• Opioids and Public Health | Journal of Ethics | American Medical Association
    https://journalofethics.ama-assn.org/issue/opioids-and-public-health

    Manufacturers of prescription opioids offered assurance in the mid-to-late 1990s that these drugs wouldn’t make patients with pain into patients with substance use disorders. Some physicians believed them and prescribed these drugs without appropriate regard for their addictiveness, contributing to prescription and street opioid misuse that has reached alarming proportions. This issue considers ethical questions that contextualize the opioid epidemic from social, cultural, and policy-based perspectives and illuminates potential solutions.
    Volume 22, Number 8: E645-750

    Le dernier numéro en date du journal d’éthique de l’American Medical Association. Son contenu confirme ce que Patrick Radden Keefe a montré dans « Addiction sur ordonnance » (traduit et publié par C&F éditions). Notamment un article par Andrew Kolodny sur le rôle (par inaction et complaisance) de la Food and Drug administration dans le déclenchement de la crise, une auteur largement cité par P.R. Keefe.

    #Opioides #FDA #Ethique #Big_pharma #Régulation

  • The US Just Had Its Deadliest Year for Overdose Deaths
    https://www.vice.com/en_us/article/pkyz7m/the-us-just-had-its-deadliest-year-for-overdose-deaths

    According to preliminary data from the Centers for Disease Control and Prevention, close to 71,000 people died of overdoses in the U.S. in 2019, a number that the agency said is likely an undercount. More than 36,000 of those deaths stem from synthetic opioids such as fentanyl, the CDC report said.

    The increase in 2019 is a reversal from 2018, which saw overdose deaths decrease for the first time in decades, with about 68,000 in total.

    Bryce Pardo, an associate policy researcher at the RAND Corporation, a nonprofit that studies the overdose crisis, said there may have been a decrease in deaths in 2018 because carfentanil exited several U.S. markets. It’s possible that some dealers stopped selling carfentanil, a synthetic opioid more potent than fentanyl, due to too many people dying, or that Chinese manufacturers decided it was too risky to produce, said Pardo. However, he said the drug re-emerged in 2019 in places like Vancouver, B.C. and Ohio.

    Pardo said there are some markets that have completely transitioned to fentanyl markets, where powder heroin is no longer available. Vancouver drug activists who recently handed out free samples of cocaine and opium that had been tested for fentanyl said there is no clean heroin available in the city.

    “The thing about this problem is it’s more like a poisoning crisis,” Pardo said. “Drug users, at least at first, aren’t demanding fentanyl. They’re looking for heroin, they’re looking for some type of diverted prescription medication.”

    He said in some cases dealers are adding fentanyl to the heroin supply because it’s cheaper and more potent and it’s easy to get online.

    #Opioides #Fentanyl

  • The troubling impact of America’s opioid epidemic on student learning
    https://www.brookings.edu/blog/brown-center-chalkboard/2020/04/13/the-troubling-impact-of-americas-opioid-epidemic-on-student-learning

    Today, the Brown Center on Education Policy is releasing a new report on one of the unexplored effects of the opioid crisis: the link between the opioid epidemic and the educational outcomes of children in hard-hit areas. Written by Rajeev Darolia and John Tyler, the report suggests a need to be aware of the potentially negative effects of the opioid crisis on student learning, particularly in certain “hot spots” and rural areas.

    Though school-age children are not typically directly involved with opioid use, they are not immune to the effects of what happens in their homes and communities. There has long been evidence that negative home or community factors can be associated with lost learning opportunities. For example, children exposed to
    higher levels of neighborhood violence have worse education outcomes than children who are less exposed. In a similar vein, childhood exposure to the ravages of the opioid epidemic may result in worse educational outcomes.

    Et cet important passage :

    Research on the societal effects of the opioid epidemic, as opposed to the direct effects on individuals with opioid-use disorder, is just emerging. Darolia and Tyler’s report contributes to this less-established line of research by examining the effects of the opioid epidemic on a critical societal question—how indirect exposure to the epidemic may harm the education outcomes of children who live in communities most affected by the opioid crisis.

    The authors present results from an original analysis into the relationship between student outcomes and opioid use. Their estimates suggest that among both rural and nonrural counties, test scores are lower in counties with higher drug-related mortality. However, the estimated test scores for rural counties show a stronger negative association with drug-related mortality than similarly affected nonrural counties. Further, the rural-nonrural gap appears to grow as mortality levels increase.

    Exposure to the epidemic is likely to impact important educational outcomes other than test scores, such as attendance, probability of school disciplinary action, graduation, and college enrollment—all of which warrant further examination.

    #Opioides #Education

  • Who Profits from the Opioid Crisis? Meet the Secretive Sackler Family Making Billions from OxyContin - YouTube
    https://www.youtube.com/watch?v=EGITecuBEHQ

    https://democracynow.org - This week, President Donald Trump’s nominee for drug czar, Republican Congressmember Tom Marino, had to withdraw from consideration after a Washington Post/”60 Minutes” investigation found he led a drug industry-backed effort to pass a law that weakened the U.S. Drug Enforcement Administration’s ability to crack down on addictive opioids. Meanwhile, calls are growing to look at the major pharmaceutical companies that have fueled the opioid crisis. A new investigation by Esquire magazine reveals how the secretive Sackler family, owners of the company that invented OxyContin, downplayed the risks of addiction and exploited doctors’ confusion over the drug’s strength. We speak with Christopher Glazek, the Esquire reporter behind the story.

    #Opioides #Sackler #Conflit_opinion

  • La surconsommation d’#opioïdes est liée à la #pauvreté
    https://www.lemonde.fr/societe/article/2020/02/20/la-surconsommation-d-opioides-est-liee-a-la-pauvrete-selon-une-etude_6030149

    « Ce résultat valide l’hypothèse des “deaths of despair” [morts de désespoir] américains », commente Mathias Dewatripont, l’un des coauteurs de l’étude, qui n’a pas encore été publiée. Conceptualisée par le Prix Nobel d’économie Angus Deaton et sa consœur Anne Case, cette hypothèse explique la surmortalité liée aux drogues et aux médicaments par le blues de la « working class » américaine, prise au piège d’une économie en berne. Aux Etats-Unis, les antalgiques opiacés ont ainsi causé au moins 200 000 décès depuis 1999. Près de 100 milliards de comprimés ont été distribués pour la seule période 2006-2014.

    #paywall

  • La surconsommation d’opioïdes est liée à la pauvreté, selon une étude, Chloé Hecketsweiler
    https://www.lemonde.fr/societe/article/2020/02/20/la-surconsommation-d-opioides-est-liee-a-la-pauvrete-selon-une-etude_6030149

    Ce travail inédit, réalisé en France, révèle également que les politiques de lutte contre la précarité ont un effet positif sur la réduction de l’usage des antalgiques opiacés.

    La #pauvreté incite-t-elle à consommer davantage de médicaments #opiacés ? Ou ces antalgiques entraînent-ils certains patients dans une spirale d’addiction et de déclin ? Pour la première fois, des économistes se sont penchés sur le cas de la France, et pour eux, dans l’Hexagone du moins, la première hypothèse est la bonne.

