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ArticlesonPainand
dependencyandasolution
totheSINtheticdrug
problem
ArticlesonPainanddependencyandasolutiontotheSINtheticdrugproblem..................1
ThisPoliceDepartmentJustChallengedBigPharmaAndWon................................................2
BigPharmaSlappedwithAnotherAddictionLawsuit..........................................................................4
HoldingBigPharmatotheFire............................................................................................................5
FightingBackAgainstOpiateAddiction..............................................................................................5
IndividualCountiesFilingSuit..............................................................................................................6
HowABigDrugCompanyInadvertentlyGotAmericansHookedOnHeroin.................................7
UseOfOpiateAndOtherAddictiveDrugsReducedByTherapeuticCannabis............24
ThisPoliceDepartmentJustChallenged
BigPharmaAndWon
TOPICS:BigPharmaHeatherCallaghanPolicePrescriptionDrugsWarOnDrugs
SEPTEMBER22,2015
ByHeatherCallaghan
Readyforapositivepolicestory?Wherewillitlead–youdecide.
Yesterday,IreportedatNaturalBlazethataGloucester,MassachusettspolicedepartmentfedupwithBigPharmapostedthetop5CEOsalariesandemailsonline.TheirFacebookstatuseruptedwithcheersinthecommentsandmanyshares.Thedepartmentbemoanedthecity’sdrug
problemandtookaimatBigPharma’sroleincreatingaddictionthroughprescriptionopioid
painkillers.
TheBigPharmasalarieswereasfollows:
5.EliLilly–[email protected]
4.AbbottLabs–[email protected]
3.Merck–KennethC.Frazier$25million+coolprivatejet.ken.frazier@merck.com908-
423-1000
2.Johnson&Johnson–[email protected]
1.Pfizer–[email protected]
ThedepartmenturgedpeopletopolitelypresstheCEOsabouttheircompanies’rolesinthe
statisticthat80%ofdrugaddictionstartswith“gateway”legalpainkillers.Indeed,theFDAjust
approvedopiateuseforchildreneventhoughstateswheremedicalmarijuanaislegalhaveseena25%dropinpainkillerdeaths.And,amajorreviewlastyearfoundthatpharmaceuticalpainkillerscausemoredeathsthancocaineandheroincombined.
Thedepartment’surgingworked.
SomeonefromPfizercalledtomeetwiththemandpeoplefollowingthepageareawaitingthe
results.
BigPharmaSlappedwith
AnotherAddictionLawsuit
PostedDecember30,2014inAddictionCulture,AddictionintheNews,DrugLawand
CrimebyMcCartonAckerman
Photoviapixabay
Muchliketherestofthenation,Chicagoisinthemidstofaprescription
painkilleraddictionepidemic.Thedifference,however,isthatChi-Townis
doingsomethingaboutit.Thecityisattemptingtoholdthepharmaceutical
companieswhomakeandmarketthesehighlyaddictivedrugslegallyresponsiblefortheresultingdevastationtheyhavecaused.
HoldingBigPharmatotheFire
ChicagoMayorRahmEmanuelisgearingupforalawsuitfiledagainstfiveleadingdrugcompanies,includingJohnson&Johnson.Thesuitwasinitially
filedlastJuneandasksforanunspecifiedamountofmonetarycompensation.
Accordingtothelegaldocuments,allfivepharmagiantsareaccusedofhiding
therisksassociatedwithopiatepainkilleruse,whilesimultaneously
overstatingthebenefits.
Thecomplaintsaysthat“thecityhaspaidfornearly400,000claimsforopioid
prescriptionfills,costingnearly$9,500,000”andhas“sufferedadditional
damagesforthecostsofprovidingandusingopiateslong-termtotreat
chronicnon-cancerpain.”
Accordingtoa2009reportfromtheU.S.DepartmentofHealthandHumanServices,about1,080Chicagoansweresenttoemergencyroomsforadverse
effectsdirectlyrelatedtoopioiduse,includingoverdoses.
“Foryears,bigpharmahasdeceivedthepublicaboutthetruerisksand
benefitsofhighlypotentandhighlyaddictivepainkillersinordertoexpand
theircustomerbaseandincreasetheirbottomline,”saidChicagoMayorRahmEmanuelinastatement.“It’stimeforthesecompaniestoendthese
irresponsiblepracticesandbeheldaccountable.”
