Survey: would you BOYCOTT CVS because of new opiate dispensing policy ?

CVS Health recently announced that it will limit new opioid prescriptions for acute pain to a 7 day supply. CVS pharmacies will also require that daily doses be no higher than 90mg morphine equivalent units for both acute and chronic pain. Customers must also use immediate release formulations before extended release opioids are dispensed. This policy, which is meant to reduce opioid abuse and misuse, will become effective February 1, 2018.

 

check here to take survey

 

To find a local independent pharmacy by zip code:

http://www.ncpanet.org/home/find-your-local-pharmacy

 

 

 

PROP Founder Calls for Forced Opioid Tapering

PROP Founder Calls for Forced Opioid Tapering

www.painnewsnetwork.org/stories/2017/7/20/prop-founder-calls-for-forced-opioid-tapering

Have you or a loved one been harmed by being tapered off high doses of opioid pain medication?

The founder of an anti-opioid activist group wants to know – or at least he posed the question during a debate about opioid tapering with colleagues on Twitter this week.

“Outside of palliative care, dangerously high doses should be reduced even if patient refuses.  Where exactly is this done in a risky way?” wrote Andrew Kolodny, MD, Executive Director of Physicians for Responsible Opioid Prescribing (PROP). 

“I’m asking you to point to a specific clinic or health system that is forcing tapers in a risky fashion. Where is this happening?”

It’s not an idle question. About 10 million Americans take opioid medication daily for chronic pain, and many are being weaned or tapered to lower doses — some willingly, some not — because of fears that high doses can lead to addiction and overdose.

Kolodny’s Twitter posts were triggered by recent research published in the Annals of Internal Medicine that evaluated 67 studies on the safety and effectiveness of opioid tapering. Most of those studies were considered very poor quality.

“Although confidence is limited by the very low quality of evidence overall, findings from this systematic review suggest that pain, function, and quality of life may improve during and after opioid dose reduction,” wrote co-author Erin Krebs, MD, of the Minneapolis Veterans Affairs Health Care System. 

Krebs was an original member of the “Core Expert Group” – an advisory panel that secretly helped draft the CDC opioid prescribing guidelines with a good deal of input from PROP. She also appeared in a lecture series on opioid prescribing that was funded by the Steve Rummler Hope Foundation, which coincidentally is the fiscal sponsor of PROP. 

Curiously, while Krebs and her colleagues were willing to accept poor quality evidence about the benefits of tapering, they were not as eager to accept poor evidence of the risks associated with tapering. 

“This review found insufficient evidence on adverse events related to opioid tapering, such as accidental overdose if patients resume use of high-dose opioids or switch to illicit opioid sources or onset of suicidality or other mental health systems,” wrote Krebs.

But the risk of suicide is not be taken lightly, as we learned in the case of Bryan Spece, a 54-year old chronic pain sufferer who shot himself to death a few weeks after his high oxycodone dose was abruptly reduced by 70 percent.  Hundreds of other pain sufferers at the Montana clinic where Spece was a patient have also seen their doses cut or stopped entirely.

Spece’s suicide was not an isolated incident, as we are often reminded by PNN readers.

“A 38 year old young lady here took a gun and put a bullet in her head after being abruptly cut off of her pain medication,” Helen wrote to us. “Her whole life ahead of her. This is happening every day, it just isn’t being reported.”

“I too recently lost a friend who took his own life due to the fact that he was in constant pain and the clinic he was going to cut him off completely,” said Tony.

“I have been made to detox on my own as doctors who were not comfortable giving out these meds would take me off, not wean me,” wrote Brian. “Was a nightmare. Thought I was gonna die. No, I wanted to die.”

“In the end when you realize that you’re not going to get help and that you have nothing left, suicide is all you have,” wrote Justin, who is disabled by pain and no longer able to work or pay his bills after being taken off opioids. “I don’t want to hurt my family. I don’t want to die. However it is the only way out now. I just hope my family and the good Lord can forgive me.”

Patient advocates like Terri Lewis, PhD, say it is reckless to abruptly taper anyone off high doses of opioids or to aim for artificial goals such as a particular dose. She says every patient is different.

“There is plenty of evidence that persons treated with opiates have variable responses – some achieve no benefit at all.  Some require very little, others require larger doses to achieve the same benefit,” Lewis wrote in an email to PNN.