    Lire aussi Antalgiques : les chiffres inquiétants de l’addiction aux opiacés en France
    https://www.lemonde.fr/les-decodeurs/article/2019/02/22/antalgiques-les-chiffres-inquietants-de-l-addiction-aux-opiaces-en-france_54

    Selon leurs calculs, l’augmentation du taux de pauvreté de 1 % dans un département se traduit par une augmentation de 10 % de médicaments opiacés. Ces chercheurs de l’Université libre de Bruxelles (ULB) ont exploité les données de vente d’antalgiques en France entre 2008 et 2017 – jusque-là jamais exploitées à l’échelle départementale – et plusieurs indicateurs socio-économiques : le taux de pauvreté (14 % en moyenne dans le pays), le taux de chômage, la densité de population ou le niveau d’éducation. Cette approche leur a permis d’étudier l’influence de ces différentes variables, et de comparer les départements entre eux.

    « Morts de désespoir »

    « Ce résultat valide l’hypothèse des “deaths of despair” [morts de désespoir] américains », commente Mathias Dewatripont, l’un des coauteurs de l’étude, qui n’a pas encore été publiée. Conceptualisée par le Prix Nobel d’économie Angus Deaton et sa consœur Anne Case, cette hypothèse explique la surmortalité liée aux drogues et aux médicaments par le blues de la « working class » américaine, prise au piège d’une économie en berne. Aux Etats-Unis, les antalgiques opiacés ont ainsi causé au moins 200 000 décès depuis 1999. Près de 100 milliards de comprimés ont été distribués pour la seule période 2006-2014.

    Cette crise pourrait-elle se propager en Europe ? En matière de consommation d’opioïdes, la France arrive en quatrième position, après le Royaume-Uni, l’Allemagne et l’Espagne, mais les autorités s’inquiètent de l’engouement des patients pour certaines molécules. En janvier, l’Agence nationale de sécurité du médicament (ANSM) a ainsi placé sous surveillance le Tramadol, après avoir constaté une augmentation des mésusages et des décès. Il s’agit de l’antalgique opiacé le plus consommé en France, avec des prescriptions en hausse de près de 70 % en dix ans. « Les gens dans la pauvreté, qui se sentent abandonnés des services publics parce qu’ils sont dans les zones rurales, qui sont moins éduqués et donc ont du mal à se réadapter au marché du travail, représentent une population à risque », souligne M. Dewatripont, ancien directeur de la Banque nationale de Belgique.

    Pour corroborer leurs résultats, les auteurs se sont intéressés aux changements induits par la mise en place du revenu de solidarité active (RSA) à partir de 2007 dans une partie des départements et à partir de 2009 partout en France. « Il y a un effet positif de cette politique en termes de réduction de la consommation d’opioïdes », note Mathias Dewatripont. « Si vous avez mal au dos, et que vous êtes moins pauvre, vous avez davantage les moyens de vous payer un abonnement au fitness », schématise-t-il. ["davantage de moyens" grâce au RSA, le propos est délirant, peut-être font ils référence à la prime d’activité... ndc]

    Cette étude suggère d’autres pistes possibles pour réduire la consommation d’opioïdes. « Sensibiliser les médecins et les inciter à prendre davantage de précautions avec les patients à risque est une première piste », avance Ilaria Natali, l’une des coauteurs. « Il faudrait aussi améliorer la pharmacovigilance, afin de détecter les patients qui font du shopping auprès de plusieurs docteurs et pharmacies », poursuit-elle.

    « Prendre en charge le patient et pas seulement la douleur »
    Cette analyse à l’échelle nationale confirme ce que les médecins observent sur le terrain. « La précarité sociale rend plus vulnérable à certaines maladies associées à des #douleurs_chroniques » , témoigne le professeur Nicolas Authier, qui dirige le centre de la douleur au CHU de Clermont-Ferrand et l’Observatoire français des médicaments antalgiques (OFMA). Une étude menée par son équipe en 2015 sur 120 patients avait révélé qu’un sur cinq était en situation de vulnérabilité sociale et un sur six en situation de précarité.

    Le médecin évoque l’impact du mode de vie, notamment le tabagisme, plus élevé chez les personnes défavorisées. Une étude publiée en 2017, portant sur près de 190 000 personnes, avait ainsi révélé que les cancers du poumon ou du larynx frappaient davantage les plus pauvres. Or 30 % des opioïdes forts sont prescrits en cancérologie. De même, le diabète, dont les complications peuvent être très douloureuses, touche davantage les plus défavorisés.

    « Soigner suppose de prendre en charge le patient douloureux dans sa globalité, avec ses problèmes financiers, de logement, et pas seulement la douleur », insiste M. Authier. « Le temps d’écoute est très important. Or la place des travailleurs sociaux dans le parcours de soins est insuffisante pour une bonne prise en charge », regrette ce psychiatre, qui plaide pour la création de structures intermédiaires entre les médecins de ville et les centres de la douleur.

    Les patients doivent aujourd’hui attendre entre trois et neuf mois pour obtenir un rendez-vous dans son centre. « C’est trop long », déplore-t-il. Pour certains antalgiques opiacés, un phénomène de dépendance peut apparaître après seulement quelques semaines de traitement. Et le sevrage est d’autant plus difficile qu’ils ont un effet anxiolytique ou antidépresseur qui peut être recherché par les patients une fois leur douleur disparue.

    Examinée à la loupe par les économistes de l’ULB, la consommation d’#oxycodone – un antalgique deux fois plus puissant que la morphine – n’est pas liée aux taux de pauvreté. Multipliée par sept en dix ans, elle s’expliquerait par d’autres facteurs non pris en compte par leur modèle, comme l’impact du #marketing des #laboratoires. « On sait qu’il y a un lien. Les laboratoires ne paient pas des commerciaux pour rien. Il n’y a qu’à voir les chiffres de ventes du Tramadol et de l’oxycodone », avance le professeur Authier.

    En France, l’oxycodone est notamment commercialisé sous la marque OxyContin par Mundipharma, filiale de la firme américaine Purdue, bien connue pour ses dérapages. « La situation en France n’a rien à voir avec celle des Etats-Unis. Mais est-elle épargnée ou juste en retard ? », s’interroge Mathias Dewatripont. En 2015, près de 10 millions de Français, soit 17 % de la population, avaient reçu une prescription d’opioïdes.

    #opioïdes

  • Le Tramadol, antidouleur de la classe des opioïdes, placé sous surveillance en France
    https://www.lemonde.fr/societe/article/2020/01/16/l-agence-nationale-du-medicament-place-sous-surveillance-le-tramadol-un-medi

    A partir du 15 avril, les patients traités avec du Tramadol devront faire renouveler leur ordonnance tous les trois mois, contre douze mois jusque-là. Publiée mercredi 15 janvier, cette décision de l’Agence nationale de sécurité du médicament et des produits de santé (ANSM) a pour objectif de limiter les risques de dépendance et de surdosage liés à une consommation non maîtrisée de cet antalgique à base d’opiacés.

    Commercialisé sous différentes marques comme le Topalgic, sous forme de génériques, il peut être associé à du paracétamol (Ixprim, Zaldiar) ou à un anti-inflammatoire (Skudexum). Ce médicament est de loin l’opioïde le plus prescrit en France : en 2017, 6,8 millions de Français en ont consommé au moins une fois dans l’année.
    Très addictif

    « Les médecins connaissent mal la molécule et les patients ne reconnaissent pas toujours les signes de dépendance », déplore Nathalie Richard, directrice adjointe des médicaments antalgiques et stupéfiants à l’ANSM. « Nous souhaitons débanaliser la prescription du Tramadol, notamment à la sortie de l’hôpital, où l’on donne souvent des ordonnances pré-imprimées aux patients », poursuit-elle.

