NEW YORK - In 2002, Andrew Kolodny, a resident in psychiatry, attended a training session on pain treatment in Philadelphia.
Seventeen years later, he still shakes his head over the surprising enthusiasm of the lecturer, an authority on the topic, for prescribing opioids.
"The message was that people are suffering because of an overblown fear, and the correct and compassionate way to treat pain is to prescribe aggressively," Kolodny recalled.
The lecturer, Thomas McLellan, had shown the class a short film examining the case of a man seeking relief from chronic back pain.
The patient had been prescribed a strong regimen of OxyContin, the pain medication produced by Purdue Pharma -- but he wanted more, complaining of crippling agony.
After the film, McClellan asked the doctors in the class for their diagnosis.
"For me and for most of the people in the room, the obvious diagnosis was that this patient became addicted to their medicine," said Kolodny, who is now the co-director of opioid policy research at Brandeis University's Heller School in Boston.
"The surprise was that the person teaching the class said it's not true addiction. It's a pseudo-addiction."
McLellan insisted the problem facing the seemingly addicted patient was that he was not getting enough drugs, Kolodny recalled.
At the time, the concept of "pseudo-addiction" was being advanced by Purdue Pharma and other laboratories to promote their opioid products.
OxyContin, an anti-pain medication similar to morphine, was introduced to the American market in 1996 with a campaign that swept aside years of caution on the use of opioids, previously reserved for the gravely ill because of their highly addictive nature.
The campaign featured deceptive marketing, controversial sales practices and endorsements from eminent physicians generously remunerated by Purdue Pharma.
But as a result of the singularly aggressive promotion of the prescription drug, both Purdue and the Sackler family, which owns the firm, now face more than 2,300 lawsuits in the United States.
They stand accused of having provoked the nationwide opioid crisis.
Opioids are blamed for more than 400,000 deaths by overdose since 1999, according to recently published data, and on average for more than 130 deaths a day.
Contacted by AFP, Purdue Pharma declined to comment.
A GREEN LIGHT
The origins of OxyContin, which has generated more than $35 billion in sales for Purdue, date to 1990.
The laboratory, based in the northeastern US state of Connecticut, was looking for a successor to its popular analgesic MS Contin, a morphine-based medication prescribed mainly to cancer patients but which was facing growing competition from generic drugs.
Purdue developed a painkiller based on oxycodone, a semi-synthetic opioid first concocted in Germany in 1916, with effects comparable to those of MS Contin.
Opioids posed well-known risks of dependence, but the laboratory had an answer: the new drug's beneficial effects would last 12 hours, twice as long as similar medications, meaning a patient would take fewer pills and face reduced danger of addiction.
But even before it reached the market, tests showed that OxyContin's effects did not last as long as originally thought, the Los Angeles Times found in a 2016 investigation.
Still, in December 1995, the US Food and Drug Administration (FDA) gave Purdue a green light to market OxyContin for the treatment of moderate to severe pain, authorizing its use for a range of ailments, many less serious than cancer.
"At the time of approval, FDA believed the controlled-release formulation of OxyContin would result in less abuse potential, since the drug would be absorbed slowly and there would not be an immediate 'rush' or high," an agency spokesman told AFP.
The FDA's approval drew growing criticism after Curtis Wright, a doctor who led the agency committee that authorized OxyContin, left to take a senior position with Purdue in 1998.
Another troubling development: once the drug was being marketed and aggressively promoted, OxyContin generated a huge black market that Purdue, critics say, ignored or minimized for far too long.
Quantities of pills were procured -- stolen from pharmacies or obtained from unscrupulous doctors -- and ground into powder to be inhaled, which multiplied their euphoric effects, according to a confidential US Justice Department report cited by The New York Times in 2018.
The 80-milligram pills, the most common dose, sell for $65 to $80 on the black market, compared to $6 in pharmacies, according to several doctors questioned by AFP.
EXPLOSION IN SALES
Despite the warning signals, Purdue continued to present OxyContin as being less addictive than other opioids.
The company's advertising budget surged from $187,500 in 1996 to $4 million in 2001, according to internal documents.
Purdue also built up a so-called "speakers' bureau" -- mainly physicians highly remunerated for attesting to the "miracle" qualities of OxyContin.
Sales exploded -- rocketing from $80 million in 1997 to $2.1 billion only four years later, internal documents showed.
Purdue also enlisted the help of the American Academy of Pain Medicine (AAPM) and the American Pain Society (APS), two respected professional organizations specializing in pain treatment, to support its campaign to destigmatize opioids.
Purdue helped finance both organizations, and several of their members worked as consultants for the laboratory.
Underscoring the close relationship, David Haddox, who headed an APS committee that endorsed the increased use of opiates, was hired by Purdue in 1999, where he remained until earlier this year.
