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Opioids Trump Commission 3/30/17
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Trump, Christie pledge to combat nation's opioid addiction
Mar 29, 2017 | Associated Press
By Jill Colvin
President Donald Trump is vowing to step up efforts to combat the nation's opioid addiction crisis, and he's tapped New Jersey Gov. Chris Christie to lead the fight. -
With Christie at his side, Trump makes push to combat opioid addiction
Mar 29, 2017 | CBSNews
By Jacqueline Alemany
President Trump hosted a personal and emotional meeting with victims of substance abuse disorder to initiate his new commission to combat opioid abuse, addiction and overdose — the cause of over 50,000 U.S. deaths in 2015. The White House has tapped New Jersey Governor Chris Christie to chair the federal commission. -
Trump holds emotional roundtable discussion on opioid abuse
Mar 29, 2017 | Newsday
By Emily Ngo
President Donald Trump on Wednesday hosted an emotional roundtable discussion with survivors of opioid abuse, an epidemic he said is “crippling” the country. -
Here’s what Trump’s new executive order means for opioid addiction
Mar 29, 2017 | PBS
By Laura Santhanam
New Jersey Gov. Chris Christie will lead a new national opioid commission created Wednesday by an executive order from President Donald Trump that also maps out his administration’s latest strategy to combat the public health crisis. -
Trump is launching a commission to deal with the deadliest drug crisis in US history
Mar 29, 2017 | Vox
By German Lopez
President Donald Trump wants to do something about the opioid epidemic. It’s just not clear what, exactly, he’ll do. Trump on Wednesday signed an executive order to deal with the opioid epidemic. It doesn’t take any specific actions against the epidemic. But it creates a commission, to be headed by New Jersey Gov. Chris Christie, that will decide what can be done. -
After pledging to solve opioid crisis, Trump's strategy underwhelms
Mar 29, 2017 | Politico
By Dan Diamond and Sarah Karlin-Smith
As a candidate, Donald Trump promised rural towns and states hit hard by opioid addiction that he'd solve the epidemic ravaging their communities. "We will give people struggling with addiction access to the help they need," Trump vowed in October. -
How Much Pain Will Congress Inflict on These Opioid Drugmakers' Stocks?
Mar 30, 2017 | Fox Business
By Keith Speights
A congressional committee once again has drugmakers in its crosshairs. This time, it's the U.S.Senate's Homeland Security and Governmental Affairs Committee investigating five opioid drugmakers to determine if the companies' practices have contributed to widespread painkiller overdoses in the U.S. -
Lawsuits, Congressional Inquiry Plague Opioid Manufacturers
Mar 30, 2017 | Medscape
By Alicia Ault
At least one city and several counties are suing the manufacturers of prescription opioids in a flurry of filings over the past few months, and more are likely to follow. -
Editorial: Time for opioid makers to come clean and help addicts go clean
Mar 29, 2017 | St. Louis Post-Dispatch
Every state in the nation, with the possible exception of Missouri, is now focused like a laser beam on the growing dangers posed by opioid abuse and overprescription. Sen.Claire McCaskill, D-Mo., wants to determine whether the national abuse epidemic resulted from deliberate attempts by big pharmaceutical companies to make opioids cheaper and more widely available while underplaying the addiction risks. Did they effectively encourage doctors to overprescribe?
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Trump, Christie pledge to combat nation's opioid addiction
Mar 29, 2017 | Associated Press
By Jill Colvin
President Donald Trump is vowing to step up efforts to combat the nation's opioid addiction crisis, and he's tapped New Jersey Gov. Chris Christie to lead the fight.
Trump convened an emotional roundtable Wednesday with Christie, members of his Cabinet, law enforcement chiefs, recovering addicts and advocates. It was the first public event tied to the launch of a new addiction commission that Christie, a longtime Trump friend and formal rival, will chair.
Trump listened intently as Vanessa Vitolo and AJ Solomon, two recovering addicts from New Jersey, described their harrowing battles with substance abuse. Both became hooked on prescription pain killers, and quickly transitioned to heroin.
Trump also heard from a mother whose son died from an overdose after a long battle with addition. Her son, Trump told the mother, hadn't died in vain.
"We want to help those who have become so badly addicted. Drug abuse has become a crippling problem throughout the United States," said Trump, citing statistics that show drug overdose is now the leading cause of accidental death in the country. "This is a total epidemic and I think it's probably, almost un-talked about compared to the severity that we're witnessing."
Christie, a longtime friend of the president, headed Trump's presidential transition before he was unceremoniously replaced by incoming Vice President Mike Pence in the days after the election due to disagreements over its direction.
While the governor has long maintained that he plans to complete his last year in office before moving to the private sector, speculation remains that he is eyeing a top job in the administration, and people close to him have said he is open to potentially joining it one day.
Christie told The Associated Press earlier Wednesday that while he has "no interest in having a permanent role" in the Trump administration at this time, he was happy to spearhead the anti-drug effort at Trump's request.
"He asked me to help with this and I'm going to," Christie said. "It's an issue that I care about a lot in New Jersey and for the country and so the president asked me to do this and I was happy to."
Christie has made the issue of addiction a centerpiece of his administration and spoke extensively about it during his own presidential bid. He has dedicated his final year in office to addressing the drug crisis. Last month, he signed legislation that limits first-time opioid prescriptions to five days' worth of drugs and requires state-regulated health insurers to cover at least six months of substance abuse treatment.
"This issue causes enormous pain and destruction to everyday families in every state in this country," said Christie, who has been working behind the scenes with White House officials since shortly after Trump's inauguration.
