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MEDICAL INDUSTRIAL COMPLEX > The Opiate Epidemic

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message 1: by Leticia (new)

Leticia Martinez (nierika) | 7 comments https://www.thefix.com/california-ove...

Overdose Law 2 Years Later: Narcan Still Scarce, Expensive
By Jonathan Sobotor 12/11/16
"We don't 'do' Narcan here." California pharmacies continue to perpetuate stigma by refusing to stock naloxone.
A pharmacist with a "so what" face and hand up
When lawmakers in California were looking for solutions to the growing number of prescription painkiller overdoses, broadening access to the antidote, naloxone hydrochloride (Narcan, Evzio, and others), seemed like the obvious answer. Treat naloxone as an over-the-counter drug, activists claimed, and it would become as commonplace in medicine cabinets as cold medicine.

In January 2015, California pharmacy law did change. The state assembly passed AB 1535 and naloxone hydrochloride was given the same special legal status as the flu shot or emergency contraception. This change enabled pharmacists to dispense naloxone widely – not only to those at risk of an overdose, but to their family, their friends, and to anyone who might be at the scene when somebody overdoses on painkillers.

Expanding access and enlisting pharmacists to help made sense considering studies finding prescription opioids — not heroin — as a culprit in most overdoses and conclusive evidence showing naloxone is effective and safe. However, two years later, many pharmacies refuse to face the problem that they had a hand in causing. I spent months researching the consequences of AB 1535, during which I encountered a baffling trend: at the large chain pharmacies, the pharmacists refused to take seriously the law meant to expand access to naloxone. In those major drug stores, it is simply not available.

To me, this refusal is not some abstract problem. Ten years ago, while struggling to overcome my addiction to prescription painkillers, I unintentionally overdosed while in the company of two friends. The OD left me prostrate and comatose, slowing my breathing reflex until my skin started to turn blue. One of the friends called 911, and one of the responding paramedics injected me with Narcan and adrenaline. Administered intravenously, naloxone sobers you up just as quickly as an opioid would get you high.

I “came to" lucid and shivering as they strapped me onto a stretcher. After I arrived at the hospital, I experienced the antidote's single drawback: its effects, while powerful, are short-lived. Less than an hour after the paramedics revived me, I experienced the unique terror of "air hunger"; the residual opioids in my bloodstream, no longer displaced by the naloxone, were causing respiratory depression all over again. I gasped for air but couldn’t catch my breath. Panicked, I yelled to the nurses for more naloxone. I am alive today because of Narcan and because my two friends risked arrest* to called 911 instead of panicking and leaving me to die.

I encountered Narcan again in my twenties as an anthropology student in the liberal northern California city of Santa Cruz, which ran one the country’s first pilot programs to make naloxone available outside of hospitals and first responders. The program, associated with a long-running needle exchange, empowered a doctor to prescribe a kit containing a 10 ml ampule of naloxone to anyone who took a 30-minute training course detailing how to use the medication safely. I attended the training to write about it for my medical anthropology class, and I kept the vial with me for several years, not expecting to use it. In fact, if I had used it to revive someone, I could have been prosecuted for the act, since technically the medicine was in my name.

Five years later, when a panicked roommate barged into my room to tell me his girlfriend had stopped breathing, I was prepared. I grabbed the ampule of naloxone and made him empty a heroin-filled syringe to inject the opioid antagonist into the muscle of her arm. Although she was not heavy, we struggled to steady her dead weight and took turns straining to count her respirations. Neither of us could hear her breathing. I injected the naloxone and we took turns administering rescue breathing as the heroin in her bloodstream was slowly rendered inert. It was the second time in my life that I had witnessed naloxone bring someone back from the brink.

In January 2016, a year after the law was passed, I focused my research on AB 1535. With my firsthand appreciation of the antidote and the historical importance of the new attitude toward naloxone, I was eager to document the positive impact the drug was making in my community.

I learned that pharmacists could dispense naloxone hydrochloride to anyone who asks. A prescription from a physician is no longer necessary, provided the dispensing pharmacist: completes an hour of professional training; agrees to train the recipient in the antidote's use; briefly mentions drug treatment options offered in the community; and notifies the recipient’s primary care physician.

The media departments of large pharmacy chains issued enthusiastic PR releases, pledging to make Narcan easy to get for those who needed it. They would not have to look far; it’s no secret that these pharmacies supply the medications used in most overdoses, and they fill the prescriptions that start many more Californians (either directly or through diversion of the drugs) on the road to dependence.

