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How judges added to the grim toll of opioids

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Benjamin Lesser, Dan Levine, Lisa Girion, and Jaimi Dowdell report in Reuters:

The opioid epidemic that has so far killed half a million Americans is routinely blamed on greedy drug makers, feckless doctors and lax regulators. But there’s another group that has contributed to the depth and duration of the catastrophe: judges.

Judges like Booker T. Stephens.

Until his retirement in May, Stephens sat on the West Virginia Circuit Court in Welch, deep in Appalachian coal country, where addiction took early root among miners who were prescribed the blockbuster opioid OxyContin for the pain their jobs inflicted. And it was in his court where the first lawsuit filed by a state against OxyContin’s maker, Purdue Pharma LP, landed in 2001.

West Virginia accused Purdue of duping doctors into widely prescribing the drug by minimizing its risks, convincing them it was less addictive than other opioids because just one dose delivered steady relief for 12 hours. In the pretrial “discovery” phase of the case, Purdue sent thousands of pages of internal memos, notes from sales calls on doctors, marketing plans and other records to the state’s lawyers who had requested them.

That evidence was clearly compelling: In a 2004 ruling, Judge Stephens rejected Purdue’s motion that he dismiss the case and sided with the state’s assertion that the material could convince a jury that Purdue’s sales pitch was full of dangerous lies.

But Stephens sealed the evidence on which he relied in that ruling. And when Purdue and the state reached a settlement that year, before the case went to trial, the evidence remained hidden, out of sight to regulators, doctors and patients. Over the next few years, as OxyContin sales and opioid-related deaths climbed, more than a dozen other judges overseeing similar lawsuits against Purdue took the same tack, keeping the company’s records secret.

It would be 12 years – and 245,000 overdose deaths – before evidence Stephens and other judges kept hidden was made public, and then only after it was leaked to a newspaper. What it showed was revelatory: OxyContin, the first billion-dollar-a-year narcotic, was not the reliable 12-hour painkiller Purdue long claimed it was. Its effects often wore off much sooner, exposing patients to a relapse of pain, withdrawal, or both – suffering relieved only by the next pill. When doctors raised concerns, the documents showed, Purdue sales reps counseled them to put patients on bigger, more dangerous doses.

The eventual release of the evidence reinforced the widely held view that OxyContin was a catalyst for the epidemic, which by then had expanded beyond prescription opioids to include illicit drugs such as heroin. The material also informed hundreds of new lawsuits seeking to force accountability on the entire opioid industry for its role in the addiction crisis.

But for untold numbers of opioid users who had overdosed, it was too late. “Heartbreaking and sickening” is how Congresswoman Katherine Clark, a Massachusetts Democrat who has been involved in investigating the causes of the opioid epidemic, described the early decisions to seal the Purdue evidence. In an interview, Clark said she believes that had the secrets come out earlier, doctors would have written fewer OxyContin prescriptions and fewer insurers would have covered the drug. “We don’t know how many lives we could have saved,” she said.

Stephens told Reuters he doesn’t second-guess his decision. “It happened, and that’s all that I can say about it,” he said. “It speaks for itself.”

Today, 15 years after Stephens protected Purdue’s secrets, Federal Judge Dan Polster is providing the same cover for multiple opioid makers, distributors and retailers. He is presiding over a mass of litigation that seeks to hold the entire industry responsible for the epidemic. Life-saving information contained in those cases, too, may remain under seal, as Polster has stuck to a strict secrecy playbook.

Polster declined to comment for this article.

The trail of hidden evidence running through the opioid crisis is emblematic of a pervasive and deadly secrecy that shrouds product-liability cases in U.S. courts, enabled by judges who routinely allow the makers of those products to keep information pertinent to public health and safety under wraps. And since nearly all such cases are resolved before trial, the evidence often remains secret indefinitely, robbing consumers of the chance to make informed choices and regulators of opportunities to improve safety.