“It is an over-generalization to claim that opiates are lousy drugs for chronic pain. Chronic pain is generated from more than 200 medical conditions, each of which generate differing patterns of illness and pain generation. For some, it may be reflective of its own unique disease process. We have to retain the ability to treat the person, not the label, not to the dose.”

Patient ‘Buy-in’ Important for Successful Tapering

And what about Kolodny’s contention that high opioid doses should be reduced even if a patient refuses? Not a good idea, according to a top CDC official, who says patient “buy-in” and collaboration is important if tapering is to be successful.

“Neither (Kreb’s) review nor CDC’s guideline provides support for involuntary or precipitous tapering. Such practice could be associated with withdrawal symptoms, damage to the clinician–patient relationship, and patients obtaining opioids from other sources,” wrote Deborah Dowell, MD, a CDC Senior Medical Advisor, in an editorial in the Annals of Internal Medicine.  “Clinicians have a responsibility to carefully manage opioid therapy and not abandon patients in chronic pain. Obtaining patient buy-in before tapering is a critical and not insurmountable task.”

The CDC guideline also stresses that tapering should be done slowly and with patient input.

“For patients who agree to taper opioids to lower dosages, clinicians should collaborate with the patient on a tapering plan,” the guideline states. “Experts noted that patients tapering opioids after taking them for years might require very slow opioid tapers as well as pauses in the taper to allow gradual accommodation to lower opioid dosages.”

The CDC recommends a “go slow” approach and individualized treatment when patients are tapered.  A “reasonable starting point” would be 10% of the original dose per week, according to the CDC, and patients who have been on opioids for a long time should have even slower tapers of 10% a month.

The Department of Veterans Affairs takes a more aggressive approach to tapering, recommending tapers of 5% to 20% every four weeks, although in some high dose cases the VA says an initial rapid taper of 20% to 50% a day is needed. If a veteran resists tapering, VA doctors are advised to request mental health support and consider the possibility that the patient has an opioid use disorder.

Have you been tapered at a level faster than what the CDC and VA recommend? Let us know by leaving a comment below.

If you think you were tapered in a risky way, you can let Dr. Kolodny know at his Twitter address: @andrewkolodny.

CDC Releases More Faulty Research About Opioids

CDC Releases More Faulty Research About Opioids

www.painnewsnetwork.org/stories/2017/9/19/cdc-releases-more-faulty-research-about-opioids

A new study by researchers at the Centers for Disease Control and Prevention estimates that opioid overdoses have shaved two and a half months off the average life span of Americans – a somewhat misleading claim because the study does not distinguish between legally obtained prescription opioids and illegal opioids like heroin and illicit fentanyl.

The research letter, published in the medical journal JAMA, looked at the leading causes of death in the U.S. from 2000 to 2015. Overall life expectancy rose during that period, from 76.8 years in 2000 to 78.8 years in 2015, largely due a decline in deaths from heart disease, cancer, stroke, diabetes and other chronic health conditions.

But deaths due to Alzheimer’s disease, suicide, liver disease, drug poisoning and opioid overdoses rose, collectively causing a loss of 0.33 years in life expectancy – most of it due to opioids.

“This loss, mostly related to opioids, was similar in magnitude to losses from all the leading causes of death with increasing death rates,” wrote lead author Deborah Dowell, MD, of the CDC’s National Center for Injury Prevention and Control.

“U.S. life expectancy decreased from 2014 to 2015 and is now lower than in most high-income countries, with this gap projected to increase. These findings suggest that preventing opioid related poisoning deaths will be important to achieving more robust increases in life expectancy once again.”

CDC2.jpg

Dowell was also one of the lead authors of the CDC’s 2016 opioid prescribing guidelines, which discourage physicians from prescribing opioids for chronic pain. She and her two co-authors in the JAMA study —  both of them CDC statisticians — do not explain why they failed to distinguish between black market opioids and legal prescription opioids, a dubious use of statistics akin to lumping arsonists in the same category as smokers or Boy Scouts learning to build campfires.  

They also fail to even mention the scourge of heroin and illicit fentanyl sweeping the country, which now accounts for the majority of opioid overdoses in several states.  

But Dowell and her co-authors don’t stop there. The say the actual number of deaths caused by opioids is “likely an underestimate” because information on death certificates is often incomplete and fails to note the specific drug involved in as many as 25% of overdose deaths. This is another disingenuous claim, because it fails to explain why the data on the other 75% of overdoses is faulty too. 

