• The Arthur Sackler Family’s Ties to OxyContin Money - The Atlantic

    Much as the role of the addictive multibillion-dollar painkiller OxyContin in the opioid crisis has stirred controversy and rancor nationwide, so it has divided members of the wealthy and philanthropic Sackler family, some of whom own the company that makes the drug.

    In recent months, as protesters have begun pressuring the Metropolitan Museum of Art in New York and other cultural institutions to spurn donations from the Sacklers, one branch of the family has moved aggressively to distance itself from OxyContin and its manufacturer, Purdue Pharma. The widow and one daughter of Arthur Sackler, who owned a related Purdue company with his two brothers, maintain that none of his heirs have profited from sales of the drug. The daughter, Elizabeth Sackler, told The New York Times in January that Purdue Pharma’s involvement in the opioid epidemic was “morally abhorrent to me.”

    But an obscure court document sheds a different light on family history—and on the campaign by Arthur’s relatives to preserve their image and legacy. It shows that the Purdue family of companies made a nearly $20 million payment to the estate of Arthur Sackler in 1997—two year after OxyContin was approved, and just as the pill was becoming a big seller. As a result, though they do not profit from present-day sales, Arthur’s heirs appear to have benefited at least indirectly from OxyContin.

    The 1997 payment to the estate of Arthur Sackler is disclosed in the combined, audited financial statements of Purdue and its associated companies and subsidiaries. Those documents were filed among hundreds of pages of exhibits in the U.S. District Court in Abingdon, Virginia, as part of a 2007 settlement in which a company associated with Purdue and three company executives pleaded guilty to charges that OxyContin was illegally marketed. The company paid $600 million in penalties while admitting it falsely promoted OxyContin as less addictive and less likely to be abused than other pain medications.

    Arthur’s heirs include his widow and grandchildren. His children, including Elizabeth, do not inherit because they are not beneficiaries of a trust that was set up as part of a settlement of his estate, according to court records. Jillian receives an income from the trust. Elizabeth’s two children are heirs and would receive bequests upon Jillian’s death. A spokesman for Elizabeth Sackler declined to comment on the Purdue payment.

    Long before OxyContin was introduced, the Sackler brothers already were notable philanthropists. Arthur was one of the world’s biggest art collectors and a generous benefactor to cultural and educational institutions across the world. There is the Arthur M. Sackler Gallery at the Smithsonian Institution, the Arthur M. Sackler Museum at Harvard, and the Jillian and Arthur M. Sackler Wing of Galleries at the Royal Academy of Arts in London.

    His brothers were similarly generous. They joined with their older brother to fund the Sackler Wing at the Met, which features the Temple of Dendur exhibit. The Mortimer and Theresa Sackler Foundation was the principal donor of the Serpentine Sackler Gallery in London; the Sackler name is affiliated with prestigious colleges from Yale to the University of Oxford, as well as world-famous cultural organizations, including the Victoria and Albert Museum in London. There is even a Sackler Rose—so christened after Mortimer Sackler’s wife purchased the naming rights in her husband’s honor.

    Now the goodwill gained from this philanthropy may be waning as the Sackler family has found itself in an uncomfortable spotlight over the past six months. Two national magazines recently examined the intersection of the family’s wealth from OxyContin and its philanthropy, as have other media outlets across the world. The family has also been targeted in a campaign by the photographer Nan Goldin to “hold the Sacklers accountable” for OxyContin’s role in the opioid crisis. Goldin, who says she became addicted to OxyContin after it was prescribed for surgical pain, led a protest last month at the Metropolitan Museum of Art, in which demonstrators tossed pill bottles labeled as OxyContin into the reflecting pool of its Sackler Wing.

    While it doesn’t appear that any recipients of Sackler charitable contributions have returned gifts or pledged to reject future ones, pressure and scrutiny on many of those institutions is intensifying. In London, the National Portrait Gallery said it is reviewing a current pledge from the Sackler Trust.

    #Opioides #Sackler

  • How Do You Recover After Millions Have Watched You Overdose? - The New York Times

    The first time Kelmae Hemphill watched herself overdose, she sobbed. There she was in a shaky video filmed by her own heroin dealer, sprawled out on a New Jersey road while a stranger pounded on her chest. “Come on, girl,” someone pleaded.

    Ms. Hemphill’s 11-year drug addiction, her criminal record, her struggles as a mother — they were now everybody’s business, splashed across the news and social media with a new genre of American horror film: the overdose video.

    As opioid deaths have soared in recent years, police departments and strangers with cameras have started posting raw, uncensored images of drug users passed out with needles in their arms and babies in the back seats of their cars. The videos rack up millions of views and unleash avalanches of outrage. Then some other viral moment comes along, and the country clicks away.

    But life is never the same for the people whose bleakest, most humiliating moments now live online forever. In interviews with The New York Times, they talked — some for the very first time — about the versions of themselves captured in the videos.

    “Why bother saving her?” asked one YouTube commenter. “I would’ve let her die,” said another. Angry Facebook messages arrived months, even years, later, when strangers stumbled across the videos.

    Addiction experts say the videos are doing little else than publicly shaming drug users, and the blunt horror of the images may actually increase the stigma against them. Users themselves disagree on whether the humiliation helped them clean up their lives.

    “We’re showing you this video of them at the worst, most humiliating moment of their life,” said Daniel Raymond, deputy director of policy and planning at the Harm Reduction Coalition, an advocacy group. “The intent is not to help these people. The intent is to use them as an object lesson by scapegoating them.”

    Mandy McGowan, 38, knows that. She was the mother unconscious in that video, the woman who became known as the “Dollar Store Junkie.” But she said the video showed only a few terrible frames of a complicated life.

    As a child, she said, she was sexually molested. She survived relationships with men who beat her. She barely graduated from high school.

    She said her addiction to opioids began after she had neck surgery in 2006 for a condition that causes spasms and intense pain. Her neurologist prescribed a menu of strong painkillers including OxyContin, Percocet and fentanyl patches.

    As a teenager, Ms. McGowan had smoked marijuana and taken mushrooms and ecstasy. But she always steered clear of heroin, she said, thinking it was for junkies, for people living in alleys. But her friends were using it, and over the last decade, she sometimes joined them.

    She tried to break her habit by buying Suboxone — a medication used to treat addiction — on the street. But the Suboxone often ran out, and she turned to heroin to tide her over.

    On Sept. 18, 2016, a friend came to Ms. McGowan’s house in Salem, N.H., and offered her a hit of fentanyl, a deadly synthetic painkiller 50 times more potent than heroin. They sniffed a line and drove to the Family Dollar across the state line in Lawrence, where Ms. McGowan collapsed with her daughter beside her. At least two people in the store recorded the scene on their cellphones.

    Medics revived her and took her to the hospital, where child welfare officials took custody of her daughter, and the police charged Ms. McGowan with child neglect and endangerment. (She eventually pleaded guilty to both and was sentenced to probation.) Two days later, the video of her overdose was published by The Eagle-Tribune and was also released by the Lawrence police.