Trump promised during his campaign to stop drugs from "pouring" into the country, and said the new group would work with local officials, law enforcement, medical professionals and addicts to improve treatment options, prevent people from getting hooked in the first place and stop the flow of drugs across the border. He signed an executive order formally establishing the commission later Thursday.
"Drug cartels have spread their deadly industry across our nation, and the availability of cheap narcotics — some of it comes in cheaper than candy — has devastated our communities," he said.
But critics say that Trump's actions as president so far undermine his rhetoric. The failed GOP "Obamacare" replacement bill that Trump pushed to pass sought to end the Medicaid expansion, which provides substance abuse and mental health treatment. It also would have stripped requirements that insurance plans provide the services as "essential" benefits.
"There is a massive gulf between President Trump's promises to tackle this crisis and the policies this administration has proposed during his first two months in office," said New Hampshire Sen. Jeanne Shaheen, a Democrat, who also called on the commission to reevaluate other budget cuts the administration has proposed.
The commission was rolled out as part of a new office led by Trump's son-in-law and top adviser Jared Kushner, whose father Christie prosecuted in his former role as U.S. attorney.
Christie, who had lunch with Kushner Tuesday, downplayed reports of tensions between the two, calling it "ancient history."
Christie's history with drug policy dates to his first elected position in county government more than 20 years ago. The issue became personal more than a decade later, when one of Christie's best friends from law school developed an addiction to prescription drugs and died of an overdose in a New Jersey motel.
The focus also gives Christie a chance to try to move past negative headlines that have helped fuel his unpopularity in New Jersey.
As Christie was appearing at the White House, two former aides were sentenced for their roles in the 2013 George Washington Bridge lane-closing scandal. Bill Baroni was sentenced to two years in prison, while co-defendant Bridget Kelly was sentenced to 18 months after they were convicted last November on counts including wire fraud, conspiracy and misusing the bridge for improper purposes.
The scandal derailed Christie's presidential aspirations and may have cost him a chance to be then-GOP nominee Trump's running mate — a role Christie openly courted.
Several of Christie's former aides now work in the Trump administration.
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With Christie at his side, Trump makes push to combat opioid addiction
Mar 29, 2017 | CBSNews
By Jacqueline Alemany
President Trump hosted a personal and emotional meeting with victims of substance abuse disorder to initiate his new commission to combat opioid abuse, addiction and overdose — the cause of over 50,000 U.S. deaths in 2015. The White House has tapped New Jersey Governor Chris Christie to chair the federal commission.
The President, who promised to prioritize fighting the opioid epidemic during his campaign, convened a roundtable discussion at the White House on Wednesday that featured powerful testimonies from those who have suffered from the drug crisis.
“Opioid abuse has become a crippling problem throughout the United States,” Mr. Trump said during his introductory remarks. “This is a total epidemic. And I think its almost untalked about compared to the severity that we’re witnessing.”
Trump, Christie, Attorney General Jeff Sessions, Senior Advisor Jared Kushner, and other participants watched Pam Garozzo, who lost her 23-year-old son Carlos to addiction, as she described his painful downward spiral. Carlos overdosed on a drug that was laced with fentanyl two days after Garozzo celebrated ten months of her son’s sobriety at a candlelight vigil hosted by Christie in December.
“I’m here because no parents should have to bury their child,” Garozzo said to the group. “That there will be empty seats at the Thanksgiving table, that there will be Christmas presents you won’t be able to give. I’ll miss his laughter. I’ll miss his smile. I’ll miss his hug.”
“Everybody should feel loved, as Governor Christie said. Every life is a precious life. Every life is worthy of being reclaimed and unfortunately Carlos couldn’t reclaim his life,” she added.
“He will not have died in vain,” Mr. Trump told her at the start at the meeting.
Vanessa Vitolo spoke of her conventional life that quickly disintegrated after college when she became addicted to Percocet she was prescribed for an injury. Soon enough, she was homeless and using heroin. She described her mother scouring the streets of Atlantic City looking for her “lost in every sense of the word” daughter.
“And what did your parents say during this whole process?” Mr. Trump asked, seemingly staggered by Vitolo’s account. “Because I’m looking at you, you’re like All-American, perfect — you’re a perfect person and so it’s hard to believe you’re living on the streets.”
Vitolo credits her second chance at life to the drug court system, a measure Christie signed in 2012 that gives non-violent drug offenders a chance at rehabilitation rather than prison. She will be graduating from drug court this year.
“It’s amazing the opportunities that have been given to me — it’s amazing I’m sitting across from you right now,” Vitolo said. “Today I’m here to represent the light that can be born out of darkness. There is hope, there is a tomorrow, you just have to fight for it.”
STATNews, a news service focusing on healthcare, reported on Tuesday that Mr. Trump is set to sign an executive order that sets an “ambitious timelines for new recommendations” to address the opioid epidemic.
Christie said on the Today show on Wednesday morning, “If people fall victim to this disease, what can we do to give them appropriate treatment to help them to reclaim their lives.”
During the listening session, Mr. Trump commended Christie for his work on battling the opioid crisis – a centerpiece of his 2016 presidential campaign and his time as New Jersey Governor.
“A great moment actually, if people remember, is you talking about your friend,” Mr. Trump said, referring to a Huffington Post video of Christie speaking about addiction that went viral. “That was probably your greatest moment during your campaign for President and it showed how much you know about this issue.”
Chuck Rosenberg, the acting Administrator of the Drug Enforcement Agency (DEA), delivered an assuring message to critics who worry that the administration plans on arresting their way out of the country’s drug problem. “Enforcement is crucial but education, prevention, and treatment is equally crucial,” he said.
Mr. Trump, who peppered participants with questions, asked Rosenberg how much of the epidemic is related to the “weakening” of the Southern border over the last ten years.
