Later On

A blog written for those whose interests more or less match mine.

Archive for July 30th, 2019

The Opioid Crisis Is About More Than Corporate Greed

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Zachary Siegel reports in the New Republic:

“Just like Doritos keep eating. We’ll make more.”

“It’s like people are addicted to these things or something. Oh, wait, people are…”

These lines are from emails sent between opioid manufacturers and distributors, recently pried loose by attorneys general suing Big Pharma for its role in fueling a massive wave of overdose deaths. Similar to the damning internal memos revealing that Big Tobacco knew that cigarettes indeed caused cancer, these emails appear to show that Big Pharma knew that a significant share of their product was landing in the street, feeding addiction. And yet they kept shipping out obscene quantities to rural towns across America, creating even more demand.

Nearly every step of the pharmaceutical supply chain is implicated in the soaring death rate. According to the Centers for Disease Control and Prevention, prescription opioids killed 218,000 people from 1999 to 2017. Many of the companies—from Johnson & Johnson to obscure distributors like Cardinal Health—are listed as defendants in hundreds of lawsuits filed by nearly every state in the country. The government thinks these corporations should pay up and treat the addiction their products caused. But the companies claim to have been acting legally and in compliance with federal regulators like the Drug Enforcement Administration (DEA). Was it all, technically, legal?

What the opioid crisis illustrates is not that there are a few bad apples in the pharmaceutical industry, but that the country’s entire health care system is driven by profit at the expense of public health and safety. Drug manufacturers, pharmacy chains, drug distributors, and insurance companies got rich while people, especially people lower down the income ladder, suffered—and the DEA, through neglect or incompetence or a mix of both, watched it all happen.

While there are significant similarities between Big Pharma and Big Tobacco, there is also a key difference that makes today’s story of corporate malfeasance even worse: namely, that the supply chain for tobacco is much simpler than opioids, which are, theoretically, tightly controlled substances that pass through a dizzying array of actors and regulators.

First, a doctor must write a prescription, which must be filled at a pharmacy, and is likely paid for by an insurance company. Depending on the needs of their customers, pharmacies place orders for these drugs (customers, it turns out, need a lot of them). Shipping companies then go between the pharmacy and the drug manufacturers. Overseeing this entire system is the DEA, which sets the quota for how many opioids a company is allowed to manufacture, and tracks where those pills go.

While politicians are making hay out of Big Pharma’s wanton greed and recklessness, far less attention has been paid to the DEA. Attorneys general suing Big Pharma recently unearthed a database that both the corporations and the government—each for their own self-interested reasons—fought to keep sealed, called the Automation of Reports and Consolidated Orders System (ARCOS). Mammoth in size and granular in detail, ARCOS tracks the shipments of every single controlled substance, from the company that manufactured it, to the company that shipped it, to the pharmacy that received it. It is the world atlas for how the opioid crisis began.

All told, from 2006 to 2012, roughly 76 billion oxycodone and hydrocodone pills criss-crossed America, according to a Washington Post analysis. While many of these pills went to legitimate patients, millions more were showered on troubled communities with a voracious thirst for pain relief. While drug manufacturers produced more and more opioids (approved by the DEA), and distributors shipped those pills to pharmacies all over the country (tracked by the DEA), drug companies saw record profits—and America’s overdose death rate soared off the charts.

“I think this [database] brings home what we all knew,” says Corey Davis, an attorney and public health expert at the Network for Public Health Law. “This wasn’t just incompetence on the part of the DEA and the Department of Justice, it was knowing and intentional failure to do what most people think is their jobs.”

What is the DEA’s job, exactly? Its first task, and the one most associated with the agency, is the Sicario-esque disruption of illicit flows of drugs coming into the U.S. from abroad, like intercepting speedboats filled with cocaine. Its other major responsibility is controlling licit pharmaceuticals. “The whole goal of the prescription system is to make sure that patients are getting their medications, and that medications are not going to those who aren’t patients,” which is called “diversion,” says Bryce Pardo, a drug policy researcher at the RAND Corporation. “That’s the whole point of the system, which was invented a hundred years ago. Clearly, the system broke. The system failed.”