    The video played in a loop on the local news, and vaulted onto CNN and Fox News, ricocheting across the web.

    “For someone already dealing with her own demons, she now has to deal with public opinion, too,” said Matt Ganem, the executive director of the Banyan Treatment Center, about 15 miles north of Boston, which gave Ms. McGowan six months of free treatment after being contacted by intermediaries. “You’re a spectacle. Everyone is watching.”

    Ms. McGowan had only seen snippets of the video on the news. But two months later, she watched the whole thing. She felt sick with regret.

    “I see it, and I’m like, I was a piece of freaking [expletive],” she said. “That was me in active use. It’s not who I am today.”

    But she also wondered: Why didn’t anyone help her daughter? She was furious that bystanders seemed to feel they had license to gawk and record instead of comforting her screaming child.

    She writes letters to her two teenage sons, who live with her former husband in New Hampshire. Her daughter, now 4, lives with the girl’s uncle. Ms. McGowan knows she will probably not regain custody, but hopes to develop a relationship with her and supplant the image embedded in her own mind of the sobbing girl in the pink pajamas.

    “I know if I do the right thing, I can be involved in her life,” Ms. McGowan said. “It’s going to be a long road for me. You don’t just get clean and your life is suddenly all put back together.”

    Still, the video lives on, popping up online almost constantly.

    Ms. McGowan is bracing herself for the day when her daughter sees it, when her daughter lashes out at her for it, when she throws it back in her mother’s face when Ms. McGowan tries to warn her not to use drugs.

    “That video is PTSD for my children,” she said. “The questions are going to come as my daughter gets older. And I have to be prepared for it. I did this. And it cost me my children.”

    #Opioides #Vidéos #Médias_sociaux #Addiction #Traitements

  • ‘The Numbers Are So Staggering.’ Overdose Deaths Set a Record Last Year. - The New York Times

    The recent increases in drug overdose deaths have been so steep that they have contributed to reductions in the country’s life expectancy over the last three years, a pattern unprecedented since World War II. Life expectancy at birth has fallen by nearly four months, and drug overdoses are the leading cause of death for adults under 55.

    “The idea that a developed wealthy nation like ours has declining life expectancy just doesn’t seem right,” said Robert Anderson, the chief of mortality statistics at the C.D.C., who helped prepare the reports. “If you look at the other wealthy countries of the world, they’re not seeing the same thing.”

    #opioides #opiacés

  • Opioid Nation | by #Marcia_Angell | The New York Review of Books

    As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape. This increasingly seems to me not a legal or medical problem, nor even a public health problem. It’s a political problem. We need a government dedicated to policies that will narrow the gap between the rich and the poor and ensure basic services for everyone. To end the epidemic of deaths of despair, we need to target the sources of the despair.

    #politique #opiacés #opioides #etats-unis

  • Alcohol Is Killing More People Per Year Than The Opioid Crisis, And Most Deaths Are Young Women

    lcohol is killing more adults in the U.S. than the opioid epidemic according to the Institute for Health Metrics and Evaluation at the University of Washington. The opioid epidemic kills an average of 72,000 people per year, while alcohol kills 88,000. In those 88,000 deaths are 2.5 million years of potential life lost, according to the Center for Disease Control and Prevention.

    The surge of alcohol related deaths is new. In ten years, the number of deaths by alcohol have increased 35 percent according the new report shared by USA Today on Friday. The statistics are based on findings from 2007 to 2017.

    Most affected by the rising alcohol epidemic are young women. Among women, deaths rose 67 percent, while for men, the percentage rose only 27 percent.

    Women are more susceptible to alcohol-related risks because they typically weigh less than men, and can feel the effects of alcohol faster, according to the National Institute on Alcohol and Abuse and Alcoholism. The complications that most affect women who drink excessively are Liver Damage, Heart Disease, Breast Cancer and complications with pregnancy.

    #Addiction #Opioides #Alcool

  • James A. Winnefeld Speaks Out on the Opioid Crisis - The Atlantic

    When speaking to Andersen, Winnefeld described how Jonathan was a quiet, kind, and clever kid, who suffered from anxiety and depression. After a false diagnosis of attention deficit disorder, Jonathan began drinking to come down from the Adderall he had been prescribed, and later moved on to harder substances such as opioids. Winnefeld and his wife tried to get Jonathan into intensive outpatient treatment, but no centers had space. During his senior year of high school, Jonathan began to spiral downward. He tried, unsuccessfully, to take his own life.

    “We realized, at that point, that we could not keep our son safe,” Winnefeld said.

    After about five days of searching, Winnefeld found a treatment center to take Jonathan. And after 15 months of treatment, Jonathan began to return to whom he once was. “It takes that long for the brain to recover from the physiological, psychological changes that have taken place,” Winnefeld said. “We saw his ambition come back. We saw his zest for life.”

    During his treatment, Jonathan received his emergency-medical-technician qualifications. In an admissions essay to the University of Denver, Jonathan wrote about a time when he had to administer CPR to someone undergoing a heroin overdose in a McDonald’s bathroom. Winnefeld shared how Jonathan wrote that “at that moment, he had decided he would dedicate his life to helping people who could not help themselves.”

    Yet addiction is a powerful thing, Winnefeld explained. Three weeks later, Jonathan passed away, relapsing on heroin that had been laced with fentanyl.

    So the Winnefelds started SAFE, which Andersen described as “amazingly comprehensive in its approach to the opioid epidemic.” SAFE combats the opioid crisis from six different angles. It works on public awareness and trying to lower the stigma of addiction. It also focuses on prevention in vulnerable populations such as high schools, and seeks to have doctors moderate their prescription of opioids.

    The nonprofit also emphasizes law enforcement’s response to opioid addiction, trying to assure that addiction isn’t criminalized. SAFE considers medical response critical to fighting the crisis, and works to make sure every first responder is equipped with the lifesaving drug naloxone, which can reverse the symptoms of an overdose.

    #Opioides #USA

  • Aux États-Unis, la crise des opioïdes bénéficie au don d’organes _ Marine Van Der Kluft - 1 Octobre 2018 - Le Figaro -

    La hausse du nombre de décès par overdose aux antidouleurs a entraîné une augmentation du nombre d’organes disponibles à la greffe.

    Aux États-Unis, la crise des opioïdes continue de faire des ravages. Morphine, oxycodone ou encore le redoutable fentanyl… Entre 2010 et 2017, le nombre d’Américains décédés d’une overdose a été multiplié par deux. Des événements tragiques qui ont eu un effet inattendu, comme l’ont constaté les banques d’organes américaines : sur la même période, le nombre de donneurs morts par overdose a quadruplé, passant de 350 à 1400.