Rosenberg responded that most heroin comes through and is produced in Mexico, but he attributed the rise in synthetics and fentanyl to Asia, specifically China. According to a DEA report conducted in 2016, heroin seizures at the U.S. - Mexico border more than doubled between 2010 and 2015 due to an increase in smuggling and enhanced law enforcement on the border.
New Hampshire Senator Maggie Hassan, a Democrat, released a statement after the meeting that she was encouraged by the White House’s initiative and ready to work with the administration on their efforts but needed to see more than “just window dressing.” New Hampshire has been hit especially hard by the opioid epidemic.
“Trumpcare would have repealed Medicaid expansion, and the President’s budget proposal would undermine efforts to strengthen our health care workforce and invest in biomedical research into how we address addiction,” Hassan wrote.
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Trump holds emotional roundtable discussion on opioid abuse
Mar 29, 2017 | Newsday
By Emily Ngo
President Donald Trump on Wednesday hosted an emotional roundtable discussion with survivors of opioid abuse, an epidemic he said is “crippling” the country.
Trump named New Jersey Gov. Chris Christie, seated to the president’s right at the White House meeting, as chairman of a new commission on drug addiction.Most popular Nation storiesIdaho woman: I crashed because I saw a sasquatchKushner to lead government overhaul initiativeWoman strikes Capitol Police cruiser, taken into custodyCops hunt Cincinnati nightclub shooting suspects30-pound turkey crashes through family's windshield
Christie, a former GOP presidential primary rival who became an early endorser of Trump’s bid, will be a liaison to local and state officials, medical experts and drug addicts, the president said.
“Solving the drug crisis will require cooperation across government and across society, including early intervention to keep America’s youth off this destructive path,” Trump said.
The president blamed illegal drugs brought across the border, noting he has beefed up law enforcement to stop drug cartels.
The proliferation of heroin use, among other opioids, has devastated suburban communities.
In Suffolk County, the number of opioid-related deaths in 2016 — at least 276 — outpaced the number in the previous year, according to the most recently available statistics from the medical examiner’s office.
In Nassau County, there had been 146 such fatalities in 2016, as of November, and that figure was lower than in 2015 for the county, according to the medical examiner’s office.
Opioid overdose is the leading cause of accidental death nationally and in New York City, surpassing motor vehicle accidents, according to New York City’s health department. In the city, there were 937 unintentional drug-overdose deaths in 2015, compared with 800 in 2014, and heroin-linked deaths rose 158 percent between 2010 and 2015, figures show.
Also in attendance at Trump’s listening session were his homeland security, education and veterans affairs secretaries, as well as Mariano Rivera, the retired Yankees pitching great who was representing his philanthropic foundation.
Vanessa Vitolo, a recovering addict who has worked with Christie on advocacy in New Jersey, shared with Trump a stirring personal account of her struggles.
A dependence on painkillers following an injury led her to heroin use and homelessness in Atlantic City, and her mother would drive the streets searching for her, Vitolo said.
“There comes a point where you feel as if you have nothing, you already ruined everything, so there’s no point to get sober,” she said, urging those struggling with drugs to fight because “there is a tomorrow, and there is a day after that.”
Also Wednesday, Senate Democrats, led by Minority Leader Chuck Schumer (D-N.Y.), sent a letter to Trump expressing a willingness to work with him to improve the health care system, provided that he abandon his quest to repeal Obamacare.
“We urge you to use your executive authority to support a stable, competitive insurance marketplace,” they wrote. They condemned Trump’s recent Twitter remarks on waiting for Obamacare to “explode,” saying millions would be hurt.
White House press secretary Sean Spicer responded, “I think they understand his principles. We need to repeal the law and replace it with something better.”
The press secretary said he questions whether Democrats will “understand that they are the ones who are going to be responsible for owning the current policies that are making so many Americans struggle.”
The Obamacare-repeal bill Trump supported was withdrawn last Friday from the House floor for lack of sufficient Republican votes, but Trump said Tuesday at a White House reception for senators that he will quickly make a deal on health care and it will be an “easy one.”
Spicer said Wednesday that Trump was being “lighthearted.”
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Here’s what Trump’s new executive order means for opioid addiction
Mar 29, 2017 | PBS
By Laura Santhanam
New Jersey Gov. Chris Christie will lead a new national opioid commission created Wednesday by an executive order from President Donald Trump that also maps out his administration’s latest strategy to combat the public health crisis.
The fight against the opioid epidemic is “one that’s incredibly important to every family in every corner of this country,” Christie said Wednesday in an interview with The Today Show, adding he and Trump “both care passionately about this issue and we want to save lives.”
“Addiction is a disease, and no life is disposable. We can help people by giving them appropriate treatment,” Christie said.
Trump tweeted late Wednesday that his signed executive order would create a presidential commission designed to combat opioid addiction and the opioid crisis.
According to Trump’s signed order, the commission is designed to:Identify existing federal dollars to combat drug addiction, including opioids;
Assess availability and access to addiction treatment centers and overdose reversal and identify underserved areas;
Measure the effectiveness of state prescription drug monitoring programs;
Evaluate public messaging campaigns about prescription and illegal opioids, and identify best practices for drug prevention.
In 90 days, the commission will submit an interim report to Trump with its findings. It will submit a final report by Oct. 1, unless more time is needed, according to the executive order. The commission will dissolve a month later.
On the campaign trail, Trump promised to tackle the nation’s opioid crisis. But in February, the New York Times reported the Trump Administration planned to eliminate the White House Office for National Drug Control Policy, a three-decades-old office that President Ronald Reagan and Congress created to orchestrate the country’s drug policy and strategies. The report concerned public health officials who worried about lost resources in the middle of nationwide opioid epidemic.