Pardo points out, in the DEA’s defense, the story of a so-called DEA whistle-blower blaming a pharma-backed piece of legislation passed by Congress in 2016, which prevented agents from stopping suspicious shipments of opioids, and stunted investigations into the very corporations that are now being villainized and sued. Just as DEA agents were working their way up the pharmaceutical supply chain, much as they would in a case against any transnational crime organization, Congress hamstrung their enforcement efforts.

Or so the story goes—but that’s not the whole of it. “These companies, often times acting legally, were asking for preclearance from the DEA to go about their business,” says Leo Beletsky, a professor of law and health sciences at Northeastern University (where I’m currently a journalism fellow). “Now, the DEA is saying their hands were tied when, in fact, their hands were not tied. They were completely asleep at the wheel. And by the time the DEA began constricting the [prescription] supply and targeting certain doctors and distributors, it was too late.”

In drug policy scholarship, there is a concept called the “balloon hypothesis.” When one end of a balloon gets squeezed, the air inside, rather than disappearing, rushes to fill the other end of the balloon. The balloon hypothesis is used to describe, often critically, America’s drug enforcement strategy. If cocaine production in Colombia is stamped out, production will shift to, say, Peru. If the Dark Web’s Silk Road gets shut down, a new Dark Web market pops up. The air has to go somewhere.

The balloon hypothesis also applies to the ever-shifting demand for drugs. “Over a period of 20 years, the DEA provided the green light to a 39-fold increase in the oxycodone quota and a 12-fold increase in the hydrocodone quota, even as our opioid epidemic unfolded,” Senator Dick Durbin wrote in a letter to the editor to The Washington Post. 

In other words, the prescription balloon expanded, under the DEA’s watch, big time. But starting in 2011, the prescription market finally began to shrink after Purdue Pharma reformulated its blockbuster drug OxyContin with so-called abuse deterrent technology, and pill mills serving the black market were shut down. The supply was squeezed. The air still had to go somewhere, and it rushed to deadlier opioids like heroin spiked with illicit fentanyl. With enforcement focused on prescription opioids, the overdose crisis got worse.

Dan Ciccarone, a physician-researcher at the University of California, San Francisco who studies heroin use, says the crisis unfolded in three waves:  . . .

Continue reading. There’s much more, including some pertinent observations on reducing demand (which ultimately is the only solution).

Proof Ole Miss Knew Identities of Two Students Who Posed in Front of Shot-Up Emmett Till Sign, But Did Little

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Jerry MitchellMississippi Center for Investigative Reporting, reports in ProPublica:

When the head of the University of Mississippi condemned fraternity members last week for posing with guns in front of a bullet-riddled memorial to the slain 14-year-old civil rights icon Emmett Till, he defended the campus investigation and the decision not to discipline the students.

He said Ole Miss had been unable to identify “all” the students involved when it received the complaint “or that they were all affiliated with the same fraternity.”

But the statement was misleading.

A bias complaint filed in March, and obtained by the Mississippi Center for Investigative Reporting and ProPublica, clearly identifies two of the men by name and their membership in Kappa Alpha Order.

The photo “shows three boys, at least two of whom are members of KA at Ole Miss,” the complaint reads.

On Monday, following questions from the news organizations about the discrepancy, interim Chancellor Larry Sparks acknowledged that his administration had mishandled the investigation and said that he has launched an internal review into a “breakdown in communications” that prevented a full examination of the incident by university administrators.

“Our ongoing review has updated our understanding of some key facts in this process,” Sparks wrote in response to questions from the Mississippi Center for Investigative Reporting and ProPublica.

The bias incident investigation “process has not concluded,” he wrote. “We will proceed accordingly to make all appropriate referrals and assessments.”

The complaint filed in March included a copy of a photo that student Ben LeClere posted on March 1 to his private Instagram account. The image showed LeClere and two fraternity brothers in front of a roadside plaque commemorating the site where Till’s body was recovered from the Tallahatchie River. The 14-year-old black youth was tortured and killed in August 1955. An all-white, all-male jury acquitted two white men charged with Till’s murder. His death helped launch the modern civil rights movement.

