“When historians trace back the roots of today’s opioid epidemic, they often find themselves returning to the wave of addiction that swept the U.S. in the late 19th century. That was when physicians first got their hands on morphine: a truly effective treatment for pain, delivered first by tablet and then by the newly invented hypodermic syringe. With no criminal regulations on morphine, opium or heroin, many of these drugs became the “secret ingredient” in readily available, dubiously effective medicines.
In the 19th century, after all, there was no Food and Drug Administration (FDA) to regulate the advertising claims of health products. In such a climate, a popular so-called “patent medicine” market flourished. Manufacturers of these nostrums often made misleading claims and kept their full ingredients list and formulas proprietary, though we now know they often contained cocaine, opium, morphine, alcohol and other intoxicants or toxins.
Products like heroin cough drops and cocaine-laced toothache medicine were sold openly and freely over the counter, using colorful advertisements that can be downright shocking to modern eyes..
But more than that, widespread opiate use in Victorian America didn’t start with the patent medicines. It started with doctors.” (A)
“When I was in medical school, a professor instructed me to think of pain as the patient’s fifth vital sign. It was a radical, new idea, one that was quickly disseminating across the country, and it was supposed to alleviate suffering, improve outcomes and transform lives.
But as we discover in Beth Macy’s timely new book, “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America” (Little, Brown, 376 pp., ★★★½ out of four), that approach was wildly misguided. It led to thousands of unnecessary deaths and created an underclass of marginalized and debilitated drug addicts. How could we have gotten this so wrong?
You’ve probably heard pieces of this story before, but in “Dopesick” we get something original: a page-turning explanation.
We begin in Appalachia, the epicenter of the opioid crisis, where “few businesses dare to set up shop because it’s hard to find workers who can pass a drug test.” It’s a place that feels forgotten, where Americans are dying in the prime of their lives and those who hang on are known as “pillbillies.”..
From there, the narrative moves to Stamford, Connecticut, and Purdue Frederick, a family-owned pharmaceutical company. In 1952, Purdue was purchased by brothers Raymond, Mortimer and Arthur Sackler – who transformed the small operation into a massive conglomerate called Purdue Pharma, cornering the pain-relief market with MS Contin and OxyContin.” (B)
“The letters arrived from the San Diego County medical examiner’s office, informing clinicians that one of their patients had died from a prescription drug overdose.
These letters appear to have had an impact — prescriptions of addictive painkillers dropped.
In a small, randomized trial, researchers showed that this intervention — aimed at making the abstract issue of safe prescribing individually tangible — led to a slight reduction in the amount of opioids these clinicians prescribed. What’s more, prescribers who received the letters doled out fewer of the most powerful doses and appeared to start fewer patients on opioids compared with doctors who did not receive the letters.
Authors of the study published Thursday and experts not involved with the research urged other communities around the country to adopt the same strategy.
“Hearing about one person’s death can be really impactful,” said Jason Doctor, the lead author of the study and an expert in behavioral science and policy at the University of Southern California. “People often don’t change their behavior unless they have a really salient, personal experience.”” (C)
“The Food and Drug Administration on Monday announced a shift in the way it evaluates drugs to treat opioid addiction that the agency says will give it more flexibility to approve new treatments.
Now, rather than merely examining whether a potential treatment reduces opioid use, the agency will consider factors like whether a drug could reduce overdose rates or the transmission of infectious diseases.
“We must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission,” FDA Commissioner Scott Gottlieb said in a statement.
The announcement is the latest in a string of efforts to improve the federal government’s response to the growing opioid crisis, which also includes legislation on Capitol Hill that aims to ensure treatment is evidence-based and, separately, to ensure more federal programs will pay for methadone treatment.” (D)
“A fast-acting class of fentanyl drugs approved only for cancer patients with high opioid tolerance has been prescribed frequently to patients with back pain and migraines, putting them at high risk of accidental overdose and death, according to documents collected by the Food and Drug Administration.
The F.D.A. established a distribution oversight program in 2011 to curb inappropriate use of the dangerous medications, but entrusted enforcement to a group of pharmaceutical companies that make and sell the drugs.
Some of the companies have been sued for illegally promoting other uses for the medications and in one case even bribing doctors to prescribe higher doses.
About 5,000 pages of documents, obtained by researchers at the Johns Hopkins Bloomberg School of Public Health through the Freedom of Information Act and provided to The New York Times, show that the F.D.A. had data showing that so-called off-label prescribing was widespread. But officials did little to intervene.” (E)
“Opioid addiction is an epidemic gripping the nation, leading to thousands of overdose deaths annually. But Dr. Kevin Zacharoff, an anesthesiologist with more than 25 years of experience in pain medicine, says opioids can also provide much-needed relief to many patients.
There are tens of thousands of people for whom opioids are the best form of treatment, Zacharoff told medical professionals and Long Islanders at a symposium at Stony Brook Medicine on Friday.
