Tag Archives: oxycontin

Drugs, Drugs, and More Drugs

The pharmaceutical industry in the United States has hoodwinked the public into believing its snake oils are worth the money you pay.  The government, “health care industry,” and insurance companies are happy to comply, and maybe some of them even believe their hype.

This does not stop them from jacking up the prices of necessary medications, like insulin for diabetes.  According to the New York Times, Martin Shkreli set a new record for Wall Street greed when he acquired the rights to Daraprim, a life-saving anti-parasitic drug, in 2015 and hiked the price from $13.50 to $750 a pill overnight.

The NYT says the Trump administration “went ballistic” when Pfizer increased prices a few weeks ago.  This has deterred Pfizer, along with Merck, Roche, and Novartis from raising prices, for now.

But not to worry, if you have stock in a pharmaceutical company, because the FDA and its sympathizers are on your side.  Only worry if your insurance company doesn’t cover the cost of your medications.

You might profit from buying stock in the companies whose drugs the FDA, the “health care industry,” and the insurance companies are pushing, such as the over-the-counter naloxone that is one of four medications promoted for “opioid use disorder.”  In terms of reputation, this “opioid crisis” has spread far and wide, to the highest government offices, academia, psychiatry, newspapers, magazines, television, the internet, the courts, and dinner-table talk.  Its funding has been greatly enhanced by the promoters of public disinformation, yet relevant facts are few.  All the stories have the monotonous flavor of canned worms, opened, sampled and regurgitated for yet another meal.

We are told about opioid-related deaths, the evil drug company that promoted its opioid drug as non-addictive, the lazy or greedy doctors who over-prescribe narcotics, and the glories of “medication-assisted treatment,” or MAT.  Somehow, heroin comes up in all these stories, yet most people should know heroin is nowhere legal in the United States, not even by prescription.  We are rarely told that this magical MAT consists of four drugs, two of which are opiates themselves, or that the federal government has added special training and licensing requirements for administration of its approved protocol. We are not told that “treatment” does not mean “cure.”  No, “cure” would imply eventual freedom from all drugs, a notion that doesn’t serve Wall Street profits.

So let me give you one example of how this scam works.  I hesitate to call it a “conspiracy” (wink, wink), because of the paranoia such a word implies.  I’d rather call it a “consortium” of interrelated interests, all of which stand to profit by exaggerating the problem and presenting expensive but ineffective solutions.

We are told opioid-related deaths have skyrocketed this century, and Oxycontin (oxycodone) is the precipitating culprit.  OxyContin is produced by Purdue Pharma, which indeed does have a shady background.  In 1952, three brothers—Arthur, Raymond, and Mortimer Sackler–all psychiatrists from Queens, New York, purchased Purdue Frederick Company.  Arthur was reputed to be brilliant in psychiatric research and pharmaceutical advertising.  Working for Roche, he found enough uses for Valium (diazepam) to make it the first drug to hit the $100 million mark in revenue.  He also “positioned” Librium (chlordiazepoxide) for Roche.  Valium and Librium are members of the “benzodiazepine” class of drugs, a class that includes Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and others.  Alternatively, oxycodone is a semi-synthetic opioid from thebaine, an opioid alkaloid in the Persian poppy.  It was developed in 1919 in Germany.

In December, 1995 the US Food and Drug Administration (FDA) approved Purdue’s OxyContin (oxycodone), to treat pain.  It hit the market in 1996. Direct-to-consumer (DTC) advertising of drugs was approved by the FDA in 1997.  Purdue marketed the drug to doctors and the public as a non-addictive treatment for pain.  It reached $45 million in sales the first year, and $1.1 billion by 2000.  By 2000, it was becoming evident that OxyContin was, indeed, addictive, but the FDA still approved a larger, 160-milligram pill for those with high tolerance.

In 2007, in US vs. Purdue Frederick Company, Inc., Purdue pleaded guilty to intent to mislead doctors and patients about the addictive properties of OxyContin.  It paid $600 million in fines, among the largest settlements for pharmaceutical companies in US history.

By 2010, revenues had hit $3.1 billion, or 30 percent of the painkiller market.  Purdue remains a privately held company, in the hands of the Sackler descendants.  It is being served with multiple lawsuits from different states for its role in contributing to the “opioid epidemic.”  According to The Week, Kentucky is one of the worst-hit states.  It has filed twelve claims against Purdue, for false advertising, Medicaid fraud, unjust enrichment, and punitive damages, among others.  The Week also says there was a four-fold increase in prescription painkillers supplied to pharmacies and MD offices between 1999 and 2010.

Meanwhile, The Guardian reported in 2017 that the US constitutes 80 percent of opioid pill production but has only five percent of the world’s population.  It claims the pharmaceutical companies made false claims of an “epidemic of pain,” in the 1990s, and the federal agencies went along.  Pharmaceutical lobbyists got Congress to loosen restraints, and doctors were often reprimanded for not supplying enough.  “Regulators became facilitators,” as the FDA approved one opioid pill after another.