FightingBackAgainstOpiateAddiction
Othercitiesandstateshavealsosteppeduptofilelawsuitsagainstpharmaceuticalcompaniesforthesamereasons.Forexample,Kentuckyfiled
itsown$1billionlawsuitagainstOxycontinmakerPurduePharmalastmonth.
Courtdocumentsrevealthestateclaimstohavelost$1billionpayingfor
overdoses,addiction-relateddeathsanddrug-relatedcrime–allofwhich
stemfromOxycontinabuse.
…thestateclaimstohavelost$1billionpayingforoverdoses,
addiction-relateddeathsanddrug-relatedcrime–allofwhichstem
fromOxycontinabuse.
“IwanttoholdthemaccountableineasternKentuckyforwhatthey
did,”saidKentuckyAttorneyGeneralJackConway.“Wehavelostanentiregeneration.HalfthepharmaciesinPikeCountyhavebulletproofglass.We
hadFedExtrucksbeingknockedoff.ItwastheWildWest.”
IndividualCountiesFilingSuit
Inadditiontostate-sponsoredlawsuits,twoCaliforniacountieshavealso
goneontheattack.
LastMay,bothOrangeandSantaClaritacountiesfiledsuitsagainstfivepharmaceuticalcompanies:Actavis,EndoHealthSolutions,Janssen
Pharmaceuticals,PurduePharma,andCephalonInc.
Officialsinbothcountiesclaimtheyhavebeenwrackedwithprescription
opioidoverdosedeathsandmassivemedicalcostsduetotheincrease
inprescriptionopiateabuse.OrangeCountyDistrictAttorneyTonyRackauckusdescribedthelawsuitasa“matterofpublicprotection,”inthatit
willultimatelykeepmoreoverdosedeathsfromoccurring.
Similartotheotherlawsuits,courtdocumentsshowthatbothCalifornia
countiesclaimthesefivecompaniesused“marketing–andnotanymedicalbreakthrough–thatrationalizedprescribingopioidsforchronicpainand
openedthefloodgatesofopioiduseandabuse…[causing]important,
sometimeslife-or-deathdecisionstobemadebasednotonscience,buton
hype.”
HowABigDrug
CompanyInadvertently
GotAmericansHooked
OnHeroin
Whenshewas18,Ariellewouldcomehomeeverydayandembarkonwhatshecallsan
“Easteregghunt."Shewasn’tlookingforcandy.Ariellewashuntingbehindstairwellsand
insideclosetsinhersuburbanLongIslandhomefortheOxyContinbottleshercousin
broughthomefromworkatapharmacyandwashidingfromhermotheraroundthehouse.
“Ifoundthemoneday,andIwantedtotrythembecauseallofmyfriendswerealready
hooked,”saidArielle,whoaskedthatherlastnamebewithheldtoavoidhurtingher
chancesofgettingajob.“Iwouldsee[mycousin]noddingoutonthecouchandnotreally
beingpresent,andthatwashowIwantedtofeel.Mybestfriendhadjustpassedaway,soI
wasnumbingoutthefeelings.”
IttookaboutayearbeforeAriellemovedfromprescriptionpainkillersintotheillegaldrug
thatkilledherbestfriend:heroin.Shesnorteditforthefirsttimeaftertaggingalongwitha
friendwhowasgoingtobuysome."Iwaslike,'Iloveit,'"shesaid.Heroinwascheaperthan
prescriptionpills--about$10abag,comparedto$60to$80perpill--andgaveheramore
potenthigh.
Herfriendhelpedherinjectthedrug.“ItwasafeelingthatIdon’tthinkanyoneshould
experience.Becauseonceyouexperienceit,youwanttoexperienceitoverandoveragain,”
shesaid.“NextthingIknow,I’maddicted.”
AriellelandedinaLongIslandjaillastyearaftershewascaughtbreakingintoahouseand
stealingmoneytobuydrugs.Now26andlivingatasubstanceabusetreatmentcenter,she
saysshe'salltooawarethatherstoryisn’tunique.
Between1996and2011,thenumberofpeoplewhoendedupinsubstanceabusetreatment
centersinSuffolkCounty,whereAriellelives,asaresultofheroinjumped425percent,
accordingtoa2012specialgrandjuryreportfromthecounty’sSupremeCourt.Duringthe
sameperiod,thenumberofpeoplewholandedinsubstanceabusetreatmentforopioidpill
usespiked1,136percent,thereportfound.
