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 lots of the group of us of us can. put forward but. the world is driven by shaped by phone person. no dares thinks. we dare to ask.

when i will show small framed wrong all my old clothes just don't call. me the old lady yet to shape out this day become agitated and in gains from it equals betrayal. when flamini find themselves worlds apart when she's to look for common ground. for years i had treated patients with heroin addiction with high dose methadone which is the appropriate treatment and so i was thinking well i see how well that works for all these people and they don't tend to overdose on it or have a lot of side effects or have any problems so why wouldn't that be fine for pain patients i really do recall individual young man who had

a rough go early in life had some problem with alcoholism was in elko recovery had a number of back surgeries and i was in the middle of a tapering course switched him over to the methadone from his other drug to ease his taper and using misguided conversion tables. 3 days after i converted them i got a call from his wife buddy a doctor and was flabbergasted it's not safe for people who just have chronic pain to give them opioids because they don't have the years of tolerance built up that people with heroin addiction have to really understand the complexity of being that drug is a reflection on. guys much training this was the published data i said there's something wrong here. and that left a. hole in my heart i still remember him very very clearly he had opened up a shop that small business and was really getting conceit. he even gave me his

a. 100 day to come running accomplish that information was dribbling in that the opioid miracle pain relievers were killing people is proof pharma and the other drug companies would have acknowledged the potentially lethal effects of opioids when these problems are 1st discovered hundreds of thousands of lives could have been saved instead they took steps to suppress negative information within a month we received a 3 page letter from purdue pharma. basically saying why are you bothering the doctors this is not a prescribing problem this is a patient misuse problem this is a drug abuse problem patients need to be able to get what they need and then we got a year later got sued in federal court we were all all the medical directors were served in our homes current efforts to stop this overprescribing have been met with much pushback from the pharmaceutical industry they rationalized that the billions

of dollars they were making were helping more people than they were whoring they insisted and still insists today that only those who are diverting and misusing the drugs to get high are responsible for the epidemic and not those who are of course private the drug producer distributed a follow up video to i got my life back the double down on their claims that oxycontin was a safe non-addictive long term chronic pain relief returning to these patients off to 2 years shows that when pain treatment is successful it stays successful over the last 3 years i've gotten much much stronger is just absolutely a god thing it's just such a difference i've been away away. and able to it's wonderful however in time even produce own video poster children were succumbing to oxycontin lethal effect of the 6 featured patients spotlighted in the videos 3 maintain they were

still helped by the product 2 were deceased from causes thought to be related to their opioid addiction and non linesmen and other things said if i was to go to the mailbox once a month and i would find a bottle an oxy and constantly i had found the needed lauren is among the lucky survivors i would allow doctors to prescribe me x. right now it's a synthetic heroin. in 2010 for do introduce the new tamper resistant oxycontin with a spotlight focused on stopping pill mills in the new tamper. just medication easy sources for prescription pain killers began to dry up prescription opioids were expensive on the black market. heroin became a cheaper alternative i can remember this 15 years ago when my patients coming in here for buprenorphine treatment were saying you know heroin is a lot cheaper than most pills and it works better in 2016 the new england journal of medicine published

a study that found that 76 percent of those seeking help for her when addiction began by abusing pharmaceutical opioids primarily oxycontin this draws a direct line between produce marketing of oxycontin then the subsequent there were an epidemic currently in the united states policymakers were hearing that all of the problems related to opioids or from so-called drug abusers and that these were wonderful medicines for for pain patients and we recognize this wasn't true one of the 1st people to stand up to the drug companies and lobby for reform was dr andrew . he helped form prop physicians for responsible opioid prescribing their organization is one of the earliest advocates for opioid prescription reform the one federal agency that seemed to understand that overdose deaths in addiction had arisen as a consequence of the medical community overprescribing was the c.d.c. you know the f.d.a. gets criticized. the c.d.c. really doesn't i mean the c.d.c.