Purdue's sales pitch to physicians was probably helped by the fact that pain treatment has long been a neglected branch of medicine, said Gregory Terman, director of the Acute Pain Service at the University of Washington and the APS president from 2015 to 2017.
"Until the opioid crisis, NIH (the National Institutes of Health) had never spent more than one percent of their budget on pain -- the most common reason people go to doctors -- let alone chronic pain, which troubles more than 100 million Americans," he said.
The APS, facing lawsuits over its promotion of opioids and unable to pay its lawyers, filed for bankruptcy in late June.
Primary care doctors "have little training in addiction or pain, and many of them believed the promises" made by Purdue, Stanford University psychiatry professor Keith Humphreys said.
LEGAL PROBLEMS MOUNT
In 2006, the medical world finally awoke to the dangers of OxyContin, jolted by an article by Leonard Paulozzi of the Centers for Disease Control and Prevention (CDC), who reported that deaths linked to opioids had exploded by 91 percent from 1999 to 2002.
In 2007, for the first time, Purdue Pharma and three of its executives pleaded guilty, in Virginia, to having deceived physicians, patients and regulatory authorities about the risks posed by OxyContin of dependence or abuse. They agreed to pay $635 million in fines.
Yet when Purdue's legal problems grew in the United States and OxyContin sales fell in 2010, the company simply turned to its international subsidiary Mundipharma to promote sales in other parts of the world.
In Europe, where drug ads targeting the general public are banned, Mundipharma aired one in Spain in 2013 drawing attention to the problem of chronic pain and encouraging people to see a doctor and demand treatment.
Asked about that, a Mundipharma spokesperson said only: "We no longer have any such activity today."
The group has also financed seminars for physicians in other countries -- notably Brazil and China -- to promote opioids as effective pain treatment, the Los Angeles Times reported in 2016.
Joseph Pergolizzi, a Florida doctor who the newspaper said had lectured in 2016 at a Mundipharma-sponsored conference in Brazil, rejected any suggestion of deceptive marketing.
"I was invited to a cancer pain conference," he told AFP, adding that he had spoken about "severe cancer pain treatment and what the options are."
Pergolizzi said he had severed all ties to Mundipharma two years ago.
BANKRUPTCY
Purdue has repeatedly stated that OxyContin is only one of several opioid medications on the market, and that it now fights actively against the abuse of such drugs.
It sought bankruptcy protection in mid-September and is now urging the states and cities suing it to agree to its transformation into a trust, with any future profits to be used to alleviate the harm caused by the opioid crisis.
The laboratory has said it is ready to make payments to the plaintiffs totaling $10 billion to $12 billion -- with $3 billion coming from the Sackler family -- if they drop all legal action.
But nearly 25 states, including New York, have rejected the proposal.
The offer from Purdue and the Sacklers falls far short of paying for "the death and destruction they inflicted on the American people," said New York Attorney General Letitia James.
lo/bbk/sst
source: news.abs-cbn.com
CLEVELAND — Three leading American drug distributors and an Israeli drugmaker blamed for a deadly US opioid epidemic settled a bellwether civil lawsuit with 2 Ohio counties Monday, just hours before they were to go on trial, a federal judge announced.
The $260 million deal set the basis for a broader potential multi-billion dollar payout to some 2,700 addiction-ravaged communities nationwide that had signed on to the Cleveland lawsuit, the first in a federal court to address the causes of the crisis.
Officials from Ohio's Summit and Cuyahoga counties -- which include the cities of Akron and Cleveland -- said they would be able to almost immediately begin boosting funds to address the massive fallout from the crisis.
The addiction epidemic has placed huge burdens on hospitals and emergency services, and on families supporting addicts and caring for children with addicted parents or parents who have died.
"Cuyahoga County has seen thousands of people die over the last several years. It's a tragedy. Summit County is no different," said Cuyahoga prosecutor Michael O'Malley.
"Our hearts go out to the families who have been touched by this," said Ilene Shapiro, the chief executive of Summit County.
"Whatever we can do to help these families rebuild and get as healthy as they can and move forward is what we are trying to do."
HUNDREDS OF THOUSANDS OF DEATHS
The settlement involved the 3 leading US drug distributors, some of the largest companies in the country -- Cardinal Health, AmerisourceBergen, and McKesson Corp.
It also included Israel's Teva, one of the world's largest generic drug manufacturers.
Pharmacy chain Walgreens opted out of the deal and will go to trial at a later date, said Federal District Judge Dan Polster. A small Ohio distributor also settled in a separate deal.
A trial would have examined allegations that the makers of the prescription painkillers and pharmaceutical distributors pushed billions of pills into communities without due care over 2 decades, making it excessively easy for patients to become addicted and creating a permanent demand.
The companies reaped tens of billions of dollars in profits while overdose deaths soared above 400,000 over 2 decades -- more than 70,000 in 2017 alone.
Plaintiffs had amassed large amounts of evidence showing that the companies knew they were fomenting an epidemic of addiction.
