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Inside Purdue Pharma’s Media Playbook: How It Planted the Opioid “Anti-Story”

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David Armstrong reports in ProPublica about how wealthy drug dealers get away with it.

In 2004, Purdue Pharma was facing a threat to sales of its blockbuster opioid painkiller OxyContin, which were approaching $2 billion a year. With abuse of the drug on the rise, prosecutors were bringing criminal charges against some doctors for prescribing massive amounts of OxyContin.

That October, an essay ran across the top of The New York Times’ health section under the headline “Doctors Behind Bars: Treating Pain is Now Risky Business.” Its author, Sally Satel, a psychiatrist, argued that law enforcement was overzealous, and that some patients needed large doses of opioids to relieve pain. She described an unnamed colleague who had run a pain service at a university medical center and had a patient who could only get out of bed by taking “staggering” levels of oxycodone, the active ingredient in OxyContin. She also cited a study published in a medical journal showing that OxyContin is rarely the only drug found in autopsies of oxycodone-related deaths.

“When you scratch the surface of someone who is addicted to painkillers, you usually find a seasoned drug abuser with a previous habit involving pills, alcohol, heroin or cocaine,” Satel wrote. “Contrary to media portrayals, the typical OxyContin addict does not start out as a pain patient who fell unwittingly into a drug habit.”

The Times identified Satel as “a resident scholar at the American Enterprise Institute and an unpaid advisory board member for the Substance Abuse and Mental Health Services Administration.” But readers weren’t told about her involvement, and the American Enterprise Institute’s, with Purdue.

Among the connections revealed by emails and documents obtained by ProPublica: Purdue donated $50,000 annually to the institute, which is commonly known as AEI, from 2003 through this year, plus contributions for special events, for a total of more than $800,000. The unnamed doctor in Satel’s article was an employee of Purdue, according to an unpublished draft of the story. The study Satel cited was funded by Purdue and written by Purdue employees and consultants. And, a month before the piece was published, Satel sent a draft to Burt Rosen, Purdue’s Washington lobbyist and vice president of federal policy and legislative affairs, asking him if it “seems imbalanced.”

On the day of publication, Jason Bertsch, AEI’s vice president of development, alerted Rosen to “Sally’s very good piece.”

“Great piece,” Rosen responded.


Purdue’s hidden relationships with Satel and AEI illustrate how the company and its public relations consultants aggressively countered criticism that its prized painkiller helped cause the opioid epidemic. Since 1999, more than 200,000 people have died from overdoses related to prescription opioids. For almost two decades, and continuing as recently as a piece published last year in Slate, Satel has pushed back against restrictions on opioid prescribing in more than a dozen articles and radio and television appearances, without disclosing any connections to Purdue, according to a ProPublica review. Over the same period, Purdue was represented by Dezenhall Resources, a PR firm known for its pugnacious defense of beleaguered corporations. Purdue was paying Dezenhall this summer, and still owes it money, according to bankruptcy filings.

Purdue funded think tanks tapped by the media for expert commentary, facilitated publication of sympathetic articles in leading outlets where its role wasn’t disclosed, and deterred or challenged negative coverage, according to the documents and emails. Its efforts to influence public perception of the opioid crisis provide an inside look at how corporations blunt criticism of alleged wrongdoing. Purdue’s tactics are reminiscent of the oil and gas industry, which has been accused of promoting misleading science that downplays its impact on climate change, and of big tobacco, which sought to undermine evidence that nicotine is addictive and secondhand smoke is dangerous.

Media spinning was just one prong of Purdue’s strategy to fend off limits on opioid prescribing. It contested hundreds of lawsuits, winning dismissals or settling the cases with a provision that documents remain secret. The company paid leading doctors in the pain field to assure patients that OxyContin was safe. It also funded groups, like the American Pain Foundation, that described themselves as advocates for pain patients. Several of those groups minimized the risk of addiction and fought against efforts to curb opioid use for chronic pain patients.

