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Tag: opioid overprescribing

  • Prevent Opioid Overdose Deaths: A Call for Specific Prescribing Laws and Physician Oversight

    Prevent Opioid Overdose Deaths: A Call for Specific Prescribing Laws and Physician Oversight

    Make doctors precisely explain why they are prescribing opioids and why they decided on the pill count and refill allowance for each patient. 

    Recently, a friend’s teenage daughter underwent a procedure common for young adults: she had her wisdom teeth extracted. I had the same procedure performed in the late 1990s, at age 20. Back then, I was given a bottle of ibuprofen for the pain and, for the bleeding, told to apply tea bags. My friend’s daughter was given something just a tad stronger: 

    Vicodin.

    A teenager was given a strong opioid painkiller to numb the pain of a routine tooth extraction. It’s absurd that this is the accepted medication for this procedure when there are no complications, nothing that would indicate breakthrough pain on a level of requiring a narcotic that is given to cancer patients.

    However, the fight against opioid abuse is finally gaining promising victories by wielding an effective weapon: lawsuits. 

    Holding Big Pharma Accountable

    As the epidemic grew, many – myself included – called for state and local authorities to take drug companies to court for knowingly encouraging large-scale consumer usage of highly addictive prescription painkillers such as OxyContin, Vicodin and Percocet. Thousands of lawsuits have now been filed and in August, the $572 million decision won by Oklahoma against Johnson & Johnson became the first large-scale trial ruling concerning Big Pharma’s role in creating the opioid crisis. The state argued that J&J, which had supplied 60% of the opioids drug makers used for painkillers, aggressively marketed the drug to doctors and patients as safe. 

    Most recently the Sackler family – owners of Purdue Pharma, which makes OxyContin – reached a tentative settlement for$10-12 billion, a move that will result in the company’s bankruptcy. 

    They lied, we died, and now they have to pay up. Hopefully these are just the first few drips in an oncoming flood of restitution owed Americans by companies responsible for an unprecedented addiction crisis. They deserve whatever fates come their way – criminal, civil, or, as the 800-pound spoon left at Johnson & Johnson’s headquarters intended, shame-filled. 

    Now, as the overdose death rate shows signs of ebbing but has by no means abated – 68,000 Americans died in 2018 compared with 72,000 in 2017, hardly cause for celebration – it’s time to ask what’s next. 

    For years, drug companies pushed opioids as a panacea for all things pain-related. The result was an absolute avalanche of prescriptions: 191 million in 2017 alone, which averages to 58 opioid prescriptions for every 100 Americans. And despite guidelines intended to discourage opioid painkillers as a first-step approach to easing pain, primary care clinicians – most patients’ initial gateways to healthcare – wrote 45% of all opioid prescriptions. 

    Surgeons also have been implicated in widespread overprescribing. One study of nearly 20,000 surgeons, led by Johns Hopkins School of Public Health researchers, noted the common practice of prescribing dozens of opioid medications even for low-pain operations. Some prescribed over 100 opioid pills for the week following a surgery, along with usage instructions far exceeding guidelines from several academic medical centers. No wonder some six percent of all patients prescribed opioids post-surgery become dependent. 

    The diagnosis is simple: Doctors have proven incapable of, or unwilling to, exercise responsible discretion in determining which conditions and medical procedures necessitate painkillers notoriously linked to addiction, misuse, and overdose. 

    A Painful Backlash

    Complicating matters, the opioid crisis has become a two-way street. 

    In response to the backlash to the initial opioid free-for-all, many doctors have become so wary of prescribing opioids that those who truly need them are unjustly suffering. Much of this hesitancy is a reaction to guidelines issued by the Centers for Disease Control in 2016 that, according to Richard Lawhern, founder of the Alliance for the Treatment of Intractable Pain, has subjected patients with legitimate chronic pain to a “draconian reduction” in doctors willing to meet their needs with opioid-based medication.

    The problem with the CDC’s directive was vagueness of language. The guidelines state that opioids are appropriate for pain caused by cancer, end-of-life care, and “palliative care.” But “palliative” is a subjective term, and therefore confusing for doctors who, understandably, now have their guards up against malpractice suits in addition to opioid addiction and abuse. In a February 2019 reiteration of its guidelines, the CDC clarified that opioids are reasonable for chronic pain but, unfortunately, repeated its ambiguous wording concerning specific conditions. 

