks. As drug makers and doctors who began to dole out pills by the handful in pain clinics learned, addicts do not behave like ordinary consumers: They don’t “choose” to buy or to wait until next week. They need their drug right away and will do anything to get it because if they don’t they will suffer excruciating symptoms.

Los Angeles Times report shows that among the lies Purdue spread about OxyContin was that one pill subdued pain for 12 hours. Except that for many patients it wears off much sooner, exposing them to unbearable pain and withdrawal. Purdue knew this, but feared lower sales if it admitted the truth. So sales reps advised doctors to just give stronger doses, which increased the addiction risk. As the money from hooked patients piled up, so did the bodies.

In 2007, Purdue pleaded guilty in federal court in Virginia to misleading doctors and patients about OxyContin’s safety and paid a $600 million fine. But that sum was hardly an annoyance. From 1995 to 2015, Purdue made $35 billion from OxyContin sales alone. The Sacklers, who own the company, is now one of the richest families in America, as revealed by this triumphant Forbes spread. They know that lax regulation keeps the heat off, and that even litigation and criminal prosecutions can do little to stop them. Berger says that until such legal programs are massive in scale and scope, companies will go on with business as usual.

“We have to have injunctive relief [a court order to stop a behavior] that bans the marketing to doctors of opioids completely for unapproved uses, as well as an expansion of the FDA and DEA to specifically target the drugs,” says Berger. His law firm, Berger & Montague, is involved in the effort to seek relief for the city of Philadelphia, which has seen above-average opioid prescribing and suffered the highest rates of fatal drug overdoses in the state last year.

Even though prescriptions have been slightly reduced across the country since 2012, Philadelphia is finding out what happens to many people hooked on opioids when they can’t get a prescription or find the price too high: They turn to heroin. Fatal overdoses of heroin, oxycodone’s close cousin, have been skyrocketing since 2007 across the country.

‘Landscapes of Despair’

The opium poppy has been part of human history since at least 3,400 BCE, when it was cultivated in Mesopotamia as the “joy plant.” Derivatives such as laudanum and morphine offered more convenient, and people wrongly believed, safer ways to get the plant’s benefits. Bayer originally touted heroin as a non-addictive substitute for morphine (even for children) until it was outlawed in the U.S. in 1925. Rendering it illegal did not stop it from destroying the lives of many of America’s most celebrated artists, from Billie Holiday to Philip Seymour Hoffman. Drug overdoses now kill more people than gun homicides and car crashes combined. In 2015, nearly two-thirds of all overdoses had one thing in common: opioids.

Syracuse University’s Shannon Monnat, a sociologist focused on rural issues and an INET grantee, has been studying the epidemic and how it impacts various populations. Her research reveals that the rise in drug-induced deaths has been especially sharp among middle-aged people (45-55), with prescription opioid overdoses increasingly impacting both middle-aged and older populations. Heroin, whose sedating and euphoric effects are very similar to prescription narcotics, looks to be the culprit in more young adult overdoses.

Monnat considers how the opioid crisis points to bigger societal problems impacting the economy, educational institutions, the health care system, political systems, and communities. Her work centers on investigating the characteristics of what she calls “landscapes of despair”—places where people are hurting economically and socially, like Appalachia, the industrial Midwest and parts of New England. She points out that persistent disadvantage and long-term poverty are clearly connected to the opioid crisis, noting that many of the areas most impacted were once robust centers of manufacturing before jobs moved to other countries.

Opioid addiction seems to thrive in downwardly mobile small cities in rural areas—but not all of them. “What’s fascinating is that some of these areas have very high mortality rates from drug overdose, like Appalachia,” say Monnat. “But others, like the Southern ‘Black Belt’ [a region that stretches across Alabama and Mississippi], have not seen such rises.”

Originally named for its rich, dark, soil, which attracted cotton planters in the 19th century, the Black Belt has a high population of African Americans. The area has a history of unremitting poverty, low incomes, high unemployment, and high mortality. Yet despite many hardships, which are linked to the legacy of slavery, Monnat says that the region is also distinct for its “very tight-knit communities, strong kinship networks, and other networks where people can find emotional support.” It seems that when people have somewhere to turn in hard times, they may build up immunity to an epidemic like the opioid scourge.

Ironically, another factor that may have protected these communities, discussed by Quinones in Dreamland, is prejudice: The low-profile heroin dealers originating from Mexico’s west coast who are associated with the current opioid scourge prefer to target white communities. They also avoid big cities where large cartels are already established. So small, predominately white towns are their sweet spot.

