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 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 the kids who are spending hundreds of this month thousands. Of her own walking. And its cheap. Really cheap really inexpensive and readily available the shame of it. Diction 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. Car accidents from 999 to 2070 over 500000 americans have died from an opioid overdose more than all the americans killed on the battlefield since world war 2. We have. Been raped in foreign dependent children winding up in the foster care system because their parents are addicted kids growing up without parents parents who have lost children you have families decimated you lack talents destroyed think that it started off with a company in stanford connecticut that had some marketing material 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 that 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 seattle morphine nothing much result. But 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 route that a drug gets to the break we were told are in humans no 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 acute pain or end of life Palliative Care that was a time when the medical community did understand that opioids needed to be prescribe. 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 then shalrie sciences started creating new semi synthetic opioids similar to heroin in 1017 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 cold dont produce in the brain are indistinguishable from the effects produced by heroin if you give an experienced heroin user oxy called tone 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 which was a study they did as Columbia 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 Frederick bingham started the per do Frederick Company on manhattans Lower East Side and 1952 it was sold to 2 other doctors raymond and modem or 2nd 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 theyve made a lot of money billions but they are now 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 doctor or 3rd sacker revolutionised form a suitable advertisers are there originated a Blitz Marketing of drugs aimed at general practitioners through medical conventions and ads 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 counted it as a safe nonaddictive stress reliever women particularly were targeted to cure the every day stress of being a wife and mom valuing became the. First 1000000000 dollar profit drug leading to an addiction crisis by the mid 1970 s. And 1987 dr Arthur Sackler died a very rich man and his successful Marketing Strategies continue to live on a per do pharma. To do began focusing on Pain Management in 1972 they patented content a controlled drug released 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 dont hear a doses in a day but youd also have european troughs right so you wouldnt have those sudden potential respiratory depression on your own how to bridge 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 synthetic 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 her due at the time it launched oxy cotton in 1096 really open to tear. Torrie in terms of aggressive promotion of narcotics they did things that really had never been seen before oxycontin was really one of the 1st pain killers that was marketed to general internists and the public for moderate pain they are the company that sort of originated the playbook inspired by the Arthur Sackler playbook produce launched a Marketing Campaign to sell oxycontin through multiple levels of attack. Lets 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 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 im back now maybe i 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. Who put oh yeah they use opinion. Its for. Boys yet spoiled yet so we thought it. Was pretty traditional yeah. But just. If you feel pretty good. Oh yes. So there you go again just below they take you there are good words for it but. These are the stories of men who cant imagine life without fashion without a sense of style without things that might be seen as weakness in this masculine world but they still demonstrate incredible strength of spirit to live as they choose. The poem talks of a group of us have used. Words for. The pandemic no certainly no borders and is blind to nationalities. Has emerged we caught up with the we do a back seat world needs to be. Judged. Commentary crisis what is this dont want to. We cant be better we should be. Everyone is contributing way but we also know that this crisis will not go on forever the challenges create the response has been masked so many good people are helping us. It makes us feel very proud that we are in it together. Lucia thats right we talk about problems all year and then summer we come up with all solutions not say were just being joined by a banker turned big point entrepreneur simon. Banks the future long term friend of this. 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 blitz number 2 promote the drug they increase their sales force and their physician called list these sales reps were offered lucrative bonuses their average compensation a pretty 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 a drug mill prescription office those questions just were not asked Health Care Professionals received all kinds of promotional perks. And 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 then. 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 they sort of. Grey shape 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 but youre not saying and not lunch im not saying and on that lunch theres no recording or transcript of it who knows what i 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 a prescribed pain of opiates do paid honorarium speaking and teaching fees to doctors boarding the oxycontin bandwagon he was taking about 100000. 00 a year. And then we look 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 it 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. Since that 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 pharma 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 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 of 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 to that was provided to them by the Pharmaceutical CompanyPurdue Pharma the joint commission on accreditation of Healthcare Organizations recently defined and adopted stringent pain standards on the basic thrust of our new standards is that 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 to surprise me here when you go to a Doctors Office how they ask you or are you having pain. Though 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 for making people spilling an oxy contemn 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. It wasnt working. Out it was watching many of my patients deteriorate. A few deaths. Retrospect clearly related to my prescription produce on 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 and look at the original data on which the just which there claim that that opioid use or Pain Medicine used for for treating pain doesnt cause addiction is scary and the rate 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 crude database to satisfy his curiosity of how many hospitalized patients became addicted to opioids grad student jane porter helped compile the statistics dr jack broke our friend the 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 obvious seed in the early derivatives of opium for pain control. As patients began to exhibit symptoms of tolerance and addiction ready to do former was quick to pacify fears we were often taught that tolerance imply the diction but it wasnt 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 and doesnt go along with the other things there 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 really there they spend the day and narcotic stupor on the so the average daily dose went from about 80 milligrams a day to over 140 milligrams just within a couple of years and it 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 their dependency an 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 and ill study actually suggest that. The long term effects my not just baby absence of benefit but actually that diet 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. To lead to addiction and overdose the children using oxy codeine by children i mean people between the ages of 12 when youre 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 that 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. 115. 00 milligrams however they do have that now patches plus oxycontin. I had a woman that lives in my building said to me to 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 will prescribe right another practice 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 that drug 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. Is youll be a reflection of reality. In a world transformed. What will make you feel safe. Isolation community. Are you going the right way or are you being that. What is true what is faith. In a world corrupted you need to descend. To join us in the depths. Of the shallowness. Joey are they of so being you. For wrong. Or a. Pretty traditional. For just you know pretty. Well yes or a. Good game just for you they take you there are good words for it but. These are the stories of men who cant imagine life without fashion without a sense of style without things that might be seen as weakness in this masculine world but they still demonstrate incredible strength of spirit to live as they choose. To call them taunts of a group of us have used. For. A german clinic treating the gravely ill russian opposition activist Alexei Navalny says its found traces of a substance that affects the nervous system despite russian doctors saying they could find no toxins in his blood. A week of huge rallies pass off peacefully but 2 weeks after the disputed election faced with tens of thousands calling for him to quit president lukashenko thanked riot police for their support. Were suitable. For the summit of the Russian Foreign ministry in moscow after vienna said its expelling a russian of fish