The deal, though, does not require the companies to admit wrongdoing.
"While the companies strongly dispute the allegations made by the two counties, they believe settling the bellwether trial is an important stepping stone to achieving a global resolution and delivering meaningful relief," the giant distributors said in a statement.
The prospects of more litigation sent the shares of the 3 distributors tumbling. AmerisourceBergen fell 3.4 percent, McKesson lost 3.2 percent, and Cardinal Health lost 2.2 percent.
Teva gained 8.8 percent on the relatively small cash payout it will make to the two countries, $20 million.
Walgreens meanwhile lost 1.5 percent as it planned to fight in court.
TALKS CONTINUE
Talks continued with the broader group of plaintiffs for a settlement likely worth tens of billions of dollars in cash and in-kind payments, mainly free drugs for treating addiction.
Negotiations for a global deal worth a reported $48 billion -- but only $18 billion in cash -- broke down Friday amid differences between some states and smaller communities over the total value and how the money would be distributed.
Officials from 4 states who had backed the tentative deal on Friday called the 2-counties agreement "an important step," but said a global settlement could take weeks.
"The global resolution on the table will distribute funds fairly between states, counties and cities while also ensuring that these companies change their business practices to prevent a public health crisis like this from ever happening again," said the attorneys general of North Carolina, Tennessee, Pennsylvania and Texas.
Major drug manufacturers and distributors have already struck deals worth billions of dollars with states and local governments around the country to compensate them for the costs of the epidemic.
A study by the Society of Actuaries estimated that the opioid epidemic cost the US economy at least $631 billion from 2015 to 2018.
In August, Purdue Pharma, the producer of OxyContin, one of the leading painkillers driving the addiction epidemic, reached a deal with 29 states and territories to compensate them.
Purdue said the deal would cost it $10 billion and force it into bankruptcy, but critics in states and localities that opposed the deal say it is worth much less, and demanded the family that built Purdue, the Sacklers, pay billions more out of their own fortune.
In an Oklahoma trial in August, drug maker Johnson & Johnson was ordered to pay $572 million to compensate the state.
The company then reached a separate deal in the Cleveland case to pay the 2 counties $20.4 million.
source: news.abs-cbn.com
NEW YORK — In a windowless hangar at New York's John F. Kennedy airport, dozens of law enforcement officers sift through packages, looking for fentanyl -- a drug that is killing Americans every day.
It's a laborious job, with more than 2 million items of mail, the vast majority of it innocuous, arriving at the postal sorting center from around the world every day.
"We're looking for the proverbial needle in the haystack," says a Customs and Border Protection (CBP) agent, standing amid piles of parcels and letters in the vast, fluorescent lamp-lit warehouse.
The US Postal Service facility has become one of multiple fronts in America's war on opioid addiction, which kills tens of thousands of people every year and ravages communities across the nation.
Sixty percent of all mail arriving in the United States from abroad comes through the center at JFK, and officers spend day and night checking suspicious looking packages for deadly narcotics.
They are mainly hunting for illegally made fentanyl, a synthetic opioid 50 times more potent than heroin and up to 100 times stronger than morphine -- but which is sometimes legally prescribed to ease pain.
According to US government data, about 32,000 Americans died from opioid overdoses in 2018. That accounts for 46 percent of all fatal overdoses.
The majority of fentanyl seized here, whether original or an "analog" product that has similar effects but a slightly different chemical formula, has been bought on the so-called "dark web," from sites usually based in China or Hong Kong.
HOME DELIVERY
Users, often looking for an ever more euphoric high, generally pay with cryptocurrencies, a simple credit card, or PayPal, according to Ray Donovan, the New York chief of the federal Drug Enforcement Administration (DEA).
"They don't need to leave their houses. They can order fentanyl directly from China and have it shipped to their doorstep," Donovan told AFP.
CBP agent and division chief Robert Redes has worked at JFK airport for more than 15 years.
Surrounded by thousands of letters and packages, he recalls when an innocent looking musical birthday card arrived from Toronto in March 2018.
Three grams of fentanyl -- enough to kill 1,500 people -- were hidden inside.
The discovery led to the arrest of a 34-year-old man in Pennsylvania who had bought the synthetic opioid online.
A search of his apartment unearthed a stash of Xanax, LSD, ecstasy, marijuana and hallucinogenic mushrooms.
Because officers are more suspicious of packages coming from China, traffickers often go through an intermediary based in a third country, explains Donovan, who led the capture of Joaquin "El Chapo" Guzman, the Mexican drug lord sentenced to life in jail in July.
It is impossible to check all the mail that arrives at JFK so with the help of trained sniffer dogs, and based on intelligence they have received, officers inspect about 1,000 packages considered high-risk every day.
LASER TECHNOLOGY
Suspicious parcels are X-rayed or examined using laser technology. Sometimes they are opened with a knife -- carefully, since inhaling just a few milligrams of fentanyl can prove fatal.