The executive order signed Wednesday by Trump asks that office to help the commission carry out some of its tasks. It does not make mention of what will happen to the “drug czar,” a leadership position created by President Ronald Reagan. President Barack Obama’s most recent appointee, Michael Botticelli, promoted expanded access to naloxone and other kinds of treatment, and shepherded a prescription drug monitoring program that is active in all states except Missouri. He also made headlines for being the first person in the position to be openly recovering from addiction.
The national drug control policy office referred questions from the NewsHour to the White House, which did not respond to requests for comment.
In January, Christie promised New Jerseyans that he would devote his final year in office to making headway in the state’s own fight against opioid addiction, the Associated Press reported. This policy work continues efforts he launched in 2011, as detailed by NJ.com.
By the end of 2016, the state had expanded access to naloxone — an opioid antidote that reverses potentially fatal overdoses within minutes — and created a program that uses electronic data to track how often doctors and pharmacists doll out prescription drugs. Christie’s administration also devoted more resources to the state’s drug courts, which allows defendants who face drug charges to choose between treatment or jail time.
Christie attended a White House meeting to discuss strategies to address opioid addiction, intervention and treatment Wednesday morning along with Trump and several members of the administration, including Attorney General Jeff Sessions, Education Secretary Betsy DeVos, Homeland Security Secretary Michael Kelly and Veterans Affairs Secretary David Shulkin, among others. The meeting also included some representatives of the law enforcement and health communities, as well as advocates and those recovering from addiction.
“Stopping this epidemic is an issue that every American regardless of political background can and must get behind,” White House Press Secretary Sean Spicer told reporters Wednesday, adding that the day’s announcement was the first step in bringing stakeholders together.
Trump’s decision to form the commission is a step in the right direction, says Mary Bassett, who leads the New York City Department of Health and Mental Hygiene. In November, she co-signed a letter sent to the Trump transition team by 10 other public health officials from the across the country asking for attention to the issue.
“Opioid overdose deaths are preventable but have claimed too many American lives, and the growing presence of more potent drugs is exacerbating the problem,” she says in a written statement from the department. “This executive order for an opioid commission seems to be an important step toward addressing the opioid epidemic at a national level.”
Preventing further tragedy requires “all hands on deck,” echoed Sen. Claire McCaskill, who earlier in the week launched an investigation into drugmakers who make the nation’s top-five selling prescription opioids.
“Drug overdose deaths, the majority of which are from heroin and prescription opioids, are a national crisis,” McCaskill said in a written statement. “We’ll need the help of Governor Christie, President Trump, and others at all levels of government, from any party affiliation, if we’re going to make progress and save lives.”
The announcement arrives the same day a new report revealed the changing profile of Americans who use and abuse heroin. According to Silvia Martins and researchers at Columbia University Mailman School of Public Health, heroin use has become more prevalent over the last decade, increasing across all measures for age, race, gender, education, income and marital status — especially among white, uneducated men.
“The nonmedical use of prescription opioids preceding heroin use increased among white individuals, supporting a link between the prescription opioid epidemic and heroin use in this population,” the report said.
Researchers analyzed more than 79,000 respondents who asked about drug use in 2002-2003 and 2012-2013 for the National Epidemiologic Survey on Alcohol and Related Conditions. Their findings were released in JAMA Psychiatry Wednesday.
“Heroin use has become more normative over time,” Martins told the NewsHour. The commission’s task is, in part, to stop that.
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Trump is launching a commission to deal with the deadliest drug crisis in US history
Mar 29, 2017 | Vox
By German Lopez
President Donald Trump wants to do something about the opioid epidemic. It’s just not clear what, exactly, he’ll do.
Trump on Wednesday signed an executive order to deal with the opioid epidemic. It doesn’t take any specific actions against the epidemic. But it creates a commission, to be headed by New Jersey Gov. Chris Christie, that will decide what can be done.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis will focus on putting together a report, due in the fall, on the opioid crisis and potential solutions to it. The commission will identify existing federal funding for the epidemic, locate places that have limited drug treatment options, review opioid addiction prevention strategies, and make recommendations to the president to improve the federal response to addiction and the opioid crisis.
Christie will work with other people designated by the president to the commission, although the final draft of the order does not specify who those people will be. The commission, which will be administrated by the White House Office of National Drug Control Policy, is expected to put out a preliminary report within three months and a final report by October.
Christie is a natural pick for the commission, due to his support for Trump since the 2016 campaign and strong advocacy in the opioid epidemic. Christie has long spoken about treating addiction as primarily a public health problem instead of a criminal justice issue. And he’s dedicated his past year as governor in large part to confronting the epidemic, recently signing a law that restricts opioid painkiller prescriptions. (One of Christie’s friends struggled with addiction, which seems to have pushed him to take on the epidemic in a compassionate, serious way.)
Whatever comes of the commission, it is long overdue. The opioid epidemic has led to the biggest drug overdose crisis in US history, with more than 560,000 people — more than the entire population of Atlanta — dying from drug overdoses between 1999 and 2015. The Obama administration and Congress previously took some steps to try to combat the crisis, but experts have long argued that there’s a desperate need for more.Trump talked a lot about opioids on the campaign trail, but he’s yet to release a specific plan
Trump acknowledged the horrors of the opioid epidemic on the campaign trail, calling it a “tragedy” and laying out some policy ideas for stopping the drug crisis.
Most of Trump’s talk has focused on tougher border security measures, including his wall, to stop the flow of illegal narcotics into the US. But experts widely argue that such measures would fall far short of dealing with the epidemic, not least because most opioid overdose deaths are linked to painkillers that are legally prescribed and obtained — sometimes through a black market — within the US.
