#opioid

#F.D.A. Did Not Intervene to Curb Risky #Fentanyl Prescriptions - The New York Times
▻https://www.nytimes.com/2018/08/02/health/fda-fentanyl-opioid-epidemic-overdose-cancer.html

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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.

[...]

About 5,000 pages of documents, obtained by researchers at Johns Hopkins University 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.

#complicité #santé #opioides #opiacés

Is it addiction or dependence? | Bloomberg American Health Initiative
▻http://americanhealth.jhu.edu/article/it-addiction-or-dependence

“Born Addicted: The Number of Opioid Addicted Babies is Soaring,” reads the headline of a recent news story on the dramatic increase in babies born afflicted by neonatal abstinence syndrome. It’s great that media outlets are reporting on the important public health issue of the national opioid crisis, but its terminology is not accurate. Babies cannot be born addicted.

Unfortunately, there is often confusion regarding certain terms describing addiction, and such confusion can exacerbate widespread stigma.

The DSM-5, published in 2013, attempted to assuage the confusion. ‘Substance use disorder’ is now the accepted term to describe what is commonly referred to as addiction, leaving dependence as the term to describe the physical tolerance that develops to alcohol and drugs, including opioids.

With the appropriate vocabulary arsenal we can now return to the problematic “addicted babies” headline. Neonatal Abstinence Syndrome is a group of medical complications that affect newborn babies when the mother has used addictive opiate drugs during pregnancy. This exposure results in infants sometimes being born in withdrawal. If untreated, the babies, exhibit a number of symptoms like excessive crying, diarrhea, vomiting, and irritability, among others. Fortunately, treatment for a few days to weeks eliminates these symptoms. The accurate terminology for these babies is that they are born dependent or in withdrawal, not addicted. An infant, cannot exhibit the uncontrollable, compulsive drug use that defines an addiction. Calling babies addicted feeds into the stigma surrounding addiction and can dissuade pregnant mothers who suffer from substance use disorder from seeking necessary care.

#Opioides #Dépendance #Neonatal_abstinence_syndrome

En Suisse aussi, la forte hausse des prescriptions d’opioïdes inquiète Pauline Turuban - 3 Juillet 2018 - RTS
►http://www.rts.ch/info/sciences-tech/medecine/9665325-en-suisse-aussi-la-forte-hausse-des-prescriptions-d-opioides-inquiete.ht

- Les prescriptions d’antidouleurs opioïdes, des médicaments au fort potentiel addictif, ont explosé ces dernières années en Suisse. Des spécialistes appellent à la vigilance alors que la crise sanitaire fait rage aux Etats-Unis. _

Aux Etats-Unis, l’addiction aux analgésiques opioïdes est au coeur d’une crise sanitaire aux conséquences dramatiques. Selon les centres pour le contrôle et la prévention des maladies (CDC), environ deux millions d’Américains sont aujourd’hui dépendants à ces substances, naturelles ou synthétiques, dont les effets sur l’organisme sont comparables à ceux de la morphine.

En 2016, 42’000 personnes ont succombé à une overdose d’opioïdes et, parmi ces décès, 40% impliquaient des antidouleurs délivrés sur ordonnance.
▻http://www.rts.ch/2018/07/03/20/22/9692764.image?w=900&h=506
La Suisse, 7e consommateur d’opioïdes au monde
Ces derniers mois, des scientifiques se sont inquiétés de savoir si une épidémie comparable était imaginable en Suisse. Bien qu’il n’existe pas de données centralisées et aussi détaillées que celles disponibles aux Etats-Unis, leurs travaux mettent en lumière une hausse drastique de l’usage de ce type de produits dans le pays.

L’étude la plus récente, basée sur les données de l’International Narcotics Control Board (INCB) et publiée en juin dans la Revue médicale suisse (RMS), indique que la consommation d’opioïdes forts a été multipliée par 23 entre 1985 et 2015, passant de 18 à 421 mg/habitant/année.

Selon ces chercheurs romands, la Suisse est le septième consommateur au monde, largement au-dessus de la moyenne européenne mais au milieu de celle de ses pays limitrophes, et nettement derrière l’Amérique du Nord.

Consommation totale d’opioïdes en 2015 Le lien ►http://www.rts.ch/info/sciences-tech/medecine/9665325-en-suisse-aussi-la-forte-hausse-des-prescriptions-d-opioides-inquiete.ht

Ventes en hausse de 80% en huit ans
Les remboursements de ces médicaments -en particulier fentanyl, buprénorphine et oxycodone- par la seule caisse-maladie Helsana ont plus que doublé entre 2006 et 2013, passant de près de 65’000 à 137’000 cas, pointe une autre étude parue l’an passé dans BMC Health Services Research.

Les ventes, elles, évoluent logiquement dans le même sens : de 36 millions en 2008, elles ont progressé de manière constante jusqu’à atteindre 66 millions d’unités vendues en 2016, soit une hausse de 80% en huit ans, selon des chiffres d’Interpharma parus dans Suchtmagazin.

Pas de signe d’une hausse des addictions
D’une manière générale, la prise de tous les antidouleurs forts, pas uniquement opioïdes, tend à augmenter. Mais selon Addiction Suisse, la part de la population qui en fait un usage quotidien et prolongé -qui pourrait dénoter une dépendance-, elle, n’augmente pas : après avoir atteint un pic en 2013 (2,5%), elle est redescendue à 1,8% en 2016, ce qui représente environ 122’000 personnes.

Et à ce stade, rien n’indique que la progression de l’usage d’opioïdes ait eu pour corollaire une multiplication des cas d’addictions.

Alors qu’aux Etats-Unis, le taux de décès liés à la drogue a bondi de 30% entre 2010 et 2015, il a baissé d’environ 10% sur la même période en Suisse. On comptait aux Etats-Unis 16,3 cas d’overdoses pour 100’000 habitants en 2015, contre 1,58 cas en Suisse, soit près de 10 fois moins.

Etienne Maffli, chercheur à Addiction Suisse et auteur de l’étude parue dans Suchtmagazin, déplore toutefois le manque de recul de ces statistiques.

« On n’a pas un thermomètre très direct : si les cas de décès venaient à augmenter, on ne le verrait que deux ou trois ans après, ce qui est déjà bien trop tard. Aux Etats-Unis, les signaux d’alarme n’ont pas fonctionné correctement », avertit le scientifique qui préconise l’établissement d’un système d’alerte précoce.

Réglementation plus forte qu’en Amérique du Nord
Reste que la délivrance d’opioïdes est bien plus réglementée en Suisse qu’en Amérique du Nord. Pour les médicaments les plus forts, une ordonnance spéciale est émise en trois exemplaires comprenant un numéro d’identification unique. Un exemplaire demeure chez le médecin, un auprès de la pharmacie et le troisième auprès de la caisse-maladie.

S’ils reconnaissent que ce système de carnets à souche limite le risque d’abus, les spécialistes cités plus haut déplorent l’absence d’un registre centralisant les prescriptions et le manque de contrôles systématiques, qui permettraient de mieux lutter contre le « tourisme pharmaceutique ».

Aujourd’hui, seules les personnes à risque faisant l’objet d’une dénonciation auprès du pharmacien cantonal sont limitées à un seul médecin et une seule pharmacie.

« Le retour à l’’opiophobie’ serait contre-productif »
La nette hausse du recours à ces substances, utilisées notamment pour traiter les douleurs liées aux cancers, est en partie liée au vieillissement de la population. Mais, pour Etienne Maffli, l’explication réside surtout dans une évolution de l’éthique médicale, qui remet davantage en question « la nécessité de souffrir, et s’interroge sur la manière dont on peut mieux soulager les patients ».

Le propos n’est pas de diaboliser les opioïdes. « Le retour à une ’opiophobie’, contre laquelle nos aînés ont combattu, serait contre-productif », notent d’ailleurs les auteurs de l’étude publiée dans la Revue médicale suisse.