To learn about the law, I started looking for naloxone, and I documented my visits to a broad cross-sample representative of every chain pharmacy in two California counties.

I discovered that I would not be able to write that positive article I had envisioned. The results of my fieldwork baffled me: the new law had made virtually no meaningful difference. Even now, at the time of this article's publication, a Californian will, more likely than not, struggle or fail to find naloxone.

When the pharmacy technician at the first location I surveyed admitted she had never heard of naloxone hydrochloride, the new law, or the press campaign, I shrugged it off as an anomaly. I waited for the pharmacist, only to learn that she was only vaguely aware of the change in the law.

Furthermore, although thousands of doses of potent painkillers waited in drug lockers to be dispensed, she told me that naloxone was not even among the medications commonly ordered. She offered to talk to her boss and call me back, so I left my number and left the pharmacy empty-handed. This was not a tiny pharmacy in an isolated town; I was within five miles of one of the best known medical teaching universities on the West Coast. There were two overdose deaths in the county that day; what if one had tried but failed to get Narcan?

My fieldwork continued throughout 2016. Pharmacy staff met my respectful requests for Narcan with puzzlement or annoyance. Still worse, more than half the pharmacists reported never dispensing the medication or receiving the requisite training. They had no naloxone hydrochloride in stock and, absurdly, had no plans to order any. One pharmacist scoffed, "We don't 'do' Narcan here."

Frequently I was directed to try my luck at a competing pharmacy nearby, only to be directed back to the original store. The first outcome from my research was my new ability to conceal rising anger. The second is the observation that every major retail pharmacy chain operating displayed implacable disinterest in supplying this essential medication to the communities from which they profit through massive sales of prescription opioids.

Compounding the problem is the rapid escalation of the price of Narcan, while insurers refuse to pay for it. At the time of publication, the least expensive naloxone hydrochloride product costs about $50, even though I found the drug for half that price not twelve months ago. One pharmacy had the kit priced at $380 on December 8th of this year.

The law makes it very clear that pharmacists must complete 60 minutes of training before they can prescribe naloxone hydrochloride. Coordinating special training might not be straightforward, but it isn’t without precedent. In 2009, two major chain pharmacies lobbied the California State Assembly to change pharmacy law to give pharmacists the ability to administer flu shots. Their efforts were successful. Anyone can walk into one of those stores and get the shot.

I don’t know what needs to happen within a company for it to begin the wide-scale dispensing of a drug like naloxone, but we can look to the immunization programs to identify what elements encourage companies to move quickly. I have a source within one profitable corporation who told me about the tremendous pressure exerted by managers on pharmacists to exceed flu shot targets to increase revenues. No such pressure exists for naloxone hydrochloride. Another difference between these two items is how they are ultimately paid for: a dose of the flu vaccine costs about the same as a dose of naloxone, but private healthcare insurers along with Medi-Cal and Medicare (among the state’s largest healthcare insurers) cover the full cost of immunizations. If a connection exists and these companies are motivated solely by profit, then Californians will continue to leave with painkillers to misuse in one hand, but nothing to undo the imminent overdose in the other.

*Progressive attitudes and the Good Samaritan laws that embody them were not prevalent at the time, and all three of us were cited and had to appear later in criminal court.


message 2: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments Jump In Overdoses Shows Opioid Epidemic Has Worsened https://www.npr.org/sections/health-s...
ER visits for opioid overdose up 30%, CDC study finds

Also, check out my 5-star review for STOPPNow: (Stop the Organized Pill Pushers) Now (written by Janet Colbert a retired neonatal intensive care nurse who is bringing attention to this opiate epidemic): https://www.goodreads.com/review/show...


message 3: by James, Group Founder (last edited Mar 07, 2018 10:12AM) (new) - rated it 5 stars

James Morcan | 7197 comments This is an excellent documentary on the overprescribing of medical drugs, including the massive opioid epidemic...

The Shocking Truth in America! (2018) https://www.youtube.com/watch?v=chcUv...

And here's a Huffington Post article on the same subject: https://www.huffingtonpost.com/entry/...


message 4: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments In this latest podcast episode of Underground Knowledge I interview Janet Colbert, a retired neonatal intensive care nurse and author of STOPPNow: (Stop the Organized Pill Pushers) Now, who lays out her vision for how to stop the Opiate Epidemic.

