How Oxycontin, Florida and the Sackler Family Created the Opioid Crisis In America

Why are the Sacklers worth $13 billion today? Answer: “The Oxy Express Explained”

By Mark A. York (July 30, 2018)

 

 

 

 

 

 

 

 

(MASS TORT NEXUS MEDIA)

A COMPARISON OF OXYCODONE PRESCRIBING

In the first six months of 2010, Ohio doctors and health care practitioners bought the second-largest number of oxycodone doses in the country at just under 1 million pills.

Florida doctors bought 40.8 million in the same period, the comparison is astounding, yet it flew under the DEA, Opioid Big Pharma and everyone elses radar for years and years.

Of the country’s top 50 oxycodone-dispensing clinics, 49 were in Florida. From August 2008 to November 2009, a new pain clinic opened in Broward and Palm Beach counties on average of every three days.

Pharmacies and distributors are at fault as well, pharmacies ordered jaw-dropping numbers of pills from opioid drug distributors, the middlemen between manufacturers and pharmacies.

90 of 100 of the nation’s top 100 oxy-buying doctors in 2010, were in Florida. 49 of 50 of the country’s top oxy-dispensing clinics were in Florida. For some reason this didn’t raise an alarm or cause anyone to look further at the time.

Purdue Pharma New What Was Happening In Florida

Purdue and the Sacklers chose to ignore Florida, because apparently nobody there sued them or complained. In 2007, in other states, the infamous drug maker and three of its executives pled guilty in federal court and paid out $634.5 million in fines for purposefully misleading regulators, doctors, and patients about the addictiveness of their opioid painkiller. Around the same time, Purdue was also sued by several states, including Washington, over similar allegations. Purdue agreed to a $19.5 million multi-state settlement. And in 2015, Purdue settled a case with Kentucky, agreeing to pay $24 million.

As part of the state settlements, Purdue was supposed to set up monitoring programs to make sure that its opioid drug didn’t wind up in the wrong hands. It was supposed to watch out for shady pharmacies, unusually large orders, or suspiciously frequent orders. But on this front, Everett alleges that Purdue once again put profits over people.

Obviously, this was ignored as the Florida based “Oxy Expres”; rolled on for years and years with np input, comment or oversight by Purdue Pharma and the Sackler family other than “show me the money” and enjoying a life of luxury on the misery created and managed in the Purdue Pharma boardroom. But, the Purdue boardroom isn’t the only guilty “Opioid Big Pharma” industry player who designed and supported the opioid prescribing crisis.

For the current status of efforts to make Opioid Big Pharma accept responsibility in litigation filed in federal and state courts across the country, see:  https://www.masstortnexus.com/Briefcases/254/OPIOID-CRISIS-BRIEFCASE-INCLUDING-MDL-2804-OPIATE-PRESCRIPTION-LITIGATION

Why Distributors Are Liable

Cardinal Health, one of the nation’s biggest distributors, sold two CVS pharmacies in Sanford a combined 3 million doses of oxycodone, flooding the town of 54,000 with an average of 250,000 oxycodone pills every month.

West of Jupiter, a Walgreens drug distribution center sold 2.2 million tablets to a single Walgreens’ pharmacy in tiny Hudson, a roughly six-month supply for each of its 12,000 residents. It shipped more than 1.1 million pills to each of two Fort Pierce Walgreens pharmacies.

For 40 days starting in late 2010, the distribution center shipped 3,271 bottles of oxycodone — 327,100 doses of the drug — to a Port Richey Walgreens pharmacy, prompting a distribution manager to ask: “How can they even house this many bottles?”

There were 53 million oxycodone prescriptions filled in 2013 by US pharmacies, according to NIDA. This translates to approximately one bottle of this addictive drug for every 6 people in the country. How was this not noticed by those responsible for monitoring narcotics prescribing in the United States?

Charts and Data On Florida’s Oxycontin Gold Mine

https://www.documentcloud.org/documents/3936665-Purdue-Pharma-1-in-48-Study.html

https://www.documentcloud.org/documents/3534759-uS-Atty-on-Purdue-Settle.html#document/p2/a384323

A Boardroom Contrived Opioid Epidemic

This is the pain chart created by the “Opioid Big Pharma Industry” to support massive over-prescribing of opioids across the country to everyone who walked in to a medical treatment facility, this was an effort to increase narcotic prescribing practices in mainstream medical care–and it worked very very well! This chart became a standard treatment assessment protocol tool across the country.

 

 

 

 

https://www.documentcloud.org/documents/3936646-DEA-NATL-DRUG-ASSESSMENT-2010.html#document/p51/a383739

HOW WEST VIRGINIA WAS TARGETED

It-Was-Raining-Opiates-How-drug-companies-submerged-West-Virginia-in-opioids-for-years

Reliably red on the political map, Huntington is a West Virginia town with a 182-year-old university, a storied football team and more than 100 churches.

It’s where Will Lockwood graduated from high school. It’s where he enrolled at Marshall University. It’s where he first tried OxyContin. By the time Lockwood entered Marshall, Detroit dealers were trickling into Huntington, selling OxyContin and pills with OxyContin’s active ingredient, oxycodone.

Even though Lockwood could step out his front door and get the drug, Detroit street dealers weren’t the preferred supplier, they were in Florida.

It may have been 1,000 miles away, but to Lockwood, getting OxyContin and oxycodone from Florida’s loosely regulated pain clinics “was legal, in a sense.”

Twice a month, different “crews” from Huntington crowded into vans and headed south to Palm Beach and Broward counties, home to more than 200 pill mills, the pain clinics where anyone with a fake ache and hard cash could walk out with pills and prescriptions.

After hitting a string of clinics, the Huntington crews drove back with “around 500 to 600 pills per person,” said Lockwood.

But it wasn’t just a few hundred pills. It was tens of thousands.

And it wasn’t just Huntington, The West Virginia vans were part of a nationwide caravan heading to South Florida. Cars bearing tags from Kentucky, Tennessee, the Carolinas, Virginia and Ohio crowded into one clinic parking lot after another, loading up on pills and prescriptions.

News stories and law enforcement focused on those “parking lot” states in Appalachia, where dealers and addicts with a tank of gas or a cheap plane ticket traveled the “Oxy Express” to Palm Beach and Broward.

But Florida’s pill pipeline reached far beyond those roadways.

By 2010, Florida was the oxycodone drug dealer of choice for drug users and dealers in the Great Lakes, Northeast and Mid-Atlantic regions as well as the Southeast, DEA records show, an area spanning virtually every state east of the Mississippi. It wasn’t just that Florida guaranteed a flow of cheap oxycodone. For 10 years, key lawmakers and agency heads repeatedly looked the other way as crooked doctors and bogus clinics flooded almost half the nation with the highly addictive drug.

In failing to crack down, Florida extended by years the amount of time highly addictive oxycodone would be available to both first-time experimenters and addicts. It gave criminals the raw materials for trafficking. It gave Will Lockwood the OxyContin needed to feed his growing habit, It paved the way for his eventual jump to heroin.

Jumping state lines

Teenage high-school wrestling buddies in New Port Richey ran oxycodone into Tennessee; they were paid with cash hidden in teddy bears. A Hillsborough County man mailed 17,000 pills to Glen Fork, W.Va., a month’s supply for every man woman and child in the tiny town.

Boston Chinatown crime boss trafficked pills from Sunrise into Massachusetts, New York, Rhode Island and South Carolina. Wellington twins and pill mill kingpins Paul and Phil George, brothers who oversaw one of the largest operations in the country from their five Palm Beach and Broward clinics, pushing oxycodone into Kentucky, Tennessee, Ohio and South Carolina.

A husband and wife team operating out of a Forest Hill Boulevard clinic funneled pills to Delaware. At Palm Beach International Airport, two federal security agents accepted $500 a pop each time they waved through thousands of pillsbound for Connecticut and New York.

A Palm Bay man’s Puerto Rican family bought local pills destined for the working class town of Holyoke, Mass. In Rhode Island, police pulled over a Lauderhill man caught speeding through Providence. They found 903 oxycodone tablets and 56 morphine pills in the car.

Senior citizen and Tulane business graduate Joel Shumrak funneled more than 1 million pills into eastern Kentucky from his South Florida and Georgia clinics, much of it headed for street sales — an estimated 20 percent of the illicit oxycodone in the entire state.

Van loads of pill-seekers organized by “VIP buyers” traveled from Columbus, Ohio, to three Jacksonville clinics, where armed guards handled crowd control (federal indictment) and doctors generated prescriptions totaling 3.2 million pills in six months. In Miami, Vinny Colangelo created 1,500 internet website names to entice drug users throughout the nation to one of his six South Florida pain clinics or pharmacies.

Even the Mafia got in on the Florida oxy express action: A Bonanno crime family associate oversaw a local crew stocking up on Palm Beach and Broward pain clinic oxycodone, upstreaming profits to the New York family.

At times, it seemed almost no section of the country was free of Florida-supplied pills: When Olubenga Badamosi was arrested driving his Bentley Continental in Miami in 2011, the Oregon man was one of two traffickers overseeing a crew smuggling South Florida oxycodone to sell in Salt Lake City, Seattle and Denver as well as Oregon, Nevada, Texas and even Alaska.