LongIslandisoneofmanyareasofthecountrywhereheroinaddictionisreaching
harrowinglevels,accordingtoGregoryBunt,themedicaldirectoratDaytopVillage,aNew
York-basedsubstanceabusetreatmentcenter.ThecrisisisgettingrenewedattentionafteractorPhillipSeymourHoffmandiedlastmonthfromanapparentheroinoverdose.Therise
inheroinusemirrorsadecade-longspikeinabuseofprescriptionopioids--painkillersthatareamedicalcousintoheroin,butarelegalaslongasthey’represcribedbyadoctor.
Inrecentyears,moreprescriptiondrugabusershavestartedturningtoheroinforacheaper
highasthepriceofpillsskyrocketsontheblackmarket,Buntsaid.Twofactorshave
contributedtothecostincrease:opioidaddictionboostingdemandanddoctorsbecoming
morecautiousaboutprescribingopioids,decreasingsupply,Buntsaid.
Anotherreasonforthepriceincrease:TheDrugWar,accordingtoaJanuary2012
reportfromRadleyBalko.Governmentcrackdownshavemadeitdifficultforevenreputabledoctorstoprescribepainpills.Tofillthevoid,doctorsandotherslookingtomakeabuckoff
theprescriptionpillscreatedso-called"pillmills"--officesthatprescribepainmedication
inhighvolumeandoftenservepeopleaddictedtothedrugs.
Theresult:Nearlyfouroutoffivepeoplewhorecentlystartedusingheroinused
prescriptionpainkillersfirst,accordingtoa2013studyfromtheCenterforBehavioralHealthStatisticsandQuality.
“Alotofpeoplewhogotintroublewiththeprescriptionopiatesareswitchingoverto
heroin,andtheygetmorefortheirbuck,sotospeak,”Buntsaid.Inhisexperience,he
added,muchoftheheroinavailabletodayislacedwithotheradditives,likeadditional
painkillers--makingitmoredangerous.
“Onceyouinjecttheherointhat’savailabletoday,you’reatveryhighriskforfatal
overdose,”hesaid.
Seefull-sizeimagehere.
InfographicbyAlissaSchellerforTheHuffingtonPost
Fordecades,opioidpainkillers,likeoxycodone,hydrocodoneandmorphine,hadbeenused
successfullytotreatconditionslikeintensepainattheendoflifeforcancerpatientsand
acutepainafteraninjurylikeabrokenbone.
ButeverythingchangedwhenOxyContin--andthemarketingcampaignthatcamewithit--
startedinthe1990s,expertssay.Thedrug,developedbyPurduePharma,hadatime-
releasemechanismthatspacedoutitseffectsoveralongerperiodoftime.
IndozensofseminarsinritzyhotelconferenceroomsacrossNorthAmerica,thecompanysolddoctorsontheideathatthetime-releasefunctionmadeOxyContinperfectfora
populationofpatientswhoweresufferingfromchronicpain.Representativesalsoargued
thatthedrug'sspaced-outeffectsmadeitlesslikelythatpatientswouldgetaddicted--
whichwasthemainfactordeterringmanyphysiciansfromprescribingopioidsforchronic
pain.
“Thiscampaignfocusedonconvincingdoctorsthattheyshouldn’tworryaboutaddiction,so
themedicalcommunitywastaughttobelievethataddictiontoopiateswasrelativelyrare,”
saidAndrewKolodny,thedirectorofPhysiciansforResponsibleOpioidPrescribing.
Thepitchwasconvincing,Kolodnysaid,becausenodoctorwantstobelievethatthey’re
keepingapatientinpainunnecessarily.By2001,OxyContinhadexceededmorethan$1
billioninsales,andby2003,nearlyhalfofthedoctorsprescribingOxyContinwereprimarycarephysicians,accordingtoa2004reportfromtheGovernmentAccountabilityOffice.
“Asprescriptionsbegantotakeoff,itledtoanepidemicofopioidaddiction,”Kolodnysaid.
“Weallbecamemuchmorelikelytohaveopioidsinourhomes,soitcreatedahazard.”
“Wehavenowthisincrediblyunusualpublichealthcrisisthat’sessentiallycausedby
physicians,causedbythehealthcareindustry,”saidMeldonKahan,themedicaldirectorof
substanceuseservicesattheWomen’sCollegeHospitalinToronto.
