Written By Josh Mur
August 14, 2015
The infamously untrustworthy Food and Drug Administration (FDA) has furthered its reputation as one of America’s most beloved hypocrites with its latest motion. It was reported on Thursday that the FDA has just approved OxyContin prescriptions for children between the ages of 11 and 16 years-old.
For those unfamiliar, OxyContin is an opiate-based pharmaceutical painkiller used to ease severe pain. Aside from being known for its powerful effects on users, it is also notorious for its widespread abuse. Its effects on the mind and body are strikingly similar to heroin, making it dangerously addictive. It typically contains anywhere between 40-160 milligrams of OxyCodone, which lasts around 12 hours thanks to its extended release. However, abusers generally crush the pills to inhale or inject them with a syringe by mixing it with water, thus receiving a dose that is meant to stretch over a 12-hour span almost instantly.
After a 2004 study was abandoned due to an apparent lack of monetary resources, the FDA announced that pediatric studies on the effects of OxyContin would be underway in order to establish whether or not this pharmaceutical version of heroin should be available for children. After a very short period of trials and research, the FDA has concluded that three years is enough time to evaluate the long-term effects of extended use of a highly potent drug in children. Keep in mind that the FDA is the same government organization that has lumped marijuana and psilocybin mushrooms into the same category as Schedule 1 narcotics, deeming them to have zero medicinal value and heightened potential for abuse (because we all know a handful of people addicted to psychedelic mushrooms, right?).
One of the most blatant problems with this new allowance is that opiate addiction itself has become one of the most pressing health crises of modern times. In 2010 alone, 16,651 people died from opiate overdoses — making up 60% of all overdose deaths. Prescription drug overdoses are now responsible for more deaths than all illegal drug overdoses combined. Another recent study has shown that 4 out of 5 new heroin addicts initially became addicted from using prescription opiates. One can’t help but ask whether or not prescribing children OxyContin will lead to heroin addiction at an earlier age.
This is just the latest move which allows for the mass (over)medication of America’s youth. As we reported last year, at least 10,000 toddlers are now prescribed amphetamine-based ADHD drugs in the U.S.
Ironically, despite the fact that marijuana and heroin are all considered to lack any acceptable medicinal value, both of them have synthetic pharmaceutical versions available to patients. For example, Marinol and Cesamet are pharmaceutical drugs that are readily available, typically to cancer patients. The irony is in the fact that these drugs are literally modeled on active ingredients in marijuana. On the other hand, we have the drug of discussion, OxyContin, which, as stated earlier, is modeled around heroin itself. There is clearly either a major conflict of interest, unfathomable stupidity, or perhaps both.
RELATED: How an Illegal “Drug” is Reducing Opiate Painkiller Addiction
Regardless of the motive behind these contradictions, the message is clear: these regulators have proven themselves unfit to handle this sort of responsibility. Even considering the fact that children will have to undergo a more extensive evaluation than adults to obtain a prescription, these methods and regulations are supported by the imbeciles responsible for the clear absurdities stated above. Furthermore, does not the FDA’s refusal to recognize the inefficiency in its own approved medications while ignoring the success of “alternative” medicine imply that it is guilty of more ignorance than meets the eye?
Health is not a monopoly, it is a state of well-being. The fact that we have corporations and organizations that immensely benefit from the sales of medication implies two things. First, illness and injury are key components in the demand for sales, manufacturing, and further development of medicine — constituting a clear conflict of interest between the physical and mental well-being of American citizens and the financial well-being of Big Pharma. Second, it implies that the FDA’s evaluation methods are not nearly efficient enough to safely decide whether or not certain chemicals should be available for human consumption. This is why a naturally occurring chemical like psilocybin — which is proven to have not only psychological benefits, but physical benefits as well — is considered illegal in the United States.
NEW YORK — The number of U.S. heroin users has grown by nearly 300,000 over a decade, with the bulk of the increase among whites, according to a new government report.
Experts think the increase was driven by people switching from opioid painkillers to cheaper heroin.
The Centers for Disease Control and Prevention released the report Tuesday. It’s based on annual face-to-face surveys of about 67,000 Americans — the government’s main source of data on use of illegal drugs.
In recent surveys, nearly 3 in every 1,000 Americans said they used heroin in the previous year. That’s up from under 2 per 1,000 about a decade ago, a 62 percent increase which translates to hundreds of thousands more people, government researchers said.
The findings mirror trends seen in earlier reports, which noted marked increases in heroin use in people who are white and living outside of major cities, said Katherine Keyes, a Columbia University epidemiologist who researches drug abuse issues.
But the new report offers some additional details about people using heroin, government scientists said.
While heroin use more than doubled among whites, it seemed to level off in other racial and ethnic groups, the report found.
But it grew among different income levels, in different parts of the country. And the rate of heroin use doubled in women — a more dramatic rise than what was seen in men.