Rather than not prescribe opioids at all, Zacharoff believes there needs to be more discussion among health professionals and in medical schools about the risks and benefits of opioids as pain treatment. Currently, only about 4 percent of all medical schools in the country have curriculums dedicated to pain management and addiction, he said. Stony Brook is in the process of developing a curriculum for fourth-year medical students to be implemented next year on those topics, he said.
“The only thing that really concerns me is that we don’t throw the baby away with the bath water,” he said. “Opioids have been around for 4,000 years.”” (F)
“Addiction to prescription opioids like oxycodone has risen so rapidly in the last decade that now an average of 40 people die of overdoses in the U.S. each day, according to the Centers for Disease Control and Prevention (CDC). President Donald Trump declared opioid addiction a public health emergency last year, helping bring more attention to the crisis.
But newly published research led by the Mayo Clinic is raising serious questions about whether awareness of the dangers of opioid prescriptions is translating to fewer prescriptions and a reduction in use of the powerful painkillers.
Opioid prescription rates have remained flat for insured patients over the last 10 years, according to data published today in the BMJ. And even though prescriptions doled out to Medicare patients have recently shown signs of leveling, prescribing rates for some of those older people are actually higher than they were a decade ago.” (G)
“The New York State Department of Health recently began urging doctors prescribing opioids for patients with severe pain to consider medical marijuana as an alternative. The guidance was part of an emergency regulation that went into effect July 12.
The national opioid crisis on average causes 115 U.S. overdose deaths a day in the United States. New York has been focused on reducing its share of that toll. In 2016, opioids killed 18 of every 100,000 New Yorkers, according to the Centers for Disease Control and Prevention. New York’s State Health Commissioner Howard Zucker in June explained why the state is making this welcome move. “Medical marijuana has been shown to be an effective treatment for pain that may also reduce the chance of opioid dependence.”” (H)
“The new goal is pain elimination, which I believe is one factor that has fueled the overconsumption of opioids although there are other factors present…
But patients’ rising expectations of eliminating pain and the medical professions’ willingness to join in this mission has exacted a great societal cost. I am not blaming anyone here. Of course, patients want pain to go away. Of course, physicians want to relieve suffering. Isn’t a doctor’s mission to make his patient feel better?
Could this really result from a doctor’s prescription?
The consequences of this approach have exploded. Narcotics and opioids are addictive agents. Any individual who takes these medicines over time risks addiction, which is a new disease. In fact, the addiction may very well be a more severe illness than the original medical condition…
Consider this sobering statistic: The U.S. is about 5% of the world’s population yet consumes about 80% of the world’s oxycodone supply…
The medical profession and the scientific community need to triple down on research to develop new drugs and techniques that attack pain but leave patients protected from the ravages and misery of drug addiction.” “ (I)
(A) How Advertising Shaped the First Opioid Epidemic, by By Jon Kelvey, cdn.com/uUasjiYUx7Ife2mLvzZD61wklig=/800×600/filters:no_upscale()/https://public-media.smithsonianmag.com/filer/d7/d7/d7d7f166-3063-45f8-bf0c-d0bbf18e2362/vintage-advert-for-medicine.jpg
(B) ‘Dopesick’ is a page-turning look at the nation’s opioid crisis and big Pharma, by Matt McCarthy, https://www.usatoday.com/story/life/books/2018/08/06/dopesick-page-turning-look-nations-opioid-crisis-beth-macy-big-pharma-book-review/882892002/
(C) Clinicians were told their patient had died of an overdose. Then opioid prescribing dropped, by ANDREW JOSEPH, https://www.statnews.com/2018/08/09/opioid-prescribing-medical-examiner-letters-overdose/
(D) FDA will broaden how it evaluates new addiction treatment drugs, by LEV FACHER, https://www.statnews.com/2018/08/06/fda-expands-medication-assisted-treatment/?utm_source=STAT+Newsletters&utm_campaign=7daa54108e-DC_Diagnosis&utm_medium=email&utm_term=0_8cab1d7961-7daa54108e-149527969
(E) F.D.A. Did Not Intervene to Curb Risky Fentanyl Prescriptions, by Emily Baumgaertner, https://www.nytimes.com/2018/08/02/health/fda-fentanyl-opioid-epidemic-overdose-cancer.html
(F) Despite epidemic, doctor says opioids also help patients, by Janelle Griffith, https://www.newsday.com/news/health/stony-brook-medicine-symposium-opioids-1.20278189
(G) Opioid Prescribing Hasn’t Declined In The Last Decade Despite Addiction Crisis, by Arlene Weintraub, https://www.forbes.com/sites/arleneweintraub/2018/08/01/opioid-use-hasnt-declined-in-the-last-decade-despite-addiction-crisis/#430bb8945dec
(H) New York Points The Way In Dealing With Opioid Crisis, by Kevin Murphy, https://www.forbes.com/sites/kevinmurphy/2018/08/02/new-york-points-the-way-in-dealing-with-opioid-crisis/#5e1407f38f62
(I) The Misguided Expectation of Eliminating Pain, by Michael Kirsch, https://www.forbes.com/sites/kevinmurphy/2018/08/02/new-york-points-the-way-in-dealing-with-opioid-crisis/#5e1407f38f62