Doctors at heart of US opioid crisis

Painkillers representational image. (Reuters)
Updated 10 August 2017

Doctors at heart of US opioid crisis

CHICAGO: When 55-year-old Sheila Bartels left her doctor’s office in Oklahoma, she had a prescription for 510 painkillers.
She died the same day of an overdose.
Her doctor, Regan Nichols, is now facing five second-degree murder charges — one for each patient who overdosed after she prescribed them opioid drugs, such as Oxycontin — prescriptions that can lead to addiction.
“Doctors bear enormous responsibility for the opioid crisis,” said David Clark, a professor of anesthesiology at Stanford University who worked on a government-sponsored panel that studied the crisis, and recommended new training and guidelines for health care providers and regulators.
“We didn’t have (a crisis) until doctors became enamored with what they imagined to be the potential for opioids in controlling chronic pain,” Clark told AFP.
An estimated two million Americans are addicted to opioid drugs — many forced to buy pills illegally when prescriptions run out. Some, in desperation, resort to heroin and synthetic opioids smuggled into the US by Mexican drug cartels.
Ninety people die every day in the United States from opioid overdoses.
More than 180,000 have died since 1999, including pop icon Prince, who passed away in April 2016 at age 57 after an accidental overdose of fentanyl, a powerful opioid painkiller.
Doctors in the United States prescribe more opioids than in any other country — enough to medicate every American adult.
While those physicians who are prosecuted for overprescribing make headlines, experts say they are not solely to blame, and that the US health care system as a whole must be held accountable for the country’s spiralling opioid epidemic.
“Pharmaceutical companies targeted general practitioner doctors, the ones who see most of the people who have pain,” Ohio attorney general Mike DeWine, whose state has been hard hit by the crisis, told AFP.
“I think they certainly were misled, and they were told things that were not true.”
The problem is not a new one — it began two decades ago, as doctors were being taught to better manage their patients’ pain and drug companies were touting the efficacy of opioid painkillers.
The painkillers — meant only for patients in the most dire need — started getting into the hands of those with chronic conditions that had been treated with simple over-the-counter drugs like aspirin.
And they didn’t know they were addictive.
“You had people with a simple toothache, or knee surgery, or back surgery, that were on these opioids for too long a period of time or prescribed a higher dosage than they needed,” said Robert Ware, chief of police in the town of Portsmouth, Ohio, which became a sort of ground zero for the crisis.
As more and more people were getting addicted, “pill mills” began to pop up in Portsmouth and across the nation to meet demand. These clinics were run by doctors who would prescribe opioid drugs to anyone who could pay.
In Portsmouth, a struggling Ohio town bordering two other states where the steel industry was once king, Ware was seeing pill mills become part of the economy, as addicts from nearby states traveled there to get their fix.
Eventually, state regulators and local law enforcement shut down the pill mills by arresting doctors and requiring that clinics be associated with established, reputable medical programs.
The Justice Department has promised a further crackdown on unscrupulous doctors and pharmacists.
On Tuesday, President Donald Trump — hosting a meeting on the crisis during his summer vacation — suggested more prosecutions as a whole may be necessary.
But in Portsmouth, Ware said the community has learned a tough lesson.
“You cannot arrest your way out of this problem,” the chief said.
The town’s opioid addicts came from a cross-section of society, because most got hooked through legitimate prescriptions.
And addicts needed help to recover over the long run.
So Portsmouth beefed up its health care offerings and addiction treatment — and went from being a haven for pill mills to a refuge for recovery.
Overdoses there are now trending downward, in contrast to the rest of the country, Ware said.
“We are kind of ahead of the curve in getting out of the problem,” he said.
Across the country, overall drug overdose deaths are rising to new highs — 60,000 estimated fatalities in 2016. Certain states, like Ohio and West Virginia, have been harder hit than others.
DeWine is fighting the epidemic from another front — suing the drug companies. According to The Washington Post, at least 25 states, cities and countries are doing the same.
“These drug companies are primarily responsible for this drug opiate epidemic. They created the problem. It’s about time that they did something to help clean the problem up,” DeWine said.
The federal government has proposed a 20 percent reduction next year in the amount of opioids drug companies are allowed to produce.
But physicians still appear to be writing prescriptions with gusto.
While the numbers have declined, doctors still handed out nearly 250 million prescriptions for opioids in 2013 alone, according to the Centers for Disease Control.
“Physicians have not fully accepted their roles as individual prescribers in feeding this particular epidemic,” said Clark.
“There was never good evidence that these drugs could reduce pain well,” he added, “especially for prolonged periods of time.”


Hong Kong leader: National security law has been ‘effective’

Updated 7 min 2 sec ago

Hong Kong leader: National security law has been ‘effective’

  • Beijing imposed the national security law on Hong Kong in June
  • ‘One of our urgent priorities is to restore Hong Kong’s constitutional order and political system from chaos’
HONG KONG: Hong Kong leader Carrie Lam said Wednesday that the city’s new national security law has been “remarkably effective in restoring stability” after months of political unrest, and that bringing normalcy back to the political system is an urgent priority.
Lam made the comments in her annual policy address, more than a month after it was postponed so that she could seek Beijing’s support for various economic measures aimed at reviving the semi-autonomous Chinese territory’s economy.
Beijing imposed the national security law on Hong Kong in June, aiming to crack down on dissent following months of anti-government protests in the city that at times descended into violence. Last year’s protests were triggered by a proposed extradition law that would have allowed suspects in Hong Kong to be sent to the mainland. The proposal was eventually scrapped.
“Advocacies of Hong Kong independence and collusions with external forces have progressively subsided, some of the prominent figures have kept a low profile, radical organizations have ceased operations or dissolved,” Lam said in her address.
“After a year of social unrest with fear for personal safety, Hong Kong people can once again enjoy their basic rights and freedoms, according to the law,” she said.
Lam also criticized foreign governments for interfering in Hong Kong’s affairs, saying it had jeopardized national security.
Beijing has in recent months taken a tougher stance on dissent in Hong Kong, sparking concerns over the possible end of the “one country, two systems” framework under which Hong Kong has been operating since it was handed over to China by Britain in 1997.
Earlier this month, China passed a resolution disqualifying four pro-democracy Hong Kong lawmakers after they were accused of violating their oaths of office. The move prompted all of Hong Kong’s pro-democracy legislators to resign en masse as a show of solidarity.
Lam said that Hong Kong has experienced one of its most severe political challenges over the past year.
“One of our urgent priorities is to restore Hong Kong’s constitutional order and political system from chaos,” she said.
She said the government would introduce a bill by the end of this year to amend local laws related to oath-taking, to “deal with those who have engaged in conduct that breaches the oath of the swearing-in.”