• Etats-Unis : l’accord à 26 milliards sur les opiacés prêt pour la prochaine étape
    https://www.letemps.ch/economie/etatsunis-laccord-26-milliards-opiaces-pret-prochaine-etape

    Trois distributeurs américains de médicaments et le laboratoire Johnson & Johnson ont reçu le soutien d’assez d’Etats pour passer à la prochaine étape de l’accord lié aux opiacés. Ils ont accepté en juillet de payer 26 milliards de dollars pour solder des litiges.

    Ce règlement à l’amiable doit leur permettre d’éviter des milliers d’actions en justice intentées par des Etats américains et collectivités locales qui accusent les entreprises d’avoir un rôle dans cette crise sanitaire, à l’origine de plus de 500 000 morts par overdose en 20 ans aux Etats-Unis.

    #AmerisourceBergen, #Cardinal_Health et #McKesson ont, dans un communiqué commun, expliqué avoir reçu le feu vert de 42 des 49 Etats qui les poursuivaient, ainsi que du district de Washington, la capitale, et de cinq territoires américains.

    Le laboratoire pharmaceutique Johnson & Johnson a indiqué dans un message séparé être aussi prêt à passer à la prochaine étape prévue dans l’accord. « Ce règlement ne constitue pas une admission de responsabilité ou d’acte répréhensible et l’entreprise continuera de se défendre contre tout litige que l’accord final ne résout pas », a souligné la société.

    Aux collectivités locales de se prononcer
    Johnson & Johnson, qui fait partie des laboratoires accusés d’avoir alimenté la crise en produisant des opiacés, a confirmé en juin avoir arrêté la production et la vente de ces substances. Les distributeurs de médicaments sont, eux, accusés d’avoir fermé les yeux sur des commandes d’opiacés suspectes.

    Selon les termes négociés, le versement des 26 milliards de dollars (23,7 milliards de francs) - qui doivent permettre aux Etats et collectivités de financer les traitements rendus nécessaires par ce fléau - dépend du nombre d’Etats américains qui valideront l’accord.

    Chaque Etat participant a maintenant jusqu’au 2 janvier pour demander à leurs collectivités locales respectives si elles veulent aussi être parties prenantes à l’accord. Si les conditions sont remplies, l’accord entrera en vigueur « 60 jours après que les distributeurs auront déterminé qu’il y a une participation suffisante pour procéder », détaille le communiqué.

    S’il se confirme, l’accord sera le plus important de l’épique et complexe bataille juridique engagée par les Etats et collectivités américaines pour faire payer les entreprises.

    #Johnson_&_Johnson #opioides #sackler #big_pharma #purdue_pharma #oxycontin #procès #addiction #opioïdes #santé #pharma #purdue #opiacés #etats-unis #drogue #opioids #mundipharma #marketing #McKinsey

  • Le « naming », un piège à Louvre Texte Nicolas Cori Photo Denis Allard/Réa Édité par François Meurisse - 6 Aout 2019 - Les Jours

    Le musée s’est embourbé dans un contrat de mécénat avec la généreuse famille Sackler, accusée d’avoir créé la crise des opioïdes aux États-Unis.

    Prenez La Joconde, son sourire mystérieux et ses millions de visiteurs annuels. Imaginez maintenant des hordes d’activistes dénoncer régulièrement devant elle la complicité du Louvre face à l’une des plus grandes crises sanitaires qu’ait connues les États-Unis.
    Un tel scénario a dû donner des cauchemars à la direction du musée parisien. Le 1er juillet dernier, une poignée de militants emmenés par la photographe américaine Nan Goldin, les pieds dans l’eau et des banderoles à la main, ont manifesté devant la pyramide du Louvre afin de demander à ce que l’aile Sackler des antiquités orientales soit débaptisée. La famille Sackler est propriétaire du groupe pharmaceutique Purdue Pharma, accusé d’avoir incité les médecins américains à prescrire à tout va depuis le début des années 2000 de l’Oxycontin, un analgésique contenant de l’opium, créant ainsi la plus grosse épidémie d’overdoses médicamenteuses jamais vue outre-Atlantique. Eh bien, quelques semaines après ce modeste happening, la direction du Louvre a décidé d’effacer en toute discrétion le nom de Sackler de ses salles, tout en adoptant une communication très alambiquée.

