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September 19, 2015

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McKTex likes this.

I don't think your first link is working right Russell, but this seems like an exceptionally fine plan of Campenello's. I have a family member, an ex-criminologist most of whose work was on drugs, who tells me that almost all respectable (non-ideologically-driven) studies show that this "harm reduction" approach is the most cost-effective and successful one. Too bad the prevailing official stance in the UK and the US, and many others countries, is still ideologically driven criminalisation and punishment.

link should be good now - thanks GFTNC!

I remember reading about Narcan and a quick search turns up this
A big concern for Baltimore and other cities is the price of naloxone, which has risen dramatically as demand has gone up. In February, the Baltimore City Health Department was paying about $20 a dose. By July, the price had climbed to nearly $40 a dose.

Maryland Rep. Elijah Cummings, ranking member of the House Oversight and Government Reform Committee, places the blame squarely on the manufacturers and, in particular, Amphastar Pharmaceuticals, the company that makes the naloxone most widely used by health departments and police.

"When drug companies increase their prices and charge exorbitant rates, they decrease the access to the drug," Cummings said this summer. "There's something awfully wrong with that picture."

Amphastar says it raised prices because of increased manufacturing costs, including a rise in the prices of raw materials, energy and labor.

http://www.npr.org/sections/health-shots/2015/09/10/439219409/naloxone-price-soars-key-weapon-against-heroin-overdoses

The Gloucester approach is being considered in a couple of places in Maine, as well.

Is Gloucester the town from which the fishing boat of Kipling's "Captains courageous" hails? If so, the good people of Gloucester are showing the same level-headed attitude that Kipling praises in his great book. Good for them.

I had heard that around here (the Merrimack Valley and the I-95 corridor up to Maine), the crackdown on prescription opioid abuse is creating an explosion of heroin abuse as a substitute.

That's what comes of focusing on the symptom, rther than the disease. People just keep substituting one substance for another.

Matt McIrvin -- I'm not an expert, so someone in one of the relevant fields can correct any of this if it's inaccurate. Most of it is just gleaned from reading/listening to the local news.

In Maine this process has been going on for several years already. There was a worsening problem with the abuse of prescription drugs for a number of years, then a crackdown made those drugs more expensive and harder to get, and heroin started to fill the gap because it’s cheaper. (Imagine that!)

[messed up a link and chopped off half my comment]

Now there’s an added problem in that heroin is being laced with fentanyl, or maybe sometimes replaced by it, and addicts have even less of a chance of knowing what they’re getting than they otherwise might.

I guess the relevance of Chief Campanello calling out the drug companies is that a lot of people got/still get started on the road to addiction with prescription drugs.

I first became aware of the heroin problem on a visit to Ohio, where I grew up, six or seven years ago. I still have friends and family there, and the heroin epidemic has touched several families I know. I don’t know if it got very bad in Ohio before it did in Maine (where I live), or if I just didn’t hear about it right away in Maine. At this point it’s in the local news practically every day; one night this summer IIRC there were fourteen (known) overdoses (including one death) in Portland alone. There’s a lot of ferment in terms of what to do: crack down on dealers “from away” (as if that tide can be stemmed), try the Campanello approach, etc.

A year and a half ago I did a face plant on asphalt and ended up in the ER getting stitches in my face. The doc who sewed me up talked about working two days a week in an addiction clinic. He had some fascinating stories and theories, but I had best not try to quote them after the fact. In relation to wj's 11:10, though, he did say that he thought a certain % of the population was genetically at extra risk for addiction to opioids, which I can well believe.

I have little respect for this sort of publicity stunt. If the people of this community are abusing prescription drugs, this has a hell of a lot more to do with the local pharmacists than with the CEOs of major pharmaceutical corporations. In fact, it has a hell of a lot more to do with THIS VERY SHERIFF's WILLINGNESS TO POLICE AND PROSECUTE HIS OWN COMMUNITY'S PHARMACISTS AND DOCTORS than it does with the CEOs of major pharmaceutical corporations.

"..he did say that he thought a certain % of the population was genetically at extra risk for addiction to opioids, which I can well believe."

I think that *everyone's* brain is wired (part genetics, part chance) to trigger the 'pleasure circuit' for certain inputs...many of which were pro-survival for hunter-gatherer bands on the savannah, but destructive in modern civilization.

Look under the hood of most 'addictions', and you'll find a 'natural' urge.

Patrick, I'm not sure if I agree. When I was in high school, a classmate's father who was a pharmacist got arrested for filling scrip. From what I understand, he sold it to someone who said he was from out of town, had a scrip and kept at him until he sold it, at which point he was arrested. This was in the late 70's, early 80's, at the height of the War on Drugs, but It seems like with these war on drugs kabuki theatres, the stage is filled with small fish, but the people who are profiting from this are never really questioned.