is like you know they care about public health in america at its best and brightest and today had kind of this blue ribbon committee that looked people that had no ties to the pharmaceutical industry no conflicts of interest declare and they spent a long time reviewing all of their research and what they came back and said is incredibly damning there's no evidence to support long term use of opioids for chronic pain. what can any drug company say beyond that chronic pain is 80 said. in percent of the market what separates the current opioid epidemic from the heroin and crystal meth epidemics of the past is that it affects white middle class and rural communities far more than urban minority poor click to the early eighty's late sixty's. puce and the negative consequences of the abuse of opiates was primarily limited primarily not exclusively limited to minority populations

poor individuals inner city populations. from ny perspective what ended up happening is this current circumstance going to jump start from. prescription opioids and as a result of that it impacted much employer socioeconomic strata in our community particularly individuals who have access to health care middle class for the most part white families in 2007 produce foreman 3 of its executives pled guilty in federal court to charges of misleading the public about oxycontin their risk of addiction and ease of abuse they were fined over $635000000.00 the biggest pharmaceutical settlement and us history now that may sound like a lot it is a lot but if you look at the damage that's been done particularly since then in terms of the number of people that are taking. not only oxy cotton but many types

of opioids for conditions that really had there's no value for these drugs. today the opioid epidemic commands national attention there are now dozens of court cases against purdue and other pharmaceutical companies for their collusion to promote drugs they knew were dangerous for turning a blind eye to the sale of opioids to doctors and clinics that we're told will and for the destruction of states and communities ravaged by the up at them. i'm not sure i'm enough of a medical expert to say what steps need to be taken at this point. but you know what what's very clear is that unless you have. public health experts regulators criminal investigators local officials and the medical community working together. in some kind of established program the problem

will never get solved the one thing that we have to do is slowly and surely. the. prescriptions we need to get the doctors are no strongly encouraged to cautiously prescribe for both chronic pain and acute pain this will lessen the chance of surplus pills being diverted in the buz surgeons or dartmouth hitchcock medical center in lebanon new hampshire recently published guidelines to reduce the number of excess opioid pills prescribed for acute pain what we found was that only about a quarter of the opioid pills that were being prescribed were taken by the patients so it was clear that we were over prescribing these opioids and so we came up with a guideline and said ok for a partial mastectomy 5 pills should be enough to satisfy 80 percent of the patients for lack of stopping gallbladder removal calls the stock to me 15 pills should be enough to worry and say well did a whole bunch of patients come back for refills what we're really taking care of

their pain ok and the answer that was we were taking care of the pain because less than one percent of the patients ended up needing an opioid we felt some doctors question the use of opioids at all and feel they were more effective non-addictive options even for acute pain when we think about treating patients in pain we should understand what the ability of the body is to respond to those things themselves. we hear and orphans and we stimulate those who. activity and exercise. oftentimes when somebody is in pain we tell them not to move that's the bad it that's bad it was. as we exercise use our systems normally we can create our own and orphans and pain control that's number one and. number 2 is to go to over the counter medications for example there are lots of good studies that show that the combination of taking acetaminophen which is tylenol. and

ibuprofen which comes in multiple forms like advil and motor and in aleve it's a combination of those medications together actually is much more effective than opioids for taking care of acute pain we can use. activity we can talk about comedy reading there's things to divert people from pain if we sit home all day in pain we will guarantee you you will have pain if you try to be active you won't necessary get rid of it but you'll learn to deal with it better on the other hand there are those patient there is no alternative but to use narcotics i can count those on one hand and any one of them on it's very rare.

is your media a reflection of reality. in a world transformed. what will make you feel safe. isolation or community. are you going the right way or are you being

led so. direct. what is true what is faith. in the world corrupted you need to descend. to join us in the depths. or a made in the shallowness. doctors are getting the message that certain uses of opioids are not appropriate for example long term chronic use there are lots of educational programs out there there are. d.n.a. enforcement activities out there. in fact some doctors are now complaining that it's so hard to write a narcotic prescription that they don't even bother to talk to people who are chronic pain patients and i get e-mails from these people who believe that their

opiate prescription isn't working for them. they are very scared of the discussions going on they're scared that their doctors not be able to prescribe it the federal government's going to take away their pellets and that are allowing them to have a quality of life that they don't believe is possible about the drugs there are a lot of patients that are. going to have pain acute pain and chronic pain that aren't attics that need to be treated properly with pain medication that does work for some people so i don't think we should throw the baby with the bathwater about 10 to 12000000 americans who have been put on long term opioids. many of whom may never be able to come on and who many of whom are convinced that the opioids are helping them they're desperate to maintain their supply and the idea of folks out there telling other doctors that these aren't safe and effective that they don't work well long term they rightly believe that it could make it harder for them to continue to access opioids and so. from some of these