LeClere was clutching a shotgun in the photo, and fraternity brother John Lowe was squatting beneath the bullet-pocked sign. A third fraternity member stands on the other side of the sign with an AR-15 semi-automatic rifle. (The complaint misidentified Lowe as holding the rifle when he was in fact squatting.)

It appears that man is Howell Logan, a Kappa Alpha member who was identified on Twitter and Instagram by former high school classmates from the private Deerfield-Windsor School in Albany, Georgia. Logan was a star athlete there.

Late last week, three social media accounts appearing to belong to Logan were deleted, around the same time as social media accounts bearing the names of LeClere and Lowe were deleted. The image in the Instagram photo is strikingly similar to photos shared by Logan’s former classmates. Logan’s height also appears to match the height of the man seen in the photograph.

Logan did not return requests for comment, and neither did LeClere and Lowe. It is not clear whether the students shot the memorial or were merely posing in front of it.

The Kappa Alpha chapter at Ole Miss suspended the three men in the photo last week after being asked for comment by the Mississippi Center for Investigative Reporting and ProPublica.

In his initial statement on Friday, Sparks called the photo “offensive.” The university, he said, had turned over the image to the FBI, which concluded no specific crime had occurred.

Susan Glisson, who ran Ole Miss’ William Winter Institute for Racial Reconciliation for two decades before retiring in 2016, called the university’s response so far “unconscionable.”

She questioned why Ole Miss officials deferred their own inquiry while awaiting an FBI decision. “Pursuing the possibility of an investigation did not prevent the university from engaging in long-established protocols for how to respond to incidents like this,” she said.

On Monday, Sparks acknowledged that Ole Miss officials had confirmed the status of the two named students shortly after the complaint was filed. LeClere is currently an enrolled junior and majoring in managerial finance. Lowe is not currently enrolled. . .

Continue reading.

Written by LeisureGuy

30 July 2019 at 4:21 pm

Over 900 migrant children have been taken from their parents since President Trump officially ended separations, according to Justice Dept. data.

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Miriam Jordan reports in the NY Times.

More than a year after President Trump officially ended migrant family separations at the southern border, immigration authorities continue to routinely separate families for reasons as minor as a parent not changing a baby’s diaper or having a traffic citation for driving without a license, according to new documents filed Tuesday in federal court.

More than 900 children have been removed from an adult — usually a parent — with whom they arrived at the southern border since June of 2018, according to tallies provided by the Department of Justice to the American Civil Liberties Union, which is challenging the separations.

“The administration is still doing family separation under the guise that they are protecting children from their own parents even though the criminal history they are citing is either wrong or shockingly minor,” said Lee Gelernt, with the A.C.L.U.’s Immigrants Rights Project. “This is just circumventing the court’s order.”

The new numbers were filed with Judge Dana M. Sabraw in San Diego as part of the court’s continuing supervision of the family separation issue. In its motion on Tuesday, the civil rights group asked the judge to clarify a set of standards for such separations that would ensure that children are taken from their parents only when there is evidence that the parent is a genuine danger to the child, or is unfit to provide care.

Family separations began occurring in large numbers in the spring of 2018 under the Trump administration’s “zero tolerance” border enforcement policy, which called for nearly all adults who entered the country illegally to face criminal prosecution. Any children accompanying them were placed in shelters or foster care. Migrant families often ended up hundreds or thousands of miles apart for weeks or longer.

After Mr. Trump terminated the policy and Judge Sabraw issued an order to reunify all separated families, cases of separations dropped precipitously. But they have recently been climbing rapidly, Mr. Gelernt said, with a total of 911 separations over the past year.

The latest separations are mainly based on crimes committed by the parent, according to the new documents, but A.C.L.U. lawyers argue that many of the violations are as minor as traffic tickets.

“Right now, the government can separate based on any criminal history, regardless of the severity, and based on subjective criteria,” Mr. Gelernt said. “We want them only separating in specific circumstances.”

The separations were central to the Trump administration’s  . . .

Continue reading.

The optics are bad but the reality is worse. What has the US become? Those children are traumatized and will suffer for years from the official actions of the US government.