Toute la difficulté est de savoir où se situe la limite entre une meilleure prise en charge de la douleur et une prescription trop libérale d’opioïdes qui pourrait constituer un risque. « On ne sait pas vraiment où se situe l’optimum », insiste Etienne Maffli. La vigilance est donc nécessaire pour, résume-t-il, ne pas « dépasser cet optimum » et risquer un dérapage à l’américaine.

#opioides #fentanyl #pharma #drogues #big_pharma #opiacés #drogue #santé #santé_publique #addiction #opioïdes #overdose #Suisse

Heroin and Opioids - Bloomberg
▻https://www.bloomberg.com/quicktake/heroin

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Everything about the massive surge in opioid abuse cuts across traditional boundaries of drug use in the U.S. It’s hit white residents in the countryside as well as minorities in cities. It involves long-banned substances like heroin, legally prescribed painkillers like OxyContin and, increasingly, street drugs that mimic powerful synthetic opioids like fentanyl. Their combined death toll now exceeds that of car crashes or firearms and opioid abuse is seen as a prime factor in declining American longevity. Behind the crisis is a tangle of issues from addiction to treatment to enforcement, regulatory policy involving drugmakers and diplomacy with nations where opioids are manufactured.

Officials of Purdue Pharma Inc., the maker of OxyContin, confirmed in November that they are in settlement talks with a group of state attorneys general and trying to come up with a global resolution of the government opioid claims. States and the federal government have made the opiate-antidote drug naloxone more readily available; it’s been credited with reversing more than 26,000 overdoses between 1996 and 2014. Still, in 2016 fatal drug overdoses jumped by 21 percent, and the rate of deaths from synthetic opioids like fentanyl doubled.

Extracts of the poppy plant have been a source of trouble since the 19th century Opium Wars. Heroin, first produced in 1898 by Bayer, the German pharmaceutical company, was marketed as a non-addictive substitute for morphine. By the early 1900s, widespread heroin use led states like New York to open addiction centers in hospitals. Heroin’s latest wave arose from changes in prescription opiate use. Opioid painkillers rose in popularity in the 1990s, partly in response to what was seen as widespread undertreatment of chronic pain. In 1996, Purdue Pharma Inc. introduced OxyContin as an alternative to stronger opioids reserved mainly for the dying. Its annual sales surged to $1 billion. In 2007 Purdue paid $600 million in fines and its executives pleaded guilty to federal criminal charges for misbranding the product as less addictive than other painkillers. In 2010, it released a reformulated version that was harder to crush for snorting. A May 2015 study found that while the new version reduced illicit use of the painkiller, it led more people to take up heroin, whose price was dropping. Nearly 90 percent of new heroin users in the U.S. are now white, compared with an equal mix of whites and nonwhites before 1980. Globally, poppy cultivation has reached its highest level since the 1930s.

#Opioides #Purdue_Pharma #Procès

Opioid Makers Sued for Premium Hikes in First-of-Kind Cases - Bloomberg
▻https://www.bloomberg.com/news/articles/2018-05-02/opioid-makers-sued-over-rising-premiums-in-first-of-kind-cases

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The companies are accused of conspiring, racketeering and creating a public nuisance. Opioid abuse has killed more than 350,000 people since 1999, while costing private businesses and American governments $500 billion annually.

The drug manufacturers said they’ve tried to address the crisis.

“Our actions in the marketing and promotion of these medicines were appropriate and responsible,” Janssen Pharmaceuticals said in an emailed statement. “The allegations made against our company are baseless and unsubstantiated.”

Purdue Pharma is “deeply troubled by the prescription and illicit opioid abuse crisis, and we are dedicated to being part of the solution,” said Bob Josephson, a company spokesman.

Kristin Hunter Chasen, a spokeswoman for McKesson Corp., said the company is “deeply concerned” about the impact the opioid epidemic is having across the country. “We’ve offered a number of impactful policy solutions and support programs and partnerships that we believe can have a meaningful impact on this challenging issue, including the formation of a foundation dedicated to combating the crisis.”

#Opioides #Pharmacie #Marketing

Purdue Pharma Cuts Rest of Its Sales Force in Opioids Pullback - Bloomberg
▻https://www.bloomberg.com/news/articles/2018-06-20/purdue-pharma-cuts-rest-of-its-sales-force-in-opioids-pullback

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Oxycontin-maker Purdue Pharma LP cut the remainder of its sales force this week, the latest move by the company to distance itself from opioids as it faces accusations that it contributed to the nation’s addiction crisis.

The Stamford, Connecticut-based drugmaker said it will retain about 550 employees after chopping around 350 positions, including about 250 employees focused on promoting the treatment for opioid-induced constipation, Symproic. That product launched last year in partnership with Japan-based Shionogi & Co. The other employees worked in the company’s headquarters.

#Opioides #Purdue_Pharma #Sackler

OxyContin Manufacturer Says It Will Stop Promoting Opioid Painkiller To Doctors : NPR
▻https://www.npr.org/2018/02/12/585177743/oxycontin-manufacturer-says-it-will-stop-promoting-opioid-painkiller-to-doctors

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SHAPIRO: How much money has this drug made for Purdue Pharma over the years?

QUINONES: Well, it’s a private company. I’m not sure exactly. But estimates that I have read - between $35 and $40 billion in sales since the drug came out in 1996. It’s basically the reason why the Sackler family, which owns Purdue, is one of the wealthiest families in America. Forbes magazine pegged it as one of the wealthiest families in America due almost entirely to the sales of OxyContin.

#Opioides #Sackler

Opioid Makers, Blamed for Overdose Epidemic, Cut Back on… — ProPublica
▻https://www.propublica.org/article/opioid-makers-blamed-for-overdose-epidemic-cut-back-on-marketing-payment

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The past two years have been a time of reckoning for pharmaceutical manufacturers over their role in promoting opioid drugs that have fed a national epidemic.

Lawsuits and media reports have accused Purdue Pharma, the maker of OxyContin, of aggressively marketing the powerful narcotic even after it knew the drug was being misused. Prosecutors have charged the founder of Insys Therapeutics and several of the company’s sales representatives and executives for their roles in an alleged conspiracy to bribe doctors to use its fentanyl spray for unapproved uses. State and local governments have sued a host of drugmakers, alleging they deceptively marketed opioids and seeking to recoup what it costs to treat people addicted to the drugs.

But as public attention increases, the marketing tide may finally be retreating, a new ProPublica analysis shows. Pharmaceutical company payments to physicians related to opioid drugs decreased significantly in 2016 from the year before.

In 2016, drug makers spent $15.8 million to pay doctors for speaking, consulting, meals and travel related to opioid drugs. That was down 33 percent from $23.7 million in 2015 and is 21 percent less than the $19.9 million in spent in 2014. Companies are required to report the payments publicly under the Physician Payment Sunshine Act, a part of the 2010 Affordable Care Act.

A number of studies have shown a correlation between marketing of opioids and doctors’ prescribing of the drugs. Hadland and his colleagues reported in May that for every meal a physician received related to an opioid product in 2014, there was an increase in opioid claims by that doctor for Medicare patients the following year. And a report from the New York State Health Foundation published this month found that physicians who received payments from opioid makers prescribed more opioids to Medicare patients than doctors who didn’t receive the payments.

The sharp drop in marketing is more pronounced than the much slower reduction in the use of prescription opioids. The number of opioid prescriptions in Medicare, the public health program for seniors and the disabled, peaked at 81.7 million in 2014, and then dropped to 80.2 million in 2015 and 79.5 million in 2016, according to the Centers for Medicare and Medicaid Services. (Enrollment in Medicare’s prescription drug program continued to grow during that time, so the rate of opioid prescriptions per beneficiary dropped even more.)

