The profits of opioid addiction epidemic (2)

Empire of Pain. THE SECRET HISTORY OF THE SACKLER DYNASTY

The winner takes it all. And the winner is: the Sackler family. They are not alone, they needed accomplices. CDC says:

In 2019, an average of 38 people died each day from overdoses involving prescription opioids, totaling more than 14,000 deaths.1  While prescription opioids were involved in over 28% of all opioid overdose deaths in 2019, there was a nearly 7% decrease in prescription opioid-involved death rates from 2018 to 2019.

 From 1999–2019, nearly 500,000 people died from an overdose involving any opioid, including prescription and illicit opioids.

This rise in opioid overdose deaths can be outlined in three distinct waves.

The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 19993.

The second wave began in 2010, with rapid increases in overdose deaths involving heroin4.

The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl5,6,7. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.

And regarding synthetic opioids, you'll find many details inside this book: "The empire of pain" that explains the largest man-made epidemic nowadays.

 My intention was to tell a different kind of story, however, a saga about three generations of a family dynasty and the ways in which it changed the world, a story about ambition, philanthropy, crime and impunity, the corruption of institutions, power, and greed. As such, there are aspects of the public health crisis that this book gives scant attention to, from the science of addiction to the best strategies for treatment and abatement to the struggles of people living with an opioid use disorder. The issue of pain and appropriate pain management is enormously complex, and while this book is highly critical of the mass marketing of opioids for moderate pain, it does not explore at any length the harder question, which is currently a matter of heated debate, about the long-term therapeutic value of opioids for severe chronic pain. 

Beyond that, somebody should remember that the regulator was and is on vacation...

Highly recommended. 

The US opioid crisis: the public health epidemics that never should have happened

Pain Killer:An Empire of Deceit and the Origin of America’s Opioid Epidemic
DOPESICK: Dealers, Doctors & the Drug Company that Addicted America

In 2018, an opioid epidemic that began two decades earlier with OxyContin finally seized the nation’s attention. Over 250,000 Americans had died from overdoses involving prescription painkillers. Every day, hospital emergency rooms nationwide treated 1,000 people for abusing or misusing these drugs. Prescriptions written for narcotic painkillers—and overdoses associated with the drugs—had started to slowly decline. But counterfeit versions of fentanyl were rapidly driving up the overall numbers of overdose deaths.

The more you know about it, the more you get concerned about how this tragic epidemics could have been avoided. The details explained in a book written 15 years ago, and reedited now, are horrendous.
The connection between pharma sales promotion, lobbying and an inappropriate regulation is a dramatic story that has a known outcome: 65,000 deaths a year from addiction to oxycodone and fentanyl.

The “opioid crisis” is actually two separate crises, each with its own causes and solutions. One involves illegal narcotics, such as counterfeit fentanyl, and requires the attention of law enforcement as well as compassionate treatment for those addicted to these lethal drugs. The other crisis lies in the medical use of opioids, and its solution is much easier. There is no question that opioids, particularly when used at low dosages, work for some patients who can’t otherwise find relief. But if companies value their employees, if governments want to reduce the number of people addicted to opioids, if doctors want the best for their patients, then a new approach to the treatment of pain must become a priority. Many experts believe that most types of pain can be successfully treated with methods popular before the opioid era began, such as physical therapy, exercise, behavior modification, and non-narcotic drugs. Many institutions have begun to adopt these methods, and federal officials recently recommended that doctors limit opioid dosages and switch to another type of treatment, rather than raise the dosage, if patients don’t respond. Some states have taken the more draconian step of limiting the number of opioids a doctor can initially prescribe, to just a few days’ supply.

For two decades, drug companies such as Purdue used pain patients as shields and surrogates to advance their corporate interests. For pain treatment to change, patients will need to fight to put their concerns ahead of these interests, and doctors, employers, hospitals, and other institutions have to become fierce advocates for treatments outside the flood of narcotics that has proved so profitable and expedient for drugmakers and insurers. The lesson of the past two decades is a clear one. Change is not optional. It is essential if we are to alter the cascade of death, addiction, and despair that is now a fundamental part of American life.

In another recent book, you'll find the emotional side of the loss, how mothers lost their sons and the impact. Both books illustrate a national emergency that the government has recognised now, after two decades!

PS. Latest article in FT

PS. If you want to know what's going on in our country check this report. Five years growth in publicly funded opioid drugs: 45%!!!. Public health officials and prescribing physicians should read both books before it is too late.