    « C’est une sinistre ironie : les décès dus à la drogue pourraient augmenter la disponibilité des organes », observent les responsables de la banque d’organes de Nouvelle-Angleterre (région du nord-est des États-Unis) dans un éditorial publié dans la revue Transplantation. En effet, après avoir atteint un pic en 2014, la liste des patients en attente d’une transplantation a diminué pour la première fois depuis vingt-cinq ans. Une baisse qui s’explique en partie par la crise des opioïdes.

    Des candidats idéaux aux greffes
    Les personnes décédées d’une overdose d’opioïdes sont-elles pour autant de bonnes candidates au don d’organes ? Selon le Pr Olivier Bastien, directeur du prélèvement et des greffes d’organes et de tissus à l’Agence de la biomédecine, il s’agit même de conditions idéales, dans le cas où les secours arrivent rapidement. « Le fentanyl est 1000 fois plus puissant que la morphine. Une overdose de ce produit bloque la respiration du patient. L’arrêt cardiaque est rapide, et les organes ne sont pas touchés. Si les secours arrivent vite, ils réalisent un massage cardiaque qui va permettre de faire repartir le cœur. Cependant, le cerveau aura été trop longtemps privé d’oxygène et le patient sera en état de mort cérébral », explique le médecin.

    Risque d’infections
    Cependant, les organes prélevés sur ce type de patients sont régulièrement mis de côté, ce que regrette une équipe de chercheurs de la faculté de médecine Johns Hopkins (Baltimore, États-Unis). « Malgré les caractéristiques favorables de ces donneurs, leurs reins et leur foie sont jetés trois fois plus souvent que ceux issus des morts par traumas », observent-ils dans une étude publiée dans la revue Annals of Internal Medicine.

    Ces patients sont en effet plus susceptibles d’avoir développé des infections consécutives à l’injection de drogues, et notamment l’hépatite B, C et le VIH. Pourtant, les risques de transmission sont désormais très faibles, avec moins d’un cas sur 1000 pour l’hépatite C et un sur 10.000 pour le VIH. En outre, l’étude montre que le taux de survie cinq ans après une greffe d’organes provenant d’une personne décédée d’overdose est équivalent à celui consécutif à la greffe d’organes provenant d’un donneur décédé par trauma.

    « Bien que ça ne soit pas la solution idéale à la pénurie, l’utilisation de ces organes devrait être optimisée », concluent les chercheurs de Johns Hopkins. C’est la stratégie qu’a choisie la banque d’organes de la Nouvelle Angleterre, région qui compte des états très touchés par la crise des opioïdes, comme le Vermont ou le Massachusetts. Alors que le taux national de décès par overdose était de 13,5% en 2017, celui-ci s’élevait à 27% en Nouvelle-Angleterre.

    Désormais, même si les tests révèlent la présence d’une hépatite B, C ou du VIH, l’établissement n’hésite plus à proposer la transplantation. « Les nouveaux traitements ont rendu le VIH maîtrisable et l’hépatite C curable », expliquent-ils. En effet, la loi américaine prévoit la possibilité d’une greffe si le receveur a déjà la maladie ou si le risque de décéder dépasse celui lié à l’infection. Ainsi, en 2016 a eu lieu la première transplantation d’un organe infecté par le VIH vers un patient lui-même atteint du sida. « C’est la preuve qu’avec une bonne stratégie, un élément salvateur peut émerger d’une tragédie nationale », expliquent-ils.

    #opioïdes #greffes #Chirurgie #drogues #Morphine #oxycodone #fentanyl #VIH #sida #optimisation #transplantation

  • Neonatal Abstinence Syndrome: An Update

    Purpose of review

    This review provides an update focused on the evolving epidemiology of neonatal abstinence syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to treat NAS, and the emerging role of quality improvement work in the field of NAS.

    The rise in the incidence of NAS disproportionately occurred in rural and suburban areas. Polysubstance exposure and genetic polymorphisms modified NAS expression and severity. Several centers have explored the use of new bedside assessments, focused on fewer factors to identify infants with NAS, that resulted in a decreased proportion of infants receiving pharmacotherapy for NAS. In addition, buprenorphine was shown to be a promising therapeutic alternative to morphine for treatment of NAS. Lastly, local, state and national quality improvement initiatives aimed to improve outcomes for infants with NAS emerged as an effective manner to advance the care of infants with NAS.

    NAS remains a critical public health issue associated with significant medical, economic and personal burden. Emerging data on drivers of disease, assessment of withdrawal and treatment for NAS provide clinicians and hospitals with new knowledge and an urgency to promote standardization of care for infants with NAS.

    #Bébés #Opioides #Syndrome_sevrage_neonatal

  • Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused - The New York Times

    Prosecutors found that the company’s sales representatives used the words “street value,” “crush,” or “snort” in 117 internal notes recording their visits to doctors or other medical professionals from 1997 through 1999.

    The 120-page report also cited emails showing that Purdue Pharma’s owners, members of the wealthy Sackler family, were sent reports about abuse of OxyContin and another company opioid, MS Contin.
    “We have in fact picked up references to abuse of our opioid products on the internet,” Purdue Pharma’s general counsel, Howard R. Udell, wrote in early 1999 to another company official. That same year, prosecutors said, company officials learned of a call to a pharmacy describing “OxyContin as the hottest thing on the street — forget Vicodin.”

    A spokesman for Purdue Pharma, Robert Josephson, declined to comment on the allegations in the report but said the company was involved in efforts to address opioid abuse.

    Suggesting that activities that last occurred more than 16 years ago are responsible for today’s complex and multifaceted opioid crisis is deeply flawed ,” he said in a statement.

    La famille sacquer savait, dès le début...

    In May 1996, five months after OxyContin’s approval, Richard Sackler and Mr. Udell were sent an older medical journal article describing how drug abusers were extracting morphine from MS Contin tablets in order to inject the drug , prosecutors reported. A Purdue Pharma scientist researched the issue and sent his findings to several Sacklers, the government report states.
    “I found MS Contin mentioned a couple of times on the internet underground drug culture scene,” the researcher wrote in that 1996 email. “Most of it was mentioned in the context of MS Contin as a morphine source.”

    #Opioides #Sackler

  • OxyContin and our opioid crisis : how the misleading marketing of one pain pill helped get America addicted - The Washington Post

    Cet article comporte la vidéo de John Sullivan vantant les mérites d’OxyContin... celui-ci devait décéder neuf ans plus tard après s’être assoupi au volant, conséquence de son addiction selon sa femme. La vidéo a été diffusée auprès de 15 000 médecins en 1998.

    #Opioides #Vidéo #Marketing #John_Sullivan

  • The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy

    Un article scientifique de 2009 sur le marketing d’Oxycontin.