Still, the toll of opioid overdoses continues to grow. Some 42,000 people died of opioid overdoses in 2016, the most recent year available, and about 40 percent of those involved a prescription opioid. The epidemic has shifted somewhat away from prescription drugs as more people die of heroin and synthetic opioids like fentanyl.

Purdue Pharma, which has received the most attention because of its one-time blockbuster OxyContin, has ratcheted back its spending on doctors, especially for programs in which doctors talk to their peers over lunch or dinner to help companies market their products. Purdue ended its speaker program for OxyContin at the end of 2016 and for Hysingla ER in November 2017. Earlier this year, it ended all direct promotion of its opioids to prescribers and last week, the company laid off its remaining sales representatives.

Purdue spokesman Robert Josephson said in an email that payments to doctors related to opioids have decreased since 2016 and that there would be very little such spending in 2018.

”Pharmaceutical manufacturers are legally permitted in the U.S. to promote all FDA-approved products to physicians in accordance with the subject product’s label,” Endo said in a statement. “This includes opioid products, which are safely used by millions of Americans to improve their quality of life.”

That said, Endo said it stopped promoting Opana ER in the United States in January 2017 before voluntarily withdrawing the drug in September. “Today, Endo does not promote any opioid products to U.S. physicians,” the company said in a statement.

#Opioides #Marketing #Pharmacie

Enquête. OxyContin, un antidouleur addictif à la conquête du monde | Courrier international
►https://www.courrierinternational.com/article/enquete-oxycontin-un-antidouleur-addictif-la-conquete-du-mond

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Face à l’épidémie d’addiction aux opioïdes analgésiques qui a déjà causé 200 000 morts dans le pays, l’establishment médical américain commence à prendre ses distances avec les antalgiques. Les plus hauts responsables de la santé incitent les généralistes à ne plus les prescrire en cas de douleur chronique, expliquant que rien ne prouve leur efficacité sur le long terme et que de nombreux indices montrent qu’ils mettent en danger les patients.

Les prescriptions d’OxyContin ont baissé d’environ 40 % depuis 2010, ce qui se traduit par plusieurs milliards de manque à gagner pour son fabricant, basé dans le Connecticut, Purdue Pharma.

La famille Sackler, propriétaire du laboratoire, a donc décidé d’adopter une nouvelle stratégie : faire adopter l’oxycodone, l’analgésique qui a déclenché la crise des opioïdes aux États-Unis, dans les cabinets médicaux du reste du monde.
Best-seller pharmaceutique

Un réseau d’entreprises internationales détenues par la famille est en train de s’implanter en Amérique latine, en Asie, au Moyen-Orient, en Afrique et dans d’autres régions, et d’encourager le recours généralisé aux antalgiques dans des endroits très mal outillés pour faire face aux ravages de l’abus d’opioïdes et de la dépendance qu’ils induisent.

Pour mener à bien cette expansion mondiale, ces entreprises, regroupées sous le nom collectif de Mundipharma, utilisent quelques-unes des méthodes controversées de marketing qui ont fait de l’OxyContin un best-seller pharmaceutique aux États-Unis. Au Brésil, en Chine et ailleurs, les sociétés mettent en place des séminaires de formation dans lesquels on encourage les médecins à surmonter leur “opiophobie” et à prescrire des antalgiques. Elles sponsorisent des campagnes de sensibilisation qui poussent les gens à solliciter un traitement médical de leurs douleurs chroniques. Elles vont même jusqu’à proposer des ristournes aux patients afin de rendre plus abordables les opioïdes sur ordonnance.
Les leçons de l’expérience américaine

Le directeur américain de la santé publique [surgeon general], Vivek H. Murthy, a déclaré qu’il conseillerait à ses homologues étrangers d’être “très prudents” avec les médicaments opiacés, et de tirer les leçons des “erreurs” américaines. “Je voudrais les exhorter à envisager avec une extrême prudence la commercialisation de ces médicaments”, a-t-il déclaré dans une interview.

Aujourd’hui, avec le recul, nous nous rendons compte que pour nombre d’entre eux les bénéfices ne compensaient pas les risques.”

L’ancien commissaire de l’agence des produits alimentaires et des médicaments [Food and Drug Administration] David A. Kessler a estimé que l’aveuglement face aux dangers des antalgiques constitue l’une des plus grosses erreurs de la médecine moderne. Évoquant l’entrée de Mundipharma sur les marchés étrangers, il a déclaré que la démarche était “exactement la même que celle des grands fabricants de cigarettes. Alors que les États-Unis prennent des mesures pour limiter les ventes sur leur territoire, l’entreprise se développe à l’international.”
Un marketing agressif

Des représentants de Mundipharma et certains de ses matériels promotionnels s’emploient à minorer les risques d’addiction des patients aux opioïdes. Ces affirmations rappellent la première campagne de commercialisation de l’OxyContin aux États-Unis à la fin des années 1990, dans laquelle Purdue avait trompé les médecins au sujet de la nature addictive du médicament.

En 2007, Purdue et trois hauts responsables de l’entreprise ont plaidé coupable face aux accusations fédérales de publicité mensongère sur leurs médicaments. Ils ont été condamnés à une amende de 635 millions de dollars. L’agence fédérale de lutte contre la drogue [Drug Enforcement Administration] a estimé en 2003 que le marketing “agressif, excessif et inapproprié” de l’entreprise avait “aggravé de manière très importante” l’usage abusif et le trafic illégal de l’OxyContin.

Purdue était une petite firme pharmaceutique new-yorkaise lorsque les frères Mortimer et Raymond Sackler, tous deux

[...]
Harriet RyanLisa Girion et Scott Glover

#Mundipharma #Sackler #Opioides

La « drogue zombie », autopsie d’un fantasme d’internet
▻http://observers.france24.com/fr/20171110-drogue-zombie-intox-fake-news-fantasme-internet-intox-f

Les vidéos et les articles qui en parlent font peur : depuis plusieurs mois, de nombreux sites affirment qu’une nouvelle drogue transformerait les humains en vrais zombies. Au minimum pace qu’elle aurait un effet léthargique. Dans le pire des cas, parce qu’elle pousserait carrément au #cannibalisme. Décryptage sur le vrai du faux de la drogue-zombie.

Notre enquête nous a permis de comprendre que s’il existe bien un ensemble de drogue de synthèse qui provoque des effets évoquant les morts-vivants tels que décrits dans la fiction, aucune n’a des effets aussi dévastateurs que le cannibalisme, et rien ne prouve qu’elle serait en cause dans les cas relayés récemment.

#panic_sociale #phénomène_psychogénique_de_masse

Back pain: how to live with one of the world’s biggest health problems | Society | The Guardian
▻https://www.theguardian.com/society/2018/jun/14/back-pain-how-to-live-with-one-of-the-worlds-biggest-health-problems

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This month, the Lancet published a series of three papers written by a large, international group of experts who came together to raise awareness of the extent of the problem of low back pain and the evidence for recommended treatments. The authors were scathing about the widespread use of “inappropriate tests” and “unnecessary, ineffective and harmful treatments”.

The papers tell us low back pain is an “extremely common symptom, experienced by people of all ages”, although it peaks in mid-life and is more common in women than in men. There are 540 million people affected globally at any one time and it is the main cause of disability worldwide.

The six-year investigation that began as an attempt to find relief from her own pain and ended up exposing an exploitative, corrupt and evidence-free $100bn industry, is fittingly described in the title of her book: Crooked.

The camera lies … MRI scans show up disc degeneration but unfortunately most people will have some. Photograph: HadelProductions/Getty Images

The proliferation of unnecessary and risky interventions has been far worse in the US, with its insurance-based healthcare system, than in the NHS. But the UK is far from immune. When a healthcare system functions as a marketplace, there will inevitably be incentives for certain treatments to be pursued over others, for services that can generate a surplus. It is a struggle for patients and clinicians everywhere to resist pain medication that is incredibly effective in the short term, even if it is incredibly harmful in the long term.