Addiction goods and innovation failure

When Innovation Goes Wrong: Technological Regress and the Opioid Epidemic 

The medical use of opioids to treat pain will always involve costs and benefits, and the optimal level of opioid prescription is unlikely to be zero. The mistake that  doctors and prescribers made in recent decades was to assume overoptimistically that a time release system would render opioids non-addictive. Thousands of years of experience with the fruits of the poppy should have taught that opioids have never been safe and probably never will be. The larger message of the opioid epidemic is that technological innovation can go badly wrong when consumers, professionals, and regulators underestimate the downsides of new innovations and firms take advantage of this error. Typically, consumers can experiment with a new product and reject the duds, but with addiction, experimentation can have permanent  consequences.

A must read, by Cutler et al.

 Robert Doisneau

Pharma, Big Pharma

 White Market Drugs. BIG PHARMA AND THE HIDDEN HISTORY OF ADDICTION IN AMERICA

A book to understand the contribution to addiction over a century.

By showing how the twenty-first-century opioid crisis is only the most recent in a long history of similar crises of addiction to pharmaceuticals, Herzberg forces us to rethink our most basic ideas about drug policy and addiction itself—ideas that have been failing us catastrophically for over a century.

This is the outline:

Introduction
The First Crisis
1 Drug wars and white markets
2 “Legitimate addicts” in the first drug war
3 Preventing blockbuster opioids
The Second Crisis
4 Opioids out, barbiturates in
5 A new crisis and a new response
6 White markets, under control
The Third Crisis
7 White market apocalypse
Conclusion: Learning from the past
Appendix: White market sales and overdose rates, 1870–2015

The profits of opioid addiction epidemic

 American Overdose. The Opioid Tragedy in Three Acts

Formerly in this blog you may have read about opioid epidemics. In the US is a great social and public health tragedy. If you want some details about fentanil consumption in Catalonia, check this report (p.153-155).

In the book America overdose, you'll find an exceelent description about what has happened in US in practical terms. Wirtten by a journalist from The guardian, it may help any public health official of any country to understand the huge danger we have to confront. The starting point for McGreal’s deeply reported investigation is the miners promised that opioid painkillers would restore their wrecked bodies, but who became targets of “drug dealers in white coats.” And says (in chapter 21):

It would be a mistake to conclude that responsibility for the opioid epidemic lies only with the greed of the drug companies or that it is shared solely with corrupt doctors and pharmacists who profited from mass prescribing. They were facilitated by politicians, regulators, and a broader medical industry with an agenda or that chose not to see. The opioid makers were helped in that because, for many years, the primary victims were those it was easy to look away from—the “dumbass hillbillies,” as Willis Duncan put it.

Purdue may have targeted some of the poorest parts of Appalachia because that’s where the data said opioids were already being prescribed. But it proved a convenience that these regions were among the most marginalized in the country and the easiest to stigmatize as the drug makers pursued the disreputable tactic of blaming the victims for their addiction.

Like the nineteenth-century opium dealers, the painkiller manufacturers used the power of the huge profits of addiction to keep the faucets of mass prescribing open. The quarter of a billion dollars a year the drug industry spends on lobbying bought the complicity of Congress and organizations such as the American Medical Association through silence and distraction. The din of money drowned out the warnings sounded by Dr. Art Van Zee about the devastation already wrought to his Virginia community in the late 1990s and the research by doctors such as Jane Ballantyne that should have prompted critical questioning of the claims made for opioids. Congress and the FDA were told loudly and clearly that a national disaster was unfolding more than a decade before the CDC’s Tom Frieden called it an epidemic.

Drawing on the tobacco companies’ playbook, opioid manufacturers obscured the evidence of the dangers of their products even when it was staring the industry in the face. Instead, the drug makers and their front organizations sought to discredit those who advocated caution.

 

Why we must not let the tech and drug industry forge the future alone

On the tech industry by Martin Wolf in FT

Selected statements on 7 reasons

What are the economics of these extraordinary valuations? The answer must be monopoly. As of September 30, the book value of Apple’s equity was $134bn, while its market valuation was close to $900bn. The difference has to reflect the expectation of enduring “super-normal” profits. This may not be the product of malign behaviour, but of innovation and economies of scale and scope, including the network externalities that lock in customers. Yet only monopoly could deliver such super-normal profits

How should we think about competition policy for businesses that benefit from such powerful monopoly positions? A question is whether these positions are temporary — as the great Austrian economist, Joseph Schumpeter, with his idea of “creative destruction”, would argue — or lasting. This suggests a host of responses, but one at least seems straightforward. Schumpeter would argue that new entries are a necessary condition for eroding such temporary monopolies. If so, the technology giants should be strongly deterred from buying up their potential competitors. That must be anti-competitive

Yet these enormously profitable businesses are parasitic on the investments in collecting information made by others. At the limit, they will become highly efficient disseminators of non-information. This links to a further point: they can, as we now know, be used by people of ill will for the deliberate dissemination of dangerous falsehoods. These facts raise huge issues.