    However unintended, the result is patients who rely on opioids for legitimate medical reasons suffering for the sins of Big Pharma and, subsequently, the incompetence of government officials and the inadequacies – including cowardice – of doctors.

    The scale of the crisis and forcefulness of the backlash also has resulted in patients who, through no fault of their own, became dependent on opioids and, at the drop of a guideline, found themselves completely cut off from a highly addictive drug and dropped into a hellish withdrawal. The unsurprising consequence of this overreaction by doctors is patients turning to the streets for unregulated, often fentanyl-tainted heroin. Any laws written to specify opioid painkiller administration must include reasonable ways of relieving already-addicted patients through treatment centers and weaning agents like methadone and buprenorphine (suboxone). 

    However, the conviction permeating the chronic pain community – that doctors rather than laws should be the primary determinant of opioid prescriptions – simply doesn’t hold water. It’s become clear that doctors don’t necessarily know best. We need rules that hamstring the parasitic overprescribers while unhandcuffing the paranoid underprescribers.

    Guidelines Aren’t Enough

    It’s time for legislators to take the mystery out of this branch of medicine. If doctors can’t stop writing opioid prescriptions to those who don’t need them, or refusing to write prescriptions for those who do, then we must enact laws with clear prescribing instructions. 

    We’re all familiar with mandatory sentencing guidelines; we need mandatory dispensing guidelines – laws that bring harsh punishment for overprescribing pain medication when it’s not indicated, while reassuring doctors that they will not be unfairly punished for providing chronic pain patients with the relief they require.

    The time has come for customized ailment and procedure-related opioid painkiller dosing laws, complete with extensive medical rationale requirements. Make doctors precisely explain why they are prescribing opioids and why they decided on the pill count and refill allowance for each patient. 

    We also need to look at something else: ourselves. Especially in post-surgery settings, the opioid overprescribing epidemic was exacerbated by the naïve, altogether modern notion that patients should never feel discomfort or pain. 

    If alternatives to opioids don’t kill 100% of post-procedure pain, the new one-word answer should be “tough.” The idea that we can go through life without ever experiencing pain is not only delusional but, as we’re seeing, destructive. Things heal. Patients will need more, well, patience. 

    Numbing people literally to death is not the answer. It is irresponsible and dangerous to prescribe opioids for an ingrown toenail. Or for carpal tunnel syndrome. Or to a child following a tonsillectomy or, of course, a teenager after a tooth extraction. 

    On the flip side, it is cruel and flat-out stupid to deny patients with serious chronic pain access to a now-demonized family of medicines that for many has meant the difference between functioning and debilitation. 

    The time for general guidelines is behind us. We need strict, specific statutes that greatly diminish doctors’ discretion while placing transparency and responsibility squarely on their shoulders. 

    View the original article at thefix.com

  • Brain Research Could Help ID People At Risk For Addiction

    Brain Research Could Help ID People At Risk For Addiction

    Understanding risk factors for addiction could help doctors better respond to the opioid crisis.

    Addiction is a brain disease, but there has been surprisingly little research into the brain structures that can contribute to the disease.

    Now, study authors are arguing that a better understanding of how brain development and damage can contribute to addiction is important to help identify people who are most at risk. 

    “Addiction is a disease of decision-making,” Antoine Bechara, a professor of psychology at the University of Southern California told the school’s news service. “The majority of people have intact brain mechanisms of decision-making that keep them resilient to succumbing to an addiction. The question is, who is more vulnerable and how do we best determine that?”

    Weak Prefrontal Cortex Plays A Role

    Bechara is the lead author of a paper published in the journal Psychological Science in the Public Interest. His paper examines the role of the prefrontal cortex and the insula in increasing a person’s risk for addiction. The researchers note that a “weak prefrontal cortex”—the area of the brain associated with decision making—can increase risk for addiction. 

    Weakness in that area of the brain can be caused by genetic factors. However, environmental factors including early childhood abuse can also inhibit the development of the prefrontal cortex. When the area is under-developed, a person can become susceptible to substance use disorder. 

    “There are several factors that create the situation where the prefrontal cortex is suboptimal or weak, and the decision-making capacity doesn’t develop normally,” said Bechara. “These are people who become more susceptible to becoming addicted not just to opioids but other drugs they have access to.”

