opioid prescriptions – Opiate Nation

Looking Back to See the Future

(Translation into most languages is available to the right.)

When I am doing research for an upcoming blog post, I can get lost. There is so much information now on drug addiction and the opioid epidemic that I suddenly look at the clock and realize I’ve been wandering virtually around the world and becoming more discouraged with each new article or report: Scotland has more drug overdose deaths per capita than any European country (1); Fentanyl is flooding California with overdose deaths skyrocketing (2); the use of over-the-counter codeine (an opiate) cough medicine among eighth graders in the US has increased (3); and, Australia now has the eighth-highest per-capita opioid consumption in the world (4).

The Politics of Drugs: Purdue & the DOJ

(Seventh in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

When public health is at risk, one can only wonder about the motives behind politicians’ decisions – our “public servants” as they used to be referred to – regardless of what they may say. But we don’t have to guess their motives because actions speak louder than words and the actions of the US Department of Justice (DOJ) this week regarding Purdue Pharma and the Sackler family are unconscionable. This deal is not justice for the victims and their families for this pervasive and criminal corporate greed.

Lifespan of Heroin & Opioid Addicts

(Second in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right. If you feel this blog is important, please repost to your social media using the buttons below. Thank You!)

When our 25 yr old son died of a heroin overdose in 2014, the statistics for the average life-span of a heroin addict was 5 years. Five years. Not very long if you are 15 or 20 or even 30, the age when most young adults’ nowadays are just getting in gear with their career, a long-term relationship, and planning a family. To have your life swept away before you have a chance to experience some of the most wonderful years of living on this earth is painful to consider.

Woefully Unprepared

(Today begins a series of topical blogs based on excerpts from Opiate Nation, chapter by chapter, that will run for 28 weeks. Translation into most languages is available to the right.)

It’s a bit ironic that as I begin blogging through Opiate Nation we are in the midst of a pandemic. Ironic in several significant ways.

Opiate Nation was written because of the opioid epidemic – which, in reality, is a pandemic. Every industrialized nation, and many emerging and third-world nations too, are dealing with the results from the ease of availability of opioids, whether natural and home-grown, or synthetic and imported. Or both, as is the case in America.

And like the Coronavirus pandemic that crept up on us so gradually that it’s deadliness caught us by surprise and mostly unprepared as nations, the opioid epidemic crept up on us too. In both cases, certain international players were unscrupulous for various reasons, causing delays in awareness when there might have been a chance for all of us to not be caught off balance.

The “inoculation” that should have happened, especially in the United States, by way of accurate scientific information disseminated by responsible leaders, didn’t happen. Instead, false information fueled by political agendas and financial motivation created a scenario that so crippled a timely public health response that, for many nations, it became too little too late.

CAN MONEY REALLY COMPENSATE ?

CNN reported this week that Mallinckrodt, a large opioid manufacturer, has reached a settlement agreement in principle worth $1.6 billion with attorneys general for 47 states and US territories. Mallinckrodt announced that the proposed deal will resolve all opioid-related claims against the company and its subsidiaries if it moves forward. Plaintiffs (states) would receive payments over an eight-year period to cover the costs of opioid-addiction treatments and other needs.

Compensation: recompense given for loss injury, or harm suffered. Are the settlements that are being levied against Purdue Pharma, Johnson & Johnson, TEVA, Mallinckrodt, McKesson Corp., Cardinal Health Inc., AmerisourceBergen Corp. really compensation for the millions of lives ruined by opioid addiction? Or for all the lives lost in the past 20 years?

American Pain

From my earliest memories, I have had leg aches. They come on fairly suddenly for no apparent reason. It wasn’t until my 20’s when I figured out they related to the weather and changes in barometric pressure. I know, it sounds like folk-magic. But it’s true . As I was growing up, my parents would wrap my knees in stretch bandages and rub my legs with witch hazel. One thing they never did was offer me a pill for my pain. Never. In the pre-1980’s world, pain was part of life and mostly bearable.

My how things have changed. America–with 5% of the world’s population–went from consuming less than 5% of the world’s prescription opioids in the 1960’s to now consuming some of the highest percentages of prescription opioids such as oxycodone, morphine, fentanyl, etc.

In 2015, John Temple, an investigative journalist and journalism professor, wrote American Pain. It was one of three key books released that year in response to our opioid epidemic, the other two being Dreamland and The Big Fix. The title is taken from the “king” of the Florida pill mills, American Pain, a mega-clinic expressly created to serve addicts posing as patients. From a fortress-like former bank building with security guards, American Pain’s five doctors distributed massive quantities of oxycodone to hundreds of customers a day, mostly traffickers and those addicted, who came by the van load. Former strippers operated the pharmacy, counting out pills and stashing cash in garbage bags. Under their lab coats, the doctors carried guns. Continue reading “American Pain”

Medication Assisted Treatment – Part 1

Medication Assisted Treatment, or MAT, is finally gaining acceptance as a response to drug addiction in the US––it is a cultural shift from the view that addiction is a “moral failure.” The Hazelden Betty Ford Foundation, one of the top drug treatment providers in the country, used to subscribe almost exclusively to the abstinence-only model, based on an interpretation of the 12 steps of Alcoholics Anonymous and Narcotics Anonymous popularized in American addiction treatment in the past several decades. But in 2012, they announced they would begin providing MAT. There are four opioid substitutes that are used for MAT in opioid addiction: methadone, buprenorphine, naloxone, and naltrexone. More on these in the next blog.

November 6, 2013, the New York Times did an extensive article discussing the development, use, and risks of opioid substitutes, in particular bupreorphine and the combination drug, Suboxone. The author explaining that “While addiction is considered a chronic, relapsing disease, experts believe that replacing illegal drugs with legal ones, needles with pills, or more dangerous opioids with safer ones reduces the harm to addicts and to society. Addicts develop a tolerance to its euphoric effects and describe themselves as normalized by it, their cravings satisfied. It also diminishes the effects of other opioids but, studies have shown, does not entirely block them, even at the highest recommended doses.”

In a Frontline report in 2016, one of the doctors who specializes in addiction medicine related that doctors are limited by the DEA to treat only 100 patients per year with Suboxone. The thought behind this law is that they don’t want it to be abused––and it can be abused, as a commodity sold on the street to ward of withdrawals or for those who cannot afford the cost of a doctor and the medication. Our family faced the dilemma of the high costs for the doctors visits and the Suboxone because they were not covered by our son’s health insurance. We made the decision for him to not use this option, all hoping that a sober living house and meetings would help him succeed in his desire for sobriety. He was dead from a heroin overdose 7 months later.

The physician on Frontline pointed out the contradiction––the contradiction that has frustrated me and my husband for years––that there is still no limit on how many oxycodone or other opioid prescriptions physicians can write—the very abuse of which is documented to be fueling the opiate epidemic and creating the need for Suboxone. I personally experienced this absurd mentality towards opiates when my oral surgeon sent me home with 60 Vicodin after a root canal––60. I used two. He is the same oral surgeon who did JL’s wisdom teeth extraction and gave him multiple prescriptions for Percocet two weeks before and two weeks after the surgery––which fueled his relapse on heroin and ultimately, his death. He should have his license revoked.

As of a 2017 report by SAMHSA (Substance Abuse and Mental Health Services Administration), physicians who have prescribed buprenorphine/Suboxone to 100 patients for at least one year can now apply to increase their patient limits to 275 under new federal regulations. It is good to see movement in the right direction and I hope there will be more progress soon, especially in terms of making medication options a covered public health care benefit available to addicts who want to get their lives back.