Fentanyl purchased on the internet is often extremely pure, says Redes. It is cut and then sold on the streets.
"We're dealing with rather small quantities," as opposed to seizures of heroin or cocaine, which are measured in kilograms, he says.
"But it doesn't take very much fentanyl to result in overdoses and even deaths."
A laser spectrometer is the officers' best weapon. It is connected to a database that can identify 450 types of narcotics without opening the package.
Traffickers frequently flood the market with new "analogs," however, meaning officers need to constantly update the digital drug library, says Redes.
Unlike private competitors such as FedEx or UPS, the US Postal Service has limited electronic tracking of mail. Only 40 percent of incoming correspondence is tracked, complicating the work of agents.
A federal law requiring 100 percent tracking of international packages will come into force by the end of next year.
The US government has even launched a competition offering $1.5 million in prize money to anyone who can invent technology that makes it easier to detect opiates in the mail.
"It may seem overwhelming. (But) it's technology that's really going to win the day," says Redes.
FAST AND CHEAP
For New York's special narcotics prosecutor Bridget Brennan -- who has seen cocaine, crack, heroin and now fentanyl ravage communities in her more than 20 years investigating the drug trade -- fentanyl is the "perfect product" for traffickers.
It takes about 4 months to turn poppies grown in Mexico's Sierra Madre range into refined heroin, Brennan says at her Chinatown office.
Compared to making heroin, manufacturing a kilogram of fentanyl in a laboratory requires less labor and is much faster, because Mexico's unpredictable weather is not a factor.
It also costs about 10 times less: anywhere between $5,000 and $10,000, says Brennan.
Fentanyl is so powerful that half a million pills can be made from just one kilo. They are then sold on the streets of the United States for $8-10 each.
According to the DEA, a kilo of fentanyl purchased in China for between $3,000 and $5,000 can generate revenue of more than $1.5 million in the United States.
Fentanyl, a powerful painkiller approved by the US Food and Drug Administration for a range of conditions, has been central to the American opioid crisis which began in the late 1990s.
The epidemic was sparked by doctors, encouraged by the pharmaceutical industry, overprescribing opioid pain medication oxycodone, sold by Purdue Pharma under the brand name OxyContin.
Drug overdoses are so frequent in part because users who purchase on the street don't know what they are buying, says Brennan.
"They are getting pills that say they are oxycodone but are fentanyl. Sometimes sellers don't know what they are selling," she told AFP.
PRINCE
Purdue -- owned by the Sacklers, one of America's richest families -- filed for bankruptcy last month in a settlement aimed at warding off thousands of state and federal lawsuits related to the opioid emergency.
Powerful opioids like oxycodone had been intended to be used for pain relief for serious illnesses such as cancer, because of how addictive they are.
Between 8 and 12 percent of patients are addicted by the end of the treatment, and many start to purchase black market opiates or illicit drugs such as heroin, according to the National Institute on Drug Abuse.
The danger was tragically illustrated in 2016 when music icon Prince died at age 57 after overdosing on the opioid hydrocodone, which had been mixed, apparently without his knowledge, with fentanyl.
The US Centers for Disease Control and Prevention have reported more than 400,000 deaths from opioid overdoses from 1999 to 2018, with an explosion in the death rate between 2013 and 2017.
MEXICO AND CHINA
China was the first country to manufacture illegal fentanyl for the US market, but the problem surged when trafficking through Mexico began around 2005, according to Donovan.
It was led by major cartels such as El Chapo's Sinaloa group that were seeking to make up for losses endured when Colombian traffickers began skipping Mexico to export cocaine to Europe, Australia, Russia and China on their own.
The Mexican cartels began to produce more poppies in an attempt to manufacture heroin as strong as that found in Colombia.
They failed though, so they started to import fentanyl from China and mix it with heroin to make it stronger and give it a competitive edge.
After El Chapo was first captured in Mexico in 2014, his sons and other traffickers started building more fentanyl labs and smuggling the drug to the US as their profits soared, says Donovan.
To reduce costs and evade Chinese laws, they then began to import only the chemical precursors of fentanyl, going on to make the finished product themselves in their clandestine labs.
President Donald Trump declared the opioid crisis a "public health emergency" in October 2017 and accused China of fueling it.
Against the backdrop of a trade war with Washington, Beijing changed its policy in May and designated all analogs of fentanyl as controlled substances.
But the list does not include many of the precursors needed to make it, allowing Mexican traffickers to fill the void, the DEA's chief for North and Central America, Matthew Donahue, told Congress in July.
He called the manufacture of fentanyl precursors by Mexican cartels themselves "an alarming development."
BORDER SEIZURES
Back at the postal center at JFK airport, seizures of fentanyl are down these days; authorities say most of it is entering the US at official border posts with Mexico.