UNDERGROUND KNOWLEDGE #7: Janet Colbert (The Opiate Epidemic) https://www.youtube.com/watch?v=oXnzY...


message 5: by Lance, Group Founder (new)

Lance Morcan | 1952 comments https://www.cbsnews.com/video/60-minu...

This is a news report on a recent 60 Minutes piece on opioids misuse in US..

It's an incredible case where DEA agents found overwhelming evidence about a pharmaceutical company breaking all the rules regarding supply of opioids in painkillers etc. BUT the DEA's own lawyers wouldn't prosecute because they didn't wanna go up against the pharmaceutical company's high powered team(s) of Harvard-trained lawyers. This prompted at least one senior DEA agent to become a whistleblower.

I see Trump this week came out and called opiate abuse one of the biggest crises facing America if not the biggest.


message 6: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments ABC News: New numbers on opioid overdoses show a 54% spike last year https://www.youtube.com/watch?v=cehTC...


message 7: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments As U.S. opioid crisis grows, Trump calls for death penalty for dealers https://newsstand.google.com/articles...


Science (Fiction) Comedy Horror and Fantasy Geek/Nerd (ScienceFictionComedyetcGeekNerd) | 13 comments It reminds me a little bit about the situation with painkillers, psychotropic drugs and generally life-long medications. As long as the traders have the legitimacy of the state, they are allowed to get millions of people hooked on. It is in the interests of companies not to make their drugs as less addictive as possible.
If it's cooked in the basement laboratory or smuggled, it is illegal drug trafficking. The differences are basically marginal. What is morally more reprehensible is difficult to quantify. But at least the criminals are not hypocritical.


message 9: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments Mario wrote: "It is in the interests of companies not to make their drugs as less addictive as possible. ..."

That's a huge part of the problem, yeah.


Science (Fiction) Comedy Horror and Fantasy Geek/Nerd (ScienceFictionComedyetcGeekNerd) | 13 comments James wrote: "Mario wrote: "It is in the interests of companies not to make their drugs as less addictive as possible. ..."

That's a huge part of the problem, yeah."


It´s like with sugar, nicotine, fat, salt, media consumption etc. Making people addicted has always been a great possibility to make money. From transatlantic slave trade over the opium wars until the hypocritical drug politic, beginning with the 70. Puppetmaster tells to smash all competitors and everything is banned without sense, explanation or scientific facts.

Today you can´s sell heroin and Pervitin like Bayer did. That would be a bit too offensive.
But soft addictions one won´t even recognize like with food or nondescription or easily described drugs are so subtle. One won´t notice until he stops eating the stuff. And why should he? Chance eating manners fort he sake of his health? And the gods in white give one the pills because one needs them. So why should one stop taking them?
And finally and worst, one always watched inside the mental enfeeblement machine in ones living room. Great childhood memories, sitting silent together, not moving, everyone who wants to say something gets shouted down. True, pure nostalgia


Emily Walden | 2 comments How many people must die before the appropriate actions are taken against the US Drug Cartels? https://www.washingtonpost.com/news/w...
Sad that the US has allowed this to happen!


message 13: by Janet (last edited Apr 17, 2018 11:20AM) (new) - rated it 5 stars

Janet Colbert | 35 comments STOPPNow: (Stop the Organized Pill Pushers) Now The heroin crisis we now see was almost non-existent prior to the prescription pain pill explosion. 8 of 10 heroin users start with the not so innocent highly addictive pain pill. The opiate epidemic is a physician prescribed epidemic and it's origin was Broward County Florida. We need a wall but we need a wall around Big Pharma first. STOPPNow (Stop the Organized Pill Pushers) Now by Janet Colbert


Janet Colbert | 35 comments Leticia wrote: "https://www.thefix.com/california-ove...

Overdose Law 2 Years Later: Narcan Still Scarce, Expensive
By Jonathan Sobotor 12/11/16
"We don't 'do' Narcan her..."

STOPPNow (Stop the Organized Pill Pushers) Now by Janet Colbert STOPPNow: (Stop the Organized Pill Pushers) Now Very interesting to read Leticia The CDC reports 26,500 overdoses reversed by laypeople using naloxone from 1996- 2014. What is wrong with California. A law just passed in Florida first of all 3 day limit on prescribing during the acute phase of illness. But also For those that prescribe an opioid drug for treatment of pain other than acute co-prescribe an emergency opioid antagonist - Narcan. We must be aware and take seriously the danger of the opiate in order to end the opiate epidemic


message 15: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments Nation's top pain doctors face scores of opioid lawsuits
https://finance.yahoo.com/news/nation...