In an unprecedented analysis, Reuters found that over the past 20 years, judges sealed evidence relevant to public health and safety in about half of the 115 biggest defective-product cases consolidated before federal judges in so-called multidistrict litigation, or MDLs. Those cases comprised nearly 250,000 individual death and injury lawsuits, involving dozens of products used by millions of consumers: drugs, cars, medical devices and other products. And the numbers don’t convey the full extent of information locked away because they don’t include thousands of product-liability cases heard in state courts.

The impact is broad. Although secrecy makes complete analysis impossible, Reuters found that hundreds of thousands of people were killed or seriously injured by allegedly defective products after judges in just a handful of cases allowed litigants to file under seal, beyond public view, evidence that could have alerted consumers and regulators to potential danger.

For example, beginning in the early 1980s, judge after judge kept under seal evidence that the trigger on Remington Arms Co’s Remington 700 hunting rifle was prone to misfiring. In 2014, after decades of secrecy, a judge presiding over a class-action lawsuit in Missouri refused to seal the trove of documents, which showed that the company had been aware of the defective trigger since the late 1940s. By then, nearly 200 people had died from accidental shootings blamed on the problem. The company then recalled the defective rifles.

Thousands more people died in rollover accidents involving General Motors Co cars and trucks while judges agreed to hide records showing the company knew that reinforcing vehicle roofs would save lives. After a decade of lawsuits in which those records were kept secret, a Los Angeles judge released the information in 2004 at the request of plaintiffs who wanted to share it with regulators. In 2009, the federal government upgraded a decades-old standard on roof strength.

Remington declined to comment. In a statement emailed to Reuters, GM said: “Advances in auto safety effectively addressed this concern many years ago … Also, it’s fair for individuals or companies to be able to request that certain sensitive or personal information be safeguarded.”

THE LAW AND THE REALITY

In fact, court records are presumed to be public as a matter of law. They can only be sealed for valid concerns about privacy, including personal medical records, and to protect company trade secrets.

In most states and nearly all the 13 federal appellate circuits, judges are legally obliged to weigh any litigant’s request that information be sealed against the broader public interest in making it public. They also must explain in the court record any decision in favor of secrecy. Judges incur no penalty for failing to do these things.

In practice, secrecy has become so ingrained in the system that judges rarely question it. In 85 percent of the cases where Reuters found health and safety information under seal, judges provided no explanation for allowing the secrecy.

Judge Stephens was bound by West Virginia law to weigh secrecy against transparency and provide in the court record his reasoning. Like many judges in his position, he did neither. “This case was sealed because both sides agreed and asked me to seal it,” he told Reuters.

That reasoning explains why secrecy has become the norm: It makes things easier for everyone involved. Corporate lawyers want to protect their clients’ reputations. Plaintiffs’ lawyers want to avoid miring their clients’ cases in lengthy courtroom wrangling over requests that filings be sealed or redacted. And judges want to keep the business of justice moving. . .

Continue reading. Judges act as though they work for the corporations, not for the public.

There’s much more. It’s a long article and it shows how very bad things have gotten.

Written by LeisureGuy

25 June 2019 at 1:47 pm

ICE Agents Are Losing Patience with Trump’s Chaotic Immigration Policy

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Jonathan Blitzer reports in the New Yorker:

Last Monday, when President Trump tweeted that his Administration would stage nationwide immigration raids the following week, with the goal of deporting “millions of illegal aliens,” agents at Immigration and Customs Enforcement were suddenly forced to scramble. The agency was not ready to carry out such a large operation. Preparations that would typically take field officers six to eight weeks were compressed into a few days, and, because of Trump’s tweet, the officers would be entering communities that now knew they were coming. “It was a dumb-shit political move that will only hurt the agents,” John Amaya, a former deputy chief of staff at ice, told me. On Saturday, hours before the operation was supposed to start in ten major cities across the country, the President changed course, delaying it for another two weeks.