Mixed with fillers, heroin, methamphetamines or cocaine, or in the form of small blue pills resembling OxyContin tablets, it is hidden in vehicles or trafficked by pedestrians crossing on foot.
CBP's executive director for cargo and conveyance security, Thomas Overacker, recently acknowledged that officers can only inspect about one percent of private vehicles and 16 percent of commercial trucks that enter the US from Mexico.
Seizures are soaring nationwide, however.
Last year, the CBP intercepted 985 kilos (2,170 pounds) of illegal fentanyl and its analogs, compared to less than one kilo in 2013.
When the fentanyl reaches New York, it is mostly distributed by Dominican crime syndicates, according to the DEA's Donovan.
They then hand over profits to Chinese money laundering gangs associated with the Mexican cartels, and which are increasingly present in Mexico, highlighting the global nature of drug trafficking networks.
US authorities have been fighting the drug trade for half a century, but in fentanyl, they are facing the deadliest drug yet.
As well as cracking down on traffickers, the government recognizes that it must also focus efforts elsewhere, such as treating addiction.
The National Institutes of Health has devoted almost $1 billion to tackle the opioid crisis.
"The fight against drug abuse is a generations-long struggle. It will not be completed overnight," Donahue told the congressional hearing.
source: news.abs-cbn.com
WASHINGTON -- The US pharmaceutical industry faces tens of billions of dollars in potential damage payments for fueling the opioid addiction crisis after Oklahoma won a $572 million judgment against drugmaker Johnson & Johnson.
One day after the healthcare giant was found guilty of flooding the market with highly addictive painkillers, another top opioid producer, Purdue Pharma, was reported to have offered $10-12 billion to settle more lawsuits before they come to trial.
Dozens more companies in the US prescription drugs chain -- giants like Teva Pharmaceuticals, Allergan, Mallinckrodt, Walmart, CVS and Walgreens Boots -- could face similarly large payouts as the next major opioids case gears up in Ohio.
Nearly 2,300 lawsuits similar to Oklahoma's have been rolled into one trial to begin in October.
The states, cities, towns and Native American tribes who filed the suits are demanding huge sums to pay for the fallout of the crisis -- overwhelmed health and social systems, families unable to care for themselves, and babies born addicted to the drugs.
$454 BILLION DAMAGE ESTIMATE
The case has drawn comparison to the $206 billion the tobacco industry agreed to pay 46 states in 1998 for the consequences of decades of nicotine addiction.
In the consolidated Ohio case, one estimate submitted to the court puts the total costs that communities face due to the epidemic at $453 billion over the coming decade.
In the Oklahoma case, Judge Thad Balkman said the $572 million would cover estimates of just one year of "abatement," or mitigation efforts related to the rash of addiction and overdose deaths the state has experienced.
Balkman said J&J's aggressive promotion of prescription painkillers, downplaying and hiding the high addiction risks, "compromised the health and safety of thousands of Oklahomans."
That was a clear message for the companies accused of doing the same in the Ohio case.
Purdue, which settled out of court early on in the Oklahoma case for $270 million, confirmed Tuesday it was in talks to avoid going to trial in Ohio as well.
"While Purdue Pharma is prepared to defend itself vigorously in the opioid litigation, the company has made clear that it sees little good coming from years of wasteful litigation and appeals," the company said in a statement.
The company, whose Oxycontin painkiller became an emblem of the addiction epidemic, and whose wealthy owners the Sackler family have come under international scorn, would not confirm or deny the media reports that it had offered up to $12 billion to resolve its liability.
However, it said, "The people and communities affected by the opioid crisis need help now."
"Purdue believes a constructive global resolution is the best path forward, and the company is actively working with the state attorneys general and other plaintiffs to achieve this outcome."
MILLIONS ADDICTED
The cases seek to address the costs of millions of Americans sinking into addiction after using potent opioid painkillers that the companies churned out and doctors freely, and often criminally, prescribed over the past two decades.
Well over 400,000 people died of opioid overdoses in that period, while the companies involved raked in billions of dollars in profits.
And while the flood of prescription opioids into the black market has now been curtailed, addicts are turning to heroin and highly potent fentanyl, where the risk of overdose and death is even higher.
Even so, the lawsuits are complex and legally challenging.
The producers, wholesale distributors and pharmacies that liberally distributed the prescription painkillers argue they acted legally in a highly regulated industry, and say the fault lies mainly in doctors over-prescribing the drugs.
The Oklahoma and Ohio suits depend on evidence showing the drug industry knew the risks and covered them up, encouraging overprescription to make more money.
Both suits rely on "public nuisance" laws that are rarely used in such a case, and J&J says it will appeal Monday's judgment based in part on the over-expansive use of the statute.
But University of Georgia law professor Elizabeth Burch said the Oklahoma case brought out evidence about the drug companies' behavior that had not been seen before -- evidence that could hurt the defendants in the Ohio trial.
