Merck's Fraudulent Virtue Signalling A Moral Atrocity

statnews |  The warning signs of what would become a deadly opioid epidemic emerged in early 2001. That’s when officials of the state employee health plan in West Virginia noticed a surge in deaths attributed to oxycodone, the active ingredient in the painkiller OxyContin.

They quickly decided to do something about it: OxyContin prescriptions would require prior authorization. It was a way to ensure that only people who genuinely needed the painkiller could get it and that people abusing opioids could not.

But an investigation by STAT has found that Purdue Pharma, the manufacturer of OxyContin, thwarted the state’s plan by paying a middleman, known as a pharmacy benefits manager, to prevent insurers from limiting prescriptions of  the drug.

The financial quid pro quo between the painkiller maker and the pharmacy benefits manager, Merck Medco, came to light in West Virginia court records unsealed by a state judge at the request of STAT, and in interviews with people familiar with the arrangement.

“We were screaming at the wall,” said Tom Susman, who headed the state’s public employee insurance agency in the early 2000s and led the push to limit OxyContin prescribing in West Virginia.

“We saw it coming,” he said of the opioid epidemic, which today causes 28,000 overdose deaths a year in the United States. “Now to see the aftermath is the most frustrating thing I have ever seen.”

Overprescribing of OxyContin and other opioid painkillers is blamed for helping to plant the seeds for the current opioid crisis. West Virginia has been hit harder than any other state: It suffers the highest per capita drug overdose death rate in the country — more than double the national average. It also has one of the highest rates of painkiller prescribing.

Nancy Pelosi's Daddy Built This...,

stockboardasset |  Earlier this month, U.S. Attorney General Jeff Sessions unveiled a plan to go after doctors and pharmacies suspected of healthcare fraud by oversubscribing opioids. America’s opioid epidemic killed 33,000 people in 2015 making it the worst drug crisis in our history. Last week, President Donald Trump declared the opioid crisis a national emergency allowing the executive branch to direct funds towards treatment facilities and supplying police officers with naloxone.

As a socio-economist on the front lines of the opioid crisis in Baltimore, Maryland. I am about to take you through an opioid experience like you’ve never seen before. We’re going to travel into the inner city of Baltimore and interview current and former addicts of opioids and heroin. Some of these individuals used heroin 15-minutes before the cameras started rolling.

These individuals have never been given the chance to tell their story until now. Baltimore’s mainstream news is not allowed to share this because it breaks the narrative that everything is awesome. It turns out that Baltimore could have the largest methadone clinic in the United States called Turning Point Clinic. Each of the interviewees are current and past patients of the clinic and speak very negatively about it. A similar description of Baltimore is heard  from each of the interviewees of a hellacious city with decades of deindustrialization, drug abuse, and violent crime. 

bitterqueen |  Nancy Pelosi's father Thomas D'Alesandro Jr. allegedly was a "constant companion" of notorious mobster Benjamin "Benny Trotta" Magliano and other underworld figures during his political years in Baltimore, MD.  D'Alesandro was a Congressman for five terms from 1938 to 1947, and Baltimore mayor for three terms from 1947 to 1959.   Magliano was identified by the FBI as one of Baltimore's "top hoodlums," and he widely was acknowledged as the representative for New York's Frankie Carbo who made his bones with Murder, Inc. and later became a made guy in the Lucchese family.  The allegations are included in D'Alesandro's recently-released FBI files which Friends of Ours has obtained pursuant to the Freedom of Information Act.

In 1947 the FBI investigated Magliano for securing a draft exemption from Selective Service for himself and prize fighters he controlled by falsely representing they had essential employment at American Ship Cleaning Company which was operated by John Cataneo.   In fact, Magliano and his boxers had no such employment, and they were convicted with Cataneo in federal court for their unpatriotic draft-dodging scam.  Peter Galiano, one of the convicted boxers, told the FBI in January 1947 that "Thomas D'Alesandro was a constant companion of John Cataneo; Benjamin Magliano . . . and [redacted]":

It was reported that these individuals had worked hard for Thomas D'Alesandro's reelection to Congress and on his campaign at that time to become Mayor of Baltimore.  It was stated that John Cataneo and Magliano during the time of this campaign were under Federal indictments for violation of the Selective Service Act and for fraud against the Government and were subsequently convicted in Federal court.  Cataneo allegedly admitted giving large sums of money toward the Democratic campaign and stated that he would receive the sanitation contracts for Baltimore if Mr. D'Alesandro was elected mayor.

At that time the FBI never investigated D'Alesandro concerning this or numerous other allegations involving hoodlum associations and public corruption.  Of course, while in Congress D'Alesandro sat on the appropriations committee and was a friend of Director J. Edgar Hoover.  For example, an FBI memo dated March 27, 1946 from E. G. Fitch to D. M. Ladd provides:

Supervisor Orrin H. Bartlett advised me that while talking to Congressman Thomas D'Alesandro, Jr. (D., Md.) on March 26, 1946, the Congressman advised Agent Bartlett he was running for Congress again in the fall 1946 election and that in 1947 he was running for the office of Mayor of Baltimore.  Congressman D'Alesandro advised Agent Bartlett that since he had been on the Appropriations Committee, he has been back of the Director and the Bureau one hundred percent, and further, that he was vitally interested in and completely satisfied with the results of the Bureau's work.