“Nearly everybody gets back pain at some point in their life,” says Martin Underwood, co-author of the Lancet series, a GP and a professor at Warwick Medical School. “For most people, it’s a short-term episode that will resolve over a period of days or weeks, without the need for any specific treatment. They catch or twist or stretch something, and it’s awful, and then it gets better.” Of those who experience a new episode of back pain, under 1% will have serious causes that need specific treatment for issues such as cancer in the spine, a fracture, diseases or infection, he says. But there is another group, in which, “after the natural period of healing – normally six weeks for most things – people go on to get pain lasting months and years, which can be very disabling, even though the original cause of the pain is no longer there. We would label this as nonspecific low back pain, simply because we don’t know what is causing the pain.”

“At best, these spine surgeons define success as a 38% improvement in pain and function,” says Ramin, “but if a hip or a knee surgeon had a 38% success rate, that physician would no longer do that surgery. And 38%? I think that’s really optimistic.” In her book, she describes the scandal of the Pacific Hospital in Long Beach, California, which carried out more than 5,000 spinal fusion surgeries. “Surgeries were being performed on large numbers of patients who were often immigrants – Spanish-speaking labourers – and being billed to workers’ compensation insurance or public health insurance. Could you do worse than butcher these Latino field workers who don’t understand what’s happening to them, but are being told they can get free medical care?”

We like to think that this could never happen in the UK, and Underwood admits there is a huge difference between the two healthcare systems. “Most spinal surgeons in the UK will avoid operating for nonspecific low back pain because they’re aware of all these problems,” he says. “But there is still pressure from patients for something to make them better, and some people are still getting operated on. My advice for anybody is: don’t have surgery for back pain unless there is a clear, specific indication.”

When I ask Underwood what works, he tells me: “Whatever you do for a patient at a time when their back is really bad, the chances are they’re going to be a lot better three weeks later. So we treat people and we see them getting better and we ascribe their improvement to the treatment we’ve given, but we know that natural improvement over time is always much larger than the positive effect you get from the treatment.” The evidence is strongest for therapist-delivered interventions such as the cognitive behavioural approach, based on the same principles as CBT, exercise treatment and physiotherapy. He has also worked on a trial that showed training physiotherapists to deliver the cognitive behavioural approach in a group, combining movement and reassurance about movement, is helpful to patients and could be delivered in the NHS at low cost.

#Mal_de_dos #Opioides #Médecine

The #Opioid Timebomb: The #Sackler family and how their painkiller fortune helps bankroll London arts | London Evening Standard
▻https://www.standard.co.uk/news/health/the-opioid-timebomb-the-sackler-family-and-how-their-painkiller-fortune-

We sent all 33 non-profits the same key questions including: will they rename their public space (as some organisations have done when issues arose regarding former benefactors)? And will they accept future Sackler philanthropy?

About half the respondents, including the Royal Opera House and the National Gallery, where Dame Theresa Sackler is respectively an honorary director and a patron, declined to answer either question.

Of the rest, none said it planned to erase the Sackler name from its public space. The organisations’ positions were more guarded on future donations.

Only the V&A, Oxford University, the Royal Court Theatre and the National Maritime Museum said outright that they were open to future Sackler grants.

The V&A said: “The Sackler family continue to be a valuable donor to the V&A and we are grateful for their ongoing support.”

Millions for London: Where Sackler money has gone
MUSEUMS AND GALLERIES

Serpentine Galleries

Grants received/pledged: £5,500,000
Used to fund (among other things): Serpentine Sackler Gallery
Will you accept future Sackler grants? Won’t say

Tate

Grants received/pledged: £4,650,000
Used to fund (among other things): Sackler Gallery, Sackler Escalators, Sackler Octagon
Will you accept future Sackler grants? Won’t say

Dulwich Picture Gallery

Grants received/pledged: £3,491,000
Used to fund (among other things): Sackler Centre for Arts Education
Will you accept future Sackler grants? Won’t say

V&A Museum

Grants received/pledged: £2,500,000
Used to fund (among other things): Sackler Courtyard
Will you accept future Sackler grants? Yes

The Design Museum

Grants received/pledged: £1,500,000
Used to fund (among other things): Sackler Library and Archive
Will you accept future Sackler grants? No reply

Natural History Museum

Grants received/pledged: £1,255,000
Used to fund (among other things): Sackler Biodiversity Imaging Laboratory
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

National Gallery

Grants received/pledged: £1,050,000
Used to fund (among other things): Sackler Room (Room 34)
Will you accept future Sackler grants? Won’t say

National Portrait Gallery

Grants received/pledged: £1,000,000
Used to fund (among other things): Pledged grant still being vetted
Will you accept future Sackler grants? Being vetted. Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

The Garden Museum

Grants received/pledged: £850,000
Used to fund (among other things): Sackler Garden
Will you accept future Sackler grants? No reply

National Maritime Museum

Grants received/pledged: £230,000
Used to fund (among other things): Sackler Research Fellowships
Will you accept future Sackler grants? Yes

Museum of London

Grants received/pledged: Refused to disclose grants received
Used to fund (among other things): Sackler Hall
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

Royal Academy of Arts

Grants received/pledged: Refused to disclose grants received
Used to fund (among other things): Sackler Wing, Sackler Sculpture Gallery
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

THE PERFORMING ARTS

Old Vic

Grants received/pledged: £2,817,000
Used to fund (among other things): Productions and projects
Will you accept future Sackler grants? Won’t say

Royal Opera House

Grants received/pledged: £2,500,000
Used to fund (among other things): Won’t say
Will you accept future Sackler grants? Won’t say

National Theatre

Grants received/pledged: £2,000,000
Used to fund (among other things): Sackler Pavilion
Will you accept future Sackler grants? Won’t say

Shakespeare’s Globe

Grants received/pledged: £1,660,000
Used to fund (among other things): Sackler Studios
Will you accept future Sackler grants? Won’t say

Royal Court Theatre

Grants received/pledged: £360,000
Used to fund (among other things): Sackler Trust Trainee Scheme
Will you accept future Sackler grants? Yes

UNIVERSITIES/RESEARCH

University of Oxford

Grants received/pledged: £11,000,000
Used to fund (among other things): Bodleian Sackler Library, Keeper of Antiquities
Will you accept future Sackler grants? Yes

University of Sussex

Grants received/pledged: £8,400,000
Used to fund (among other things): Sackler Centre for Consciousness Science
Will you accept future Sackler grants? Won’t say

King’s College, London

Grants received/pledged: £6,950,000
Used to fund (among other things): Sackler Institute for Translational Neurodevelopment
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

The Francis Crick Institute

Grants received/pledged: £5,000,000
Used to fund (among other things): One-off funds raised via CRUK to help build the Crick
Will you accept future Sackler grants? N/A

UCL

Grants received/pledged: £2,654,000
Used to fund (among other things): Sackler Institute for Musculo-Skeletal Research
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

Royal College of Art

Grants received/pledged: £2,500,000
Used to fund (among other things): Sackler Building
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

The Courtauld Institute of Art

Grants received/pledged: £1,170,000
Used to fund (among other things): Sackler Research Fellowship, Sackler Lecture Series
Will you accept future Sackler grants? Won’t say

Royal Ballet School

Grants received/pledged: £1,000,000
Used to fund (among other things): Won’t say
Will you accept future Sackler grants? Won’t say

Imperial College London

Grants received/pledged: £618,000
Used to fund (among other things): Knee research
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

Old Royal Naval College

Grants received/pledged: £500,000
Used to fund (among other things): Sackler Gallery
Will you accept future Sackler grants? Won’t say

OTHER

Royal Botanic Gardens, Kew

Grants received/pledged: £3,100,000
Used to fund (among other things): Sackler Crossing footbridge
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

