In March 2019, facing an estimated 2,600 lawsuits1,2 relating to its role in creating the opioid epidemic, Purdue Pharma — the maker of OxyContin — announced the company was considering filing for bankruptcy protection.
Around that same time, New York expanded its lawsuit against the company to include allegations that company funds had been fraudulently transferred into trusts and offshore accounts owned by members of the Sackler family in an effort to shield assets from litigation.3,4 In all, court documents reveal the Sacklers transferred more than $10 billion of the company’s funds into family trusts.5
How this does not fall under the fraudulent conveyance statutes, which is attempting to avoid a debt by moving assets to another person or legal entity, boggles my mind. It appears the only reason they got away with this is they found the loophole of transferring their assets offshore.
The New York complaint also charged Purdue with secretly setting up a new company, Rhodes Pharma, in 2007 while the company was being investigated by federal prosecutors, as a way to protect the Sacklers from the mounting OxyContin crisis and continue their profit scheme.6 Rhodes Pharma makes generic opioids, allowing the Sacklers to benefit from the opioid epidemic both in terms of brand name sales and generic sales.7
Rhodes Pharma and Richard Sackler also hold the patent to a new, faster-dissolving form of buprenorphine, a mild opioid drug used in the treatment of opioid addiction,8 allowing the Sacklers to further profit from the addiction crisis they helped instigate, the economic burden of which is costing the U.S. an estimated $504 billion a year.9
Indeed, according to a lawsuit filed in Massachusetts,10 Purdue Pharma and the Sacklers sought to increase opioid prescriptions while simultaneously developing overdose treatment to boost its profits.
US Government Enters Opioid Business
Purdue finally filed for Chapter 11 bankruptcy in September 2019.11 At the end of October 2020, Purdue Pharma agreed to plead guilty to three federal criminal charges relating to its role in the opioid crisis, including violating a federal anti-kickback law, conspiracy to defraud the U.S. government and violating the Food, Drug and Cosmetic Act.12,13
To settle the charges, Purdue is supposed to pay $8.3 billion in fines, forfeiture of past profits and civil liability payments.14 However, the company doesn’t have enough cash to cover the payments so, instead, Purdue Pharma will be dissolved, and its assets used to erect a “public benefit company,” in other words, a government-owned and controlled drug company.
The estimated financial cost of opioid addiction and death in the U.S. was $504 billion in 2015. In addition to health care costs, criminal justice costs and lost productivity due to addiction or incarceration, this figure also takes into account projected lost earnings and the value of statistical life for people who died prematurely.
This new company will reportedly be controlled by a trust that will “balance the trust’s interests against those of the American public and public health.”15 Future earnings from this public benefit company will be used to pay off the $8.3 billion penalty, which in turn is supposed to be used to combat the opioid crisis.
This is a remarkable development, and one wonders just how functional this setup is going to be. In essence, the government will now be in the business of making and selling opioids, the profits from which will then be used to combat opioid addiction. It seems like a circular and rather illogical setup. According to CNN:16
“Deputy Attorney General Jeffrey Rosen, who announced the settlement, defended the plans for the new company to continue to sell that drug, saying there are legitimate uses for painkillers such as OxyContin.”
Sackler Family Walk Away Scot-Free, Again
The Sackler family, meanwhile, have reached a separate settlement in which they will pay $225 million in civil liability for causing false claims about OxyContin to be made to Medicare and other government health care programs.17
While the agreement does not release the Sacklers from potential criminal liability, it seems the family will walk away scot-free. And, considering they already transferred some $10 billion into their family trusts, the $225 million fine is a very small fraction, so they won’t end up wanting financially either.
Proving they have no remorse, Sackler family members, in a recent statement, shifted blame for the company’s illegal activities on its managers, saying they “relied on management assertions the company acted lawfully.”18 This, even though several Sackler family members sat on the company board and were intimately familiar with the company’s marketing strategy.