    The authors would like to see further research into whether brain scanning can predict which individuals are at risk for addiction. They also point out that brain stimulation could potentially help treat addiction.

    Who’s At Risk? 

    Understanding who is at risk for developing addiction could help doctors better respond to the opioid crisis, by finding a middle ground amid what Bechara calls the “two extreme positions” that medical providers have taken. 

    “First, the pharmaceutical companies sold the idea that opioid medications will only be used by people in pain and people won’t become addicted,” he said. “That’s not true, because you have no way of telling who is susceptible to becoming addicted and who is not.”

    He continued, “The overreaction by doctors is another extreme; because of the fear that everyone is going to be addicted to opioids, they are not prescribing them to people in chronic pain who may need them. There are a lot of people who could benefit from controlled administration of those medications, which work very well to treat pain.”

    View the original article at thefix.com

  • DEA Was "Slow To Respond" To Opioid Crisis, Report Reveals

    DEA Was "Slow To Respond" To Opioid Crisis, Report Reveals

    According to a watchdog report, the DEA allowed the drug crisis to reach a level that could have been prevented.

    The DEA could have done more to blunt the impact of the national opioid crisis, which has claimed more than 300,000 lives in the U.S. since 2000, according to a new report.

    The “harsh” report—released by the Justice Department’s Office of the Inspector General, which is responsible for auditing the DEA—found that despite rising opioid abuse being reported early on before the full-blown epidemic emerged, the DEA failed to act in a timely manner, allowing the drug crisis to reach a level that could have been prevented.

    “DEA is responsible for regulating opioid production quotas and investigating its illegal diversion,” said inspector general Michael E. Horowitz in a video summarizing the report’s findings. “We found that DEA was slow to respond to this growing public health crisis and that its regulatory and enforcement efforts could have been more effective.”

    Opioid Manufacturing Skyrocketed From 1999 To 2016

    The report noted that from 1999-2016, despite increasing reports of opioid abuse, the amount of opioid manufacturing authorized by the agency “also increased dramatically during that same time.”

    It should be noted that during this time period, a number of high-profile events occurred that established opioid abuse as a national public health crisis. From 1997-2002, OxyContin prescriptions for non-cancer related pain increased from 670,000 in 1997 (a year after OxyContin went on the market) to about 6.2 million in 2002, according to a timeline provided in the report.

    In 2007, Purdue Pharma and three company executives pleaded guilty to charges of false branding of OxyContin and were fined $634 million. Meanwhile, the rate of drug overdoses, fueled by opioid abuse, surged.

    Too Little, Too Late

    The agency waited until recent years to scale back opioid production. “It wasn’t until 2017 that DEA significantly reduced the production quota for oxycodone by 25%,” the report noted.

    The report did acknowledge the agency’s recent efforts to tighten up enforcement of drug diversion (when prescription drugs end up being abused in a way it was not intended) but said that more work is needed overall.

    The inspector general offered a list of nine recommendations to improve the DEA’s opioid response. They include developing a comprehensive national strategy that involves better cooperation between federal and local authorities and timely monitoring of emerging drug abuse trends, among others.

    View the original article at thefix.com

  • Small-Town Ohio Physician Ordered 1.6M Pain Pills in Four Years 

    Small-Town Ohio Physician Ordered 1.6M Pain Pills in Four Years 

    According to her attorney, Dr. Margaret Temponeras’ inappropriate prescribing was the result of being misled by pharmaceutical companies.

    A feature in the online edition of the Cleveland Plain Dealer examines the circumstances behind a family physician in a southern Ohio suburb who, by ordering more than 1.6 million opioid pills, was credited by federal and state authorities for allegedly helping to fuel the state’s opioid overdose crisis.

    The State Medical Board has accused Dr. Margaret Temponeras of prescribing painkillers for “other than a legitimate medical reason” and to patients who showed clear signs of dependency between 2006 and 2011 from a pain clinic and dispensary she operated. 

    Guilty Plea

    After federal authorities raided her offices in 2015, Temponeras pled guilty to a charge of drug conspiracy in 2017, and is currently awaiting sentencing. Her attorney was quoted in the Plain Dealer as saying that the doctor was misled by pharmaceutical firms, which according to the article, have paid millions of dollars to settle lawsuits over their alleged contributions to the opioid crisis in Ohio, which ranked fourth on a list of the states that received the highest amount of prescription painkillers between 2006 and 2012.