ChartviatheHarvardKennedySchool.
In2007,Purdueandthreeofitstopexecutivespleadedguiltytomisleadingdoctors,regulatorsandpatientsaboutOxyContin’sriskofaddiction.Thecompanyagreedtopay
morethan$600millioninfines.In2010,Purduedevelopedaversionofthedrugthatwas
hardertocrushandsnortorinjectthantheoriginal,aimedatdeterringabuse.InApril,the
FDAbannedtheoriginalOxyContinandallofitsgenericversionsfromhittingthemarket.
PurdueSpokesmanRaulDamaswroteinanemailstatementtoTheHuffingtonPostthat
“likeanypublichealthissue,opioidabuseistheresultofmanyfactors,notjustonedrugor
onecompany.”Brand-nameOxyContinrepresentsasmallshareofoxycodone-baseddrugs
onthemarket,andPurduehastakenstepstocurbtheaddictionepidemic,likepayingforaddictionhotlinesandworkingwithlawenforcementtohelpthembetteridentifypillsthat
arefrequentlyabused.
“Therecentincreaseinheroinabuseisanunfortunateresultofmanydifferentfactors,and
whatoftengetslostisthatprescriptionopioidsplayanimportantroleinhelpingpatients
andphysiciansaddresstheveryrealissueofchronicpain.”Damaswrote.“Purduehasled
thedevelopmentofabuse-deterrentopioids,buttheseeffortsneedtobecomplementedby
publiceducationandtreatment,sothatweaddressdemand,aswellassupply.”
Peopletypicallybecomeaddictedtotheprescriptionpillsinoneoftwoways,Kolodnysaid.
Themajorityofyoungerusers,likeArielle,findthepillslyingaroundathomeoratfriends’
houses.Buttheotherdemographicsufferingfromprescriptionpainkilleraddiction--
middle-agedAmericans--typicallygetthepillsfromtheirdoctorsforthingslikechronic
backorheadpain.Oncetheirbodiesadjust,theirdoctorshavetoupthedosestomitigate
thepain.
BettyTullyexperiencedthisphenomenonfirsthand.ShewenttoherdoctorinJanuaryof
2001,lookingforafixforthepainthathadplaguedherlowerbackfordecades.Tully’s
doctorsaidhehadjustthething,anew“miracledrug”thatcouldhelpherpainwithout
puttingheratriskofaddiction.Hestartedheron20milligramsofOxyContin.Soon,she
wasaskingformore,soheuppedherdoses.
“ByJune,Iwasanabsolutezombie.Icouldn’tworkanymore,Icouldn’tdrivemycar
anymore.Ileftmycarrunningonedayonthestreet,”theformerrealestateagentsaid.“I
wascallinghisofficeandscreamingthatIneededthismedicine.”
Bytheendof11months,Tullywason280milligramsofOxyContinperday.Themotherof
two,whohadhelddownjobssinceshewas12yearsold,refusedtoleavethehouseforfear
she’dmissadoseandgothroughterriblesymptomsofwithdrawallikenauseaandprofuse
sweating.Whenshedecidedtogetclean,ittookhersixyearstocompletelygetoffthedrug,
andshesaysshe’sluckyshewasabletofinallykickthehabit.Indeed,accordingtoKolodny,
"middle-agedwomengettingpainpillsfromdoctors"aredyingfromoverdosesatsomeof
thehighestratesinhistory.In2010,40percentofU.S.drugoverdosedeathswerewomen,
manyofwhomdiedfromabusingprescriptionpills.
“Ishouldbeamongthosestatistics,”Tullysaid.“There’snotmanypeoplethatcantakethat
muchandbebreathingeveryday.”
HowtheAmericanopiate
epidemicwasstartedbyone
pharmaceuticalcompany
FROM
MikeMariani
(StephenLam/SanFranciscoChronicle/SanFrancisco/CORBIS)
March4,2015
ThestateofKentuckymayfinallygetitsdeliverance.Aftermorethanseven
yearsofbattlingtheevasivelegaltacticsofPurduePharma,2015maybethe
yearthatKentuckyanditsattorneygeneral,JackConway,areabletomove
forwardwithacivillawsuitallegingthatthedrugmakermisleddoctorsand
patientsabouttheirblockbusterpainpillOxyContin,leadingtoavicious
addictionepidemicacrosslargeswathsofthestate.