Trump has signaled other policies, including making drug treatment more accessible. But he’s offered few specifics on how he would accomplish that, typically promising to “spend the money” on drug treatment without many more details. (Although he did vow to raise the cap on how many patients doctors can prescribe to buprenorphine, an opioid used to let people with opioid use disorders manage their addiction more easily and in a much safer fashion.)
More spending on addiction treatment is desperately needed: According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn’t get treatment. Patients with drug abuse disorders also often complain of weeks- or months-long waiting periods for care. (Even Prince, a wealthy superstar musician, couldn’t access care quickly enough — and died as a result.)
This is why the Obama administration took some steps to provide more treatment options, such as unlocking more than $100 million in funding for drug treatment in 2016. And it’s why Congress in late 2016 approved $1 billion over two years for drug treatment to combat the opioid epidemic.
Trump’s policy proposals to this point, however, have not done anything to fill this gap. His recent budget plan wouldn’t increase funding for drug treatment above what Congress already approved. In fact, Trump has proposed $100 million in cuts to the Substance Abuse and Mental Health Services Administration’s mental health block grants, which could ultimately impact some addiction services.
Trump also has not yet nominated a permanent director of the White House Office of National Drug Control Policy, who is commonly referred to as the nation’s “drug czar.” This office is meant to coordinate all of the nation’s anti-drug spending, bringing together the many federal agencies that tackle drugs through a variety of criminal justice, national defense, and public health programs. But without a permanent head of the office, the nation’s future drug strategy remains unclear.
There are similar vacancies in other agencies that deal with drug addiction, including the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration.
Keith Humphreys, a drug policy expert at Stanford, praised Christie’s appointment to the commission. But he argued that Trump should prioritize filling old positions over establishing a new commission. “We have multiple positions in government that can do all these things already,” he said. “Instead, a new layer of government is being created with no infrastructure or historical memory.”
To this end, Humphreys argued, much of what Trump is tasking the commission to do was already done by the surgeon general’s 2016 addiction report. “There is no need to reinvent the wheel with another planning and evaluation process,” Humphreys said, “just pick up [the surgeon general’s] report and act on it.”
There’s a reason for the sense of urgency: With tens of thousands of people dying from drug overdoses every year for the past few years, there’s a need to take action quickly. And it’s not really a mystery what needs to be done — with experts saying the problem comes down to lose access to opioid painkillers and too few drug treatment options. So to start yet another months-long investigative process seems like a slow reaction to an urgent crisis.
Still, the president’s commission presents an opportunity for Trump to reverse course on this issue and potentially direct policies and funds to dealing with the opioid epidemic in a more serious manner. Whether it will actually live up to that potential remains to be seen. But tens of thousands of lives may depend on it.The opioid epidemic, explained
In 2015, more Americans died of drug overdoses than any other year on record — more than 52,000 deaths in just one year. That’s higher than the more than 38,000 who died in car crashes, the more than 36,000 who died from gun violence, and the more than 43,000who died due to HIV/AIDS during that epidemic's peak in 1995.
This latest drug epidemic, however, is not solely about illegal drugs. It began, in fact, with a legal drug.
Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There's a good reason for that: About one in three Americans suffer from chronic pain, according to a 2011 report from the Institute of Medicine.
Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is very weak (despite their effectiveness for short-term, acute pain), while the evidence that opioids cause harm in the long term is very strong.
So painkillers proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.
As a result, opioid overdose deaths trended up — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety). By 2015, opioid overdose deaths totaled more than 33,000 — close to two-thirds of all drug overdose deaths.
Seeing the rise in opioid misuse and deaths, officials have cracked down on prescriptions painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.
Ideally, doctors should still be able to get painkillers to patients who truly need them — after, for example, evaluating whether the patient has a history of drug addiction. But doctors, who weren’t conducting even such basic checks, are now being told to give more thought to their prescriptions.
Yet many people who lost access to painkillers are still addicted. So some who could no longer obtain prescribed painkillers turned to cheaper, more potent opioids: heroin and fentanyl, a synthetic opioid that's often manufactured illegally for nonmedical uses.
Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.
So other types of opioid overdoses, excluding painkillers, also rose.
That doesn't mean cracking down on painkillers was a mistake. It appeared to slow the rise in painkiller deaths, and it may have prevented doctors from prescribing the drugs to new generations of people with drug use disorders.
But the likely solution is to get opioid users into treatment. So federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and Suboxone.
Some states, like Louisiana and Indiana, have taken a “tough on crime” approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current opioid crisis.
Trump’s new commission offers a chance to establish more funding, coordination, and guidance behind these mixed federal and state efforts. Now the country will have to wait over the next few months to see what, exactly, the commission produces.
For more on the opioid epidemic, read Vox’s in-depth explainer and visual explainer.
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After pledging to solve opioid crisis, Trump's strategy underwhelms
Mar 29, 2017 | Politico
By Dan Diamond and Sarah Karlin-Smith
As a candidate, Donald Trump promised rural towns and states hit hard by opioid addiction that he'd solve the epidemic ravaging their communities. "We will give people struggling with addiction access to the help they need," Trump vowed in October.
Trump won many of those communities — often overwhelmingly. But as president, he's proposing deep cuts to research and treatment in favor of funding a border wall to stop drug traffic, while hinting at bringing back policies like criminalization of drug misuse — and announcing Wednesday yet another big presidential commission to study the problem.
Public health advocates say those plans at best duplicate those of the Obama White House and at worst could set back efforts to tackle a problem that contributes to more than 47,000 deaths per year. Many experts advocate treatment and support services over jail for drug abusers, saying they reduce the risk of a person committing another crime.