    It Was a Family Affair

    According to the Statement of Facts cited by the Department of Justice press release, Temponeras, who operated a family practice in Wheelersburg, Ohio, also opened a pain management clinic in the town, her father, gynecologist Dr. John Temponeras, also worked at the clinic. From 2005 until 2011, the pair saw more than 20 patients a day, who paid $200 and $225 in cash for examinations. Federal records indicated that in some cases, patients drove to the clinic from Kentucky and West Virginia.

    Patients received monthly prescriptions for oxycodone and Xanax, some of which were filled by her father; records show that their office ordered more than 107,000 pills in 2008, which rose to more than 655,000 the following year and to more than 800,000 in 2010. Medi-Mart Pharmacy in Portsmouth, Ohio, initially filled many of the prescriptions but when DEA officials began warning local pharmacists about Temponeras’s prescribing habits, she began filling prescriptions at her clinic, where employees – none of whom were pharmacists – handled medication. The Plain Dealer noted that state law at the time did not require a solo practitioner’s office to have a license to dispense drugs.

    Top Opioid Prescriber

    By 2012, Temponeras ranked 18th on a national list of practitioners who ordered opioids between 2006 and 2012, with some 1.66 million pain pills placed by her office. The Plain Dealer noted that more than 1.4 million were obtained from Miami-Luken, a pharmaceutical wholesale distributor in southwest Ohio that was indicted on drug conspiracy charges in 2018 for selling millions of opioids throughout southern Ohio, Kentucky and West Virginia while also failing to report suspicious orders to the DEA. During testimony before a U.S House subcommittee, Miami-Luken’s chairman of the board mentioned Temponeras as someone they “never should have supplied” with medication due to the large amounts she had ordered.

    In 2011, state and federal agents raided Temponeras’s offices, resulting in the permanent loss of both her and her father’s medical licenses. Both were also indicted, along with Medi-Mart Pharmacy owner Raymond Fankell, by a federal grand jury. 

    All three pled guilty to conspiracy to distribute a controlled substance, which carries a possible jail sentence of up to 20 years. As of the publication of the Plain Dealer article on September 1st, all three are free on bond.

    View the original article at thefix.com

  • Doctors Prescribe More Opioids Late In The Day, When Running Late

    Doctors Prescribe More Opioids Late In The Day, When Running Late

    Time constraints and “chaotic practice environments” may be to blame for the troubling reliance on prescriptions.

    Doctors are significantly more likely to prescribe opioid pain pills later in the day or when their appointments are running behind schedule, according to a new study. 

    The study, published in JAMA Network Open, looked at records from nearly 700,000 primary care appointments. The study authors found that doctors were 33% more likely to prescribe opioids late in their day than they were during their earlier appointments. In addition, appointments running behind schedule increased the likelihood of an opioid being prescribed by 17%. 

    It’s often mentioned that time constraints on patient appointments cause doctors to turn to prescriptions, rather than engaging to find alternative treatments, a process that can take much longer. The researchers wanted to use measurements and data to see if that is truly the case. 

    A Long-Suspected Factor in Overprescription

    “Many observers have blamed chaotic practice environments (ie, increasing financial pressure, productivity expectations, and the cognitive effort of caring for complex patient populations) for high rates of opioid prescribing because opioids can be a quick fix for a visit where pain is a symptom,” study authors write. “The concept that time pressure can drive physician decision-making is long-standing, but little empirical literature has examined the existence of this phenomenon or its magnitude.”

    They found that the theory did hold up, across all providers. 

    “Physicians were significantly more likely to prescribe opioids as the workday progressed and as appointments started later than scheduled,” they wrote. 

    Awareness of Bias May Help Reduce Opioid Dependence

    The researchers said that there are vast difference in prescription rates between individual doctors and hospitals that can’t be explained just looking at the the time of day of appointments. However, they point out that the difference in prescribing at different times of the day can also help explain some of the difference in prescribing between different providers.

    “Full-time clinicians may have higher opioid prescribing rates simply because of the effort involved in long clinical days,” they wrote. “Sharing individual data on these patterns with physicians could raise awareness of this bias and help them develop approaches such as schedule modifications to lower the burden of taxing or time-consuming decisions late in the day.”

    On a national level, addressing this difference could help reduce opioid prescriptions and ultimately lead to fewer people becoming dependent on opioids. 