On Sunday, I spoke to an ice officer about the week’s events. “Almost nobody was looking forward to this operation,” the officer said. “It was a boondoggle, a nightmare.” Even on the eve of the operation, many of the most important details remained unresolved. “This was a family op. So where are we going to put the families? There’s no room to detain them, so are we going to put them in hotels?” the officer said. On Friday, an answer came down from iceleadership: the families would be placed in hotels while ice figured out what to do with them. That, in turn, raised other questions. “So the families are in hotels, but who’s going to watch them?” the officer continued. “What happens if the person we arrest has a U.S.-citizen child? What do we do with the children? Do we need to get booster seats for the vans? Should we get the kids toys to play with?” Trump’s tweet broadcasting the operation had also created a safety issue for the officers involved. “No police agency goes out and says, ‘Tomorrow, between four and eight, we’re going to be in these neighborhoods,’ ” the officer said.

The idea for the operation took hold in the White House last September, two months after a federal judge had ordered the government to stop separating parents and children at the border. At the time, the number of families seeking asylum was rising steadily, and Administration officials were determined to toughen enforcement. A D.H.S. official told me that, in the months before the operation was proposed, “a major focus” of department meetings “was concern about the fact that people on the non-detained docket”—asylum seekers released into the U.S. with a future court date—“are almost never deported.” By January, a tentative plan had materialized. The Department of Justice developed a “rocket docket” to prioritize the cases of asylum seekers who’d just arrived in the country and missed a court date—in their absence, the government could swiftly secure deportation orders against them. D.H.S. then created a “target list” of roughly twenty-five hundred immigrant family members across the country for deportation; eventually, the Administration aimed to arrest ten thousand people using these methods.

From the start, however, the plan faced resistance. The Secretary of D.H.S., Kirstjen Nielsen, argued that the arrests would be complicated to carry out, in part, because American children would be involved. (Many were born in the U.S. to parents on the “target list.”) Resources were already limited, and an operation on this scale would divert attention from the border, where a humanitarian crisis was worsening by the day. The acting head of ice, Ron Vitiello, a tough-minded former Border Patrol officer, shared Nielsen’s concerns. According to the Washington Post, these reservations weren’t “ethical” so much as logistical: executing such a vast operation would be extremely difficult, with multiple moving pieces, and the optics could be devastating. Four months later, Trump effectively fired them. Vitiello’s replacement at ice, an official named Mark Morgan—who’s already been fired once by Trump and regained the President’s support after making a series of appearances on Fox News—subsequently announced that ice would proceed with the operation.

Late last week, factions within the Administration clashed over what to do. The acting secretary of D.H.S., Kevin McAleenan, urged caution, claiming that the operation was a distraction and a waste of manpower. Among other things, a $4.5 billion funding bill to supply further humanitarian aid at the border has been held up because Democrats worried that the Administration would use the money for enforcement operations. McAleenan had been meeting with members of both parties on the Hill, and there appeared to be signs of progress, before the President announced the ice crackdown. According to an Administration official, McAleenan argued that the operation would also threaten a string of recent gains made by the President. The Trump Administration had just secured a deal with the Mexican government to increase enforcement at the Guatemalan border, and it expanded a massive new program called Remain in Mexico, which has forced some ten thousand asylum seekers to wait indefinitely in northern Mexico. “Momentum was moving in the right direction,” the official said.

On the other side of the argument were Stephen Miller, at the White House, and Mark Morgan, at ice. In the days before and after Trump’s Twitter announcement, Morgan spoke regularly with the President, who was circumventing McAleenan, Morgan’s boss. In meetings with staff, Morgan boasted that he had a direct line to the President, according to the ice officer, who told me it was highly unusual for there to be such direct contact between the agency head and the White House. “It should be going to the Secretary, which I find hilarious, actually, because Morgan was already fired once by this Administration,” the officer said.

Over the weekend, the President agreed to halt the operation. But it’s far from certain whether McAleenan actually got the upper hand. Officials in the White House authorized ice to issue a press release insinuating that someone had leaked important details about the operation and therefore compromised it. “Any leak telegraphing sensitive law-enforcement operations is egregious and puts our officers’ safety in danger,” an ice spokesperson said late Saturday afternoon. This was a puzzling statement given that it was Trump who first publicized the information about the operation. But the White House’s line followed a different script: some members of the Administration, as well as the former head of ice, Thomas Homan, were publicly accusing McAleenan of sharing information with reporters in an attempt to undermine the operation.