Purdue’s campaign may have helped thwart more vigorous regulation of opioid prescribing, especially in the decade after the first widespread reports of OxyContin abuse and addiction began appearing in 2001. It may also have succeeded in delaying the eventual reckoning for Purdue and the billionaire Sackler family that owns the company. Although Purdue pleaded guilty in 2007 to a federal charge of understating the risk of addiction, and agreed to pay $600 million in fines and penalties, the Sacklers’ role in the opioid epidemic didn’t receive widespread coverage for another decade. As backlash against the family swelled, the company filed for Chapter 11 bankruptcy in September.

“Efforts to reverse the epidemic have had to counter widespread narratives that opioids are generally safe and that it is people who abuse them that are the problem,” said Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health, who has served as a paid expert witness in litigation alleging that Purdue’s marketing of OxyContin misled doctors and the public. “These are very important narratives, and they have become the lens through which people view and understand the epidemic. They have proven to be potent means of hampering interventions to reduce the continued oversupply of opioids.”

Satel, in an email to ProPublica, said that she reached her conclusions independently. “I do not accept payment from industry for my work (articles, presentations, etc),” she wrote. “And I am open to meeting with anyone if they have a potentially interesting topic to tell me about. If I decide I am intrigued, I do my own research.”

As for Purdue’s funding of AEI, Satel said in an interview that she “had no idea” that the company was paying her employer and that she walls herself off from information regarding institute funders. “I never want to know,” she said. She didn’t disclose that the study she referred to was also funded by Purdue, she said, because “I cite peer-reviewed papers by title as they appear in the journal of publication.”

The sharing of drafts before publication with subjects of stories or other interested parties is prohibited or discouraged by many media outlets. Satel said she didn’t remember sharing the draft with Rosen and it was not her usual practice. “That’s very atypical,” she said. However, Satel shared a draft of another story with Purdue officials in 2016, according to emails she sent. In that case, Satel said, she was checking facts.

Satel said she didn’t remember why the doctor with a patient on high doses of painkillers wasn’t named in the Times story. The draft she sent to Purdue identified him as Sidney Schnoll, then the company’s executive medical director, who defended OxyContin at public meetings and in media stories. In an interview, Schnoll described Satel as an old friend and said her description of his patient was accurate. He left Purdue in 2005 and now works for a consulting company that has Purdue as a client, he said.

Purdue, in a statement, said it has . .

Continue reading.

Written by LeisureGuy

19 November 2019 at 4:45 pm

Jeff Bezos Mocks France

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Matt Stoller writes in Big:

Those of you who have read BIG for awhile know that I pay a lot of attention to foreign enforcers. I wrote up how the Russians are actually effective at protecting competition in search, whereas the EU is not. I’m also intrigued by Rod Sims in Australia, who is likely to take significant action.

My favorite enforcer in Europe is the German head of their cartel office, Andreas Mundt. Mundt has been the most aggressive antitrust enforcer in the world when it comes to Facebook. In February, his office attacked the core of its targeted advertising program, ruling “that the company stop automatically sharing data among the services it owns, like Instagram and WhatsApp, or websites that use its “like” and “share” buttons.”

This ruling wasn’t just about privacy. Data is a key input in advertising, so preventing Facebook from using data to undermine its competitors who sell advertising would have a big impact on the market. Mundt is also a fighter. A German court just ruledagainst Mundt using the rationale that Facebook’s collection of data isn’t a competition problem. And Mundt is appealing.

Mundt, however, is on the leading edge of enforcement. Many European officials are, like center-left Americans in the antitrust bar, still libertarian-leaning, though sort of embarrassed about it. The most recent example of European unwilling to confront power happened last month when the French decided to impose a tax on big techinstead of restructuring market power directly. The tax applies to companies with revenue of higher than 750 million euros and 25 million euros in France.

So what did Jeff Bezos do? His response is almost comical.

Virginie Lemaire recently opened her email to an unsettling message from Amazon: fees for sellers like her in France will be increasing by 3%.

