they were getting to be alive again in a way they hadn't for years and that they consider to be the best thing that happened to me if i wasn't on this vacation i just wouldn't be able to do the things that i'm doing now there's no question the best strongest and most opioids of serious medical side effects patients are just a.t.m. machines. or you push buttons. and you can do pharmaceutical companies all though we're not entirely transparent about the thank you. we're told they were non-addictive when in fact they were and we don't get taught in medical schools about this is that we induce we only get told about illnesses that we're supposed to cure. thinking that doctors are always right so if you have a prescription it's easy and we talk about opioid painkillers we are centrally talking about heroin the drug companies or the cartel. doctors are the

pushers and the pharmacists are the suppliers and that's how the ada is seen there's not a city in the united states right now that doesn't major opiate addiction problem and it's not just in cities it's in rural areas in fact in some places it's worse in rural areas than anywhere else at the peak of the epidemic millions of people in the united states were prescribed $259000000.00 prescriptions of opioids and it means on average every adult is on one opiate you know once or twice a year if not more scares the living out of me opioids are a major category of medical spending according to the centers for disease control it's about. $24000000000.00 in direct cost for the medications and other $75000000000.00 in health care costs people are doing and. 80. and pack

a day that's a $1000.00 worth of medication to kids who are spending hundreds of dollars a day if not thousands. of her own walking. and it's cheap. really cheap really inexpensive and readily available the shame of addiction keeps us from knowing the actual numbers but at least 2000000 americans and probably millions more are addicted to prescription opioids prescription drugs. causing more deaths for example. car accidents from 999 to 2070 over 500000 americans have died from an opioid overdose more than all the americans killed on the battlefield since world war 2. we have iraq in rates of foreign dependent children winding up in the foster care system because their parents are addicted kids growing up without parents parents who have lost children

you have families decimated you have talents destroyed think that it started off with a company in stanford connecticut that had some marketing material this is the worst manmade epidemic in the history of. american medicine it's very clear when one looks at the overprescribing of opioids that's led to this public health crisis that the medical community really forgot the 1st of all which is do no harm. opioids are among the world's oldest known drugs there are medical religious and recreational use predates recorded history. these are really drugs such as opium codeine and morphine works directed from poppy flowers and it's some kind of mystery of nature why did the poppy play out create morphine that can bind to the opioid receptors in human brains and probably that's a mystery of nature will never be. able to answer but that is the case because it's

chemically similar to the compounds that her own brain makes an 874 an english chemist by mixing morphine and other assets created a powerful opioid that was eventually called die a seal morphine nothing much resulted from his discovery 23 years later a german chemist working for what is now the bayer pharmaceutical corporation created the same substance baier quickly promoted the drug is less dangerous than morphine as well as a cough suppressant because of the heroic feelings recipients experienced they called it heroin heroin is a very slight chemical manipulation of the morphine molecule makes the compound heroin much more fat soluble the brain is mostly fat so if someone is exposed to heroin it gets into the brain many many times faster than morphine would the more route that a drug gets to the break we were told in humans the more apt it's to cause

a high this heroic drug originally promoted as a cough suppressant and for other common conditions were soon diverted and abused in 1904 the united states congress banned heroin declaring it a dangerous addictive illegal narcotic it probably would take too long for me to. provide a theory of why as americans we have. such love affairs with with drugs that potentially can kill us opioid addiction led doctors to fear its use for anything but short term richard pain or end of life palliative care that was a time when the medical community did understand that opioids needed to be prescribed. there obviously important medicines for easing suffering at the end of life that play an important role when used on a short term basis for severe acute pain for example after major surgery the.

scientist started creating new semi synthetic opioids similar to heroin in 1917 oxy code was one of several semi synthetic opioids developed in germany you literally start with opium to make hydrocodone and oxy caught on in the effects that hydrocodone oxy co don't produce in the brain are indistinguishable from the effects produced by heroin if you give an experienced heroin user oxy code on and heroin it's hard for that terrilyn user to tell which is which in fact if you ask them which they like a little bit better and unlike a blind taste test which was a study they did as columbia university the oxy codell is preferred to the heroin so one i'm saying is that when we talk about opioid pain medicine worse since they talking about her own health and 892 doctors joan perdue gray and george