The emerging Trump strategy, including failed plans to repeal Obamacare protections that enabled millions to get substance abuse treatment, "doesn't bode well for the public health approach, such as it is," said Leo Beletsky, a law professor at Northeastern University who specializes in health and drug policy. He points to Republican rhetoric about criminalizing the crisis, as well as proposed funding cuts to research and treatment.
"This new shift will certainly make the situation much worse," Beletsky added.
Trump will sign an executive order Wednesday creating a high-level opioids commission led by New Jersey Gov. Chris Christie, who has spoken about the need to prioritize treatment for opioid addiction. It includes Attorney General Jeff Sessions, who has suggested more of a crime-and-punishment approach.
Public health experts question the value of the commission. It was just last November when Surgeon General Vivek Murthy released his office's first-ever report on opioids and addiction, which included tools and recommendations collected from more than a year of research. The CDC also released prescribing guidelines after thorough study.
"These people don't need another damn commission," said a former Obama administration official who worked to address the opioid crisis and asked not to be named. "We know what we need to do. ... It's not rocket science."
The White House on Tuesday also shuffled the leadership at the Office of Drug Control Policy, replacing acting head Kemp Chester — a compromise pick between the outgoing Obama and incoming Trump administrations — with acting head Rich Baum, a former Hill GOP staffer who's been critical of legalizing marijuana and wants to tackle drug cartels abroad.
Baum specializes in what's called the "supply side" of drug policy — cracking down on the flow of illegal drugs — as opposed to "the demand side," or treating the end user. Baum is close to GOP policy experts who worked to enact the "war on drugs" tactics under previous Republican presidents, several sources told POLITICO.
But many officials are doubtful about the supply side approach.
"Our hope is they would take a public health approach to addressing this epidemic," said Laura Hanen, chief of government affairs at the National Association of County and City Health Officials. She pointed out that while there have been inroads to clamp down on over-prescribing of prescription opioids, there's been a corresponding uptick in heroin and fentanyl. "You squeeze one end of the balloon and the air goes to the other end. ... If we're only going to use a supply side approach I doubt it 'll be very effective."
Drug-policy experts also worry about Sessions' punitive view of drug abuse and his skepticism about treatment, which he believes seldom works. "We can wish that we could just turn away and reduce law enforcement," he said in a speech last year. "But I do believe that we're going to have to enhance prosecutions. There just is no other solution."The White House issued a budget request recently that would siphon billions of dollars from NIH research and CDC public health work this year while steering about $2 billion toward construction of Trump's border wall with Mexico.
The president has promoted the wall as a linchpin of his strategy to fight the opioid epidemic. "A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin poisoning our youth," Trump said in October in New Hampshire — a state hard-hit by the opioid crisis.
"We must ... focus on prevention and law enforcement," Trump said at a Wednesday event showcasing the effort. "That is why I have issued previous executive actions to strengthen law enforcement and dismantle criminal cartels. Drug cartels have spread their deadly industry across the nation and the availability of cheap narcotics — and by cheap, some of it comes in cheaper than candy — has devastated our communities."
But Trump's own homeland security czar said the border wall "in and of itself will not do the job" and drug-policy experts warned cartels would be motivated to find a way around it. In any case, it may be a non-starter this year; Congress will rebuff the request, Sen. Roy Blunt (R-Mo.), a senior appropriator, signaled on Tuesday.
Democrats on the Hill also blasted Trump for a plan that they say prioritizes optics like a border wall and a political commission over investing more dollars in caring for people who are addicted to opioids, recovering or are at risk. They also said that the ill-fated American Health Care Act — the House Republican plan to strike down Obamacare — would have dealt a critical blow to coverage for millions of substance misusers.
"I'd take President Trump's proposed efforts on opioids more seriously if he hadn't spent the last two months trying to derail the historic steps forward on substance abuse treatment through the Affordable Care Act — and if his budget didn't also include a 20 percent cut to mental health services, which are so important in the fight against this epidemic," Sen. Patty Murray (D-Wash.) said in a statement.
"I was pleased to see then-candidate Trump recognize this issue on the campaign trail," Sen. Maggie Hassan (D-N.H.) told POLITICO. "[But] I am concerned that rather than show a commitment to increasing resources to boost treatment capacity, President Trump has so far pushed policies that would harm our efforts to combat the crisis."
Several advocates pointed out that the failed House Republican bill to repeal Obamacare would have significantly hindered access to addiction treatment. The legislation was not only projected to lower coverage but also would have eliminated essential health benefit guarantees — including mental health — for millions of Americans covered through various ACA-related programs.
The bill would have slashed Medicaid expansion, which experts have concluded helped nearly 1.3 million low-income Americans gain access to substance-use treatment.
Trump's budget proposal for next year keeps the $500 million allotted to states through the 21st Century Cures Act to fight opioid addiction and proposes $175 million more to fight drug trafficking. But it would cut funding by 14 percent for the Coast Guard, whose maritime interdiction efforts are necessary at a moment when cocaine production and trafficking is at an all-time high.
Drug policy experts across the federal government say they weren't consulted on the executive order to create the opioids commission.
"The first time I learned about this was when I saw it in the press" on Sunday night, one said.
Policy experts stressed that the Obama administration made its own blunders in fighting the opioid epidemic, such as failing to increase access to drugs like naloxone, which can keep addicts from dying from overdoses. The same experts are nervous to see the current administration potentially repeat the last one's mistakes.
"Paradoxically, the [opioid] crisis also helped to get us here," Beletsky added. "The failure to curb overdoses — and address the deep structural issues that have fueled them — also helped Trump make the case that government wasn't working."
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How Much Pain Will Congress Inflict on These Opioid Drugmakers' Stocks?
Mar 30, 2017 | Fox Business
By Keith Speights
A congressional committee once again has drugmakers in its crosshairs.