Pharmacy delivers oxy ‘pot of gold’

It would be hard to overstate Florida’s role in feeding the country’s voracious appetite for oxycodone. Oxycodone 30-milligram tablets were favored by addicts. And in 2009 and 2010, roughly four of every 10 of those pills were sold in Florida. Small wonder: Of the nation’s top 100 oxycodone-buying doctors, 90 were in Florida.

Pharmacies, too, ordered jaw-dropping numbers of pills from drug distributors, the middlemen between manufacturers and pharmacies.

Cardinal Health, one of the nation’s biggest distributors, sold two CVS pharmacies in Sanford a combined 3 million doses of oxycodone, flooding the town of 54,000 with an average of 250,000 oxycodone pills every month.

West of Jupiter, a Walgreens drug distribution center sold 2.2 million tablets to a single Walgreens’ pharmacy in tiny Hudson, a roughly six-month supply for each of its 12,000 residents. It shipped more than 1.1 million pills to each of two Fort Pierce Walgreens pharmacies. By contrast, a single Walgreens pharmacy in the Central Florida townOviedo bought 169,700 doses of oxycodone in 30 days.

People on both sides of the counter knew what was going on: In a letter to the chief executive of Walgreens, Oviedo’s police chief warned that people were walking out of the town’s two Walgreens stores and selling their drugs on the spot, crushing and snorting them, or — still in the pharmacy’s parking lot — injecting them.

Why Pharmacies are LIABLE

In Fort Pierce, a Walgreens pharmacist accidentally provided an extra 120 oxycodone pills to a customer. When the druggist called to ask that the man return the pills, the customer’s girlfriend bluntly responded that he was an addict, that he sold oxycodone and the 120 pills were “a pot of gold,” DEA records show.

That was in September. The same man came back to the same Walgreens in December and January with a prescription in hand, and the pharmacy filled his prescriptions every time.

‘Wild West of Oxycodone Prescribing’

Cincinnati-based Masters Pharmaceuticals Inc. was a middling-sized drug distributor selling oxycodone to Florida pharmacies.

It sold to other customers in other states. But mostly, it sold to Florida: Oxycodone made up more than 60 percent of its drug sales in 2009 and 2010, according to federal records. Of its top 55 oxycodone customers, 44 were in Florida.

Company CEO Dennis Smith worried that the Florida-bound oxycodone was getting in the wrong hands. A trip to Broward did nothing to ease his mind. “It was,” he later testified, “the Wild West of oxycodone prescribing.”

Bus and park benches touted pain clinics. When Smith picked up and thumbed through City Beat, a free magazine, he found pages of ads for pain clinics. “It would show young people sitting around a pool and it named the pain clinic and say (sic) ‘we dispense on site,’ and that really hit home hard.”

Smith stopped selling to pain clinics. But the company continued to shovel millions of oxycodone pills to Florida pharmacies. Masters executives figured the pharmacies would keep an eye out for excessive prescriptions written by pill mill doctors. But not all pharmacies were worrying about doctors at pain clinics, many  pharmacies were courting the pill mills prescribers.

A Lake Worth Family Pharmacy

In 2009, the small pharmacy off Lucerne Avenue in Lake Worth had a history. It had been in business for 43 years. The owner and head pharmacist had been there for 32. It had shaded parking and a downtown location, a stone’s throw from the City Hall Annex.

When a Masters inspector visited, he was alarmed to find Tru-Valu Drugs bustling with a long line of young, thin, tattooed customers arriving in groups of 10 to pick up pills. There were signs in the pharmacy warning of limits on the number of oxycodone pills handed out. Even Mallinckrodt Pharmaceuticals, an oxycodone manufacturer, was worried about the volume of its pill sales there.

Of the 300,000 doses of all drugs the small pharmacy dispensed in December 2008, 192,000 were for oxycodone 30 mg, the dosage preferred by traffickers and users alike.

The huge oxycodone volume was no accident. The owner and head pharmacist, unidentified in DEA records, told a Masters inspector that the pharmacy “has pushed for this (narcotic) business with many of the area pain doctors.”

And, despite the torrent of oxycodone going out the door, the pharmacy owner expressed frustration that drug distributors were limiting the amount of narcotics they would sell to his now-closed pharmacy.

Ohio to Florida and Back

Pharmacy after pharmacy benefited from the combination of Masters’ Ohio oxycodone business and Florida’s unregulated pill mills.

In Englewood, north of Fort Myers, the pharmacy owner filled prescriptions for six pain clinics — including clinics an hour’s drive away. A Masters inspector found cars from Tennessee and Kentucky in the parking lot and young men leaving the pharmacy carrying large trash bags.

Superior Pharmacy not only filled oxycodone prescriptions for pain clinics, it shared waiting room space with a pain clinic in a Temple Terrace strip mall outside Tampa. Neither Masters nor Superior had so much as Googled the background of pain clinic doctors writing those prescriptions, the DEA later said.
Had they done so, the DEA dryly noted, they “would likely have come across a press release” announcing one of the doctors had been arrested and charged with trafficking in prescription drugs.

Hundreds of thousands of oxycodone pills were sent from Ohio distributors to Florida pharmacies. Unknown thousands of pills headed right back up to Ohio.

When Ohio police burst into Christopher Thompson’s home outside Columbus, they found an assault rifle, $80,000 in cash and oxycodone from his Florida deals. A construction worker whose own pill habit started at age 14, Thompson oversaw a ring of 15 Ohio buyers who traveled to Florida to pick up oxycodone to resell in Central Ohio.

Two hours to the west in Martin’s Ferry, David L. Kidd orchestrated a ring of buyers traveling to West Palm Beach and Central Florida to pick up oxycodone for resale on the streets of eastern Ohio and West Virginia.

Doctors and pharmacies from Florida were complicit with Kidd’s ring in fueling Ohio’s opioid epidemic, wrote the U.S. attorney for West Virginia after Kidd’s 2011 arrest: “The steady flow of pain pills into the Ohio Valley from Florida must stop.”

Driving To Pick Up Death By Rx

With more drugs came more deaths, in January 2010, say police, Fort Lauderdale pathologist Dr. Lynn Averill started a seven-month oxycodone shopping spree, buying 437,880 oxycodone pills from drug distributors.

The same month, Matthew Koutouzis drove from Toms River, N.J., to see Averill in her Broward County pain clinic. The 26-year-old collected prescriptions for 390 pills and overdosed two days later. Brian Moore traveled 13 hours from his Laurel County, Ky., home to see Averill. He left with prescriptions for 600 pills and also overdosed within 48 hours.

Kenneth Hammond didn’t make it back to his Knoxville, Tenn., home. He had a seizure after picking up prescriptions for 540 pills and died in an Ocala gas station parking lot.

Keith Konkol didn’t make it back to Tennessee, either. His body was dumped on the side of a remote South Carolina road after he overdosed in the back seat of a car the same day of his clinic visit. He had collected eight prescriptions totaling 720 doses of oxycodone, methadone, Soma and Xanax. Konkol had every reason to believe he would get those prescriptions: In three previous visits to the Plantation clinic, he had picked up prescriptions for 1,890 pills.

An estimated 60 percent of her patients were from out of state, a former medical assistant told the DEA. In 2015, Averill pleaded not guilty to eight manslaughter charges. She is awaiting trial in Broward County. Averill was just one doctor at just one clinic. In 2010, the year Averill’s patients overdosed, Florida received applications to open 1,026 more pain clinics.

An online message board advising drug users summed it up: “Just go anywhere in South Florida and look for a ‘pain management clinic.’ It shouldn’t be too hard; you can’t swing a dead cat without hitting one.” Complain about anything from a back injury to a hangnail, it advised, “and they’ll set you right up.”

By this time, Kentucky had reined in its pill mills. It didn’t matter, Ohio, Delaware, North Carolina, Connecticut acted as well, but other state’s efforts didn’t matter either, Florida continued ignoring the pill mills and rogue doctors feeding the nation’s oxycodone habit, the pills flowed.

“There were folks down there, where if I had an opportunity to, get my hands around their throat, I would have wrung their neck,” said Huntington Mayor Steve Williams. On Florida’s inaction he stated, “There was total evidence as to what was happening. It lays at the foot, in my opinion, of the public officials there that allowed it to continue on.”

Governor Jeb Bush Backed A Solution

One of the first dinners Florida Gov. Jeb Bush hosted after moving into the governor’s mansion in 1999 was a small one. Among those sitting at the table with Bush were Lt. Gov. Toni Jennings, state Sen. Locke Burt and James McDonough, who would become the state’s hard-nosed drug czar. There was an urgent topic on the agenda that night: the explosion of prescription painkillers. For the state’s first family, it may have been personal. Bush had talked publicly about one of his children’s struggle with addiction.

By the time the meal ended, all had agreed on the need for establishing a prescription drug monitoring program that would collect information and track prescriptions written for controlled substances, such as oxycodone.

Absent a prescription drug monitoring database, there was no way to know whether someone was “doctor shopping,” going from doctor to doctor, getting more and more prescriptions to feed their habit.

And there was no way to know whether a doctor was overprescribing, key to pinpointing whether a pill mill was operating, and where. Similar databases had been adopted by more than a dozen states. It was being described as a “silver bullet” to curb overprescribing. Soon enough, $2 million to get the database up and running would be on the table — but it came with a catch.