For years, officials have focused their worry on misuse of prescription opioid painkillers like Vicodin and OxyContin. Experts say recent restrictions on prescribing such painkillers may be reducing illicit supplies of them at a time when the heroin supply has been increasing.
Heroin has become a popular alternative. It is essentially the same chemical as that in the prescription painkillers, but it costs roughly five times less on the street, said CDC Director Dr. Tom Frieden.
“An increasing number of people are primed for heroin use because they were addicted to an opioid painkiller,” Frieden said.
The new report found that people who abused opioid painkillers were 40 times more likely to abuse heroin.
The heroin death rate quadrupled over a decade, reaching nearly 8,300 in 2013, with most of the fatal overdoses involving other drugs at the same time — most often cocaine.
Deaths involving opioid painkillers have been leveling off but continue to be more common than heroin-related deaths, government statistics show.
The state of Kentucky may finally get its deliverance. After more than seven years of battling the evasive legal tactics of Purdue Pharma, 2015 may be the year that Kentucky and its attorney general, Jack Conway, are able to move forward with a civil lawsuit alleging that the drugmaker misled doctors and patients about their blockbuster pain pill OxyContin, leading to a vicious addiction epidemic across large swaths of the state.
A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.
On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales for its manufacturer, Stamford, Connecticut-based pharmaceutical company Purdue Pharma. By 2000 that number would balloon to $1.1 billion, an increase of well over 2,000 percent in a span of just four years. Ten years later, the profits would inflate still further, to $3.1 billion. By then the potent opioid accounted for about 30 percent of the painkiller market. What’s more, Purdue Pharma’s patent for the original OxyContin formula didn’t expire until 2013. This meant that a single private, family-owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.
OxyContin’s ball-of-lightning emergence in the health care marketplace was close to unprecedented for a new painkiller in an age where synthetic opiates like Vicodin, Percocet, and Fentanyl had already been competing for decades in doctors’ offices and pharmacies for their piece of the market share of pain-relieving drugs. In retrospect, it almost didn’t make sense. Why was OxyContin so much more popular? Had it been approved for a wider range of ailments than its opioid cousins? Did doctors prefer prescribing it to their patients?
During its rise in popularity, there was a suspicious undercurrent to the drug’s spectrum of approved uses and Purdue Pharma’s relationship to the physicians that were suddenly privileging OxyContin over other meds to combat everything from back pain to arthritis to post-operative discomfort. It would take years to discover that there was much more to the story than the benign introduction of a new, highly effective painkiller.
In 1952, brothers Arthur, Raymond, and Mortimer Sackler purchased Purdue Pharma, then called Purdue Frederick Co. All three men were psychiatrists by trade, working at a mental facility in Queens in the 1940s.
The eldest brother, Arthur, was a brilliant polymath, contributing not only to psychiatric research but also thriving in the fledgling field of pharmaceutical advertising. It was here that he would leave his greatest mark. As a member of William Douglas McAdams, a small New York-based advertising firm, Sackler expanded the possibilities of medical advertising by promoting products in medical journals and experimenting with television and radio marketing. Perhaps his greatest achievement, detailed in his biography in the Medical Advertising Hall of Fame, was finding enough different uses for Valium to turn it into the first drug to hit $100 million in revenue.
The Medical Advertising Hall of Fame website’s euphemistic argot for this accomplishment states that Sackler’s experience in the fields of psychiatry and experimental medicine “enabled him to position different indications for Roche’s Librium and Valium.”
Sackler was also among the first medical advertisers to foster relationships with doctors in the hopes of earning extra points for his company’s drugs, according to a 2011 exposé in Fortune. Such backscratching in the hopes of reciprocity is now the model for the whole drug marketing industry. Arthur Sackler’s pioneering methods would be cultivated by his younger brothers Raymond and Mortimer in the decades to come, as they grew their small pharmaceutical firm.
Starting in 1996, Purdue Pharma expanded its sales department to coincide with the debut of its new drug. According to an article published in The American Journal of Public Health, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” Purdue increased its number of sales representatives from 318 in 1996 to 671 in 2000. By 2001, when OxyContin was hitting its stride, these sales reps received annual bonuses averaging over $70,000, with some bonuses nearing a quarter of a million dollars. In that year Purdue Pharma spent $200 million marketing its golden goose. Pouring money into marketing is not uncommon for Big Pharma, but proportionate to the size of the company, Purdue’s OxyContin push was substantial.
Boots on the ground was not the only stratagem employed by Purdue to increase sales for OxyContin. Long before the rise of big data, Purdue was compiling profiles of doctors and their prescribing habits into databases. These databases then organized the information based on location to indicate the spectrum of prescribing patterns in a given state or county. The idea was to pinpoint the doctors prescribing the most pain medication and target them for the company’s marketing onslaught.