Hoover sent warm congratulations to D'Alesandro upon his November 1946 re-election to the House and then his May 1947 election as Baltimore Mayor, and after leaving Congress for City Hall D'Alesandro wrote Hoover by letter dated May 14, 1947:

Thank you very much for message congratulating me on my election as Mayor of the City of Baltimore.  I was most pleased to receive your good wishes and assure you that I will do my utmost to give the people of Baltimore an efficient and outstanding administration.  I, too, will miss you and many other friends in Washington but I am grateful for the proximity of our two cities which will afford the opportunity for frequent visits when and if time permits.  Whenever you are in Baltimore, please make it a point to visit me at City Hall. 

Meanwhile, the allegations against D'Alesandro continued to pile up.  Finally, in January 1961 President John F. Kennedy requested the G-men to address "allegations of D'Alesando's involvement with Baltimore hoodlums; with favoritism in awarding city contracts; [and] protection for political contributors and the prosecution of local cases."  President Kennedy wanted to appoint D'Alesandro to the United States Renegotiation Board which was a government watchdog against profit gouging by defense contractors.  A February 6, 1961 memo from Hoover to the Baltimore and Washington Field Offices cautiously advises:  "The White House has requested that we proceed with a special inquiry investigation but that if substantial derogatory information were developed, we should report this and discontinue any further inquiries because substantiation of any of the allegations would eliminate D'Alesandro."

Feeling Torches and Pitchforks for Dr. Carmen Puliafito and R.Kelly About Now...,

LATimes |  In USC’s lecture halls, labs and executive offices, Dr. Carmen A. Puliafito was a towering figure. The dean of the Keck School of Medicine was a renowned eye surgeon whose skill in the operating room was matched by a gift for attracting money and talent to the university.

There was another side to the Harvard-educated physician.

During his tenure as dean, Puliafito kept company with a circle of criminals and drug users who said he used methamphetamine and other drugs with them, a Los Angeles Times investigation found.

Puliafito, 66, and these much younger acquaintances captured their exploits in photos and videos. The Times reviewed dozens of the images.

Shot in 2015 and 2016, they show Puliafito and the others partying in hotel rooms, cars, apartments and the dean’s office at USC.

In one video, a tuxedo-clad Puliafito displays an orange pill on his tongue and says into the camera, “Thought I’d take an ecstasy before the ball.” Then he swallows the pill.

In another, Puliafito uses a butane torch to heat a large glass pipe outfitted for methamphetamine use. He inhales and then unleashes a thick plume of white smoke. Seated next to him on a sofa, a young woman smokes heroin from a piece of heated foil.

As dean, Puliafito oversaw hundreds of medical students, thousands of professors and clinicians, and research grants totaling more than $200 million. He was a key fundraiser for USC, bringing in more than $1 billion in donations, by his estimation.

What Happened To The 80's Crack Babies?

theatlantic |  Epidemics are hard to cover. Navigating the gaps between the private, personal, and societal and managing to be relatable while also true to science is a tough part of health reporting, generally. Doing those things in the middle of public panic—and its attendant misinformation—requires deftness. And performing them while also minding the social issues that accompany every epidemic means reporters have to dig deep, both into multiple disciplines and into ethics. With multiple competing narratives, politics, and the sheer scale of disease, it’s often easy to forget the individuals who suffer.

That’s why I was struck by a recent article in the New York Times by Catherine Saint Louis that chronicles approaches for caring for newborns born to mothers who are addicted to opioids. The article is remarkable in its command and explanation of the medical and policy issues at play in the ongoing epidemic, but its success derives from something more than that. Saint Louis expertly captures the human stories at the intersection of the wonder of childbirth and the grip of drug dependency in a Kentucky hospital, all while keeping the epidemic in view.

One particular passage stands out:

Jay’la Cy’anne was born with a head of raven hair and a dependence on buprenorphine. Ms. Clay took the drug under the supervision of Dr. Barton to help reduce her oxycodone cravings and keep her off illicit drugs.

“Dr. Barton saved my life, and he saved my baby’s life,” Ms. Clay said. She also used cocaine on occasion in the first trimester, she said, but quit with his encouragement.

[...]

For months, Ms. Clay had stayed sober, expecting that she’d be allowed to take her baby home. Standing in the hospital corridor, her dark hair up in a loose ponytail, she said, “I’m torn up in my heart.”

Generally, treatment for drug-dependent babies is expensive and can go on for months. Nationally, hospitalization costs rose to $1.5 billion in 2012, from $732 million in 2009, according to researchers at Vanderbilt University.

In the space of a few paragraphs, the story introduces a mother and child and the drug dependency with which they both struggle, and also expands its scope outwards to note the nature of the epidemic in which they are snared. It doesn’t ignore the personal choices involved in drug abuse, but—as is typical for reporting on other health problems—it considers those choices among a constellation of etiologies. In a word, the article is humanizing, and as any public health official will attest, humanization and the empathy it allows are critical in combating any epidemic.

The article is an exemplar in a field of public-health-oriented writing about the opioid crisis—the most deadly and pervasive drug epidemic in American history—that has shaped popular and policy attitudes about the crisis. But the wisdom of that field has not been applied equally in recent history. The story of Jamie Clay and Jay’la Cy’anne stood out to me because it is so incongruous with the stories of “crack babies” and their mothers that I’d grown up reading and watching.

What Exactly Is The Plan Again For Dealing With This Opioid Epidemic?

nbcboston |  "We started seeing it last year here and there. But now, it's just raining needles everywhere we go," said Morrison, a burly, tattooed construction worker whose Clean River Project has six boats working parts of the 117-mile (188-kilometer) river.