Florida Attorney General Misfires Against Purdue

In 2001, OxyContin-maker Purdue Pharma was fending off early criticism of its blockbuster painkiller. At issue was whether Purdue’s aggressive marketing campaign had misled doctors and patients alike. Purdue and three top executives later pleaded guilty to federal charges of illegally marketing the drug. Far from being safe and non-addictive, OxyContin carried the same addiction risk as morphine, and was every bit as potent.

But that was six years away. In 2001, towns in Maine reported an alarming uptick in crime tied to OxyContin. The first of several congressional hearings was ramping up. Critics and parents who lost children were piling on. Reporters were starting to write stories.

In November, Florida Attorney General Bob Butterworth appeared poised to take on the company. Calling OxyContin street sales “a major threat to public health,” Butterworth told a state Board of Medicine committee that Purdue should consider temporarily taking the drug off the market. It wasn’t only traffickers concerning Butterworth. It was the sales pitch.

In late 2001, Butterworth called a young assistant attorney general into his office and gave him a magazine article on OxyContin and an assignment: Look into Purdue marketing. Former Florida Attorney General Bob Butterworth and Palm Beach County State Attorney Dave Aronberg. The young lawyer, now-Palm Beach County State Attorney Dave Aronberg, said he knew nothing about OxyContin. But he didn’t like what he read.

During the yearlong inquiry, 589 Floridians died after taking oxycodone. Nothing criminal was found, Aronberg later said. Instead, Butterworth and Purdue struck a settlement. As part of a $2 million deal, Purdue would pay to establish a prescription monitoring database, the same silver bullet sought by Bush. After Florida’s computerized system was up and running, the same system would be free to any other state. The entire country, not just Florida, would benefit.

It could have been a groundbreaking deal. There was one catch. State lawmakers had to vote to create the prescription monitoring program by 2004, or Purdue would keep its money.

Marco Rubio Kills The Anti-Oxy Rx Bill

A political gight killed the program. “And there was one person who was responsible,” said former state Sen. Burt, now an Ormond Beach insurance executive. “And it was Marco Rubio.”

A rising state lawmaker in 2002, now-U.S. Sen. Marco Rubio had the clout to make or break the legislation. He had been one of two state House majority whips and was on the fast track to becoming House speaker.

Rubio didn’t kill the 2002 bill out of opposition to prescription monitoring—it was politics “as usual” yet nobody blamed Rubio for the resulting opioid crisis that seems to have started in his political backyard and flourished beyond belief..

U.S. Sen. Marco Rubio, R-Fla., was a leader in the Florida House in 2002 when he blocked a vote on prescription monitoring. That year, Rubio favored a bill changing the Miami-Dade County charter, which failed to pass because of a single “no” vote in the Senate. Burt cast the vote.

Angered by what he saw as Burt’s betrayal, Rubio killed the prescription drug monitoring bill. “When I found out he broke his word, it made the choice easy,” Rubio told The Miami Herald.

It’s not certain that the full Legislature would have passed the bill had it made it to a floor vote. Rubio was the first, not the last, in a line of state legislative leaders over years who would refuse to seriously consider the bill. Most cited privacy concerns.

But prescription monitoring databases in Florida and other states free to use Florida’s model would have pinpointed rogue doctors, would-be pill mills and doctor-shoppers across the country, just as all three were beginning to converge. In doing so, it could have curbed a national opioid epidemic when it was just an emerging problem, not the monster it would become.

Only weeks after the 2002 bill was killed, Bush suppressed a sob as he discussed his daughter’s arrest for forging a prescription. Court-ordered to drug treatment and then briefly to jail, Noelle Bush survived her pill addiction. The 2004 deadline for greenlighting a monitoring system passed. So did Purdue’s million-dollar obligation to pay for it.

Between 2002, the year Rubio killed the database that could have identified doctor-shoppers, and late 2011, when the database finally came online, more than 20,800 Floridians died after taking prescription opioids, including OxyContin, annual Florida Medical Examiners’ reports show. “Not getting that bill through the Legislature resulted in Florida becoming the pill mill capital of the United States,” said Burt.

“There was heartache for thousands of families beyond measure and it didn’t have to happen.”

Florida Officials Were Told Of The Oxy Express 

The East Kentucky hills and valleys of Greenup County suit Keith Cooper, a long-haired undercover cop-turned-sheriff: “It’s a backwater. I tell people all the time I am a hick sheriff from a hick location, and by 2011, the rural county and its sheriff had big city problems.

Greenup is near the stretch of interstate highways that provided drug traffickers and users with a straight shot to Palm Beach and Broward pill mills. It’s less than an hour’s ride to Huntington Tri-State Airport, where a $27 flight to Fort Lauderdale was a popular draw for dealers hoping to stock up.
Arrests for Florida pills soon eclipsed local arrests for pot.

“When we locked ’em up, we take all their pill bottles and all their paperwork, and we found maps to the doctors offices and everything,” recalled Cooper.
“I called the (Florida) medical board and gave them a big list of doctors,” Cooper said. He called the state pharmacy board, too. He got no response.

“So then I called the Attorney General’s Office and the Governor’s Office. I was calling them all, the whole state. Of course, I was talking to the state police the entire time. “I told them, all of the profits were down there. And all of the pain’s up here.” Nothing happened. Florida’s oxycodone pipeline continued to flow.

On the other side of the law in Greenup, Mikey Frazier was banking on it.

The Oxy Express

Frazier was on a scholarship to play baseball at his junior college in Chicago when he suffered a torn rotator cuff. Doctors prescribed Percocet, a pill containing oxycodone, in 2002. When doctors cut him off, he bought it on the street. In 2006, he moved to OxyContin, nearly pure oxycodone. In 2007, he gave his friends money to go to Florida and bring him back pills.

“My buddy had a minivan and he would actually go down one week and take two to three people with him, and then the following week I’d go,” said Frazier. He still remembers the route: “I’d take 64 East to 77 South to 95 South. And it’s just a straight shot.”

Others followed suit. “What got everyone started was because the doctors around here won’t write a strong enough prescription,” he recalled. OxyContin and generic oxycodone still could be had — just not in Kentucky, which had a prescription drug monitoring database.

In Florida, “there was none of that … stuff that they check and find out what doctor you’ve been to,” said Frazier.

“And one person does it, and then they tell a friend, and then they go do it, and that’s how it all really got started here.”

MEDICAID-MEDICAIRE PAID MILLIONS FOR OXY

Tallahassee wasn’t just ignoring the epidemic, It was financing it.

Before her office was raided by law enforcement in December 2001, Asuncion M. Luyao’s patients would wait in a line in the rain to get prescriptions from the Port St. Lucie internist and acupuncturist. She was one of the most prolific prescribers of OxyContin in the state.

And hundreds of thousands of those pills were being paid for by Medicaid, Florida’s taxpayer-financed health program for the state’s poorest and sickest citizens. Between 1999 and 2001, Medicaid shelled out $935,634 for OxyContin prescriptions written by Luyao. That was just OxyContin. Luyao was prescribing an array of addictive drugs. In the 12 months leading up to the clinic raid, Medicaid paid roughly $1 million for 7,000 prescriptions, only about 17 percent of them for OxyContin.

Nor did the raid slow her down. Between the raid and her arrest on trafficking charges four months later, Luyao wrote another 282 OxyContin prescriptions billed to Medicaid. She was not an outlier. In 24 months, taxpayers footed the bill for more than 49 million doses of pills containing oxycodone,  even though there were only 1.36 million Medicaid patients. Half were children.

The sheer volume of pills might have been a tipoff that the drugs were not all intended for legitimate use. So were arrest reports dating to 2001. One man had used his 7-year-old son’s Medicaid number to doctor-shop for OxyContin. A Miramar pharmacist who billed Medicaid $3.7 million for OxyContin pills was charged with paying Medicaid patients $150 each to use their IDs.

Medicaid paid for more than $300,000 to fill Dr. James Graves’ OxyContin prescriptions. The Florida Panhandle physician was the first doctor in the nation convicted of killing patients by overprescribing OxyContin.

Addiction risk for people taking high doses of oxycodone begins climbing after just three days, a recent study concluded. And most people on Florida Medicaid getting oxycodone prescriptions in 2011 were getting much more than a few days worth. They were getting an average of nine months worth of pills, state officials said.

  • Pill mill doctors prescribed 1 million of those pills:
  • Doctors working for the George twins’ trafficking empire prescribed at least 102,081 oxycodone pills billed to Medicaid before the ring collapsed in 2010.
  • Working out of a Delray Beach pain clinic founded by a convicted drug smuggler,  Zvi Harry Perper, son of the Broward County medical examiner, was arrested on trafficking charges, but not before he wrote prescriptions to Medicaid patients for 115,977 doses of oxycodone in 90 days.
  • In Lake Worth, Cesar Deleon was arrestedas part of a DEA pill mill sweep and charged with 55 counts of illegally distributing drugs. Deleon wrote orders for 20,302 oxycodone pills for Medicaid patients.
  • Miami internist Dr. Selwyn Carrington authorized 32,411 doses of oxycodone for Medicaid patients in just two years. He was busted for signing his name to hundreds of prescriptions.

Further, Florida wasn’t in any hurry to stop doctors linked to pill mills.

Carrington was arrested for overprescribing in March 2011. The state’s emergency order to suspend his license was signed months after he had pleaded guilty in 2012.