    “If similar patterns exist in other clinical scenarios, such as managing challenging chronic illness, this phenomenon could have relevance for public health and quality improvement efforts,” the study authors write. 

    View the original article at thefix.com

  • Opioids After Childbirth Put Women At Risk For Chronic Use

    Opioids After Childbirth Put Women At Risk For Chronic Use

    Researchers found that 27% of women who had vaginal deliveries filled an opioid prescription.

    About 1 in 50 women who are given an opioid prescription right before or after giving birth will go on to use opioids persistently in the first year postpartum, according to recent research. 

    The study, published in JAMA Network Open, looked at opioid use around the time of childbirth. Using data from more than 308,000 births that took place between 2008 and 2016, researchers found that 27% of women who had vaginal deliveries filled an opioid prescription, as did 75.7% of women who had a cesarean. Of those women, 1.7% of those with vaginal deliveries and 2.2% of those who had cesareans went on to fill prescriptions for opioids at least two more times during the year after birth. 

    The researchers said that the similarities in rates of persistent use indicated that the opioids themselves—not the pain from childbirth—put people at risk of persistent use. 

    The data “makes us think that there’s something inherent to the prescription rather than what women are going through that’s driving persistent use,” lead researcher and OB-GYN from the University of Michigan, Alex Peahl, told STAT News. 

    The rates are also similar to the rates of persistent opioid use among other populations that receive a first-time opioid prescriptions, including people getting their wisdom teeth removed. 

    Unnecessary Opioids

    The researchers said that doctors could help reduce the frequency of persistent use by avoiding prescribing unnecessary opioids to people who have recently delivered. 

    “These results suggest that maternity care clinicians can potentially decrease new persistent opioid use among women after either vaginal or cesarean delivery through judicious opioid prescribing,” the study authors wrote. 

    Marian Jarlenski, assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health, said that providers need to be aware that they can change a patients’ long-term health by not offering opioids that aren’t needed. 

    “This study shows that there continues to be a chance to really intervene on the prevention side,” she said. 

    Although 2% may seem small, given how many women give birth each year, it’s a rather significant figure.

    “It’s of course a topic that is on many people’s minds because pregnancy is one of the most common reasons why a lot of young women without any sort of health conditions come into contact with the health care system,” said Brigham and Women’s Hospital epidemiologist Rishi Desai, who was not involved with the study. 

    1 in 300 Women

    The American College of Obstetricians and Gynecologists estimates that one in 300 women who give birth by cesarian will develop persistent opioid use. Their guidelines for post-birth care include using opioids and alternative pain management techniques. 

    View the original article at thefix.com

  • Is The Opioid Lobby Behind Attacks On The CDC Prescribing Guidelines?

    Is The Opioid Lobby Behind Attacks On The CDC Prescribing Guidelines?

    “Opioid manufacturers stand to lose substantial profits with the widespread adoption of the CDC guideline. Public health, however, benefits from the guideline, and attacks on it bear industry’s fingerprints.”

    Since the Centers for Disease Control and Prevention (CDC) issued guidelines around prescribing opioids in 2016, there has been controversy over whether the recommendations are appropriate. One group believes that this skepticism is being fed by a coordinated effort by the pharmaceutical industry to undermine the guidelines.

    Writing for STAT News, Dr. Adriane Fugh-Berman, Judy Butler and Ben Goodwin point out the many ways that the pharmaceutical industry has influenced organizations that have spoken out against the CDC guidelines.

    The authors are all associated with PharmedOut, an initiative from Georgetown University Medical Center that aims to bring awareness to pharmaceutical marketing and promotes evidence-based prescribing.

    The authors point out that no one has disputed the crux of the CDC guidelines.

    “Criticism of the guideline follows a consistent pattern: no evidence provided to refute any statement in the guideline and no evidence provided for the critics’ claims,” they write.

    Yet, the constant criticism points to a coordinated effort.

    “The eerily similar attacks on the guideline, and the subsequent spinning of the CDC’s we-meant-what-we-said responses to critics as some kind of admission of error or inadequacy, raise the question of whether this is a coordinated attempt by opioid manufacturers to use third parties to undermine, discredit, and smear the guideline,” the authors wrote.

    Groups including the American Academy of Pain Management and even the American Cancer Society Cancer Action Network, which spoke out against the guidelines, received funding from industry groups, the authors note.