It’s unclear whether this DOJ agreement affects or includes the Sacklers’ other opioid company, Rhodes Pharmaceuticals. If not, it falls short in that respect too, since they would then be able to continue their opioid business. Between 2009 and 2016, Rhodes’ market share of opioid sales actually exceeded that of Purdue itself.19
Aside from Purdue and Rhodes, the Sacklers have also profited from Napp Pharmaceuticals, a Cambridge-based drug company that manufactures — you guessed it — opioids.20 In 2018, seven family members resigned from their directors’ posts at Napp following a string of bad publicity relating to alleged tax evasion schemes.
Mortimer Sackler, since deceased, was found to have avoided paying income tax, capital gains tax and inheritance taxes in the U.K. by falsely claiming non-domiciled status. The family was also accused of using a Bermuda-based company to avoid paying corporate taxes for Napp Pharmaceuticals.21
Penalties Still Won’t Cover States’ Claims
Even though $8.3 billion is a record-breaking settlement, states have filed claims exceeding $2 trillion in Purdue’s bankruptcy case, and according to a November 2017 report22 by the White House Council on Economic Advisers, the estimated financial cost of opioid addiction and death in the U.S. was $504 billion in 2015.
In addition to health care costs, criminal justice costs and lost productivity due to addiction or incarceration, this figure also takes into account projected lost earnings and the value of statistical life for people who died prematurely.
In response to the Justice Department’s settlement with Purdue Pharma, 25 state attorneys general sent a letter23 to U.S. Attorney General William Barr, in which they object to the settlement and argue against the government getting involved in the opioid business. The letter, dated October 14, 2020, reads in part:24
“We write to ask you to revise a proposed DOJ settlement agreement that reportedly would wrongly mandate that Purdue Pharma’s infamous OxyContin business be preserved as a public trust.
A business that killed thousands of Americans should not be associated with government. Instead, the business should be sold to private owners, so the government can enforce the law against it with the same impartiality as for any other company …
The role of government in any OxyContin business should be to enforce the law, just as against any other company. The public deserves assurance that no opioid business is given the special protection of being placed under a public umbrella.
Although it may take time to find a private sector buyer, the public should be confident that public officials are seeking to avoid having special ties to an opioid company, conflicts of interest, or mixed motives in an industry that caused a national crisis.”
Connecticut Attorney General William Tong also told CNN:25
“This settlement provides a mere mirage of justice for the victims of Purdue’s callous misconduct. The federal government had the power here to put the Sacklers in jail, and they didn’t. Instead, they took fines and penalties that Purdue likely will never fully pay.
Every dollar paid here is one dollar less for states like Connecticut trying to maximize money from Purdue and the Sacklers to abate the opioid epidemic. Preserving Purdue’s ability to continue selling opioids as a public benefit corporation is simply unacceptable.”
How Purdue Launched and Fueled the Opioid Epidemic
In previous articles, I’ve discussed the role false advertising played in the creation of the opioid crisis.26 To recap, a single paragraph in a 1980 letter to the editor27,28 (not a study) in The New England Journal of Medicine — which stated that narcotic addiction in patients with no history of addiction was very rare — became the basis of a drug marketing campaign that has since led to the death of hundreds of thousands of people.
Purdue Pharma used this letter to the editor as the basis for its claim that opioid addiction affects less than 1% of patients treated with the drugs. In reality, opioids have a very high rate of addiction and have not been proven effective for long-term use.29
Research30 published in 2018 also shows opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter drugs such as acetaminophen, ibuprofen and naproxen.
Various court cases have demonstrated how Purdue systematically misled doctors about OxyContin’s addictiveness to drive up sales. The inevitable result of Purdue Pharma’s ruthless and immoral marketing campaign has been skyrocketing opioid addiction, which killed 46,802 Americans in 2018 alone.31
Adding insult to injury, when it became clear that people were dying in droves from opioid overdoses, Purdue launched an extensive damage-control operation that included the suggestion that those dying from opioids were already addicts, and that this wouldn’t happen to patients who were not already addicted to drugs. The company also sought to cash in on the rising addiction trend twice by getting into the business of creating overdose treatments.