Perper was busted at a Delray Beach pill mill operated by a former felon in 2011. The state did not act against his license until 2014.

Joseph M. Hernandez was writing prescriptions from his car, a veritable pill mill on wheels, when he was busted in February 2010 on one count of trafficking in oxycodone.

.Florida’s Department of Health didn’t file paperwork to restrict his license for almost 18 months.

During that time, Hernandez wrote oxycodone prescriptions for Medicaid patients totaling 258,940 doses representing a taxpayer-footed bill of $130,165.

Purdue Pharma’s Profits Before Patients Creed

Kelly Skidmore is exactly the type of person Purdue Pharma’s OxyContin marketing was intended to reach: Diagnosed with juvenile arthritis, the former state legislator’s struggle with chronic pain began at age 4.

Skidmore was wary of opioid painkillers, though, one reason her willingness in 2009 to work with Purdue was surprising. But she did it to get Florida’s dormant drug monitoring database up and running.

Then a state representative in a district straddling Palm Beach and Broward counties, Skidmore recalled that, “They came to me and said, ‘Could you help get it across the finish line?’ ”

OxyContin and prescription opioids, a serious problem in 2002, had evolved into a full-blown crisis in the ensuing seven years. Broward alone had more pain clinics than it had McDonald’s. Deaths tied to oxycodone had exploded, up by 263 percent since the prescription monitoring database had first been proposed and killed. Overdoses from prescription opioids were claiming more than seven lives a day.

“By God, if we had had seven dolphins a day dying and washing up on Florida beaches, we would have been appropriating money and solving it,” Skidmore said.

Skidmore believed a database wasn’t going to resolve the underlying addiction crisis. Still, it was a start. Not a silver bullet, but “maybe silver buckshot,” she said. The database law passed with gaping loopholes. No health care professional would have to report opioid prescriptions or check the database before prescribing more, and the state refused to pay for it.

“Just to get that one little piece … took nine years of filing bills and then it had no teeth,” Skidmore said. “And it should have been the easiest piece.”

Where Was The DEA and Everyone Else?

The DEA all but wrung its hands over Florida’s lethal inaction. The agency ticked off a devil’s brew of regulatory loopholes: Florida’s Health Department regulated health care professionals but not pain clinics. The state’s Agency for Health Care Administration regulated pain clinics that accepted insurance, but pill mills were most often on a cash-only basis. And the prescription monitoring database, mired in a vendor dispute, remained stalled.

In early 2011, when Gov. Rick Scott took office, just one drug — oxycodone — was tied to six fatal overdoses a day. Deaths tied to all drugs claimed 25 a day. In the handful of Appalachian states where traffickers were bringing back South Florida pills, it was worse.

Ohio’s death rate for oxycodone and similar opioids had doubled in 24 months, federal records show. Kentucky’s was up by more than 50 percent. And in West Virginia, home to hard-hit Huntington, death rates tied to pill mill drugs such as oxycodone and Opana had climbed by 341 percent.

The DEA formally pinpointed Palm Beach, Broward and Miami-Dade counties as the nation’s single biggest hub for trafficking pills across state lines. Within weeks of being sworn in, Scott abolished Florida’s Office of Drug Control, eliminating the state drug czar position, announced plans to drive a final stake in the heart of the database and rebuffed Purdue Pharma’s renewed offer to help pay for it.

Scott, a tea party conservative, cited privacy concerns, expressed skepticism the monitoring program would work and raised the possibility taxpayers would be left with a $500,000-a-year bill to operate it.

Attorney General Pam Bondi had also ridden the tea party wave to her position. She shared many of Scott’s conservative convictions. Unlike Scott, the former prosecutor relentlessly lobbied to keep the database alive. Florida’s failure to adopt the drug monitoring database was so out of step with the rest of the country that it began spawning conspiracy theories on both sides of the law.

Everyone knew prescription monitoring was going to kill the pill smuggling business, said a corrupt Florida Highway Patrol trooper as he drove a load of pills out of Florida, according to a federal lawsuit. Talking to the confidential informant in the seat next to him, the trooper speculated someone in Tallahassee must have a piece of the action, “because (Scott) was so adamant about not putting that system in place. Right?”

In Greenup, an infuriated Cooper told a reporter, “In my opinion, (Scott’s) getting money from somewhere. He has to be.” A few days later, recalled Cooper, “A lieutenant with the state police I’d been talking to down there called me, said, ‘Man, just a head’s up: I wouldn’t come to Florida.’” In states on the receiving end of the Florida pill pipeline and among federal officials, Scott’s resistance triggered outrage.

In Kentucky, where as much as 60 percent of the illicit oxycodone in that state flowed from Florida, Lt. Gov. Daniel Mongiardo proposed erecting billboards at the Florida line: “Welcome to the Oxy Tourism Capital of the World.”

U.S. House Appropriations Chairman Hal Rogers, also from Kentucky, twice wrote Scott. “Canceling Florida’s prescription drug monitoring program is equal to firing firefighters while your house is ablaze,” he wrote.

  1. Gil Kerlikowske, director of the White House Office of National Drug Control Policy, asked to meet with Scott. So did DEA Administrator Michele Leonhart.

Three U.S. senators — New York’s Chuck Schumer, West Virginia’s Joe Manchin and Rhode Island’s Sheldon Whitehouse — joined Florida’s Bill Nelson in pointing out that the pills weren’t just a Florida problem: There were “serious ramifications for the rest of the country,” wrote Nelson of Scott’s reluctance to crack down. This is a perfect example of how political rhetoric, in-fighting and contrived agendas prevented an early stop to the emerging opioid crisis many years ago.

WHY DIDN’T THE DEA, DRUG DISTRIBUTORS AND PHARMACIES TAKE NOTICE BEFORE THE OPIOID CRISIS SPREAD ACROSS THE COUNTRY LIKE WILDFIRE? WAS IT BECAUSE OF THE BILLIONS IN PROFITS, QUARTERLY BONUSES AND DIVIDENDS? STOCK OPTIONS CASHED IN BY BOARDROOMS AT EVERY OPIOID BIG PHARMA COMPANY?  STAY TUNED FOR HOW “PROFITS BEFORE PATIENTS” BECAME THE NORM

(article excerpts and quotes have been taken from publicly available media sources and court records)

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BARD HERNIA MESH MDL 2846 JPML HEARING JULY 26, 2018 SANTA FE, NM

In re: MDL 2846 Davol, Inc./C.R. Bard, Inc. Polypropylene Hernia Mesh Products Liability Litigation

By Mark A. York (July 18, 2018)

BARD POLYPROPYLENE HERNIA MESH MDL 2846

 

 

 

 

 

 

 

 

 

 

 

MASS TORT NEXUS MEDIA) In what may become one of the largest single-defendant multidistrict litigation cases ever consolidated, the U.S. Judicial Panel on Multidistrict Litigation (JPML) hearing on consolidation is set for July 26, 2018 when the JPML will be requested to consolidate cases filed against C.R. Bard/Davol, alleging injuries related to their polypropylene hernia mesh products. See JPML Hearing Order July 26, 2018 (In re: Davol, Inc./C.R. Bard, Inc. Polypropylene Hernia Mesh Products Liability Litigation)

Lead counsel on the consolidation are Fleming, Nolen & Jez, L.L.P., Houston, Texas; Brenes Law Group, P.C., Aliso Viejo, California; Chapin Legal Group, LLC, Columbus, Ohio; and Hollis Law Firm, P.A., Prairie Village, Kansas who jointly filed the motion to consolidate on April 10, 2018.

The hernia mesh products at issue were manufactured by C.R. Bard, Inc. and its subsidiary, Davol, Inc., which control close to 70 percent of the U.S. hernia mesh implant market.  There are close to 100 hernia mesh lawsuits currently pending against C.R. Bard and Davol in federal courts around the country, which is expected to increase drastically upon formal consolidation into MDL 2846..  All claims involve injuries allegedly related to the companies’ polypropylene hernia mesh implants, including the Ventralex and Perfix devices and several others, the product pool encompasses almost all Bard/Davol polypropylene hernia mesh products. Plaintiffs allege that the devices were defectively designed and caused extensive long term complications, debilitating post-surgery injuries and adverse reactions.

The motion, also supported by Bard/Davol, has proposed the U.S. District Court Southern District of Ohio, or alternatively, the Western District of Missouri, as possible venues for the multidistrict litigation. Bard alternatively requested the MDL be transferred to U.S. District Court in New Jersey or the Southern District of New York.

Discussions on Bard MDL 2846 took place with co-lead counsel Kelsey L. Stokes of Fleming, Nolen & Jez, L.L.P., Houston, Texas and Adam Evans of Hollis Law Firm, P.A., Prairie Village, Kansas.

Ms. Stokes commented: “We represent hundreds of clients that have been seriously injured by hernia mesh products manufactured by Davol/C.R. Bard.  We have observed that these devastating injuries are occurring all across the United States.   Because of this widespread harm, we moved for coordination and consolidation under Section 1407.  We believe the suggested venues offer convenience to all parties and have docket conditions that are conducive to the most efficient path to a fair and just resolution for our clients.”

Ms. Stokes added, “Considering Davol/CR Bard is the market leader for products used in the most commonly performed surgery in the United States, this MDL has the potential to be one of the largest medical device MDLs ever.  The number of cases could very well reach into the hundreds of thousands.”