    Interrogé le 16 juillet sur RTL, Jean-Luc Martinez, le président du Louvre, a ainsi affirmé qu’il n’avait pas à « débaptiser ces salles » car elles ne portaient « plus le nom de Sackler » depuis des années, étant donné que le « nommage » des salles – datant des années 1990 – ne durait que « vingt ans ». Une information que, visiblement, seul l’intéressé possédait : pourquoi une manifestation quinze jours auparavant sinon ? Cet épisode est révélateur de la gêne de la direction du Louvre, mais aussi des problèmes éthiques pesant sur l’une des contreparties (lire l’épisode 2, « Les riches jouent aux gros dons ») les plus contestables du mécénat : le « naming » ou « nommage » d’espaces pour remercier un donateur particulièrement généreux. Permettre qu’une entreprise ou une personne fortunée donne son nom à un bout de musée, c’est prendre le risque de voir la réputation de l’établissement mise à mal si le mécène ne s’avère pas sans reproches. Et qui est sans tache ? Le récit du mécénat Sackler au Louvre permet de s’en rendre compte..

    Overdoses
    En 2015, le nombre d’overdoses mortelles dues à des médicaments opioïdes a atteint le chiffre de 33 000 contre 4 000 en 1994, avant l’introduction de l’Oxycontin. Ce médicament était à l’origine destiné à soulager les malades du cancer mais la firme Purdue Pharma a développé une politique marketing très agressive, convaincant les médecins de prescrire ce médicament à tous les publics. . . . . . . .

    La suite, payante sur : https://lesjours.fr/obsessions/mecenes-mecenat/ep5-louvre-sackler

    #art #musée #mécénat #culture #peinture #musées #exposition #mémoire #merci #france #opioides #sackler #Oxycontin #big_pharma #drogues #opiacés #addiction #drogue #pharma #santé_publique #overdose #opioids #Louvre #naming

    • Le discours de Nan Goldin
      « Je suis ici aujourd’hui pour demander à ce que le Louvre retire le nom “Sackler”. Il y a douze salles dans le département des antiquités orientales qui ont le nom “Sackler”. Les Sackler possèdent un groupe pharmaceutique qui a déchaîné la plus grande crise de santé publique aux États-Unis. Les gens meurent à cause d’eux. (…) 1,7 million de personnes sont dépendantes. »

  • Obama officials failed to focus as fentanyl burned its way across America - Washington Post
    https://www.washingtonpost.com/graphics/2019/national/fentanyl-epidemic-obama-administration

    In the span of a few short years, fentanyl, a synthetic painkiller 50 times more powerful than heroin, became the drug scourge of our time. Fentanyl has played a key role in reducing the overall life expectancy for Americans.

    If current trends continue, the annual death toll from #fentanyl will soon approach those from guns or traffic accidents. Among the dead are the anonymous and the famous, including musicians Prince and Tom Petty . It is so powerful that just a few flecks the size of grains of salt can cause rapid death.


    #opioids

  • Our Incomplete List of Cultural Institutions and Initiatives Funded by the Sackler Family
    https://hyperallergic.com/419850/our-incomplete-list-of-cultural-institutions-and-initiatives-funded-b

    As the opioid epidemic continues — according to a Quartz headline published earlier this month “US millennials were almost 20% more likely to die in 2016 than 2014” — everyone from politicians to everyday citizens is trying to not only help those already addicted, but to also hold accountable the pharmaceutical companies that precipitated the rise of dangerously addictive opioid prescriptions.

    In this month’s Artforum (which is still co-owned by Knight Landesman), photographer Nan Goldin wrote a heartbreaking account of how she got hooked on OxyContin herself and barely survived. As many others have already done, Goldin noted that the Sackler family, whose name we see on so many museum, library, and hospital walls, is the one responsible. “They have washed their blood money through the halls of museums and universities around the world,” she wrote. “We demand that the Sacklers and Purdue Pharma use their fortune to fund addiction treatment and education. There is no time to waste.”

