In this episode we explore the ignorance and greed that led to our Current Crisis one of the 1st. Medicine is do no harm. Said that hypocrisy is was the 1st to say this and what that means is that the cure for any medical problem shouldnt be worse than the disease that youre trying to treat a big chunk of america is in chronic pain and pain meds back pain pain arthritis events real and it affects peoples lives and they would like a way to live their lives to take care of their families without being a misnamed what the brain is trained is that different brains in their brain thats not in pain people have it in their hear theres a feel for something regardless of whatever amount of iranians theres something out there is going to you know there was this new growth its going to lemonade all your brain inside the company and the drug came out they received so many letters from people who had been suffering for years with no relief who finally felt like through oxycontin they were getting to be alive again in a way they hadnt for years and that they considered a miracle drug is the best thing that happened to me if i wasnt on this medication i just wouldnt be able to do the things that im doing now theres no question the best strongest and most opioids of serious medical side effects patients are just a. T. M. Machines some more you go back to the patient or you push buttons the more profit you can do the pharmaceutical companies all so were not entirely transparent about give take the fact about the life and that peers were told they were non indicative when in fact they were and we dont get taught in medical schools. About the misses that we and use we only get told about illnesses that were supposed to cure we also grew up thinking that doctors are always right so if you have a prescription its easy and we talk about opioid painkillers we are centrally talking about heroin pelz the Drug Companies are the cartel. Doctors are the pushers and the pharmacists are the suppliers and thats how it is seen there is not a city in the United States right now that doesnt have a major opiate addiction problem and its not just in cities its in rural areas in fact in some places its worse in rural areas than anywhere else at the peak of the epidemic millions of people in the United States were prescribed 259000000. 00 prescriptions of opioids that means on average every adult is on one opiate you know once or twice a year if not more scares the living crap out of me opioids are a major category of medical spending according to the centers for Disease Control its about. 24000000000. 00 in direct cost for the medications and other 75000000000. 00 in Health Care Costs people are doing and oxycontin 8010. 00 pack a day thats a 1000. 00 worth of medication to kids who are spending hundreds of dollars a day if not thousands. Of her own walked into. And its cheap. Really cheap really inexpensive and readily available the shame of addiction keeps us from knowing the actual numbers but at least 2000000 americans and probably millions more are addicted to prescription opioids prescription drugs. Causing more deaths for example than Car Accidents from 1999 to 2070 over 500000 americans have died from an opioid overdose. More than all the americans killed on the battlefield since world war 2. Only to have iraq in rates of form. Of children winding up in the foster care system because their parents are addicted kids growing up without parents parents who have lost children you had families decimated you land talents destroyed think that it started off with you know company in stanford connecticut that had some marketing this is the worst manmade epidemic in the history of. American medicine its very clear when one looks at the overprescribing of opioids thats led to this Public Health crisis that the medical community really forgot the 1st of all which is do no harm. Opioids are among the worlds oldest known drugs there are medical religious and Recreational Use predates recorded history. These are really drugs such as opium codeine and morphine works directed from poppy flowers and its some kind of mystery of nature why did the poppy play out create morphine it can bind to the d opioid receptors in human brains and probably thats a mystery of nature will never be able to answer but that is the case because its chemically similar to the compounds that are on brain makes an 874. 00 an english chemist by mixing morphine and other assets created a powerful opioid that was eventually called di a seal morphine nothing much resulted from his discovery 23 years later a german chemist working for what is now the bayer pharmaceutical corporation created the same substance baier quickly promoted the drug is less dangerous than morphine as well as a cough suppressant because of the heroic feelings recipients experienced they called it heroin heroin is a very slight. Chemical manipulation of the morphine molecule makes the compound heroin much more fat soluble the brain is mostly fat so if someone is exposed to heroin it gets into the brain many many times faster than morphine would the more rapid a drug gets to the break we were told or in humans the more apt its to cause a high this heroic drug originally promoted as a cough suppressant and for other common conditions were soon diverted and abused in 1904 the United States congress banned heroin declaring it a dangerous addictive illegal narcotic it probably would take too long for me to. Provide a theory of why as americans we have. Such love affairs with with drugs that potentially can kill us opioid addiction led doctors to fear its use for anything but short term richard pain or end of life Palliative Care that was a time when the medical community did understand that opioids needed to be prescribed. There obviously important medicines for easing suffering at the end of