Lemaire, a single mother of two, started her jewelry company Perle d’un jour in 2011. Trained as an artisan jeweler, she makes handmade custom pieces like necklaces, bracelets and rings.

The French small business owner started selling her products on Amazon two years ago and now generates one-fifth of her sales from the e-commerce giant’s marketplace.

So it was an unwelcome surprise when she found out Amazon would be raising seller fees for her and thousands of other small and medium-sized French businesses starting in October. The reason the company cited was simple: a 3% digital tax passed by the French government in July.

Yup, Amazon just passed the tax along to French businesses. That’s monopoly power, baby. Bezos can simply impose private taxes, pretty much at willThe idea of taxing monopolies, instead of breaking them up, is coming from those who like centralized power but are uncomfortable with American control of it.

Another example of this philosophy is the just leaked documents of plans to create a $100 billion European sovereign wealth fund to build European competitors to American and Chinese big tech.

The officials identify Google, Apple, Facebook, Amazon, Microsoft, Baidu, Alibaba and Tencent among the companies Europe needs to rival. “Europe has no such companies,” their document notes.

Europeans are embarrassed they don’t have large tech companies, instead of recognizing the leverage this gives them. Financing competitors to monopolists isn’t likely to work, and it will also violate trade commitments. And conceptually it’s problematic because it mis-frames the problem as Europeans not being innovative enough to compete. But Europeans are just as innovative as anyone else. The problem is that European markets, like markets dominated everyone by big tech, are monopolized by centralized institutions.

This philosophy also misframes leverage. Europe is not some weak set of feckless states who must bow before Google or Amazon. These are countries with sovereign power, and Amazon and Google need European markets a hell of a lot more than these countries need Amazon and Google. Europe should just break these guys up, as Mundt is effectively doing with Facebook.

The reason these officials do not want to break up big tech monopolies is that they don’t fear concentrated power, they just believe that only European leaders should be able to concentrate it. Similarly, some on the left in the U.S. just do not care that Google and Facebook have monopolized advertising, thinking as they do that advertising is a dirty business. They prefer publicly financed media, a sort of ‘we like centralized power but the people in charge have to be nice people.’ This preference for centralized power goes all the way back to Teddy Roosevelt and the New Nationalists, so the debate isn’t new.

Jeff Bezos’s almost casual ability to ward off France’s digital tax shows, however, that the philosophy of ‘concentrate power but in nice peoples’ hands’ is conceptually flawed. The only way to deal with big tech is by going at their monopoly power directly. Doing so will requires more enforcers within the European regulatory apparatus adopting Mundit’s creativity and aggressiveness, and more importantly, his philosophy that concentrations of private power are intrinsically a threat to liberty.

One of the key officials who has to change her mind is Margareth Vestager, the head of the European Competition Authority (though for how much longer it’s not clear). Vestager is somewhat assertive and gets big fines from Google, but on a conceptual level she basically accepts the thinking of big tech lobbyists. This attitude came out when she was asked about Elizabeth Warren’s plan to break up big tech. She said she opposes it, and explained why. . .

Continue reading.

Written by LeisureGuy

27 August 2019 at 10:11 am

Seattle Has Figured Out How to End the War on Drugs

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The War on Drugs, let us remember, is thanks to Richard Nixon, infamous crooked president, who rejected the findings of his own expert commission on the problem figuring that, since he was president, he knew a lot more than a group of people who had seriously studied the issues for years. (Sound familiar?) Nicholas Kristof writes in the NY Times:

On gritty streets where heroin, fentanyl and meth stride like Death Eaters, where for decades both drugs and the war on drugs have wrecked lives, the city of Seattle is pioneering a bold approach to narcotics that should be a model for America.

Anyone caught here with a small amount of drugs — even heroin — isn’t typically prosecuted. Instead, that person is steered toward social services to get help.

This model is becoming the consensus preference among public health experts in the U.S. and abroad. Still, it shocks many Americans to see no criminal penalty for using drugs illegally, so it takes courage and vision to adopt this approach: a partial retreat in the war on drugs coupled with a stepped-up campaign against addiction.