"Some of Judge Balkman's key findings will certainly play a role in future cases, but it's the evidence itself, not his ruling that will be on display," she said.
"I think it will have an effect on all the district litigations in Ohio because defendants will see they could be held liable," said University of Richmond law professor Carl Tobias.
"I think some defendants are going to have to think twice about going to trial," he said.
source: news.abs-cbn.com
SHANGHAI - Chinese state media on Friday hit back at claims by US officials that China was failing to crack down on the flow of fentanyl and fentanyl-related substances into the United States, saying that responsibility for opioid abuse lay with users.
The United States was "pushing responsibility" for fentanyl abuse to China and ignoring that Beijing had implemented strict controls on the highly addictive synthetic opioid, reported The People's Daily newspaper, published by the ruling Communist Party.
US officials say China is the main source of illicit fentanyl and fentanyl-related substances that are trafficked into the United States, much of it through international mail. Beijing denies that most of the illicit fentanyl entering the United States originates in China.
"Some people in the United States need to understand, the source of the illness lies within one's body," the newspaper said in an article which bore the pen name "Zhong Sheng", usually used to express its views on foreign policy.
"You can't be rushed to see the doctor, and you can't just scold others once you're ill," it said, adding that the United States had not done enough to fight the epidemic of opioid abuse.
The US Treasury on Wednesday imposed sanctions on three Chinese men accused of illegally trafficking fentanyl. US President Donald Trump accused Beijing of reneging on pledges to stem a flood of the drug into the United States.
source: news.abs-cbn.com
President Donald Trump has repeatedly hit out at China for failing to curb the export of illegal fentanyl to the United States.
The powerful painkiller is the primary synthetic opioid available in the US, a class of drug that was responsible for almost 32,000 overdose deaths last year.
But why is fentanyl's threat growing, and can Beijing help America cure its addiction to its deadliest drug?
- What is fentanyl? -
Fentanyl was first developed in 1959 and introduced to the US market in the 1960s as an intravenous anesthetic.
A hundred times more potent than morphine, it is used to manage severe pain, for example among cancer patients or those receiving end-of-life care.
But it is also produced illegally and trafficked into the US -- primarily from China and Mexico -- in the form of powder or tablets, and sometimes gets mixed with heroin and cocaine.
- Why is it spreading? -
A report published in December by researchers at University of California San Francisco found that fentanyl use has surged in recent years because of heroin and prescription pill shortages, and because it was cheaper for drug wholesalers to produce than heroin.
"Very little drug slang has developed to describe fentanyl, which lends support to the notion that this is not a demand-driven epidemic," said Sarah Mars, a UCSF researcher.
Users are often unaware the products they are consuming contain the drug, and a key market is people who turn to counterfeit medicines for cost reasons.
"Traffickers are exploiting high consumer demand for illicit prescription painkillers, tranquilizers, and sedatives by producing inexpensive counterfeits containing fentanyl," said a report by the Drug Enforcement Agency (DEA).
In 2016, counterfeit prescription painkiller Norco, which actually contained fentanyl, was responsible for at least 14 deaths in California.
- How deadly is it? -
Fentanyl can be lethal in a dose of as little as two milligrams, equivalent to a few grains of sand.
But it is not just deadly to users and can threaten anyone who intercepts it such as postal workers, law enforcement officers, first responders and even sniffer dogs, according to the DEA.
In 2015, New Jersey law enforcement officers carrying out a narcotics field test on what turned out to be fentanyl experienced shortness of breath, dizziness and respiratory distress, according to the Centers for Disease Control and Prevention.
- Where does it come from? -
Powdered fentanyl can be bought on the dark web or even business trading sites like Weiku.com, according to Roger Bate, a scholar at the American Enterprise Institute who published a report on the drug this week.
A kilo sourced from China can be purchased in the US for as little as $1700, which is then used to create up to a million pills that when sold for $10 to $20 each generate millions in revenue, according to the DEA.
Bate's report found that poorly policed free trade zones in places like Singapore and Dubai help bring the products into the US market.
Mexican gangs also play a large role in producing and distributing the drug, with precursor chemicals first smuggled into Mexico via the southwest US.
Some illicit fentanyl products are also brought into the US via Canada, which until 2017 did not allow authorities to open the contents of mail weighing less than 30 grams.
- Can China help? -
Trump issued his latest missive at China over its alleged inaction Thursday, tweeting: "My friend President Xi said that he would stop the sale of Fentanyl to the United States – this never happened, and many Americans continue to die!"
China has in fact already made some efforts to crack down on suppliers, leading to transshipment via Vietnam, said Bate, but it could apply much more pressure to major players in its chemical industry that would yield some results.
But he warned action by Beijing could be limited because the government may not be fully aware of the activities of the tens of thousands of smaller chemical producers operating throughout the country.
What's more, even if its efforts prove successful, other countries with manufacturing capacity like Russia or India could step in as new suppliers.