    Les médecins le prescrivent pour soulager des douleurs importantes – après une intervention chirurgicale, par exemple –, mais la durée de prescription doit être la plus courte possible, car le Tramadol se révèle très addictif.

    #Opioides #Tramadol #France #Addiction

  • A ‘Rare Case Where Racial Biases’ Protected African-Americans - The New York Times
    https://www.nytimes.com/2019/11/25/upshot/opioid-epidemic-blacks.html

    African-Americans received fewer opioid #prescriptions, some researchers think, because doctors believed, contrary to fact, that black people 1) were more likely to become addicted to the drugs 2) would be more likely to sell the drugs and 3) had a higher pain threshold than white people because they were biologically different.

    A fourth possibility is that some white doctors were more empathetic to the pain of people who were like them, and less empathetic to those who weren’t.

    #préjugés #biais #racisme #opiacés #opioides #santé #empathie #blancs #noirs #etats-unis

  • Sackler Family Members Fight Removal of Name at Tufts, Calling It a ‘Breach’ - The New York Times
    https://www.nytimes.com/2019/12/19/us/sackler-opioids-tufts.html

    CAMBRIDGE, Mass. — Two weeks after Tufts University became the first major university to remove the Sackler name from buildings and programs over the family’s role in the opioid epidemic, members of the family are pushing back. A lawyer for some of the Sacklers argued in a letter to the president of Tufts that the move was unjustified and a violation of agreements made when the school wanted the family’s financial help years ago.

    The letter described Tufts’s decision to remove the name as “contrary to basic notions of fairness" and “a breach of the many binding commitments made by the University dating back to 1980 in order to secure the family’s support, including millions of dollars in donations for facilities and critical medical research.”

    Institutions that have accepted financial support from the Sacklers have in recent months faced growing cries to distance themselves from the family.

    The forceful response by Sackler family members now may be seen as a signal to other institutions amid a flurry of announcements by major cultural organizations that they would no longer take donations from the family. The response also raised complicated legal questions about what room institutions have to unilaterally remove a donor’s name long after a gift has been accepted.

    Several institutions that have received major support from the Sacklers, including Yale University, Tate, the Metropolitan Museum of Art and the Solomon R. Guggenheim Museum, said this year that they would no longer accept gifts from some or all Sackler family members.

    But decisions by major institutions to remove the Sackler name from existing facilities have been rare. This year, the Louvre in Paris removed the name from a wing that had been known since 1997 as the Sackler Wing of Oriental Antiquities. In that case, however, the Louvre said that its naming agreements lasted only 20 years.

    #Sackler #Opioides #Jean-Foutres

  • Opioid manufacturers made parody rap videos to help push products | US news | The Guardian
    https://www.theguardian.com/us-news/2019/dec/07/opiod-makers-music-videos-sales
    https://i.guim.co.uk/img/media/f1e914cfcd94cd42c208e1f3bfba932ce2b665b4/0_118_2000_1200/master/2000.jpg?width=1200&height=630&quality=85&auto=format&fit=crop&overlay-ali

    Newly released videos show opioid manufacturers produced music videos, sponsored local news segments and held dramatic new launches for products even after they were warned against aggressive marketing.

    The music videos are evidence in a huge, multi-state lawsuit fought in Cleveland, Ohio. Opioid manufacturers fought to keep them under seal but the Washington Post and the Gazette-Mail of Charleston, West Virginia, sued to make them public.

    From 1999 to 2017, more than 702,000 people died of drug overdoses in the US – more than 70,000 in 2017 alone. According to the US Centers for Disease Control and Prevention, 68% of such deaths involved a prescription opioid.

    As a comparison, roughly 58,000 American soldiers died in battle in the Vietnam war, and about 40,000 Americans die each year in car accidents.

    In statements to the Washington Post, manufacturers argued their marketing campaigns did not mislead doctors and provided patients with needed medications.

    But the newly unearthed videos and documents show how aggressively the products were marketed.

    #Opioides #Publicité #Vidéos

  • The company that makes OxyContin could become a ’public trust’ – what would that mean?
    http://theconversation.com/the-company-that-makes-oxycontin-could-become-a-public-trust-what-w

    Purdue Pharma, which makes OxyContin and other potentially addictive prescription opioids, has declared bankruptcy. It’s also facing thousands of lawsuits for its leading role in creating the opioid crisis.

    The company is trying to reach a broad settlement with the many jurisdictions now suing. The settlement it’s proposing would transform the company from a profit-seeking privately held company into a “public beneficiary trust” that serves the public good.

    I study the history of prescription drugs. Although there are some recent efforts to establish nonprofit drugmakers to help make certain pharmaceuticals more readily available, I know of no historical precedent for a big drugmaker like Purdue becoming a nonprofit public health provider.

    But two similarly ambitious efforts to build alternatives to the profit-driven pharmaceutical model during and immediately after World War II suggest the potential limits of how well this arrangement might work.

    By all accounts, the new trust would be a for-profit entity. Indeed, profits from continued sales of pain medicines like OxyContin and addiction treatment medications like buprenorphine and naloxone – estimated by Purdue to be up to US$8 billion per year – are crucial as the “payment” Purdue is offering to compensate the public for the company’s share of the costs of the opioid crisis.

    In other words, to achieve its mission, the new Purdue would have to pursue profits just like the old Purdue. And since all pharmaceutical companies officially declare themselves to be dedicated to serving the public good, how different would it really be?

    Then, too, the new trust would still be Purdue Pharma, a company with a well-entrenched culture of maximizing sales and profits even as the opioid crisis grew. One could make a credible case that Purdue’s innovations – the “value” it brought to the table – were not related to any special therapeutic breakthrough in the drugs it developed but instead lay in its genius with marketing these products.

    I can see why it is tempting to be excited about the prospect of a new public-benefit trust devoted to addressing addiction.

    But for this proposed arrangement to make sense, Purdue would need the tools and expertise required to pursue a radically different mission than it was designed to serve. And history does not offer much assurance that isolated public-sector and nonprofit drugmakers can make a big difference in a pharmaceutical system designed for and powered by profit.

    #Purdue_pharma #Sackler #Opioides

  • La pilule de l’obéissance

    À l’origine, le remède ne devait concerner que les #enfants « hyperactifs », une pathologie relativement rare. Mais depuis quelques années, aux États-Unis, tout bambin quelque peu turbulent peut se voir prescrire de la #Ritaline, un #médicament voisin des amphétamines qui fait également fureur sur les campus. Après avoir inondé le marché américain, la pilule miracle se répand en France.

    https://www.monde-diplomatique.fr/2019/12/BRYGO/61087
    #santé #enfance #hyperactivité

    • Déjà en cours il y a une dizaine d’années. Je ne connais pas l’ampleur du problème, mais j’avais rencontré une mère abandonnée — je trouve ça mieux que « mère célibataire » qui peut laisser penser que sa situation était un choix — épuisée qui n’arrivait pas à contrôler l’énergie de son petit dernier (essentiellement par manque d’aide et de ressources). Elle était soulagée par la mise sous Ritaline de son gosse. C’était effrayant de voir ce gosse domestiqué façon robot, mais je ne pouvais absolument rien dire à ce sujet à cette mère qui était déjà dans une grande souffrance.