Opioid Misuse Paves Way for Heroin Addiction
Perhaps most egregious of all has been the reckless prescribing of opioids to young people. Here, dentists have been a major part of the problem, as opioids are frequently prescribed when extracting wisdom teeth.
Insurance claims data from 2016 and 2017 reveal 60% of children between the ages of 1 and 18 with private insurance filled one or more opioid prescriptions after surgical tonsil removal,32,33 and dentists wrote a staggering 18.1 million prescriptions for opioids in 2017.34
As noted by Ronnie Cohen in a March 2019 article35 in The Washington Post, “until recently, dentists seemed to have had no idea they may have been helping to feed an epidemic that resulted in a record 70,237 U.S. drug overdose deaths in 2017.”36
But contribute they have, and according to data37 from the University of Michigan, 31.8%, or just over 1 in 3 people who misused opioids during their high school years ended up using heroin by age 35. Data from the National Institute on Drug Abuse also confirms that prescription opioid use is a significant risk factor for subsequent heroin use:38
Incidence of heroin use was 19 times higher among those who had used opioids nonmedically than among those who had not used an opioid
86% of young, urban injection drug users had used opioid pain relievers nonmedically before starting heroin. The three primary sources of opioids were family, friends and personal prescriptions. This is the reverse trend from the 1960, when more than 80% of those who started abusing opioids had started with heroin
Of those who began abusing opioids in the 2000s, 75% reported that their first opioid was a prescription drug
Nearly 80% of heroin users reported using prescription opioids prior to heroin
Struggling With Opioid Addiction? Please Seek Help
Regardless of the brand of opioid, it’s important to realize they are extremely addictive drugs and not meant for long-term use for nonfatal conditions. Chemically, opioids are similar to heroin, so if you wouldn’t consider shooting up heroin for a toothache or backache, seriously reconsider taking an opioid to relieve this type of pain.
The misconception that opioids are harmless pain relievers has killed hundreds of thousands, and destroyed the lives of countless more. In many cases, you’ll be able to control pain without using medications.
In my previous article, “Billionaire Opioid Executive Stands to Make Millions More on Patent for Addiction Treatment,” I discuss several approaches — including nondrug remedies, dietary changes and bodywork interventions — that can be used separately or in combination to control pain, both acute and chronic.
If you’ve been on an opioid for more than two months, or if you find yourself taking a higher dosage or taking the drug more often than you initially did, you may already be addicted. Resources where you can find help include the following.
Your workplace Employee Assistance Program
The Substance Abuse Mental Health Service Administration39 can be contacted 24 hours a day at 1-800-622-HELP
You can also learn more in “How to Wean Off Opioids.” I also recommend keeping an eye out for my upcoming article about how low dose naltrexone (LDN), an opioid antagonist, is being used at ultra-low micro doses of 1 microgram to successfully treat opioid addiction.
Original Source: articles.mercola.com
As the world’s attention remains focused on the COVID-19 pandemic, essential attention is turned away from other life-threatening epidemics, including opioid addiction. Prior to the COVID-19 crisis, opioid misuse and addiction had become rampant in the U.S. In the late 1990s, drug companies assured doctors that opioid pain relievers were safe and nonaddictive, leading to an increase in prescribing rates.
Opioid overdose rates increased rapidly as it became clear that opioids can be highly addictive. In 2018, 46,802 Americans died from an opioid overdose while 1.7 million suffered from substance use disorders related to opioid pain relievers.
The economic burden of prescription opioid misuse alone is $78.5 billion in the U.S. annually, which includes not only health care costs but also lost productivity, addiction treatment and criminal justice involvement.1 The economic toll, and the death toll, from the opioid epidemic is, sadly, set to rise even further now that it has collided with the COVID-19 pandemic.