    OxyContin’s commercial success did not depend on the merits of the drug compared with other available opioid preparations. The Medical Letter on Drugs and Therapeutics concluded in 2001 that oxycodone offered no advantage over appropriate doses of other potent opioids.3 Randomized double-blind studies comparing OxyContin given every 12 hours with immediate-release oxycodone given 4 times daily showed comparable efficacy and safety for use with chronic back pain4 and cancer-related pain.5,6 Randomized double-blind studies that compared OxyContin with controlled-release morphine for cancer-related pain also found comparable efficacy and safety.7–9 The FDA’s medical review officer, in evaluating the efficacy of OxyContin in Purdue’s 1995 new drug

    application, concluded that OxyContin had not been shown to have a significant advantage over conventional, immediate-release oxycodone taken 4 times daily other than a reduction in frequency of dosing.10 In a review of the medical literature, Chou et al. made similar conclusions.11

    The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular.1,12–17 In 2001 alone, the company spent $200 million18 in an array of approaches to market and promote OxyContin.❞

    From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue’s national speaker bureau.19(p22)

    In much of its promotional campaign—in literature and audiotapes for physicians, brochures and videotapes for patients, and its “Partners Against Pain” Web site—Purdue claimed that the risk of addiction from OxyContin was extremely small.43–49

    Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”50(p99)

    In 1998, Purdue distributed 15 000 copies of an OxyContin video to physicians without submitting it to the FDA for review, an oversight later acknowledged by Purdue. In 2001, Purdue submitted to the FDA a second version of the video, which the FDA did not review until October 2002—after the General Accounting Office inquired about its content. After its review, the FDA concluded that the video minimized the risks from OxyContin and made unsubstantiated claims regarding its benefits to patients.19

    When OxyContin entered the market in 1996, the FDA approved its original label, which stated that iatrogenic addiction was “very rare” if opioids were legitimately used in the management of pain. In July 2001, to reflect the available scientific evidence, the label was modified to state that data were not available for establishing the true incidence of addiction in chronic-pain patients. The 2001 labeling also deleted the original statement that the delayed absorption of OxyContin was believed to reduce the abuse liability of the drug.19 A more thorough review of the available scientific evidence prior to the original labeling might have prevented some of the need for the 2001 label revision.

    #Opioides #Marketing #Purdue_Pharma

  • Enquête. OxyContin, un antidouleur addictif à la conquête du monde | Courrier international

    Alors que l’usage d’opioïdes antalgiques fait des ravages aux États-Unis, les fabricants de ces médicaments vantent leurs mérites dans le monde entier pour élargir leurs marchés. En minorant les risques de dépendance et les conséquences pour la santé des patients, à l’image de Purdue, producteur de l’OxyContin, sur lequel a enquêté le Los Angeles Times.

    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.

    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.

    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.”

    #Opioides #Mundipharma

  • Court Documents Show How OxyContin’s Sales Team Pushed “Hope in a Bottle” – Mother Jones

    In 2007, a sales representative for Purdue Pharma visited a family doctor in Kingston, Tennessee, to urge the physician to prescribe more OxyContin. The doctor was interested in pain management, but didn’t prescribe the opioid painkiller because he’d heard that it was often resold on the street. “Asked him why it mattered if thought was going to end on street?” read notes that the rep wrote after the visit. “Point well received.”

    That’s according to a 278-page lawsuit filed in May by the state of Tennessee against Purdue Pharma and made public earlier this month after the company dropped its effort to keep the suit sealed. The opioid maker is facing dozens of lawsuits alleging that it helped plant the seeds of today’s spiraling overdose epidemic, but this appears to be the only complaint that relies heavily on notes that company sales representatives jotted down after each visit with a prescriber or clinic. (It’s not alone in the lawsuits: opioid manufacturers and distributors across the country are facing litigation, including this recent whistleblower case against prescription fentanyl maker Insys.)

    Purdue reps focused their efforts on general practitioners, internal medicine physicians, and other prescribers without pain management expertise, the suit alleges. Physician assistants and nurse practitioners, who Purdue found to be the fastest-growing group of opioid prescribers, were deemed to be “critical to our success; contributing to both volume and growth,” according to a 2015-2016 brand strategy training. “NPs and PAs desperately seek information, typically from sales representatives,” read a 2013 marketing plan.

    #Opioides #Purdue_Pharma #Tennessee

  • Reports Warn of Growing Senior Opioid Crisis

    WEDNESDAY, Sept. 19, 2018 (HealthDay News) — Against the backdrop of an unrelenting opioid crisis, two new government reports warn that America’s seniors are succumbing to the pitfalls of prescription painkillers.

    Issued by the Agency for Healthcare Research and Quality (AHRQ), the reports reveal that millions of older Americans are now filling prescriptions for many different opioid medications at the same time, while hundreds of thousands are winding up in the hospital with opioid-related complications.

    “These reports underscore the growing and under-recognized concerns with opioid use disorder in older populations, including those who suffer from chronic pain and are at risk for adverse events from opioids,” said Dr. Arlene Bierman. She is the director of AHRQ’s Center for Evidence and Practice.

    At the same time, AHRQ’s second report found that nearly 20 percent of seniors filled at least one opioid prescription between 2015 and 2016, equal to about 10 million seniors. And more than 7 percent — or about 4 million seniors — filled prescriptions for four or more opioids, which was characterized as “frequent” use.

    The challenge, said Bierman, “is safe-prescribing for those who need opioids for pain, while avoiding overuse or misuse.”

    Clinicians, she advised, could address that concern “by using non-opioid pain medications and non-pharmacologic treatments before considering the use of opioids.” And she suggested that if and when opioids are needed, “the lowest possible dose should be used.”


  • Canada : Les surdoses mortelles d’opioïdes continuent d’augmenter Marie Vastel - 19 Septembre 2018 - Le Devoir

    Le nombre de décès causés par des surdoses liées aux opioïdes continue de se multiplier au Québec et au Canada. À tel point que, si la tendance des trois premiers mois de l’année se maintient, le nombre de morts surpassera celui de l’an dernier.

    Le Canada a maintenant perdu plus de 8000 vies, depuis janvier 2016, à cause de la crise des surdoses d’opioïdes qui sévit particulièrement à l’ouest du Québec, rapportait mardi l’Agence de la santé publique du Canada.

    Au cours des trois premiers mois de l’année 2018 seulement, ce sont 1036 personnes qui ont perdu la vie apparemment à cause d’une consommation d’opioïdes – une augmentation constante par rapport aux mêmes périodes en 2017 et en 2016. Au Québec, 82 décès liés à une consommation d’opioïdes ont été constatés entre janvier et mars 2018 : 320 en Ontario, 203 en Alberta et 390 en Colombie-Britannique.

    À ce rythme, pas moins de 328 personnes pourraient ainsi perdre la vie au Québec en 2018. En 2016, 235 décès avaient été constatés. En 2017, le gouvernement fédéral n’avait reçu que des chiffres incomplets du Québec, répertoriant seulement les décès survenus pendant la deuxième moitié de l’année, et ceux-ci s’élevaient à 181 décès.

