America Awash With Painkillers & Drug Addicts


fat finger

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The opiate abuse scandal switched to Britain this week with the news that thousands of patients in NHS hospitals have been killed off through overdosing on opium based pain killers and the spectre that one doctor in particular in Hampshire presided over the death of over 600 of her patients. 600 men and women dead, who entered hospital in many cases for routine treatment and expected to be quickly back with their families. But now dead.
The medical establishment has been quick to fight back, blaming a particular type of syringe as responsible for the deaths, but ignoring the fact that many of the dead were in no pain and required no injections for pain relief.
Here in Ireland it is known that the type of syringe was only banned in 2014 which leaves users of the HSE asking, what led to it being banned and how many people here died prematurely because doctors were over prescribing opiate based pain relief for patients who were not in any pain?
 

Ardillaun

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The story of Purdue, the Sackler family and the marketing of Librium, Valium, MS Contin and ultimately OxyContin is well worth a read:

https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

From its own research and clinical reports pouring in from physicians, Purdue knew the unlikely yarn about OxyContin being less addictive than other opioids was false but persisted in this malicious lie for years.

https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html

Thousands of deaths (more than 200,000 in the US alone) and billions of profit later, three senior executives were sentenced to community service. That seems a trifle lenient in a country where you can do years of hard time for sharing drugs with one person who overdoses:

https://www.nytimes.com/2018/05/25/us/drug-overdose-prosecution-crime.html
 
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Ardillaun

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Atlantean

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What do we know about the Purdue family ?

How could they have such contempt for their fellow man ?

............................................................................

Is the Purdue family essentially of the most maligned ethnicity [ White / Caucasian ] PLUS religion [ Christianity, vis. Catholic ] ?
IF ANSWER IS NO, .... ;

WHAT IS THE SPECIFIC ETHNICITY [ Please do NOT be curtailed by Census parameters :cool: ] OF THE PURDUE FAMILY ?

WHAT IS THEIR RELIGION [ or religion traditional to their ancestry ] ?
 

valamhic

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There are a lot of junkies on the Trump Hating threads here. They tend also to be green lefties.
 

Ardillaun

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Here's an excellent article focusing on how North American doctors were misled by wishful thinking and shoddy research into giving massive doses of opioids to patients:

The making of an opioid epidemic | News | The Guardian

Portenoy toured the country, describing opioids as a gift from nature and promoting access to narcotics as a moral argument. Being pain-free was a human right, he said. In 1993, he told the New York Times of a “growing literature showing that these drugs can be used for a long time, with few side-effects, and that addiction and abuse are not a problem”.

Long after the epidemic took hold, and the death toll rose into the hundreds of thousands in the US, Portenoy admitted that there was little basis for this claim and that he had been more interested in changing attitudes to opioids among doctors than in scientific rigour.

“In essence, this was education to destigmatise and because the primary goal was to destigmatise, we often left evidence behind,” he admitted years later as the scale of the epidemic unfolded.

Likewise, Haddox’s theory of pseudo-addiction was based on the study of a single cancer patient. At the time, though, the new thinking was a liberation for primary care doctors frustrated at the limited help they could offer patients begging to get a few hours’ sleep. Ballantyne was as enthusiastic as anyone and began teaching the gospel of pain relief at Harvard, and embracing opioids to treat her patients.

“Our message was a message of hope,” she said. “We were teaching that we shouldn’t withhold opiates from people suffering from chronic pain and that the risks of addiction were pretty low because that was the teaching we’d received.”

But then Ballantyne began to see signs in her patients that experience wasn’t matching theory. Doctors were told they could repeatedly ratchet up the dosage of narcotics and switch to a new and powerful drug, OxyContin, without endangering the patient, because the pain, in effect, cancelled out the risk of addiction. To her dismay, Ballantyne saw that many of her patients were not better off when taking the drugs and were showing signs of dependence.

Among those patients on high doses over months and years, Ballantyne heard from one after another that the more drugs they took, the worse their pain became. But if they tried to stop or cut back on the pills, their pain also worsened. They were trapped.

“You had never seen people in such agony as these people on high doses of opiates,” she told me. “And we thought it’s not just because of the underlying pain; it’s to do with the medication.”
When conscientious researchers began to do proper research on the emerging problem, their results were ignored for a long time:

Lucas and Ledgerwood visited trauma centres to collect data on deaths before and after the joint commission standards on pain treatment. In 2007, the two doctors published their findings. Before the commission’s dictum, 0.7% of trauma centre patients died from “excess administration of pain medicines”. The death toll rose to 3.6% after the commission’s policies kicked in.

The two doctors made no secret of who they blamed for “this preventable cause of death and disability”. “It’s about money. Money has influence, and it influenced the joint commission,” said Lucas.

The surgeon presented the paper to a meeting of the Central Surgical Association and saw it published by the Journal of the American College of Surgeons under the headline “Kindness Kills: The Negative Impact of Pain as the Fifth Vital Sign.”