life they play an Important Role when used on a short term basis for severe acute pain for example after major surgery ventral a scientist started creating new semi synthetic opioids similar to heroin in 1917 oxy code was one of several semi synthetic opioids developed in germany you literally start with opium to make hydrocodone and oxy caught on and the effects that hydrocodone oxy co dont produce in the brain are indistinguishable from the effects produced by heroin if you give an experienced heroin user oxy kodo and heroin its hard for that heroin user to tell which is which in fact if you ask them which they like a little bit better and unlike a blind taste test. It was a study that has claimed the university the oxy codell is preferred to the heroin so what im saying is that when we talk about opioid Pain Medicine worse since they talking about heroin tells an 1892 doctors John Purdue Gray and George Bingham started the per do Frederick Company on manhattans Lower East Side and 1952 it was sold to 2 other doctors raymond and motive. In the intervening years they expanded the company to other states moving their headquarters to stanford connecticut and changing the name to produce for produce a private family many of them are doctors many that are philanthropists a lot of money billions but they are and i hear typical rich people yachts dating models things like that theyre intellectual people they care about Science Cancer Research on arts a 3rd brother dr Arthur Sackler revolutionised form a suitable advertisers are there originated a blitz style marketing of drugs aimed at general practitioners through medical conventions as with well known doctor endorsements direct mailing and a sales force giving out free samples and perks. For the response you know wand and trust theres 963 campaign for the new tranquilizer value touted it as a safe nonaddictive stress relief for women particularly were targeted to cure the every day stress of being a wife and mom valuing became the 1st 1000000000. 00 profit drug leading to an addiction crisis by the mid 1970 s. And 1987 dr Arthur Sackler died a very rich man his successful Marketing Strategies continue to live on a per do farm. To do began focusing on Pain Management 1972 they patented content. Controlled drug release system produced form of believe that if they could link their 12 hour time release system content to an opioid pain reliever it could be marketed for chronic pain without the sudden rush or heroin high to the brain there is an inherent logic to making large acting opioids because obviously convenience you know if your dose is in a day youd also have your picks and troughs right so you wouldnt have those sudden potential respiratory depression on your own how the birth your pain at the time opioids had limited use for short term acute end of life pain neither are markets where fortunes are made you know all of their sales materials for targeted to get to get the drugs out of the oncology suites and into the hands of local practitioners to do began funding organizations that endorsed long term use of opioids for common conditions in 1993 they established partners against pain quote to help alleviate unnecessary suffering by advancing standards of chronic pain care through education 996 saw the launch of the 12 hour extended release and thetic opioid designed to be safe for both acute and long term chronic pain they called their new revolutionary drug oxycontin. The next step was to convince the skeptical medical profession of the safety and effectiveness of their powerful pain reliever per do at the time it launched oxy cotton in 1996 really opened a New Territory in terms of aggressive promotion of narcotics they did things that really had never been seen before oxy cotton was really one of the 1st painkiller is that was marketed to general internists and the public for moderate pain they are the company that sort of a. Originated the playbook inspired by the Arthur Sackler playbook produced launched a Marketing Campaign to sell oxycontin through multiple levels of attack. Its number one educate the medical community from 1906 to 2001 purdue conducted national Pain Management and speaker training conferences and resources in florida arizona and california there in appropriately influencing maybe even corrupting 5000 doctors Nurse Practitioners and nurses. To sell the koolaid several videos were created named both doctors and patients to encourage the use of opioids as a long term safe methods to treat chronic pain one such video was entitled i got my life back the Video Centers around dr allen spano sent his patients personal Success Stories thanks to oxycontin that now may not can enjoy every day. Since ive been on this new pain medication and i have not missed one day of work these videos were seen by about 15000 doctors through direct marketing seminars and medical school. So what weve got to do is identify the threats that we have its crazy for him to let it be an arms race in his off and spearing Dramatic Development the only posts really im going to resist i dont see how that strategy will be successful very critical time to sit down and talk. We now know that in patients who have no history of Substance Abuse no history of chemical dependency the likelihood that the treatment of paid using it opioid drug which is prescribed by a doctor will need to addiction is extremely low people like Russell Portnoy and many others were teaching that addiction was rare and these false words and that we should be comforting people in chronic pain just like we have learned to convert people with cancer pain and in fact if you dont do that youre probably going to be found wanting these are what is termed in the industry a k o well or a key opinion leader and if a drug company can hire these k o ls they dont have to do the promotion themselves and in fact a lot of what the k o l say to other doctors and other practitioners doesnt have to meet the same level of scrutiny by the f. D. A. Doesnt have to even conform to the labeling instructions for the drug a generation of physicians were trained that opioids were effective for chronic pain and unsafe do its number 2 promote the drug they increase their sales force and their physician called us these sales reps who are offered lucrative bonuses their average compensation produce sales rep was about 55000. 