Among the oldest tracking programs is in Santa Cruz, California, where the community group Take Back Santa Cruz has reported finding more than 14,500 needles in the county over the past 4 1/2 years. It says it has gotten reports of 12 people getting stuck, half of them children.

"It's become pretty commonplace to find them. We call it a rite of passage for a child to find their first needle," said Gabrielle Korte, a member of the group's needle team. "It's very depressing. It's infuriating. It's just gross."

Some experts say the problem will ease only when more users get treatment and more funding is directed to treatment programs.

Others are counting on needle exchange programs, now present in more than 30 states, or the creation of safe spaces to shoot up — already introduced in Canada and proposed by U.S. state and city officials from New York to Seattle.

Studies have found that needle exchange programs can reduce pollution, said Don Des Jarlais, a researcher at the Icahn School of Medicine at Mount Sinai hospital in New York.

But Morrison and Korte complain poor supervision at needle exchanges will simply put more syringes in the hands of people who may not dispose of them properly.

After complaints of discarded needles, Santa Cruz County took over its exchange from a nonprofit in 2013 and implemented changes. It did away with mobile exchanges and stopped allowing drug users to get needles without turning in an equal number of used ones, said Jason Hoppin, a spokesman for the Santa Cruz County.

Money Laundering Makes the Drug Wars Go Round

gfintegrity |  My name is Jack Blum. I am a Washington attorney specializing in money laundering compliance and issues of offshore tax evasion. I am appearing on behalf the Tax Justice Network-USA and Global Financial Integrity. Both organizations endorse the bill sponsored by Senator Levin, S. 569, the Incorporation Transparency and Law Enforcement Assistance Act.

The single most important tool in the toolkit of people trying to hide money from law enforcement and tax collection is the anonymous shell corporation. These shell corporations have no physical place of business, use nominee officers and directors, and as a rule do no business in the place of incorporation. Their sole purpose is hiding where money is, who controls it, and where it is moving, from law enforcement and tax collectors. These shell companies should not be allowed remain anonymous.

States that offer corporations to individuals without insisting on information on beneficial ownership are undermining the efforts of law enforcement to prevent crime, recover stolen assets and collect tax. They are also putting the United States out of compliance with international standards for customer identification. From our perspective gathering basic information about ownership for government use is essential to protect national security and to limit financial crime and tax evasion.

Anti-money laundering compliance is dependent on 'know your customer .' Without that knowledge financial institutions cannot evaluate the legitimacy of a transaction. Knowing that one shell corporation is owned by another shell corporation is not helpful. Having the details of the "owner's" directors who are usually professional directors who work for a corporate service company in another jurisdiction is useless. Financial institutions need to know who is behind a company to judge whether the transactions they monitor are suspicious. They need to know whether the beneficial owner is on the OFAC list, the other sanctions lists is a politically exposed person.

The proposed legislation would end the all too frequent use of loopholes in State incorporation laws to hide money.  Fist tap Bro. Makheru

Race Obsessed Youtube Dips**t Ignorant of Oregon's Legalization Status

theantimedia |  Oregon’s state legislature just reduced penalties for drug possession in a bill also intended to reduce racial profiling by law enforcement agencies.

H.B. 2355 passed both the House and Senate last week and reduces possession of illegal drugs to misdemeanors rather than felonies as long as the person in possession does not have prior drug convictions. According to a press release issued on July 7 by Oregon Attorney General Ellen Rosenblum, the bill provides for “the reduction of penalties for lower level drug offenders. The bill also reduces the maximum penalty for Class A misdemeanors by one day to avoid mandatory deportation for misdemeanants.”

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According to the text of the bill, drugs like LSD, MDMA, cocaine, meth, oxycodone, and heroin are essentially decriminalized in small amounts. Each drug listed is accompanied by the following text, indicating possession is only a felony if:

“(a) The person possesses a usable quantity of the controlled substance and: (A) At the time of the possession, the person has a prior felony conviction; (B) At the time of the possession, the person has two or more prior convictions for unlawful possession of a usable quantity of a controlled substance.”

The “misdemeanor” title applies for varying amounts of different drugs. For example, the maximum allowable amount of acid is up to “40 units,” while individuals may have up to five MDMA pills or less than one gram before their “offense” crosses the line into a felony. Less than two grams of cocaine constitutes a misdemeanor.

As Rep. Mitch Greenlick, a Democrat representing Portland, told Portland-based health outlet the Lund Report:

“We’ve got to treat people, not put them in prison. It would be like putting them in the state penitentiary for having diabetes… This is a chronic brain disorder and it needs to be treated this way.”

“When you put people in prison and given them a felony conviction, you make it very hard for them to succeed,” he added.

Drug Prohibition/War is the Dry Rot Within the American Body Politic

The corruption, dishonesty, social and ethical cannibalism within the sphere of forbidden substance users and those who prey on forbidden substance users -  has done more than any other single factor to bring on the climate of political malaise in this country.  Its still largely third rail status as a subject for national political consideration is a crucial indication of its importance. If Prohibition/War isn't the most important factor, it's certainly the most important unmentioned factor in the increasing antipathy of Americans to both traditional political parties.

For most of my lifetime, it's been out of bounds to broach the notion of drug law reform in a large public forum.   That decades-long evasion of honest debate on the relevant issues has enabled the Drug War- with its combination of unchallenged rationale and array of actual consequences - to exert a profoundly destructive effect on both official and unofficial institutions of this society. We're dealing with a corrosive situation that's been allowed to grow and fester for at least 40 years. Not drug use - but the illegal drug markets and the consequences to society of those markets. The society nurtured by that underground economy, which advantages hardened criminals over those who aren't as willing and able to resort to deceit and violence, has routinely exported the psychotic and antisocial values from jails into our communities.