Moorfields Eye Hospital

Grants received/pledged: £3,000,000
Used to fund (among other things): New eye centre (pledged only)
Will you accept future Sackler grants? Won’t say

The London Library

Grants received/pledged: £1,000,000
Used to fund (among other things): The Sackler Study
Will you accept future Sackler grants? Won’t say

The Prince’s Trust

Grants received/pledged: £775,000
Used to fund (among other things): Programmes for disadvantaged youth
Will you accept future Sackler grants? Subject to vetting that typically takes into account “reputational risk” and “all relevant new information about the donor in the public domain”

Westminster Abbey

Grants received/pledged: £500,000
Used to fund (among other things): Restoration of Henry VII Chapel
Will you accept future Sackler grants? Won’t say

Royal Hospital for Neurodisability

Grants received/pledged: £350,000
Used to fund (among other things): Won’t say
Will you accept future Sackler grants? No reply

cc @hlc

Who Could Have Imagined that Government Granted Patent Monopolies on Drugs Like OxyContin Could Lead to Abuses ? | Beat the Press | Blogs | Publications | The Center for Economic and Policy Research
▻http://cepr.net/blogs/beat-the-press/who-could-have-imagined-that-government-granted-patent-monopolies-on-drugs-lik

Si le système d’exclusivité existant aux #Etats-Unis permet de fixer des #prix faramineux, comment peut-on penser sérieusement que le vendeur ne va pas #mentir (quant à l’efficacité et l’innocuité de son #médicament, aussi #mortel qu’il puisse être) pour vendre le plus possible ?

Every student who has taken an Econ 101 class knows how a 20 percent tariff leads to #corruption. So, why is anyone in the world surprised that the patent monopoly the government gave to Purdue Pharma on OxyContin lead the company to ignore evidence that the drug was being misused?

Hey folks, people respond to incentives. If we give them a patent monopoly that allows them to sell a drug at a price that is several thousand percent above its free market price, then drug companies will try to push the drug as widely as possible. This means ignoring evidence that the drug might be less effective than claimed or even harmful.

Come on, every serious person must understand this fact. Is it really necessary to pretend we are surprised?

#opioides #opiacés #big_pharma

How the Media Portrays Black and White Drug Users Differently | Alternet
▻https://www.alternet.org/how-media-portrays-black-and-white-drug-users-differently?src=newsletter10

https://www.alternet.org/sites/default/files/story_images/crack-baby-opioids.jpg

How the Media Portrays Black and White Drug Users Differently
NYT’s sympathetic coverage of white moms struggling with opioids contrasts with its hysteria over “crack babies”
By Joyce McMillan / Salon
May 28, 2018, 5:14 AM GMT

The lives of the women profiled in the story are complex and the writer makes great effort to mute her judgments and witness the mothers nurturing their children. Because of this thoughtful observing, the women are shown in their wholeness. But the writer also uses descriptors that highlight the whiteness of her subjects. She highlights Alicia’s blond hair, a flaxen-haired child, and another’s hazel eyes. In a way, this is as much a story about the redemptive power of whiteness as it is about opioid use.

The New York Times, like many major publications that have reported on the opioid epidemic, has a history of covering societal drug use. Often, publications reference the differential response to the opioid epidemic and the way that race has influenced political response. Coverage of the opioid epidemic alludes to the “cultural overreaction” to the “crack baby” and the panic over crack use in general.

They recall the dehumanization of black women and their children, who did not benefit from the gentle words of a famed novelist. It is apt that the light shone on the New York Times, a publication that proffered racist and sensationalized journalism depicting black people as sex-crazed cocaine addicts and black children born to mothers who used cocaine as broken and irredeemable. It is not hyperbolic to claim that the New York Times had a role in the creation of the modern war on drugs, one it now deems to be a failure.

The New York Times and other major national publications fanned the flames of the drug war, and have now pivoted their coverage to protect white victims and whiteness. Telling stories in a way that allows people to exist beyond their drug use is not the issue; it should be standard practice. What is surprising is that the New York Times and other publications have not done the work of looking through the archives to see the harm they have caused historically and presently – especially the harm done to black mothers.

Black motherhood is a high-risk endeavor and little empathy is given to those who fall short of societal expectations. The New York Times and other major media publications are not totally responsible for the systemic racism that leaves black motherhood at the societal fringe, but they are crucial part of the mechanism. I don’t know how the media can atone for their actions in shaping the narratives of the drug war, but acknowledging the harm they caused is a start.

#Opioides #Racisme #Médias

Under Attack, Drug Maker Turned to Giuliani for Help - The New York Times
▻https://www.nytimes.com/2007/12/28/us/politics/28oxycontin.html

https://static01.nyt.com/images/2007/12/28/nyregion/28oxy-75.jpg

As a celebrity, Mr. Giuliani helped the company win several public relations battles, playing a role in an effort by Purdue to persuade an influential Pennsylvania congressman, Curt Weldon, not to blame it for OxyContin abuse.

Despite these efforts, Purdue suffered a crushing defeat in May at the hands of Mr. Brownlee when the company and three top executives pleaded guilty to criminal charges.

In the OxyContin case, Mr. Giuliani’s supporters suggest that as a cancer survivor himself, he was driven by a noble goal: to keep the company’s proven pain reliever available to the widest circle of sufferers.

“I understand the pain and distress that accompanies illness,” Mr. Giuliani said at the time. “I know that proper medications are necessary for people to treat their sickness and improve their quality of life.”

#Opioides #Purdue_Pharma #Procès #Rudolph_Giuliani

Raymond SACKLER Officier of the Legion of Honor - France in the United States / Embassy of France in Washington, D.C.
▻https://fr.franceintheus.org/spip.php?article5052

Dear Dr. Sackler,
Dear Mrs. Sackler
Distinguished guests,
American and French friends,

It is a great pleasure and honor for me to be here with you today on this very special occasion and I would like to express my warmest thanks to Raymond Sackler, whom we are honoring today, for welcoming us to this beautiful location.

We are gathered here this afternoon to honor one of the most remarkable medical doctors in the field of Psychiatry and a very successful businessmanwho is also a great friend of France and an exceptional individual, Raymond Sackler.

I would like to thank Mr. Sackler’s family and friends who have joined us here this afternoon to show their support and admiration, with a special word of appreciation to his wife Beverly, to whom I also want to pay tribute.

Before proceeding with the ceremony, I would like to say a few words about the award I will bestow upon Mr. Sackler. The Legion of Honor was created by Napoleon Bonaparte in 1802 to reward extraordinary accomplishments and outstanding services rendered to France.
It is France’s highest distinction and one of the most coveted in the world. And the rank of officier that I will bestow upon Raymond Sackler is truly exceptional.

Dear Dr. Sackler,

You have accomplished so much that it is difficult to briefly sum up all of your outstanding achievements.

Already at a very young age, you were interested in France and French culture. You first visited France in 1939, and since then, have come to France very often, becoming a true Francophile, as evidenced throughout your professional life and philanthropic activities.

Together with your brother Mortimer, also a medical doctor, you created a pharmaceutical laboratory in France that was and still is a great success story. Being aware of the caliber of French research in medical and pharmaceutical sciences, you chose France for their first industrial investment, co-funding Les Laboratoires SARGET (today MEDA-PHARMA). You developed this company by creating or acquiring several subsidiaries in France, Italy, Spain, the Netherlands and Portugal.

You were incredibly successful, bringing the “Laboratoires SARGET” from a staff of a few hundred people in 1961, when it was created, to more than two thousand in 1987, when it was sold. With your brother and family, you later created another pharmaceutical company, MUNDIPHARMA, which is still growing, creating many jobs in France, and thus significantly contributing to the rise of the pharmaceutical industry in our country.