Finally, the activities in which the technology industry is now engaged — what Andrew McAfee and Erik Brynjolfsson call “machine, platform, crowd” — are going to have a huge impact on our labour markets and, if artificial intelligence continues to advance, on our very place in the world.

What are the implications? They are that our futures are too important to be left to the mercies of the technology industry alone. It has done magical things. Yet nobody elected it master of the universe. Policymakers must get an intellectual grip on what is happening. The time to begin such an effort is now

On a particular drug company, in Project Syndicate:  The Opiate of the Bosses

Business ethics are again making headlines. This time, the focus is on the rapidly escalating opioid crisis that is destroying lives across the United States. While there is plenty of blame to go around, the largest share of the guilt belongs squarely on the shoulders of the major drug companies – Big Pharma.

The cynicism with which pharmaceutical firms have encouraged opioid drug use is appalling. Providing far too little analysis and oversight, they distribute opiates widely, alongside misinformation about how addictive the drugs truly are. Then they entice doctors with inducements and giveaways – including trips, toys, fishing hats, and, in one case, a music CD called “Get in the Swing with OxyContin” (one of the most popular opioids) – to prescribe them.

In 2007, several executives of the parent company of Purdue Pharma, which markets OxyContin, pleaded guilty to misleading doctors, regulators, and patients about the risk of addiction associated with the drug. The company was hit with some $600 million in fines and penalties.

On free genetic sequencing, opioids and the Hockney portrait

Selected links

FROM GENE EDITING TO A.I., HOW WILL TECHNOLOGY TRANSFORM HUMANITY?
FIVE BIG THINKERS — REGINA BARZILAY, GEORGE CHURCH, JENNIFER EGAN, CATHERINE MOHR AND SIDDHARTHA MUKHERJEE — PUZZLE OVER THE FUTURE OF THE FUTURE.

Mortality risk, insurance, and the value of life

Opioid nation by Marcia Angell

Genetics Start-Up Wants to Sequence People’s Genomes for Free

THESE DNA STARTUPS WANT TO PUT ALL OF YOU ON THE BLOCKCHAIN

Hockney

La geopolítica dels opioides sintètics

 Why America Is Struggling to Stop the Fentanyl Epidemic. The New Geopolitics of Synthetic Opioids

THE ECONOMIC TOLL OF THE OPIOID CRISIS REACHED NEARLY $1.5 TRILLION IN 2020

Hi ha dos tipus d'epidèmies les naturals i les artificials. Aquesta classificació no la trobareu als llibres d'epidemiologia. Les artificials són les que crea l'home amb l'objectiu de destruir la humanitat, i que generalment persegueixen poder i diners.

Hi ha una epidèmia artificial que ha agafat molta volada des de fa més de dues dècades als USA, es tracta de l'epidèmia dels opioides sintètics, del fentanil. Em refereixo a l'ús recreatiu del fentanil, és clar. L'ús mèdic està ben definit i l'efectivitat desmostrada. He escrit repetidament a aquest blog sobre aquesta qüestió.

Llegeixo els articles destacats de l'any a Foreign Affairs i en trobo un que m'interessa especialment i va sobre la geopolítica dels opioides sintètics. Als USA hi ha hagut 73.654 morts el 2022 fruit de sobredosi de fentanil. La suma va creixent any rera any.

L'article explica que tot el fentanil que circula als USA prové de la Xina i Mèxic i es pregunta del perquè del fracàs de la lluita contra la distribució d'aquesta droga i del que caldria fer. Tot el que s'ha fet fins ara no ha assolit el que pretenia i assenyala una estratègia geopolítica a endegar.

El cost que representa aquesta epidèmia als USA ha estat quantificat en 1.500.000.000.000$, és a dir un bilió i mig durant l'any 2020. Aquesta és una xifra descomunal, 6 vegades el PIB de Catalunya. Em fa dubtar del seu càlcul, però és una estimació oficial amb metodologia contrastada.

Aquesta setmana ja sabem que la droga ha arribat al mercat i·lícit a Mallorca. Fa uns mesos es va presentar el documental sobre la petjada del fentanil a Catalunya, on es diu que no s'ha decomissat encara però tot assenyalaria que ja circula. Motius més que suficients com per la preocupació i la necessitat de reacció immediata. El que cal fer segons l'OCDE és això.

Carry Mae Weems a Foto Colectania