And that brings us to the end of a nice wrap for the sabbath side of things looking back again in just under 30. 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 man who had a rough go early in life had some problems that 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. 3 days after i converted him i got a call from his wife that the a doctor. Was flabbergasted its not safe for people who just have chronic pain to give them opioids because they dont have the years of tolerance built up that people with heroin addiction have to really understand the complexity of being that drug is a reflection on. Guys much training this was the published data i said theres something wrong here. And that left a. Hole in my heart i still remember him very very clearly he had opened up a shop and Small Business and was really getting conceit. He even gave me his a. 100 day to get money accomplished that information was dribbling in that the opioid miracle pain relievers were killing people this produce pharma and the other Drug Companies would have acknowledged the potentially lethal effects of opioids when these problems were 1st discovered hundreds of thousands of lives could have been saved instead they took steps to suppress negative information within a month we received a 3 page letter from purdue pharma. Basically saying why are you bothering the doctors this is not a prescribing problem this is a patient misuse problem this is a drug abuse problem patients need to be able to get what they need and then we got a year later got sued in federal court we were all all the medical directors were served in our homes the current efforts to stop this overprescribing have been met with much pushback from the pharmaceutical industry they rationalized that the billions of dollars they were making were helping more people than they were whoring they insisted and still insists today that only those who are diverting and misusing the drugs to get high are responsible for the epidemic and not those who are prescribe the drug produced distributed a follow up video to i got my life back that double down on their claims that oxycontin was a safe nonaddictive long term chronic pain relief returning to these patients off to 2 years shows that when pain treatment is successful and stay successful over the last 3 years ive gotten much much stronger is just absolutely a godsend its just such a difference ive been away a weight. And able to its wonderful however in time even produce own video poster children were succumbing to oxycontin lethal effect of the 6 featured patients spotlighted in the videos 3 maintain they were still helped by the product 2 were deceased from causes thought to be related to their opioid addiction and non last minute other things said if i was to go to the mailbox once a month and i would find a bottle an oxy im constantly on the even lower and is among the lucky survivors i would allow doctors to prescribe me x. Right now its a synthetic heroin. In 2010 for do introduced a new tamper resistant oxycontin with a spotlight focused on stopping pill mills in the new tamper. Just medication easy sources for prescription pain killers began to dry up prescription opioids were expensive on the black market. Heroin became a cheaper alternative i can remember this 15 years ago when my patients coming in here for buprenorphine treatment were saying you know heroin is a lot cheaper than most pills and it works better in 2016 the new england journal of medicine published a study that found that 76 percent of those seeking help for her when addiction began by abusing pharmaceutical opioids primarily oxycontin this draws a direct line between produce marketing of oxycontin then the subsequent care one epidemic currently in the United States policy makers were hearing that all of the problems related to opioids or from socalled drug abusers and that these were wonderful medicines for for pain patients and we recognize this wasnt true one of the 1st people to stand up to the Drug Companies and lobby for reform was dr andrew. He helped form prop physicians for responsible opioid prescribing their organization is one of the earliest advocates for opioid prescription reform the one federal agency that seemed to understand that Overdose Deaths in addiction had arisen as a consequence of the medical community overprescribing was the c. D. C. You know the f. D. A. Gets criticized. The c. D. C. Really doesnt i mean the c. D. C. Is like you know they care about Public Health in america at its best and brightest and today had kind of this Blue Ribbon Committee that looking in people that had no ties to the pharmaceutical industry no conflicts of interest declare and they spent a long time reviewing all of their research and what they came back and said is incredibly damning theres no evidence to support long term use of opioids for chronic pain. What can any drug company say beyond that chronic pain is 80 said. In percent of the market what separates the current Opioid Epidemic from the heroin and crystal meth epidemics of the past is that it affects white middle class and Rural Communities far more than urban minority poor clicked the early eightys late sixtys. Puce and the negative consequences of the abuse of opiates was primarily limited primarily not exclusively limited to minority populations poor individuals inner city populations. From my perspective what ended up happening is this current circumstance got a jump start from. Prescription opioids and as a result of that it impacted the much broader socioeconomic strata in our community particularly individuals who have access to health care middle class for the most part white families in 2007 produce foreman 3 of its executives pled guilty in federal court to charges of misleading the public about oxycontin the risk of addiction and ease of abuse they were fined over 635000000. 