Adam Evans clarified the role of revision surgeries in determining eligibility to file a claim: “Having undergone a revision surgery is not a precondition to filing a case. Nor does a revision surgery, in itself, give rise to a viable case.  The question of whether or not a person has undergone a revision surgery presents a sort of false dichotomy as we evaluate these cases. All that is necessary to file a case is that a plaintiff has suffered an injury, which evidence indicates was caused by a defect in the product.  A revision surgery often provides us with the evidence with which we can connect the injury with the product defect, but there are oftentimes other sources of evidence that a defective product has caused an injury.

For example, treating physicians can conduct imaging studies, nerve conduction studies, and other types of tests, the results of which would permit them to conclude that the product is causing the symptoms of which the plaintiff complains.  On the other hand, regarding revision surgeries, a second surgical prodedure may result in findings that rule out the product defects as a cause of the patient’s symptoms.  In the end, a medical determination that the plaintiff has been injured by the mesh in some way is generally necessary in order to justify filing.”

Both Ms. Stokes and Mr. Evans are available to discuss the Bard MDL, as well as any other questions or concerns you may have regarding hernia mesh issues in general.  The list of Bard/Davol products sought to be included in MDL 2846 is fairly significant and covers almost all of the Bard polypropylene hernia mesh products.

 BARD MDL 2846 POLYPROPYLENE HERNIA MESH PRODUCTS

  • Composix
  • Composix E/X
  • Composix L/P
  • Ventralight
  • Spermatex
  • Sepramesh
  • Ventralex
  • Ventralex ST
  • Kugel Patch
  • Composix Kugel
  • Ventrio
  • Visilex
  • Ventrio ST
  • Marlex (AKA Flat Mesh; Bard Mesh)
  • Perfix Plug
  • Perfix Light Plug
  • 3D Max Light
  • 3D Max

 COMMON INJURIES

Many of the complications associated with hernia repair involving mesh are multi-factorial, and any case must undergo in-depth analysis to ascertain whether the defects of a hernia mesh played a role in the complications.  Here are some of the injuries which patients throughout the country are reporting following implantation of one of these hernia mesh products:

  • Mesh infection
  • Chronic, debilitating pain
  • Mesh migration
  • Mesh contracture
  • Hernia recurrence (as a result of migration and/or contracture)
  • Mesh rupture (aka “mechanical failure”)
  • Wound dehiscence
  • Fistula or sinus tract formation
  • Adhesions of mesh to bowel
  • Bowel perforation
  • Bowel obstruction (as a result of adhesions)

There are many other types of adverse health effects which can stem from these complications, and research is ongoing as to the direct relationship between polypropylene mesh implants and other conditions such as auto-immune disorders.

Joshua S. Kincannon, Lomurro Law Firm in Freehold, New Jersey is counsel in another emerging hernia mesh litigation, the Ethicon “Multi-Layered Hernia Mesh” Litigation, which is the subject of a pending MCL application in New Jersey State Court. Mr. Kincannon stated in support of the Bard MDL 2846: “For decades, medical device manufacturers have utilized polymers that are not safe or effective for permanent implantation in the human body.  The hernia mesh litigation is just another example of what happens when there is little to no oversight into how these products are designed, manufactured and sold to the public.”

 The moving plaintiffs are represented by Kelsey L. Stokes and George M. Fleming of Fleming, Nolen & Jez in Houston; Adam M. Evans and C. Brett Vaughn of the Hollis Law Firm in Prairie Village, Kansas; Troy A. Brenes of the Brenes Law Group in Aliso Viejo, Calif.; and Steven C. Babin Jr. of the Chapin Legal Group in Columbus, Ohio.

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THE OPIOID CRISIS AND URBAN AMERICA: “NOW FIRMLY A PART OF BIG CITY LIFE”

“THE OPIOID CRISIS IS NOW PART OF URBAN AMERICA AND BIG CITY LIFE”

Mark A. York (July 12, 2018)

Trash left by drug users under bridge in Philadelphia.  (Washington Post image)

 

 

 

 

 

 

 

 

 

 

 

(MASS TORT NEXUS MEDIA) According to sources at all levels from police and fire first responders to emergency room physicians across the country and analysts at the CDC, there’s been no slowdown in opiate based medical emergencies in the US over the last 2 years. Emergency response and ER visits for opioid overdoses went way up, with a 30 percent increase in the single year period of June of 2016 to June of 2017, according to the Centers for Disease Control and Prevention.  This is now much more common in big city and urban areas of the country that it was just four years ago.

Center for Disease Control’s Acting Director Dr. Anne Schuchat said overall the most dramatic increases were in the Midwest, where emergency visits went up 70 percent in all ages over 25. The affected populations and demographics are comparative to prior medical crisis deaths during historical healthcare pandemics when a disase struck across entire populations, while sparing no particular class of society.

See OPIOID-CRISIS-BRIEFCASE-INCLUDING-MDL-2804-OPIATE-PRESCRIPTION-LITIGATION

WHY THE HUGE INCREASE IN THE MIDWEST?

ER visits for opioid-related emergencies more than doubled in two states. Wisconsin saw the biggest increase, 109 percent and Delaware saw a 105 percent increase. In Pennsylvania, ER visits were up 81 percent.

“We’re seeing the highest ever death rates in the US,” Schuchat said. She pointed to national statistics that out of 63,000 overdose deaths in 2016, 42,000 of them involved opioids.

https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

“[This] means 115 people die each day from opioid overdose,” she said. This number has been at or above 100 for most of the last 3 years, with no end in sight and with so many different regions affected it may require more grassroots focus and demands made to elected officials to move faster on a long term solution.

There were some decreases reported in the East, with the largest being a 15 percent reduction in Kentucky, which could reflect fluctuation in drug supplies or interventions.

However, hospital visits in cities of all types increased steadily in each quarter by 51 percent. Schuchat emphasized, “Bottom line — no area of the US is exempt from this epidemic.” Looking closer at causation and access to opiates across the country is required. How are unlimited numbers of federally controlled substances still so readily accessible to so many?

US Surgeon General James Adams was also present during the briefing and mentioned how he witnessed first-hand his own young brother’s struggle with opioid addiction.

“Science is clear: Addiction is a chronic disease and not a moral failing,” the doctor said. Adams outlined that a coordinated effort is necessary to prevent opioid addiction. “To successfully combat this epidemic, everyone must play a role,” he noted.

The Surgeon General explained how health departments, along with public safety and law enforcement officials, have to work together to deal with local opioid-related emergencies.

He stressed the need to make naloxone, a life-saving drug that can reverse the effects of an overdose, more accessible in emergency situations.

URBAN AMERICA AND OPIODS

 

 

 

 

 

 

 

The CDC data shows trends in opioid overdose emergency room

In late 2016 through current medical data from the CDC and hospitals across the country, the opioid epidemic is fast becoming a big city problem.

There was a 54 percent increase in overdoses from July 2016 through September 2017 in the major metro areas of 16 states surveyed by the federal Centers for Disease Control and Prevention — a chunk of the country that includes Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio.

Nationwide, the scourge that President Donald Trump has vowed to defeat shows no sign of abating, with a 30 percent increase in opioid overdoses reported during that same period, the data released Tuesday shows.

Drug Overdose Death Rates in the U.S. Are Rising Everywhere, CDC Says

Anne Schuchat, the CDC’s acting director, said the grim new arithmetic, which came from emergency room statistics, confirmed some suspicions. “We’re currently seeing the highest drug overdose death rates ever recorded in the United States,” Schuchat said in a Q&A session with reporters. Asked specifically about the rise in urban opioid overdoses, Schuchat said health officials suspect a “change in the toxicity” of drugs on the street.

Major US Cities Filing Suit Against Opioid Big Pharma-New York, Seattle, Chicago Join MDL 2804

Urban heroin dealers have been boosting profits by cutting their drugs with fentanyl, which is 25 to 50 times more powerful. That combination was why Columbus was averaging one fatal overdose per day in the first half of last year.

“The issue of cutting heroin with fentanyl is a very major problem right now,” Schuchat said. “What you are seeing in Columbus is for sure occurring in other

Daniel Raymond, deputy director of the Harm Reduction Coalition, said that initially the opioid overdose rates “were primarily driven by prescription painkillers — they weren’t concentrated in urban areas.”

“But the recent rises are mostly driven by heroin, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets,” said Raymond, whose organization is based in New York City. “That’s certainly true in places like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths. That doesn’t mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers.”

The only bright spot — and it’s a dim one at that — was that the CDC found decreases in opioid overdoses in states like West Virginia, New Hampshire and Kentucky that have been leading the nation in the category.

“We hope this is a positive sign,” said Schuchat, who credited leadership, particularly in West Virginia, with taking bold steps to combat the crisis. “But we have to be cautious in the areas that have reported decreases.” Dr. Rahul Gupta, Director of Public Health for West Virginia has been at the forefront of addressing the opioid crisis in not only West Virginia but across the country. Dr. Gupta will be the keynote speaker at the Mass Tort Nexus National “Opioid Crisis Summit, July 20-22, 2018 in Fort Lauderdale, FL where he will be joining other prominent national healthcare and legal speakers on providing solutions to the opioid crisis, see www.opioidcrisissummit.com for attendance information.

