do no harm and shatter charges will be shored up. in this episode we explore the ignorance and greed that led to our current crisis one of the 1st. medicine is do no harm. said that hypocrisy is was the 1st to say this and what that means is that the cure for any medical problem shouldn't be worse than the disease that you're trying to treat big chunk of america is in chronic pain and pain meds back pain pain arthritis events real and it affects people's lives and they would like a way to live their lives to take care of their families without being a misnamed what the brain is trained as

a different brain than their brain that's not in pain people have it in their hear there's a feel for something regardless of whatever amount of iranians there's something out there is going to you know there was this new growth it's going to eliminate all your brain inside the company and the drug came out they received so many letters from people who had been suffering for years with no relief or finally felt like through oxycontin they were getting to be alive again in a way they hadn't for years and that they considered a miracle drug is the best thing that happened to me if i wasn't on this medication 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 sort of patients are just a.t.m. machines some more you go back to the patient the more you push buttons the more profit you can do the pharmaceutical companies all so we're not entirely transparent about the addictive the effect would be like and that peers were told

they were non-addictive when in fact they were and we don't get taught in medical schools. about the misses that we and use we only get told about illnesses that we're supposed to cure we also grew up thinking that doctors are always right so if you have a prescription it's actually we talk about opioid painkillers we are centrally talking about heroin tells the drug companies that it's right tell. doctors are the pushers and the pharmacists are the suppliers that's how it is seen there's not a city in the united states right now that doesn't have a 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 that means on average every adult is on one opiate you

know once or twice a year if not more scares the living crap 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 oxycontin $8010.00 pack a day that's a $1000.00 worth of medication to kids who are spending hundreds of dollars a day if not thousands. don't walk in. 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 than car accidents from 1999 to 2070

over 500000 americans have died from an opioid overdose. more than all the americans killed on the battlefield since world war 2. only to have iraq getting raped and then 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 talents destroyed think that it started off with a company in stanford connecticut that had some marketing 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 it can bind to the 'd 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 are on brain makes an $874.00 an english chemist by mixing morphine and other assets created a powerful opioid that was eventually called di a seattle 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 are in humans no 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 acute 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 they play an important role when used on a short term basis for severe acute pain for example after major surgery then chalets sciences started creating new semi synthetic opioids similar to aero in $1017.00 oxy kodo was one of several semi synthetic opioids developed in germany you literally start with opium to make hydrocodone and oxy caught on and 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 called tone and heroin it's hard for that heroin user to tell which is which in

fact if you ask them which they like a little bit better and i'm like a blind taste test. it was a study that is columbia university the oxy codell is preferred to the heroin so what i'm saying is that when we talk about opioid pain medicine worse since they talking about heroin pelz in 1902 doctors joan perdue gray and george frederick bingham started the per do frederick company on manhattan's lower east side and 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 4 produced by a private family many of them are doctors many that are philanthropists. a lot of money billions but they are now i hear typical rich people yachts dating models things like that they're intellectual people they care about science cancer

research on arts a 3rd brother dr arthur sackler revolutionized pharmaceutical advertising are there originated a blitz style marketing of drugs aimed at general practitioners through medical conventions as with well known doctor endorsements direct mailing and a sales force giving out free samples and perks. for the response you know wand and trust his 963 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 $1000000000.00 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 continue to live on the per do farm. to do began focusing on pain management

1972 they patented content. controlled drug release system produced form of believe that if they could link their 12 hour time release system content to an opioid pain reliever it could be marketed for chronic pain without the sudden rush or heroin high to the brain there is an inherent logic to making war knocking opioids because obviously convenience you don't hear a doses in a day but you'd also have your picks and troughs right so you wouldn't have the 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 of 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 their new revolutionary drug oxycontin. the next step was to convince the skeptical medical profession of the safety and effectiveness of their powerful pain relief her due 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 cotton 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 an hour. originated the playbook inspired by the arthur sackler playbook producer launched a marketing campaign to sell oxycontin through multiple levels of attack. it's number one educate the medical community from 1906 to 2001 produced conducted national pain management and speaker training conferences and resource in florida arizona and california there in appropriately influencing maybe even corrupting 5000 doctors nurse practitioners and nurses to to 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 i'm back now not to enjoy every day. since i've been on this new pain medication and i have not missed one day of work these videos were seen by about 15000 doctors through direct marketing seminars and medical school. is you'll be dia 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 faith.

in a world corrupted you need to descend. join us in the depths. of the shallows. so what we've got to do is identify the threats that we have it's crazy confrontation let it be an arms race off and spearing 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. 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 a generation of physicians were trained that opioids were effective for chronic

pain and unsafe blitz number 2 promote the drug they increase their sales force and their position called list these sales reps were offered lucrative bonuses their average compensation a pretty 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 a 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 bugs than. 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 they 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 i'm not lunch i'm not saying in 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 ing aggressively people always say follow the money there's considerable amount of money involved in the in the prescribing of opiates purdue paid honoraria speaking and teaching fees to doctors boarding the oxycontin bandwagon he was taking about $100000.00 a year. and then we looked 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 pharma 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 buffo 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 have run 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 health care 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 surprised to hear when you go to a doctor's office how they ask you or are you having pain. though you may go for a raise that has nothing to do with pain which just added lighter 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 2 plus 1000000. you know him and probably not for making too close 1000000 on 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. 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 r.c.

con and that was clearly just false when you go back and look at the original data on which the just which their claim that that opioid use or pain medicine used for for treating pain doesn't cause addiction is scary and 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 a 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 opioids grad student jane porter helped compile the statistics dr jack broke our friend the secretary type 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 one paragraph a letter to the editor 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 obviously and in the early derivatives of opium for. his patients began to exhibit symptoms of tolerance and addiction 'd to do former was quick to pacify fears we were often taught that tolerance imply the diction but it wasn'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 pseudo addiction pseudo addiction is a fairly new term i came in about 990 but it's crucial pseudo addiction is. when a patient is looking the life of a drug addict because pursuing high in 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 are really there they spend the day and narcotic stupor on the so the average daily dose went from about 80 milligrams a day to over 140 milligrams of just within a couple of years and it's shifted tremendously from the slightly weaker schedule 3 opioids to the stronger longer acting schedule. 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 and i'll study actually suggested 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 illegal heroin. young people began diverting the drugs described or stolen from medicine cabinets to get high this 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 but 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. $115.00 milligrams however they do 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 why and you never did anything other than what you. write another practice 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. throughput oh yeah they use opinion. yeah. it just you know pretty good. it's. so. good. but. these are the stories of men who can't imagine 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. the poem to look to for granted you doesn't just get. points for. the world is driven by a dream shaped by phone person. the day or thinks. we dare to ask. join me every thursday on the alex salmond show and i'll be speaking to guest of

the world the politics sports business i'm show business i'll see you then. jimmy medics do additional tests and then the exact substance found in alexina in the system however the active component which put the russian politician in the opposition politician in a coma is used in a whole range of common medications. these agents are used all the time in an operating room you know 1st normal fishing pier aware of everything in balance in life it can cause death trip efficiency. is fresh and the government rallies and arrests marbella independence day talks to the country's security forces for their take on the tension. and the children come home and ask their mother a question is it true that our father is a murderer how can you.