    The Sacklers are one of the wealthiest families in the world (more than the Rockefellers or Mellons, according to an October article in The New Yorker), at least partially due to the success of their pharmaceutical company, Purdue Pharma, and their deliberate downplaying of the addictiveness of OxyContin. Although Purdue Pharma pleaded guilty to felony charges in 2007 for misleading doctors, the Sackler family has never been held personally responsible.

    While Goldin’s #shameonsackler movement seeks to force the Sacklers to admit accountability, we’ve created a guide to many of the arts and cultural organizations that receive funding from the family. We recognize that this is an incomplete list; we will keep adding to it in the coming days.

    #Opioides #Opioids

  • The Arthur Sackler Family’s Ties to OxyContin Money - The Atlantic
    https://www.theatlantic.com/health/archive/2018/04/sacklers-oxycontin-opioids/557525

    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.”

    Arthur died eight years before OxyContin hit the marketplace. His widow, Jillian Sackler, and Elizabeth, who is Jillian’s stepdaughter, are represented by separate public-relations firms and have successfully won clarifications and corrections from media outlets for suggesting that sales of the potent opioid enriched Arthur Sackler or his family.

    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.

    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.

    #Opioids #Sackler

  • The Family That Built an Empire of Pain | The New Yorker
    https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain?mbid=social_twitter

    While the Sacklers are interviewed regularly on the subject of their generosity, they almost never speak publicly about the family business, Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin. Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue.

    #opioids_epidemic ou quelque chose comme ça

    • “I don’t know how many rooms in different parts of the world I’ve given talks in that were named after the Sacklers,” Allen Frances, the former chair of psychiatry at Duke University School of Medicine, told me. “Their name has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.”

  • Ex-DEA agent: Opioid crisis fueled by drug industry and Congress - CBS News
    https://www.cbsnews.com/news/ex-dea-agent-opioid-crisis-fueled-by-drug-industry-and-congress

    Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities — knowing that people were dying — and says industry lobbyists and Congress derailed the DEA’s efforts to stop it

    Joe Rannazzisi is a tough, blunt former DEA deputy assistant administrator with a law degree, a pharmacy degree and a smoldering rage at the unrelenting death toll from opioids. His greatest ire is reserved for the distributors — some of them multibillion dollar, Fortune 500 companies. They are the middlemen that ship the pain pills from manufacturers, like Purdue Pharma and Johnson & Johnson to drug stores all over the country. Rannazzisi accuses the distributors of fueling the opioid epidemic by turning a blind eye to pain pills being diverted to illicit use.

    BILL WHITAKER: Had you ever seen anything like that before?

    JOE RANNAZZISI: Never. In fact— it was my opinion that this made the whole crack epidemic look like nothing.

    JOE RANNAZZISI These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.

    A distributor’s representative told us the problem is not distributors but doctors who overprescribe pain medication, but the distributors know exactly how many pills go to every drug store they supply. And they are required under the Controlled Substances Act to report and stop what the DEA calls “suspicious orders” — such as unusually large or frequent shipments of opioids. But DEA investigators say many distributors ignored that requirement.

    JIM GELDHOF: They had a business plan. Their plan was to sell a lotta pills and make a lot of money. And they did both of those very well.

    In 2008, the DEA slapped McKesson, the country’s largest drug distributor, with a $13.2 million dollar fine. That same year, Cardinal Health paid a $34 million fine. Both companies were penalized by the DEA for filling hundreds of suspicious orders — millions of pills.

    Over the last seven years, distributors’ fines have totaled more than $341 million. The companies cried foul and complained to Congress that DEA regulations were vague and the agency was treating them like a foreign drug cartel. In a letter, the healthcare distribution alliance, which represents distributors, told us they wanted to work with the DEA. Effective enforcement, they wrote, “must be a two-way street.”