Aperniciousdistinctionofthefirstdecadeofthe21stcenturywastherisein
painkillerabuse,whichultimatelyledtoacatastrophicincreaseinaddicts,
fataloverdoses,andblightedcommunities.Butthestoryofthepainkillerepidemiccanreallybereducedtothestoryofonepowerful,highlyaddictive
druganditssmallbutruthlesslyenterprisingmanufacturer.
OnDecember12,1995,theFoodandDrugAdministrationapprovedthe
opioidanalgesicOxyContin.Ithitthemarketin1996.Initsfirst
year,OxyContinaccountedfor$45millioninsalesforitsmanufacturer,Stamford,Connecticut-basedpharmaceuticalcompanyPurduePharma.By
2000thatnumberwouldballoonto$1.1billion,anincreaseofwellover
2,000percentinaspanofjustfouryears.Tenyearslater,theprofitswould
inflatestillfurther,to$3.1billion.Bythenthepotentopioidaccountedfor
about30percentofthepainkillermarket.What'smore,PurduePharma's
patentfortheoriginalOxyContinformuladidn'texpireuntil2013.Thismeantthatasingleprivate,family-ownedpharmaceuticalcompanywithnon-descriptheadquartersintheNortheastcontrollednearlyathirdoftheentire
UnitedStatesmarketforpainpills.
OxyContin'sball-of-lightningemergenceinthehealthcaremarketplacewas
closetounprecedentedforanewpainkillerinanagewheresyntheticopiates
likeVicodin,Percocet,andFentanylhadalreadybeencompetingfordecades
indoctors'officesandpharmaciesfortheirpieceofthemarketshareofpain-
relievingdrugs.Inretrospect,italmostdidn'tmakesense.Whywas
OxyContinsomuchmorepopular?Haditbeenapprovedforawiderrangeof
ailmentsthanitsopioidcousins?Diddoctorspreferprescribingittotheir
patients?
Duringitsriseinpopularity,therewasasuspiciousundercurrenttothedrug's
spectrumofapprovedusesandPurduePharma'srelationshiptothe
physiciansthatweresuddenlyprivilegingOxyContinoverothermedsto
combateverythingfrombackpaintoarthritistopost-operativediscomfort.It
wouldtakeyearstodiscoverthattherewasmuchmoretothestorythanthe
benignintroductionofanew,highlyeffectivepainkiller.
In1952,brothersArthur,Raymond,andMortimerSacklerpurchasedPurdue
Pharma,thencalledPurdueFrederickCo.Allthreemenwerepsychiatristsby
trade,workingatamentalfacilityinQueensinthe1940s.
Theeldestbrother,Arthur,wasabrilliantpolymath,contributingnotonlyto
psychiatricresearchbutalsothrivinginthefledglingfieldofpharmaceutical
advertising.Itwasherethathewouldleavehisgreatestmark.Asamember
ofWilliamDouglasMcAdams,asmallNewYork-basedadvertisingfirm,
Sacklerexpandedthepossibilitiesofmedicaladvertisingbypromoting
productsinmedicaljournalsandexperimentingwithtelevisionandradio
marketing.Perhapshisgreatestachievement,detailedinhisbiographyin
theMedicalAdvertisingHallofFame,wasfindingenoughdifferentusesforValiumtoturnitintothefirstdrugtohit$100millioninrevenue.
TheMedicalAdvertisingHallofFamewebsite'seuphemisticargotforthis
accomplishmentstatesthatSackler'sexperienceinthefieldsofpsychiatry
andexperimentalmedicine"enabledhimtopositiondifferentindicationsfor
Roche'sLibriumandValium."
Sacklerwasalsoamongthefirstmedicaladvertiserstofosterrelationships
withdoctorsinthehopesofearningextrapointsforhiscompany'sdrugs,
accordingtoa2011exposéinFortune.Suchbackscratchinginthehopesof
reciprocityisnowthemodelforthewholedrugmarketingindustry.Arthur
Sackler'spioneeringmethodswouldbecultivatedbyhisyoungerbrothers
RaymondandMortimerinthedecadestocome,astheygrewtheirsmall
pharmaceuticalfirm.