The war on drugs has been one of America’s most grievous mistakes, resulting in as many citizens with arrest records as with college diplomas. At last count, an American was arrested for drug possession every 25 seconds, yet the mass incarceration this leads to has not turned the tide on narcotics.

The number of opioid users has surged, and more Americans now die each year from overdoses than perished in the Vietnam, Afghan and Iraq wars combined. And that doesn’t account for the way drug addiction has ripped apart families and stunted children’s futures. More than two million children in America live with a parent suffering from an illicit-drug dependency.

So Seattle is undertaking what feels like the beginning of a historic course correction, with other cities discussing how to follow. This could be far more consequential than the legalization of pot: By some estimates, nearly half of Americans have a family member or close friend enmeshed in addiction, and if the experiment in Seattle succeeds, we’ll have a chance to rescue America from our own failed policies.

In effect, Seattle is decriminalizing the use of hard drugs. It is relying less on the criminal justice toolbox to deal with hard drugs and more on the public health toolbox.

Decriminalization is unfolding here in part because of Dan Satterberg, the prosecuting attorney for King County, which includes Seattle. It’s also arguably underway because of what happened to his little sister, Shelley Kay Satterberg.

At the age of 14, Shelley ran away from home because her parents wouldn’t let her go to a concert on a school night. It was a rebellion that proved devastating. She was away for several months, was gang-raped by two men, was introduced to hard drugs and began to self-medicate with those drugs to deal with the trauma of rape.

As Dan Satterberg rose through the ranks of prosecutors, Shelley Satterberg wrestled with addiction. She was never arrested or jailed (middle-class drug users often avoid police attention, which focuses on marginalized people who use or sell in public).

Dan told me that he was angry at Shelley — angry that she had made terrible choices, angry that she had hurt their parents. But over time he also concluded that his own approach of prosecuting drug users accomplished little, except that it isolated them from the family and friends who offered the best support system to escape addiction.

In 2015, Dan took Shelley to Navos, a nonprofit that provides mental health and addiction services, and she was able to stop using street drugs and gradually put her life back in order. Dan saw that treatment made a huge difference in Shelley’s life and became a believer.

Yet it wasn’t enough. Shelley died of a urinary tract infection last year at age 51, a consequence of previous drug and alcohol abuse.

“It gave me some insight about what works better than jail,” Dan Satterberg told me. “What Shelley needed was not a jail cell and not a judge wagging a finger at her, but she needed some support.”

Seattle’s first crucial step came in 2011 when Satterberg and others started a program called LEAD, short for Law Enforcement Assisted Diversion. The idea is that instead of simply arresting drug users for narcotics or prostitution, police officers watch for those who are nonviolent and want help, and divert them to social service programs and intensive case management.

Almost immediately, this was a huge success. A 2017 peer-reviewed study found that drug users assigned to LEAD were 58 percentless likely to be rearrested, compared with a control group. Participants were also almost twice as likely to have housing as they had been before entering LEAD, and 46 percent more likely to be employed or getting job training.

LEAD isn’t cheap — it costs about $350 per month per participant to provide case managers. But it is cheaper than jail, courts and costs associated with homelessness. As a result, this approach has spread rapidly around the country, with 59 localities now offering LEAD initiatives or rolling them out.

Chian Jennings, 45, who had struggled with drugs for years, living in the streets and financing her habit by selling sex and by stealing, was smoking crack when a policeman stopped her.

“It was probably the best thing that happened to me,” Jennings told me. “It saved my life.” Instead of locking her up, the police officer handed her over to social workers at LEAD.

Through LEAD, Jennings got medical care, clothing and housing. She also gained confidence in herself, people who cared for her and the idea that life could get better. “They’re some of the most caring people I’ve ever met,” she said of the counselors. “Whether you come in high or not, they always treat you with respect.” Now, she said, “I work to make them proud of me.”