00 the biggest pharmaceutical settlement and us history now that may sound like a lot it is a lot but if you look at the damage thats been done particularly since then in terms of the number of people that are taking. Not only oxy cotton but many types of opioids for conditions that really have theres no value for these drugs. Today the Opioid Epidemic commands National Attention there are now dozens of court cases against purdue and other pharmaceutical companies for their collusion to promote drugs they knew were dangerous for turning a blind eye to the sale of opioids to doctors and clinics that were pill mills and for the destruction of states and communities ravaged by the up at them. Im not sure im enough of a medical expert to say what steps need to be taken at this point. But you know what whats very clear is that unless you have. Public Health Experts regulators criminal investigators local officials and the medical Community Working together. In some kind of established program the problem will never get solved the one thing that we have to do is slowly and surely. The. Prescriptions we need to get the doctors are now strongly encouraged to cautiously prescribe for both chronic pain and acute pain this will lessen the chance of surplus pills being diverted in the buz surgeons a Dartmouth Hitchcock Medical Center in lebanon New Hampshire recently published guidelines to reduce the number of excess opioid pills prescribed for acute pain what we found was that only about a quarter of the opioid pills that were being prescribed were taken by the patients so it was clear that we were over prescribing these opioids and so we came up with a guideline and said ok for a partial mastectomy 5 pills should be enough to satisfy 8 percent of the patients for lack of stopping gallbladder removal calls the stock to me 15 pills should be enough to worry and say well did a whole bunch of patients come back for refills when we really taken care of their pain ok and the answer that was we were taking care of the pain because less than one percent of the patients ended up needing an opioid we felt some doctors question the use of opioids at all and feel they were more effective nonaddictive options even for acute pain when we think about treating patients in pain we should understand what the ability of the body is to respond to those things themselves. We hear and orphans and we stimulate those who. Activity and exercise. Oftentimes when somebody is in pain we tell them not to move thats the bad it thats bad it was. As we exercise use our systems normally we can create our own and orphans and pain control thats number one and. Number 2 is to go to over the counter medications for example there are lots of good studies that show that the combination of taking acetaminophen which is tylenol. And ibuprofen which comes in multiple forms like advil and. In the leaves but the combination of those medications together actually is much more effective than opioids for taking care of acute pain we can use. Activity we can talk about comedy reading theres things to divert people from pain if we sit home all day in pain we will guarantee you you will have pain if you try to be active you wont necessary get rid of it but youll learn to deal with it better on the other hand there are those patient there is no alternative but to use narcotics i can count those on one hand in any one moment its a very rare. Thing. We. In the troubled 19 seventies a group of killers rampage through parts of Northern Ireland that was coordinated loyalists attacks a population of tens of thousands were forced to flee their homes and what was striking to put these attacks was that they are you see the Police Actually took part in the attacks so instead of preventing it they were active participants and the burning of full streets in belfast at that i think more than a 100 innocent civilians were. As the review can seniors and we found out more i was surprised about the extent and its occurrence which the collusion was involved in some of those cases the killers would later be named. In the gang i think it went to the very very top i think it is the focus for all the water where all the taste you know on the go ahead. Doctors are getting the message that certain uses of opioids are not appropriate for example long term chronic use there are lots of Educational Programs out there there are. D. N. A. Enforcement activities out there. In fact some doctors are now complaining that its so hard to write a narcotic prescription that they dont even bother to talk to people who are chronic pain patients and i get emails from people on phone calls who believe that their opiate prescription isnt working for them. They are very scared of the discussions going on theyre scared that their doctors not be able to prescribe at the federal governments going to take away their pellets and that are allowing them to have a quality of life that they dont believe is possible about the drugs there are a lot of patients that are. Going to have pain acute pain and chronic pain that arent attics that need to be treated properly with pain medication that does work for some people so i dont think we should throw the baby with the bathwater for about 10 to 12000000 americans who have been put on long term opioids. Many of whom may never be able to come on and who many of whom are convinced that the opioids are helping them theyre desperate to maintain their supply and the idea of folks out there telling other doctors that these arent safe and effective that they dont work well long term they rightly believe that it could make it harder for them to continue to access opioids and so. From some of these pain patients who are opioids. Threats and its its often a threat. Wanting to cause bodily harm so that. Their pain can have a different feeling about opioids and i was injured that type of threat i do worry in some ways that now perhaps the pendulum. Its swinging so far the other way that were going to see a lot of people and so