    • #shit_storm en vue

      Le petit dernier, l’Adhansia, sort des usines de Purdue Pharma , le laboratoire de l’OxyContin, considéré comme le principal responsable de la crise des #opioïdes (400 000 morts en vingt ans) (11). « Je viens d’un programme où on essaie de baisser les doses, de favoriser les thérapies comportementales, d’arrêter les médicaments, poursuit Mme O’Rourke. Mon but, c’est qu’ils soient capables d’être des enfants, de jouer et d’apprendre. Je n’ai jamais vu d’effets négatifs à long terme, excepté une croissance perturbée. Le plus grand problème, ce serait l’addiction, surtout pour les adolescents, ainsi que la revente. » Pour elle, ça ne fait pas de doute, « la télévision est responsable en grande partie du TDAH. C’est la première baby-sitter du pays ». Dans sa salle d’attente, encore un garçon. Jayden, 12 ans, « ne tient pas en place ». Diagnostiqué hyperactif, il est sous psychotropes depuis quatre ans. Sa mère, Tasha, commente : « Quand il ne les prend pas, il est insupportable. » L’école ? « Je pense que c’est ennuyeux, répond Jayden. Lire est ennuyeux. Rester assis toute la journée est ennuyeux. Je préfère jouer au base-ball avec mon père, ou à Fortnite, World of Warcraft ou NBA 2K [des jeux vidéo] avec mes copains. »

    • On ne parle que des garçons par rapport à ces produits. C’est peut être une solution que les femmes (mères, personnel enseignant et personnel medical qui sont largment fémininisés) ont trouvé pour rendre un peu moins insupportables les comportements masculins.

      « Je préfère jouer au base-ball avec mon père, ou à Fortnite, World of Warcraft ou NBA 2K [des jeux vidéo] avec mes copains. »
      Il me semble qu’il y a une histoire de domination masculine dans tout ceci, les filles sont « rithalinés » sans chimie par la culture du viol.

    • Quand même @monolecte il y a aussi des femmes qui foutent le père dehors, souvent avec raison d’ailleurs ! et même si il est très content de retrouver sa « liberté » et qu’il ne paye pas la pension, j’estime que cela n’en fait pas une « femme abandonnée » pis on dirait qu’on parle d’un chien. Non plus qu’une femme célibataire, d’ailleurs. #famille_monoparentale c’est pas mal parce que oui, même seule avec un enfant c’est une famille, n’en déplaise à certaines pourritures de psys. Alors disons #mère_monoparentale ?

    • @mad_meg

      les filles sont « rithalinés » sans chimie par la culture du viol

      Affreusement d’accord avec toi :/

      https://onlinelibrary.wiley.com/doi/abs/10.1002/cbl.30337

      It is estimated that half to three‐quarters of all women with attention‐deficit/hyperactivity disorder (ADHD) are undiagnosed. Boys are more likely to be given an ADHD diagnosis (13.2%) than girls (5.6%). Girls are also diagnosed, on average, 5 years later than boys (boys at age 7, girls at age 12) (Foley, 2018).

  • Watch Richard Sackler Deny His Family’s Role in the Opioid Crisis — ProPublica
    https://www.propublica.org/article/watch-richard-sackler-deny-his-familys-role-in-the-opioid-crisis

    Des vidéos (répugnantes) de Richard Sackler répondant au procureur du Kentucky. Les yeux clairs des assassins tant décrit par les romans et les chansons.

    Four years ago this week, Dr. Richard Sackler sat in a conference room at a law office in a Louisville, Kentucky, office park. Lawyers for the Kentucky attorney general’s office were taking his deposition as part of the state’s lawsuit alleging that the family business, Purdue Pharma, illegally marketed the opioid painkiller OxyContin by understating its addictive properties.

    Sackler, who has been at various times Purdue’s president and co-chairman of its board, testified for more than eight hours. The lawyers asked him about his role at the company, what decisions he was involved in and whether he believes Purdue played any part in the opioid crisis that has resulted in more than 200,000 overdose deaths related to prescription drugs since 1999.

    Despite hundreds of lawsuits against Purdue stretching back well over a decade, that August 2015 deposition, which was recorded on video, is believed to be the first time any member of the Sackler family was questioned under oath about their role in the marketing of OxyContin.

    #Opioides #Richard_Sackler #Sackler #Vidéos

  • Inside Purdue Pharma’s Media Playbook : How It Planted the Opioid “Anti-Story” — ProPublica
    https://www.propublica.org/article/inside-purdue-pharma-media-playbook-how-it-planted-the-opioid-anti-story

    In 2004, Purdue Pharma was facing a threat to sales of its blockbuster opioid painkiller OxyContin, which were approaching $2 billion a year. With abuse of the drug on the rise, prosecutors were bringing criminal charges against some doctors for prescribing massive amounts of OxyContin.

    That October, an essay ran across the top of The New York Times’ health section under the headline “Doctors Behind Bars: Treating Pain is Now Risky Business.” Its author, Sally Satel, a psychiatrist, argued that law enforcement was overzealous, and that some patients needed large doses of opioids to relieve pain. She described an unnamed colleague who had run a pain service at a university medical center and had a patient who could only get out of bed by taking “staggering” levels of oxycodone, the active ingredient in OxyContin. She also cited a study published in a medical journal showing that OxyContin is rarely the only drug found in autopsies of oxycodone-related deaths.

    “When you scratch the surface of someone who is addicted to painkillers, you usually find a seasoned drug abuser with a previous habit involving pills, alcohol, heroin or cocaine,” Satel wrote. “Contrary to media portrayals, the typical OxyContin addict does not start out as a pain patient who fell unwittingly into a drug habit.”

    The Times identified Satel as “a resident scholar at the American Enterprise Institute and an unpaid advisory board member for the Substance Abuse and Mental Health Services Administration.” But readers weren’t told about her involvement, and the American Enterprise Institute’s, with Purdue.

    Among the connections revealed by emails and documents obtained by ProPublica: Purdue donated $50,000 annually to the institute, which is commonly known as AEI, from 2003 through this year, plus contributions for special events, for a total of more than $800,000. The unnamed doctor in Satel’s article was an employee of Purdue, according to an unpublished draft of the story. The study Satel cited was funded by Purdue and written by Purdue employees and consultants. And, a month before the piece was published, Satel sent a draft to Burt Rosen, Purdue’s Washington lobbyist and vice president of federal policy and legislative affairs, asking him if it “seems imbalanced.”

    Purdue’s tactics are reminiscent of the oil and gas industry, which has been accused of promoting misleading science that downplays its impact on climate change, and of big tobacco, which sought to undermine evidence that nicotine is addictive and secondhand smoke is dangerous.

    Media spinning was just one prong of Purdue’s strategy to fend off limits on opioid prescribing. It contested hundreds of lawsuits, winning dismissals or settling the cases with a provision that documents remain secret. The company paid leading doctors in the pain field to assure patients that OxyContin was safe. It also funded groups, like the American Pain Foundation, that described themselves as advocates for pain patients. Several of those groups minimized the risk of addiction and fought against efforts to curb opioid use for chronic pain patients.

    She has become an influential voice on opioids, addiction and pain treatment. Her writings have been published in The Wall Street Journal, USA Today, The Atlantic, Slate, Health Affairs, Forbes, Politico and elsewhere. She frequently appears on panels, television shows and in newspaper articles as an expert on the opioid crisis and pain prescribing guidelines. “We’ve entered a new era of opiophobia,” she recently told The Washington Post.

    Satel has been a resident scholar at the American Enterprise Institute since 2000. Among the notable figures who have spent time at AEI are the late Supreme Court Justice Antonin Scalia and former Trump national security adviser John Bolton. Current fellow Scott Gottlieb returned to AEI this year after serving as commissioner of the U.S. Food and Drug Administration, which approves and regulates prescription drugs like OxyContin.