For Homan, his involvement in the Administration’s internal fight marked an unexpected return to the main stage. Last year, he resigned as acting head of iceafter the Senate refused to confirm him to the post. Earlier this month, Trump announced, on Fox News, that Homan would be returning to the Administration as the President’s new border tsar, but Homan, who hadn’t been informed of the decision, has remained noncommittal. Still, according to the Administration official, Homan and the President talk by phone regularly. Over the weekend, Homan, who has since become an on-air contributor to Fox News, appeared on television to attack McAleenan personally. “You’ve got the acting Secretary of Homeland Security resisting what ice is trying to do,” he said.

Meanwhile, the President spent the weekend trying to leverage the delayed operation to pressure congressional Democrats. If they did not agree to a complete overhaul of the asylum system at the border, Trump said, he’d greenlight the ice operation once more. “Two weeks,” he tweeted, “and big Deportation begins.” At the same time, his Administration was under fire for holding immigrant children at a Border Patrol facility in Clint, Texas. Two hundred and fifty infants, children, and teen-agers have spent weeks in squalid conditions; they have been denied food, water, soap, and toothbrushes, and there’s limited access to medicine in the wake of flu and lice outbreaks. “If the Democrats would change the asylum laws and the loopholes,” Trump said, “everything would be solved immediately.” And yet, last week, when an Administration lawyer appeared before the Ninth Circuit to answer for the conditions at the facility, which were in clear violation of a federal agreement on the treatment of children in detention, she said that addressing them was not the government’s responsibility. Michelle Brané, of the Women’s Refugee Commission, told me, “The Administration is intentionally creating chaos at the border and detaining children in abusive conditions for political gain.” (On Monday, Customs and Border Protection transferred all but thirty children from the Clint facility; it isn’t yet clear where, exactly, they’ll go.)

President Obama was never popular among ice’s rank and file, but the detailed list of enforcement priorities he instituted, in 2014, which many in the agency initially resented as micromanagement, now seemed more sensible—and even preferable to the current state of affairs. The ice officer said, “One person told me, ‘I never thought I’d say this, but I miss the Obama rules. We removed more people with the rules we had in place than with all this. It was much easier when we had the priorities. It was cleaner.’ ” Since the creation of ice, in 2003, enforcement was premised on the idea that officers would primarily go after criminals for deportation; Trump, who views ice as a political tool to showcase his toughness, has abandoned that framework entirely.  . .

Continue reading.

Written by LeisureGuy

25 June 2019 at 1:38 pm

A conservative’s vision: Let’s make politics great again

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Jennifer Rubin has an interesting post in the Washington Post:

Peter Wehner, a former adviser to President George W. Bush and a prominent Never Trump voice, is out with a new book, “The Death of Politics: How to Heal Our Frayed Republic After Trump.” At a time when politicians are held in low regard and a moral retrograde sits in the White House, Wehner makes the counterintuitive argument that we must recognize politics as a noble endeavor. My conversation with him covered a lot of ground; it has been condensed for length and lightly edited for clarity.

You make the point that Trump simply lit the fuse but that the antecedents of the nasty, crude and rancorous politics had been underway for years. How did Republicans, who used to value civility, faith and respect, become the ones to most fall prey to this phenomenon?

It’s a question I’ve pondered a fair amount. Before turning to the GOP, it’s worth pointing out that the Republican Party hasn’t cornered the market on nasty politics. Ted Kennedy’s attacks on Robert Bork were an ugly inflection point in the history of the modern Supreme Court nomination process. The attacks in 2012 against Mitt Romney by Harry Reid and a super PAC supporting President Obama were dishonest and disgraceful. So were many of the attacks by Clinton supporters against Ken Starr and especially against women with whom Clinton had affairs. Vicious things were said about George W. Bush and Ronald Reagan. So it’s not as if the hands of Democrats are clean here. All parties and all political ideologies have a lot to answer for. Because of the nature and stakes of politics, and the built-in flaws in human nature, politics is rarely as high-minded as we might wish.