We don't give nearly enough consideration to the negative consequences engendered by mass incarceration and what that has brought back to our communities from the bedlam(s) of the prison industrial complex. It is the criminal marketplace rather than the effect of forbidden substances which has acquired a hegemonic influence over our communities and popular culture. Who among us is factoring in the current state of most of our jails and prisons and what these contagiously export into our communities?  Who is factoring in the personal and public health problems and socially corrosive mentalities bubbling up out of prisons - which factors are incontestably worse than the worst impacts even of forbidden substance addiction, per se.

Race obsessives think that the main problem in America is drawn along racial lines. I disagree. The big problem in America is the long-term result of nearly a half-century of a profoundly and deceptively metastasizing Drug War. This dry rot has spread throughout our society corrupting banks, schools, police, courts, jails, politicians, professions, rents, housing, social welfare programs, the public health system, big pharma. 

The problems of forbidden substance misuse and abuse are dwarfed by the problems of Greed, Punitive Morality, Stigmatization, and Deception on both sides of the crooked line irrationally drawn by the forbidden substance criminal statutes.  The country would see a noticeable improvement within two years of effective drug law reform that worked to minimize the economic demand in the criminal marketplace: cannabis legalization, opioid addiction maintenance, a liberalized prescription and/or registry regime for some of the other substances, all while retaining laws against illegal sales operations.

In less than ten years, we might even get many of our worst schools and neighborhoods back on the path to recovery from that long-standing condition of beleaguered competition with the burdens imposed by the illicit economy.

Addicts Pawns in a Sprawling National Network of Insurance and Treatment Fraud

BostonGlobe  |  Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by The Boston Globe and STAT has found.

They are being sent to treatment centers hundreds of miles from home for expensive, but often shoddy, care that is paid for by premium health insurance benefits procured with fake addresses.

Patient brokers are paid a fee to place insured people in treatment centers, which pocket thousands of dollars in claims for each patient. They often target certain Blue Cross Blue Shield plans, because of their generous benefits and few restrictions on seeking care from out-of-network treatment programs.

The fraud is now so commonplace that brokers use a simple play on words to describe how it works: “Do you want to Blue Cross the country?”

Prohibition Has Been An Epic Policy Failure

Illicit drug markets were flourishing in white communities in the 1970s, and they continue to flourish in white communities to this very day. The crucial difference between affluent white drug markets and gritty black urban drug markets is the drive-through customer service provided to strangers in mostly black ghetto neighborhoods. 

White neighborhoods feature a drug market staffed by affluent teenagers doing it as a sideline for free drug supplies, social-peer status, and disposable income with a customer base of similarly well-heeled schoolmates and friends. Black and brown ghettos feature a market run in deadly earnest by poor and marginalized people viewing it more like a career choice- as their best chance at earning good money, fast money, and possibly even a boost to long-term upward mobility.

Open-air street markets are riskier all around, and much more criminogenic. But that's principally a function of the illegal marketplace, not the underlying commodity "drugs" being bought and sold. Prohibition has been an epic policy failure. Instead of success in curbing the use of officially forbidden drugs, 50 years of get-tough criminalization, zero tolerance, and mandatory minimums have resulted in;

1. a state of perpetual civil conflict
2. an unregulated supply of a wider array of harder and harder drugs
3. diverse harder drug abuse by younger and younger people
4. broad-based antagonism against police and government
5. unparalleled levels of police corruption

Unfortunately, the respectable negroes of impoverished black ghettos made the same mistake as the morally upright but deeply hypocritical WW2 generation of adults in more affluent white communities.  Faced with an unfamiliar phenomenon (the newfound popularity of some legally prohibited drugs among the youth), they imagined that a law enforcement crackdown would solve the problem and reset their status quo back to more familiar conditions, back before the kids were smoking pot and experimenting with drugs. 

Let's be clear- the initial 1960s-era domestic "illegal drug problem" related almost entirely to marijuana; the heroin market was confined to "bad neighborhoods" in a handful of large cities, and it took years for the cocaine market to develop a significant consumer base anywhere in the country.

Instead, the resulting Drug War only made matters worse, across the board. Including problems of police brutality and the impression that a coercive regime was being imposed upon urban black neighborhoods by outsiders. Which is, yes, what the citizens originally asked for. But the source of the folly was the naive idea that "drugs" were the primary source of the breakdown of civic order, rather than the illicit markets empowered by a simplistic prohibition regime that was- and still is- rationally indefensible.

Even the most responsible black American parents of teenagers are in much the same position as practically every other ethnic population- there's only so much they can do to counteract negative peer group influence on their adolescent children, given the circumstances of the modern world. And the stance that "studying is a white thing" would have a lot less social currency in the absence of the attractions of economic success provided by opportunities in the retail illicit drugs trade. "Studying is a white thing" is part of a narrative of fake resistance promulgated by criminals and delinquents. It's an excuse proffered by nihilistic elements of the black lumpenproletariat - pornographically promoted by Madison Avenue - not by "black culture".

The source of the problem- the basis for the appeal of the story that tells boys to kick school to the curb and go for fast money and instant gratification- isn't the inherent criminality of "black culture", or black people. It isn't ethnically based. It's mostly about Pinocchio Pleasure Island. The real-life Pleasure Island of the drug dealing game. In the absence of a lucrative underground market in prohibited drugs, criminality is a pretty pathetic career path.  In the presence of that avenue of opportunity, it's a glamor profession. Or at least it contains enough glamorous aspects to make it a very attractive occupation, especially for teenage males at the outset. Remember what eventually happens to the boys on Pleasure Island.