    Purdue said its annual payments of $50,000 to AEI were part of the institute’s corporate program. That program offers corporations the opportunity to “gain access to the leading scholars in the most important policy areas for executive briefings and knowledge sharing,” according to the institute’s website.

    Purdue’s counterattack against an ambitious investigative series about OxyContin abuse may have contributed to that drop. An October 2003 series in the Orlando Sentinel, “OxyContin Under Fire,” found that Purdue’s aggressive marketing combined with weak regulation had contributed to “a wave of death and destruction.”

    The series, however, was marred by several errors that were detailed in a front-page correction nearly four months later. The reporter resigned, and two editors on the series were reassigned. While acknowledging the mistakes, the newspaper did not retract the series, and its review upheld the conclusion that oxycodone was involved in a large number of the overdoses in Florida.

    Dezenhall Resources, in an email, took credit for forcing the newspaper to issue the corrections. “Dezenhall’s efforts resulted in a complete front-page retraction of the erroneous 5-day, 19-part, front-page Orlando Sentinel series,” Hershow wrote in a 2006 email summarizing Dezenhall’s work for Purdue under the subject line “Success in Fighting Negative Coverage.”

    Purdue officials and the company’s public relations agencies came up with a 13-point plan to generate media coverage of the errors. It included getting a doctor to talk about how the series “frightened and mislead (sic) the people of Florida” and having a pain patient write a newspaper opinion column on the subject. The Sentinel series, one Purdue official wrote to other company executives and Dezenhall’s Hershow, was an opportunity to let the country know about “all of the sensational reporting on OxyContin abuse over the past 4 years. The conclusion: this is the most overblown health story in the last decade!”

    In the six years after Purdue challenged the Sentinel’s findings, the death rate from prescription drugs increased 84.2% in Florida. The biggest rise, 264.6%, came from deaths involving oxycodone. The state became a hotbed for inappropriate opioid prescribing as unscrupulous pain clinics attracted out of state drug seekers. The route traveled by many from small towns in Appalachia to the Florida clinics was nicknamed the “Oxycontin Express.”

    In 2017, 14 years after the Sentinel series was published, the Columbia Journalism Review described it as “right too soon” and said it “eerily prefigured today’s opioid epidemic.”

    Purdue also added Stu Loeser to its stable. The head of an eponymous media strategy company, Loeser was press secretary for Michael Bloomberg when he was mayor of New York City, and he is now a spokesman for Bloomberg’s possible presidential bid.

    Soon after Loeser began representing Purdue, Satel wrote in a 2018 piece for Politico headlined, “The Myth of What’s Driving the Opioid Crisis,” about “a false narrative” that the opioid epidemic “is driven by patients becoming addicted to doctor-prescribed opioids.”

    Loeser told Purdue executives in an email that “we are going to work with AEI to ‘promote’ this so it comes across as what it is: their thoughtful response to other writing.” His team was working to target the Satel story “to land in social media feeds of people who have searched for opioid issues and potentially even people who have read specific stories online,” he added.

    Loeser said in an interview that he didn’t end up working with AEI to promote the story. He said Purdue is no longer a client.

    Une belle bande d’ordures accoquinée avec une brochette de journaux peu regardants (quoique parmi les meilleurs du monde, ce qui est encore plus inquiétant).

    #Opioides #Sackler #Purdue_Pharma #Médias #Fake_news #Conflits_intérêt #Complicités #New_York_Times #Public_relation

  • Opioid prescription doses are increasingly being tapered, often more rapidly than recommended : Physicians advise caution, collaboration with patients on tapering plans — ScienceDaily
    https://www.sciencedaily.com/releases/2019/11/191118100836.htm

    Baisser trop vite les doses d’opioides a également des conséquences dramatiques... la crise est là pour durer. Il faut la prendre en compte, et faire participer les Sackler et les autres profiteurs et organisateurs de la vente des opioides aux coûts d’une désintoxication réussie.

    Stigma and safety fears have made daily dose tapering of opioid prescriptions more common. New research from UC Davis Health physicians, however, shows tapering can occur at rates as much as six times higher than recommended, putting patients at risk of withdrawal, uncontrolled pain or mental health crises.

    The study — “Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017” — is published in JAMA Network Open. The results also will be presented at the Nov. 16-19 North American Primary Care Research Group meeting in Toronto.

    “Tapering plans should be based on the needs and histories of each patient and adjusted as needed to avoid adverse outcomes,” said study author Alicia Agnoli, assistant professor of family and community medicine. “Unfortunately, a lot of tapering occurs due to policy pressures and a rush to get doses below a specific and sometimes arbitrary threshold. That approach can be detrimental in the long run.”

    They also found that the rate of dose reduction often was well beyond the CDC’s recommendation of 10% per month. The average reduction overall was 27.6% per month. Nearly 20% of patients tapered at a rate of 40% per month, and 5% tapered at a rate faster than 60% per month.

    The 2016 policy could have been misinterpreted, leading many prescribers and health systems to insist on faster-than-recommended tapering, according to Agnoli.

    “There is definitely a lot of pressure to reduce opioid use among patients, but there also is a need for more training and guidance for prescribers on how to help them safely do so,” Agnoli said.

    #Opioides #Désintoxication

  • Amour, gloire et opioïdes – Binge Audio
    https://www.binge.audio/amour-gloire-et-opioides

    Des podcast sur la crise des opioides

    La crise des opioïdes est désormais mondiale : 34 million de personnes en consomment, 27 millions y sont accros, et les morts se comptent par centaines de milliers.

    Cette crise est particulièrement forte aux Etats-Unis, où une famille est considérée comme responsable de cette addiction généralisée : les Sackler, propriétaires des laboratoires Purdue Pharma qui commercialisent l’OxyContin, le médicament à l’origine du problème.

    Retour sur l’histoire de cette famille, milliardaire et mécène, devenue paria.

    #Sackler #Opioides

  • Addicted to Screens? That’s Really a You Problem - The New York Times
    https://www.nytimes.com/2019/10/06/technology/phone-screen-addiction-tech-nir-eyal.html

    Nir Eyal does not for a second regret writing Silicon Valley’s tech engagement how-to, “Hooked: How to Build Habit-Forming Products,” even as he now has a new book out on how to free ourselves of that same addiction.

    In his original manual for building enthralling smartphone apps, Mr. Eyal laid out the tricks “to subtly encourage customer behavior” and “bring users back again and again.” He toured tech companies speaking about the Hook Model, his four-step plan to grab and keep people with enticements like variable rewards, or pleasures that come at unpredictable intervals.

    “Slot machines provide a classic example of variable rewards,” Mr. Eyal wrote.

    Silicon Valley’s technorati hailed “Hooked.” Dave McClure, the founder of 500 Startups, a prolific incubator, called it “an essential crib sheet for any start-up looking to understand user psychology.”

    But that was 2014. That was when making a slot-machinelike app was a good and exciting thing. When “seductive interaction design” and “design for behavior change” were aspirational phrases.

    “Nir Eyal’s trying to flip,” said Richard Freed, a child psychologist who supports less screen time. “These people who’ve done this are all trying to come back selling the cure. But they’re the ones who’ve been selling the drugs in the first place.”

    “I’m sure the cigarette industry said there’s just a certain number of people with a propensity for lung disease,” he added.

