US health official reveals fentanyl almost killed his son

“The head of the nation’s top public health agency says the opioid epidemic will be one of his priorities, and he revealed a personal reason for it: His son almost died from taking cocaine contaminated with the powerful painkiller fentanyl.
“For me, it’s personal. I almost lost one of my children from it,” Dr. Robert Redfield Jr. told the annual conference of the National Association of County and City Health Officials.
The AP viewed a video of his speech, which he delivered Thursday in New Orleans. Redfield declined to speak about it Monday, except to say in a statement: “It’s important for society to embrace and support families who are fighting to win the battle of addiction — because stigma is the enemy of public health.”
Redfield mentioned his younger son while talking about his priorities for the U.S. Centers for Disease Control and Prevention, where he started as director in March. He listed the opioid crisis first, calling it “the public health crisis of our time.”
Public records show that the son, a 37-year-old musician, was charged with drug possession in 2016 in Maryland. The outcome of the case is not available in public records.” (A)

“Sen. Elizabeth Warren (D-MA) wants to know what, exactly, President Donald Trump is doing in response to the opioid epidemic.
Experts and observers have concluded that your efforts to address the opioid crisis are ‘pathetic’ and ‘ambiguous promises’ that are ‘falling far short of what is needed’ and are ‘not … addressing the epidemic with the urgency it demands,’” Warren wrote in a new letter to Trump. “I agree, and I urge you to move quickly to address these problems.”
The letter points out that Trump, on the campaign trail and as president, has repeatedly promised to take serious action on the crisis, vowing to “liberate our communities from this scourge of drug addiction” and declaring the opioid epidemic a national public health emergency in October.
Since then, the administration has renewed the declaration twice — in January and April. And the declaration will require another renewal next week. But experts have complained that the administration has taken little action to actually leverage the declaration and take serious action on the opioid epidemic, with Stanford drug policy expert Keith Humphreys previously describing the administration’s actions as “pathetic.”
“Six months after you first declared the opioid crisis a public health emergency, you pledged that ‘we will be spending the most money ever on the opioid crisis,’” Warren wrote. “Yet your claim appears to have no basis in reality. While the U.S. Senate reached a budget agreement earlier this year to spend an additional $6 billion over two years to address the opioid crisis, your Administration’s own proposals to address the opioid crisis, including your most recent opioid initiative policies released on March 19th, lack commitments of federal funds.”
The letter asks Trump to clarify what actions his administration is taking, as well as whether he will extend the public health emergency declaration next week and what other steps he will take if so. (Read the full letter.)” (B)

“A Senate report released Thursday lays out systematic failures in the reporting system for suspicious opioid orders, faulting some drug distributors and manufacturers for their roles and criticizing the Drug Enforcement Administration for a years-long lull in enforcement actions.
The findings, the latest in a series of reports from Sen. Claire McCaskill (D-Mo.), the top Democrat on the Senate’s leading oversight committee, pointed in particular to disparities between two leading drug distributors: McKesson and AmerisourceBergen.
The two distributors shipped nearly identical volumes of opioids to Missouri between 2012 and 2017: roughly 650 million doses each.
But the number of orders each company flagged to authorities as suspicious were nowhere close: 224 from AmerisourceBergen and 16,714 from McKesson.
Taken together, the “Big Three” group of distributors, including Cardinal Health, sent 52 dosage units for each of the state’s citizens in 2015.
“It’s staggering. Over six years we averaged 260 pills for every man, woman, and child in Missouri,” McCaskill said in a statement. “The opioid crisis these pills have fueled is a failure of policy and oversight by the government and a failure of basic human morality on the part of many pharmaceutical companies and distributors — a failure that has destroyed families and communities all over our state.” (C)