bingham started the per do frederick company on manhattan's lower east side in 1952 it was sold to 2 other doctors raymond and modem or 2nd in the intervening years they expanded the company to other states moving their headquarters to stanford connecticut and changing the name to produce for produce a private family many of them are doctors many that are fully into pasts they've made a lot of money billions but they are not your typical rich people yachts dating models things like that their intellectual people they care about science cancer research arts a 3rd brother doctor or 3rd sacker revolutionised form a suitable advertising or originated a blitz marketing of drugs aimed at general practitioners through medical conventions and ads with well known doctor endorsements direct mailing and a sales force giving out free samples and perks. for the response even. no

wand andros is $963.00 campaign for the new tranquilizer value touted it as a safe non-addictive stress reliever women particularly were targeted to cure the every day stress of being a wife and mom valuing became the 1st 1000000000 dollar profit drug leading to an addiction crisis by the mid 1970 s. and 1987 dr arthur sackler died a very rich man his successful marketing strategies continued to live on a per do far enough. to do began focusing on pain management in 1972 they patented content a controlled drug release system produced form a believe that if they could link their 12 hour time release system content to an opioid pain reliever that could be marketed for chronic pain without the sudden rush or heroin high to the brain there is an inherent logic to making large acting opioids because obviously convenience you don't hear a doses in

a day but you'd also have fewer repeats and troughs right so you wouldn't have a sudden potential respiratory depression on your own how to bridge your pain at the time opioids had limited use for short term acute end of life pain neither are markets where fortunes are made you know all of their sales materials for targeted to get to get the drugs out of the oncology suites and into the hands of local practitioners to do began funding organizations that endorsed long term use of opioids for common conditions in 1993 they established partners against pain quote to help alleviate unnecessary suffering by advancing standards of chronic pain care through education 996 are the launch of the 12 hour extended release and thetic opioid designed to be safe for both acute and long term chronic pain they called the new revolutionary. drug oxycontin. the next step was to

convince the skeptical medical profession of the safety and effectiveness of their powerful pain reliever per do at the time it launched in 1996 really opened a new territory in terms of aggressive promotion of narcotics they did things that really had never been seen before oxy khat was really one of the 1st painkiller is that was marketed to general internists and the public for moderate pain they are the company that sort of out of originated the playbook inspired by the arthur sackler playbook produce launched a marketing campaign to sell oxycontin through multiple levels of attack. let's number one educate the medical community from 1906 to 2001 purdue conducted national pain management and speaker training conferences and resources in florida

arizona and california there in appropriately influencing maybe even corrupting 5000 doctors nurse practitioners and nurses to just sell the kool-aid several videos were created named both doctors and patients to encourage the use of opioids as a long term safe methods to treat chronic pain one such video was entitled i got my life back the video centers around dr allen spano sent his patients personal success stories thanks to oxycontin that now may i can enjoy every day. since i've been on this new pain medication i have not missed one day of work these videos were seen by about 15000 doctors through direct marketing seminars and medical school. in the troubled 19 seventies a group of killers rampage 3 cups of new. that was coordinated loyalist attacks

protect a population of tens of thousands were forced to flee their homes a mob was striking to put these attacks was a p.r. you see the police actually took part in the attacks so instead of preventing it they were active participants in the burning of coal streets in belfast at the time more than a 100 innocent civilians were unloaded as the review can seniors and we found out more i was surprised about the extent of the crates which the pollution was involved in some of those cases the killers would later be named. i think it went to the very very top i think it is. the water where politicians you know on the go ahead. the world is determined by.

the day or thinks. we dare to ask.

we now know that in patients who have no history of substance abuse no history of chemical dependency the likelihood that the treatment of paid using it opioid drug which is prescribed by a doctor will need to addiction is extremely low people like russell portnoy and many others were teaching that addiction was rare and these false words and that we should be comforting people in chronic pain just like we have learned to convert people with cancer pain and in fact if you don't do that you're probably going to be found wanting these are what is termed in the industry a k o well or a key opinion leader and if a drug company can hire these k o l's they don't have to do the promotion themselves and in fact a lot of what the k o l say to other doctors and other practitioners doesn't have to meet the same level of scrutiny by the f.d.a.