Written by LeisureGuy

30 July 2019 at 4:17 pm

Prayer to Our Lady of Waiting Rooms

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Carrie Shipers is the author of Family Resemblances (University of New Mexico Press, 2016); Cause for Concern (Able Muse Press, 2014), selected by Molly Peacock for the 2014 Able Muse Book Award; and Ordinary Mourning (ABZ Press, 2010). She teaches at Rhode Island College in Providence, and she wrote this poem:

Prayer to Our Lady of Waiting Rooms

Let the seats be plentiful and padded.
Let the magazines be recent or let the book
I’ve brought last until we can leave.
Let the TV on its bolted stand be off,
muted, or showing something I can ignore—
weather, gameshows, CNN. Let the room
be mostly empty—no one shouting, sobbing,
asking about my husband’s health.
Let everyone be strangers except
the staff. Let the walls be freshly painted,
soothing to behold. Let my husband
be there for a physical or routine checkup.
Let no one comment on my clothes
or unwashed hair, how I can sit
so calmly while he has staples
or a catheter removed, his lungs or heart
or kidneys tested, an infected wound
debrided. Under no circumstances
let me be called into the back by a nurse
who touches my arm, says I’m sorry but—
Let my husband walk out whistling
before I’ve finished my book, looked
at my watch too many times. Let the news
be good or benign, his next appointment
not for months. When the waiting is over,
let us walk outside feeling better,
or at least no worse, than we did before

Written by LeisureGuy

30 July 2019 at 4:03 pm

Posted in Art, Daily life

Walk flowers

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The top of the photo is severely cropped because I wanted to remove the close-up of my finger. To make up for that, here’s a photo of Molly resting.

Written by LeisureGuy

30 July 2019 at 1:50 pm

Posted in Cats, Daily life, Molly

The Anger of the White Male Lie

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Ijeoma Oluo has a good essay in Medium:

Continue reading.

Written by LeisureGuy

30 July 2019 at 12:00 pm

Posted in Daily life

Poem about Tree of Life synagogue massacre wins Doolin poetry prize

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The dead keep piling up and all I have are poems
to wrap them in. Pockmarks across synagogue walls
are a new font in a familiar language I refuse to utter.
Men have begun again to speak in tongues syntaxed
by phonemes of caliber and clip capacity: diction I
will not assemble into sentences; sounds I cannot make
into words. What color, the stripes being woven like old
narratives into new camp pajamas? How many stars
asterisk prayers into the bluest night? There is no
metaphor for what I cannot abide; no pentameter
for the sound of earth falling from the hands of love
into a freshly-filled grave. My iambs are a pair
of backwards-turned boots in the stirrups of a riderless
horse. We measure the inarticulate grammar of fear
in the steady metronome of newsfeed updates,
punctuate the lulls between carnage with promises
enjambed in the wind. Cover my eyes with verses
if you must. Bribe the ferryman with curses and dust.
A poet’s contract is blood-inked, bone-stamped,
ratified eternal at the frontier where hope kisses rust.

                                                                  – Matt Hohner

That’s the poem by Matt Hohner, chosen by poet Annemarie Ní Churreáin as the winner of the Doolin poetry competition, part of Doolin Writers’ Weekend. It’s from this Irish Times article, which notes:

Matt Hohner, a Baltimore native, holds an MFA in writing and poetics from Naropa University in Boulder, Colorado. He has been a finalist for the Moth International Poetry Prize and taken both third and first prizes in the Maryland Writers Association Poetry Prize. He won the 2016 Oberon Poetry Prize the 2018 Sport Literate Anything but Baseball Poetry Prize, and the Doolin Writers’ Weekend Poetry Prize. Hohner’s work has been published in numerous journals and has been nominated for a Pushcart Prize. An editor for Loch Raven Review, Hohner’s book Thresholds and Other Poems, his first full-length book, was published by Apprentice House Press in Fall 2018. He lives in Baltimore, Maryland.

Also included in the article is a video:

Big Boys Don’t Cry, written and performed by Joe Byrne, was chosen by Dave Lordan as the winner of the Doolin Writers’ Weekend Poetry Video Competition 2019.


Written by LeisureGuy

30 July 2019 at 8:03 am

Posted in Art, Books, Daily life, Video

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