Jennings remains a work in progress. She says she still sometimes uses cocaine, but less over time, and she adds that she’s no longer stealing. If she had been held in jail, she said, “it would have pissed me off, and I would have gotten high when I got out. I’d still be homeless, stealing for food and drug money.”

Prison, she says, just makes people more miserable and more dependent on drugs when they are released. “This bit about ‘I learned my lesson’ — no, it doesn’t work that way,” she said. “People are hurting inside. That’s why they’re using in the first place.”

The war on drugs began in 1971 out of a legitimate alarm about narcotics both in the United States and among U.S. troops in Vietnam. But the “war” approach locked up enormous numbers of people and devastated the family structure. Drug laws discriminated against African-Americans (possession of crack cocaine, disproportionately used by blacks, drew far harsher sentences than possession of the same quantity of powdered cocaine, more likely to be used by whites).

Yet locking up endless waves of users has had little deterrent effect, and overdose deaths have surged. The White House has estimated that the economic cost of the opioid crisis in the United States exceeds $500 billion a year, equivalent to about $4,000 per household. And that doesn’t even include cocaine, meth and other drug use.

While the U.S. doubled down on the criminal justice approach to drugs, Portugal took the opposite avenue, decriminalizing possession of all drugs in 2001. It was a gamble, but it succeeded. As I’ve reported, Portugal’s overdose deaths plunged. The upshot is that drug mortality rates in the United States are now about 50 times higher than in Portugal. . .

Continue reading.

Written by LeisureGuy

26 August 2019 at 3:05 pm

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).

The Four Ordinary People Who Took On Big Pharma

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Beth Macy writes in the NY Times:

In the beginning, there were just four: the Godfather from Philly, the Army sergeant from Georgia, the professor from California and the feisty mom from Florida.

It was the early 2000s, and they usually talked over old-school computer message boards. Occasionally they gathered in person, carrying posters of their children and middle-aged spouses — all dead from OxyContin overdoses.

Today we know just how dangerous this drug is. Purdue Pharma, the company that made OxyContin, the first extended-release opioid to be widely prescribed, may finally be held to account. Some 200,000 people have died from overdosing on prescription opioids, and around 2,000 lawsuits attempting to make opioid makers and distributors pay for the damage unleashed by careless overprescribing are wending their way through the courts. But experts predict it will take more than $100 billion to turn the crisis around, and it’s hard to feel optimistic when you know the story of how long and hard these four labored in obscurity before anyone listened to them.

The four called themselves RAPP, short for Relatives Against Purdue Pharma, and they testified at hearings, lent support at whistle-blower trials and marched outside pharmaceutical-funded physician meetings at fancy resorts. They were outgunned at every pass — by a pharma-funded phalanx of lawyers and by doctors who had become paid spokesmen for the company. One resort even turned a sprinkler on them. But they picked up new members by the week.

Their leader was Ed Bisch, an I.T. worker from Philadelphia who’d lost his 18-year-old son, Eddie, in 2001. They called him the Godfather because he’d brought them together in the first place, via his website, OxyKills, shortly after Eddie’s death.

Mr. Bisch had wanted to believe Purdue’s excuses at first. He was persuaded, even, to change the name of his message board to OxyAbuseKills, after the company approached him about softening his tone, then gave him a $10,000 grant to put toward his education efforts. “They kept blaming it on the ‘abusers,’ but finally I said, ‘Look, at least 50 percent of my emails are from relatives of peoplewho are patients who are either dead or addicted,’” Mr. Bisch recalled. “It took me a while to realize how evil this company was.”

Barbara Van Rooyan, a professor of counseling at Folsom Lake College in California until she retired in 2012, told Mr. Bisch recently that finding his website “saved my life and gave me hope that the grief could be used for some good.” Her 24-year-old son, Patrick, died after taking OxyContin at a Fourth of July party in 2004. “It’s kind of like a muscle relaxant, and it’s F.D.A.-approved, so it’s safe,” the friend told Patrick.