COVID-19 Pandemic Heightens Risks for Opioid Addicts
There are physical and psychological reasons why COVID-19 poses a significant challenge for people with opioid use disorder (OUD), which affects at least 2 million Americans, and those who misuse opioids — another 10 million.2 Worldwide, 40.5 million people struggle with opioid dependence, a global prevalence of 510 cases per 100,000 people.3
Chronic respiratory disease increases the risk for fatal overdose in people who use opioids, and COVID-19 leads to compromised lung function.
Further, opioid misuse can lead to slowed breathing and hypoxemia, which can cause cardiac, pulmonary and brain complications, as well as overdose and death. As such, according to an article in the Annals of Internal Medicine, “these individuals may be at increased risk for the most adverse consequences of COVID-19.”4
People who are addicted to opioids may also be more likely to suffer from conditions that make them more vulnerable to COVID-19, including being a smoker who suffers from lung or heart disease, being homeless or having experienced other health effects from drug addiction.5 Threat of infection aside, there are a number of indirect ways that people with OUD may be adversely affected by COVID-19 as well.
“Before the first COVID-19 case in the United States, a different epidemic — the opioid crisis — was taking the lives of 130 Americans per day,” wrote two doctors from Yale School of Medicine in Annals of Internal Medicine.
“Given that infection epidemics disproportionately affect socially marginalized persons with medical and psychiatric comorbid conditions — characteristics of those with opioid use disorder (OUD) — we are gravely concerned that COVID-19 will increase already catastrophic opioid overdose rates.”6 Some of the challenges faced by people with OUD during the COVID-19 pandemic include:7
Closure of substance use treatment clinics
Focus of emergency departments on COVID-19 patients — not opioid overdose
Social distancing and shelter-in-place orders adversely affecting mental health
Disruptions in Care, Increased Anxiety Are Problematic
Disruptions of care during the COVID-19 pandemic are a major concern for people with opioid use disorder, who depend on regular face-to-face health care. Many rehab facilities have closed, limited programs or limited new admissions over fears of COVID-19 spreading in a communal living facility.8
Access to medications for addiction treatment may be restricted, while patients may also face simultaneous challenges like loss of work, housing and food security, which could trigger a downward spiral leading to relapse and delayed recovery.
“The COVID-19 pandemic strikes at a moment when our national response to the opioid crisis was beginning to coalesce, with more persons gaining access to treatment and more patients receiving effective medications. COVID-19 threatens to dramatically overshadow and reverse this progress,” according to researchers with the Johns Hopkins School of Medicine.9
The social isolation imposed by the pandemic is also highly problematic and, by increasing stress and anxiety, could heighten substance abuse, opioid usage and overdose.
In addition to limiting access to peer-support groups and other vital sources of social connection for recovering addicts, “Persons who are isolated and stressed — as much of the population is during a pandemic — frequently turn to substances to alleviate their negative feelings,” wrote Dr. Nora Volkow with the National Institute on Drug Abuse. “Those in recovery will face stresses and heightened urges to use substances and will be at greatly increased risk for relapse.”10
There’s also the issue of social isolation indirectly contributing to overdose deaths because no one is there to administer naloxone, an overdose-reversing drug. Volkow continued:11
“Social distancing will increase the likelihood of opioid overdoses happening when there are no observers who can administer naloxone to reverse them and thus when they are more likely to result in fatalities.
Emergency department physicians with increased caseloads may be less likely to initiate buprenorphine therapy for patients with OUD, which is an important component of mitigating the effects of the opioid crisis.”
There are even reports of stigma and discrimination, according to Dr. Peter Grinspoon, who recovered from opioid addiction and teaches medicine at Harvard Medical School. “There are reports surfacing of police departments across the country that are refusing to offer naloxone to patients who have overdosed, on the pretext that it is too dangerous because the ‘addict’ might wake up coughing and sneezing coronavirus droplets.”12
Job Loss Associated With Opioid Overdose Deaths
The U.S. unemployment rate may skyrocket to 32.1% in the second quarter of 2020, according to the Federal Reserve Bank of St. Louis.13 Previously, the highest rate of unemployment in U.S. history was 24.9%, which occurred in 1933 during the Great Depression.14 The massive job losses may singlehandedly increase opioid overdose deaths, as a strong connection has been revealed between the two in the past.