Epidemic of Despair

Other researchers have also tried to explain the disturbing decline in American life expectancy – which began over adecade ago for middle-aged white Americans. Princeton researchers Anne Case and Angus Deaton were the first to document that trend,  when they estimated that nearly half a million white Americans may have died early because of depression, chronic pain, suicide, alcohol and drug abuse, and other health problems – an epidemic of despair linked to unemployment, poor finances, lack of education, divorce and loss of social connections.

The evidence was right there for Deborah Dowell and her co-authors had they looked for it. The JAMA study found that over 44,000 Americans committed suicide in 2015, a 66% increase from 2000, and over 40,000 died from chronic liver disease or cirrhosis, another 66% increase. Opioid overdoses during that same period rose to 33,000 deaths. 

Which is the bigger epidemic?

As PNN has reported, the CDC ignored early warnings from its own consultant that the agency’s opioid guidelines were being viewed as “strict law rather than a recommendation,” causing many doctors to stop prescribing opioid pain medication. Chronic pain patients also feel “slighted and shamed” by the guidelines, and are increasingly suicidal or turning to street drugs. We’ve also reported that the CDC has apparently done nothing to study the harms or even the possible benefits the guidelines have caused since they were released 18 months ago.

Instead of going back in time and selectively mining databases to fit preconceived notions about opioids, perhaps it is time for the CDC to take a giant step forward and see what its opioid guidelines have actually done.

When “yes” sometimes means “yes”, sometimes means “maybe”, sometimes means “no”

Mexican cartels: ready to meet Americans’ insatiable appetite for illegal narcotics

Methamphetamine, also known as crystal methDEA: Meth making Illinois comeback via Mexican cartels

https://www.ilnews.org/news/justice/dea-meth-making-illinois-comeback-via-mexican-cartels/article_bffd2f90-9f09-11e7-b789-1773257f4680.html

The Drug Enforcement Agency says Illinois’ meth problem is re-emerging and it’s not from domestic production. It’s coming from Mexico and one solution to combat the problem may be as simple as education.

DEA St. Louis Field Division Special Agent in Charge James Shorba oversees the southern third of Illinois, from Springfield down to Illinois’ southern border. He also oversees some of the Quad Cities, the states of Missouri, Kansas, Iowa, Nebraska and South Dakota.

 Shroba said there’s sometimes a “hyperfocus” on the significant problem of opioid abuse.

“I don’t know if it’s fair to say that we have a methamphetamine problem or an opioid problem, or a cocaine problem,” Shroba said. “Some Americans have an insatiable appetite for illegal narcotics.”

While the rates of overdose on meth don’t equal that of opioid overdose, “it’s still at alarmingly high rate,” Shroba said. “We forget that Mexican transnational organizations are the predominant producers of methamphetamine in the western hemisphere and they have an overabundant supply which has saturated streets all across America, in particular cities like Kansas City, St. Louis, [and] Fairview Heights.”

He said efforts years ago to curb domestic production of meth in makeshift labs worked.

“But as the government has enacted different legislation by, for example, placing pseudoephedrine-based cold medicine behind the counter at a pharmacy, it’s acted as a disincentive for individuals to make it themselves,” Shroba said. “Well, in steps the Mexican cartels.”

 The street price of meth indicates a saturated market.

“Between 2007, if you were going to buy a gram of 100 percent pure methamphetamine in the US market,” Shroba said, “that would cost you about 300 bucks. In 2017, that would cost you about $65.”

There’s so much meth out there from Mexico Shroba said “our information is the cartels are restricting supply, so that they can bring the price back up.”

Just like on a popular TV show, the DEA can pinpoint where the meth flooding Illinois streets is coming from “because of the minerals that may be in the water or the concentration of other elements that might be present in that narcotic allows us to pin it down to a particular trafficking organization that made it,” Shroba said.

There are some interesting ways to get the narcotic across the border to places like Chicago, Kansas City or St. Louis.

  “You’re only limited by your imagination,” Shroba said. “I’ve seen everything from trafficking organizations using semi-submersible submarines to fishing vessels, high speed boats that are stripped down, put extra engines and all they have gasoline and narcotics on board.”

Then, Shroba said, there’s the sad stories of people being used as human mules to carry drugs over the border.

Shroba said the DEA assists in busting the big time drug dealers.

“We target the biggest and baddest drug dealers that are there, that are bringing in significant quantities to places like Belleville, and Fairview Heights or Springfield.”