The following year, with support from RAPP, Ms. Van Rooyan petitioned the Food and Drug Administration to recall OxyContin until it could be reformulated to make it harder for abusers to crush or dissolve the pills for a more intense high; she also wanted the drug restricted to end-of-life care and to treatment of cancer and other severe pain. It took eight years before the F.D.A. responded by noting that Purdue had voluntarily reformulated the drug in 2010 (so that point was moot), and her restriction petition was denied.

By 2007, RAPP numbered in the hundreds. That August scores of them converged in the rain outside a tiny federal courthouse in Abingdon, Va., because they wanted “to look evil in the face,” as the Florida mother, Lee Nuss, put it. Three of Purdue’s top executives had flown in to be sentenced on misdemeanor misbranding charges. Purdue’s parent company pleaded guilty to a felony misbranding charge, admitting that for six years it had fraudulently marketed OxyContin as being less prone to abuse and having fewer narcotic side effects than competing drugs.

All four of the original members of RAPP spoke at the hearing. They knew one another so well by then that they car-pooled to Abingdon and doubled up in hotel rooms to save money. One of them, Ed Vanicky, had fed evidence to the Virginia prosecutors — including a now-infamous cassette tape of a public-relations conference in which a Purdue spokesman brushed off the problems of OxyContin in Appalachia by saying, “The fact is, these rural areas have had problems with prescription drug abuse since the Civil War.” (In other words, the hillbillies, not Purdue’s drug, were defective.)

Mr. Vanicky was an Army sergeant in 2000 when he found his 44-year-old wife, Mary Jo, in bed dead after taking OxyContin for a herniated disc. He had just returned home from a yearlong posting in Korea and had never even heard the word OxyContin until the coroner who performed his wife’s autopsy inquired about it.

As she stepped down from the Abingdon witness stand, the Florida mother, Ms. Nuss, brandished a small brass urn containing some of the ashes of her son, Randall, who was 18 when he overdosed on OxyContin. There was a metal detector in the courthouse, and her friends still can’t figure out how she managed to sneak in that urn.

In the end, the company was forced to pay some $634 million in fines. A pittance, compared to the billions it had earned on the drug.

That fine is still the largest paid by Purdue to date, and it would do nothing to slow the epidemic. Not a single executive went to jail, and none of the settlement money went to treatment. OxyContin sales surged in its aftermath, topping $2 billion in 2008.

When Purdue finally reformulated OxyContin to make it abuse-resistant, the pill-addicted switched to heroin and, later, fentanyl to keep their dopesickness at bay. Within another decade, nearly 400,000 people would be deadMore than 2.6 million Americans are now addicted.

Today, the group’s prescience is clear. But they are sad, and they are tired. They still believe the company’s owners, the Sackler family, and executives should go to jail. But more than anything, they want the judges overseeing the lawsuits to make sure Purdue and the family use their riches to guarantee Americans access to treatment.

Recent news of the company’s misdeeds — like the allegation from New York’s attorney general, Letitia James, that Sackler family members moved hundreds of millions of dollars into private or offshore accounts, paying themselves when they knew the company was already insolvent or close to it — only confirms what the four have long believed.

In March, Oklahoma settled its case against Purdue and the Sacklers for $270 million — in part because the company was contemplating filing bankruptcy, and the state feared bankruptcy claims would insulate it from paying restitution. That meant all the documents in the case would remain sealed — a fate RAPP laments because it allows the company to hide its tactics from public scrutiny, occluding the dangers of the drug. “I have been saying for years that sealing the lawsuits let them get away with murder,” Mr. Bisch said.

This summer Vanity Fair published a rare interview with David Sackler, grandson of one of the three brothers who founded Purdue Pharma, who said his family had suffered “endless castigation,” including the taunting of his 4-year-old at nursery school. With a tone-deafness reserved for people who can afford to surround themselves with sycophants, he told the writer Bethany McLean, “Look at all the good Purdue has done.”