pain patients who are opioids. perceived threats and it's it's often a threat. wanting to cause bodily harm so that. they're like maybe i have a different feeling about opioids and i was injured that type of threat i do worry in some ways that now perhaps the pendulum. swinging so far the other way that we're going to see a lot of people and so it's cut off from their long term supplies of opiates which are not appropriate for them to be on. but i imagine we'll be seeing those people coming to our addiction treatment programs as that begins to happen as states but more restrictions in place for physicians people want to blame big pharma and say they're greedy they're terrible now but the problem is that big pharma is the engine for medical innovation in this country they develop drugs they are willing

to invest millions and invested $40000000.00 before they made a dime from it. so if we if we say let's you know what's make all of our drug companies nonprofit it's like we're not going to have a lot of innovative drugs that are going to a cure cancer are things like that so it's a problem and the rest of the world is counting on american drug companies to come up with cures chronic pain is truly a life altering problem for millions of people 'd. search for serious non-addictive solutions for pain really we can probably produce better drugs in terms of alleviating pain without the addictive component and some of the faculty here at the similar institute are working very hard on the piping we need to treat pain is very important to treat i've been studying the. courage of studies in england we close up that we found a gene which we call coded. we can block the information in the brain and we don't

quite know what that will do i think what's needed is a drugs which don't. necessarily all 'd. drugs which work at this but don't reach the reward system there is some process in the playing field in developing new drugs the focus of our study is really to investigate the role that the immune system actually plays and so that's. a new line of. research. the. cells to actually valid. response is worth on the animals so we decided to shoot from animals as well as. an expression and then produce an expression and i think the really promising aspect of our study then is that these clues are a target for treating better so we could inhibit the activity. and actually improve the clinical efficacy of get rid of some of these problematic tolerance addiction exaggerated i came to stanford to understand how

proteins these very fascinating molecules work at the most basic level i'm an instructor in the department of molecular and cellular physiology where we study very basic aspects of biology and the work that we've been doing lately is to understand how. they bind to their receptors and function these models provide is really remarkable ways of developing new drugs and what i'll do next is put up a. drug like morphine here in orange and inside it's receptor you can see if it's really nicely and i was alluding to that i can i can kind of cut away and you can see how well those little balls are fitting inside that receptor because what we can do now is to say well this is the receptor binding poket what other drugs. and then can we use this kind of knowledge to develop better drugs that act these receptors are not addictive opioid would be a medication that targets them you. turns it on provides pain relief but doesn't

trigger the rewarding pathways in the brain that cause tolerance for cause addiction you know with these other drugs that target different systems. are coming down the pike actually see either a complete turn to drugs that are actually used to treat pain or we can actually apply these drugs to improve the clinical profile of our people it's. true it's could still be administered but if we shut down the signaling that occurs at the same. time and then we can eliminate these problems of tolerance addiction as i said earlier the system better because as well despite all the attention focused on the opioids to make the crisis continues to grow. according to the c.d.c. . 2016 there were over 62000 deaths due to overdue this is the worst manmade epidemic in modern medical history. we still haven't reversed it and we've known about it for more than 10 years so we're are where are these

teachers that taught us to do these things why aren't they all fair helping to reverse this during the making of this documentary resort to interview representatives from purdue in the form of suitable industry and those doctors who advocated for sure all your. own would appear on. this is a common problem experienced by most journalists covering all preorder. i would love to talk to anyone from the sackler family because they you know they're smart people and this is a complicated problem and i want to hear what they say about it it's a family company and there is a sense that i get from talking to people that are associated with it that they feel that they've been mistreated by the media by the government by politicians. and that they feel attacked but you know i was interviewing someone who has a very high opinion of the company and very high opinion of the family i mean he didn't want his name used because he's like if look i stand by the 100 percent but

if i give you my name then like i'll be just pillory you know people look askance at me all the internet people trolling me. and so i feel like they have this you know they would say it's a well grounded cynicism about the media and about just you know coverage of their drug i believe that. in terms of the blame opioid addiction epidemic produced. forum was a purse shoot financial profit and the fact that they didn't care about an epidemic of addiction and overdose deaths that they were fuelling. the fact that the food and drug administration failed to properly regulate the claims that produce was making the failure of the medical establishment. and the fact that it took money from purdue and other opioid makers and promoted aggressive use of state medical