Startingin1996,PurduePharmaexpandeditssalesdepartmenttocoincide
withthedebutofitsnewdrug.AccordingtoanarticlepublishedinThe
AmericanJournalofPublicHealth,“ThePromotionandMarketingof
OxyContin:CommercialTriumph,PublicHealthTragedy,"Purdueincreaseditsnumberofsalesrepresentativesfrom318in1996to671in2000.By
2001,whenOxyContinwashittingitsstride,thesesalesrepsreceivedannual
bonusesaveragingover$70,000,withsomebonusesnearingaquarterofa
milliondollars.InthatyearPurduePharmaspent$200millionmarketingits
goldengoose.PouringmoneyintomarketingisnotuncommonforBig
Pharma,butproportionatetothesizeofthecompany,Purdue’sOxyContinpushwassubstantial.
BootsonthegroundwasnottheonlystratagememployedbyPurdueto
increasesalesforOxyContin.Longbeforetheriseofbigdata,Purduewas
compilingprofilesofdoctorsandtheirprescribinghabitsintodatabases.
Thesedatabasesthenorganizedtheinformationbasedonlocationtoindicate
thespectrumofprescribingpatternsinagivenstateorcounty.Theideawas
topinpointthedoctorsprescribingthemostpainmedicationandtargetthem
forthecompany'smarketingonslaught.
Thatthedatabasescouldn'tdistinguishbetweendoctorswhowereprescribing
morepainmedsbecausetheywereseeingmorepatientswithchronicpainor
weresimplylooserwiththeirsignaturesdidn'tmattertoPurdue.TheLos
AngelesTimesreportedthatby2002PurduePharmahadidentifiedhundredsofdoctorswhowereprescribingOxyContinrecklessly,yettheydidlittle
aboutit.Thesamearticlenotesthatitwasn’tuntilJuneof2013,atadrug
dependencyconferenceinSanDiego,thatthedatabasewasevereven
discussedinpublic.
Combiningthephysiciandatabasewithitsexpandedmarketing,itwould
becomeoneofPurdue'spreeminentmissionstomakeprimarycaredoctors
lessjudiciouswhenitcametohandingoutOxyContinprescriptions.
Beginningaround1980,oneofthemoresignificanttrendsinpain
pharmacologywastheincreaseduseofopioidsforchronicnon-cancerpain.
Likeotherpharmaceuticalcompanies,Purduelikelysoughttocapitalizeon
theabundantfinancialopportunitiesofthistrend.Thelogicwassimple:
Whilethenumberofcancerpatientswasnotlikelytoincreasedrastically
fromoneyeartothenext,ifacompanycouldexpandtheindicationsforuse
ofaparticulardrug,thenitcouldboostsalesexponentiallywithoutanyreal
changeinthecountry'shealthdemography.
ThiswasindeedoneofOxyContin’sgreatesttacticalsuccesses.Accordingto
"ThePromotionandMarketingofOxyContin,"from1997to2002
prescriptionsofOxyContinfornon-cancerpainincreasedalmosttenfold.
Meanwhile,in1996theFDAapprovedan80mgversionofthepill;four
yearslateritapproveda160mgtablet.AccordingtotheFDA’s“Historyof
OxyContin:LabelingandRiskManagementProgram,”higherdosageswere
approvedspecificallyforopioid-tolerantpatients.
Thesehigh-milligrampillswereprobablyoneofbiggestreasonsthat
OxyContinbecamesuchapopularstreetdrug.Recreationalusersandaddicts
couldcrush,sniff,andinjectthepillforapowerfulhighthat,aspromised,
lastedovereighthours.Theeuphoriceffectsandpotentialforabusewere
comparabletoheroin.Butclearlydoctorsandpharmaciesneverdrewthe
ghastlyparallel.Why?
ThestateofKentucky'slawsuitagainstPurduePharmaisnotthefirstlegal
troublethecompanyhasruninto.In2007,inUnitedStatesofAmericav.The
PurdueFrederickCompany,Inc.,Purdueanditstopexecutivespleadedguiltytochargesthatitmisleddoctorsandpatientsabouttheaddictive
propertiesofOxyContinandmisbrandedtheproductas"abuse
resistant."Prosecutorsfounda"corporateculturethatallowedthisproducttobemisbrandedwiththe
intenttodefraudandmislead."PurduePharmapaid
$600millioninfines,amongthelargestsettlementsinU.S.historyfora
pharmaceuticalcompany.