The useless not-see narrative blames the dysfunctions of poor black communities on a lack of moral character - a deficiency purportedly inherent to lower racial IQ or some allegedly monolithic "black culture." The useless BLM narrative blames the problems in impoverished black ghettos on some all-pervading, amorphous, undifferentiated, supposedly rampant white racism, i.e., an inherent moral deficiency of monolithic "white culture." 

Neither of those stories address the actual source of the problem.

Jay-Z's No Prophet, Just Old, and No, No Respect...,

theguardian |  After a consortium led by Jay-Z bought Tidal (previously known as WiMP) in January 2015, it had a star-studded launch where many of the biggest pop acts on the planet pledged to give it exclusive material first. That amounted, initially, to a Madonna video that soon appeared on YouTube. After that came Rihanna’s Anti, in January 2016, which ended up being released early by mistake, then 1m copies were given away to appease fans while Tidal blamed Universal Music Group for the error. UMG countered by saying it was actually Tidal’s fault. The album eventually ended up on other streaming services. 

The release of Kanye West’s The Life Of Pablo did no better. Despite West’s assurances that it would never be on Apple, a matter of a few weeks after its Tidal debut it was available on … Apple. And Spotify. And everywhere else. To paraphrase Oscar Wilde, to lose one exclusive may be regarded as a misfortune; to lose two or more looks like carelessness. 

That said, Beyoncé’s Lemonade remains a streaming exclusive on Tidal over a year after its release. But the knock-on effect was to send fans to pirate sites as well as CD retailers and iTunes to spend their money there rather than taking the carrot and joining Tidal. The fact that Lemonade, according to IFPI numbers, sold 2.5m copies globally last year to become the biggest album in the world would suggest that it was downloads and CDs that accounted for the bulk of that. The “album equivalent streams” of Lemonade on Tidal will have barely touched the sides here. 

Universal, smarting from the Frank Ocean debacle last August – in which Apple Music got an exclusive for the contract-fulfilling album Endless and then, the next day, Ocean put out Blonde himself – reportedly imposed an embargo on exclusives. Warner Music Group and most indie labels were always against them. That leaves Sony, which has hinted exclusives will be considered on a case-by-case basis, the unspoken subtext being they have fallen in line with all the other labels. 

There will be the occasional outlier, such as the totally autonomous Chance the Rapper’s two-week exclusive with Apple Music for his album Coloring Book in May 2016, for which he claims he was paid $500,000; but everyone else is increasingly of the belief that exclusives dangerously impede the reach of an album and, as such, only annoy fans at a time where loyalty can no longer be presumed and has to be earned again with every new release.

Jay-Z has an allegiance to his own service and one of its biggest investors, hence this Tidal–Sprint deal; but it feels like a message beamed in from a different place and a different time. In an age of digital ubiquity, exclusives are an anachronistic bet on a roulette wheel where the only pockets are marked as either “invisibility” or “irrelevance”.

The Real Cause of the Opioid Epidemic

charleshughsmith |  We also know that the proximate cause of this epidemic is Big Pharma, which promised non-addictive painkillers that lasted for 12 hours but delivered addictive painkillers that did not last 12 hours.

The unsavory truth was reported by the Los Angeles Times last May (2016) in a scathing investigative series: 'You Want a Description of Hell?' Oxycontin's 12-hour problem.

There are plenty of other participants who share responsibility for the public health and law-enforcement disaster: physicians who all too readily passed out prescriptions for powerful synthetic opioids like aspirin; the government agencies that approved the synthetic heroin as "safe" (heh) and paid for their distribution via Medicaid, the Veterans Administration, etc., and the patients who all too willingly accepted the false promises of synthetic opioids.

But what's missing from the public conversation is the underlying cause of the epidemic: a structural scarcity of paid work and positive social roles for vast swaths of America's workforce.

We all know what paid work means: jobs. Positive social roles include jobs--supporting oneself and one's family provides purpose, meaning, identity and a source of pride, all atrributes of positive social roles--but the concept extends beyond work to any role in which the participant feels needed and that offers dignity: this includes volunteer, guardian, mentor, coach, etc., many of which are unpaid.

A significant essay in the March/April issue of Foreign Affairs describes The Dignity Deficit: Reclaiming Americans' Sense of Purpose (subscription or registration required)

At its core, to be treated with dignity means being considered worthy of respect. Certain situations bring out a clear, conscious sense of our own dignity: when we receive praise or promotions at work, when we see our children succeed, when we see a volunteer effort pay off and change our neighborhood for the better. We feel a sense of dignity when our own lives produce value for ourselves and others. Put simply, to feel dignified, one must be needed by others.

Giving people welfare, cheap prescriptions for opioids and Universal Basic Income (UBI) does not make them feel needed--it makes them feel superfluous and worthless.

Cops Weaponizing Narcan to Torture and Stigmatize Addicts

dailybeast |  M______ Charles M_____ turned 26 in jail on March 2, a week after his arrest for misdemeanor heroin possession. But his entire life may as well boil down to an inglorious 30 seconds of tightly edited video, played on local news channels, that shows him nearly dying.

On Feb. 18 a closed-circuit surveillance camera captured him shooting heroin, then falling out of his seat on a crowded city bus in Philly suburb, Upper Darby. The video cuts to a police officer hovering over the unconscious man and applying a dose of the powerful overdose antidote naloxone.