Having said that, Donald Trump is in a category all his own when it comes to the politics of cruelty, crudity and dehumanization. He’s the face, voice and moral representative — or to be more precise, the immoral representative — of the Republican Party, and some large number of Republicans support him and his tactics that at times seems cult-like. So what happened?

My sense is that on the right there were dark, latent forces that were far more widespread than I imagined. Pre-Trump, they were kept more or less on the fringes of the Republican Party. Trump tapped into them, though — he has an almost preternatural ability to zero in on cultural and ethnic flashpoints, to activate the amygdala region of the brain — and mainstreamed them. One manifestation of that is Trump’s validation of Alex Jones, the conspiracy peddler whose show Trump appeared on during the 2016 campaign and was praised by Trump. But there are plenty of others.

Remember the issue that brought Donald Trump to national political prominence — it was a racist conspiracy theory alleging that Barack Obama wasn’t a U.S. citizen. I warned Republicans about him in 2011 — don’t play “footsie with peddlers of paranoia” and those who delight in making our public discourse more childish and freakish, I wrote — but I didn’t anticipate that the pathologies were so far-reaching.

What else do you think is going on?

On the right there have been rising feelings of resentment, grievances and rage. A lot of people on the right feel like they have been condescended to by the elite culture, disrespected and mocked for their beliefs, and there’s some merit in that. I did an event at Stanford shortly before the 2016 election with Arlie Hochschild, a sociologist who wrote an outstanding book, “Strangers in Their Own Land: Anger and Mourning on the American Right.” She said to me prescient words. “What his rise is about,” she told me, “is lost honor and humiliation. Trump is a kind of anti-depressant to his supporters.”

This is combined with a “Flight 93” mindset — the sense that many are engaged in an existential struggle with the Left and that virtually any tactics, regardless of how ruthless, should be employed in order to prevail. I have friends who in their individual lives are deeply decent, and yet they have admitted to me that they want to figuratively slit the throat of liberals and those on the left, who they are convinced are comprised of malicious people who want to destroy America and destroy them. If that’s your outlook, it can lead you into some pretty dark alleyways.

There’s also fear many Trump supporters have about the rapid rate of social change, most especially in the area of sexual ethics, that has left them bewildered and fearful. In addition to that, we’re in the midst of massive economic changes. All of this has roiled our politics and allowed some ugly impulses to rise to the surface.

It’s true that so-called “social justice warriors” on the left are increasingly illiberal in some of their tendencies. We see that on college campuses, which are increasingly opposed to open inquiry and viewpoint diversity. But in politics it’s most pronounced these days on the right. The nomination, election and passionate enthusiasm for Donald Trump is evidence of that. In the areas we’re talking about, he’s made everything worse.

You note political polarization is a contributing factor to the rotten state of politics. How do we improve political discourse without tackling polarization, which was brought about by many political, social and cultural factors?

It might be helpful here to define polarization. James Q. Wilson, who was one of America’s outstanding social scientists, described it as not simply partisan disagreements alone, but rather an intense commitment to a candidate, a culture, or an ideology that sets people in one group definitively apart from people in another, rival group. “Such a condition is revealed when a candidate for public office is regarded by a competitor and his supporters not simply as wrong but as corrupt or wicked,” according to Wilson, “when one way of thinking about the world is assumed to be morally superior to any other way; when one set of political beliefs is considered to be entirely correct and a rival set wholly wrong.”

Part of the explanation for the acute state of political polarization is what the journalist Bill Bishop describes as “the big sort.” He’s shown how Americans have been sorting themselves into homogeneous communities. It’s referred to as a “way-of-life segregation.” We increasingly live with people who think, vote and pattern our lives like we do, who reinforce our beliefs. On one level that’s understandable, of course; on another, it’s harmful, since people we begin to view those who live differently than we do as aliens, hostile forces, and even existential threats to our way of life.