“Sometimes places that have had such high rates have no place to go” but down, she added, with West Virginia being one of the states to address the issues pro-actively in all  areas.

The new CDC “Vital Signs” report was released a week after Attorney General Jeff Sessions issued a “statement of interest” in support of local governments that are suing the big pharmaceutical makers and distributors, accusing them of swamping many states with prescription painkillers and turning millions of Americans into junkies.

The new CDC numbers come from analysis of emergency room data from 16 states, including some hardest hit by the plague — Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maine, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin.

The CDC Research Shows:

  • Emergency rooms in half of the states surveyed reported “substantial” increases in opioid overdoses, with mammoth jumps in Wisconsin (109 percent), Delaware (105 percent), Illinois (66 percent), Indiana (35 percent), Maine (34 percent) and North Carolina (31 percent).
  • The Midwest, in particular, saw a 70 percent increase in opioid overdoses.
  • The only state with a “statistically significant decrease” was Kentucky (15 percent). “The decrease in Kentucky may reflect some fluctuations in drug supply,” Schuchat said.
  • “Nonsignificant” decreases of 10 percent or less were reported in Massachusetts, New Hampshire, Rhode Island and West Virginia.
  • The highest rate of increases were in large metro areas, which the CDC defines as a population of 1 million or more “and covering a major city.”
  • Every demographic group saw a substantial increase in overdose rates, including men (30 percent), women (24 percent), people ages 25 to 34 (31 percent), 35 to 54 (36 percent), and 55 or older (32 percent).

Is Fentanyl The New Crack Cocaine?

https://www.drugabuse.gov/publications/drugfacts/fentanyl

The Centers for Disease Control and Prevention issued a Health Alert Network warning about the increased supply of the illicit drugs, which are many times stronger than fentanyl, the prescription painkiller.

“The dramatic rise in the supply of illicitly manufactured fentanyl and fentanyl analogs has been mirrored by an equally dramatic rise in deaths involving synthetic opioids other than methadone, a category which includes fentanyl and fentanyl analogs,” the CDC said in its alert.

Death rates doubled between 2015 and 2016, the CDC said. “More than 55 percent of opioid overdose deaths occurring nationally in the 12 months ending November 2017 involved synthetic opioids, accounting for more than 27,000 overdose deaths,” the CDC said in the health alert, citing preliminary numbers.

That’s up from 20,000 overdose deaths from synthetic opioids in 2016.

Other illicit synthetic opioids include furanylfentanyl and acrylfentanyl. “Finally, drug submissions testing positive for a synthetic illicit opioid known as U-47700, first encountered by the DEA in 2016, increased from 533 submissions in 2016 to 1,087 during January–June, 2017,” the CDC said in the alert, referring to the Drug Enforcement Administration.

What Is Fentanyl?

Fact Sheet: Fentanyl-Laced Heroin and Cocaine (fentanyl-analogues)

  • Fentanyl, a schedule II prescription narcotic analgesic, is roughly 50-80 times more potent than morphine. This medication is used to manage both pain during surgery and chronic moderate to severe pain for persons who already are physically tolerant to opiates. • However, fentanyl also can be produced in clandestine laboratories in powder form and mixed with or substituted for heroin.

“Ohio alone reported more than 1,700 opioid overdose deaths testing positive for fentanyl analogs during July 2016–June 2017, with more than 1,100 of those deaths involving carfentanil.”

Emergency responders and physicians may not know that people overdosing on the synthetics may need extra care, the CDC said.

Fentanyl and Fentanyl Analogs Defined

For updated information on the opioid crisis and MDL 2804 (Opiate Prescription Litigation USDC Northern District of Ohio, Judge Daniel Polster) subscribe to www.masstortnexus.com/news

 

 

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Johnson & Johnson Latest Baby Powder Cancer Trial Continues In Missouri

J&J’s Facing Latest Baby Powder Cancer Trial Alone In Missouri Court

By Mark A. York (July 6, 2018)

 

 

 

 

 

 

ANOTHER J&J BABY POWDER OVARIAN CANCER TRIAL

(MASS TORT NEXUS MEDIA) The case of Gail Ingham v. Johnson & Johnson, No. 1522-CC10417, Circuit Court, City of St. Louis, Missouri, Judge Rex Burlison

Johnson & Johnson is flying solo in their latest baby powder cancer trial underway in St. Louis City Circuit Court, in front of Judge Rex Burlison, who has refused the many attempt by J&J to dismiss, remove and simply evade another ovarian cancer trial linked to J&J’s baby powder. This time they’re standing alone, after co-defendant Imerys Talc settled claims with 22 plaintiffs right before the trial began. The US unit of French minerals company Imerys SA settled claims by women for at least $5 million, related to Imerys mined talc supplied to Johnson & Johnson for making baby powder that’s been linked to ovarian cancer in several previous trials across the country.

The question becomes, just when did J&J become aware of the many adverse events and dangers of using its baby focused Talcum Powder products that have also been used by millions of adults worldwide?

See Mass Tort Nexus Briefcase: J&J Talcum Powder Litigation-St-Louis-County-Missouri

At the start of the trial, plaintiff trial attorney Mark Lanier told jurors about a study of infants who had been born dead. “They took biopsies and all of them had asbestos that had migrated from the womb across the placenta.”

Then Lanier showed the jury an internal J&J email where someone at the company recommended moving the product from the baby aisle or replacing talcum with corn starch.

Lanier has stated he’s uncovered stacks of new evidence showing J&J officials knew by the 1960s its baby powder was tainted with at least trace amounts of asbestos and hid the product’s cancer risks to protect its reputation.

Why would Johnson & Johnson be sending internal e-mails of this type, if there weren’t known risks associated with the talc products?

J&J USE OF FRONT COMPANIES AND LOBBYING GROUPS

With J&J at the helm, the Cosmetic Toiletry and Fragrance Association (CTFA), now the PCPC, formed a talc lobbyist group in response to the first epidemiologic studies that discovered an association between ovarian cancer and genital talc use in the early 1980s. J&J and Luzenac, now Imerys Talc, were the primary actors and contributors to the Talc Interested Party Task Force (TIPTF). J&J and Imerys coordinated all the activities of the talc lobbyist group in the District of Columbia.

The stated purpose of the TIPTF was to pool financial resources of primarily J&J and Imerys to collectively defend talc at all costs and prevent regulation of any type over the cosmetic ingredient. The talc lobbyist group hired scientists to perform biased talc safety research studies. Members of the lobbyist group edited research reports by scientists on their payroll prior to submitting them to governmental agencies. Furthermore, TIPTF members knowingly released false information about the safety of talc to the public and used political and economic influence on regulatory bodies to prevent any intervention.

PCPC coordinated the defense of talc and acted as a mouthpiece for TIPTF members, including J&J and Imerys. PCPC’s revenue is generated through a dues system based on its members’ annual sales. $76.5 billion in annual sales puts J&J in the top hundred of the highest grossing companies in the world, and the highest revenue generator in the PCPC. Consequently, the PCPC had an extremely vested interest in protecting J&J’s products and financial interests.

J&J SUPPRESSED ADVERSE FINDINGS ON TALC

According to scientific evidence, there have been studies showing a direct link between talcum powder and ovarian cancer that started emerging close to 50 years ago. How as this kept from public view? Starting in 1971, Dr. W.J. Henderson and other notable researchers in Cardiff, Wales conducted the first study that suggested an association between talc and ovarian cancer.

In 1982, the first epidemiological study on talc powder use in the female genital area emerged. This study found a 92 percent increased risk of developing ovarian cancer in women who reported genital talc use. Shortly after the study’s publication, Dr. Bruce Semple of J&J spoke with lead researcher Dr. Daniel Cramer. Dr. Cramer advised Dr. Semple that J&J needed to place a warning on its talcum powder products about ovarian cancer risks so that women could make informed decisions about their health. Since 1982, there have been more than 27 additional epidemiological studies indicating a significant link between talc and ovarian cancer.

In 1993, a U.S. National Toxicology Program published a study on the toxicity of non-asbestiform talc that determined that there was clear evidence of carcinogenic activity. Consequently. researchers concluded that talc was a carcinogen, with or without asbestos contamination. Then, in 1994, the Cancer Prevention Coalition notified J&J’s CEO that studies as far back as the 1960s “…show conclusively that the frequent use of talcum powder in the genital area poses a serious health risk of ovarian cancer.”

The coalition further indicated that 14,000 women die from ovarian cancer each year and that this type of cancer is very difficult to detect and has a low survival rate. The coalition begged the company to withdraw its talc products from the market or at least provide safety information.

Since then, the World Health Organization, the Canadian government, and various other cancer organizations have classified talc as a carcinogen.

The Ingham v. Johnson & Johnson Missouri Trial

The current case before Judge Burlison is at least the fifth ovarian cancer trial held in his court in the last two years. In previous trials, plaintiffs from across the country have been awarded substantial judgments totaling more than $300 million. One of the first talc trials resulted in a $72 million verdict for Jacqueline Fox, of Birmingham, AL which was vacated by a state appeals court last October, based on the US Supreme Court’s Bristol-Myers Squibb (BMS) v. Superior Court of California decision of June 2017 related to non-resident plaintiffs in state court actions.