Naloxone (sold under the brand name Narcan) has been the subject of increasing media attention since the Food and Drug Administration approved a nasal spray version of the drug in last November to reverse the effects of opioid overdose, namely severe respiratory depression that can be fatal if left untreated. Narcan works by reversing those symptoms. A number of police departments now outfit their officers with it, and changes to state laws have made the drug legal for sale over the counter in some pharmacies. In 2014, Pennsylvania passed a law that made naloxone available through a standing prescription to laypeople, including drug addicts themselves and their families.

The video footage of M_____’s overdose concludes with him back on his feet and being escorted off the bus by police paramedics—a seemingly happy ending to a nearly fatal tragedy.

But M_____’s story is anything but happy. And it’s far from over.

After saving his life, the police arrested him for the tiny amount of heroin (four baggies) they found on him. While M_____ suffered the first pangs of opioid withdrawal in a jail cell (imagine severe flu combined with anxiety and depression) the police humiliated him by tweeting a link to the video provided by the transit authority.

It went viral.

Baltimore Having to Ration Opioid Overdose Remedy

washingtontimes |  Citing the deadly opioid crisis, Baltimore officials made it easier on Thursday to acquire an overdose-reversing drug over the counter, saying the antidote should be as prevalent as possible to prevent more deaths.

City Health Commissioner Leana Wen waived training requirements for acquiring and using naloxone, a fast-acting medication that’s become a vital and ubiquitous tool in fighting the nation’s heroin and prescription painkiller crisis.

Dr. Wen said the training only took a few minutes — naloxone can be administered as a nasal spray or injected into the muscle, like an EpiPen. But the associated paperwork was cumbersome, so she implemented a recent state law allowing her to scrap the training altogether.

“Any resident can go into any of our pharmacies in Baltimore City and immediately get the medication for saving someone’s life,” she said.

City residents on Medicaid can acquire two doses of naloxone for $1 — it’s free if they don’t have the money — while those on private insurance typically face co-pays of $10 to $40.

Baltimore estimates that 20,000 residents use heroin and thousands more abuse prescription opioids. There were 481 fatal overdoses in the city during the first nine months of 2016, according to preliminary data, and deaths related to fentanyl have risen twentyfold in recent years, the health department said.

Cost of Being Rescued From Opioid Overdose Tripled...,

scientificamerican |  First came Martin Shkreli, the brash young pharmaceutical entrepreneur who raised the price for an AIDS treatment by 5,000 percent. Then, Heather Bresch, the CEO of Mylan, who oversaw the price hike for its signature Epi-Pen to more than $600 for a twin-pack, though its active ingredient costs pennies by comparison.

Now a small Virginia company called Kaleo is joining their ranks. It makes an injector device that is suddenly in demand because of the nation’s epidemic use of opioids, a class of drugs that includes heavy painkillers and heroin.

Called Evzio, it is used to deliver naloxone, a life-saving antidote to overdoses of opioids. More than 33,000 people are believed to have died from such overdoses in 2015. And as demand for Kaleo’s product has grown, the privately held firm has raised its twin-pack price to $4,500, from $690 in 2014.

Founded by twin brothers Eric and Evan Edwards, 36, the company first sought to develop an Epi-Pen competitor, thanks to their own food allergies.

Now, they’ve taken that model and marketed it for a major public health crisis. It’s another auto-injector that delivers an inexpensive medicine.

One difference, though, is that Evzio talks users through the process as they inject naloxone. The company says the talking device is worth the price because it can guide anyone to jab an overdose victim correctly, leave the needle in for the right amount of time and potentially save his or her life.

According to Food and Drug Administration estimates, the Kaleo product, which won federal approval in 2014, accounted for nearly 20 percent of the naloxone dispensed through retail outlets between 2015 and 2016, and for nearly half of all naloxone products prescribed to patients between ages 40 and 64—the group that comprises the bulk of naloxone users.

Drugs, Mental Illness, Terrorism...,

thenews |  Terrorism, drugs-for-arms and money laundering are intrinsically linked and pose a considerable threat to global peace and security. They destabilise the political and financial stability of many nation-states. They were accelerated in the wake of 9/11. Militants and extremists have a nexus with criminal networks involved in dealing drugs and arms.

Evidence available with intelligence agencies confirms that from Al-Qaeda to Daesh the real challenge involves the free flow of legal and illegal funds. Until today, the international community has failed to sever their financial lifeline.

It is an open secret how the drug trade in post-Taliban Afghanistan was institutionalised through the puppet regime in Kabul and the patronising attitude of war lords in many provinces of the country. Once opium started being processed at a mass scale into morphine and heroin in Afghanistan, it brought tonnes of money for commanders on the ground.

Since 2004, the controlled democracy in Afghanistan has been playing into the hands of more sophisticated narco-enriched commanders. It is no longer a secret that the Taliban – with whom the US and its allies have always been in negotiation since 2004 – knew how to buy or muscle a vote which would protect their opium interests in every election.

Even Afghanistan’s neighbours have been making profits from the windfall: criminal groups from Central Asia, says the UN, have made profits worth $15.2 billion from the trafficking of opiates in 2015. Tajikistan is, by far, the worst affected by the drug plague owing to a combination of history, poverty and geography.

In the late 1990s, the drug trade was believed to be a source of finance for the Islamic Movement of Uzbekistan (IMU) – a terrorist group which had bases in Afghanistan and Tajikistan. After the war in Afghanistan, the IMU lost most of its influence. But the drugs trade continued with organised criminals taking the place of political or religious activists. In a survey conducted by the Open Society Institute, eight out of 10 of those polled said – hardly surprisingly – that “the main reason to turn to drug trafficking was to make big money”.