doesn't have to even conform to the labeling instructions for the drug or a generation of physicians were trained that opioids were effective for chronic pain and unsafe blitz number 2 promote the drug they increased their sales force and their physician called us these sales reps were offered lucrative bonuses their average compensation produce sales rep was about $55000.00 but they could get that increased by an extra $250000.00 bonus if they could get enough doctors writing prescriptions if you can increase your salary 5 fold you're going to cut corners who's the doctor writing the prescription for is that just the drug mill prescription office those questions just were not asked health care professionals received all kinds of promotional perks. and fishing hats stuffed plush toys musical compact disks and of course the proverbial free lunch pharmaceutical

companies were off this all the time to get penn soon then. prescription pads for their products were written and that's why he had to do was sign it you could take him out to lunch you can go to meetings you go to the meetings and there's a reception by those guys knew what they were doing and they must have been good at it or they wouldn't have done it but what happened is the sort of. gray shape the physician to them to be beholding for the goodies that they provided for them they're all guidelines for what the sales rep can and can't say but you're not saying and not lunch i'm not saying and on that lunch there's no recording or transcript of it who knows what i said primary care doctors who fell for this began prescribe being aggressively people always say follow the money there's considerable amount of money involved in the in the prescribing of opiates do paid honoraria speaking and teaching fees to doctors boarding the oxycontin bandwagon he was taking about $100000.00

a year. and then we look to see how much the drugs that he was writing prescriptions for were costing us and so the drugs he wrote for those drug companies cost us $500000.00 a year so they can easily target dark jurors that are covering 80 percent of all of the narcotic prescriptions and that's what produced it blitz number 3 get the state and federal regulatory agencies on board as well as the legislative branches big pharma is one of the most powerful lobby groups in washington they have armies of lobbyists that they use to reward congresspeople to reward senators most of it is done legally and above the board and in fact if you look at the websites that are out there you can see how much money is paid by each drug company to each senator and each congressman but there's also

a lot of sort of dark money that goes for. you know political action committees and other organization. since that that we really don't know about in our system of special interest politics. the special interests unfortunately often are the ones that carry the day when it comes to produce farm and there was essentially an unholy alliance between. the company executives and the advisory board of the f.d.a. they reviewed the drug big pharma is supposed to be regulated by the f.d.a. but unfortunately through the producer laws big pharma is actually paying the f.d.a. . very large sums of money to review their drug applications so the f.d.a. doesn't do independent testing i've never bought into and that has taken account of the drug companies clinical trials for them i was investigating whether or. where their company executives were essentially writing the advisory decision.

that legitimized approving this struck the joint commission that accredits health care organizations mandated pain is treated like the 5th vital signs as patients routinely had their temperature and blood pressures checked doctors were expected to ask each person to rate their pain on a scale from $1.00 to $10.00 doctors and hospitals were mohnish to if they did not treat this pain the joint commission developed this pain as the 5th vital sign. as part of a grant through that was provided to them by the pharmaceutical company purdue pharma the joint commission on accreditation of healthcare organizations recently defined and adopted stringent pain standards on the basic thrust of our new standards is that organizations of practitioners have an obligation to ask the patient even if the patient doesn't look like he or she is in pain ask them to be

surprised but here when you go to a doctor's office now they ask you are you having paid. though you may go for a raise that has nothing to do with pain which just added white or fluid to the fire because because it became equivalent to say if you have pain you need opioids . at least in the united states. you know i mean probably not for making people spilling an oxy contemn produce marketing of oxycontin depending on how you look at it very successful very tragic all the marketing legislative maneuvering cash and free giveaways handed to doctors and politicians might have been justified if opioids were a safe effective non-addictive treatment for chronic pain but they weren't my personal experience that it was the work. that i was watching many of my patients deteriorate. a few deaths.

retrospect clearly related to my prescription produce own sales reps were saying that the rate of addiction is only one percent. with artsy con and that was clearly just false when you go back and look at the original data on which the which there claimed that that opioid use or pain medicine used for for treating pain doesn't cause addiction is scary the right of addiction among pain patients who are treated by don't tolls is much less than one percent cited a study by porter and chick few bothered to check out the source of this critical statistic in 197917 years before the creation introduction of oxycontin. dr herschel jek used boston university's new crew database to satisfy his curiosity of how many hospitalized patients became addicted to opiates grad student jane porter helped compile the statistics dr jack broke our friend the secretary typed