How does this relate to heroin, a known street drug, one might ask.  It’s a good question, for which there are no easy answers.  The idea that prescription painkiller pills are “gateway” drugs to heroin use has been mentioned.  One source notes that heroin is less expensive on the street than OxyContin, which can cost $1/milligram, or $80 for an 80-mg pill.  A more significant problem with heroin, we are told, is that it is increasingly laced with fentanyl, another opiate that is up to 5000 times stronger than heroin.  Synthetic fentanyl is being smuggled in from China.  Heroin is coming from Mexico, some say.  Fact is, there are few facts available in this gigantic obfuscation of facts that characterizes sensationalism.

So we don’t exactly know how prescription pain-killers are related to heroin/fentanyl deaths.

Death from opioids usually comes from respiratory depression.  In other words, people who overdose pass out and stop breathing.  Many other drugs cause respiratory depression, too, and a mixture can have cumulative effects.  It is common for people with chronic pain to take both a narcotic (opioid) and a muscle relaxant/sedative of the benzodiazepine class mentioned above.  The benzodiazepines also cause respiratory depression, as does alcohol.   Too, it’s not clear how many of these opioid-related deaths are complicated by other substances.  One psychiatric journal mentioned that a third of opioid deaths were complicated by benzodiazepines.  It’s probably safe to say that hard-core street addicts could be taking many drugs at any given time.

But our “medication-assisted treatment” bypasses all these inconvenient details.  It does include a drug, naloxone, which reverses the effects of opioids and can save lives in a primary opioid emergency.  It has been around over 45 years and is well known in emergency rooms for its life-saving effects.  Since this crisis began, police and ambulance drivers have had to use it on numerous occasions.  Now, the US Surgeon General Jerome Adams, MD, MPH, has encouraged over-the-counter preparations of naloxone for those with opioid use disorder and their loved ones.  FDA head Scott Gottlieb is also advocating expanded access to treatment, Medicaid funding, and other systemic changes to pay for the problem.

Manufacturers of OTC naloxone have jumped to increase prices accordingly.  Narcan intranasal (Adapt Pharma Inc.) retails for $135/dose, more than double its price a few years ago.  Kaleo’s Evzio auto-injector now retails for $4,500, more than 6.5 times its $690 average price in 2014.

What’s not clear about this scenario is how a passed-out opioid over-doser who has stopped breathing will be able to administer the naloxone.  Irreversible brain damage occurs mere minutes after a person stops breathing.  The life-saving medication requires someone alert, quick to recognize the problem, and to administer the antidote.

With all the calls for funding, research, and treatment, no one is admitting that substance use treatment is notoriously ineffective.  FDA head Gottlieb and others are begrudgingly accepting the idea that cure may not be practical, and long-term maintenance must be considered.  So the magic bullet, the aforementioned MAT, or “medication-assisted treatment,” is not a cure.  It is designed to convert illegal opioid use to legal opioid use for perhaps a lifetime.  Of course this will require funding for treatment, for the treating facilities, support staff, the researchers, and for the prescriptions.

Who benefits from this crisis?  Well, the National Institute of Health has earmarked $1.1 billion to develop “scientific solutions,” backed by a $1.3 trillion omnibus package passed by Congress, according to Psychiatric News.

US President Donald Trump has declared the “opioid crisis” a public health emergency.  We have the White House Opioid Commission looking for ways to fund and treat the problem, including such issues as insurance coverage.  It recommends funding for no less than eight professional organizations.

The four approved medications in MAT are naloxone, mentioned above, naltrexone, and opioids buprenorphine and methadone, in case you want to buy stock in the companies.  Insurance company stock will most likely benefit, too.

The common denominator in this “emergency” is the use of more drugs to treat the drug problem in the drug-crazed culture we have created.

Crazies ‘R’ Us

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One of my alter-egos, Kookie the Shrink, with New-Age, eco-friendly, portable, non-pharmaceutical, public domain feel-good idea that hasn’t been invented yet.

Everyone knows psychiatrists are crazy.  Just ask my deceased mother, who claimed psychiatrists enter the profession to solve their own problems.  Fact is, I only began having problems in medical school.  My problems got worse after psychiatry residency, when I started practicing psychiatry in a “health care industry” so saturated with sanctimonious hypocrisy that I was astounded.  No one seemed to notice or care that externally imposed rules and expectations were making a mockery of the principles I was taught in training.  While everyone in the “health care industry” claims to be acting in the patients’ and public’s best interest, the so-called “healers” have become passive tools in a tidal wave of co-dependency that cripples to control and calls it “care.”

While “health care” professionals across the board have succumbed to this debilitating delusion, I feel particularly betrayed by the leadership in my own chosen specialty, because psychiatrists should know better.  I believe the psychiatric establishment has abdicated its philosophical foundations.  Instead of promoting mental health and self-reliance, it is busy kissing up to the profiteers in government, pharmaceutical and insurance industries, and seeking ever new ways to bind patients and the public to its mind-numbing agenda.