At the same time, you and your wife, Beverly, became patrons of a number of worthy causes: many scientific institutions, universities, and museums such as the Louvre and the Musée d’Art Contemporain de Bordeaux have benefited from your generosity. You also expressed a special interest in IHES, the Institut des Hautes Etudes Scientifiques, that is very well represented this afternoon.

I’d like to recognize the new Chairman of the Friends of IHES, Prof. Michael Douglas, the new Director of IHES Emmanuel Ullmo and its former director Jean-Pierre Bourguignon.

If IHES is what it is today, a worldclass scientific center that is second to none, it is to a large extend thanks to you mon cher Jean-Pierre, to your talent, dedication and commitment to the Institute.

It is also thanks to the support of many of you, Luc Hardy, and Raymond and Beverly Sackler in particular.

Cher Raymond,

Since 1990, you have made 3 donations to IHES, leading to the creation of 2 permanent endowments to host 2 scientists every year. You also supported the agreement between IHES and the Raymond and Beverly Sackler School of Mathematical Sciences at Tel Aviv University. You encouraged IHES to diversify its scientific activities by making an additional donation in 2012 to create a Chair in Physics and Cosmology.

Your long friendship and tremendous generosity toward French arts and science mirror your exceptional qualities as human beings. Your professional and social success go hand in hand with a unwavering intellectual curiosity and a strong commitment to future generations.

You were originally named Chevalier of the Legion of Honor by President Mitterrand. Your name had been proposed by the Minister of Foreign Affairs and Benoît d’Abboville, then French Consul in New York, who presented you with the award here in New York in 1990.

Today, in recognition of your continued dedication and commitment to French-American cultural and scientific cooperation, the President of the French Republic has promoted you to the rank of Officier dans l’Ordre national de la Légion d’Honneur.

It is my great pleasure and privilege to award you this distinction. I will now proceed in French:

Raymond SACKLER,

Au nom du Président de la République, je vous fais Officier dans l’Ordre de la Légion d’Honneur.

#Opioides #Sackler #Légion_honneur

Yale donor linked to opioid crisis
▻https://yaledailynews.com/blog/2017/11/13/yale-donor-linked-to-opioid-crisis

https://yaledailynews.com/wp-content/themes/ydnlabs/css/images/blueY.png

By 2008, when Raymond and Beverly Sackler endowed Yale with funds for an Institute for Biological, Physical and Engineering Sciences, Purdue Pharma’s misrepresentation of the drug was commonly known — the company had already settled multiple suits.

“These are gifts that different family members made as individual family gifts. These were not gifts from the company — these were individual family gifts, so in that sense, these individuals have wealth that they gave to us, so it’s no more complicated than that when they made these gifts a number of years ago,” said Vice President for Development Joan O’Neill. “We have no reason that we wouldn’t have been excited by the generosity that they provided to Yale and that they’ve provided to institutions around the world.”

In 2009, Richard and Jonathan Sackler endowed the Richard Sackler and Jonathan Sackler Professorship, to be held by the Yale Cancer Center director, with a $3 million gift. Mark Lemmon, the co-director of the Yale Cancer Biology Institute at Yale’s West Campus, currently holds the David A. Sackler Professorship of Pharmacology. According to Dean of the School of Medicine Robert Alpern, the Sacklers have given many gifts over the years to research and lectureship at Yale.

As of July 2014, Richard S. Sackler, former co-chairman and president of Purdue Pharma, was a member of the School of Medicine dean’s council and the Yale Cancer Center director’s advisory board. That year, Alpern called Sackler a “steadfast friend of the medical school.”

In March 2014, Sackler and his children established the Richard Sackler Family Endowment in Medicine, funded by a gift of stock donated by Sackler in 2009, to support three professorships. Raymond and Beverly Sackler have given to Yale to support archaeological excavation work and the establishment of the Raymond and Beverly Sackler Visiting Professor/Lecturer at the School of Medicine.

Asked whether Yale considered the source of the Sackler family’s wealth a factor in deciding whether to accept their donations and why the University ultimately accepted them, Alpern responded that the Sackler family had been “incredibly generous” to the University as well as other organizations. He added that members of the family have always been professional and never asked for anything in return.

#Opioides #Sackler #Yale

University of Glasgow :: Story :: Biography of Mortimer Sackler
▻https://www.universitystory.gla.ac.uk/biography/?id=WH27277&type=P

https://www.universitystory.gla.ac.uk/images/UGSP00105_m.jpg

Dr Mortimer Sackler (1916-2010) was an American physician and entrepreneur. He was Chairman and co-Chief Executive of Purdue Pharma, a leading American pharmaceuticals company. Alongside his brothers Arthur and Raymond, he used his fortune from the pharmaceutical industry to become a prominent philanthropist and he greatly supported the University of Glasgow.

Sackler was born on 7th December 1916 in Brooklyn to Isaac and Sophie (nee Greenberg), Polish Jewish immigrant Brooklyn grocers. After attending Erasmus Hall High School, Sackler sailed to the UK in 1937 and, with the help of Glasgow’s Jewish community, enrolled at Anderson’s College of Medicine, an institution that became part of the University of Glasgow in 1947. He attended the College between 1937-1939. His brothers Arthur and Raymond also studied at Anderson’s College in the years 1937-39 and 1938-40 respectively. Mortimer Sackler was prevented from finishing his degree at the University by the outbreak of the Second World War and finished his MD degree in Massachusetts. Dr Mortimer Sackler and his brothers bought the New York pharmaceuticals company Purdue Frederick Co in 1952. All three were research psychiatrists.

Mortimer Sackler received an honorary degree from the University of Glasgow in 2001 for his support of the University. He funded the Sackler Institute of Psychobiological Research, a research unit at the Southern General Hospital which investigates neuro-psychiatric disorders in association with the Sackler Institute at the University of Edinburgh. The Institute was opened in 2004.

Dr Mortimer Sackler died on 24th March 2010.

#Opioides #Sackler #Mortimer_Sackler

The OxyContin Clan: The $14 Billion Newcomer to Forbes 2015 List of Richest U.S. Families
▻https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxycontin-clan-the-14-billion-newcomer-to-forbes-2015-list-of-richest-u-s-families/#33de89e275e0

https://thumbor.forbes.com/thumbor/600x315/https%3A%2F%2Fblogs-images.forbes.com%2Falexmorrell%2Ffiles%2F2015%2F07%2Fsacklers-1940x1284.jpg

The richest newcomer to Forbes 2015 list of America’s Richest Families comes in at a stunning $14 billion. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers.

How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century — OxyContin.

The Sacklers’ OxyContin score came long after the family initially got into the pharmaceutical business. Brothers Arthur, Mortimer and Raymond Sackler — each practicing psychiatrists — bought a small, struggling drug manufacturer in New York City in 1952, which would eventually become Purdue Pharma. The brothers initially sold small-time products like laxative and earwax remover.

Arthur, simultaneously, was a standout in the field of medical advertising. He helped Pfizer PFE -0.08% establish itself in the prescription drug arena, and he is credited with writing scientific papers that contributed to Valium becoming the first $100 million drug, according to his listing in the Medical Advertising Hall of Fame.

By the time Arthur died in 1987 at age 73, brothers Mortimer and Raymond had Purdue Pharma dabbling in pain medications. They eventually took generic painkiller oxycodone — invented in World War I-era Germany — and installed a timed-release mechanism, which promised to stymie abuse by spreading the drug’s effects over half-day period. This enabled them to market it beyond the traditional target audience for powerful opioids — cancer patients — and not long after OxyContin’s launch in 1995, primary-care doctors were prescribing it for an array of painful symptoms. Sales hit $1.5 billion by 2002.