    Jim Geldhof says his investigations were getting bogged down too. He was looking into one mid-sized distributor that had shipped more than 28 million pain pills to pharmacies in West Virginia over five years. About 11 million of those pills wound up in Mingo County, population 25,000. Suddenly, he said, he ran into roadblocks from one of attorney Jonathan Novak’s bosses.

    JIM GELDHOF: “I spent a year working on this case. I sent it down there and it’s never good enough. Every time I talked to this guy he wants something else. And I get it for ’em and that’s still not good enough.” You know? And this goes on and on and on. When this— these roadblocks keep— get thrown up in your face, at that point you know they just don’t want the case.

    He said one big reason for the slowdown: DC’s notorious revolving door. Novak said he saw a parade of DEA lawyers switch sides and jump to high-paying jobs defending the drug industry. Once they’d made the leap, they lobbied their former colleagues, novak’s bosses, and argued the dea’s cases were weak and ultimately would lose in court. It had a chilling effect on dea litigators.

    JONATHAN NOVAK: Some of the best and the brightest former DEA attorneys are now on the other side and know all of the — the — the weak points. Their fingerprints are on, memos and policy and — and — and emails going out where you see this concoction of what they might argue in the future.

    The bill, introduced in the House by Pennsylvania Congressman Tom Marino and Congresswoman Marsha Blackburn of Tennessee, was promoted as a way to ensure that patients had access to the pain medication they needed.

    Jonathan Novak, who worked in the DEA’s legal office, says what the bill really did was strip the agency of its ability to immediately freeze suspicious shipments of prescription narcotics to keep drugs off U.S. streets — what the DEA calls diversion.

    JONATHAN NOVAK: You’re not gonna be able to hold anyone higher up the food chain accountable.

    BILL WHITAKER: Because of this law?

    JONATHAN NOVAK: Because of this law

    Tom Marino a été proposé par Trump pour devenir le “drug czar” de la la Maison Blanche... mais il a du se retirer suite à cette émission.

    Who drafted the legislation that would have such a dire effect? The answer came in another internal Justice Department email released to 60 Minutes and The Washington Post under the Freedom of Information Act: “Linden Barber used to work for the DEA. He wrote the Marino bill.”

    Ad: Hi, My name is Linden Barber. I’m the director of the DEA litigation and compliance practice at Quarles and Brady’s Health Law Group.

    Barber went through the revolving door. He left his job as associate chief counsel of the DEA and within a month joined a law firm where he lobbied Congress on behalf of drug companies and wrote legislation. He advertised what he could offer a client facing DEA scrutiny.

    Ad continued: If you have a DEA compliance issue, or you’re facing a government investigation, or you’re having administrative or civil litigation involving the Controlled Substances Act, I’d be happy to hear from you.

    JONATHAN NOVAK: It’s not surprising that this bill, that has intimate knowledge of the way that DEA, you know, regulations are enforced, the way that those laws work, was written by someone who spent a lot of time there, charged a lot of cases there.

    #Opioids #Big_pharma #Lobbies #Pantouflage

  • TV News Has an Ugly Role in the Pharma Epidemic That Has Killed 200,000 Americans | Alternet
    https://www.alternet.org/drugs/tv-news-have-remained-silent-about-big-pharma-role-opioid-crisis

    When they do report on drugs, TV news media spend more time on Prince and celebrity deaths than on drug policy that affects millions. More time on state marijuana laws than far more deadly federal opioid-prescription legislation. More time discussing how El Chapo escaped from prison than how to put devious prescription distributors and pharmaceutical drug-dealers behind bars. More time on how to clean up the mess than on how to stop the flow. And with drug commercials a mainstay of TV broadcast and cable news programming, it is easy to understand why the topic rarely surfaces.

    Andrew Tyndall, who tracks ABC, NBC and CBS Evening News programs on Tyndall Reports.com, kindly provided search results for his narcotics category and returned 149 stories on the three networks from Feb. 1, 2014, to May 1, 2016.

    Many stories each on Bill Cosby, El Chapo, Philip Seymour Hoffman and Prince; many gut-wrenching tales of addicts, families, first responders, communities, courts and police battling the epidemic. And a whole bunch of stories on medical marijuana and pot legalization. But not one story on pharmaceutical drug policies or laws enacted at the root of the opioid crisis.