Two concurrent trends show how the psychiatric establishment–which depends on pharmaceutical advertising for its numerous professional publications—is desperately seeking relevance in a drug-pushing world.

The first trend, toward “medication-assisted treatment” for “opioid use disorder,” has been heavily embraced by the psychiatric establishment and the mainstream media.  The Friday, August 11, 2017 issue of USA Today claims “Opioids to be declared a national emergency.”  Here, we learn that President Donald Trump “’is drawing documents now’ to officially label the crisis as a national emergency.”  Such a designation would trigger specific tools for federal and state governments, including grants from the Public Health Emergencies Fund, a suspension of some of the patient privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and waive Medicaid restrictions on federal funding for mental health hospital admissions.

The second trend is the ongoing fight by the American Psychiatric Association (APA) and its state-level affiliates to stop the push by psychologists for prescription privileges.  This is an ongoing turf battle, with bills for psychologist prescribing introduced in multiple state legislatures every year.

The common denominator in these trends is that they are turf battles over drugs.  They have nothing to do with caring for patients, mental health, or the mind’s intrinsic self-healing potential.  The professional contestants, however, all claim they have patients’ best interests in mind.

Contributing factors abound.  In psychiatry, the shift from psychotherapy to medication management has been particularly devastating to professional self-esteem.  Psychiatry, now more than ever, seeks to align with the “scientific” foundations of medicine. Meanwhile, insurance and government have delegated “talk therapy” to less expensive psychologists and social workers.  What used to be 45-minute psychiatric consultations have become 15-minute “med checks.” Freud has been replaced by Prozac.

This follows a general cultural trend toward quick-fix solutions, with pills becoming the treatment of choice in all specialties except surgery.  The rise in illegal drug use can’t compare with the explosion of drugs for medical conditions, vaccines, and pseudo-conditions.  Over-medication is a major cause of accidents, drug interactions, and overdoses.  Unintentional injuries from falls and overdoses from prescription and illegal drugs are now the fourth leading cause of death in the US, according to one study.  Another study cites medical error the third leading cause in hospitalized patients.

The “opioid crisis” is attributed in part to Purdue Pharma’s misrepresenting OxyContin in 1997, when it was introduced, as having low abuse potential.  That same year, the FDA approved direct-to-consumer advertising. Pharmaceutical DTC advertising took off at the turn of the century.

That prescription painkillers fall in a different category from heroin—which cannot be prescribed in the US—bears mention, but they are linked by their black market affiliation.  OxyContin’s introduction on the market, and its aggressive marketing campaign to specialists and family practitioners brought Purdue Pharma $45 million in sales the first year.  That increased to $3.1 billion by 2010, or 30 percent of the prescription painkiller market.  In 2007, Purdue pleaded guilty in a federal lawsuit claiming it intended to mislead doctors and patients about its addictive properties.  It paid $600 million in fines.  The state of Kentucky, the state most ravaged by prescription painkiller and heroin use, has made 12 claims against Purdue, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages.  OxyContin costs up to $1/mg on the street, or up to $80 for an 80 mg tablet.

Other reports say fentanyl, a prescription opioid that can be synthesized by drug traffickers, dramatically increases the risk of fatal overdoses.  Its deadliest component, carfentanil, is five thousand times stronger than heroin.  Add this to the fact that multiple common drugs and alcohol also depress the respiratory center, with a cumulative effect.  Benzodiazepines, like Xanax, are often taken along with opiates.

The “opioid crisis,” is now being traced to pharmaceutical companies and to the FDA, according to The Guardian’s latest report.  (www.theguardian.com/commentisfree/2017/aug/13/dont-blame-addicts-for-americas-opoid-crisis-real-culprits)

The collusion between the psychiatric community and the pharmaceutical industry to push drugs on a gullible public smacks of a cronyism that few seem to recognize.  The FDA-approved “medication-assisted” treatment for opioid use disorder contains two opioids—methadone and buprenorphine—which are also abused.  However, the psychiatric establishment, which has sub-specialties in addiction, has a piss-poor success record with addiction treatment and virtually ignores Alcoholics Anonymous and its spin-offs, like Narcotics Anonymous.  These are peer run, free, and have a better track record than the “experts” can claim, despite their education and degrees.  The APA also ignores non-pharmaceutical treatments like acupuncture, which even the NIH has admitted has utility in chronic pain.  Auricular acupuncture for substance abuse has a long and under-appreciated track record.

Where does psychiatric officialdom stand on the mental health advantages of low-stress lifestyles, nutrition, physical therapy, and exercise?  Ask, and let me know what you find out.

Crazies ‘R’ Us indeed.  The psychiatrists need to get off the drugs and learn to use their minds to heal themselves first.