In Part 2 of an interview, addiction psychiatrist Adam Bisaga discusses his new book, Overcoming Opioid Addiction.
“Clearly there are patients that have some serious pain syndromes that respond well to painkillers. … Then you have patients who have many problems, [who] got put on painkillers [and use them] as a way of coping with all the other problems in life.”
“It’s not easy to tell, even for experts, but certainly for … primary care providers” when patients on prescription opioids are “doing well” and when they are not. “That’s an assumption that got us into trouble with the epidemic.”
Regarding ibogaine and kratom: “People with addiction have a propensity for magic thinking.”
In the US addiction is seen as a “more nonmedical kind of problem, a social problem, a moral problem,” than in Western Europe.
In a two-part Q&A, addiction psychiatrist Adam Bisaga talks about his new book, Overcoming Opioid Addiction.
In Part 1, Bisaga argues why it has now become unethical to refer patients to most opioid treatment facilities in the US.
“This is the most lethal of all psychiatric disorders.”
“Up to two percent of [opioid use disorder] patients every year will die—one in 50. … So if you’re using for 10 years, your chance of dying is about one in five.”
“Right now, more than 50% of patients would not have a place to go for treatment, and many of those places that take patients do not offer effective treatment. Would that be acceptable for any other disorder?”
In a Q&A, Palm Beach County State Attorney Dave Aronberg and his chief assistant describe how bad actors in the drug detox industry use illegal gifts and kickbacks to prey on out-of-state drug addicts.
In the past year and a half, Aronberg’s office has arrested 45 for alleged involvement in such schemes, convicting 16 so far.
To improve this situation, Aronberg recommends reforms to the Affordable Care Act, Americans with Disabilities Act, and Federal Housing Act.
Kolodny describes hate mail, death threats by angry pain patients.
He argues (using charts) that epidemic started in 1996, with Purdue Pharma’s unprecedented marketing campaign for OxyContin.
He argues (with charts) that false “unbranded marketing,” minimizing risks of opioid painkillers, boosted sales of all prescription opioids.
He describes “ah ha” moment in 2006, when he read a study showing that as opioid prescriptions skyrocketed, so did deaths from prescription opioid overdose.
Hundreds of lawsuits by municipalities against Purdue Pharma and others today focus on allegedly false, unbranded marketing. Kolodny helped present an overview of the plaintiffs’ case in January at a settlement conference in federal court in Cleveland.
Hanly is one of three co-lead plaintiffs lawyers for the 430+ cases pending in federal court filed by municipalities against opioid manufacturers like Purdue Pharma and distributors like McKesson. He personally has about 110 cases there, and 30 more in state courts.
He won a reported $75 million settlement from Purdue for 5,000 individual addicts in 2007.
Addicts were difficult plaintiffs; sometimes turned out that OxyContin had not been their first opioid.
A global settlement will need two parts: (a) money for past expenses; (b) a forward-looking component. It “might need to be paid out over a number of years. … The problem’s going to be with us for a generation.”
Paul Hanly, Jr., 66, is one of three plaintiffs lawyers who has been appointed to lead the more than 430 (and counting) lawsuits in federal court that have been brought against the nation’s biggest opioid manufacturers and distributors. Most of these cases have been filed on behalf of cities or counties around the country, and name as defendants Purdue Pharma and at least four other corporate families of opioid manufacturers. Many cases also name the three leading pharmaceutical distributors, led by McKesson Corporation. The cases against the manufacturers allege misleading marketing—underplaying the drugs’ risks of addictiveness—while those against the distributors allege failure to report and forego suspicious sales. The defendants deny wrongdoing.