This time, it's the U.S.Senate's Homeland Security and Governmental Affairs Committee investigating five opioid drugmakers to determine if the companies' practices have contributed to widespread painkiller overdoses in the U.S.
Sen. Claire McCaskill (D-Mo.) sent letters toPurdue Pharma, Johnson & Johnson (NYSE: JNJ), Insys (NASDAQ: INSY), Mylan (NASDAQ: MYL), and Depomed (NASDAQ: DEPO) requesting information to help the committee in its investigation.How much pain will this latest Senate probe inflict on the drugmakers' stocks?What the investigation is all about
According to the Centers for Disease Control and Prevention (CDC), more than 33,000 Americans died from opioid overdoses in 2015 -- an all-time record. Nearly half of those deaths involved prescription opioid drugs.McCaskill suspects that major drugmakers are largely to blame.
According to a press release from the committee, the investigation "willexplore whether pharmaceutical manufacturers -- at the head of the opioids pipeline -- have contributed to opioid over-utilization and over-prescription" causing the current epidemic.In her letter to the five companies, McCaskill said, "This epidemic is the direct result of a calculated sales and marketing strategy major opioid manufacturers have allegedly pursued over the past 20 years to expand their market share and increase dependency on powerful -- and often deadly -- painkillers."
McCaskill also stated in her letter that drugmakers have allegedly encouraged physicians to prescribe opioid drugs "for all cases of pain and in high doses." She mentioned that there are reports that the companies have downplayed the risk of opioid addiction in their marketing and promotional efforts.The targeted drugmakers
Privately held Purdue Pharma's products include opioid painkillers, prescription sleep drugs, and several over-the-counter medicines. In 2007, the company and three of its executives plead guilty to charges of misleading the public about the addiction risks of its opioid drug OxyContin. Purdue paid a $634.5 million fine.
Johnson & Johnson was included with Purdue and several other pharmaceutical companies in a 2015 lawsuit by the city of Chicago alleging that the drugmakers deceptively marketed their opioid drugs. Both J&J and Purdue denied the allegations.
Insys wasn't named in the Chicago lawsuit, but has been impacted by the opioid controversy elsewhere. Six former executives and managers face charges alleging that they bribed physicians to prescribe opioid spray Subsys even when it wasn't medically appropriate.
Mylan markets several generic opioid drugs, including fentanyl and oxycodone. The company has been targeted by McCaskill and the Senate committee before, but over pricing increases of its generic opioid overdose treatment drug naloxone.
Depomed generates more than 60% of its total revenue from opioid drugs Nucynta and Nucynta ER. J&J sold the commercialization rights for Nucynta to Depomed in 2015.Questions and answers
Three questions come to mind with this latest news.
First, why is a Senate committee focused on homeland security and governmental affairs launching this investigation rather than the Senate committee that focuses on health? This one is easy to answer: It's politics. All Senate committees have a lot of leeway in what comes under their jurisdiction, and McCaskill seems to relish going after pharmaceutical companies.
Second, why these five drugmakers and not others? I'm not sure. Mylan, for example, is only ranked as the 17th largest supplier of opioid drugs in the U.S. It's not clear why the company was included in the latest investigation while other drugmakers (for example, the others sued by the city of Chicago) weren't. Perhaps the most likely answer is the one already mentioned: politics.
Third, will the Senate investigation seriously hurt these stocks? I suspect the answer is "no." J&J's and Mylan's stock price barely moved after the Senate probe was announced. Insys is still basking in the glow of its long-awaited scheduling for cannabinoid drug Syndros.
DepoMed's stock is down, but not because of the Senate investigation. The company replaced its CEO and named three new directors to its board (including the new CEO) after significant pressure from activist investor Starboard Value LP.
The Senate committee will likely get its pound of flesh from each of these companies. And if clear evidence is subsequently found of misdeeds (through the legal process, not from the committee), the drugmakers should pay the appropriate penalties. For now, though, other factors will drive what happens with these stocks.
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Lawsuits, Congressional Inquiry Plague Opioid Manufacturers
Mar 30, 2017 | Medscape
By Alicia Ault
At least one city and several counties are suing the manufacturers of prescription opioids in a flurry of filings over the past few months, and more are likely to follow.
In addition, Claire McCaskill, the top Democrat on the Senate Homeland Security and Governmental Affairs Committee, has opened an inquiry into whether opioid manufacturers' business practices — such as aggressive marketing, sales quotas, and sponsoring continuing medical education and advocacy groups ― have contributed to overprescribing and overuse of the drugs.
McCaskill sent letters seeking documentation by April 25 to Depomed, Insys, Johnson & Johnson's Janssen Pharmaceuticals, Mylan, and Purdue Pharma.
It is not the first time the opioid manufacturers have faced litigation, but the pressure seems to be rising. In 2007, Purdue Pharma and several executives pled guilty to aggressively and fraudulently promoting OxyContin, paying $600 million to settle the case.
Eight years later, in 2015, Chicago led an attack, suing five opioid makers ― Purdue Pharma, Endo International, Teva Pharmaceuticals, Johnson & Johnson, and Allergan.
In September 2016, a judge ruled the suit could proceed. That suit, which alleges that the companies put profit over science through deceptive and fraudulent marketing of the drugs, is seeking repayment of expenses related to the current opioid epidemic.
In August 2016, Suffolk County, New York, sued on the same basis, alleging deceptive marketing and naming Purdue Pharma, Teva Pharmaceuticals USA, Inc, Cephalon, Inc, Johnson & Johnson's Janssen Pharmaceuticals, and Endo Pharmaceuticals, in addition to several physicians that included Russell Portenoy, Perry Fine, Scott Fishman and Lynn Webster.
