How to kill 300,000 Americans - Review

Goatman

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#1
Review: Dopesick by Beth Macy — how to kill 300,000 Americans



America is dying of opioid addiction, a pharmaceutical plague as terrible as any medieval one. In rural communities across the land the synthesised poppy holds sway: cheerleaders overdose in school libraries; burly construction workers die in site toilets; farm boys trade their mules for a high; and young parents expire in the front seats of the family car at the shopping mall, needles in their arm, their babies in the back.
Opioid drug overdose rates are climbing: 300,000 Americans have died over the past 15 years and experts predict another 300,000 in the next five. Every hour seven people are dying. Drugs are the leading cause of death for the under fifties, above guns and car accidents.



Full article here:




Recent review by The Times' Melanie Reid, herself a tetraplegic following a riding accident and no stranger to pain relief as practiced here in UK.

Beth Macy's book follows the story of the introduction of the first synthetic opioid << OXYCONTIN>> under a US Government contract awarded to a Big Pharma company called Purdue.
They were given a 17 year monopoly on supply.
The drug became known as ' OXYCOFFIN' amongst users.
Purdue reps told prescribers the addiction rate was 0.5% of users. In reality it was 56 %.
In 2007 Purdue was fined $600M.

Macy quotes one cop as saying:

' Heroin took over from Oxycontin as easily as a light switch going on and off'

Another devastating critique of the issue here How to Kill 300,000 Americans with Opioids | Trey Goff

The last paragraph of The Times' review brings this issue into context for Brits:

' Dopesick is very American It reads like
a CSI script, and it wouldn't surprise me if
it wins a Pulitzer or stimulates a Netflix
series. It's exhausting - the story jumps
around a lot , with too many case studies -
but its also essential. The urgency of its
message is compounded by the fact that
as I write this (August 2018) , the latest figures show the

number of deaths in England and Wales
due to the synthetic opioid Fentanyl rose

by 29 per cent in 2017. Carfentanil was
behind another 27 fatalities - the first
time it has been recorded.

Soul-sucking opioids,offering bliss and death, seem unstoppable.'


There are a lot of FOLO folks ( and medical perss) on this board, both British and US. It would be interesting to hear from those with DIRECT experience of the problem.

( That said, this book is not the first exposé of the issue - responses in the form of 'Nothing to see here - move along' whilst anticipated, do little to help. Neither does cheerleading for the former Soviet Union from the usual suspects)

@Auld-Yin I am not qualified to offer a good opinion on this topic, but there are plenty of Arrse lurkers who could do a worthwhile review - any chance of getting a copy ?

Le Chevre
 
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#2
Happily gave an Informative, because it is although I'm more concerned (far from obsessively) about what goes on locally. I doubt your Mr Average Uncle Samster gives a monkey's pink backside about UK drug issues...which seem epidemic. Rather insular view I admit.
 
#3
What's the answer? Do you legalise it or continue the war against drugs?

It's all very Darwinian.
 
#4
What's the answer? Do you legalise it or continue the war against drugs?

It's all very Darwinian.
Improve the economy and give people hope. Then go after the people who sell it with a vengeance.

It’s good stuff, but I tried to ween myself off of it as quickly as possible.
 

Goatman

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#5
@Lardbeast - I hear you...re 'Darwinian' this comment from an Amazon reviewer of Macy's book makes that point quite well

No parent wants to think the opioid crisis has hit their own homes and families. No, that's other people's problems; the poor, the badly raised, the down-and-out, the truly addicted. But about 30 years ago, doctors and law enforcement in the backwoods of Virginia and in the towns as well, began noticing the overdoses and deaths. Tracing the deaths pointed to Oxycontin - a miracle drug made for late-stage-cancers - that were being prescribed over and over again by doctors either unwilling or unable to prescribe the right pain meds for the right pain. Oxycontin was being pushed on doctors by its manufacturer, Purdue Pharma, which is owned by the Sackler family. ("The New Yorker" had a bombshell report about the Sackler family, their philanthropy, and Purdue in their October 20, 2017 issue that's worth getting your hands on if interested.) Macy covers a court case where Purdue was sued by various state governments for it's pushing of Oxycontin and their other pain products. The company was convicted and the three company officials received sentences of community service...

A bit more from the slightly more highbrow New Yorker article referenced above:

Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue.

But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.

Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.

Question: to ask the Secretary of State how many prescriptions for OxyContin/Oxycodone were issued by the National Health Service since 2006?

Answer: The information is not held by my Department in the format requested. I will write to the Hon. and Gallant Member in response to his Question and a copy of my Letter will be placed in the Library of the House.

;-)
 
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#6
Leave my morphine alone, it's really good stuff.

I'm probably dependent on it by now and I've no intention of trying to give it up. Doesn't give me any sort of high though.
 
#7
How does primary healthcare work in America?

Over here, you need to be registered with a specific GP who is effectively a state employee (General Practitioner - first point of contact with the medical profession if you are sick but not so sick that you need to go straight to hospital. Called a Family Doctor in America IIRC). If you move house or want to change GPs then you need to go through a process that involves transferring your medical records to your new GP. One doctor has all your medical records. If you're treated in hospital, your GP is informed and details go in to your medical records.