What I argue in “The Death of Politics” is that we have to rethink our attitudes toward one another and toward the pursuit of truth. It’s not simply recognizing that people who hold different views than we do aren’t by definition stupid, corrupt, wicked or malicious; it’s that we come to a place where we believe we might have something to learn — or at least something to consider — from those whose views and outlooks and life experiences are different than mine. That’s never easy to do, and it’s harder to do in this environment than any time I can recall.

Can you elaborate on what you mean by that?

You bet. I describe in the book the friendship between the British philosopher and poet Owen Barfield and C.S. Lewis, the twentieth-century British medievalist, literary critic, author and apologist for the Christian faith. They were members of a literary group called The Inklings, and they exercised enormous influence on each other. But their friendship was not based on seeing the world in exactly the same way. In fact, they engaged in some fairly intense disagreements, including on the relationship between imagination and truth.

In his book “Surprised by Joy,” Lewis described what he called a “First Friend” and a “Second Friend.” The First Friend is your alter ego, the person who sees things as you do. You “join like raindrops on a window” is how Lewis put it.

The Second Friend is not your alter ego but your anti-self. He shares your interests but approaches them at a different angle. “He has read all the right books but has got the wrong thing out of every one,” Lewis wrote. “How can he be so nearly right and yet, invariably, just not right?” He went on to say this:

You go at it, hammer and tongs, far into the night, or walking through fine country that neither gives a glance to, each learning the weight of the other’s punches, and often more like mutually respectful enemies than friends. Actually (though it never seems so at the time) you modify one another’s thought; out of this perpetual dogfight a community of mind and deep affection emerge.

“In an argument,” Barfield said, “we always, both of us, were arguing for the truth, not for victory.”

That’s just a very different approach to dialogue and debate — engaging with others in order to refine our views, to widen the aperture of understanding, to see things we would otherwise be blind to. If each of us — pro- and anti-Trump, those on the right and those on the left and those in between — could move closer toward the spirit of the Lewis-Barfield model of dialogue and debate, we’d all be far better off. It would certainly help us think of our national politics as something other than a fight to the death.

It’s ironic that the people leading “Values Voters” contributed mightily to this problem. How does the evangelical community address the grotesque failure of moral and spiritual leadership?

Evangelicals themselves need to . . .

Continue reading. There’s much more.

Written by LeisureGuy

24 June 2019 at 4:10 pm

Which is greater, Republican dishonesty or Republican hypocrisy? Trump Wants Your Employer to Ditch Its Health Care Plan

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Kevin Drum blogs:

For years, opponents of Obamacare have been exercised by President Obama’s supposed “Lie of the Year” for 2013: If you like your health care plan, you can keep it. This turned out to be untrue in a specific sense: you could keep your plan if your insurance company continued to offer it. However, many insurance companies decided to cancel their existing plans and replace them with new ones that conformed to Obamacare’s rules. In 2013 the cancellation letters went out and Republicans pretended to be outraged.

Fast forward to 2019. The Trump administration has just issued a final rule governing HRAs and is busily promoting it. An HRA is a Health Reimbursement Account, and what it means is this: your employer can now decide to cancel its group plan and replace it with an HRA that reimburses you for an individual plan that you buy in the open market. There are various rules in place about how much employers have to spend and who can qualify, but the nut of the thing is simple. It’s a new policy that actively appeals to employers to ditch their group plan—most likely for an assortment of individual plans that provide worse coverage.

This will spawn outraged coverage from Fox News and the rest of the conservative noise machine, right?

Written by LeisureGuy

22 June 2019 at 2:59 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. . .

Continue reading.

Written by LeisureGuy

21 June 2019 at 10:23 am

California report card

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Kevin Drum has an interesting post on how California measures up these days, and it’s worth looking at if that sort of thing interests you. (I am reminded of a friend whose recommendations often ran, “It’s the sort of thing you’d like if you like that sort of thing.) But since California does represent a certain cross-section of America, and since I lived there for more than 30 years, it seems of interest to me.