    In fact, a 2017 analysis found that “opposition to the guidelines was significantly more common among organizations with funding from opioid manufacturers than those without funding from the life sciences industry.” It also found that no groups disclosed their opioid-related funding when formally submitting comments on the CDC guidelines.

    The authors also pointed out that a 2019 letter against the recommendations drafted by Health Professionals for Patients in Pain and signed by 300 providers received extensive press coverage, while a similar letter in support of the guidelines drafted by PharmedOut received very little coverage.

    Even chronic pain patients can have their stories hijacked for the bottom line of opioid manufacturers, the authors said.

    “It is essential that we not abandon patients on long-term opioids—but it is also important that we not create more of them,” they wrote.

    Ultimately, the CDC guidelines will cut down on profits, and that has the industry fighting against the guidelines, the authors wrote.

    “Opioid manufacturers stand to lose substantial profits with the widespread adoption of the CDC guideline,” they said. “Public health, however, benefits from the guideline, and attacks on it bear industry’s fingerprints.”

    View the original article at thefix.com

  • Dentists Need To Make Sweeping Changes To Opioid Prescribing

    Dentists Need To Make Sweeping Changes To Opioid Prescribing

    Dentists have decreased the amount of opioid prescriptions they write by nearly 500,000—but some believe it’s not enough.

    Three years ago, P. Angela Rake decided to make a major change at her oral surgery practice.  

    “After the loss of Prince, I just drew a line in the sand that I’m going to change my prescribing practices,” Rake said, according to The Chicago Tribune. In just two years, she reduced the amount of opioids she was prescribing by 70%. 

    It wasn’t just the death of the superstar that moved her. Rake had also seen her own brother get hooked on opioids that he was given during cancer treatment. Having seen firsthand the dangers of opioid addiction, she knew that she couldn’t continue to prescribe opioids to her patients in the usual manner. 

    Today, she only prescribes opioids when absolutely necessary. The patients who do need opioids get few pills and lower doses. Rake now says she feels like the opioid industry deceived her. 

    “When these drugs came into being routinely prescribed, the industry-funded message we were being told was that the risk of addiction was less than 1 percent. We were misled.”

    The truth is that the risk of addiction for young people given opioids after oral surgery is closer to 6%. Now, more dentists are becoming aware of the danger of these pills for the youngest patients, said Andrew Kolodny, co-director of opioid treatment research at Brandeis University.

    “Dentists and oral surgeons are the No. 1 prescribers of opioids to teenagers. What’s so disturbing is that it’s so unnecessary. These are kids who could have gotten Advil and Tylenol,” he said. “It’s almost a rite of passage in the United States having your wisdom teeth out. The aggressive prescribing of opioids to adolescents may be why we’re in an epidemic.”

    Dentists have decreased the amount of opioid prescriptions they write by nearly half a million, from 18.5 million in 2012 to 18.1 million in 2017. However, that’s a far cry from the 70% reduction that Rake made, and some within the industry say it is not enough. 

    Romesh Nalliah, who teaches at the University of Michigan School of Dentistry and has studied opioid prescribing among dentists, said that dentists are concerned about customer satisfaction, and sometimes that relies on doling out opioids. 

    “Dentists are also business owners. They don’t want patients to say, ‘Dr. Nalliah did my extraction, and now I’m in agony,’” Nalliah said. Despite that, he has now changed the way that he prescribes opioids, and urges others in the field to do the same. 

    He said, ”I don’t want to be responsible for someone becoming addicted to opioids. I personally think we can cut opioid prescribing in dentistry to less than half of what we do now.”

    View the original article at thefix.com

  • What Does 2019 Hold For Opioid Lawsuits?

    What Does 2019 Hold For Opioid Lawsuits?

    Many are looking at the settlements with Big Tobacco to see how the opioid settlements—if there are any—might take shape.

    During 2018, as opioid overdose rates continued to soar, municipalities from around the country vowed to hold drug manufacturers and distributors accountable. This year, 2019, will show how many of the lawsuits around the opioid epidemic will pan out. 

    The plaintiffs — mostly local and county governments from around the country — hope that settlements from the lawsuits will help them recoup some of the costs of treating people addicted to opioids and maybe even help finance better treatment options going forward.