But, Shroba said, “We’re not going to arrest our way out of this problem.”

“We have to have aggressive education programs in schools,” Shroba said. “We have to invest in the right places.”

“It’s those new first-time users,” Shroba said, “or those individuals who are potentially the new first-time users that we have to get to and we’ve got to get to them when they’re in grade school.”

 

The American Patient Defense Union — The Time Has Come!

The American Patient Defense Union — The Time Has Come!

www.medium.com/@noorchashm/the-american-patient-defense-union-the-time-has-come-7818424cf1b1

For the past 4 years I’ve been living in a crucible from hell — as a husband-turned-activist, father, surgeon and citizen.

But my family is not alone — there are literally hundreds of thousands of American families every year, avoidably affected or harmed by our healthcare establishment’s ethically defunct corporate directives.

The overt business influence and a rich revenue stream from our insurance investments has corrupted American medicine at its highest levels of establishment.

As a surgeon, turned patient-activist, I’ve often thought that individual American patients need a professional watchdog force to defend them, in a personalized way, as they navigate the finely polished corporate healthcare maze.

There is powerful precedent for such a concept.

American Laborers and workers, susceptible to corporate abuse, have their unions.

Americans susceptible to civil rights violations have the ACLU and NAACP.

But who defends individual patients whose rights are ignored? Who defends those patients who are harmed or are in harm’s way? Very certainly not the healthcare corporations and their minions! And not the “advocacy groups” focused on creating “safe space” for patients to commiserate or kumbaya for empathy/sympathy — and not those organizations designed to address broad and impersonal policy, public health or research issues.

Don’t take me wrong. Patients need empathic shoulders, policy diplomats, and research advocates — but what is sorely missing is an army capable of providing liability blows, when things are bad or go wrong.

To be clear, I am not talking about creating another “advocacy group”. Instead, what I know is missing in the healthcare marketplace is a patient-powered strike force. An army capable of delivering well-crafted and precision-made liability signals to the corporate risk managers guarding every level of our healthcare establishment — providers, hospitals, insurers, pharmaceutical and device makers, even federal and state level political leaders guided by industry lobby.

Any one of us, healthy today, can be on the receiving end of patient harm tomorrow — and when this happens today, there is no real force defending us!

Yes, there are medical malpractice lawyers. But most of those, take on only the cases where there is a reasonable assurance of a win — and, anyway, the vast majority of plaintiff’s cases against doctors and hospitals lose in court.

In the year 2017, American patients are where American laborers and the African-American people were in the early part of the 20th century. That is, literally defenseless in the face of an increasingly corporatized medical marketplace designed to serve the healthy and the wealthy “majority”, and polished to achieve “cost and liability containment” for the corporation.

In the 20th century, American laborers and the African-American people created and supported powerful unions, such as the AFL-CIO, the ACLU and the NAACP. And the American patient has a lot to learn from those examples.

These unions defend the rights of individual citizens against powerful corporate and status quo forces using the force of liability and litigation.

IMAGINE American history without the AFL-CIO, the ACLU or the NAACP. What would America look like today?

Irrespective of the political criticism some direct at unions, the state of labor and civil rights in America would be unimaginable had these forces not emerged onto the scene with the teeth they possess.

Unions give Americans voice — they empower citizens in the face of utilitarian corporate forces.

Unions are necessary for the evolution of a well-balanced market and a just democratic republic. Because unions empower and balance the marketplace equation.

There is no question that the individual American patient, today, needs a powerful counterbalance to the well-polished and powerful corporate healthcare establishment — with its robust complement of well-polished marketing and legal defenses.

Isn’t it time for the American patient to have a union of his or her own, with the power to impose real liability on the healthcare establishment when needed by the susceptible patient — and every patient who walks into a hospital or provider’s office is susceptible, make no mistake.

The lucrative nature of healthcare reimbursements has, in many cases, turned the patient into nothing more than a package on the conveyor belt of corporate medicine. Inside hospitals, administrators and leading doctors, use the term “service line” to describe their money machine.

In such an environment countless patients, already vulnerable because of their illness, are also susceptible to the corporate system’s impersonal orientation, to predatory practices, and when avoidably harmed, to irreversible loss and liability.