Written by LeisureGuy

19 June 2019 at 12:25 pm

The Self-Destruction of American Power

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Fareed Zakariah writes in Foreign Affairs:

Sometime in the last two years, American hegemony died. The age of U.S. dominance was a brief, heady era, about three decades marked by two moments, each a breakdown of sorts. It was born amid the collapse of the Berlin Wall, in 1989. The end, or really the beginning of the end, was another collapse, that of Iraq in 2003, and the slow unraveling since. But was the death of the United States’ extraordinary status a result of external causes, or did Washington accelerate its own demise through bad habits and bad behavior? That is a question that will be debated by historians for years to come. But at this point, we have enough time and perspective to make some preliminary observations.

As with most deaths, many factors contributed to this one. There were deep structural forces in the international system that inexorably worked against any one nation that accumulated so much power. In the American case, however, one is struck by the ways in which Washington—from an unprecedented position—mishandled its hegemony and abused its power, losing allies and emboldening enemies. And now, under the Trump administration, the United States seems to have lost interest, indeed lost faith, in the ideas and purpose that animated its international presence for three-quarters of a century.

A STAR IS BORN

U.S. hegemony in the post–Cold War era was like nothing the world had seen since the Roman Empire. Writers are fond of dating the dawn of “the American century” to 1945, not long after the publisher Henry Luce coined the term. But the post–World War II era was quite different from the post-1989 one. Even after 1945, in large stretches of the globe, France and the United Kingdom still had formal empires and thus deep influence. Soon, the Soviet Union presented itself as a superpower rival, contesting Washington’s influence in every corner of the planet. Remember that the phrase “Third World” derived from the tripartite division of the globe, the First World being the United States and Western Europe, and the Second World, the communist countries. The Third World was everywhere else, where each country was choosing between U.S. and Soviet influence. For much of the world’s population, from Poland to China, the century hardly looked American.

The United States’ post–Cold War supremacy was initially hard to detect. As I pointed out in The New Yorker in 2002, most participants missed it. In 1990, British Prime Minister Margaret Thatcher argued that the world was dividing into three political spheres, dominated by the dollar, the yen, and the deutsche mark. Henry Kissinger’s 1994 book, Diplomacy, predicted the dawn of a new multipolar age. Certainly in the United States, there was little triumphalism. The 1992 presidential campaign was marked by a sense of weakness and weariness. “The Cold War is over; Japan and Germany won,” the Democratic hopeful Paul Tsongas said again and again. Asia hands had already begun to speak of “the Pacific century.”

There was one exception to this analysis, a prescient essay in the pages of this magazine by the conservative commentator Charles Krauthammer: “The Unipolar Moment,” which was published in 1990. But even this triumphalist take was limited in its expansiveness, as its title suggests. “The unipolar moment will be brief,” Krauthammer admitted, predicting in a Washington Post column that within a very short time, Germany and Japan, the two emerging “regional superpowers,” would be pursuing foreign policies independent of the United States.

Policymakers welcomed the waning of unipolarity, which they assumed was imminent. In 1991, as the Balkan wars began, Jacques Poos, the president of the Council of the European Union, declared, “This is the hour of Europe.” He explained: “If one problem can be solved by Europeans, it is the Yugoslav problem. This is a European country, and it is not up to the Americans.” But it turned out that only the United States had the combined power and influence to intervene effectively and tackle the crisis.

Similarly, toward the end of the 1990s, when a series of economic panics sent East Asian economies into tailspins, only the United States could stabilize the global financial system. It organized a $120 billion international bailout for the worst-hit countries, resolving the crisis. Timemagazine put three Americans, Treasury Secretary Robert Rubin, Federal Reserve Chair Alan Greenspan, and Deputy Treasury Secretary Lawrence Summers, on its cover with the headline “The Committee to Save the World.”