“Last month, Democratic Sen. Claire McCaskill of Missouri introduced a bill going after, of all things, nonprofits. The word “nonprofit” tends to conjure images of idealistic charities committed to saving vanishing forests, teaching underprivileged kids or counseling the victims of sexual assault. The reality can be far different.
McCaskill’s proposed legislation follows from a scorching report she released in February detailing how opioid manufacturers funneled almost $9 million over five years to various advocacy groups that amplified messages and policies favorable to their industry. Many of these nonprofits had lobbied against laws to decrease opioid use and tried to downplay charges against physicians and pharmaceutical industry officials responsible for over-prescribing. As years of evidence began to confirm we were facing an epidemic, the Centers for Disease Control and Prevention issued the first national standards to limit opioid prescriptions for chronic pain in 2016. Many of these corporate-funded groups immediately began to criticize the new rules.
McCaskill’s bill, the Patient Advocacy Transparency Act, would require pharmaceutical manufacturers to disclose their payments to patient advocacy groups, professional societies and other nonprofit organizations….” (D)

“The Justice Department is expanding its efforts to combat the opioid abuse epidemic to drugmakers, it announced Wednesday.
In the finalization of an April proposal, the Drug Enforcement Agency (DEA) may cut back the amount of a drug allowed to be produced in a given year if it believes a particular company’s opioids are being diverted for misuse.
The goal is to encourage opioid manufacturers to become more vigilant about how their drugs are being used, they said. It will also help the DEA respond to changing drug threats and reduce the availability of potentially addictive drugs outside legitimate uses while ensuring its availability for genuine medical, scientific, research and industrial needs…
“DEA must make sure that we prevent diversion and abuse of prescription opioids,” Attorney General Jeff Sessions said in a statement. “By taking diversion of these opioids into account, will allow the DEA to be more responsive to the facts on the ground. More importantly, it will help us stop and even prevent diversion from taking place.” (E)

“Beyond good medical management, the FDA recognized it too has a part to play in ameliorating the opioid crisis, citing its revised blueprint for drug manufacturer training to be finalized later this year and its innovation challenge to foster development of novel, pain-treating medical devices. At the same time, payers like Aetna, Anthem and Cigna are making their own efforts to combat overprescribing.
Gottlieb also said the FDA will work to encourage medical professional societies to develop evidence-based guidelines on correct opioid prescribing practices to reduce careless or superfluous dispensing. “Unfortunately,” Gottlieb writes, “the fact remains that there are still too many prescriptions being written for opioids.”..
And despite limited progress, costs in dollars and deaths are still rising.
Opioid addiction and overdose treatment costs in large employer-based health plans increased by a factor of nine between 2004 and 2016, even though opioid prescriptions have steadily fallen since their peak in 2009.
The rate of drug overdose deaths involving synthetic opioids such as fentanyl doubled between 2015 and 2016. In 2016 alone, there were more than 63,600 drug overdose deaths in the U.S.
Experts agree that a multifaceted and comprehensive approach is needed to slow the cresting opioid epidemic. Bipartisan legislation is currently being workshopped in Congress, with measures ranging from restructuring grants to help states boost addiction treatment in hard-hit areas to removing barriers to non-addictive medication research.
It’s a “difficult challenge both for the FDA and for providers,” Gottlieb admitted in the statement. “We don’t want to act in ways that are poorly targeted.” (F)

“A lawsuit filed on behalf of Tennessee taxpayers against Oxycontin-maker Purdue Pharma reveals how they fueled the opioid epidemic to snare profits. Michael Schwab/USA TODAY NEWTWORK – TENNESSEE
The marching orders for Purdue Pharma’s 87 Tennessee opioid marketers from their bosses each day were simple: “Sell hope in a bottle” and “always be closing,” newly revealed internal records show.
A lawsuit unsealed this week in Knox County Circuit Court filed on behalf of Tennessee taxpayers accuses Purdue Pharma — a family-owned firm that has turned OxyContin into a Forbes-rating fortune — of intentionally fueling the opioid epidemic that has claimed thousands of lives.
The lawsuit, filed by Tennessee Attorney General Herbert H. Slatery III, uses Purdue’s own company records and its staffers’ own words to show the firm’s founders and executives pushed medical providers to prescribe increasingly high doses of OxyContin for longer periods — even after Purdue promised the state it would stop.” (G)