A 2019 study in the Medical Care Research Review journal looked at the effects of state-level economic conditions — unemployment rates, median house prices, median household income, insurance coverage and average hours of weekly work — on drug overdose deaths between 1999 and 2014.15 According to the authors:
“Drug overdose deaths significantly declined with higher house prices … by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were more pronounced and only significant among males, non-Hispanic Whites, and individuals younger 45 years.
Other economic indicators had insignificant effects. Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.”
An earlier investigation, published in the International Journal of Drug Policy in 2017, also connected economic recessions and unemployment with rises in illegal drug use among adults. Twenty-eight studies published between 1990 and 2015 were included in the review, 17 of which found that the psychological distress associated with economic recessions and unemployment was a significant factor. According to the authors:16
“The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important.”
Pandemic May Lead to 75,000 ‘Deaths of Despair’
In a report by the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, it’s estimated that up to 75,000 people may die during the COVID-19 pandemic from drug or alcohol misuse and suicide. These “deaths of despair” are expected to be exacerbated by three factors already at play:17
Unprecedented economic failure paired with massive unemployment
Mandated social isolation for months and possible residual isolation for years
Uncertainty caused by the sudden emergence of a novel, previously unknown microbe
In order to come up with their 75,000 figure, the study used data on deaths of despair from 2018 as a baseline, projected levels of unemployment from 2020 to 2029 and then used economic modeling to estimate the additional number of deaths annually. Nine different scenarios were tested, ranging from quick recovery to slow recovery.
In the best-case scenario, 27,644 deaths of despair were estimated while in the worst-case example, 154,037 deaths could occur. While 75,000 was deemed to be “most likely,” the researchers noted, “When considering the negative impact of isolation and uncertainty, a higher estimate may be more accurate.”18
“Undeniably policymakers must place a large focus on mitigating the effects of COVID. However, if the country continues to ignore the collateral damage — specifically our nation’s mental health — we will not come out of this stronger,” Benjamin F. Miller, PsyD, chief strategy officer of WBT, said in a news release.19
A commentary by Dr. Jeffrey A. Lieberman, a psychiatrist with Columbia University’s department of psychiatry, similarly suggested a mental health crisis is looming.20 “The sobering reality is that high-quality mental health care is not available to most people,” Lieberman wrote. “This lack of strategy and access is especially concerning amid disasters such as COVID-19, which can cause considerable psychological trauma.”
Prolonged Isolation May Lead to Drug Abuse
As mentioned, prolonged isolation only exacerbates the issue. “The stressors from the pandemic are very, very real and how we cope with these stressors varies enormously,” Volkow told ABC News. “Social isolation is one of the factors that leads [people with substance abuse disorder] … to take drugs, and social isolation leads them to relapse, and the social isolation leads them to continue taking them.”21
With weeks of extended isolation already logged for most Americans, some communities are already reporting a rise in drug overdose deaths. Jacksonville, Florida, for instance, had a 20% increase in overdose emergency calls in March 2020.
Four counties in New York State also reported a rise in overdoses, while Columbus, Ohio, had a surge in overdose deaths, including 12 over a 24-hour period the first week of April.22
Whether overdose deaths are increasing across the U.S. is unknown, as Volkow noted that with COVID-19 shutdowns, collecting reliable data is difficult. However, a spokesperson for the U.S. Centers for Disease Control and Prevention told ABC News that officials are “aware of the concerns involving COVID-19 and drug overdoses and that it could affect some populations with substance use disorders.”23
Experts are recommending increased resources for people struggling with drug addiction, including access to online meetings. Remember that even if you’re socially isolated at home, you can reach out to friends and loved ones via phone or online. Connecting with others, even virtually, can help you to feel less alone. It’s also a good idea to set a limit on watching the news or browsing social media, especially if it increases anxious feelings.24
Original Source: articles.mercola.com