00 but they could get that increased by an extra 250000. 00 bonus if they could get enough doctors writing prescriptions if you can increase your salary 5 fold youre going to cut corners whos the doctor writing the prescription for is that just the drug mill prescription office those questions just were not asked Health Care Professionals received all kinds of promotional perks oxycontin fishing hats stuffed plush toys musical compact disks and of course the proverbial free lunch pharmaceutical companies were off this all the time to get penn soon bugs than. Prescription pads for their products were written and thats why he had to do was sign it you could take him out to lunch you can go to meetings you go to the meetings and theres a reception by those guys knew what they were doing and they must have been good at it or they wouldnt have done it but what happened is the sort of. Gray shaped the physician to them to be beholding for the goodies that they provided for them theyre all guidelines for what the sales rep can and cant say that youre not saying and that lunch im not saying in on that lunch theres no recording or transcript of it who knows what is said primary care doctors who fell for this began prescribe ing aggressively people always say follow the money theres considerable amount of money involved in the in the prescribing of opiates produced paid honoraria speaking and teaching fees to doctors boarding the oxycontin bandwagon he was taking about 100000. 00 a year. And then we looked to see how much the drugs that he was writing prescriptions for were costing us and so the drugs he wrote for those Drug Companies cost us 500000. 00 a year so they can easily target dark jurors that are covering 80 percent of all of the narcotic prescriptions and thats what produced did blitz number 3 get the state and federal regulatory agencies on board as well as the legislative branches big pharma is one of the most powerful lobby groups in washington they have armies of lobbyists that they use to reward congresspeople to reward senators most of it is done legally and above the board and in fact if you look at the websites that are out there you can see how much money is paid by each drug company to each senator and each congressman but theres also a lot of sort of dark money that goes for you know Political Action committees and other organization. That we really dont know about in our system of special interest politics. The special interests unfortunately often are the ones that carry the day when it comes to produce farm and there was essentially an unholy alliance between. The Company Executives and the Advisory Board of the f. D. A. They reviewed the drug big pharma is supposed to be regulated by the f. D. A. But unfortunately through the badoo for laws big pharma is actually paying the f. D. A. Very large sums of money to review their drug applications so the f. D. A. Doesnt do independent testing ive never bought into and that has taken account on the Drug CompaniesClinical Trials for them i was investigating whether or. Where their Company Executives were essentially writing the advisory decision. That legitimized approving this struck the joint commission that accredits Health Care Organizations mandated pain is treated like the 5th vital signs as patients routinely had their temperature and blood pressures checked doctors were expected to ask each person to rate their pain on a scale from 1. 00 to 10. 00 doctors and hospitals were mohnish to if they did not treat this pain the joint commission developed this pain as the 5th vital sign. As part of a grant of that was provided to them by the Pharmaceutical CompanyPurdue Pharma the joint commission on accreditation of Health Care Organizations recently defined and adopted stringent pain standards on the basic thrust of our new standards is the organizations and practitioners have an obligation to ask the patient even if the patient doesnt look like he or she is in pain ask them be surprised to hear when you go to a Doctors Office how they ask you or are you having pain. No you may go for a raise that has nothing to do with pain which just added lighter fluid to the fire because because it became equivalent to say if you have pain you need opioids. At least in the United States you know 2 plus. You know i mean probably not there making 2 plus 1000000 on them produce marketing of oxycontin thats depending on how you look at it very successful very tragic all the marketing legislative maneuvering cash and free giveaways handed to doctors and politicians might have been justified if opioids were a safe effective nonaddictive treatment for chronic pain but they werent my personal experience that it wasnt working. That i was watching many of my patients deteriorate. A few deaths. Retrospect clearly related to my prescription produce own sales reps were saying that the rate of addiction is only one percent. With artsy con and that was clearly just false when you go back to look at the original data on which the just in which their claim that that opioid use or Pain Medicine used for for treating pain doesnt cause addiction is scary and the right of addiction among pain patients who are treated by dont tolls is much less than one percent cited a study by porter and chick few bothered to check out the source of this critical