Perhapsknowingthatdoctorswouldbevigilantagainstprescribingdrugs
withthepotentialforabuse,PurduesetouttodistinguishOxyContinfrom
rivalsassoonasitdropped.Thecornerstoneofitsmarketingcampaignwas
thedrug'sincrediblylowriskofaddiction,anenviablecharacteristicmade
possiblebyitspatentedtime-releaseformula.Throughanarrayof
promotionalmaterials,includingliterature,brochures,videotapes,andWeb
content,Purdueproudlyassertedthatthepotentialforaddictionwasvery
small,atonepointstatingittobe"lessthan1percent."
Thetime-releaseconceitevenworkedontheFDA,whichstatedthat
"Delayedabsorption,asprovidedbyOxyContintabletsisbelievedtoreduce
theabuseliabilityofadrug."Armedwiththetime-releaseformulaand
misleadingstatisticsabouttheriskofaddiction,Purduepositionedthedrug
asarelativelysafechoiceforCNCPpatients.Salesrepresentativestoldsome
doctorsthatthedrugdidn'tevenproduceabuzz,accordingtoUSAToday.
(Thisforapillthathassincedrawnfrequentcomparisonstoheroininterms
ofanalgesia,euphoria,andthepropensityforaddiction.)
Betweenphysiciandatabases,incentive-happysalesreps,andanaggressive
blitzpackageofpromotionalephemera,Purdue'smultifacetedmarketing
campaignpushedOxyContinoutofthenicheofficesofoncologistsandpain
specialistsandintotheprimarycarebazaar,whereprescriptionsforthedrug
couldbehandedouttomillionsuponmillionsofAmericans.Themost
scathingironyisthatwhatallowedOxyContintoreachsomanyhouseholds
andcommunitieswastheclaimthatitwasn'tdangerous.
Kentuckyoriginallyfileditscivilsuit,CommonwealthofKentuckyv.Purdue
Pharma,oversevenyearsago,backin2007.AfteryearsofPurduePharma
fightingtokeepthetrialoutofPikeCounty,andKentuckianswatchingasthe
suitpinballedfromappealscourttoappealscourt,atonepointevenbeing
transferredtoNewYork,Purduehasfinallyexhausteditsadjournment
artistry.Unlessthepharmaceuticalcompanywinsitslatestappealinthestate
SupremeCourt,trialwillmostlikelybeginthisyear.
Kentuckyisfilingatotalof12claimsagainstthecompany,includingfalse
advertising,Medicaidfraud,unjustenrichment,andpunitivedamages.In
totalthesuitcouldcostPurduePharma$1billion(whichisjustone-thirdof
itsannualrevenuesfromOxyContin).
Nostatehasbeenmoredevastatedbythenationwideopiateproblemthan
Kentucky.MuchoftheeasternpartofthestateandtheAppalachianshas
watchedasmen,women,andteenagersfellvictimtothepotentpainpills.
Therewereseveraldifferentgateways—backinjuries,operations,parents'
medicinecabinets—butallofthemledtoanimplacableaddictionthatrivals
thatofthehardeststreetdrugs.Andthat’stherub.Becausetherewas
simplysomuchOxyContinavailableforoveradecade,ittrickleddownfrom
pharmaciesandhospitalsandbecameastreetdrug,covetedbyteensand
fiendsandsoldbydealersatapremium(pricesoftenshotupwellover$1a
milligram,pricingthepopular80mgtabletsatover$100forasinglepill).
WhateverthegrayareasonOxyContin'smanypathstoperdition,the
statisticsonthefirstdecadeofthiscenturybearoutastaggeringepidemic.
From1999to2010,thesaleofprescriptionpainkillerstopharmaciesand
doctors'officesquadrupled.Intheexactsametimespan,thenumberof
overdosedeathsfromprescriptionpainkillersalsoquadrupled,risingto
almost17,000.
Tocallthisacoincidencewouldbeanalogoustodeclaringnoconnection
betweenlooseningenforcementondrunkdrivinglawsandobservinga
suddenincreaseindeathscausedbydrunkdriving.Itgoesalmostwithout
sayingthatthesefiguresdovetailseamlesslywiththereleaseofOxyContin
andPurdue'smarketingtimeline,whichhithardestintheearly2000s.
Thefiguresonfataloverdoses,whichinrecentyearshaveeclipsedthe
numberofdeathscausedbycocaineandheroincombined,speaknothingof
theskyrocketingratesofaddictionthroughoutthecountry.Funeralsfrom
overdosesareanguishingenough,butasplaceslikePikeCountyknowtoo
well,fatalitiesareonlyonedimensionofaproblemwhoseinsidioussprawl
affectslocaleconomiesandhealthcarecosts,incitescrime,andruptures
familiesthroughthevagariesofaddiction,rehabstints,andprisonsentences.