    Except one—ironically, a Feb. 27, 2014, NBC News story on FDA approval of a new painkiller, Zohydro ER, which is five to 10 times more powerful than hydrocodone. Senior-level FDA officials during the Obama administration approved the painkiller over the FDA’s Advisory Board recommendations, which are normally followed.

    TV news continues to focus on the heartbreaking individual stories of addiction, the damage opioids have wreaked on our communities, and how doctors, clinics, courts, police and first responders are dealing with the crisis. While well-intentioned, their failure to confront the root causes—Big Pharma, its lobbyists and the laws that enable them—will doom us to a continuing cycle of misery. We need Big News to step up and do more. It’s the crisis in our backyards. There will be no solution until we curtail and rethink the pharmaceutical pipeline.

    #Opioids #Médias #Big_Pharma

  • The Family That Built an Empire of Pain | The New Yorker
    https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain

    Histoire d’une famille de voyous aux 200 000 morts. De quoi penser autrement le monde de la pharmacie. Il faut stopper les big pharma et revenir à une véritable recherche médicale débarrassée de l’argent, de la publicité et de la complicité des organismes de régulation.

    According to Forbes, the Sacklers are now one of America’s richest families, with a collective net worth of thirteen billion dollars—more than the Rockefellers or the Mellons. The bulk of the Sacklers’ fortune has been accumulated only in recent decades, yet the source of their wealth is to most people as obscure as that of the robber barons. While the Sacklers are interviewed regularly on the subject of their generosity, they almost never speak publicly about the family business, Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin. Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue.

    But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.

    Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.

    Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids. Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. The most recent figures from the Centers for Disease Control and Prevention suggest that a hundred and forty-five Americans now die every day from opioid overdoses.

    He told me that, though many fatal overdoses have resulted from opioids other than OxyContin, the crisis was initially precipitated by a shift in the culture of prescribing—a shift carefully engineered by Purdue. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.”

    Sackler saw doctors as unimpeachable stewards of public health. “I would rather place myself and my family at the judgment and mercy of a fellow-physician than that of the state,” he liked to say. So in selling new drugs he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves). John Kallir, who worked under Sackler for ten years at McAdams, recalled, “Sackler’s ads had a very serious, clinical look—a physician talking to a physician. But it was advertising.” In 1997, Arthur was posthumously inducted into the Medical Advertising Hall of Fame, and a citation praised his achievement in “bringing the full power of advertising and promotion to pharmaceutical marketing.” Allen Frances put it differently: “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”

    During the sixties, Arthur got rich marketing the tranquillizers Librium and Valium. One Librium ad depicted a young woman carrying an armload of books, and suggested that even the quotidian anxiety a college freshman feels upon leaving home might be best handled with tranquillizers. Such students “may be afflicted by a sense of lost identity,” the copy read, adding that university life presented “a whole new world . . . of anxiety.” The ad ran in a medical journal. Sackler promoted Valium for such a wide range of uses that, in 1965, a physician writing in the journal Psychosomatics asked, “When do we not use this drug?” One campaign encouraged doctors to prescribe Valium to people with no psychiatric symptoms whatsoever: “For this kind of patient—with no demonstrable pathology—consider the usefulness of Valium.” Roche, the maker of Valium, had conducted no studies of its addictive potential. Win Gerson, who worked with Sackler at the agency, told the journalist Sam Quinones years later that the Valium campaign was a great success, in part because the drug was so effective. “It kind of made junkies of people, but that drug worked,” Gerson said. By 1973, American doctors were writing more than a hundred million tranquillizer prescriptions a year, and countless patients became hooked. The Senate held hearings on what Edward Kennedy called “a nightmare of dependence and addiction.”