"It's quite difficult for a few guys in the garage to make, but not difficult for legitimate chemical plants to make," Bate said.
He advocates instead for measures to fund drug and mental health programs so that fewer people become addicted, and greater availability of the drug naloxone to treat those who have overdosed.
source: news.abs-cbn.com
OTTAWA - The epicenter of Canada's opioid crisis, British Columbia province, on Wednesday sued more than 40 drug companies to recover the costs of emergency paramedic responses and hospitalizations for overdoses.
It marks the first lawsuit against opioid manufacturers by a government in Canada -- and the western province said it is in talks with other jurisdictions to join the class action.
"It's time opioid drug companies take responsibility for the human and financial toll their products have taken on so many families," said British Columbia Attorney General David Eby in a statement.
Overprescribing and illicit sales of diverted painkillers have been widely blamed for the opioid crisis sweeping North America.
However, allegations by British Columbia that the drug companies "deceived prescribers and patients about the risks and benefits of opioids" and "seriously harmed the public healthcare system" have not been proven in court.
The suit names opioid manufacturers, wholesalers and distributors as defendants -- including Purdue, whose popular OxyContin drug has been blamed for triggering the crisis -- accusing them of contributing to an "epidemic of addiction."
In the United States, Purdue was among manufacturers named by New York City in a $500 million lawsuit filed in January to recoup costs that could help battle the opioid crisis.
Canadian victims and their families reached a proposed Can$20 million settlement with the company but it was blocked in March by a judge who found the sum to be insufficient.
Purdue and others have since stopped marketing opioids in Canada at the direction of the federal government.
Ottawa has also poured tens of millions of dollars into strengthening emergency services and distributing the overdose antidote naloxone.
Opioid overdoses claimed nearly 4,000 lives in Canada last year, according to public health data. British Columbia was hardest hit, with about a third of those overdose deaths.
amc/ska
source: news.abs-cbn.com
CHICAGO - Nebraska on Tuesday carried out America's first execution using fentanyl -- the opioid at the center of the country's deadly overdose crisis -- as part of a previously-untested, four-drug combination.
Carey Dean Moore, sentenced to death for two 1979 murders, was the first prisoner executed in the Midwestern state in 21 years, in what was its first ever lethal injection.
The 60-year-old was pronounced dead at 10:47 am (1547 GMT). The execution lasted approximately 20 minutes, according to Scott Frakes, director of the Nebraska Department of Correctional Services.
Moore's execution survived a last-minute legal challenge from a drug company and protests about the new lethal injection protocol.
It was a pivotal test for Nebraska, where the state legislature abolished the death penalty in 2015, only to see voters reinstate it the next year in a referendum. The state last performed an execution in 1997 by electric chair.
"I recognize that today's execution impacts many people on many levels," said Frakes.
The execution was carried out with "professionalism, respect for the process and dignity for all involved," he said.
QUESTIONS ABOUT DRUGS USED
The lethal injection consisted of the sedative diazepam to bring on unconsciousness, the painkiller fentanyl citrate, the muscle relaxer cisatracurium to stop breathing, and potassium chloride to stop the heart.
Only potassium chloride has been used before in executions.
Robert Dunham, director of the Death Penalty Information Center, said the new procedure was an indication of the trouble states are having in acquiring death penalty drugs.
"It indicates that states are looking for drugs that are available," Dunham told AFP.
Pharmaceutical manufacturers and providers have been increasingly hostile to selling such drugs to states. Officials across the country have had to scramble to find the execution drugs they need or find alternatives.
Dunham said Nebraska's use of fentanyl was problematic, because use of the powerful opioid is closely controlled by law, and the state has not disclosed its source for the drug.
"The manner in which they obtained it is highly questionable," he said.
COURTS WEIGH IN
Last week, German drug maker Fresenius Kabi challenged Nebraska with regards to two other drugs in the protocol, claiming the company was the likely source of the substances, and if so, Nebraska improperly obtained them.
It demanded that the state disclose the source of its drugs.
But the state insisted the drugs were legally acquired and both a federal judge and an appellate court sided with Nebraska.
Even the pope himself was not able to change Moore's fate.
Two weeks ago, Pope Francis changed the Catholic Church's teaching, declaring the death penalty "inadmissible" in all cases.
Nebraska Governor Pete Ricketts, a Catholic who supported the reinstatement of the death penalty, was resolute.
"While I respect the pope's perspective, capital punishment remains the will of the people," Ricketts said.
A handful of demonstrators gathered during the rainy morning to protest the execution. A small group also gathered in the early evening in the state capital Lincoln to criticize the governor's decision.
"Ricketts would kill Jesus," one protester's sign read.
The American Civil Liberties union also criticized the governor, saying he had carried out an execution "shrouded in secrecy."