it up and submitted it to the new england journal of medicine. short letter was one of the many printed in january of 1980 the power graph simply stated the statistics and made no conclusion. what everybody was citing as evidence that we didn't have to worry about getting our patients addicted in some cases this was being described as a landmark study it was this a one paragraph letter to the editor of this of course would tell you nothing about the risk of addiction when you put a patient on long term opioids but it turns out in fact they have always been just as addictive as we always knew they were there for many hundreds if not thousands of years when people used the obvious see it in the early derivatives of opium for pain control. as patients began to exhibit symptoms of tolerance and addiction to do former was quick to pacify fears we were often taught that tolerance imply the

diction but it doesn't tolerance just means that you may need to increase the dose of the drug to get the same effect but that doesn't go along with compulsive use of the trial and doesn't go along with any of the other things that with the concept of pseudo addiction what we were told was that if you had a patient coming in early who looked addicted that it wasn't addiction it was a pseudo addiction pseudo addiction is a fairly new term attorney came in about 990 but it's crucial pseudo addiction is. when a patient is looking the life of a drug addict because pursuing relief so pseudo addiction is a relief seeking behavior in this state as drug addiction produces remedy for so-called pseudo addiction actually endangered lives if you had a patient who appeared addicted to educational message was that you should increase

the dose of the opioid. give them more opioids and sure enough if you give somebody who's addicted all of the pills that they could possibly want they do stop coming and orally there they spend the day and narcotics stupor on the sofa the average daily dose one for about 80 milligrams a day to over 140 milligrams it's very just within a couple of years and it's shifted tremendously from the slightly weaker schedule 3 opioids to the stronger longer acting schedule it's so by now the horse is out the door is closed you've got people running around thinking believing that they need these opiates to have a peaceful successful life completely pain free will the price that they paid was their dependency an addiction to opiates dr peter grace research assistant professor with the university of colorado boulder published

a study indicating that opioids like oxycontin when used long term increase chronic pain rather than the long term use that really isn't scientifically justified by now study actually suggest that. the long term effects my not just baby absence of benefit but actually that diet might be causing a long time time release opioids when crushed snorted or injected. rushed to the brain similar if not better than a legal heroin. young people began diverting the drugs described or stolen from medicine cabinets to get high. to lead to addiction and overdose the children using oxy codeine by children i mean people between the ages of 12 when you're starting up to 25 all those children they crush the oxy code and they can get a whole day supply out of a sustained release. they became 2 kinds of opioid addicts the abusers and

those unknowingly addicted to a drug their trust a doctor had prescribed in the 1009. he's linda g. and noddy from exeter new hampshire sought treatment for back pain and fibromyalgia at her local clinic at one point. $150.00 milligrams however they do have that now patches plus oxycontin. i had a woman that lives in my building said to me dr like you were cross and that was because of the opiates i don't drink so. and you never did anything other than what you will prescribe is and then write another proctors was the off label use of drugs this is the use of drugs to treat elements other than what they were designed for off label use is not illegal or regulated by the f.d.a. doctors began prescribing oxycontin for migraines and depression there's no law against writing the drug for an off label use so there might be the drug detail

guy comes in your office and you know with a wink and a nod and says you might want to use that try try that drug for this because some other doctors we know have used it for that even though it's not approved for that in addition to oxycontin other opioids were put off label use one of which was methadone a drug used to treat heroin addiction. is you'll be a reflection of reality. in a world transformed. what will make you feel safe. isolation community. are you going the right way or are you being that. direct. what is true what is fake.

in the world corrupted you need to descend. to join us in the depths. of the shallowness. we talk about problems all. summer we come up with solutions. long. who put oh yeah they have so being you.

just can't do a pretty girl. oh yeah it's. so. good they just they take you. through. the stories of men who come to madge in life without fashion without a sense of style without things that might be seen as weakness in this masculine world but they still demonstrate incredible strength of spirit to live as they choose. to call them to look as if you should go. through. so what we've got to do is identify the threats that we have it's crazy confrontation let it be an arms race on all sides very dramatic development only personally i'm going to resist i don't see how that strategy will be successful very critical time to sit down and

talk. german clinic treating the seriously ill russian opposition activists alexina valley says it has found traces of a substance that affects the nervous system that's despite russian doctors earlier saying they could not find any toxins in his blood also to come this hour the austrian ambassador is summoned to the russian foreign ministry in moscow after vienna said it's expelling a russian official for breaking the rules of diplomacy and a weekend of huge rallies passed off peacefully and by the 3 weeks after the disputed election tens of thousands calling for him to quit president because thanks riot police for their support. the baptist was suitable.