It is a virtual certainty that our federal government will not be able to autonomously defend the patient position well. Not because it is intentionally corrupted or malicious, but because our federal system is designed to accommodate and serve diverse stakeholders based on their lobby power — not just patients. And in the healthcare marketplace, today, patients are the weakest of all the stakeholders in the market equation — even though they are the basic source of value to the establishment.

THIS, is not right.

BUT — — IMAGINE, a union designed to achieve balance and justice for every American patient with a legitimate grievance. And, in my experience, almost all patients who complain about something have a legitimate grievance or need more accurate information.

IMAGINE, a union focused on the defense of individual patients’ rights in navigating a complex and, at times, impersonal healthcare system led by corporate directives.

IMAGINE, a union designed to provide its individual members access to an unprecedented watchdog organization designed to promote and defend the rights of its every member.

IMAGINE, a union designed to focus on the adverse experiences of individual patients — in order to generate granular, personalized, professionally crafted and adequately powered liability signals to the corporate healthcare establishment’s guardians. And I assure you, when corporations receive real liability signals, they respond quite efficiently!

IMAGINE, a union that operates as a Co-Op organization sustained and owned strictly by its members: that is, every individual American who is a patient or a potential patient — irrespective of race, ethnicity, religion, gender, sexual orientation, socioeconomics or immigration status.

IMAGINE, a union formed of the patient, by the patient and for the patient — for every patient.

IMAGINE, an unprecedented member-powered watchdog co-op committed to delivering adequately powered and expertly crafted liability signals to the healthcare establishment using the adverse experiences of individual patients — for the sole purpose of defending patients’ rights and improving safety and quality in a muscular way.

IMAGINE, THE AMERICAN PATIENT DEFENSE UNION — “You Are Not Alone”.

The only question is: Are individual American patients, in the millions, willing to invest in creating such a union with enough teeth to correct the system’s inequities by generating transparent liability signals and through muscular litigation when needed?

More importantly, are YOU, the American patient, willing to rise up?

 

Nurse Fired for Refusing Flu Shot Sues Hospital, Federal and State Governments for $100,000,000

Nurse Fired for Refusing Flu Shot Sues Hospital, Federal and State Governments for $100,000,000

http://healthimpactnews.com/2014/nurse-fired-for-refusing-flu-shot-sues-hospital-federal-and-state-governments-for-100000000/

Health Impact News Editor

Nurses all across the United States are having their Constitutional rights trampled upon for refusing mandatory flu vaccinations. As we have previously reported, thousands of nurses across the United States are taking a stand against forced flu vaccinations, choosing to either lose their job as a result, or endure shame and ridicule for being forced to wear a mask while on duty during flu season.

nurses-3-wearing-masks

Nurses proudly wearing the masks in protest of mandatory flu vaccines. Photo from Nurses Against Mandatory Vaccines Facebook Page.

Dreonna Breton lost her job in December 2013 for refusing to receive the flu vaccine while she was pregnant, even though she had a doctor’s exemption.

It was only a matter of time before some of these nurses began taking legal action to protect their rights. Some litigation began last year, but details are not available publicly.

Dr. Karen Sullivan Sibert, herself a pro-vaccine doctor, wrote an opinion piece explaining how requiring nurses to wear masks for refusing the flu vaccination violates HIPAA law for patient privacy. (See: Pro Vaccine Doctor Explains how Mandatory Flu Vaccines for Healthcare Workers Violates HIPAA Law)

In addition to the violation of personal rights, the CDC published a study in 2013 showing that vaccination of healthcare workers with the seasonal flu vaccine offered no significant measurable protection of patients from the flu. (See: CDC Study: Mandatory Flu Vaccinations of Health Care Workers Offer NO Protection to Patients)

And as we have reported here at Health Impact News, the flu vaccine is not without risk. The government’s own data on settled cases due to vaccine injuries show that the flu vaccine causes more serious injuries, including death, than all other vaccines combined. (See: Flu Vaccine is the most Dangerous Vaccine in the U. S. based on Settled Cases for Injuries)

NDreonna Breton lost her job for refusing to receive the flu vaccine while she was pregnant, even though she had a doctor's exemption.ow, the Law Offices of James Elsman has issued a press release stating that they have a client who is a nurse that has lost her job due to refusing the flu vaccination, and she has filed a class action suit for one hundred million dollars against the hospital that fired her, as well as the state and federal governments.

It should be noted that the new Affordable Health Care Act (Obamacare) has mandated that healthcare facilities must have 90% of their employees vaccinated with the flu vaccine to receive full reimbursements of Medicare and Medicaid payments.