Mr. Vanicky read the article and told me, “I bet it sucks to be a Sackler these days.” He has personally called the offices of many attorneys general to thank them for filing suit against the Sacklers and Purdue.

Now 72,  . . .

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Written by LeisureGuy

21 July 2019 at 3:27 pm

It’s bad when the government lies to the public: Most Heroin Addicts Didn’t Start By Being Prescribed Pain Pills, Despite Drug Czar’s Claims

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Philip Smith reports in Drug War Chronicles:

As part of its campaign to stem opioid addiction and overdoses, the White House Office of National Drug Control Policy (ONDCP — the drug czar’s office) has launched an education campaign called The Truth About Opioids, but some of the material it is presenting has more than a whiff of spin to it — and could imperil the ability of pain patients to get the relief they need.

The web site declares in big, bold letters that “80% of heroin users started with a prescription painkiller,” and highlights the words “80%,” “heroin,” “started,” and “prescription” in lurid purple. The graphic suggests that heroin users were prescribed opioids, developed a habit, and then went on to junk, with the further implication that a way to reduce heroin addiction is to tighten and reduce the prescribing of opioids.

The web site then asks readers if they are “shocked,” “ah-ha,” “outraged,” or “fired up” by the information. It is only if readers scroll down the page that they are informed that the basis for the statistic is a 2013 study of “Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers.” (Emphasis added.)

That’s right, even though the graphic shouts out that people prescribed opioids then went on to become heroin addicts, the science it uses to back its claim is about recreational pain pill users. That’s deceptive.

Misleading claims about prescribing opioids and the potential for opioid addiction are, of course, nothing new. Twenty years ago, PurduePharma infamously claimed that the risk of addiction from OxyContin was so low as to be negligible, a marketing tactic that helped kick into overdrive the pain pill phase of the current wave of opioid use.

But the drug czar’s office, with its misleading suggestion that being prescribed opioids leads to heroin addiction, tips the pendulum too far in the other direction. There are real world consequences to using such faulty information. The Drug Enforcement Administration cited that 80% figure last year when it ordered steep decreases in the supply of prescription opioids, and it claimed in the Federal Register that patients got addicted “after first obtaining these drugs from their health care providers.”

“The 80% statistic is misleading and encourages faulty assumptions about the overdose crisis and medical care,” Pain News Network columnist Roger Chriss argued in a column last year.

And now, a new study from researchers at Penn State University published in the Journal of Addictive Studies bolsters that claim. Concentrating on southwestern Pennsylvania, an area with high levels of addiction, the researchers conducted surveys and in-depth interviews with drug users to determine their drug using histories. The sample size was small, with 125 people surveyed and 30 interviewed, but the results were illuminating.

The researchers found that two out of three of those interviewed got their first prescription opioids not from a doctor’s prescription, but either bought or stole it from a family member or friend. Another 7 percent bought their drugs from a stranger or a dealer. And only one out of four (26 percent) began with opioid medications prescribed by a doctor.

“What emerged from our study — and really emerged because we decided to do these qualitative interviews in addition to a survey component — was a pretty different narrative than the national one. There’s a lot about that narrative that I think is an overly simplistic way of thinking about this,” said lead author Ashton Verdery, PhD, an assistant professor of sociology, demography and social data analytics at Penn State.

“We found that most people initiated through a pattern of recreational use because of people around them. They got them from either siblings, friends or romantic partners,” he continued. “Participants repeatedly reported having a peer or caregiver in their childhood who had a substance use problem. Stories from childhood of witnessing one of these people selling, preparing, or using drugs were very common. Being exposed to others’ substance use at an early age was often cited as a turning point for OMI (opioid misuse) and of drug use in general.”

Among study participants, recreational drug use — or polysubstance abuse, in public health speak — was common, Verdery noted, and usually began not with prescription opioids but with drugs such as alcohol, marijuana, cocaine, methamphetamine, and prescription sedatives and stimulants.