    Mr. Eyal said he was not reversing himself. His Hook Model was useful, certainly, and he believed in the tactics. But it was not addicting people. It’s our fault, he said, not Instagram’s or Facebook’s or Apple’s.

    “It’s disrespectful for people who have the pathology of addiction to say, ‘Oh, we all have this disease,’” he said. “No, we don’t.”

    #Médias_sociaux #Addiction #Dopamine #Mir_Eyal

  • Purdue Pharma Warns That Sackler Family May Walk From Opioid Deal - The New York Times
    https://www.nytimes.com/2019/09/19/health/purdue-sackler-opioid-settlement.html

    Après avoir été maïtres-assdassins, les Sacklers deviennent Maîtres chanteurs. Belle famille.
    Pour tout savoir, un seul livre : « Addiction sur ordonnance » par Patrick Radden Keefe https://cfeditions.com/addiction

    Members of the Sackler family could withdraw their pledge to pay $3 billion as part of a nationwide deal to address the opioid crisis if a bankruptcy judge does not block outstanding state lawsuits against them and their company, Purdue Pharma, Purdue lawyers said in a legal complaint.

    Whether the threat is posturing or real, the move by Purdue, the maker of OxyContin, to inject it into the company’s bankruptcy proceeding could jeopardize the tentative settlement it reached last week with representatives of thousands of local governments that have brought lawsuits against it. Two dozen state attorneys general who have sued the company in their own courts have signed on to the agreement, too.

    The $3 billion to be paid over seven years, plus another contribution the Sacklers would make with the proceeds of the sale of their British drug company, Mundipharma, is a key component of the deal. But all lawsuits must be resolved, the lawyers said.

    The new complaint, filed in bankruptcy court in White Plains on Wednesday night, is aimed at about two dozen states that have not signed on to the settlement and are continuing to pursue cases against both the company and various Sacklers.

    #Sackler #Too_much #Opioides

  • En ciblant Purdue Pharma, « l’appareil judiciaire américain s’attaque au capitalisme débridé »
    https://www.lemonde.fr/economie/article/2019/09/16/en-ciblant-purdue-pharma-l-appareil-judiciaire-americain-s-attaque-au-capita

    Aujourd’hui, face à une crise qui à elle seule a réussi à faire chuter l’espérance de vie aux Etats-Unis, la quasi-totalité des Etats du pays a lancé des poursuites pour réclamer des dédommagements au nom du million de familles touchées par ce fléau. Au total, 2 600 plaintes ont été enregistrées. Pour tenter d’éteindre l’incendie, la société a demandé, dimanche 15 septembre, à être placée sous la protection du chapitre 11 de la loi sur les faillites. Et elle propose une résolution globale spectaculaire : la nationalisation de Purdue.
    Nationalisation des pertes

    Il s’agirait de confier la gestion de l’entreprise et l’ensemble de ses gains futurs à un trust représentant les Etats, l’ensemble des bénéfices leur étant reversés pour financer l’aide aux victimes et la recherche sur la lutte contre l’addiction. La transaction est évaluée à dix milliards de dollars et la famille Sackler a promis d’y ajouter trois milliards. Vingt-neuf Etats et territoires ont accepté la transaction, mais 26 autres s’y opposent formellement, dont celui de New York.

    Ils ne sont pas du tout d’accord avec cette nouvelle version de la privatisation des gains et de la nationalisation des pertes. Car, durant toutes ces années, la famille Sackler a vu sa fortune exploser, pour représenter, selon Forbes, près de 13 milliards de dollars. Elle doit rendre gorge, exigent les procureurs généraux, sortes de ministre de la justice des Etats. D’autant que l’enquête de celui de New York affirme que près d’un milliard de dollars aurait été discrètement envoyé en Suisse pour échapper au fisc.

    #Purdue_Pharma #Opioides #Capitalisme_sauvage #Sackler

  • Tentative opioids settlement falls short of nationwide deal
    https://www.apnews.com/fcb693fee634449cb8a0dc146251b18d

    HARTFORD, Conn. (AP) — A tentative settlement announced Wednesday over the role Purdue Pharma played in the nation’s opioid addiction crisis falls short of the far-reaching national settlement the OxyContin maker had been seeking for months, with litigation sure to continue against the company and the family that owns it.

    The agreement with about half the states and attorneys representing roughly 2,000 local governments would have Purdue file for a structured bankruptcy and pay as much as $12 billion over time, with about $3 billion coming from the Sackler family. That number involves future profits and the value of drugs currently in development.

    In addition, the family would have to give up its ownership of the company and contribute another $1.5 billion by selling another of its pharmaceutical companies, Mundipharma.

    Several attorneys general said the agreement was a better way to ensure compensation from Purdue and the Sacklers than taking their chances if Purdue files for bankruptcy on its own.

    Arizona Attorney General Mark Brnovich said the deal “was the quickest and surest way to get immediate relief for Arizona and for the communities that have been harmed by the opioid crisis and the actions of the Sackler family.”

    In a statement after Wednesday’s announcement, the company said that it “continues to work with all plaintiffs on reaching a comprehensive resolution to its opioid litigation that will deliver billions of dollars and vital opioid overdose rescue medicines to communities across the country impacted by the opioid crisis.”

    Even with Wednesday’s development, many states have not signed on. Several state attorneys general vowed to continue their legal battles against the Sacklers and the company in bankruptcy court. Roughly 20 states have sued members of the Sackler family in state courts.

    Connecticut, Iowa, Massachusetts, Nevada, New Jersey, New York, Pennsylvania, North Carolina and Wisconsin were among the states saying they were not part of the agreement.

    “Our position remains firm and unchanged and nothing for us has changed today,” Connecticut Attorney General William Tong said in a statement.

    “The amount of money that’s being offered in this settlement doesn’t even scratch the surface for what’s needed,” Hampton said. “We want to see Purdue have their day in court. We know more money will come if this case goes to trial.”

    Les ordures sans vergogne :

    On Wednesday, the Sackler family said in a statement that it “supports working toward a global resolution that directs resources to the patients, families and communities across the country who are suffering and need assistance.”

    “This is the most effective way to address the urgency of the current public health crisis, and to fund real solutions, not endless litigation,” it said.

    In March, Purdue and members of the Sackler family reached a $270 million settlement with Oklahoma to avoid a trial on the toll of opioids there.

    A court filing made public in Massachusetts this year asserts that members of the Sackler family were paid more than $4 billion by Purdue from 2007 to 2018. Much of the family’s fortune is believed to be held outside the U.S., which could complicate lawsuits against the family over opioids.

    The Sacklers have given money to cultural institutions around the world, including the Smithsonian Institution, New York City’s Metropolitan Museum of Art and London’s Tate Modern.

    #Opioides #Sackler #Procès #Accord_amiable

  • Sacklers Reject Demand That They Surrender Personal Wealth To Settle Opioid Claims : NPR
    https://www.npr.org/2019/09/09/758927743/sacklers-reject-demand-they-surrender-personal-wealth-to-settle-opioid-claims

    The family that owns Purdue Pharma, maker of Oxycontin, has rejected a demand that they give up $4.5 billion of their personal wealth to settle opioid claims against the company, according to state attorneys general negotiating with the company.

    As a consequence, talks toward a national settlement with members of the Sackler family reached an impasse over the weekend, according to an email obtained by NPR.

    Two attorneys general directly involved in the talks predicted in the email that the company will now file for bankruptcy “imminently.”