statistic in 197917 years before the creation introduction of oxycontin. Dr herschel jek used boston universitys new crew database to satisfy his curiosity of how many hospitalized patients became addicted to opioids grad student jane porter compiled the statistics dr Jacques Rogge of House Press Secretary typed it up and submitted it to the new england journal of medicine. Short letter was one of the many printed in january of 1980 the power graph simply stated the statistics and made no conclusion. What everybody was citing as evidence that we didnt have to worry about getting our patients addicted in some cases this was being described as a landmark study it was this one paragraph a letter to the editor this of course would tell you nothing about the risk of addiction when you put a patient on long term opioids but it turns out in fact they have always been just as addictive as we always knew they were there for many hundreds if not thousands of years when people used the obviously and in the early derivatives of opium for pain control. As patients began to exhibit symptoms of tolerance and addiction to do former was quick to pacify fears we were often taught that tolerance imply the diction but it doesnt tolerance just means that you may need to increase the dose of the drug to get the same effect but that doesnt go along with compulsive use of the trial it doesnt go along with any of the other things that with the concept of pseudo addiction what we were told was that if you had a patient coming in early who looked addicted that it wasnt addiction it was pseudo addiction pseudo addiction is a fairly new term attorney came in about 990 but its crucial pseudo addiction is. When a patient is looking the life of a drug addict because pursuing high in relief so pseudo addiction is a relief seeking behavior in this state as drug addiction produces remedy for socalled pseudo addiction actually endangered lives if you had a patient who appeared addicted to educational message was that you should increase the dose of the opioid. Give them more opioids and sure enough if you give somebody whos addicted all of the pills that they could possibly want they do stop coming and are only there they spend the day and narcotic stupor on the sofa the average daily dose went from about 80 milligrams a day to over 140 milligrams just within a couple of years and its shifted tremendously from the slightly weaker schedule 3 opioids to the stronger longer acting schedule. So by now the horse is out the door is closed youve got people running around thinking believing that they need these opiates to have a peaceful successful life completely pain free will the price that they paid was the dependency in addiction to opiates dr peter Grace Research assistant professor with the university of colorado boulder published a study indicating that opioids like oxycontin when used long term increase chronic pain rather than the long term use that really isnt scientifically justified by now study actually suggests that. The long term effects might not just maybe absence of benefit but actually that it might be causing a long time time release opioids when crushed snorted or injected. Rushed to the brain similar if not better than illegal heroin. Young people began diverting the drugs described or stolen from medicine cabinets to get high this to lead to addiction and overdose the children using oxy codeine by children i mean people between the ages of 12 when theyre starting up to 25 all those children they crush the oxy code and they can get a whole day supply out of a sustained release but they became 2 kinds of opioid addicts the abusers and those unknowingly addicted to a drug their trust a doctor had prescribed in the 1009. Hes linda g. And noddy from exeter New Hampshire sought treatment for back pain and fibromyalgia at her local clinic at one point. 150. 00 milligrams however they do that now patches plus oxycontin. I had a woman that lives in my building said to me you drive like you would cross and that was because of the opiates i dont drink so. And you never did anything other than what you. Write i know there proctors was the off label use of drugs this is the use of drugs to treat elements other than what they were designed for off label use is not illegal or regulated by the f. D. A. Doctors began prescribing oxycontin for migraines and depression theres no law against writing the drug for an off label use so there might be the drug detail guy comes in your office and you know with a wink and a nod and says you might want to use that try try try for this because some other doctors we know have used it for that even though its not approved for that in addition to oxycontin other opioids were put off label use one of which was methadone a drug used to treat heroin addiction. Youre sitting somewhere i. Just lets see i guess. I was on the floor somethings in my bathroom you know crying praying. Theres time for western worms i was having chilling fever and i didnt have any sense of snakes or smell from the most young women or girls would you. Recently she you know sometimes or just used to. Snap on somebodys song around the circle for research. I have heard and. Push myself to this for me in the 5 years ago to. Go. For years i had treated patients with heroin addiction with high dose methadone which is the appropriate treatment and so. I was thinking well i see how well that works for all these people and they dont tend to overdose on it or have a lot of side effects or have any problems so why wouldnt that be fine for pain patients i do recall individual young men who had a rough go early in life. Without all ism was in alcohol recovery a number of back surgeries and i was in the middle of a tapering course switched him over to methadone for his other drug to ease his taper and using misguided conversion tables