“It is important to note that interviewees universally reported initiating OMI only after previously starting their substance use career with another drug (e.g., alcohol, marijuana, cocaine). Opioids were never the first drug used, suggesting that OMI is likely associated with being further along in one’s drug using career,” he added.

Researchers studying opioid addiction need to be aware of the role other substances play in the process, Verdery said. Understanding how opioid addiction is intertwined with other drug use is necessary to figure out the correct steps to take to prevent addiction before it takes hold. . .

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Written by LeisureGuy

21 June 2019 at 10:23 am

The War on Cocaine Only Strengthens Drug Cartels, Study Finds

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Philip Smith reports in Drug War Chronicles:

If you’ve spent nearly a half-century and $250 billion trying to stop the flow of cocaine into the US and the white powder is now cheaper and more plentiful than ever, maybe it’s time to rethink. That’s the implicit lesson lurking behind a new study on the impact of drug interdiction efforts on drug trafficking organizations.

Interdiction is the supply side approach to reducing drug use. Rather than reducing demand through education, prevention, and treatment, interdiction seeks to reduce the supply of drugs available domestically by blocking them en route to the US or at the border.

Published in the Proceedings of the National Academy of Sciences and conducted by scientists from a half-dozen American universities, the study relied on a computer model called NarcoLogic that shows how drug traffickers respond to interdiction strategies and tactics. More sophisticated than previous attempts to simulate the drug trade, NarcoLogic models local- and network-level trafficking dynamics at the same time.

“Our team consists of researchers who worked in different parts of Central America during the 2000s and witnessed a massive surge of drugs into the region that coincided with a reinvigoration of the war on drugs,” David Wrathall of Oregon State University’s College of Earth, Ocean and Atmospheric Sciences said in a press release announcing the research results. “We asked ourselves: did drug interdiction push drug traffickers into these places?”

The short answer is yes, and that has implications that go far beyond drug policy. The Central American migrants who are at the center of the current “border crisis” are fleeing not only poverty but also high levels of violence generated by the movement of Mexican drug trafficking groups into the region a decade ago as they faced increasing interdiction efforts at home and from US authorities.

In fact, although it is not addressed in this new research, it was earlier interdiction efforts aimed at Colombian cocaine trafficking groups in the 1980s that led directly to the transformation of formerly small-scale Mexican cross-border smuggling organizations into the Frankenstein’s monster of drug prohibition that the cartels are today. With the Colombians under intense pressure, Mexican traffickers rose to the occasion and have been making billions of dollars a year ever since.

This despite five decades of US interdiction efforts with an average annual expenditure of $5 billion. Instead of curbing the flow of cocaine into the United States, all that has been accomplished is making the drug trafficking operations more widespread and harder to eradicate. Putting pressure on one route or location simply leads traffickers to scatter and regroup. This is the “balloon effect,” where suppressing traffic or production in one area prompts it to pop up elsewhere, and the “cockroach effect,” where traffickers simply decentralize their operations.

“Between 1996 and 2017, the Western Hemisphere transit zone grew from 2 million to 7 million square miles, making it more difficult and costly for law enforcement to track and disrupt trafficking networks,” Wrathall said. “But as trafficking spread, it triggered a host of smuggling-related collateral damages: violence, corruption, proliferation of weapons, and extensive and rapid environmental destruction.”

And for all that effort, the impact on cocaine price and availability has been negligible — or even perverse.

“Wholesale cocaine prices in the United States have actually dropped significantly since 1980, deaths from cocaine overdose are rising, and counterdrug forces intercept cocaine shipments at a low rate. More cocaine entered the United States in 2015 than in any other year,” Wrathall said. “And one thing people who support interdiction and those who don’t can agree on is that change is needed. This model can help determine what that change should look like.”

The main takeaway from the study is not that drug trafficking became more widespread and resilient because of ineffective interdiction efforts, but because of interdiction itself. The policy aimed at suppressing the drug trade has only made it stronger and wealthier. . .

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Written by LeisureGuy

11 April 2019 at 9:27 am

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