    Richard Sackler worked tirelessly to make OxyContin a blockbuster, telling colleagues how devoted he was to the drug’s success. The F.D.A. approved OxyContin in 1995, for use in treating moderate to severe pain. Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. But the F.D.A., in an unusual step, approved a package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism “is believed to reduce the abuse liability.” David Kessler, who ran the F.D.A. at the time, told me that he was “not involved in the approval.” The F.D.A. examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterward. Within two years, he had taken a job at Purdue.

    A 1995 memo sent to the launch team emphasized that the company did “not want to niche” OxyContin just for cancer pain. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. As May put it, “What Purdue did really well was target physicians, like general practitioners, who were not pain specialists.” In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.” Because OxyContin was so powerful and potentially addictive, David Kessler told me, from a public-health standpoint “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.

    Almost immediately after OxyContin’s release, there were signs that people were abusing it in rural areas like Maine and Appalachia. If you ground the pills up and snorted them, or dissolved them in liquid and injected them, you could override the time-release mechanism and deliver a huge narcotic payload all at once. Perversely, users could learn about such methods by reading a warning label that came with each prescription, which said, “Taking broken, chewed or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose.” As more and more doctors prescribed OxyContin for an ever-greater range of symptoms, some patients began selling their pills on the black market, where the street price was a dollar a milligram. Doctors who were easily manipulated by their patients—or corrupted by the money in play—set up so-called pill mills, pain clinics that thrived on a wholesale business of issuing OxyContin prescriptions.

    The company did not pull the drug from shelves, however, or acknowledge that it was addictive. Instead, Purdue insisted that the only problem was that recreational drug users were not taking OxyContin as directed. “Their rap has always been that a bunch of junkies ruined their product,” Keith Humphreys, the Stanford professor, said. In 2001, Michael Friedman, Purdue’s executive vice-president, testified before a congressional hearing convened to look into the alarming increase in opioid abuse. The marketing of OxyContin had been “conservative by any standard,” he maintained. “Virtually all of these reports involve people who are abusing the medication, not patients with legitimate medical needs.”

    Doctors who prescribed OxyContin were beginning to report that patients were coming to them with symptoms of withdrawal (itching, nausea, the shakes) and asking for more medication. Haddox had an answer. In a 1989 paper, he had coined the term “pseudo-addiction.” As a pain-management pamphlet distributed by Purdue explained, pseudo-addiction “seems similar to addiction, but is due to unrelieved pain.” The pamphlet continued, “Misunderstanding of this phenomenon may lead the clinician to inappropriately stigmatize the patient with the label ‘addict.’ ” Pseudo-addiction generally stopped once the pain was relieved—“often through an increase in opioid dose.”

    But Purdue didn’t need the media’s help to know that something was seriously off with the distribution of OxyContin. For years, it had maintained a contract with I.M.S., a little-known company, co-founded by Arthur Sackler, that furnished its clients with fine-grained information about the prescribing habits of individual doctors. Purdue’s sales representatives used the data to figure out which doctors to target.

    Such data could also be used to track patterns of abuse. “They know exactly what people are prescribing,” Kolodny said. “They know when a doctor is running a pill mill.” At the 2001 hearing, James Greenwood, a Pennsylvania congressman, asked Friedman whether Purdue would take any action if, say, I.M.S. data revealed that a rural osteopath was writing thousands of prescriptions.

    Friedman replied that it was not up to Purdue to assess “how well a physician practices medicine.”

    Greenwood then observed that, in a recent case involving a Pennsylvania doctor, Richard Paolino, who was wantonly overprescribing OxyContin, a local pharmacist had alerted the authorities. “He looked at this data and he said, ‘Holy God, there is some guy in Bensalem called Paolino, and he’s writing prescriptions out the wazoo,’ ” Greenwood said. “Now, he had that data and he blew the whistle. And you had that data. What did you do?”

    Purdue had not alerted the authorities. Clinicians like Paolino were breaking the law—he was sentenced to a minimum of thirty years in prison. But overprescribing generated tremendous revenue for the company. According to four people I spoke with, at Purdue such prescribers were given a name that Las Vegas casinos reserve for their most prized gamblers: whales.