Positive Long-Term Growth Outlook for the Opioids Market

medgadget |  Opioids are the most widely prescribed medications to treat moderate to severe chronic pain. These analgesics are used to manage pain in cancer patients and also to treat severe constant pain in patients suffering from terminal illnesses. These are generally administered via subcutaneous, oral and intramuscular routes; other routes of administration include nasal insufflations, patient controlled analgesia, transdermal and oral mucosa routes via lozenges. Opioids can be classified into three major classes namely, strong agonists (fentanyl, oxymorphone, and morphine), mild to moderate agonists (codeine and hydroxycodone), and opioids with mixed receptor reactions (buprenophrine and pentazocine). Although they form one of the most widely used analgesic classes, they cause certain adverse effects such as constipation, nausea, vomiting, sedation, respiratory depression and others. However, the major concern with this drug class is the high level of drug abuse observed worldwide, leading to illegal trade of these drugs worth hundreds of billions of dollars. According to a study published in the Journal of American Medical Association in April 2011, the rate of deaths occurring due to the overdose of prescription opioids has increased substantially in the last decade in the U.S. alone. This study also indicated that high doses of opioid drugs prescribed for pain management possessed increased risk of overdose mortality in the patients.

This report gives readers a comprehensive overview of the Opioids Market: http://www.transparencymarketresearch.com/opioids-market.html

The leading molecules in this segment that constituted about 65% of the total opioids market include OxyContin (oxycodone), Nucynta (tapentadol), Rybix and Ultram (tramadol), Exalgo (hydromorphone), Ultiva (remifentanil) and fentanyl.The remaining 35% market revenue was contributed by other generic opioids as well as combination formulations of NSAIDs with opioids.The actual market scenario for this drug class, however, could be different due to the strong product pipeline, with two major entries MoxDuo IR (morphine/oxycodone) and Remoxy (oxycodone) set to hit the market in 2016. The market entry of these two drugs is expected to boost growth of the overall opioids market during the forecast period. The number of patients suffering from chronic pain is on a constant rise globally. Thus, increasing incidence of chronic pain conditions will continue to encourage the use of pain management drugs, thereby driving the opioids market. Doctors usually prescribe medicines in the initial stages of pain, followed by other treatment options. Prescription drugs are easy to use and economical and are expected to support the growth of the opioids market globally.

America Cannot Solve Its Pain and Misery With Addictive Distortions

unz |  All over America, I’ve seen posters warning against drug addictions. In Cheyenne, it’s “METHAMPHETAMINE / Don’t live this tragic story.” A few blocks away, I stepped over used needles on the sidewalk. In Buffalo, it’s an image of a beer bottle and a pill bottle, with “HEROIN addiction starts here…” Appended to it was a homemade sign, “SHOOT YOUR LOCAL HEROIN DEALER.” Also in Buffalo, it’s a photo of a seemingly dead man on the floor, with “Learn how to recognize OPIOID OVERDOSE and SAVE A LIFE.” In Cleveland, it’s a tagged toe in a morgue, with “DEATH BY HEROIN OVERDOSE IN CUYAHOGA COUNTY HAS QUADRUPLED,” and this was in 2014, before the prevalence of fentanyl.

 

In 2016, Philly had 277 murders and 907 fatal drug overdoses. For 2017, murders are up 21% and drug deaths, 33%. What’s your town’s drug toll?

A 33-year-old friend admits to popping street-bought Xanax every now and then to help her sleep. I suspect she’s on various pills, if not heroin, for she’s always broke and borrowing money. She has a spotty memory, sporadic hygiene and pinpoint pupils.

At Friendly, I sat next to my buddy Jeff, who’s in his late 40’s and HIV positive. Each day, Jeff pops a dozen pills, including Klonopin, a benzodiazepine that can trigger paranoid or suicidal thoughts, as well as degrade your memory, judgment and coordination. Mixed with other substances, particularly alcohol, it can slow your breathing or even kill you. Jeff is always drinking.

“Jeff, man, you’re always so outgoing, so gregarious, I can’t imagine you having anxieties!”

“That’s because of the Klonopin, dude. Without it, I’d be a mess. Without it, I’d be up all night pissed off, you know, about some stupid argument I had 15 years ago, some fight with a hot dog vendor who gave me ketchup instead of mustard!”

“That’s serious.”

“Here’s what it looks like,” Jeff showed me some innocent white pills in a yellow bottle. “You want one?”

“No, thanks.”

Jeff took one out anyway and gave it to the bartender, 42-years-old Lisa. She stashed it away for later.

Methamphetamine is Nazism in Pill Form

guardian |  The story Ohler tells begins in the days of the Weimar Republic, when Germany’s pharmaceutical industry was thriving – the country was a leading exporter both of opiates, such as morphine, and of cocaine – and drugs were available on every street corner. It was during this period that Hitler’s inner circle established an image of him as an unassailable figure who was willing to work tirelessly on behalf of his country, and who would permit no toxins – not even coffee – to enter his body.

“He is all genius and body,” reported one of his allies in 1930. “And he mortifies that body in a way that would shock people like us! He doesn’t drink, he practically only eats vegetables, and he doesn’t touch women.” No wonder that when the Nazis seized power in 1933, “seductive poisons” were immediately outlawed. In the years that followed, drug users would be deemed “criminally insane”; some would be killed by the state using a lethal injection; others would be sent to concentration camps. Drug use also began to be associated with Jews. The Nazi party’s office of racial purity claimed that the Jewish character was essentially drug-dependent. Both needed to be eradicated from Germany.