boards that failed to regulate the way in which doctors prescribing and even encouraged aggressive prescribing there's a lot of blame to go around the question is is who is guilty or who should feel guilty i don't know that anybody feels too guilty i kind of wish a few more people did feel a little more guilty despite public outcry pharmaceutical companies find new and creative ways to market their heroin builds. what's in the parts lauren and we do have power and data we can employ from there and it looks to be very opioid centric including painkillers marketed to children the food and drug administration announced about a month ago that they were determining that oxycontin a safe and effective for children 11 and up which is very disturbing most of the companies that now operate in the space in this space have gone dark. it's not the

big names that you and i would recognize like pfizer or johnson and johnson pfizer does have a little bit but not a lot. is actually these small very focused companies the focus on pain and then not names in the household names they don't have to worry as much about the sort of reputational damage as forces in our nation strengthen against the over prescribing of opioids suitable companies see their us market eventual narrowing. as one door closes another opens produce private company owners international from monday for months has already begun the same kind of marketing campaign in latin american asia the middle east and africa. nations where chronic pain is high and people haven't the money or access to medical treatment communities ill equipped to handle an opioid epidemic los angeles times reporter harriet ryan was the 1st to break the story interviewed someone who is going around the world training physicians in

foreign countries for credit for teaching them how to use oxycontin he admitted he doesn't use it as a practice citizen think it's a. as big pharma broadens its horizons our nation continues to struggle in the aftermath of their deceit. and it wasn't until february of 2017 after much had been exposed about the overprescribing of opioids that a new doctor at the clinic noticed 70 year old linda g.n.r. he had a serious opioid addiction he discontinued her high dose prescriptions causing linda to experience a painful withdrawal process get nauseous you might throw up and get diarrhea there's a whole array of stuff you feel pretty miserable for people like myself need some relief from the chronic pain. and it doesn't take 150 milligrams of the whole to do that today life is better but that doesn't make up for the decades

of endangerment and loss of quality of life linda innocently experienced by trusting her doctors would do her no harm just quite a journey one i don't want to go through it again. happy with how things are now. i think it's fair to say that this epidemic of opioids addiction and overdose deaths was in many ways caused by. i buy green eat so i think inform public is critical to resolving this problem. people need to understand that these drugs are very potent very dangerous. very addictive the opioid epidemic can only be contained if it is attacked from multiple fronts start with an information regulatory agencies that placed public welfare above special interests health care and pharmaceutical industries government by providing each an

oath to help the sick and to do no harm. the battle continues. pleasure to have this opportunity to speak with you all about the opioid addiction epidemic i'm going to just jump right in i'll start off by saying i have no financial relationship with pharmaceutical companies and i think you'll understand if you hear my talk why no pharmaceutical companies that want to relationship with me. i'm going to start off by saying something very obvious or something that should be obvious but unfortunately is not obvious when we talk about drugs like oxy co don't which isn't oxycontin or hydrocodone which is invited and we're talking about drugs that come from opium to to make oxycodone and hydrocodone you start with opium and the effects that hydrocodone and oxy co don't produce in the brain are indistinguishable from the effects produced by heroin if you give an

experienced heroin user oxy called onan heroin to administer. like a blind taste test in fact they did a study like this at columbia. the heroin user can't tell which is which and if you ask them which they like a little bit better they actually rate the oxycodone higher than the heroin so when we talk about opioid painkillers we are essentially talking about heroin. so what we've got to do is identify the threats that we have it's crazy confrontation let it be an arms race is on often very dramatic developments only personally i'm going to resist i don't see how that strategy will be successful

very critical of time time to sit down and talk. in the troubled 19 seventies a group of killers rampage through parts of northern ireland that was coordinated loyalist attacks particular population of tens of thousands were forced to flee their homes and what 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 take more than a 100 innocent civilians were murdered as the live you can see in yours and we found out more i was surprised about the extent. to 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 the phone in.

the water where politicians you know on the go ahead. in the headlines this choose the 25 august for moscow and germany clinic treating the gravely ill russian opposition activist election of me says it's found traces of a substance that affects the nervous system that's despite russian talk to saying they could find no toxins in his blood. but we can do a huge rallies peacefully in 2 weeks after the disputed election there faced with tens of thousands calling for to quit present location. thank to riot police for their support. the back of the super bowl. up. to the russians.