    “We are still in the throes of a public health crisis in Summit County,” Greta Johnson, a county official in Akron, Ohio, told NPR. In order to respond to that crisis, she said, the county needs funds from the major companies that caused or contributed to the epidemic. “We’re confident the court will see it that way as well.”

    Johnson’s argument, echoed in dozens of lawsuits, may sit well with Federal Judge Dan Polster, who is presiding over the largest group of lawsuits out of his Cleveland courtroom. Polster has called the opioid epidemic a “man-made plague,” and called for comprehensive solutions to the issues of addiction and recovery. 

    While defendants will likely try to have certain allegations dismissed on legal technicalities — like the statutes of limitations being up — Richard Ausness, a law professor at the University of Kentucky, told NPR that effort is unlikely to succeed entirely.

    “The judge has made it clear that he wants a settlement ultimately from this, along the lines of the tobacco settlement,” Ausness said. “If that is indeed the way that he feels, he is probably not going to let the defendants off the hook.”

    As the court cases proceed, the public could learn even more about practices that led to millions of Americans becoming hooked on opioids. Attorney Joe Rice, who represents some governments suing Big Pharma, said that he would like to see the information about misleading advertising and other unscrupulous practices become common knowledge. 

    “Our next battle is to get the documents that are being produced made available to the public instead of everything being filed under confidentiality agreements so we can get the facts out,” he said. 

    Many people are looking at the settlements with big tobacco to see how the opioid settlements — if there are any — might take shape. Tobacco companies have paid more than $100 billion in damages to Americans, some of which have been used to fund anti-smoking public health campaigns. A similar settlement with manufacturers and distributors could impact how future generations are educated about drug use.  

    View the original article at thefix.com

  • Doctor Accused Of Prescribing Pills Linked To Overdose Deaths

    Doctor Accused Of Prescribing Pills Linked To Overdose Deaths

    The doctor’s prescription writing was allegedly so extreme that a local CVS stopped accepting prescriptions he wrote. 

    There’s a lot of attention on the so-called “third wave” of the opioid epidemic, synthetic opioids, but the arrest of a California doctor this week for allegedly illegally distributing prescription pills shows that medications are still a dangerous part of the epidemic.

    Orange County doctor Dzung Ahn Pham, 57, who owns Irvine Village Urgent Care was arrested on Tuesday for allegedly providing prescriptions to patients whom he never actually examined, according to a press release issued by the U.S. Attorney’s Office.

    He is facing two charges of illegally distributing oxycodone. At least five people who reportedly received medications from Pham overdosed, and another man who was allegedly using pills from Pham was involved in a fatal car accident.  

    “This case clearly and tragically illustrates the dangers of drug dealers armed with prescription pads,” United States Attorney Nick Hanna said in the press release. “This doctor is accused of flooding Southern California with huge quantities of opioids and other dangerous narcotics by writing prescriptions for drugs he knew would be diverted to the street. Prosecutors in my office, working with their law enforcement partners, will tirelessly pursue everyone involved in the trafficking of opioids as part of our persistent and ongoing efforts to stop the trail of misery that follows these dangerous drugs.”

    Pham’s prescription writing was allegedly so extreme that a local CVS stopped accepting prescriptions he wrote. 

    According to an affidavit, Pham provided medications including Adderall, oxycodone, tramadol, sSuboxone, norco, soma, alprazolam, and hydrocodone bitartrate-acetaminophen to patients who requested them via text message. At least 84 patients had prescriptions within a day or two after sending texts. 

    Last summer, undercover agents from the Drug Enforcement Administration also reportedly received pills from Pham, including a “Holy Trinity, [which] is the combined use of an opioid (such as hydrocodone), a benzodiazepine (such as Valium), and carisoprodol (a muscle relaxer like Soma),” according to the press release. The doctor then reportedly sent the undercover agent to a specific pharmacy that still accepted his prescriptions. 

    The pill mill operation was reportedly lucrative for Pham, who is believed to have deposited more than $5 million into personal accounts over the past five years. He also reportedly deposited $1.7 million into a business account. Investigators say he was charging $100-$150 per visit; it’s not clear how patients who requested prescriptions via text were charged. 

    William D. Bodner, DEA Los Angeles Associate Special Agent in Charge, said that targeting doctors who write prescriptions irresponsibly is a priority. 

    “This arrest should serve as a warning to any physician who utilizes their position to traffic opioids,” he said.

    View the original article at thefix.com