Afterwards, Lucas got a stream of letters and emails from doctors who recognised the problem. But, unlike Ballantyne, he wasn’t surprised when the policy remained the same. “Did I expect a change? No. It is too ingrained into the medical profession. It’s become financial just like the drug industry is financial. It’s nothing to do with right or wrong. It’s about how the money flows,” he said. “When you write a paper you want there to be unemotional data out there. You want that unemotional data to be analysed and interpreted in one way or the other, but you don’t expect the Renaissance.”
 

Ardillaun

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Why back pain especially?
Just to expand a little on what I said earlier, the problem of dangerously escalating dose and diminishing benefit does not arise with terminal cancer patients. A close relative of mine with a dreadful wasting disease had his death mercifully hastened by opioids but he had no good days left at all. That’s the challenge with opioids in back pain and even more with adolescent dental surgery - you run the risk of cutting healthy and useful lives short in their prime, or even before that because anybody under the age of 25 can become addicted much more quickly. This loss is already being seen in US life expectancy figures.

Americans and Canadians have an odd need to talk about their bowels but these ads were a new frontier for me in such discussions:

Bizarre Opioid-Induced Constipation Super Bowl 50 commercial | Daily Mail Online

Twitter
 
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gatsbygirl20

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They should be used with great caution in back pain.
It is a real problem

I have suffered from severe, chronic back pain all my adult life as a result of a spinal injury

I cannot take any of the normal anti-inflammatory painkillers because of an allergy

When the pain was very severe I begged my doctor for something

He prescribed Tramadol

It was like taking heroin---euphoria, dependence, feelings of terror and paranoia if my supply was running low

After a few months on the drug, my pain got worse and the drug itself seemed ineffective

I resolved to wean myself off it. I succeeded with great difficulty after a year or so

I still struggle with the pain.

But anything is better than being imprisoned in the nightmare of dependency---it was a terrible time
 

Ardillaun

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It is a real problem

I have suffered from severe, chronic back pain all my adult life as a result of a spinal injury

I cannot take any of the normal anti-inflammatory painkillers because of an allergy

When the pain was very severe I begged my doctor for something

He prescribed Tramadol

It was like taking heroin---euphoria, dependence, feelings of terror and paranoia if my supply was running low

After a few months on the drug, my pain got worse and the drug itself seemed ineffective

I resolved to wean myself off it. I succeeded with great difficulty after a year or so

I still struggle with the pain.

But anything is better than being imprisoned in the nightmare of dependency---it was a terrible time
Thank you so much for sharing that. When I started reading your post, I must confess I thought I was going to see criticism of restrictions on opioids but instead your experience graphically illustrates the hazards of these drugs better than anything I could quote. I don’t mean to sound like a monomaniac on this issue but our quiet Canadian town has been changed forever by the opioid problem. Ten years ago, I didn’t bother locking my doors; now we have a group of young people who are hooked and need to steal to maintain their habit. My medical colleagues dropped the ball on this one.
 
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gatsbygirl20

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Thank you so much for sharing that. When I started reading your post, I must confess I thought I was going to see criticism of restrictions on opioids but instead your experience graphically illustrates the hazards of these drugs better than anything I could quote. I don’t mean to sound like a monomaniac on this issue but our quiet Canadian town has been changed forever by the opioid problem. Ten years ago, I didn’t bother locking my doors; now we have a group of young people who are hooked and need to steal to maintain their habit. My medical colleagues dropped the ball on this one.
The dependence on Tramadol that I developed over such a short time was like nothing I had ever experienced before

I used to be a chain smoker and managed to quit cold turkey. I had cravings but they were manageable over time

Tramadol was different

It's grip was psychological, life-altering, personality altering

I counted the pills every night, terrified that I would run out before the dawn. I had strange, uncharacteristic flashes of paranoia and fear.

The pain got worse. But I had moved on from caring about pain to obsessing about the drugs and where I would get my next supply

While this was going on, I was raising a family, cooking healthy meals for them, worrying about their diet, going out to work.....

I would never want to return to that time.
 

Franzoni

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Tramadol seems to be fairly common these days.....i've seen the side effects first hand and it's not pretty for those around someone on it...
 

Ardillaun

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A friend’s 80 something year old mum fell and broke some vertebrae. She was given an opioid for pain. Within a few days she was talking to her mother and other long-gone relatives, as well as experiencing constipation and insomnia. The opioid was stopped and other drugs were prescribed, including cannabis. Her recovery has been rapid.
 

Ardillaun

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Looks like a few corporate execs may be in for a trial at least:

A former opioid sales executive admitted Wednesday in Boston's federal court to participating in a nationwide conspiracy to bribe doctors to prescribe a highly addictive fentanyl spray for people who didn't need it and will cooperate with prosecutors targeting his co-workers...

...The scam stretched across the U.S., involving pharmacies and pain management clinics and practitioners from Saginaw, Michigan, to southwest Florida and Laredo, Texas, prosecutors say.