    La tendance à la hausse est la même dans les provinces les plus touchées par ce phénomène. L’an dernier, 3996 personnes sont décédées de surdoses d’opioïdes au Canada (1473 en Colombie-Britannique et 1265 en Ontario), tandis que le chiffre atteignait 3005 personnes en 2016 (1011 en Colombie-Britannique et 867 en Ontario). Si on extrapole les statistiques du comité consultatif fédéral-provincial sur l’épidémie de surdoses d’opioïdes, dévoilées mardi, plus de 1500 personnes pourraient ainsi décéder en Colombie-Britannique cette année, plus de 800 en Alberta et près de 1300 en Ontario.

    Des décès constatés entre janvier et mars dernier, 94 % ont été classées comme des surdoses accidentelles. Et 73 % de celles-ci impliquaient la drogue #fentanyl (une drogue de synthèse qui peut être 100 fois plus forte que la morphine et qui est intégrée à certaines drogues du marché noir à l’insu des consommateurs).

    La ministre Petitpas-Taylor a déploré l’état de la crise. « Nous avons toujours dit qu’il n’y a pas de solution magique pour la crise des opioïdes. On va continuer de travailler en étroite collaboration avec les provinces et territoires, et aussi les gens qui travaillent dans la rue avec ces gens qui sont souvent affectés par la crise des opioïdes », a-t-elle réagi mardi.

    #Quebec #opioïdes #overdose #big_pharma #pharma #drogues #drogue #opiacés #overdose #santé #santé_publique #marché_noir

  • Opinion | The Federal Agency That Fuels the Opioid Crisis - The New York Times

    Every day, nearly 200 people across the country die from drug overdoses. Opioids have been the primary driver of this calamity: first as prescription painkillers, then heroin and, more recently, illicitly manufactured fentanyl. The death toll has risen steadily over the past two decades.

    The Drug Enforcement Administration, the agency that most directly oversees access to opioids, deserves much of the blame for these deaths. Because of its incompetence, the opioid crisis has gone from bad to worse. The solution: overhauling the agency, or even getting rid of it entirely.

    A decade into the crisis, more and more prescription drug users turned to the black market. Even though the D.E.A. had tried to “eradicate” illicit drugs for nearly 50 years, users could easily buy stolen and counterfeit pills, along with a cheaper option, heroin. Soon, some began injecting. Outbreaks of H.I.V. and hepatitis C followed. Meanwhile, people who sought evidence-based treatment were rarely able to access it because of the agency’s evolving regulatory and enforcement strategies, like blocking the expansion of mobile methadone clinics and shutting down addiction treatment providers without arranging alternatives for affected patients.

    The Drug Enforcement Administration has had over 40 years to win the war on drugs. Instead its tactics have fueled the opioid crisis. To finally make a dent in this national emergency, we need to rethink the agency from the bottom up.

    Leo Beletsky, an associate professor of law and health sciences at Northeastern University, is the faculty director of the Health in Justice Action Lab, where Jeremiah Goulka is a senior fellow.

    #Opioides #DEA #War_on_drug

  • United States Patent : 9861628

    Buprenorphine-wafer for drug substitution therapy


    The present invention relates to oral pharmaceutical dosage forms comprising buprenorphine with the dosage form releasing buprenorphine instantly upon oral, preferably sublingual, application of the dosage form. The present invention also relates to the use of such dosage forms for treating pain in a human or animal or for drug substitution therapy in drug-dependent human subjects.


    Chronic pain, which may be due to idiopathic reasons, cancer or other diseases such as rheumatism and arthritis, is typically treated with strong opioids.

    Over the last decades prejudices in the medical community as to the use of strong opioids for treating chronic pain in patients has significantly decreased. Many of the se prejudices were due to some of the characteristics being inherent to opioids.

    While opioids have always been known to be useful in pain treatment, they also display an addictive potential in view of their euphorigenic activity. Thus, if opioids are taken by healthy human subjects with a drug seeking behaviour they may lead to psychological as well as physical dependence.

    These usually undesired characteristics of opioids can however become important in certain scenarios such as drug substitution therapies for drug addicts. One of the fundamental problems of illicit drug abuse by drug addicts (“junkies”) who are dependent on the constant intake of illegal drugs such as heroin is the drug-related criminal activities resorted to by such addicts in order to raise enough money to fund their addiction. The constant pressures upon addicts to procure money for buying drugs and the concomitant criminal activities have been increasingly recognised as a major factor that counteracts efficient and long-lasting withdrawal and abstinence from drugs.

    Therefore, programmes have been developed, particularly in the United States and western European countries, in which drug addicts are allowed to take prescription drugs under close supervision of medical practitioners instead of illegal drugs such as street heroin.

    The aim of drug substitution theory is thus to first enable addicts to lead a regular life by administering legal drugs to prevent withdrawal symptoms, but because of their legal character and prescription by medical practitioners do not lead to the aforementioned described drug-related criminal activities. In a second and/or alternate step in the treatment of drug addiction may be to slowly make the drug addict less dependent on the drug by gradually reducing the dose of the substitution drug or to bridge the time until a therapy place in a withdrawal programme is available.

    The standard drug used in drug substitution therapy programmes has for a long time been methadone. However, in recent years the potential of other opioids as substitution drugs in substitution therapy has been recognised. A particularly suitable drug for that purpose is the opioid buprenorphine, which is a mixed opioid agonist/antagonist.

    Nowadays, buprenorphine preparations are administered in drug substitution programmes in the form of a tablet for sublingual administration. One of the reasons that the tablets are formulated for sublingual administration is that this the preferred route of administration for buprenorphine. Furthermore, if a patient swallows such tablets they will not provide euphorigenic activity.

    One example of sublingual tablets for drug substitution therapy is the preparation Subutex.RTM. (being marketed in Germany by Essex Pharma).

    Nevertheless, drug addicts sometimes still try to divert these sublingual buprenorphine tablets by removing them from the mouth when the supervising healthcare professional’s attention is directed to other activities. Later the tablets may be sold or the active agent buprenorphine isolated/extracted to apply it parenterally.

    Another buprenorphine preparation aimed at preventing this potential possibility of abuse has recently gained administrative approval in the United States (Suboxone.RTM.). The Suboxone.RTM. preparation comprises buprenorphine hydrochloride and the opioid antagonist naloxone hydrochloride dihydrate. The presence of naloxone is intended to prevent parenteral abuse of buprenorphine as parenteral co-administration of buprenorphine and naloxone in e.g. an opioid-dependent addict will lead to serious withdrawal symptoms.

    However, there remains a need for other diversion and/or abuse-resistant dosage forms of buprenorphine, which can be used in drug substitution therapy as described above. Additionally, it would be desirable to have a buprenorphine preparation available which is diversion and/or abuse-resistant in cases where the preparation is used for drug substitution therapy and which could also provide efficient analgesia in cases where the preparation is administered to alleviate pain in a patient.


