AP. NOV. 9, 2021. – A New Jersey law requiring conversations between prescribers and patients to discuss risks of addiction before an opioid-based pain reliever is prescribed, resulted in a more than fourfold increase in the percentage of doctors warning patients about the risks of addiction and a significant drop in patients started on opioids. The study was conducted by Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University’s Heller School for Social Policy and Management. The Patient Opioid Notification Act requires that medical practitioners discuss the addictive potential of opioid-based painkillers with their patients – and parents of minor patients – as well as discuss, when appropriate, safer non-opioid pain relief alternatives. Prior to enactment, only 18% of the participants warned patients about the risk of opioid addiction when prescribing opioids. After enactment, 95% routinely warned patients about the risk of addiction.
The “opioid crisis” has become a major health topic. Prescription opioid drugs are strong painkillers that are known to be highly addictive. Doctors began using morphine on a wide scale during the 1800s, and its use spiked during and after the Civil War. Medical providers were initially assured that opioid pain relievers wouldn’t pose a threat of addiction, which prompted a substantial increase in the prescriptions being dispensed for these medications. This has led to widespread use and misuse of opioids, which has had drastic consequences for countless Americans. Around that time morphine addiction became a recognized health problem. Since then, medical professionals have sparingly used opium-based painkillers. Rates of drug overdose deaths involving heroin, natural and semisynthetic opioids (morphine, codeine, hydrocodone, and oxycodone), and methadone decreased between 2018 and 2019, while the rate of overdose deaths involving synthetic opioids (fentanyl, fentanyl analogs, and tramadol) other than methadone continued to increase.
Consent without being fully informed of real risks of a medical intervention – including risk of illness and death – is not consent, it’s reckless neglect, or deception. The Oklahoma Supreme Court on Tuesday overturned a $465 million judgment against Johnson & Johnson in a lawsuit by the state alleging the drug-maker fueled the opioid epidemic through the deceptive marketing of painkillers. However, opioid drug prescriptions in some Oklahoma counties have recently spiked. While the overall opioid dispensing rate in 2019 was 46.7 prescriptions per 100 people, some counties. Before the 1990s, painkillers were mostly used for treating patients with severe health problems. Since these patients were often diagnosed with cancer or end-of-life conditions, there was a low risk of addiction and abuse. However, prescribing practices changed. It should be noted that regulating the practice of medicine in general and of opioid prescribing practices in particular, is strongly at odds with the overall CDC mission and might reasonably be considered to represent substantial overreach. This being the case, some might argue that the only CDC action consistent with its mission would be to withdraw entirely from any and all attempts to regulate pain management by clinicians and to withdraw and repudiate the 2016 CDC guidelines. On the other hand, the illicit opioid crisis, which now accounts for more than three-fourths of opioid-associated deaths, arguably does fall within the CDC mission.
Drug companies began aggressive marketing campaigns designed to promote opioid drugs among doctors and patients. These campaigns succeeded. Since 1990, prescriptions for opioid painkillers have increased ten times over. Before physicians and other medical professionals realized the dangers associated with these drugs, the nation had found itself in the center of a public health emergency. According to the U.S. Centers for Disease Control and Prevention, approximately 68% of the 70,000+ drug overdose deaths that occurred in 2017 were attributed to opioids. What’s more, the number of opioid-related overdose fatalities that occurred that year was six times higher than the same types of deaths that occurred in 1999. In less than a decade, opioid addiction has spiraled out of control.
Disadvantaged groups often face issues of safety and violence at higher rates than others in the community. Children in Tulsa County experience abuse and neglect at higher rates than the national average. Additionally, there are racial disparities in homicide victimization and large disparities by region of the City in DVIS calls.
McGreal in his book “American Overdose: The Opioid Tragedy” talked to Dr. Charles Lucas, a surgeon in Detroit who resisted growing pressure to overprescribe opioids, ended up being subject to a complaint and summoned before a hospital ethics committee for failure to provide adequate pain treatment. Opioid tapering is associated with increased incidence of mental health crises and mortality among patients prescribed opioids long-term for chronic conditions.
The death toll has risen as well. The Centers for Disease Control and Prevention (CDC) estimated that opioid drug abuse contributed to 16,651 deaths in 2010 alone. More people die of opioid drug overdoses than die of heroin and cocaine overdoses each year. But the forces driving runaway, medically inappropriate dispensing of opioids were not knowledge, competence, integrity or professional courage. There were other forces at play.