ThedegreetowhichPurduePharmaisresponsibletoKentuckyforadecade
rottedandwarpedbyitspopulardrugisstillpendingintheeyesofthejustice
system.Nowthatfederalregulationshavefinallycaughtuptothe
pharmaceuticaldrugprobleminthiscountryanddoctorshavewiseduptothe
sinisterrealitiesofthedrugnicknamed"HillbillyHeroin,"thehardandfast
daysofOxyContinareover.
Manyarenowarguingthattheepidemichasn'tgoneawaysomuchasithas
evolved:Heroinuseisagainontheupswing.Likeashrewdvirusthat
mutatesonceitconfrontsavaccine,Americans'addictiontoopioidshas
survivedthegovernmentcrackdownonOxyContinandfledtotheseedy
asylumofheroin.It'sakindofevolutioninretrograde,withpillusersturning
toanold20th-centuryscourgethatonceflourishedinurbandecayandis
uglier,morestigmatized,andmorelethalthanitspharmaceuticalcounterpart.
ButforOxyContin,adrugthat,despiteitsmanufacturer ’smanyclever
disguises,wasalwaysfrighteninglyclosetoheroin,there'samorbidsortof
symmetry.
TheSolutionto
PainReliefis
NatureasUsual
UseOfOpiateAndOther
AddictiveDrugsReducedBy
TherapeuticCannabis
UseOfOpiateAndOtherAddictiveDrugsReducedByTherapeuticCannabis
AccordingtoareviewpublishedintheJournalofPsychoactiveDrugs,regulatingaccess
tocannabiswouldofferaneffectivetreatmentforchronicpainpatientsbesidesreducingmorbidityassociatedwiththeuseofprescriptionopiatesandotherpharmaceuticals.
Cannabiscouldbeusefulintreatingchronicpainandcertainsubstanceabusedisorders,
accordingtoareportbyaresearcherwiththeCentreforAddictionsResearchofBritish
Columbia.Theresearcheralsoreportedthattherapeuticcannabisposesfewerrisksto
healththanmanyconventionalalternatives
Hewrites:“Whenusedinconjunctionwithopiates,cannabinoidsleadtoagreater
cumulativereliefofpain,resultinginareductionintheuseofopiates(andassociatedside-
effects)bypatientsinaclinicalsetting.Additionally,cannabinoidscanpreventthe
developmentoftolerancetoandwithdrawalfromopiates,andcanevenrekindleopiate
analgesiaafterapriordosagehasbecomeineffective.Novelresearchsuggeststhat
cannabismaybeusefulinthetreatmentofproblematicsubstanceuse.Thesefindings
suggestthatincreasingsafeaccesstomedicalcannabismayreducethepersonalandsocial
harmsassociatedwithaddiction,particularlyinrelationtothegrowingproblematicuseof
pharmaceuticalopiates.”
Theauthorcontinues:“Sinceboththepotentialharmsofpharmaceuticalopiatesandthe
relativesafetyofcannabisarewellestablished,researchonsubstitutioneffectsuggeststhat
cannabismaybeeffectiveinreducingtheuseanddependenceofothersubstancesofabuse
suchasillicitopiates,stimulantsandalcohol.Assuch,thereisreasontobelievethata
strategyaimingtomaximizethetherapeuticpotentialbenefitsofbothcannabisand
pharmaceuticalcannabinoidsbyexpandingtheiravailabilityandusecouldpotentiallylead
toareductionintheprescriptionuseofopiates,aswellasotherpotentiallydangerous
pharmaceuticalanalgesics,licitandillicitsubstances,andthusareductioninassociated
harms.”
Theauthorconcludes,“Despitealackofregulatoryoversightbyfederalgovernmentsin
NorthAmerica,community-basedmedicalcannabisdispensarieshaveprovensuccessfulat
supplyingpatientswithasafesourceofcannabiswithinanenvironmentconduciveto
healing,andmaybereducingtheproblematicuseofpharmaceuticalopiatesandother
potentiallyharmfulsubstancesintheircommunities.”
https://www.youtube.com/watch?v=fuJPrjEAzeEmedicalstoryofMarijuanaandtherisks