This current case filed by Gail Ingham of O’Fallon, Mo. was removed to federal court last year by J&J, but US District Court Judge Stephen Limbaugh remanded it back to Judge Burlison’s court in July.

On May 15, 2018 Burlison told parties to get ready for trial and ruled that he would not sever, transfer or stay claims, finding sufficient contacts between Johnson & Johnson in Missouri to invoke a long arm statute.

WIDELY DIFFERENT VIEWS

Johnson & Johnson has defended lawsuits alleging its baby powder caused ovarian cancer in women in the past, as several trials across the country have linked their illnesses to exposure to asbestos in the company’s talc.

The talc cases which now number close to 10,000 in state and federal courts, with claims that the company sold talc in its iconic white Johnson’s Baby Powder bottles knowing it either caused ovarian cancer or was tainted with asbestos and failed to warn consumers to protect the brand.

A J&J representative, said in an emailed statement “The talc in Johnson’s Baby Powder does not contain asbestos or cause ovarian cancer and we will continue to defend the safety of our product,”

J&J FACING OVER 9,000 SUITS

Last month, jurors in California awarded a woman who said she routinely used talc on children and herself $25.7 million over her mesothelioma diagnosis. A South Carolina jury couldn’t reach a verdict on similar claims the same week as the California ruling.

Those decisions followed a New Jersey jury’s finding in April that J&J and a unit of talc supplier Imerys SA must pay $117 million to a banker who claimed his cancer was tied to baby powder use.

J&J still faces talc lawsuits by more than 9,000 plaintiffs, primarily focused on ovarian cancer, according to a May securities filing. That number has grown from 1,200 in 2016. An unknown number of consumers claim that J&J’s talc products caused mesothelioma. See J&J Talcum Powder MDL 2738 USDC New Jersey Briefcase.

 WHEN AND WHAT DID J&J KNOW ABOUT TALC DANGERS?

In opening statements, Lanier said the “big fight” in the case was whether there’s asbestos in J&J’s talc products and whether J&J knew it and hid it.

He then offered that multiple studies by universities, companies, agencies and even J&J itself found asbestos in talc, but that J&J had “manipulated the science in more ways than I can count” to obscure the facts. The company was compelled to protect its baby powder brand as its “sacred cow,” based on the millions of dollars earned every year.

“To say that J&J rigged test results is false,” Peter Bicks, J&J’s lawyer  told jurors. “J&J always went above and beyond in testing for asbestos.”

Most of the women in St. Louis trial used baby powder, but others used Shower-to-Shower, another of J&J’s talc-based products which J&J sold the product to Valeant Pharmaceuticals International Inc. in 2012 and Valeant now faces asbestos suits over that body powder product.

The women, whose jobs range from school bus driver to executive director of a job-retraining program, come from states across the country, such as Pennsylvania, California, Arizona and New York. Six of the women have died, so their families are pressing wrongful-death claims against J&J.

When Krystal Kim, one of the women suing, learned testing by her lawyers of the Johnson’s Baby Powder she used showed it was laced with asbestos, she felt sick. “I was scared and mad at the same time,” said Kim, a 52-year-old former computer consultant now battling ovarian cancer. “It certainly wasn’t what I expected to have in my house or to be putting on my body every day.”

Kim traveled to St. Louis for the trial and she’s banking on jurors holding J&J accountable for her cancer after hearing Lanier’s evidence. “I’m hoping this jury says no more little girls should be harmed by this powder,” she said. “I’m hoping it stops here.”

The trial is expected to last another week to 10 days and we will provide updates until a verdict is returned.

The case is Ingham v. Johnson & Johnson, No. 1522-CC10417, Circuit Court, City of St. Louis, Missouri, Judge Rex Burlison

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Opiate Rx Big Pharma And “Profits Before Patients” Have Taken A Toll On American Children – Now A Part Of Daily Life In The USA

Opioid Industry Model of “Profits Before Patients” and The Impact on American Children

By Mark A. York (July 5, 2018)

 

 

 

 

 

 

 

 

 

 

(MASS TORT NEXUS MEDIA) In West Virginia, home of the highest overdose rates in the nation, the foster population has increased by 42 percent since 2014. 

The number of children in state or foster care hit a record low in Massachusetts earlier this decade. Since then, that number has risen by a quarter, and there are now more children in state care than ever before.

In Ohio, the number of children in state custody has grown by 28 percent since 2015. Foster populations are up more than 30 percent in Alabama, Alaska, California, Idaho, Indiana, Minnesota and New Hampshire since 2014. states like Illinois, Oklahoma, Massachusetts, Pennsylvania, Colorado and New Jersey now adopting new approaches to help keep parents and children together, even as parents are receiving treatment for their addictions.

“We are now seeing major opioid related social issues in areas not previously seen, including white suburban communities, urban areas, rural areas, crossing gender lines, racial lines, economic disparity, this flew under the mainstream radar for 15 years”

>States, Counties, Cities and others are now suing opioid drug makers and distributor in both state and federal courts, see Mass Tort Nexus Briefcase “Opioid Litigation Versus Opiate Prescription Industry MDL 2804, US District Court of Ohio”

The opioid epidemic plaguing the nation is taking a catastrophic toll on our most  vulnerable group, the children of the opiate addicts and those with substance use disorders. Many children are sent to live with grandparents or other family members, often due to a parent overdose or other addiction displays other problems but tragically, a growing number are being placed in the foster-care system, with many states unable to keep up with the demand from both a budget as well as staffing is struggling to keep up with demand.

From 2013 to 2015, the number of children in foster care nationwide jumped almost 7 percent to nearly 429,000, according to the U.S. Department of Health and Human Services’ Administration on Children and Families, the 2016 to 2018 numbers have moved that number closer to 550,000. Parental substance use was cited as a factor in about 32 percent of all foster placements. From 2000 to 2015, more than half a million people died of an overdose, and currently 91 people a day die from opiate overdoses.

Unfortunately, many children, the indirect victims of the crisis, are not getting the care and services they need. “This is a neglected subpopulation,” says John Kelly, PhD, associate professor of psychiatry in addiction medicine at Harvard Medical School, and the founder and director of the at Massachusetts General Hospital. “Because we’re trying to put out the fire in terms of stopping overdose deaths, we haven’t really been attending to other casualties, including kids most importantly.”

To lessen the long-term effects on children, psychologists are treating children in the foster-care system in outpatient, inpatient and residential treatment programs and in school-based mental health programs.

“Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance.  https://www.ncbi.nlm.nih.gov/pubmed/28406856

[STUDY OBJECTIVES: The prevalence of opioid use disorder (OUD) during pregnancy is increasing. Practical recommendations will help providers treat pregnant women with OUD and reduce potentially negative health consequences for mother, fetus, and child. This article summarizes the literature review conducted using the RAND/University of California, Los Angeles Appropriateness Method project completed by the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration to obtain current evidence on treatment approaches for pregnant and parenting women with OUD and their infants and children]

Everett Washington Schools and Opioids

The front office at an elementary school was never intended as an intake center for drug-counseling and social-services referral hub.  For 31 year old Tiffany Smith and others in Everett, it has become just that for the last two years, as she attempts to end her heroin addiction while raising three children.

Smith often chats with the office staff and updates Principal Celia O’Connor-Weaver on her progress in treatment. The first time she ventured inside, Smith carried paperwork from Child Protective Services, and needed to tell the principal that her children, who taken into foster care months before might still get visits from state social workers, even now that the kids were returned home.

Explaining all of this to the principal meant describing what led to the boys’ removal, which meant confessing that she had been addicted to opiates, at times living in her car, the kids staying at her grandmother’s house, until her grandmother finally called state authorities.

“I was afraid of the judgment, that my kids would be affected at school , but it wasn’t that way at all. They said they have a lot of parents that have gone through opiate addictions and what can we do to help? It was not what I was expecting.”

In her six years as principal at the elementary school in Everett, an epicenter of the opioid crisis in Washington, 525 Snohomish County kids were removed from addicted parents just in 2017, in Seattle’s King County, more than 1,000 children were removed.

This problem is now prevalent across the United States where schools, social service agencies and public-health workers scramble to stem adult addictions, less visible have been the reverberations downstream, the children of opioid addicts. Educators and child-welfare workers have reported increased learning problems and behavioral outbursts from the kids of addicted parents. Research suggests dire life-outcomes for these students. Yet the potential for school-based interventions has been underutilized — even as public-health investigators say schools offer the most efficient hope for stemming a looming social crisis.

During the most mundane moments, like recess, teachers watch and 8-year-olds pretend to revive overdosed patients, or hearing how a parent confesses that they’ve relapsed.

The focus of schools should be learning and teaching kids, but often many kids’ minds are not focused on that, they’re worried about their parents, about their next meal and who’s going to be home to take care of them. When a parent becomes addicted or goes into rehab, it changes everything for a family.

Drug users’ children flooding to foster care

In Tiffany Smith’s case, three years of methadone treatment have helped her regain solid enough footing to secure housing and begin working toward a GED, in hopes of becoming a drug and alcohol counselor. But her children are still reeling. Smith’s 6-year-old cannot stand to be apart from his mother and struggles with speech, cognitive and learning delays.

“He was talking fine before foster care,” Smith said. “But when he came out, he couldn’t pronounce some words. They said it was due to the trauma.”