That the databases couldn’t distinguish between doctors who were prescribing more pain meds because they were seeing more patients with chronic pain or were simply looser with their signatures didn’t matter to Purdue. The Los Angeles Times reported that by 2002 Purdue Pharma had identified hundreds of doctors who were prescribing OxyContin recklessly, yet they did little about it. The same article notes that it wasn’t until June of 2013, at a drug dependency conference in San Diego, that the database was ever even discussed in public.
Combining the physician database with its expanded marketing, it would become one of Purdue’s preeminent missions to make primary care doctors less judicious when it came to handing out OxyContin prescriptions.
Beginning around 1980, one of the more significant trends in pain pharmacology was the increased use of opioids for chronic non-cancer pain. Like other pharmaceutical companies, Purdue likely sought to capitalize on the abundant financial opportunities of this trend. The logic was simple: While the number of cancer patients was not likely to increase drastically from one year to the next, if a company could expand the indications for use of a particular drug, then it could boost sales exponentially without any real change in the country’s health demography.
This was indeed one of OxyContin’s greatest tactical successes. According to “The Promotion and Marketing of OxyContin,” from 1997 to 2002 prescriptions of OxyContin for non-cancer pain increased almost tenfold. Meanwhile, in 1996 the FDA approved an 80mg version of the pill; four years later it approved a 160mg tablet. According to the FDA’s “History of OxyContin: Labeling and Risk Management Program,” higher dosages were approved specifically for opioid-tolerant patients.
These high-milligram pills were probably one of biggest reasons that OxyContin became such a popular street drug. Recreational users and addicts could crush, sniff, and inject the pill for a powerful high that, as promised, lasted over eight hours. The euphoric effects and potential for abuse were comparable to heroin. But clearly doctors and pharmacies never drew the ghastly parallel. Why?
The state of Kentucky’s lawsuit against Purdue Pharma is not the first legal trouble the company has run into. In 2007, in United States of America v. The Purdue Frederick Company, Inc., Purdue and its top executives pleaded guilty to charges that it misled doctors and patients about the addictive properties of OxyContin and misbranded the product as “abuse resistant.” Prosecutors found a “corporate culture that allowed this product to be misbranded with the intent to defraud and mislead.” Purdue Pharma paid $600 million in fines, among the largest settlements in U.S. history for a pharmaceutical company.
Perhaps knowing that doctors would be vigilant against prescribing drugs with the potential for abuse, Purdue set out to distinguish OxyContin from rivals as soon as it dropped. The cornerstone of its marketing campaign was the drug’s incredibly low risk of addiction, an enviable characteristic made possible by its patented time-release formula. Through an array of promotional materials, including literature, brochures, videotapes, and Web content, Purdue proudly asserted that the potential for addiction was very small, at one point stating it to be “less than 1 percent.”
The time-release conceit even worked on the FDA, which stated that “Delayed absorption, as provided by OxyContin tablets is believed to reduce the abuse liability of a drug.” Armed with the time-release formula and misleading statistics about the risk of addiction, Purdue positioned the drug as a relatively safe choice for CNCP patients. Sales representatives told some doctors that the drug didn’t even produce a buzz, according to USA Today. (This for a pill that has since drawn frequent comparisons to heroin in terms of analgesia, euphoria, and the propensity for addiction.)
Between physician databases, incentive-happy sales reps, and an aggressive blitz package of promotional ephemera, Purdue’s multifaceted marketing campaign pushed OxyContin out of the niche offices of oncologists and pain specialists and into the primary care bazaar, where prescriptions for the drug could be handed out to millions upon millions of Americans. The most scathing irony is that what allowed OxyContin to reach so many households and communities was the claim that it wasn’t dangerous.
Kentucky originally filed its civil suit, Commonwealth of Kentucky v. Purdue Pharma, over seven years ago, back in 2007. After years of Purdue Pharma fighting to keep the trial out of Pike County, and Kentuckians watching as the suit pinballed from appeals court to appeals court, at one point even being transferred to New York, Purdue has finally exhausted its adjournment artistry. Unless the pharmaceutical company wins its latest appeal in the state Supreme Court, trial will most likely begin this year.
Kentucky is filing a total of 12 claims against the company, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages. In total the suit could cost Purdue Pharma $1 billion (which is just one-third of its annual revenues from OxyContin).
No state has been more devastated by the nationwide opiate problem than Kentucky. Much of the eastern part of the state and the Appalachians has watched as men, women, and teenagers fell victim to the potent pain pills. There were several different gateways — back injuries, operations, parents’ medicine cabinets — but all of them led to an implacable addiction that rivals that of the hardest street drugs. And that’s the rub. Because there was simply so much OxyContin available for over a decade, it trickled down from pharmacies and hospitals and became a street drug, coveted by teens and fiends and sold by dealers at a premium (prices often shot up well over $1 a milligram, pricing the popular 80mg tablets at over $100 for a single pill).