    Given the sometimes fractious nature of the Sackler family, it was striking that they were united in their silence on the subject of OxyContin. These were urbane, expensively educated, presumably well-informed people. Could they conceivably be unaware of the accumulated evidence about the tainted origins of their fortune? Did they simply put it out of mind? “Greed can get people to rationalize pretty bad behavior,” Andrew Kolodny had told me. Someone who knows Mortimer, Jr., socially told me, “I think for him, most of the time, he’s just saying, ‘Wow, we’re really rich. It’s fucking cool. I don’t really want to think that much about the other side of things.’ ”

    Purdue had long denied that the original OxyContin was especially prone to abuse. But, upon receiving its patents for the reformulated drug, the company filed papers with the F.D.A., asking the agency to refuse to accept generic versions of the original formulation—because they were unsafe. The F.D.A., ever obliging, agreed, blocking any low-cost generic competition for Purdue. For more than a year, Purdue continued to sell the original formulation of OxyContin in Canada. According to a recent study, OxyContin sales in Windsor, Ontario—just across the border from Detroit—suddenly quadrupled, a clear indication that the pills were being purchased for the U.S. black market. Through I.M.S. tracking data, Purdue would have been able to monitor the Canadian surge, and to deduce the reason for it. (The company acknowledges that it was aware of the spike in sales, and maintains that it alerted authorities, but will not say when it did so.)

    By the time Purdue reformulated OxyContin, the country was in the middle of a full-blown epidemic. Andrew Kolodny, the addiction specialist, told me that many older people remain addicted to the reformulated OxyContin, and continue to obtain the drug through prescriptions. These people purchase the drug legally, and swallow the pills whole, as instructed. “That’s Purdue’s market now,” Kolodny said. Younger people, who can less readily secure prescriptions for pain—and for whom OxyContin may be too expensive—have increasingly turned to black-market substitutes, including heroin.

    Purdue and other pharmaceutical companies have long funded ostensibly neutral nonprofit groups that advocate for pain patients. The C.D.C. guidelines were nonbinding, yet many of these organizations fought to prevent the agency from releasing them. This kind of obstruction is typical at both the state and the federal level. A recent series by the Associated Press and the Center for Public Integrity revealed that, after Purdue made its guilty plea, in 2007, it assembled an army of lobbyists to fight any legislative actions that might encroach on its business. Between 2006 and 2015, Purdue and other painkiller producers, along with their associated nonprofits, spent nearly nine hundred million dollars on lobbying and political contributions—eight times what the gun lobby spent during that period.

    The Times report described Joseph Pergolizzi, Jr.—a Florida doctor who runs a pain-management clinic and hawks a pain-relieving cream of his own invention on cable TV—giving paid talks in places like Brazil about the merits of OxyContin. In Mexico, Mundipharma has asserted that twenty-eight million people—a quarter of the population—suffer from chronic pain. In China, the company has distributed cartoon videos about using opioids for pain relief; other promotional literature cites the erroneous claim that rates of addiction are negligible. In a 2014 interview, Raman Singh, a Mundipharma executive, said, “Every single patient that is in emerging markets should have access to our medicines.” The term “opiophobia” has largely fallen into disuse in America, for obvious reasons. Mundipharma executives still use it abroad.

    #Opioids #Big_pharma #Capitalisme_sauvage #Addiction

  • The opioid epidemic as a microcosm of a broken pharmaceutical market (PDF)
    http://harvardlpr.com/wp-content/uploads/2017/07/SarpatwariSinhaKesselheim.pdf

    In this article, we argue that non-rigorous patenting standards and ineffectual policing of both fraudulent marketing and anticompetitive actions played an important role in launching and prolonging the opioid epidemic. We further show that these regulatory issues are not unique to prescription opioids but rather are reflective of the wider pharmaceutical market.

    #brevets #drogues #pharma #opioids #régulation

    • Je suis avec une belle soeur américaine, les gens n’ont plus les moyens de se payer leur « painkiller » et se detournent sur l’héroine et les opioides pour leur faible cout.
      Tain cette fois ci j’ai un témoin à ma main.