its cut off from their long term supplies of opiates which are not appropriate for them to be. But i imagine well be seeing those people coming to our Addiction Treatment program that begins to happen as states but more restrictions in place for physicians people want to blame big pharma and they would say theyre greedy theyre terrible now but the problem is that big pharma is the engine for medical innovation in this country they develop drugs they are willing to invest millions may invest in 40000000 dollars before theyve made a dime from it. So if we if we say lets you know whats make all of our Drug Companies nonprofits like were not going to have a lot of innovative drugs that are going to a carrot cancer are things like that so its a problem and the rest of the world is counting on american Drug Companies to come up with cures chronic pain is truly a life altering problem for millions of people d. Search for safe nonaddictive solutions for pain really we can probably produce better drugs in terms of alleviating pain without the addictive component and some of the faculty here at the similar institute are working very hard on the we need to treat pain is very important to treat ive been studying the system to the microchip studies in england we cloned that we found a gene which we call code that. We can block the information in the brain and we dont quite know what that will do i think whats needed is a drugs which dont. Necessarily all d. Drugs which work at this but dont reach the reward system there is some process in the Playing Field in developing new drugs the focus of our study is really to investigate the role that the immune system actually plays and so thats. A new line of. Research in regard to the. Cells to actually valid. Response is worth on animals so we decided to shoot from animals as well as. Expression and produce an expression and i think the really promising aspect of our study then is that these. Are a target for treating better so we could inhibit the activity. And actually improve the clinical efficacy of get rid of some of these problematic tolerance addiction exaggerated i came to stanford to understand how proteins these very fascinating molecules work at the most basic level im an instructor in the department of molecular and cellular physiology where we study very basic aspects of biology and the work that weve been doing lately is to understand how. They bind to their receptors and function these models provide is really remarkable ways of developing new drugs because what ill do next is put up a. Drug like morphine here in orange and inside its receptor you can see if its really nicely and i was told into that i can i can kind of cut away and you can see how well those little balls are fitting inside that receptor because what we can do now is to say well this is the receptor binding pocket what other drugs in this bind pocket and then can we use this kind of knowledge to develop better drugs that act these receptors are not addictive opioid would be a medication that targets them you. Turns it on provides pain relief but doesnt trigger the rewarding pathways in the brain that cause tolerance for cause addiction you know with these other drugs that target different systems. Are coming down the pike actually actually apply these drugs to improve the clinical profile of our heads so. Its could still be administered but if we shut down the signaling that occurs at the same time then we can eliminate these problems of tolerance addiction. As i said earlier the system better because as well despite all the attention focused on the opioids to make the crisis continues to grow. According to the c. D. C. 2016 there were over 62000 deaths due to overdue this is the worst man made up a diabetic in modern medical history. We still have it reversed and weve known about it for more than 10 years show where are where are these teachers that taught us to do these things why are they all very helping to reverse this during the making of this documentary we saw to interview representatives from purdue in the form of suitable industry and those doctors who advocated for the sure hope your knowing would appear on. This is a common problem experienced by most journalists covering people preordered i would love to talk to anyone from the Sackler Family because they you know theyre smart people and this is a complicated problem and i want to hear what they say about it its a Family Company and there is a sense that i get from talking to people that are associated with it that they feel that theyve been mistreated by the media by the government by politicians. And that they feel attacked and you know i was interviewing someone who has a very high opinion of the company and very high opinion of the family. He didnt want his name used because hes like if look i stand by them 100 percent but if i give you my name then like ill be just pilloried you know people look askance at me all the internet people trolling me. And so i feel like they have this you know they would say its a well grounded cynicism about the media and about just you know coverage of their drug i believe that. In terms of the blame for opioid addiction epidemic produced forum was pursued financial profit and the fact that they are. And care about an epidemic of addiction and Overdose Deaths that they were fuelling. The fact that the food and Drug Administration failed to properly regulate the claims that produce was making the failure of the medical establishment. And the fact that it took money from purdue and other opioid makers and promoted aggressive use of state medical boards that failed to regulate the way in which doctors prescribing and even encouraged aggressive prescribing theres a lot of blame to go around the question is is who is guilty or who should feel guilty i dont know that anybody feels too guilty i kind of wish a few more people did feel a little more guilty despite public outcry ph