THE BEGINNING OF THE END

Just as American hegemony grew in the early 1990s while no one was noticing, so in the late 1990s did the forces that would undermine it, even as people had begun to speak of the United States as “the indispensable nation” and “the world’s sole superpower.” First and foremost, there was the rise of China. It is easy to see in retrospect that Beijing would become the only serious rival to Washington, but it was not as apparent a quarter century ago. Although China had grown speedily since the 1980s, it had done so from a very low base. Few countries had been able to continue that process for more than a couple of decades. China’s strange mixture of capitalism and Leninism seemed fragile, as the Tiananmen Square uprising had revealed.

But China’s rise persisted, and the country became the new great power on the block, one with the might and the ambition to match the United States. Russia, for its part, went from being both weak and quiescent in the early 1990s to being a revanchist power, a spoiler with enough capability and cunning to be disruptive. With two major global players outside the U.S.-constructed international system, the world had entered a post-American phase. Today, the United States is still the most powerful country on the planet, but it exists in a world of global and regional powers that can—and frequently do—push back.

The 9/11 attacks and the rise of Islamic terrorism played a dual role in the decline of U.S. hegemony. At first, the attacks seemed to galvanize Washington and mobilize its power. In 2001, the United States, still larger economically than the next five countries put together, chose to ramp up its annual defense spending by an amount—almost $50 billion—that was larger than the United Kingdom’s entire yearly defense budget. When Washington intervened in Afghanistan, it was able to get overwhelming support for the campaign, including from Russia. Two years later, despite many objections, it was still able to put together a large international coalition for an invasion of Iraq. The early years of this century marked the high point of the American imperium, as Washington tried to remake wholly alien nations—Afghanistan and Iraq—thousands of miles away, despite the rest of the world’s reluctant acquiescence or active opposition.

Iraq in particular marked a turning point. The United States embarked on a war of choice despite misgivings expressed in the rest of world. It tried to get the UN to rubber-stamp its mission, and when that proved arduous, it dispensed with the organization altogether. It ignored the Powell Doctrine—the idea, promulgated by General Colin Powell while he was chairman of the Joint Chiefs of Staff during the Gulf War, that a war was worth entering only if vital national interests were at stake and overwhelming victory assured. The Bush administration insisted that the vast challenge of occupying Iraq could be undertaken with a small number of troops and a light touch. Iraq, it was said, would pay for itself. And once in Baghdad, Washington decided to destroy the Iraqi state, disbanding the army and purging the bureaucracy, which produced chaos and helped fuel an insurgency. Any one of these mistakes might have been overcome. But together they ensured that Iraq became a costly fiasco.

After 9/11, Washington made major, consequential decisions that continue to haunt it, but it made all of them hastily and in fear. It saw itself as in mortal danger, needing to do whatever it took to defend itself—from invading Iraq to spending untold sums on homeland security to employing torture. The rest of the world saw a country that was experiencing a kind of terrorism that many had lived with for years and yet was thrashing around like a wounded lion, tearing down international alliances and norms. In its first two years, the George W. Bush administration walked away from more international agreements than any previous administration had. (Undoubtedly, that record has now been surpassed under President Donald Trump.) American behavior abroad during the Bush administration shattered the moral and political authority of the United States, as long-standing allies such as Canada and France found themselves at odds with it on the substance, morality, and style of its foreign policy.

OWN GOAL

So which was it that eroded American hegemony—the rise of new challengers or imperial overreach? As with any large and complex historical phenomenon, it was probably all of the above. China’s rise was one of those tectonic shifts in international life that would have eroded any hegemon’s unrivaled power, no matter how skillful its diplomacy. The return of Russia, however, was a more complex affair. It’s easy to forget now, but in the early 1990s, leaders in Moscow were determined to turn their country into a liberal democracy, a European nation, and an ally of sorts of the West. Eduard Shevardnadze, who was foreign minister during the final years of the Soviet Union, supported the United States’ 1990–91 war against Iraq. And after the Soviet Union’s collapse, Russia’s first foreign minister, Andrei Kozyrev, was an even more ardent liberal, an internationalist, and a vigorous supporter of human rights. . .

Continue reading. There’s more.

Written by LeisureGuy

14 June 2019 at 1:59 pm

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