#Opioides #Sackler

In the Discussion About the Sacklers and Oxycontin, It’s Important to Get the Facts Right | artnet News
▻https://news.artnet.com/opinion/discussion-sacklers-oxycontin-facts-elizabeth-a-sackler-1203458

https://news.artnet.com/app/news-upload/2018/01/sackler.jpg

Some of the many media articles about the family, such as Christopher Glazek’s piece in Esquire, have drawn the correct distinction between Elizabeth Sackler and her father Arthur M. Sackler—who have never been involved in nor benefited from the sale of Oxycontin—and other branches of the Sackler family, who have been involved in and benefited directly from this harmful drug through their company Purdue Pharma.

Se foutre de la gueule du monde : Et la publicité Valium et la crise de dépendance qui s’en est suivie ? C’est par Arthur peut-être ? Et MS Contin ?

#Opioides #Sackler

Benzodiazépines : Valium, Tranxen, Lexomil, Xanax...
▻https://www.passeportsante.net/fr/Actualites/Dossiers/DossierComplexe.aspx?doc=que-penser-des-benzodiazepines-les-benzodia

https://static.passeportsante.net/i60238-xanax-lexomil-que-penser-des-benzodiazepines.jpg

L’ensemble des risques généraux liés à l’usage des benzodiazépines est bien connu et figure dans le Résumé des Caractéristiques du Produit (AMM) de chacune d’elle1. Ainsi, leur usage peut entraîner :

Une amnésie antérograde (perte de la mémoire des faits récents) qui augmente proportionnellement avec la dose.
Une altération des fonctions psychomotrices pouvant survenir dans les heures suivant la prise.
Un syndrome associant, à des degrés divers, des troubles du comportement et une altération de l’état de conscience. Peuvent être ainsi observés les effets suivants : aggravation de l’insomnie, cauchemars, agitation, nervosité, idées délirantes, hallucinations, état confuso-onirique, symptômes de type psychotique, désinhibition avec impulsivité, euphorie, irritabilité, amnésie antérograde et suggestibilité.
Une tolérance caractérisée par une diminution progressive de l’effet thérapeutique pour une même dose administrée pendant plusieurs semaines. La tolérance peut conduire à une augmentation des doses pour obtenir l’effet recherché.

Ces effets secondaires ne sont pas fréquents et s’estompent rapidement après la prise. En réalité, le principal problème des benzodiazépines est la très forte dépendance qu’elles induisent, aussi bien sur le plan psychique que physique.
Une dépendance psychologique et physique fortes

Au début, la dépendance n’est que psychologique, mais peu à peu, la tolérance s’installe, nécessitant une augmentation de la dose pour obtenir l’effet initial. « Quand on prend des benzodiazépines pendant plus d’un mois, on a des signes de dépendance physique qui se manifestent notamment par les “effets rebonds”, c’est-à-dire qu’au moment où on arrête, pendant quelques temps, on va plus mal qu’avant. » explique le Docteur Mallaret, praticien hospitalier. Les symptômes qui apparaissent alors sont des manifestations du sevrage. Ils peuvent être extrêmement différents en fonction des individus, de la durée de consommation et du produit ingéré :

Anxiété
Tremblements et agitation
Convulsions et attaques d’apoplexie
Paranoïa, hallucinations et délire

Ces symptômes ne sont pas anodins et il est indispensable d’être sous surveillance médicale en cas d’arrêt du traitement. Celui-ci doit être progressif : les doses absorbées doivent être diminuées petit à petit pour éviter des effets secondaires sévères, et une éventuelle rechute.

C’est ce risque de dépendance qui est à l’origine des durées de prescription, fixées à 12 semaines. Malheureusement, celles-ci ne sont que trop peu respectées… L’ANSM révèle que le temps de traitement médian est de 7 mois pour une benzodiazépine anxiolytique et hypnotique. Toujours selon elle, environ la moitié des sujets traités par ces médicaments le sont plus de 2 ans (avec ou sans interruption de traitement). Cette dépendance s’accompagne également d’un surdosage : environ 18% des patients ont une posologie journalière estimée supérieure à celle recommandée par l’autorisation de mise sur le marché. Une addiction que beaucoup vivent comme un enfer : « Au départ c’est un simple traitement de trois semaines, mais en fait, vous n’arrivez jamais à vous en débarrasser. J’ai mis dix ans pour m’en sortir… » témoigne une ancienne consommatrice. Un cas extrême qui rappelle toutefois que les recommandations ne sont pas à prendre à la légère. Malheureusement, il n’est pas jamais évident de savoir qu’on devient dépendant, car comme toute substance, ses effets sont différents sur chacun…

Les risques présentés par les benzodiazépines sont d’autant plus inquiétants que leur consommation s’est dangereusement banalisée. En France, elle bat même des records en Europe : 3,8 millions en consomment régulièrement, soit deux fois plus qu’en Espagne et cinq fois plus qu’en Allemagne1. L’ANSM (Agence nationale de sécurité du médicament et des produits de santé) note que plus de 25 millions de personnes ont été exposées à ces médicaments entre 2006 et 2011. Un chiffre qui n’a pas manqué de faire réagir La Haute Autorité de Santé, auteur récent d’une campagne d’information sur le sujet2.

…ou penser à d’autres alternatives
Pour le professeur Edouard Zarifian , psychiatre et auteur de l’ouvrage "La Force de guérir", la réponse est évidente : « Je ne critique pas le médicament, mais son utilisation systématique et abusive. Il faut revenir à la clinique. Il s’agit d’un homme ou d’une femme dont la plainte en matière de sommeil ne doit pas être prise au premier degré. C’est une erreur de commencer à prescrire un médicament avant même d’aller plus loin. On n’a qu’une chance sur cent de se trouver devant un vrai trouble du sommeil. Ce qu’il faut, c’est découvrir à quoi correspond cette plainte. » Outre ce travail relationnel relatif aux professionnels de soin, il existe aussi des moyens pour diminuer son anxiété sans passer par la case « médicaments ». En Angleterre et en Allemagne, où la consommation de benzodiazépines est moindre, la phytothérapie est très utilisée, tout comme la psychothérapie. Nombreux sont les professionnels de soins à déplorer d’ailleurs le non-remboursement de cette pratique en France.

#Opioides #Benzodiazépines #Valium #Lexomil #Sackler

Valium: It’s more addictive than heroin, with horrifying side-effects, so why is it still given to millions? | Daily Mail Online
▻http://www.dailymail.co.uk/femail/article-2289311/Valium-Its-addictive-heroin-horrifying-effects-given-millions.html

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One of the first - and most infamous - of the ‘benzos’ was Valium. Launched in the 1960s it quickly became the pill for every ill, dished out in profligate quantities to anyone struggling with the travails of daily life. Sixty per cent of users were women and Valium was soon dubbed ’mother’s little helper’.

But Valium and the other benzos are derived from chemical compounds which make some of them more addictive even than heroin.

And their legacy is a vast group of people suffering appalling withdrawal symptoms so severe they are unfit for work, relationships or even independent living. Some have also been left with permanent effects, including memory loss.

Increasingly worried about what the drug might be doing to her after six years on it, Baylissa started researching clonazepam-type drugs on the internet and was shocked by what she read. People reported memory loss, dementia, paranoia, hallucinations and excruciating pain, either as a result of being on the drug or coming off it.

Valium’s pernicious legacy has touched everyone from schoolgirls and poverty stricken single mothers to middle-class divorcees and wealthy socialites. In some cases, distraught addicts resort to suicide: Department of Health figures show the drug is implicated in 300-500 deaths a year in this country.

But the scale of the problem has been largely ignored. Despite guidelines dating back to 1988, which warn doctors to limit the prescribing of this potent and controversial drug, clinicians have found it an effective way to handle many hard-to-diagnose, hard-to-treat patients.

There are now 183 different formulations of Valium-derived medications. Doctors in Britain issue almost 18 million prescriptions a year for benzodiazepiones, and every GP has at least 180 long-term users on their books.