    • J’imagine qu’une addiction ou dépendance après prise de painkiller amène les consommateurs à rechercher un produit conforme à leur dépendance ou addiction.
      Si tu commences dès le départ à lutter contre la douleur avec de l’alcool, l’alcool restera ta substance de lutte.
      Le cas des opioïdes est assez différent puisqu’ il s’agit de prescription médicale.

      Il existe d’ailleurs différents types de médicaments :

      les antalgiques opioïdes faibles comme la codéine et ses dérivés, le tramadol couplé ou non au paracétamol ;

      les antalgiques opioïdes mixtes comme la buprénorphine et la nalbuphine ;

      les antalgiques opioïdes morphiniques comme le fentanyl, la morphine et l’oxycodone.

      L’addiction est une pathologie cérébrale multifactorielle, chronique, récurrente, caractérisée par la poursuite répétée d’une consommation ou d’un comportement pour lutter contre une souffrance, malgré des conséquences sur la santé. La capacité à ressentir du plaisir et à trouver la motivation à poursuivre des activités quotidiennes est touchée. Des envies irrésistibles de consommer sont présentes et obsédantes. Les émotions négatives, lorsque ces envies ne sont pas assouvies, sont présentes. Une mauvaise prise de décision, une perte de contrôle, un manque de régulation personnelle, sont également des éléments présents dans cette maladie et à l’origine de rechutes.

      Les antalgiques opioïdes ont un potentiel addictif non négligeable de par leur action pharmacologique et neurobiologique.

      Aux Etats-Unis, selon l’enquête nationale menée par la Substance Abuse and Mental Health Services Administration en 2014, 1,9 millions de personnes avaient un trouble lié à l’usage de substances impliquant les antalgiques opioïdes. En 2014, 467.000 adolescents américains utilisaient régulièrement ces médicaments et 168.000 d’entre eux souffraient d’une addiction aux tueurs de douleur. La population féminine serait plus exposée à la dépendance à ces médicaments que les hommes. Un début de consommation à un jeune âge, entre 16 et 45 ans, des consommations excessives, des antécédents familiaux d’addiction, des antécédents personnels d’abus de substances, des pathologies psychiatriques associées (trouble bipolaire, dépression, TOC, hyperactivité avec déficit de l’attention...), des antécédents d’abus sexuel avant l’adolescence, des facteurs génétiques, des facteurs développementaux, l’environnement sont des facteurs de risque de développement d’une addiction. Mais tout le monde ne devient pas addict !

      Les antalgiques opioïdes, pris de façon chronique, peuvent entraîner un état pharmacologique appelé dépendance physiologique, qu’il faut distinguer de l’addiction. Il s’agit d’un syndrome de manque (sevrage) associé ou non à un phénomène de tolérance (augmenter les doses pour retrouver les effets de la première fois).

      http://www.huffingtonpost.fr/laurent-karila/painkillers-tueurs-de-douleur-anatomie-addiction_b_9994100.html

  • Prince : death by ignorance and fear / Boing Boing
    http://boingboing.net/2016/06/05/prince-death-by-ignorance-and.html


    C’est un article excellent sur le système médical, la morale et la dépendance. A lire.

    Prince was human—a person working hard for his paycheck just like everybody else. I remember him taking some actors into the hallway to teach them complicated dance moves for an upcoming scene—again, in 4-inch heels. Prince was a petite guy, but he wore those heels well, and could move nimbly in them, and he seemed to be moving all the time. I can’t help but fast forward now to the ensuing decades of performance and the toll it obviously took on his body, leading to his double hip replacement surgery in 2010. The surgery failed to relieve his pain, and so his long-term chronic pain treatment began.

    #drogues #toxicomanie #médecine #musique

    • Glancing at comments like “He did it to himself,” “Surprise, another rock star drug addict,” and other #victim-blaming attitudes, angers and upsets me. (...)

      In the case of prescription #opioids, these people are not addicts looking for a high, but for relief from their pain. Fentanyl is up to 100 times more potent than morphine and can be 30 to 50 times more powerful than heroin. Even when taken in small amounts, it can be fatal.

      #santé #douleur #addiction