    “States have already begun preparations for handling the bankruptcy proceedings,” wrote Josh Stein, North Carolina’s state attorney general, and Herbert Slatery, attorney general for Tennessee.

    “The Sacklers refused to budge,” the email concluded, “and have declined to offer any counterproposal.”

    The email, first reported by The Associated Press, was sent Saturday to other state attorneys general. It details an offer made to the Sacklers that would have forced them to pay billions of dollars to compensate states for their role helping to fuel the prescription opioid epidemic.

    The deal would also have forced Purdue Pharma into bankruptcy proceedings while dissolving the Sacklers’ overseas opioid business.

    But in a statement emailed to NPR Sunday night, the drug company suggested a deal might still be possible.

    “Purdue Pharma believes a settlement that benefits the American public now is a far better path than years of wasteful litigation and appeals,” the statement said. “Those negotiations continue and we remain dedicated to a resolution that genuinely advances the public interest.”

    Overdose deaths linked to prescription opioids have killed more than 218,000 Americans since the addiction crisis began in the late 1990s, according to the Centers for Disease Control and Prevention.

    State and local governments have filed more than 2,000 lawsuits claiming Purdue Pharma played a central role marketing opioid medications, while downplaying the risks.

    Over two decades, opioid sales generated billions of dollars in profits for the company, making the Sacklers one of the richest families in the U.S.

    A spokesperson for Purdue Pharma declined an interview request by NPR and wouldn’t say whether the company is, in fact, considering an immediate bankruptcy filing. Last March, company officials acknowledged that filing for Chapter 11 protection is one strategy being considered.

    If Purdue Pharma does file for bankruptcy without first reaching some kind of structured deal, it could take years to sort out the remaining value of the company’s assets and then determine who’s first in line for compensation.

    Pressure to reach a settlement is also intensifying because a federal opioid trial involving Purdue Pharma and more than 20 other drugmakers, distributors and pharmacy chains is set to begin next month in Cleveland.

    While that legal process moves forward, state attorneys general have promised to continue pursuing the Sacklers personally to recoup profits the family received from opioid sales, even if Purdue Pharma seeks Chapter 11 protection.

    “I won’t let them get away with their crimes,” Pennsylvania Attorney General Josh Shapiro wrote Saturday on Twitter. “I will sue them personally, so that we can dig into their personal pocketbooks.”

    The Wall Street Journal also reported Friday that the U.S. Justice Department is involved in separate talks with Purdue Pharma.

    According to the newspaper, those negotiations involve possible civil penalties tied to federal probes of Oxycontin sales, but could also include criminal charges using statutes normally used to prosecute drug dealers.

    #Opioides #Sackler #Procès

  • Opinion | These Newborn Babies Cry for Drugs, Not Milk - The New York Times
    https://www.nytimes.com/2019/09/07/opinion/sunday/babies-opioid-addiction-west-virginia.html

    Un éditorial plein de fougue et de colère, très bien écrit et qui pose les véritables questions de la rapacité, des entreprises et de la défaillance du système pour réguler celles-ci.

    His body dependent on opioids, he writhes, trembles and cries. He is exhausted but cannot sleep. He vomits, barely eats and has lost weight.

    He is also a baby. Just 1 month old, he wails in the nursery of the CAMC Women and Children’s Hospital here. A volunteer “cuddler” holds him while walking around, murmuring sweetly, hour after hour, but he is inconsolable. What his body craves is heroin.

    Every 15 minutes in America, a child is born after a prenatal exposure to opioids. Here in West Virginia, 14 percent of babies are born exposed to drugs, and perhaps 5 percent more to alcohol, totaling nearly one out of five newborns. Some get by without symptoms, but for many, their very first experience after birth is the torment of withdrawal.

    Pharmaceutical executives are battling lawsuits by blaming drug users. I wish those executives had to cuddle these infants who, partly because of their reckless greed, suffer so much.

    Executives in three-piece suits were drug lords as guilty as any from Medellín. The Washington Post reported that pharma companies shipped 76 billion opioid pain pills from 2006 through 2012. A single pharmacy in Kermit, W.V., sold more than 13 million over those seven years — and Kermit has a population of just over 400 people.

    So today, hospitals in West Virginia and across America struggle to calm babies who sometimes begin to go through withdrawal as soon as the umbilical cord is cut.

    There’s plenty of blame to go around, encompassing opioid-abusing moms and opioid-prescribing doctors. But it’s appropriate to feel special loathing for executives at pharma companies whose corporate strategy was to profit by getting people hooked. Some of the companies funded a movement claiming that pain was the “fifth vital sign” and urged doctors to prescribe more painkillers, and then paid them kickbacks to do so.

    Almost 80 percent of heroin users began with prescription pain pills, though not necessarily prescribed to them.

    Newborn babies struggling through withdrawal are only one dimension of America’s opioid crisis. Every seven minutes another American dies of an overdose; 2.1 million children live with a parent with a drug dependency.

    McKinsey and Company, the global consulting company, issued a sober report last fall warning that “the opioid crisis will worsen over the next three to five years.” What McKinsey didn’t say was that it had previously advised Johnson & Johnson to be more aggressive in peddling opioids for back pain and to encourage doctors to prescribe stronger, more addictive pills.

    These drug-addicted newborns are suffering partly because of Johnson & Johnson, McKinsey, Purdue Pharma, McKesson and many other companies; these babies are a reminder of why corporate regulation is essential.

    #Opioides #Bébés

  • Opioid crisis goes global as deaths surge in Australia
    https://www.apnews.com/cfc86f47e03843849a89ab3fce44c73c

    Half a world away, Australia has failed to heed the lessons of the United States, and is now facing skyrocketing rates of opioid prescriptions and related deaths. Drug companies facing scrutiny for their aggressive marketing of opioids in America have turned their focus abroad, working around marketing regulations to push the painkillers in other countries. And as with the U.S., Australia’s government has also been slow to respond to years of warnings from worried health experts.

    In dozens of interviews, doctors, researchers and Australians whose lives have been upended by opioids described a plight that now stretches from coast to coast. Australia’s death rate from opioids has more than doubled in just over a decade. And health experts worry that without urgent action, Australia is on track for an even steeper spike in deaths like those seen in America, where the epidemic has left 400,000 dead.

    “If only Australia could understand how quickly this can get out of hand. We’re not immune to it,” says Jasmin Raggam, whose brother Jon died in 2014 of an opioid overdose and whose brother-in-law is now addicted to the opioid OxyContin. “I was screaming from the mountaintops after Jon died and I’d started doing my research. And it was like I’m screaming and nobody wants to hear me.”

    Opioids were once reserved for treating pain that was short-term, terminal or related to cancer. But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic pain.

    Starting in 2000, Australia began approving and subsidizing certain opioids for use in chronic, non-cancer pain. Those approvals coincided with a spike in opioid consumption, which nearly quadrupled between 1990 and 2014, says Sydney University researcher Emily Karanges.

    A few years ago, a pharmacist at the hospital told her they needed to hire an extra person just to handle all the prescriptions they were handing out for Endone, a brand of oxycodone. Stevens discovered that the hospital’s Endone prescriptions had increased 500 percent in 8 years, with no decrease in other opioids dispensed. Further study revealed that 10 percent of patients were still taking opioids three months after surgery, even though the drugs are generally only recommended for short-term use.

    “We were just pumping this stuff out into our local community, thinking that that had no consequences,” says Stevens, a vocal advocate for changing opioid prescribing practices. “And now, of course, we realize that it does have huge consequences.”