Despite being highly addictive and having alarming side-effects, Valium had become one of the world’s best-selling drugs by the mid-Seventies. It was originally manufactured by Hoffmann La Roche, but the company lost its patent protection in 1985. Some 500 different versions of the drug were subsequently marketed by different companies worldwide.

It was on a holiday to France in April 2011 that Fiona made the life-changing decision to stop taking Valium. ’I didn’t take enough with me — I don’t know if that was on purpose or not — and we were sitting in a cafe one day when I had a panic attack, mewling like a puppy.

’People were staring and it was awful, but it took about three weeks for the real withdrawal symptoms to appear. By then I was whimpering and shaking the whole time, I couldn’t sleep, I was depressed and just exhausted.’

Back home, with no further help from her GP, Fiona sought information about Valium withdrawal on the internet and tackled her long-term dependency by gradually reducing her dose to zero over five months.

’It was absolute hell,’ she says. ’I felt sick, I had long periods of shaking uncontrollably, excruciating muscle cramps, and all the symptoms of severe flu. I couldn’t go out, leave the house at all, or do anything at all.’

#Opioides #Sackler #Valium

America’s opioid epidemic began more than a century ago – with the civil war | Science | The Guardian
▻https://www.theguardian.com/science/2017/dec/30/americas-opioid-epidemic-began-more-than-a-century-ago-with-the-civil-w

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An estimated two million people abused opiates during the war, after using drugs disseminated by healthcare providers, doctors and nurses to stem pain

For many Americans, it was the prescription of a well-meaning physician that sent them down the dark road.

Aggressive marketing and over-prescribing of painkillers touched off a scourge of opiate addiction and Congress, pushed by the destruction it had wrought, introduced a new law to reform painkiller prescribing.

It was 1915 and Congress was considering what would become the first law to criminalize drug use, the Harrison Narcotic Act. By this time, addiction had already touched middle-class housewives, immigrants, veterans and even physicians hoping to soothe their own aches and pains. Between the 1870s and 1880s, America’s per capita consumption of opiates had tripled.

More than a century later, Americans are fighting some of the same demons.

Since 1999, more than half a million Americans have died of drug overdoses. Recent data shows the trend accelerated in 2016, when 63,600 people were killed by overdoses and the rate of Americans dying increased by 21%.

“There was a massive opioid epidemic after the civil war,” said Robert Heimer, a professor of epidemiology and pharmacology at Yale University School of Public Health. “Except is wasn’t a black market – it was a perfectly legal market filled with patent medicines that contained not just cocaine and opiates, morphine mostly, but also alcohol.”

Laudanum, Heimer said, “was commonly taken as a relief of colds, coughs, and in stronger form was particularly good for lung diseases such as tuberculosis, which was common at the time, in addition to being widely used in combat situations to facilitate amputations”.

Where Purdue Pharma marketed Oxycontin to doctors as a “continuous around-the-clock analgesic” formulation of semi-synthetic oxycodone great for chronic pain, Mrs Winslow’s Soothing Syrup marketed morphine and alcohol to parents as a “perfectly harmless and pleasant” way to produce “quiet sleep, by relieving the child from pain”.

History, Courtwright said, offers some “grounds for optimism”. Beginning in the 1890s, physicians began to criticize colleagues who reached for the prescription pad when patients had aches and pains; pharmacists refused to sell heroin or cocaine (then both legal); and in 1906 muckraking journalists and campaigners successfully argued for reforms to end the sale of patent medicines.

By 1915, Courtwright argues in the New England Journal of Medicine, “the Harrison Act closed the barn door after the horse was back in”. Problematically, the Harrison Act also became the first law to criminalize drug use and opiate maintenance therapies, such as methadone and buprenorphine.

#Opioides #Histoire #Addiction #Laudanum

The Sackler family made billions from OxyContin. Why do top US colleges take money tainted by the opioid crisis? | US news | The Guardian
►https://www.theguardian.com/us-news/2018/jan/27/universities-sackler-family-purdue-pharma-oxycontin-opioids

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Purdue Pharma pleaded guilty in 2006 in federal court to marketing OxyContin “with the intent to defraud or mislead”. At the time, the company paid a $600m fine – widely seen as a slap on the wrist – while executives paid additional fines of $34.5m.

Over the years, some of America’s leading universities have accepted large sums of money from the Sacklers for science research and the Sackler name is prominently attached to their institutions. So, in light of recent revelations about the origins of the Sackler wealth, will these universities attempt to somehow hold the Sacklers to account?

For now, they are not saying.

Four universities contacted declined requests for an interview. “We will not be able to offer anyone for an interview,” said Weill Cornell Medicine, home of the Raymond and Beverly Sackler Center for Biomedical and Physical Sciences.

“At this time, we do not have any comment,” replied Tufts University, which is home to the Sackler School of Graduate Biomedical Sciences.

Questions to Columbia University about its Sackler Institute for Developmental Psychobiology went unanswered.

Among the universities contacted, the one that did respond was Yale, which has a professorship funded by the Sacklers at its Cancer Center and which is also home to the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences.

While Yale would not agree to an interview, nor would it answer specific questions about its decision to accept Sackler funds, it did provide a written statement which said in part: “The Sackler family has provided generous gifts to support research at Yale in service of our mission to improve the world today and for future generations.”

The statement also acknowledged the toll of opioids and catalogued the broader work the university is doing to combat the epidemic. “Yale faculty members, staff, and students – particularly those in the departments of psychiatry, internal medicine, and emergency medicine – are working tirelessly to determine the causes of and treatments for addiction.”

As for OxyContin, universities may find it increasingly difficult to champion their research under the Sackler banner

But do Yale’s good works justify its decision to accept Sackler funds?
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Reich says the answer is complicated. “The relevant question is not just a utilitarian one about whether or not tainted money can be used to produce some aggregate social benefit,” he says. “There’s the question about whether Yale or any other university wants to be complicit in the reputation laundering of the donor. And at the very minimum there is that negative to put on the ledger of whatever good could be done with the gift.”

For a long time, the Sacklers flew under the radar. Forbes concedes that when it launched its initial list of wealthiest US families in 2014, it missed the Sacklers entirely, but their 2015 edition notes that their wealth exceeds that of famed families like the Mellons and the Rockefellers.

It was only last October, when investigations into the origins of the family’s wealth were published by the New Yorker, Esquire and others, that the spotlight began to shine intensely on them.

#Opioides #Universités

New York City sues ’Big Pharma’ for $500m for fueling opioid epidemic | US news | The Guardian
▻https://www.theguardian.com/us-news/2018/jan/23/new-york-city-sues-big-pharma-for-500m-for-fueling-opioid-epidemic

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New York City on Tuesday sued the makers of prescription painkillers such as OxyContin, Percocet and fentanyl that have played a central role in the opioid crisis killing tens of thousands across the nation.

The mayor of New York, Bill de Blasio, and his wife Chirlane McCray, who leads the city’s efforts on mental health and drug addiction, announced a $500m lawsuit “to hold manufacturers and distributors to account”, filed in New York state supreme court.

“More New Yorkers have died from opioid overdoses than car crashes and homicides combined in recent years. ‘Big Pharma’ helped to fuel this epidemic by deceptively peddling these dangerous drugs and hooking millions,” De Blasio said. A record 1,000-plus people died in New York from opioid-related overdoses in 2016, the mayor reported.

New York City on Tuesday sued several companies, led by Purdue Pharma, the family-owned creator of OxyContin the original brand of slow-release, powerful prescription narcotics that ushered in the crisis 20 years ago with aggressive marketing campaigns and insufficient warnings about addiction and abuse.

Additional defendants include Endo, which makes the painkiller Percocet; Cephalon, which makes the fentanyl lollipop-type lozenge Actiq; Janssen, which makes fentanyl patches; and other opioid makers, including Johnson & Johnson, Watson, Teva and Allergan.

#Opioides #Procès