This is just a cursory google search, but things like this essay by Radley Balko

http://deasucks.com/essays/docwar.htm

make me wonder if going after the pharmacists and doctors is a way to deal with this. I also know, from several experiences of friends and family, that pain management is a pretty fraught problem and when people want relief they are going to take.

I also know, from several experiences of friends and family, that pain management is a pretty fraught problem and when people want relief they are going to take.

This is what I worry about. I know from some unpleasant experiences that when you need it, you need it, and it scares me that some people aren't getting pain management that they might need when doctors fear being hammered.

he did say that he thought a certain % of the population was genetically at extra risk for addiction to opioids, which I can well believe.

Yep. You will hear the notion 'addictive personality'. That implies a chemical imbalance or some other disorder. Some people are genetically predisposed to addiction, they just don't know it until they are introduced to the agent. Some people beat it, others don't.

I recall there was also a rash of pharmacy robberies to get Oxycontin, though I don't imagine they were the primary source.

There are two opposing forces headed for a train wreck here -- addiction susceptibility and the recent trend to let go of this "grit your teeth and bear it" suffering we've expected of people in extreme physical pain in this culture.

The answer is probably going to be coming up with less addictive formulations of pain meds already on the market and entirely new classes of pain meds.

My sister shattered her leg in a horseback riding accident two years ago (nearly lost the leg and she'll never be the same again) and that was bad enough, but the pain was so unbearable (I went with her to a few rehab sessions and her screaming was something out of Abu Ghraib, jesus) that she got hooked on some painkiller exponentially more additive than heroin, and finally last Fall, after weird personality changes, she hunkered down for two weeks, quit the meds with terrible withdrawal symptoms, and is now herself again .. with a limp.

But I think she would have offed herself if she hadn't had the pain medication for the first year.

On top of that, her doctor theorizes that the anti-anxiety med she's been taking for years contributed to a loss of bone density which led to the injury.

All she did was dismount and her leg shattered into dozens of shards just above the knee.

The horse had nothing to do with it.

The answer is probably going to be coming up with less addictive formulations of pain meds already on the market and entirely new classes of pain meds.

This is the best hope, AFAICT.

But I think she would have offed herself if she hadn't had the pain medication for the first year.

And this is at the very root of the problem, again, AFAICT. Though it is but one of the unacceptable outcomes.

The drug companies have, at some prompting, started creating less abusable formulations of pain meds. In essence they have reduced/begun to reduce? the ability to ingest them in nonprescribed ways, snorting in particular, to get an accelerated high. Unfortunately this has been, with price, a key contributor to the move to heroin.

when people want relief they are going to take.

The difference between you are arrested for doing so or not seems to be a matter of how you deal with pain. If you cope with alcohol, no problem -- now that Prohibition is behind us. If you cope with other drugs, you get busted.

And there are addictive personalities/genetics there, too. We just call them alcoholics, rather than druggies. And don't lock them up when they just sit around drinking.

And don't lock them up when they just sit around drinking.

That's just for starters. The social costs of alcohol consumption are staggering.

Unfortunately this has been, with price, a key contributor to the move to heroin.

That, and falling prices for heroin.

Why, it's as if our semi-military efforts to stamp out production have been a total failure. Who couldda' known?

The social costs of alcohol consumption are staggering.

Quite true. But as we found out with Prohibition, simply making a drug illegal does nothing to address the problems it causes.

Although it does provide lots of money for criminal groups. Which they can use for far more than just moving their illegal drug.

This post reminds me of how pill mills were set up in Florida to permit addicts with a superficially-legal-looking access to the drugs they wanted.

So, I think while I agree with this post, it's possible that Patrick's points also have some merit. I wouldn't assume that they do, but I'd want to know for certain whether that is a problem.

I have a hard time seeing how a local sheriff can effectively police doctors. And once a doctor writes a prescription, how is a pharmacist at fault for filling it, unless he or she somehow knows the person getting the drugs is either abusing or selling them.

It doesn't take a crooked doctor or pharmacist for prescription-drug abuse to occur (not that I'm against going after any that are out there). It can be a diffuse problem with no particularly bad actors involved in the initial distribution. If anything, a patient who is a good enough liar is the most likely culprit in moving drugs from the sphere of legitimate medical use to recreational use or addiction-appeasement.

Part of the problem is that people don't understand it and are too casual about keeping track of their opioid medications. Another part is that doctors aren't particularly well trained in the science of addiction.

I wouldn't try to claim that this sheriff's landed upon a perfect solution, but he seems to be making a good-faith effort at solving a really damaging problem, and I think he's almost certainly improved upon simply locking addicted people up as criminals.

hairshirthedonist- You're probably right that its tough for a sheriff to effectively and directly police doctors, given that the sheriff isn't in the position to second guess the medical judgment of a doctor.