    It is an object of the present invention to provide an oral pharmaceutical dosage form of the active agent buprenorphine that is less prone to diversion and/or abuse in drug substitution therapy. It is another object of the present invention to provide an oral dosage form of the active agent buprenorphine that can be used for drug substitution therapy and/or pain treatment.

    In one embodiment the present invention relates to an oral pharmaceutical dosage form comprising at least buprenorphine or a pharmaceutically acceptable salt thereof with a dosage form releasing buprenorphine or said pharmaceutically acceptable salt thereof instantly upon or oral, preferably sublingual, application of the dosage form. It is, however, understood that the invention and its various embodiments which are set out below, can be extended to any opioid or analgesic whose preferred route of administration is oral, prefereably sublingual, as is the case for buprenorphine.

    An instant release of buprenorphine or a pharmaceutically acceptable salt thereof upon oral, preferably sublingual, application means that substantially all of the buprenorphine or said pharmaceutically acceptable salt thereof will be released within less than three minutes, preferably within less than two minutes or less than one minute. Even more preferably, substantially all of the buprenorphine or said pharmaceutically acceptable salt thereof will be released within less than thirty seconds, twenty seconds, ten seconds or even within less than five seconds after oral, preferably sublingual, application of the dosage form. In one of the preferred embodiments these oral dosage forms will comprise between approximately 0.1 mg and approximately 16 mg buprenorphine or the equivalent amounts of a pharmaceutically acceptable salt thereof.

    In a further preferred embodiment these oral pharmaceutical dosage forms will achieve an average C.sub.max of between 1.5 ng/ml and approximately 2.25 ng/ml in the case of a dose of 0.4 mg buprenorphine hydrochloride being administered. In the case of a dose of 8 mg buprenorphine HCl being administered, the C.sub.max will typically be between approximately 2.5 and 3.5 ng/ml and if a dose of 16 mg buprenorphine hydrochloride is administered the C.sub.max will preferably be between 5.5 to 6.5 ng/ml.

    Yet another preferred embodiment of the invention relates to oral pharmaceutical dosage forms which may provide for the above-mentioned characteristics and/or an average Tmax of from approximately 45 to approximately 90 minutes.

    In a particularly preferred embodiment the dosage forms will additionally comprise an opioid antagonist, preferably naloxone or a pharmaceutically acceptable salt thereof.

    In yet a further preferred embodiment, the pharmaceutical dosage form will comprise buprenorphine and the opioid antagonist, which preferably is naloxone, in a weight ratio of from approximately 1:1 to approximately 10:1.

    One embodiment of the present invention also relates to oral pharmaceutical dosage forms, which may have some or all of the aforementioned characteristics and wherein the dosage form has a film-like or wafer-like shape.

    Another embodiment relates to a method of manufacturing the afore-mentioned described dosage forms.

    Embodiments of the present invention also relate to the use of the afore-described oral, preferably sublingual, pharmaceutical dosage forms in the manufacture of a medicament for treating pain in a human or animal and/or for drug substitution therapy in drug-dependent human subjects.

    One aspect of the invention also relates to a method of drug substitution therapy in drug-dependent human subjects wherein the aforementioned oral pharmaceutical dosage forms are administered to a drug-dependent subject in need thereof.

    #Opioides #Sackler #Brevet #Cynisme #Capitalisme_sauvage

  • Opioid billionaire granted patent for addiction treatment | Financial Times

    Purdue owner Richard Sackler listed as inventor of drug to wean addicts off painkillers
    Richard Sackler’s family owns Purdue Pharma, the company behind the opioid painkiller OxyContin © Reuters

    David Crow in New York

    A billionaire pharmaceuticals executive who has been blamed for spurring the US opioid crisis stands to profit from the epidemic after he patented a new treatment for drug addicts.

    Richard Sackler, whose family owns Purdue Pharma, the company behind the notorious painkiller OxyContin, was granted a patent earlier this year for a reformulation of a drug used to wean addicts off opioids.

    The invention is a novel form of buprenorphine, a mild opiate that controls drug cravings, which is often given as a substitute to people hooked on heroin or opioid painkillers such as OxyContin.

    The new formulation as described in Dr Sackler’s patent could end up proving lucrative thanks to a steady increase in the number of addicts being treated with buprenorphine, which is seen as a better alternative to other opioid substitutes such as methadone.

    Last year, the leading version of buprenorphine, which is sold under the brand name Suboxone, generated $877m in US sales for Indivior, the British pharmaceuticals group that makes it.

    Before the opioid crisis, the Sackler family was primarily known for its philanthropy, emerging as one of the largest donors to arts institutions in the US and UK. But the rising number of addictions and deaths has highlighted the family’s ownership of Purdue, which some members have tried to shy away from.

    It’s reprehensible what Purdue Pharma has done to our public health
    Luke Nasta, director of Camelot

    Dr Sackler’s patent, which was granted by the US Patent and Trademark Office in January, acknowledges the threat posed by the opioid crisis, which claimed more than 42,000 lives in 2016.

    “While opioids have always been known to be useful in pain treatment, they also display an addictive potential,” the patent states. “Thus, if opioids are taken by healthy human subjects with a drug-seeking behaviour they may lead to psychological as well as physical dependence.”

    It adds: “The constant pressures upon addicts to procure money for buying drugs and the concomitant criminal activities have been increasingly recognised as a major factor that counteracts efficient and long-lasting withdrawal and abstinence from drugs.”

    However, the patent makes no mention of the fact that Purdue Pharma has been hit with more than a thousand lawsuits for allegedly fuelling the epidemic — allegations the company and the Sackler family deny.

    “It’s reprehensible what Purdue Pharma has done to our public health,” said Luke Nasta, director of Camelot, an addiction treatment centre in Staten Island, New York. He said the Sackler family “shouldn’t be allowed to peddle any more synthetic opiates — and that includes opioid substitutes”.

    Buprenorphine is prescribed to opioid addicts in tablets or thin film strips that dissolve under the tongue in less than seven minutes. These “sublingual” formulations are used to stop drug abusers from hoarding a stockpile of pills they can sell or use to get high at a later date.

    The patent describes a new, improved form of buprenorphine that would come in a wafer that disintegrated more quickly than existing versions — perhaps in just a few seconds.

    The original application was made by Purdue Pharma and Dr Sackler is listed as one of the inventors alongside five others, some of whom work or have worked for the Sackler’s group of drug companies.

    “Drug addicts sometimes still try to divert these sublingual buprenorphine tablets by removing them from the mouth,” the patent application stated. “There remains a need for other . . . abuse-resistant dosage forms.”
    US opioid epidemic
    What next for the Sacklers? A pharma dynasty under siege

    In June, the Massachusetts attorney-general filed a lawsuit against Dr Sackler and seven other members of the Sackler family, which accused them of engaging in a “deadly, deceptive scheme to sell opioids”.

    Purdue and the family deny the allegations and Purdue said it intends to file a motion to dismiss. The company points out that OxyContin was, and still is, approved by the US Food and Drug Administration.