It is much less discomforting – especially for America’s journalism institutions instrumental in helping to fabricate out of nothing a bogus scientific rationale for runaway use of opioids against all evidence – to focus on Big Pharma (another example of the unfortunate excesses of corporate greed) as the reason for the lethal crisis, than to accurately indict America’s most trusted institutions including the impotent and enabling watchdog press that helped to create the needed fabrications. The more attention diverted to Big Pharma, the less on the necessary roles of media, the medical profession, research and oversight institutions. Corporate greed is a given; incompetence and betrayal by the core democratic and public health institutions trusted to protect American well-being and lives must be disguised.
And just as blanket Medical-Media messaging has constructed pill manufacturers, somehow, as responsible for the runaway dispensing – against all longstanding lines of evidence – of addictive opioids for the non-medical condition of chronic pain, generating the increasingly lethal opioid crisis – the same collaborating forces successfully fabricate a STORY of street fentanyl as explaining continuously mounting opioid-related deaths, those deaths correlated with increasing provision of the Medical-Media “treatment”(s) had rates that were six times higher.
The Oklahoma Supreme Court ruled in a 5-1 decision that District Judge Thad Balkman in 2019 was wrong to find that New Jersey-based J & J and its Belgium-based subsidiary Janssen Pharmaceuticals violated the state’s public nuisance statute.
The rise in opioid prescriptions has had public health consequences. The misuse and abuse of opioid drugs contributes to a rising number of emergency room visits. Many patients have become addicted and require substance abuse treatment. “The court has allowed public nuisance claims to address discrete, localized problems, not policy problems,” according to the opinion written by Justice James R. Winchester.
What is the Policy Problem?
Methodological Challenges in Policy Evaluation by ANDERS HANBERGER, A Umeå University, Sweden scholar suggests that “When a policy process starts, nobody knows what line of action will
eventually be implemented, policy evaluation has to continuously examine the content of different policy components. In order to understand and explain public policy, different stakeholders’ perceptions of the policy problem need to be scrutinized. A policy evaluation should also facilitate the interpretation of policy in a broader context. What values and order does the policy or program promote? Using an open evaluation framework and a mix of criteria can facilitate a broader interpretation of the policy process.”
State and local governments have borne much of the burden during this crisis. Government agencies pay for emergency room visits and administer substance abuse programs. Government health care also covers millions of people who take prescription drugs. The rise in opioid use impacts these agencies and costs taxpayers millions of dollars each year.
The high court said the question is whether the company’s marketing and sale of opioids created a public nuisance, but that it was not minimizing the suffering of thousands of Oklahomans because of opioids. “J&J no longer promotes any prescription opioids and has not done so for several years,” since 2015, Winchester wrote. “Even with J&J’s marketing practices these … medications amounted to less than 1% of all Oklahoma opioid prescriptions.”
The misuse of and abuse of opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health, as well as, social and economic welfare. Nearly 841,000 people have died since 1999 from a drug overdose.
The U.S. Department of Health and Human Services has provided substantial grants to support prevention, treatment, and recovery, as well as allocating funds to overdose reversing medications to save lives and to prioritize consistent research in order to beget updated data. Drug overdose deaths involving psychostimulants (methamphetamine, amphetamine, and methylphenidate) are increasing with and without synthetic opioid involvement.
The court also rejected the state’s appeal to increase the damage award. In dissent, Justice James E. Edmondson said he would uphold the verdict but send the case back to district court to recalculate the damages award. The state had asked that the award be increased to $9.3 billion.
In 2019, the rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone were lower than in 2018.
• From 2007 to 2017, more than 4,600 people in Oklahoma died from opioid overdoses, state statistics show.
• In 2019, 70,630 drug overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths increased by over 4% from 2018 (20.7 per 100,000) to 2019 (21.6 per 100,000).
• Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths. 72.9% of opioid-involved overdose deaths involve synthetic opioids.
• Opioids were involved in 49,860 overdose deaths in 2019 (70.6% of all drug overdose deaths).
While these initiatives are essential, they aren’t the only important steps that must be taken to fight this threat to public health and safety. Local agencies, businesses, charitable organizations, activists, and others are taking matters into their own hands to combat addiction.
Drug Take-Back Programs and Disposal Education
Every April and October, National Prescription Take Back Day takes place to encourage Americans to remove opioids from their homes. This initiative can reduce the risk that these highly addictive medications might be stolen and/or misused by friends, relatives, and visitors. The U.S. Department of Justice’s Drug Enforcement Administration has collected nearly 11 million pounds of unused, unwanted, and expired prescription medications through its free and anonymous events that occur nationwide.
*This article was written after significant research on Opioid Drug Abuse and Addiction.