Whatever the gray areas on OxyContin’s many paths to perdition, the statistics on the first decade of this century bear out a staggering epidemic. From 1999 to 2010, the sale of prescription painkillers to pharmacies and doctors’ offices quadrupled. In the exact same time span, the number of overdose deaths from prescription painkillers also quadrupled, rising to almost 17,000.
To call this a coincidence would be analogous to declaring no connection between loosening enforcement on drunk driving laws and observing a sudden increase in deaths caused by drunk driving. It goes almost without saying that these figures dovetail seamlessly with the release of OxyContin and Purdue’s marketing timeline, which hit hardest in the early 2000s.
The figures on fatal overdoses, which in recent years have eclipsed the number of deaths caused by cocaine and heroin combined, speak nothing of the skyrocketing rates of addiction throughout the country. Funerals from overdoses are anguishing enough, but as places like Pike County know too well, fatalities are only one dimension of a problem whose insidious sprawl affects local economies and health care costs, incites crime, and ruptures families through the vagaries of addiction, rehab stints, and prison sentences.
The degree to which Purdue Pharma is responsible to Kentucky for a decade rotted and warped by its popular drug is still pending in the eyes of the justice system. Now that federal regulations have finally caught up to the pharmaceutical drug problem in this country and doctors have wised up to the sinister realities of the drug nicknamed “Hillbilly Heroin,” the hard and fast days of OxyContin are over.
Many are now arguing that the epidemic hasn’t gone away so much as it has evolved: Heroin use is again on the upswing. Like a shrewd virus that mutates once it confronts a vaccine, Americans’ addiction to opioids has survived the government crackdown on OxyContin and fled to the seedy asylum of heroin. It’s a kind of evolution in retrograde, with pill users turning to an old 20th-century scourge that once flourished in urban decay and is uglier, more stigmatized, and more lethal than its pharmaceutical counterpart. But for OxyContin, a drug that, despite its manufacturer’s many clever disguises, was always frighteningly close to heroin, there’s a morbid sort of symmetry.
For those recovering from addiction, “relapse” has been a shameful event for years and years. Friends and family would scorn the fallen addict, self help organizations would make the person throw away their “clean time” and get a beginner’s chip while having to attend 90 AA meetings in 90 days. Relapse during recovery meant jobs would be lost and relationships would end, among other hardships. Instead of facing all this humiliation, many in addiction recovery would return to the preferred substance, as this seemed like a better option. We want to say here and now that there is better alternative.
Let’s say goodbye to ‘relapse’ for good – it’s a slip, and it’s a natural part of recovery. Learn from it.
Instead of having a relapse, we should call it a “slip.” As we live our life, it is natural to make mistakes. It is how human beings learn. It took a lot of falling before we learned to walk or ride a bike. Relapse is often a natural part of addiction recovery. There are other areas in life where we fall down (what we call “limiting behaviors”) as well: binging on sweets, not following through on our personal commitments like exercising, or not paying a bill on time. But when we yell at someone or spank the dog, this limits our growth and learning potential as well. If we are able to view all of this – including relapse during recovery – as lapses of judgment, and learn from them, it can propel us to greater depths of healing and personal fulfillment.
Every day, we are given opportunities for growth and learning. This especially applies to relapse. How you are with yourself as you face your issue is the issue. Meaning, we can beat ourselves up, feel humiliated, or actually take this episode as an opportunity to look at the triggers and grow from it. We counsel and teach our recovering participants to address the inner aspect that propelled them to use, create a better behavioral plan of action, set up a better support system, and look at the underlying cause or causes that led to the act.
We don’t view slips as being bad or wrong, but opportunities for further growth and development. It’s an invitation to take a deeper cut. In this way we don’t need to be guilted or shamed or go back to square one, but we do need to push on from where we left off.
Changing an addictive habit normally takes a good amount of time for the old pattern to fade and for the new habit to become firmly locked into place like a steel gate. This new pattern doesn’t come easy and one should anticipate some bumps in the road. The real challenge is to turn to your tools when a relapse does occur. Relapses during recovery then become bumps that are small insignificant annoyances. But if these small bumps are not handled at the onset appropriately and directly, they can turn into flames!
It is easy to be spiritual on the mountaintop but bringing the mountaintop into the valley is the real opportunity.
It is easy to be spiritual and successful at an addiction treatment center. And why shouldn’t it be? You’re in a residential treatment setting, you get support, you’re away from the addictive substance, and you’re constantly working on yourself. Upon discharge, the challenge and opportunity is to bring this healing environment with you as you face your day-to-day life.
The keys to continued recovery after a relapse – whoops, a slip – include:
In doing so, the success rate drastically increases for addiction recovery.