    “We believe it is inappropriate for [Massachusetts] to substitute its judgment for the judgment of the regulatory, scientific and medical experts at FDA,” it said in a recent statement to the Financial Times.

    Andrew Kolodny, a professor from Brandeis University who has been a vocal advocate for greater use of buprenorphine to battle the opioid crisis, said the idea Dr Sackler “could get richer” from the patent was “very disturbing”. He added: “Perhaps the profits off this patent should be used to pay any judgment or settlement down the line.”

    Earlier this week, Purdue donated $3.4m to boost access to naloxone, an antidote given to people who have just overdosed on opioids.

    #Opioides #Cynisme #Capitalisme_sauvage #Brevets #Sackler

  • La crise des #opioïdes, un défi pour le #marché du #travail américain

    L’épidémie, qui a fait l’an dernier près de 72.000 morts par overdose, soit davantage que pendant toute la guerre du Vietnam, a aussi envahi le marché du travail, en éloignant de l’emploi des victimes souvent précaires. Pour l’économiste de Princeton Alan Krueger, près d’un quart du déclin de la participation au marché du travail est imputable à la consommation de ces analgésiques à haut risque. Ses travaux montrent que près de la moitié des hommes de 25 à 54 ans sortis du marché de l’emploi prenait quotidiennement des médicaments contre la douleur, et, dans les deux tiers des cas, des médicaments sur ordonnance. « Je pense qu’il y a un lien avec la baisse du taux de participation des personnes âgées de 25 à 55 ans » , a admis l’ancienne présidente de la Fed Janet Yellen l’an dernier, hésitant toutefois sur le sens du lien de causalité. Quant aux économistes de la Fifth Third Bank, ils comparent désormais l’ampleur des effets de l’épidémie sur le marché du travail aux ravages de la grippe espagnole de 1918.

  • Au Canada, les fabricants d’opiacés seront poursuivis en justice

    La Colombie-Britannique, l’une des provinces canadiennes les plus touchées par les surdoses d’opiacés, a annoncé, mercredi 29 août, avoir lancé des poursuites contre plus de quarante entreprises pharmaceutiques fabriquant ou commercialisant ces puissants analgésiques à l’origine de milliers de morts au Canada.

    Par cette action en justice, la première du genre dans le pays, le gouvernement provincial espère récupérer les millions de dollars qu’auraient coûtés les services d’urgence et les hospitalisations, liés à ces médicaments antidouleurs vendus sur ordonnance.

    « Il est temps que les compagnies [qui fournissent] des opiacés assument leur responsabilité face au coût financier et humain que leurs produits ont entraîné pour tant de familles », a fait valoir le ministre de la justice de la Colombie-Britannique, David Eby, dans un communiqué.

    Lire aussi : Le New Hampshire en overdose
    Près de 4 000 morts en 2017

    La quarantaine de sociétés poursuivies sont principalement américaines et canadiennes. Parmi elles figure Purdue Pharma, dont le médicament OxyContin est accusé d’être une des causes de l’épidémie d’opiacés qui frappe toute l’Amérique du Nord.

    Selon le gouvernement provincial de la Colombie-Britannique, les fabricants et distributeurs de ces médicaments ont eu recours à un « marketing trompeur » cachant les vrais risques des opiacés.

    Purdue Pharma fait déjà l’objet de plusieurs procédures aux Etats-Unis, notamment de la part de la ville de New York qui lui réclame un demi-milliard de dollars pour aider à financer la lutte contre cette épidémie.

    Les victimes canadiennes et leurs familles avaient de leur côté obtenu 20 millions de dollars canadiens (13,2 millions d’euros) de la société américaine, somme jugée insuffisante par un juge qui a bloqué la transaction en mars.

    La crise des opiacés a fait près de 4 000 morts en 2017 au Canada, principalement à la suite de surdoses au fentanyl, un puissant analgésique, selon l’Agence de santé publique du pays. Environ 90 % des 3 987 décès enregistrés l’an dernier ont été recensés dans trois provinces : la Colombie-Britannique, l’Ontario et l’Alberta.

    #Opioides #Santé_publique #Canada

  • The Opioid Crisis Is Also a Crisis of Speech - Pacific Standard

    Ca ressemble beaucoup à du travail de Public Relation pour contrer la prise de conscience de la crise des opioides. L’American Academy of Pain Medicine est la seule organisation citée... et elle ne semble pas blanc-bleu.

    In particular, chronic pain patients are silenced thanks to the War on Drugs—and, especially in the last few years, in the name of the opioid crisis. Opioid addiction is a serious problem in the United States; 42,000 people died from opioid overdoses in 2016, according to the Department of Health and Human Services, and the U.S. has seen an increase of more than 500 percent in heroin-related deaths since 2002. The understandable desire to reduce America’s number of opioid addicts, though, has had catastrophic consequences for chronic pain patients. Walmart, for example, has limited opioid prescriptions so that patients have to get refills every week, rather than filling them a month at a time. Insurance companies have also placed limits on the amount of opioid medication they will cover. Some pharmacies won’t handle prescriptions over the phone, and sometimes aren’t even allowed to tell patients if the medicine is in stock.


  • Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017 - The New York Times

    Fentanyl is a big culprit, but there are also encouraging signs from states that have prioritized public health campaigns and addiction treatment.

    By Margot Sanger-Katz

    Aug. 15, 2018

    Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.

    Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year.

    A large government telephone survey suggests that around 2.1 million Americans had opioid use disorders in 2016, but that number may be an undercount because not all drug users have telephones and some may not mention their drug use because of the stigma. Dr. Ciccarone said the real number could be as high as four million.

    The number of opioid users has been going up “in most places, but not at this exponential rate,” said Brandon Marshall, an associate professor of epidemiology at the Brown University School of Public Health. “The dominant factor is the changing drug supply.”

    Strong synthetic opioids like fentanyl and its analogues have become mixed into black-market supplies of heroin, cocaine, methamphetamine and the class of anti-anxiety medicines known as benzodiazepines. Unlike heroin, which is derived from poppy plants, fentanyl can be manufactured in a laboratory, and it is often easier to transport because it is more concentrated.

    Congress is debating a variety of bills to fight the epidemic. Many of the measures, which have passed the House but have not reached the Senate floor, are focused on reducing medical prescriptions of opioids, and are meant to reduce the number of new drug users. But the package also includes measures that could expand treatment for people who already use opioids.

    The epidemic could also intensify again. One worrying sign: Dr. Jones said there is some early evidence that drug distributors are finding ways to mix fentanyl with black tar heroin, which could increase death rates in the West. If that becomes more widespread, the overdose rates in the West could explode as they have in parts of the East.


