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25 d’agost 2018

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.





14 de gener 2024

La geopolítica dels opioides sintètics (2)

 The Least of Us. True Tales of America and Hope in the Time of Fentanyl and Meth

Fentanilo, retrato de un asesino de masas

L'epidèmia de fentanil segueix el seu curs. Als USA moren 70.000 persones a l'any. A El País hi trobareu un reportatge d'investigació ben fet on explica tots els detalls de la preocupant situació. M'he quedat amb un missatge clar: els precursors els fabriquen a Wuhan i són legals. Recordem Wuhan de la pandèmia planetària recent. Wuhan seria també el pròleg d'aquesta altra epidèmia. La geopolítica China-USA novament entra en acció. I caldria ser conscients que el que passa a altres llocs no està tant lluny. El passat 30 de desembre vaig explicar com ja s'ha decomissat a Mallorca aquesta droga.

El reportatge explica tots els elements clau que provoquen que l'epidèmia vagi a més i fa referència a dos llibre: Fentanyl, inc i a aquest altre:



PS. Article interessant a VOX.EU

11 de maig 2021

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. 





17 de juny 2021

Opioid prescription in Catalonia

Sistema d'Informació sobre Drogodependències de Catalunya

You'll find these information in p.152 of the report:

In Catalonia, Fentanyl consumption has risen 24% in 5 years, in daily dose per inhabitant, while Tapentadol has jumped 300%!!!

Somebody should understand why it is this so and take some action.






30 de desembre 2023

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