Law Offices of James Elsman Announces Suit: Nurse Refuses Shots — Sues Hospital, Federal and State Governments for $100,000,000 Claiming Flu-Shots Have Many Dangers and Questionable Advantages

Reuters.com

DETROIT, Jan. 22, 2014 /PRNewswire/ — A nurse was fired from her Hospital job for refusing to take the flu-shot on religious and health grounds, and is “blowing the cover off many dangers of the flu vaccine,” says her lawyer, James Leonard Elsman of Birmingham, Michigan.

Karen Bashista of S. Lyon, Livingston County, Michigan was a nurse for St. Joe Hospital, and was fired for not taking the flu-shot; though she offered to wear a mask, be moved to another floor and function, etc.  She said “Hospital doctors got waivers of such.”

Elsman said this is the first suit in the U.S.A., which joins a termination with a major challenge to the efficacy of the much-vaunted “flu-shot,” because he is suing not only the Hospital, but also the C.D.C. (“Centers for Disease Control”) of the U.S. Government, and the State Community Health Dept.

Nurse Bashista continued:  “People are just waking up to the dangers of flu-shots and other vaccination shots that we don’t question, because ‘government’ recommends such.  Well, if government is so smart, why can’t they even administer Obamacare?  Government is grasping at straws and many physicians know this, more and more.  Why don’t they always take the flu-shots?”

Elsman said the flu-vac is made many months “before” the yearly-strains are even known, so it is a guess in the dark.  “A shot into your body is putting an attenuated flu virus into you — remember when Piers Morgan of CNN actually got the flu, ‘right after’ some CNN doctor gave him the flu-shot on live TV?  A scandal is brewing.  There is no proof of efficacy, i.e. that it works in all cases.  Medicine should be ashamed.  Mrs. Bashista is standing up for all Americans.”

$100 million is prayed for, because the suit is a Class Action on behalf of all Americans in all States, concluded Elsman.  “We will no longer take modern-medicine’s or the Government’s kool-aid.  People deserve ‘informed consent’!”

Contact: James Elsman, J.D. News Conference for all Media,
  248-645-0750 with Mrs. Bashista
  elsmanlawfirm@aol.com 2:00 p.m.
  635 Elm St. Friday, January 24, 2014
  Birmingham, MI 48009 at lawyer’s office

SOURCE Law Offices of James Elsman

If a hospital system can be sued for mandating that their employees have flu shots… could the same/similar system be sued for forcing their employee prescribers to LIMIT opiate medications that pts can have ?  Is forcing a person to take medication the same/similar as denying necessary medication ?

FDA: OK to give ADDICTS meds the DEA says are dangerous given together ?

FDA To Providers: Do Not Withhold Medication-Assisted Opioid Addiction Treatment Due To Potential Interactions

https://insidehealthpolicy.com/daily-news/fda-providers-do-not-withhold-medication-assisted-opioid-addiction-treatment-due

FDA is updating its existing warnings on the dangers of combining addiction medications and certain anxiety and insomnia drugs to emphasize that despite the potential for potentially deadly interactions, medication-assisted treatment (MAT) for opioid addiction should not be withheld from patients already taking these anxiety medications. Instead, providers should develop a treatment plan that closely monitors any concomitant use of the drugs, FDA says. The agency announced Wednesday that it is updating both the existing boxed warnings for the drugs…

Interesting summary of various articles – interesting read

EDS and Chronic Pain News & Info

edsinfo.wordpress.com/2016/10/23/summary-of-posts-about-the-opioid-crisis/

https://edsinfo.wordpress.com/

 

 

AG Sessions: all pts using opiates are USERS ???

Sessions opioid speech keeps focus squarely on users and doctors, lets drugmakers off easy

www.thinkprogress.org/sessions-painkillers-purdue-dd0261c2101c/

“Today we are facing the deadliest drug crisis in American history,” Attorney General Jeff Sessions said Thursday in West Virginia, the latest stop on his ongoing tour of places hit hardest by opioid addiction and overdose deaths.

“Talk to the police about it, and they’ll tell you many people became addicted almost the first time they tried these powerful and addictive drugs,” Sessions said.

But despite acknowledging the severity of the opioid crisis today, the rest of Sessions speech ignored the role of the corporations that have sold these pills over the years.