  • « La crise des opioïdes travaille en profondeur, et pour longtemps, la société américaine »

    Mouvement de désocialisation

    Ce changement des pratiques médicales – suscité par les laboratoires ayant développé et commercialisé ces antidouleurs – a provoqué une catastrophe. Les chiffres parlent d’eux-mêmes : pour l’année 2016, les autorités sanitaires américaines ont recensé 64 000 morts par overdose, dont une grande part provoquée par des produits à base d’opioïdes, obtenus sur prescription ou illégalement sur le marché noir. Dans ce bilan, l’héroïne est bien à l’origine d’environ 15 000 morts, mais une étude publiée en 2014 par le Journal of the American Medical Association (JAMA) suggère qu’aux Etats-Unis, les trois quarts des utilisateurs d’héroïne actuels sont entrés en dépendance après une prescription d’opioïdes par leur médecin.
    Les trois quarts des utilisateurs d’héroïne actuels sont entrés en dépendance après une prescription d’opioïdes par leur médecin

    Au total, même s’il est impossible de le démontrer formellement et de le quantifier de manière précise, il est plausible qu’une très large part de la mortalité par overdose enregistrée ces dernières années outre-Atlantique soit directement ou indirectement le fait de la mise sur le marché de ces analgésiques. Un simple chiffre permet de s’en convaincre : en 1990, au plus fort de la guerre de l’Etat fédéral contre les cartels colombiens, le nombre de morts par overdose aux Etats-Unis n’excédait pas 10 000 par an, toutes catégories confondues. C’est aujourd’hui sept fois plus. Pour fixer les idées, rappelons que les armes à feu font environ 34 000 morts par an aux Etats-Unis, ou encore que le pic de mortalité annuelle due au sida y a été atteint en 1995 avec quelque 46 000 morts…

    Et il ne s’agit encore là que de mortalité. Le problème posé par la crise des opioïdes est bien plus vaste. Ce fléau travaille en profondeur, et pour longtemps, la société américaine. Selon un rapport récent de l’Académie des sciences des Etats-Unis, environ 2 millions d’Américains souffrent d’une dépendance aux opioïdes ; une étude récente, conduite par l’économiste Alan Krueger (université de Princeton), suggère que l’augmentation continue, entre 1999 et 2015, des prescriptions d’opioïdes, pourrait expliquer une partie de la baisse, récente et rapide, du taux de participation de la population au marché de l’emploi. La part de la population qui travaille ou est en recherche d’emploi a en effet atteint, aux Etats-Unis, à peine plus de 62 % en 2015.

    Lire aussi : Les opioïdes ravagent aussi le rap aux Etats-Unis

    Du jamais-vu depuis quarante ans. En l’espace d’une quinzaine d’années, au sein de l’Organisation pour la coopération et le développement économiques (OCDE), le pays est passé des plus forts taux de participation au marché de l’emploi, au plus faible de tous (avec l’Italie). L’évolution de cet indicateur signale un mouvement de désocialisation peut-être plus inquiétant encore que la mortalité galopante attribuable à la crise des opioïdes.


  • Les Etats-Unis, homme malade des pays du Nord
    https://abonnes.lemonde.fr/demographie/article/2018/08/16/les-etats-unis-l-homme-malade-des-pays-du-nord_5342838_1652705.html ?

    Les Etats-Unis sont atteints d’une maladie « systémique », et cela devrait inciter les autres pays développés à la vigilance. C’est, en substance, la conclusion de deux études publiées, mercredi 15 août, dans le British Medical Journal. La première, conduite par Steven Woolf (Virginia Commonwealth University), révèle une hausse inquiétante de la mortalité chez les adultes américains d’âge moyen au cours des dix-sept dernières années et singulièrement depuis 2012, où l’espérance de vie américaine a commencé à stagner, avant de décliner à partir de 2015.

    Outre-Atlantique, cette baisse de l’espérance de vie enregistrée en 2015 s’est même confirmée en 2016. L’indice pointait alors à 78,6 ans, soit 0,3 an de moins qu’en 2014. Des données préliminaires rendues publiques en mai par l’Associated Press indiquaient que l’année 2017 devait connaître une nouvelle chute de la longévité. Elle serait alors la troisième année d’affilée de déclin – situation sans précédent depuis plusieurs décennies.

    Pour comprendre, Steven Woolf et ses coauteurs ont comparé les caractéristiques de la mortalité de la population américaine âgée de 25 à 64 ans, par origine ethnique, entre 1999 et 2016. « Entre 1999 et 2016, les taux de mortalité toutes causes confondues n’augmentent pas uniquement parmi les Blancs, mais aussi chez les Amérindiens », écrivent les auteurs. Les trois autres groupes ethniques étudiés (Noirs, Hispaniques et Asiatiques) ont d’abord connu une baisse de mortalité, qui s’est interrompue entre 2009 et 2011, avant de partir à la hausse.

    Premier constat : les overdoses sont la première cause d’accroissement de la mortalité, dans tous les groupes. Les taux de mortalité due à l’utilisation de drogues ou de médicaments augmentent ainsi de plus de 410 % chez les Amérindiens, 150 % chez les Noirs, 80 % chez les Hispaniques…

    Lire aussi : « La crise des opioïdes travaille en profondeur, et pour longtemps, la société américaine »

    Ce sont les stigmates de la crise des opioïdes qui frappe les Etats-Unis depuis la mise sur le marché, au milieu des années 1990, de puissants antalgiques proches de la morphine. Ceux-ci ont plongé dans la dépendance plus de 2 millions d’Américains et entraînent aux Etats-Unis plusieurs dizaines de milliers de morts par an. Ce constat n’est pas nouveau.
    Des inégalités sociales fortes

    Mais, soulignent Steven Woolf et ses coauteurs, ce n’est pas la seule cause. « Les taux de mortalité à mi-vie, expliquent les chercheurs, ont aussi augmenté pour un large éventail de maladies touchant de multiples fonctions et organes du corps humain. » Chez les Amérindiens, les taux de mortalité entre 25 et 64 ans ont ainsi augmenté pour douze causes différentes, dont les maladies dues à l’hypertension (+ 270 %), le cancer du foie (+ 115 %), les hépatites virales (+ 112 %), les maladies du système nerveux central (+ 100 %)… Suicides, maladies hépatiques liées ou non à l’alcool, tumeurs cérébrales, maladies respiratoires ou métaboliques ou encore obésité font grimper la mortalité dans parfois plusieurs groupes.

    Les taux de mortalité augmentent à travers l’ensemble de la population américaine pour une douzaine d’affections. Cela signale, pour les auteurs, que la dégradation de la santé aux Etats-Unis est le fait « de causes profondes et systémiques ». « Nous soupçonnons que l’inégalité croissante des revenus, les déficiences de l’éducation, la fracture sociale et le stress peuvent jouer un rôle important, explique M. Woolf. D’autres facteurs pourraient inclure le manque d’accès universel aux soins, la possession d’armes à feu par la population et les taux élevés d’obésité. »

    #Santé_publique #Opioides #Etats_unis #Mortalité

  • #F.D.A. Did Not Intervene to Curb Risky #Fentanyl Prescriptions - The New York Times

    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