Appalachia is known for kinship networks, but it also has a legacy of isolation and an outlaw tradition associated with the history of moonshining and bootlegging which can feed into today’s underground selling and distribution of opioid drugs. In this region, much of the struggling white working-class has seen economic distress with little hope of relief from America’s political system. Democrats often openly disdain the people they call rednecks and hillbillies, while concentrating on identity politics rather than economic distress. Republicans promote policies of free trade and deregulation that cast the region further into destitution.

Monnat has found that counties with large numbers of people employed in physical labor—especially physical occupations with higher disability rates—have higher drug fatalities. These are places where coal miners work in backbreaking positions and military veterans suffer the pain of injuries. Drug companies have besieged these areas with aggressive marketing of pain pills. “In Appalachia, you’d see mining companies with physicians on staff prescribing opioids to keep people in pain working,” she says. “That was happening before OxyContin, but companies like Purdue targeted these communities to push OxyContin as a safer alternative to other pain medications.”

The National Institutes of Health report that the opioid epidemic, which started as a regional crisis, is now a national crisis, decimating communities and even helping to reshape the American political landscape. Monnat finds a relationship between the landscapes of despair and the 2016 presidential election. Voting patterns show that areas in which President Trump did better than expected, like Pennsylvania and Ohio, were also places where opioid overdoses and deaths from alcohol and suicide occurred at high rates over the past decade.

During his campaign, Trump expressed concern for people in regions like Appalachia and flung stinging barbs at the politicians who had failed them. These voters supported him in high numbers, yet his policies will likely give more power to the pharmaceutical companies that have turned their suffering into stock windfalls.

Profit Trumps People

Trump the campaigner shook his fist at Big Pharma for “getting away with murder”—one of those statements that occasionally drops from his lips with atomic accuracy. But Trump the president has done an about-face. As journalist David Dayen pointed out, a draft of an executive order on drug prices (which never materialized) called for deregulation of the FDA and favors to industry. It was written by a pharmaceutical lobbyist.

In March, President Trump issued an executive order creating a commission to study drug addiction and the opioid epidemic. The commission, headed by New Jersey Governor Chris Christie, has so far released recommendations that locate the overprescribing problem “in doctor’s offices and hospitals in every state in our nation,” while making nary a mention of pharmaceutical marketing departments. The panel suggests insufficient remedies like new treatment facilities and educating schoolchildren on the dangers of opioids, along with ineffective ideas like more funds to Homeland Security. Regulation of Big Pharma? Nope.

The federal government did announce it would team up with drug makers to research and generate non-opioid pain medications and additional medication-assisted treatment options. Among the participants? Purdue.

Economist William Lazonick of the University of Massachusetts Lowell and an INET grantee, agrees with Berger that the way the pharmaceutical industry operates amounts to a catastrophe for the public. “It’s crazy that each and every drug is not treated like a regulated monopoly,” he says. “Taxpayers fund much of the research that goes into creating these drugs through the NIH and other public research facilities. Moreover, the companies are gifted with a monopoly through patents which last two decades.”

Lazonick notes that Big Pharma claims it needs high profits to keep inventing new drugs, but the industry spends more of its profits buying back its own stock than increasing investment in R&D on new drugs. Executives running drug companies are incentivized to make profits any way they can because they are rewarded by high stock prices. Lazonick explains that they stoke those stock prices by gouging patients or lying about the safety of products—whatever it takes.

He observes that for the past several decades America has undergone a devastating experiment based on the philosophy of economist Milton Friedman, who claimed that the only social responsibility of a company is to make a profit. Untimely deaths from tobacco-related illnesses, auto safety failures, and now, harmful opioid drugs, prove that the experiment is a tragic failure.

Lazonick sees the need for nothing less than a new structure of corporate governance that ensures the ethical responsibly of drug makers to do what they are supposed to do: create high-quality, low-cost products that are safe. The current structure, based on the misguided idea that companies should be run for the sole purpose of enriching shareholders, is particularly perverse when it comes to products that are potentially fatal. The problem with this model is that when shareholders are the only people who matter, the rest of us suffer.

Since taxpayers support pharmaceutical companies by funding public research and many other things they require to do business, Lazonick says it is only fair and logical that someone representing the public sits on their boards. Berger adds that companies should be required to make drugs widely available at affordable prices in return for their use of publicly funded basic research at no cost whatsoever.

America, for the time being, stands out among nations in letting pharmaceutical companies run amok to inflate drug prices, advertise and market drugs without proper regulation, and use taxpayer resources while exposing them to egregious harm. “The only thing America’s drug companies are competitive about,” says Lazonick, “is getting people addicted.”

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