Except that the sheriff IS in a position to police the resale of prescription medication by people who fraudulently obtain it from doctors. And he is in a position to notice if its consistently particular doctors who just happen to prescribe enough meds that they can be resold. And he is in a position to inform the appropriate authorities, of which there are several. All of those things aren't just things he's in a position to do, they're literally his job.

Meanwhile, the CEO of a pharmaceutical company is hardly in a better position to question a doctor's medical judgment. And to the extent that we should hold companies responsible for the harm their products cause... uh, we did? By imposing a bunch of rules requiring that the products in question be distributed only upon the order of a competent medical professional, via a pharmacist who otherwise keeps the products in question under lock and key?

This is literally a solved problem. The sheriff is just deflecting.

I think there is a difference between the doctor who is prescribing enough meds to be resold (and presumably making a profit off of that) and the doctor who is duped into providing pills and I don't believe that the laws are (or perhaps can be) written to distinguish that. You are trying to legislate against a pattern of behavior, and when you have a war on drugs that utilizes informants and tries to turn small fish against bigger fish (while the Big Pharma CEOs remarkably stay aloof from the whole struggle) suggests that there is a disconnect rather than a solved problem.

This NewYorker article gives more background

http://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic

some grafs

In 2007, Purdue Pharma and three of its top executives pleaded guilty to criminal charges that they had misled the F.D.A., clinicians, and patients about the risks of OxyContin addiction and abuse by aggressively marketing the drug to providers and patients as a safe alternative to short-acting narcotics. (Doctors had been taught that because OxyContin was time-released, it wouldn’t cause a high that would lead to addiction.)

-snip-

The rise in prescription narcotics may have been driven partly by the pharmaceutical industry, but many patients also welcomed—and encouraged—it. Many people believe deeply in the power of modern medicine to cure illness, and bristle at the notion that pain is a fact of life. The promise of a set of medicines that could cure pain was appealing to many patients—and, with a customer-is-always-right mentality having pervaded the doctor’s office, patients were able to pressure physicians to satisfy their requests for the pain pills they’d begun hearing about.

The pain-pill epidemic has also forced doctors like me to consider our own role. Doctors have a duty to relieve suffering, and many of us became doctors to help people. But giving that help isn’t straightforward, especially when it comes to chronic pain. Try explaining the downsides of narcotics to a patient while declining to give him the medication he wants. He might accuse you of not understanding because you’re not the one in pain; he might question why you won’t give him what another doctor prescribed; he might give you a bad rating on a doctor-grading Web site. He might even accuse you of malpractice. None of this is rewarding for doctors: we’re frustrated that we can’t cure the pain, and that our patients end up upset with us.

Doctors have a hard time saying no, whether a patient is asking for a narcotic to relieve pain or an antibiotic for the common cold. We are predisposed to say yes, even if we know it isn’t right. Some of us just don’t want to take the extra time during a busy day to explain why that prescription for a narcotic isn’t a good idea. Some of us also use the promise of prescription narcotics to persuade patients to keep their medical appointments, or to take their other medications.

And here's the article from alternet, whose title kind of tells you where they are coming from.

http://www.alternet.org/drugs/who-behind-opioid-epidemic-big-pharma-course

I knew oxycontin was addictive back in the 90s and I'm not even a doctor. I just watch the news.

Then you should know this isn't a solved problem. ;^)

Knowing something is addictive isn't the same as being expert in seeing the signs of addiction in someone you only spend a relatively short time with.

I know there's something called NASCAR, but it doesn't make me a race-car driver.

why is anyone assuming that Campanella is NOT pursuing criminal investigation and prosecution of folks who are illegally trafficking in opioids?

if you're using and you want to get clean, he will not prosecute you. he wants people to contact ceos at pharmacy companies to ask for their help in getting more discipline in how opioids are handled and distributed.

how does that rule out prosecuting people who sell or distribute drugs illegally?

hairshirthedonist- the "solved problem" I was referring to was the problem of how to prevent drug companies from profiting by selling addictive narcotics. The solution we as a society have adopted is that we require those addictive narcotics to be distributed by a multi layered system of professionals who have direct access to those taking the drugs, and who are legally responsible for monitoring the users condition and making sure that they're not just supplying addicts.

If a city has a prescription drug abuse problem, that suggests that this system isn't working. The solution to that isn't to make politically convenient noise about drug company CEOs. It's to figure out where the medical system broke down such that prescription drugs are flooding the streets.

Going after a CEO is a sham. It's really easy to figure out the CEOs level of responsibility- were the drugs distributed through the standard legal channels out society specifies? Great. Done. Talking up the responsibility of far away CEOs is just a way to distract from a regional problem that is ultimately the responsibility of regional people. Including the ones talking up going after CEOs.

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