    Just like in the U.S., as opioid prescriptions rose, so did fatal overdoses. Opioid-related deaths jumped from 439 in 2006 to 1,119 in 2016 — a rise of 2.2 to 4.7 deaths per 100,000 people, according to the Australian Institute of Health and Welfare. Most of those deaths were related to prescription opioids, rather than illegal opioids such as heroin.

    More than 3 million Australians - an eighth of the country’s population - are getting at least one opioid prescription a year, according to the latest data.

    In Australia, pharmaceutical companies by law cannot directly advertise to consumers, but are free to market the drugs to medical professionals. And they have done so, aggressively and effectively, by sponsoring swanky conferences, running doctors’ training seminars, funding research papers, giving money to pain advocacy groups and meeting with doctors to push the drugs for chronic pain.

    “If the relevant governing bodies had ensured that the way the product was being marketed to doctors especially was different, I don’t necessarily think we would see what we’re seeing now,” says Bee Mohamed, who until recently was the CEO of ScriptWise, a group devoted to reducing prescription drug deaths in Australia. “We’re trying to undo ten years of what marketing has unfortunately done.”

    Mundipharma, the international arm of Purdue, has received particular criticism for its marketing tactics in Australia. In 2018, addiction specialist Dr. Simon Holliday filed a complaint against the company over a marketing pamphlet for its drug Targin, a painkiller designed to prevent the constipation that is common with other opioids.

    The campaign, which encouraged people suffering painkiller-induced constipation to talk to their doctors, never mentions Targin by name, because it legally can’t. But the advertising agency Mundipharma hired described on its website how they worked around that regulation, by using print, radio and online ads to target regions where pain medication use was high. Google search data showed that people looking for information on constipation from painkillers used terms like “blocked up,” so the agency used the phrase “blocked pipes.”

    In a statement, Mundipharma said the campaign was a “disease awareness initiative” that did not violate the spirit of any law and did not market any medication.

    Stevens, the Sydney pain specialist, has pushed back against several drug companies over their marketing tactics. A couple years ago, she says, Mundipharma was marketing Targin to surgeons at her hospital, reassuring them that they could prescribe higher doses. Unlike pain specialists, surgeons are generally not well-educated on the intricacies of opioids, she says.

    In a statement, Mundipharma said it strictly adheres to the Medicines Australia code of conduct and has always been transparent about the risks associated with opioids. Still, in a submission last year to the TGA as it considered tougher restrictions on opioids, Mundipharma appeared to minimize the severity of Australia’s problem.

    “We acknowledge that there is an issue associated with opioid misuse,” the company wrote. “However to describe the Australian situation as a ‘crisis’ is alarmist and risks stigmatizing patients who have a legitimate need for opioid analgesics to manage their pain.”

    This is Australia’s poorest state, and like Appalachia, it is the country’s epicenter for opioids. Tasmania has the nation’s highest rate of opioid packs sold per person — 2.7 each. One region has the highest number of government-subsidized opioid prescriptions in Australia: more than 110,000 for every 100,000 people.

    Ten years ago, while working as a dairy farmer, Casey jumped off a truck and felt her knees give way. An operation provided temporary relief, but the pain came back. She was told she had osteoarthritis.

    A doctor prescribed her opioids to ease her pain. When she stuck the first patch on her skin, it felt like heaven.

    But the agony eventually returned, so the doctor upped the dosage. The side effects were hell — depression, anxiety, panic attacks. And her pain got worse.

    #Opioides #Australie #Mundipharma

  • Addiction treatment costs: She spent more than $110,000 on drug rehab. Her son still died. - Vox
    https://www.vox.com/policy-and-politics/2019/9/3/20750587/rehab-drug-addiction-treatment-sean-blake-opioid-epidemic

    In story after story, the same experience was repeated over and over: of patients and families getting sucked into an American rehab industry that is largely unregulated, shockingly ineffective, and ruinously expensive.

    Vox is launching an investigation into the notoriously opaque addiction rehab industry, called The Rehab Racket. We’re crowdsourcing the experiences of patients and families, with an emphasis on cost and quality of care. If you have a story you’d like to share with us, please visit our submissions page.

    Vox has launched The Rehab Racket, an investigation into America’s notoriously opaque addiction treatment industry. As part of this, we’re crowdsourcing patients and families’ rehab stories, with an emphasis on the cost of treatment and quality of care. If you’d like help our reporting by sharing your story, please fill out this survey.

    Addiction treatment is difficult work, but it can succeed, and evidence-based care does exist. For opioid addiction in particular, studies show medications like methadone and buprenorphine cut the death rate among patients by half or more.

    But the parents I spoke to have learned — as thousands of Americans discover each year — that much of the US rehab industry does not provide evidence-based, effective care.

    American rehab is dominated by a 12-step approach, modeled after Alcoholics Anonymous, that only works for some patients and doesn’t have strong evidence of effectiveness outside of alcohol addiction treatment.

    That’s often coupled with approaches that have even less evidence behind them. There’s wilderness therapy, focused largely on outdoor activities. There’s equine therapy, in which people are supposed to connect with horses. There’s a confrontational approach, which is built around punishments and “tough love.” The research for all these is weak at best, and with the confrontational approach, the evidence suggests it can even make things worse.

    “It is a scam,” Carol Beyer, founder of Families for Sensible Drug Policy and a mom in New Jersey, told me. She estimates she spent well over $100,000 on treatment — including 12-step and “tough love” programs — and still lost her two sons to drug overdoses.

    #Opioides #Rehabilitation #Capitalisme_sauvage

  • #Overdoses aux #opioïdes : l’#antidote existe mais reste trop difficile à se procurer
    https://www.francetvinfo.fr/sante/medicament/overdoses-aux-opioides-l-antidote-existe-mais-n-est-pas-encore-assez-di

    L’antidote à base de #naloxone pour stopper en urgence une surdose d’opioïdes médicamenteux ou illicites comme l’héroïne est encore très loin d’être facilement accessible à tous, ont dénoncé samedi 31 août l’association France patients experts addictions et plusieurs spécialistes.

    Des kits d’antidotes prêts à l’emploi pour stopper l’overdose en attendant l’arrivée des secours sont actuellement commercialisés en France : une forme injectable en intramusculaire, le Prenoxad, depuis mai 2019, et un spray nasal, le Nalscue, depuis 2018. "La procédure pour commander le Prenoxad est trop compliquée, les pharmaciens doivent s’adresser directement au laboratoire. En pratique, il n’est pas vraiment à la disposition de tous", explique le Pr Michel Reynaud, président du Fonds actions addictions.

    Une pharmacie sur quarante

    « D’après un testing réalisé avec une association d’usagers de drogues, l’antidote n’était présent que dans une pharmacie sur quarante et les deux tiers des pharmacies ne connaissaient pas ce produit », relève Michel Reynaud.

    La situation en France est certes sans commune mesure avec la crise des opioïdes aux Etats-Unis et leurs plus de 70 000 décès en 2017, selon le ministère de la Santé. Mais la tendance à l’augmentation des overdoses ces dernières années est préoccupante, en particulier celles dues à des médicaments antidouleurs, selon le Pr Nicolas Authier, de l’Observatoire français des médicaments antalgiques (Ofma)."Entre 2000 et 2015, les décès par overdoses d’opioïdes médicaments (hors héroïne et méthadone) sont passés de 75 à 200", dit-il et « c’est probablement une sous-estimation ».