Drug Policy Expert Robert DuPont: The Opioid Crisis is Now About Synthetics and Polydrug Use

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Robert L. DuPont, MD, at the 2018 National Rx Drug Abuse and Heroin Summit in Atlanta in April.
QUICK TAKEAWAY:
  • Psychiatrist Robert L. DuPont, MD, has been campaigning against opioid addiction for 50 years.
  • In a new Q&A, he says that the opioid crisis, “the defining epidemic of the 21st Century,” needs a “new narrative.”
  • “What’s killing these people is not just opioids. It’s opioids in combination with other drugs of abuse.”
  • “The global illegal market is switching from agricultural products to purely synthetic drugs.”
  • “So illegal drug users … are able to buy more drugs, at higher potency, and lower prices, with more convenient delivery, than ever before.”
  • “We need to end the war between the treatment modalities.”

Continue reading “Drug Policy Expert Robert DuPont: The Opioid Crisis is Now About Synthetics and Polydrug Use”

Q&A Pt 2: Adam Bisaga, MD, on Opioid Disorder, Chronic Pain, Genetics, Kratom, and Stigma

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QUICK TAKEAWAY:
  • 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.

Continue reading “Q&A Pt 2: Adam Bisaga, MD, on Opioid Disorder, Chronic Pain, Genetics, Kratom, and Stigma”

Q&A Pt 1: Adam Bisaga, MD: Referring Patients to Most Opioid Treatment Centers Is Now Unethical

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QUICK TAKEAWAY:
  • 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?”

Continue reading “Q&A Pt 1: Adam Bisaga, MD: Referring Patients to Most Opioid Treatment Centers Is Now Unethical”

Prosecutor Dave Aronberg on the ‘Florida Shuffle’: Lethal Fraud in the Opioid Detox Industry

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QUICK TAKEAWAY:
  • 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.

Continue reading “Prosecutor Dave Aronberg on the ‘Florida Shuffle’: Lethal Fraud in the Opioid Detox Industry”

Q&A (Pt 2): Addiction Expert Discusses Hate Mail and Why Opioids are “Lousy” Drugs for Pain

 

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Andrew Kolodny, M.D. (Courtesy of Brandeis University)
QUICK TAKEAWAY:
  • Pain patients sending Kolodny hate mail have been misled into thinking he wants to cut off their legal supply of opioids, he says.
  • Kolodny describes three groups of addicts today. “Fentanyl is a game-changer.”
  • Kolodny co-founded Physicians for Responsible Opioid Prescribing to get the message across: “chronic pain patients taking [opioids] as directed are being harmed.”
  • Opioids are “lousy drugs” for chronic pain, Kolodny says. Appropriate for brief or intermittent use, though risky. 
  • Patients on very high doses must be tapered down “whether they agree or not,” Kolodny contends. Patients should not be forced off opioids, however.

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Q&A (Pt 1): Opioid Activist Andrew Kolodny Outlines the Origins of the Epidemic

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Slide Prepared by Physicians for Responsible Opioid Prescribing
QUICK TAKEAWAY:
  • 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.

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Q&A: Opioid Plaintiffs Lawyer Paul Hanly on What a Settlement Might Look Like

QUICK TAKEAWAY:
  • 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.”

By Roger Parloff 

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Paul Hanly, Jr. (Courtesy of Simmons Hanly Conroy)

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.

Hanly spent the first 20 years of his career as a mass-tort defense attorney, eventually serving as national coordinating counsel for the Continue reading “Q&A: Opioid Plaintiffs Lawyer Paul Hanly on What a Settlement Might Look Like”