In one case, Burlakoff wasn't happy one doctor in Michigan was averaging only four Subys prescriptions per week, court documents say. So Burlakoff flew to Michigan, took the doctor to dinner and told his co-workers to "expect a nice `bump' fellas," prosecutors say. In the two months after the dinner, the doctor — who received bribes and kickbacks — wrote about 120 prescriptions for the spray, according to court documents.

Burlakoff also dressed up as a life-sized bottle of Subsys for a promotional video aimed at encouraging sales reps to push doctors to prescribe higher doses of the spray, court documents say. In the video, Burlakoff, wearing the fentanyl spray costume, danced and rapped with other sales reps about the drug based on a song by rapper A$AP Rocky, prosecutors say.
Cooperation agreements, like plea bargains, are nifty tools to have around.
 
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Ardillaun

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The Subsys scandal has been the subject of a Senate report. So far, few doctors have faced criminal charges. Here’s one example of prescribing gone astray:

In July 2017, FBI agents seized patient records from Dr. Steven Simon, a pain specialist operating outside Kansas City, Missouri, in Overland Park, Kansas.179 According to the Kansas City Star, Dr. Simon “was the eighth-highest-paid Subsys speaker nationally from August 2013 to December 2015, taking in more than $200,000 in meals, speaking fees and related travel expenses.”180 According to the CMS Open Payments database, Dr. Simon accepted over $230,000 from Insys between 2013 and 2016.181 As mentioned above, Dr. Simon also ranked as the top prescriber of Subsys in the Medicare Part D program in Kansas, as well as “the top-paid Kansas doctor in the Subsys speaking program.”182
According to recent lawsuits, Dr. Simon aggressively pushed Subsys in high volumes and dosages even in cases in which patients lacked a cancer diagnosis and complained of side effects. One former patient has alleged, for example, that Dr. Simon prescribed Subsys even after the patient—who did not have a cancer diagnosis—was discharged from the hospital with the recommendation that he “begin to taper opioids” because “continuing at current high amounts is likely not realistic as an outpatient.”183 After a year on Subsys, this patient has stated, a nurse in Dr. Simon’s office asked him if he would “feel comfortable telling me that you have at least precancerous cells”—presumably to aid in the prior authorization process for the medication.184 Later, an Insys sales representative visiting the clinic advised on insurance approval issues and even urged the patient to change insurers.185 Between December 2013 and May 2014, according to medical records, Dr. Simon and his nurse increased the Subsys dosage for this patient to the “maximum allowable and most expensive dose.”186
https://www.hsgac.senate.gov/imo/media/doc/Fueling%20an%20Epidemic%20-%20Inside%20the%20Insys%20Strategy%20for%20Boosting%20Fentanyl%20Sales.pdf
Simon, born in 1947, began his work life four decades ago in Missouri as a pharmacist, the family business. But he ran afoul of the Missouri Board of Pharmacy in 1976 after he pleaded no contest to federal drug charges, specifically distribution of methaqualone (quaaludes) and dl-amphetamines. He received a $5,000 fine and a suspended prison sentence.

In the recent interview with The Star, Simon said he “made a bad decision” and was fortunate the punishment was not harsher.

“A U.S. District judge not known for his leniency decided to give me a chance,” Simon said.

The Board of Pharmacy tried to suspend his license, but Simon sued. His attorneys argued that the no contest plea and the suspended sentence did not amount to a criminal “conviction,” and therefore the board had no grounds for suspension.

The case ultimately went to the Missouri Court of Appeals, which found in Simon’s favor.

He then went to medical school at Ross University in the Caribbean, and after he completed his education, he returned to the Kansas City area and applied for a physician’s license with the Kansas State Board of Healing Arts in 1984.

Applications for those licenses now ask whether the applicant has been arrested or charged with a crime. But at the time, they only asked about felony convictions.

“There is no conviction, and that’s the way the board looked at it, as well,” Paul Katz, a lawyer who represented Simon at the time, told The Star.

Read more here: https://www.kansascity.com/n/business/health-care/article158833804.html#storylink=cpy
 

Ardillaun

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Of course, opioid manufacturers spent money educating Canadian physicians too:

Purdue Pharma, the maker of OxyContin, paid Canadian doctors nearly three-and-a-half times more money than it doled out to U.S. prescribers, according to a Star analysis of the drug maker’s physician payments adjusted for the countries’ populations.

Purdue Canada gave just over $2 million to Canadian health-care professionals in 2016 for services such as consulting and delivering speeches on conditions and treatments...

The discrepancy between Purdue’s Canadian and U.S. physician payments has doctors and drug safety advocates raising an alarm that the drug maker may be focusing its marketing efforts on Canadian doctors.

“That Purdue spent more than four times as much per Canadian physician should shatter the myth that we are not exposed to the same level of aggressive marketing tactics as in the U.S.,” said Trudo Lemmens, a professor of law and bioethics at the University of Toronto.

https://www.thestar.com/news/investigations/2018/05/03/why-did-the-maker-of-oxycontin-pay-canadian-doctors-nearly-three-and-a-half-times-more-money-per-capita-than-it-doled-out-to-us-prescribers.html
 
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