America - Land of the Free. Can you go to any GP if you're sick? Is there a central computer for medical records or does each doctor keep their own records? Can your medical records be spread far and wide? Problem there is that no doctor that you see can know what other doctors have prescribed for you.

Also, I believe that doctors' income in America comes largely from their patients' insurance. Doctors are effectively employees of their patients. Don't give them what they want and they'll go elsewhere.

There are a few videos on YouTube about drug seekers coming to American hospitals, pharmacies and doctors' offices. I get the impression that addictive pain killers will be prescribed for conditions like back ache. The only people I know of who have been prescribed drugs like morphine, fentanyl and oxycontin by their GPs are cancer victims, Are doctors in America more likely to prescribe addictive pain killers than doctors in other countries?
 
#8
@Lardbeast - I hear you...re 'Darwinian' this comment from an Amazon reviewer of Macy's book makes that point quite well

Presumably, if this stuff was being prescribed for late-stage cancers - i.e. for palliative care - then it hardly mattered how addictive it was. Same goes for any synthetic opiate.

Not sure why a manufacturer should be excoriated for producing a powerful synthetic opiate, if its being deliberately misused by people for whom it was not intended? Was it proved that this company sold the drug with the intention of then being able to sell to a captive market of addicts?
 

Goatman

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#10
Happily gave an Informative, because it is although I'm more concerned (far from obsessively) about what goes on locally. I doubt your Mr Average Uncle Samster gives a monkey's pink backside about UK drug issues...which seem epidemic. Rather insular view I admit.
To be clear, the book is about the American 'Opioid epidemic' rather than the scourge of Spice and other synthetic cannabinoids which is apparently sweeping the British prison system and UK inner cities.

Not sure why a manufacturer should be excoriated for producing a powerful synthetic opiate, if its being deliberately misused by people for whom it was not intended? Was it proved that this company sold the drug with the intention of then being able to sell to a captive market of addicts?
I'm guessing that the Federal case against Purdue Pharma was brought because they very much targetted end-of-life and chronic pain sufferers with Oxycodin - and equally deliberately downplayed the addictive nature of the drug.

recent NYT coverage: Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused


Mr. Udell and other company executives testified in Congress and elsewhere that the drug maker did not learn about OxyContin’s growing abuse until early 2000, when the United States attorney in Maine issued an alert. Today, Purdue Pharma, which is based in Stamford, Conn., maintains that position.

The episode remains relevant as lawmakers and regulators struggle to stem a mounting epidemic that involves both prescription opioids and, increasingly, illegal opioid compounds like heroin and counterfeit forms of fentanyl. President Trump has declared the problem a public health emergency.

Over the past two decades, more than 200,000 people have died in the United States from overdoses involving prescription opioids. States and cities continue to file a wave of lawsuits against Purdue Pharma and other opioid manufacturers and distributors.


From Melanie Reid's review quoted above:

A few heroic locals [in Macy's home state, Virginia] tried to alert the authorities, but Purdue responded with a video saying the real epidemic was untreated pain. Journalists were intimidated and Senate reports were buried. Rudy Giuliani, the former mayor of New York, was hired to convince public officials to trust the company. ....It's now estimated that Oxycontin cost $1 trillion in lost productivity,and bills for healthcare,social services, education and law enforcement

I agree it is a very difficult area. But white knighting a large US based pharmaceutical company who have already been fined $600M by their own Justice Department seems a little Quixotic TBH.

Some extant NHS guidelines on the use of long-term pain relief here

googles "FOLO" Fear of living offline ?
:-D

Fear of Life Offline ?

Apologies: widely used abbreviation meaning Forces of Law and Order.

Sackcloth and ashes for the Sub-Editor

[ see me! Ed.]
 
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#11
The interesting thing with fentanyl is the narrow band between ‘therapeutic dose’ and ‘dead’

As discussed above, NHS is very shy about giving opiates for chronic pain conditions. It’s hard enough getting Codeine - morphine and fentanyl are reserved for top of the tree conditions.

Funnily enough, I worked on the pre-clinical testing of fentanyl delivery methods... our laboratory tests (on dogs) were going fine till this happened: Lab technician handed three-year jail term after partner’s drug overdose

Lovely girl Katie - but unfortunately moved in some very dodgy circles.
 

Auld-Yin

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#12
#14
What? The same codeine you can buy without prescription in Tesco?
You can’t buy coedine , you can butycombined paracetamol and cordons tableys, iirc max 8mg coedine per 500mg paracetamol, 3 days supply at a time

That’s almost impossible to use at an addictive/recreational dose.... well, at least if you do then the last of your worries is going to be addiction to anything...
 

Goatman

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#15
@Goatman - ok I'll try for a copy.
Thanks A_Y.... not sure if @labrat would be interested in reviewing it? Or someone from the Professionally Qual forum maybe - a fellow Moderator?

The whole issue is really a big problem in the USA - hence the title of the thread - not 'How to legally wax 300,000 Brits'

I'm unsighted on whether we have a similar sized problem here. Might ask my GP what our local practice's view is.
 
#20
I think Codeine you can get OTC is of the weak variety? Not sure. When I was really suffering my GP prescribed me stronger codeine stuff.

The codeine you can buy OTC is 8mg codeine combined with 500mg paracetamol. The next strength up (30/500) requires a prescription - which I got without question when I told the locum at my GPs that I'd got a bit of back pain.
 

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