Janet Colbert | 35 comments STOPPNow: (Stop the Organized Pill Pushers) Now James - STOPPNow held a protest outside of the Broward Convention Center when Lynn Webster was speaking there. He sent one of his cronies out to talk to me he asked, why were we there. I commented on the allegeded deaths Dr Lynn Webster was responsible for and ties with the drug companies. His response "people die"! Scott Fishman author of the book "Responsible Opioid Prescribing" distributed at medical board meetings is anything but responsible. I have quotes from it in the book STOPPNow and the Senate Investigation letter inquiring how much Scott Fishman was paid by the drug companies to write the book. Of course the senate investigation has been buried. Conspiracy - Corruption - Greed


message 17: by B. (new)

B. | 119 comments Opioids are way over prescribed for minor things....I have a family member who was affected by this, it’s a terrible ordeal. I’m proud to say that the company I work for is directly responsible for less opioid prescription because of the surgical equipment we sell-the patient feels less pain after the procedure than normal minimally invasive cases; due to this, patient only need Tylenol, even after major operations-for this, again, I am proud!


Janet Colbert | 35 comments STOPPNow: (Stop the Organized Pill Pushers) NowB. wrote: "Opioids are way over prescribed for minor things....I have a family member who was affected by this, it’s a terrible ordeal. I’m proud to say that the company I work for is directly responsible for..." The CDC guidelines for prescribing are located in the Appendix of the book STOPPNow. Your company should supply each doctor they market to with a copy. Might help


message 19: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments HOW CAN AUSTRALIA STOP THE OPIOID EPIDEMIC BEFORE IT’S TOO LATE? https://ajp.com.au/columns/opinion/ho...


Janet Colbert | 35 comments STOPPNow: (Stop the Organized Pill Pushers) Now STOPPNow (Stop the Organized Pill Pushers) Now by Janet ColbertLance wrote: "https://www.cbsnews.com/video/60-minu...

This is a news report on a recent 60 Minutes piece on opioids misuse in US.. And Lance worse yet. Some of the DEA lawyers are now working for the drug companies advising them. Greed has driven the opiate epidemic.

It's an incredible case..."



Janet Colbert | 35 comments Mario wrote: "It reminds me a little bit about the situation with painkillers, psychotropic drugs and generally life-long medications. As long as the traders have the legitimacy of the state, they are allowed to..." You are right. The drug companies contrived a way to addict as many as they possibly could. And then they control the politicians like puppets on a string to keep it going as long as possible.


Janet Colbert | 35 comments STOPPNow: (Stop the Organized Pill Pushers) NowJay wrote: "I see a connection between the time opium poppy cultivation and export from Afghanistan slowed down with the withdrawal of most Coalition combat troops and the rise of Fentanyl as the number one ki..." Jay - First I am sorry for the loss of your brother. More than likely he started on the not so innocent opiate known as the pain pill. 8 of 10 heroin users have. The prescription pill seems so innocent. And yes you are right regarding synthetic fentanyl (manufactured in China) is killing an onslaught of new victims. It like heroin is cheap. Many are dying not even knowing the heroin or cocaine is laced with the cheaper deadlier fentanyl. We will not stop all addiction, but I continue to believe we should at least be able to stop the one prescribed by doctors. We need production cut. We need less prescribing. We need the tentacles of the drug companies stopped. Read the book STOPPNow (Stop the Organized Pill Pushers) Now. I wrote it to inform. stoppnow.com tab current projects lists what we need help with to put an end to the opiate epidemic.


Janet Colbert | 35 comments STOPPNow: (Stop the Organized Pill Pushers) Now STOPPNow (Stop the Organized Pill Pushers) Now by Janet Colbert International Overdose Awareness Day which began in Australia is Friday, August 31 2018. The CDC announced the death toll in the United States for the year 2017 was 72,300 Many events are planned throughout the nation inclding one in Pembroke Pines Florida see stoppnow.com End the Opiate Epidemic.


message 25: by James, Group Founder (new) - rated it 5 stars

James Morcan | 7197 comments Teachers Are Serving As First Responders To The Opioid Crisis https://www.huffingtonpost.com.au/ent...


message 26: by J.W. (new)

J.W. Barlament | 3 comments Honestly, I think this entire crisis is just one result of a much larger problem. We live in a society that breeds negativity, and negativity routinely leads people down very dark paths.


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