Those physicians "were allegedly instrumental in promoting opioids for sale and distribution nationally and in Suffolk County," according to a press release from the law firm, Simmons Hanly Conroy, that filed the county's suit.
Simmons Hanly Conroy also sued the same drug makers on behalf of Broome and Erie counties in New York in early February, again seeking compensatory and punitive damages for the costs of injuries, loss of productivity, social services, deaths, and criminal activity.
The firm, which specializes in asbestos and other mass tort actions, has also been a top contributor to McCaskill, with individual attorneys donating a little more than $90,475 to her coffers from 2011 to 2016, according to OpenSecrets.org, which tracks campaign finance issues.
Purdue Fires Back
Purdue Pharma is seeking dismissal of a suit brought by the city of Everett, Washington, in January 2017.
Everett was the subject of a lengthy 2016 Los Angeles Times investigative story about how Southern California gangs created a huge business trafficking OxyContin in that northwest town and surrounding areas of Snohomish County.
"There is clear evidence that Purdue ignored their responsibility to stop the diversion of OxyContin into the black market, directly leading to the heroin crisis on our streets today," said Everett Mayor Ray Stephanson in a press release.
The city is seeking compensation for the additional costs of coping with the epidemic, including costs related to addiction treatment, social services, housing, law enforcement, prosecution, prisons and jails, diversion programs, and emergency medical services.
In a lengthy rebuttal posted March 10 on its website, Purdue claimed that much of the illegal activity in question was known to various law enforcement agencies long before a Purdue employee notified superiors about suspicions.
That claim is a major underpinning of the drug maker's motion to dismiss the Everett suit, filed March 20 in the US District Court Western District of Washington, Seattle. The company argued that "there is no basis in law for a municipality to bring such an action against a pharmaceutical manufacturer and the City's Complaint fails to state a claim due to multiple, independent legal failings."
Among other issues, the company did not have any legal duty to notify the city of Everett, the filing said.
The company's lawyers also said that Purdue cannot bear responsibility for the city's problems. Purdue's alleged failure to report "is multiple layers removed from the 'drug abuse, addiction and crime' attributable to illegal drug trafficking in Everett, separated by many intentional torts, crimes, and intervening acts by others," said the filing.
The city's claims, which cover events before 2010, also fall outside the 4-year statute of limitations, said the Purdue attorneys.
Need for "Injunctive Relief"
Andrew Kolodny, MD, codirector of the Opioid Policy Research Collaborative at the Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, told Medscape Medical News that he believes the suits against Purdue and other opioid makers are necessary.
Dr Kolodny blames the US Food and Drug Administration for allowing the companies to market extended-release opioids outside of the palliative care setting. This practice led to many more people having access to and abusing that formulation. "We may get in the courts what we didn't get from FDA," he said.
Litigation is also needed "because the companies are still doing this stuff, and we need some injunctive relief," Dr Kolodny said, adding that he predicted more suits in the future. "There are a few law firms actively looking for clients," he said.
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Editorial: Time for opioid makers to come clean and help addicts go clean
Mar 29, 2017 | St. Louis Post-Dispatch
Every state in the nation, with the possible exception of Missouri, is now focused like a laser beam on the growing dangers posed by opioid abuse and overprescription. Sen.Claire McCaskill, D-Mo., wants to determine whether the national abuse epidemic resulted from deliberate attempts by big pharmaceutical companies to make opioids cheaper and more widely available while underplaying the addiction risks. Did they effectively encourage doctors to overprescribe?
This epidemic didn’t occur by accident. Across the country, pain management clinics have proliferated, particularly in blue-collar districts where on-the-job injuries such as back strains are common. Opioids such as OxyContin and Percocet have become the drug of choice even though doctors know they are highly addictive.
Prosecutors have accused some clinics of serving as “pill mills” that exploit addictions to boost profits. Big pharmaceutical companies have been more than happy to meet the demand rather than monitor sales and warn authorities when unusual spikes in demand occur, critics suggest.
“This epidemic is the direct result of a calculated sales and marketing strategy major opioid manufacturers have allegedly pursued over the past 20 years to expand their market share and increase dependency on powerful — and often deadly — painkillers,” McCaskill stated in a letterTuesday soliciting information from major pharmaceutical companies.
She accused manufacturers of trying to downplay addiction risks and “encourage physicians to prescribe opioids for all cases of pain and in high doses.” She noted that one company, Purdue Pharma, has paid $635 million in fines to settle criminal and civil charges linked to misrepresentation of OxyContin’s addictive qualities.PauseCurrent Time0:00/Duration Time0:00Loaded: 0%Progress: 0%0:00Fullscreen00:00Mute
In 2014, the city of Chicago sued several manufacturers, alleging they deliberately marketed opioid products in a way that downplayed addiction risks. In February, Everett, Wash., sued Purdue, alleging the company knew its products were being illegally trafficked in the city and did nothing to stop it.
The Obama administration’s drug czar, Michael Botticelli, launched a campaign two years ago to pressure doctors into imposing tighter standards and be on the lookout for patients who are shopping around for doctors once they’ve exceeded prescription limits.
Every state in the country except Missouri has responded to the addiction crisis by passing laws to create prescription drug databases that doctors can access to verify whether a patient has a history pointing toward abuse. State Sen. Rob Schaaf, R-St. Joseph, has repeatedly fought it, tellingThe New York Timesin 2014 that if addicts “overdose and kill themselves, it just removes them from the gene pool.”
The pharmaceutical companies don’t have to respond to McCaskill. But we’ve seen how stonewalling worked forBig Tobacco, and it’s definitely not in their interest to go that route when a growing body of evidence suggests they could do far more to fight, instead of feed, this epidemic.
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