Thursday’s speech hit most of the same notes Sessions has struck in other appearances to discuss opioid addiction, treatment, and law enforcement. He echoed Nancy Reagan’s call to “just say no” and offered tepid praise for treatment programs. He even used the fact that treatment too often fails to save addicts’ lives as a springboard to focus on enforcement.

Sessions mentioned drug manufacturers only once — a shout-out to former pharma industry lobbyist turned West Virginia Attorney General Patrick Morrisey for suing some of the companies he used to represent — then launched into several paragraphs of detailed criticism of doctors, dealers, and gangs.

Sessions’ speech focused on users and ignored the other end of the prescription drug pipeline. Like other law enforcement figures, Sessions rarely discusses the drug approval processes that allowed companies like Purdue Pharmaceuticals to make misleading claims about their drugs, or the legal logics that keep the Sackler family that owns Purdue safe from lawsuits.

The crisis Sessions lamented Thursday began with the introduction of OxyContin in 1996. The drug’s ubiquity and high price have helped the Sacklers to amass a $14 billion fortune over the years.

OxyContin caught on because it was marketed as a wonder-drug that could wipe out extreme pain for 12 hours off of a single dose. “Unlike short-acting pain medications, which must be taken every 3 to 6 hours,” Purdue wrote in a 1996 press release, “OxyContin Tablets are taken every 12 hours, providing smooth and sustained pain control all day and all night.”

It’s by now well known that Purdue’s marketing overpromised, and the drug underdelivered. “The drug wears off hours early in many people,” the Los Angeles Times reported in a groundbreaking investigation of the company last year, “and when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug.”

Most damningly, the Times’ expose found, Purdue knew its marketing was a lie. Its own drug trials had shown as much, the Times found, yet the company “held fast to the claim of 12-hour relief, in part to protect its revenue… Without that, it offers little advantage over less expensive painkillers.”

After the drug hit the market, more real-world evidence of OxyContin’s shortcomings began piling up atop the internal trials evidence. Purdue simply recommended upping a patient’s dose – not increasing the frequency with which a patient takes the same concentration of the heroin-lite medication, but dumping larger volumes of it into the bloodstream at the same “smooth and sustained” 12-hour clip.

Heroin and its chemical relatives have an especially pernicious effect on human brain chemistry. Unlike cannabis – Sessions’ personal bugaboo – the withdrawal of opioids from a neurology that’s become dependent upon them is violent and debilitating.

OxyContin isn’t the main murder weapon in the 60,000-plus overdose deaths in 2016 that Sessions cited on Thursday. It is more often heroin, increasingly cut with the even-more-dangerous pharmaceutical invention fentanyl.

But putting a civilian with a pain problem on OxyContin, telling them they’re going to feel fine for 12 hours, then telling them not to take any more even though their pain has resurfaced just a few hours later? That amounts to leaving patients stuck between the pill bottle warnings on one side and the lure of cheaper, harder hits of the same brain chemicals from some street dealer. It’s “the perfect recipe for addiction,” as Dr. Theodore Cicero told the Times.

Hundreds of thousands of people have died in the United States from prescription drug overdoses since OxyContin went on the market.

Purdue, meanwhile, has racked up billions in profits – thanks in part to an aggressive internal sales culture built on telling doctors the answer to problems with OxyContin was almost always more OxyContin, the Times found — and stymied every serious attempt to claw back some of that money to the victims of the epidemic.

The lawsuits started piling up fast, within the drug’s first six years on the market. But the corporate-friendly eccentricities of American liability law kept Purdue’s ill-gotten profits out of reach. Most the more than 100 lawsuits over OxyContin dosing deceptions have been dismissed because of “a legal doctrine which shields drug companies from liability when their products are prescribed by trained physicians.”

Where courtroom shields were at risk of cracking, Purdue wrote checks to make cases go away. West Virginia itself won one of the largest settlements Purdue’s ever paid, a $10 million handshake deal that the company only offered after its lawyer – future Attorney General Eric Holder – failed to convince a judge to dismiss the case before trial.

Trial records are public. Taking the fight further would mean exposing Purdue’s secrets to every other lawyer in the world, a class-action nightmare that could threaten the Sackler family’s Oxy fortune. Out came the checkbook.

To this day, the Sacklers have retained their titanic fortune. Even as official attention turns squarely to opioid users, prescribers, and distributors, the people who actually created the drugs Sessions and other government officials decry can apparently rest easy.