“The Massachusetts attorney-general opened up a new front in the legal fight last month when she sued Purdue’s current and former executives and directors — including several Sacklers and a board member at GlaxoSmithKline, for their alleged role in fuelling the US opioid addiction epidemic. ..
This crisis is killing people, too — 42,200 died from overdoses in 2016 — but many of the 2.6m Americans with opioid abuse disorders will cycle in and out of addiction for decades, which will put long-term strain on public services.
Already, the cracks are starting to show. Addiction treatment in the US is provided mainly by a patchwork of thousands of independent operators more used to dealing with alcoholism than opioid abuse. Their inability to handle the epidemic means that police are fighting more drug-related crime, emergency rooms are at breaking point, and child protection offers are scrambling to find homes for displaced kids. A recent report estimated that the crisis is costing Ohio up to $8.8bn a year — more than its annual budget for primary and secondary education combined.
But if the financial case for restitution is clear-cut, the legal one is less so. While there was a direct link between the sale of cigarettes and lung cancer deaths, many people suffering from opioid addiction have since progressed from prescription painkillers to heroin. Dealers’ tendency to cut the street drug with fentanyl, a dangerous synthetic opioid imported from China, is responsible for a rise in overdoses.
Other actors also share some blame, from the US Food and Drug Administration, which approved the painkillers, to the doctors who prescribed pills so liberally and the wholesalers that did not report suspiciously large orders. Then there are the academics who authored studies — paid for by pharma companies — concluding there is hardly any risk of addiction. The many links in the chain will make it more difficult for lawyers to show the companies are the prime suspects — the “proximate cause” of the epidemic.” (H)

(A) US health official reveals fentanyl almost killed his son, by Mike Stobbe, US health official reveals fentanyl almost killed his son, https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0
(B) Elizabeth Warren wants answers about Trump’s “pathetic” response to the opioid epidemic, by German Lopez, https://www.vox.com/policy-and-politics/2018/7/19/17590434/elizabeth-warren-trump-opioid-epidemic
(C) System for reporting suspicious opioid orders repeatedly failed, report finds, by LEV FACHER, https://www.statnews.com/2018/07/12/senate-report-opioids-distribution/
(D) Big Pharma is quietly using nonprofits to push opioids, by PAUL D. THACKER, http://www.latimes.com/opinion/op-ed/la-oe-thacker-funders-opioid-misinformation-20180719-story.html#
(E) DOJ expands focus to drugmakers in efforts to curb opioid epidemic, https://www.fiercehealthcare.com/hospitals-health-systems/doj-finalizes-rule-opioid-production-limits?mkt_tok=eyJpIjoiWXpCaE4yRXdaVEprWkRjdyIsInQiOiJvVFhGQ2VcL3lBRnNiZ1JUV3AydjZnZDdtSWE4XC9YRW1tVHhuMTRvVE5WZGFJYWRQQ1NMY2xLZkRucW9Id25YNTRnSDRLS0lyWXBzZ2R0TnAxMjZ4QmZZbFwvVnJ4UGMwRWFISE5Zb1kxUGQ3Vm9lcjJPeEh4QTZUVjdxNUp3YnhYeiJ9&mrkid=654508
(F) Gottlieb: FDA seeking ‘right balance’ in regulating opioid prescriptions, by Rebecca Pifer, https://www.healthcaredive.com/news/gottlieb-fda-seeking-right-balance-in-regulating-opioid-prescriptions/527370/
(G) Purdue Pharma pushed opioids as ‘hope in a bottle,’ records show, by Jamie Satterfield, https://www.knoxnews.com/story/news/crime/2018/07/06/purdue-pharma-lawsuit-oxycontin-tennessee-opioids/762143002/
(H) Ending America’s opioid crisis requires more than a moral crusade, by David Crowe, https://www.ft.com/content/cb112920-8079-11e8-bc55-50daf11b720d

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