"The 38-year-long journey to this execution further proves what we've been saying all along: The ACLU believes the death penalty in America is a broken process from start to finish and should be abolished nationwide," the group said in a statement.
'I AM GUILTY'
Moore had been on death row for 38 years and did not want further delays of his execution.
In 1980, while still in his early 20s, he was sentenced to death for the killings the year prior of two Omaha taxi drivers five days apart.
Expressing contrition, he admitted to fatally shooting the first driver during a robbery committed with his brother, and killing the second driver to "foolishly" prove to himself that he could commit murder on his own.
In his final words, Moore alluded to a written statement dated August 2, in which he pointed to other Nebraska death row inmates who claim their innocence.
"I am guilty, they are not," he wrote. "Why must they remain there one day longer?"
Moore also asked forgiveness from his brother.
Moore's execution was the 16th in the United States this year, according to the Death Penalty Information Center.
nov/ia
source: news.abs-cbn.com
WASHINGTON - U.S. President Donald Trump will declare the nation's opioid crisis a public health emergency on Thursday in a bid to redirect federal resources and loosen regulations to combat widespread abuse, senior administration officials said.
Trump's planned announcement comes in response to an epidemic that has worsened in recent years and especially wreaked havoc in rural areas. But the move stops short of declaring a national emergency, which would have freed up additional federal funds to combat the epidemic.
Officials said the declaration would help fight abuse of prescription painkillers, heroin and fentanyl by expanding access to treatment, and curb delays in staffing the Department of Health and Human Services to help states grapple with the crisis.
"The declaration ... will really reorient all of the federal government and the executive branch's resources towards focusing on providing relief for this urgent need," one official told reporters on a conference call ahead of a speech by Trump on the issue at 2 p.m. ET (1800 GMT).
The United States is battling a surge in opioid-related deaths, including 33,000 in 2015, more than any year on record, according to federal data.
Opioids, primarily prescription painkillers, heroin and fentanyl - a drug 50 to 100 times more powerful than morphine - are fueling the drug overdoses. About 100 Americans die each day from related overdoses, Centers for Disease Control data shows.
The reach of the crisis has pressured Trump to act, but Thursday's move may still frustrate public health officials and others who had urged a quicker and more forceful response.
"We must instill a heightened sense of urgency in the White House," Democratic U.S. Representative Elijah Cummings wrote in an op-ed on Wednesday ahead of the announcement.
In July, members of a White House commission on the drug crisis had recommended that Trump declare a national emergency. One month later, the president said he would make an announcement on the opioid crisis, but later said more time was needed to coordinate the response.
That effort was further complicated earlier this month when Trump’s choice for White House adviser on drug policy, former congressman Tom Marino, withdrew from consideration.
On Wednesday, the president told Fox Business Network he would be declaring the crisis a national emergency, which would have opened up additional federal funds.
But officials told reporters on the conference call Thursday that those funds under the Federal Emergency Management Agency have been nearly exhausted after recent storms struck Puerto Rico, Texas and Florida.
The administration would have to work with Congress to help provide additional funding to address drug abuse, they added.
Thursday's declaration also allows the Department of Labor to issue grants to help dislocated workers affected by the crisis. HIV/AIDS health funding would also be prioritized for those who need substance abuse treatment, officials said.
Additional actions under the move would be announced in coming weeks by various agencies, they said.
source: news.abs-cbn.com
WASHINGTON - Drug manufacturer Mallinckrodt Pharmaceuticals was fined $35 million Tuesday for supplying and not reporting suspicious massive orders of its highly addictive oxycodone, helping to fuel the US addiction crisis.
The Justice Department said the company agreed to pay the amount to settle allegations that it did not meet obligations to report to the Drug Enforcement Administration suspect orders from pharmacies in Florida and elsewhere.
Mallinckrodt, which manufactures drugs in the United States but keeps its corporate headquarters in London, has been under investigation since 2011 by the DEA for shipping huge amounts of oxycodone via distributors to small communities that could not possibly generate demand.
The barely controlled pumping of hundreds of millions of doses of opioids into US communities by major drug manufacturers during the past decade is blamed for a sharp surge in addiction and overdose deaths which totaled an estimated 60,000 last year.
Attorney General Jeff Sessions said in a speech Tuesday that the United States "has paid an increasingly high price for drug abuse. We have paid for it in broken relationships and broken lives and death rates the likes of which we have never seen before."
"Mallinckrodt's actions and omissions formed a link in the chain of supply that resulted in millions of oxycodone pills being sold on the street," he said in a separate statement on the settlement.
The $35 million settlement was equivalent to 7.2 percent of the company's 2016 net profits.
In a statement, the company said it disagreed with the government's allegations and denied it violated any laws.
"We are proud of the fact that Mallinckrodt has long been an industry leader in actively combating the serious issue of prescription drug abuse," said the company's general counsel Michael-Bryant Hicks.
pmh/mdl
source: news.abs-cbn.com