Some drugs, however, had their uses, particularly in a society hell bent on keeping up with the energetic Hitler (“Germany awake!” the Nazis ordered, and the nation had no choice but to snap to attention). A substance that could “integrate shirkers, malingerers, defeatists and whiners” into the labour market might even be sanctioned. At a company called Temmler in Berlin, Dr Fritz Hauschild, its head chemist, inspired by the successful use of the American amphetamine Benzedrine at the 1936 Olympic Games, began trying to develop his own wonder drug – and a year later, he patented the first German methyl-amphetamine. Pervitin, as it was known, quickly became a sensation, used as a confidence booster and performance enhancer by everyone from secretaries to actors to train drivers (initially, it could be bought without prescription). It even made its way into confectionery. “Hildebrand chocolates are always a delight,” went the slogan. Women were recommended to eat two or three, after which they would be able to get through their housework in no time at all – with the added bonus that they would also lose weight, given the deleterious effect Pervitin had on the appetite. Ohler describes it as National Socialism in pill form.

Austin Indiana the HIV Capital of America

medicalxpress |  Jessica and Darren McIntosh were too busy to see me when I arrived at their house one Sunday morning. When I returned later, I learned what they'd been busy with: arguing with a family member, also an addict, about a single pill of prescription painkiller she'd lost, and injecting meth to get by in its absence. Jessica, 30, and Darren, 24, were children when they started using drugs. Darren smoked his first joint when he was 12 and quickly moved on to snorting pills. "By the time I was 13, I was a full-blown pill addict, and I have been ever since," he said. By age 14, he'd quit school. When I asked where his care givers were when he started using drugs, he laughed. "They're the ones that was giving them to me," he alleged. "They're pill addicts, too."

Darren was 13 when he started taking pills, which he claims were given to him by an adult relative. "He used to feed them to me," Darren said. On fishing trips, they'd get high together. Jessica and Darren have never known a life of family dinners, board games and summer vacations. "This right here is normal to us," Darren told me. He sat in a burgundy recliner, scratching at his arms and pulling the leg rest up and down. Their house was in better shape than many others I'd seen, but nothing in it was theirs. Their bedrooms were bare. The kind of multigenerational drug use he was describing was not uncommon in their town, Austin, in southern Indiana. It's a tiny place, covering just two and a half square miles of the sliver of land that comprises Scott County. An incredible proportion of its 4,100 population – up to an estimated 500 people – are shooting up. It was here, starting in December 2014, that the single largest HIV outbreak in US history took place. Austin went from having no more than three cases per year to 180 in 2015, a prevalence rate close to that seen in sub-Saharan Africa.

Exactly how this appalling human crisis happened here, in this particular town, has not been fully explained. I'd arrived in Scott County a week previously to find Austin not exactly desolate. Main Street had a few open businesses, including two pharmacies and a used-goods store, owned by a local police sergeant. The business with the briskest trade was the gas station, which sold $1 burritos and egg rolls. In the streets either side of it, though, modest ranch houses were interspersed among shacks and mobile homes. Some lawns were well-tended, but many more were not. On some streets, every other house had a warning sign: 'No Trespassing', 'Private Property', 'Keep Out'. Sheets served as window curtains. Many houses were boarded up. Others had porches filled with junk – washing machines, furniture, toys, stacks of old magazines. There were no sidewalks. Teenage and twenty-something girls walked the streets selling sex. I watched a young girl in a puffy silver coat get into a car with a grey-haired man. I met a father who always coordinates with his neighbour to make sure their children travel together, even between their homes, which are a block apart. Driving around for days, knocking on doors looking for drug users who would speak with me was intimidating. I've never felt more scared than I did in Austin.

The mystery of Austin is only deepened by a visit to the neighbouring town of Scottsburg, the county seat, eight miles south. It's just a bit bigger than Austin, with a population of about 6,600, but it's vastly different. A coffee shop named Jeeves served sandwiches and tall slices of homemade pie, which you could eat while sitting in giant, cushiony chairs in front of a fireplace. A shop next door sold artisanal soap and jam. The town square had a war memorial and was decorated for Christmas. The library was populated. The sidewalks had people and the streets had traffic. There were drugs in Scottsburg, but the town did not reek of addiction. The people didn't look gaunt and drug-addled. No one I asked could explain why these two towns were so different, and no one could explain what had happened to Austin. But a new theory of public health might yet hold the answer. Known as syndemics, it may also be the one thing that can rescue Austin and its people.

The term syndemics was coined by Merrill Singer, a medical anthropologist at the University of Connecticut. Singer was working with injecting drug users in Hartford in the 1990s in an effort to find a public health model for preventing HIV among these individuals. As he chronicled the presence of not only HIV but also tuberculosis and hepatitis C among the hundreds of drug users he interviewed, Singer began wondering how those diseases interacted to the detriment of the person. He called this clustering of conditions a 'syndemic', a word intended to encapsulate the synergistic intertwining of certain problems. Describing HIV and hepatitis C as concurrent implies they are separable and independent. But Singer's work with the Hartford drug users suggested that such separation was impossible. The diseases couldn't be properly understood in isolation. They were not individual problems, but connected.

Singer quickly realised that syndemics was not just about the clustering of physical illnesses; it also encompassed nonbiological conditions like poverty, drug abuse, and other social, economic and political factors known to accompany poor health.