Her older son, now 7, was born prematurely and spent his first two days of life trembling from heroin withdrawal as his mother watched, devastated. “Seeing my baby shake from detoxing really hurt — I knew it was my fault,” she said.

In Washington state, this number is alarming, but not widely known, 10,000 high-school seniors said they’d used heroin or gotten high on opioid-derived painkillers in 2016, those numbers were about the same as two years prior, but foster care placements have surged.

Between 2011 and 2017, the state took children from drug-abusing parents nearly 14,000 times. Last year’s rate was the highest for drug-related causes since 2010 — up 16 percent over 2015 — while state hospitals report a steady increase in substance-exposed newborns.

Child-welfare workers hear complaints about increasingly severe problems in school — more physical violence toward peers, or kids who need to be taught separately — from students whose parents are staggering through addiction, said Jenna Kiser, who oversees intake at the state Children’s Administration.

Jenny Heddin, a state agency supervisor stated, “These numbers are very concerning, when children from these homes come into foster care, they can be very difficult to serve.”

This represent one corner of a national wave. More than 37 states report unprecedented numbers of kids entering foster care, many of them for reasons related to a parent’s substance abuse, according to the federal Department of Education.

Damaging children’s futures

By the time Child Protective Services is knocking on someone’s door, the problem is already severe. And so far, efforts to respond might best be described as triage — focused more on addiction treatment than prevention, both in Washington and across the country.

As in many other states political infighting prevents treatment, earlier this year, Washington Gov. Jay Inslee proposed spending $20 million on a multipronged effort to combat opioid addiction. The bill never made it to the floor for a full vote, and it contained little funding for prevention. (But $1.7 million targeted for youth did get funding.)

Yet researchers warn that ignoring that aspect of the crisis virtually guarantees costly problems to come as the children of addicts grow into adulthood. Kevin Haggerty, a professor at the University of Washington who studies risk factors for drug abuse, authored one of the few peer-reviewed studies tracking life outcomes for these young people.

In the early 1990s, he identified 151 elementary and middle-school children in Washington who were growing up with heroin-addicted parents. Fifteen years later, as young adults, 33 percent had dropped out of high school. The vast majority were addicts themselves, and half had criminal records. Only 2 percent had made it through college. (Nationally, 33 percent of all kindergartners in 1992 grew up to earn a college degree.)

“The results are astounding at how poor the outcomes are, having a drug-addicted parent,” said Caleb Banta-Green, principal research scientist at the Alcohol and Drug Abuse Institute at the University of Washington’s School of Public Health.

“We need to be doing a lot more for kids being parented by opiate-addicted parents — and we’re not.”

“Families literally bring their problems to our door now to help them navigate their lives,” Harrington-Bacote said. “Public schools are doing things that fall way outside of regular academic education. But if they don’t, it’s not going to get addressed at all.”

OHIO EXAMPLES OF HOW BIG PHARMA OPIOID Rx MONEY DESTROYS LIVES

Way before social workers showed up in his living room this March, Matt McLaughlin, a 16-year-old with diabetes, had taken to a routine not of his doing, trying to scrounge up enough change for food while his mom, Kelly, went out to use heroin. On a good night, the high school junior would walk his neighborhood in Andover, Ohio to pick up frozen pizza from the dollar store, and on bad nights, he’d play video games to keep his mind off his hunger and unknown blood sugar levels.

When Matt was little, his mom Kelly was a Head Start caseworker who taught parents how to manage their autistic children, who hosted potlucks and played Barbie with Matt’s sister, Brianna. “Growing up, we were the house that everyone wanted to come to,” remembered Brianna, now 20. “I loved every minute of it.”

Kelly had neck surgery and got addicted to OxyContin, and by 2015, she was spending her days napping, disappearing for hours at a time, or going to her neighbor’s house, where she would exchange cash for packets of heroin. She started yelling at the kids, food became scarce, life changed for the worse, “It’s like her personality did a 180,” Brianna said. “I felt like I lost my mom to this pit that I couldn’t pull her out of.”

Ashtabula County Children Services a tip when someone called the police and urged them to check on the family.

She’d been to detox several times over the years, trying to rid herself of what felt like a demon that had taken over her brain. Last year, she managed to stay clean for 63 days, until a friend came over “and laid out a line—and that was all it took.” There are five heroin dealers within a five-mile radius and all more than willing to provide an addict the opiate of choice, which is the norm for rural Ohio anymore.

He kids were once again forced to pack their bags as Kelly would go to detox another time, they were lucky to have relatives nearby: The spiraling opioid epidemic has disrupted so many families that all the foster homes in Ashtabula County are full, this story is repeated across the country every day.

The scourge of addiction to painkillers, heroin, and fentanyl sweeping the country has produced a flood of bewildered children who, having lost their parents to drug use or overdose, are now living with foster families or relatives. In Ashtabula County, in Ohio’s northeast corner, the number of children in court custody quadrupled from 69 in 2014 to 279 last year. “I can’t remember the last time I removed a kid and it didn’t have to do with drugs,” says a child services supervisor.  Her clients range from preschoolers who know to call 911 when a parent overdoses to steely teenagers who cook and clean while Mom and Dad spend all day in the bathroom. Often, the kids marvel at how quickly everything changed—how a loving mom could transform, as one teenager put it, into a “zombie.”

The pattern mirrors a national trend: Largely because of the opioid epidemic, there were 30,000 more children in foster care in 2015 than there were in 2012—an 8 percent increase. In 14 states, from New Hampshire to North Dakota, the number of foster kids rose by more than a quarter between 2011 and 2015, according to data amassed by the Annie E. Casey Foundation. In Texas, Florida, Oregon, and elsewhere, kids have been forced to sleep in state buildings because there were no foster homes available, says advocacy group Children’s Rights. Federal child welfare money has been dwindling for years, leaving state and local funding to fill in the gaps. But Ashtabula County is one of the poorest counties in Ohio, and despite a recent boost in funding, the state contributes the lowest share toward children’s services of any state in the country. 

More Broken Families, Less Funding

Ohio also has one of the nation’s highest overdose rates. In 2016, at least 4,149 Ohioans died of drug overdose—a 36 percent jump from the year before, according to the Columbus Dispatch. In 2015, 1 in 9 US heroin deaths occurred in Ohio.

It’s hard to overstate just how pervasive the epidemic feels here. Detective Taylor Cleveland, who investigates drug cases in Ashtabula, told me, “I’m dealing with ruined homes two and three times a day.” Cleveland, who coaches youth soccer and recently adopted a 17-year-old player whose mom overdosed, leads a task force that responds to every overdose in the county. Once, he arrived at an overdose scene only to realize that the victim slouched over in the motel room was his cousin, whose young daughter had called 911. “Every OD that happens, I get a text. I’ve gotten two texts while we’ve been talking.” We’d been talking for less than an hour.

Given the scale of the crisis, it’s not hard to understand why, when Donald Trump promised Ohioans on the campaign trail to “spend the money” to confront the opioid crisis and build a wall so drugs would stop flowing in, locals in this historically blue county took notice. In late October, Trump became the first presidential candidate since John F. Kennedy to visit Ashtabula County. He promised to bring back jobs, to open the long-shuttered steel plants, to build the wall. Twelve days later, Ashtabula residents voted for a Republican president for the first time since Ronald Reagan in 1984.

WHITE HOUSE PROMISED ON OPIOIDS BUT DIDN’T DELIVER

But since he took office, Trump’s plans to tackle the epidemic head-on have fizzled. Republicans’ recent effort to repeal and replace Obamacare would slash funding for Medicaid, which is the country’s largest payer for addiction services—and which covers nearly half of Ohio’s prescriptions for the opioid addiction medication buprenorphine. The bill would enable insurers in some states to get out of the Obamacare requirement to cover substance abuse treatment. A memo leaked in May revealed Trump’s plans to effectively eliminate the White House’s drug policy office, cutting its budget by 95 percent. (The administration has since backpedaled on the plans, following bipartisan criticism.) Trump’s 2018 budget proposes substantial cuts to the Administration for Children and Families, the Substance Abuse and Mental Health Services Administration, and the Temporary Assistance for Needy Families program.

“I think some people felt as though nothing else is working,” said one Ashtabula resident when I asked why so many in a Medicaid-dependent area would vote for Trump. Now, she says, “I’m really, really scared. You don’t get it until you live in a small town and you see people die every day.”

Like so many other Midwest Rust Belt counties, Ashtabula, Ohio has seen better days. Locals proudly tell me that the Port of Ashtabula used to be one of the biggest in the world, where barges unloaded iron mined from Minnesota’s Mesabi Range onto trains headed for the steel mills of the Ohio River Valley. Today, once-bustling streets have given way to vacant storefronts and fast-food chains; the surrounding countryside is made up of farm fields, trailer parks, and junkyards. One in three kids now live below the federal poverty line, less than half of adults have a high school education. The financial downturn accelerated in the ’90s, when manufacturing jobs started disappearing.

Then Opiate Big Pharma and their marketing campaigns introduced newer “less addictive” painkillers like OxyContin and others like Vicodin were liberally prescribed in communities wrestling with dwindling economic opportunity and rife with workplace injuries common to mines, lumberyards, and factories. As authorities started to tighten the rules on prescribing drugs like OxyContin, the use of heroin, which is chemically nearly identical to opioid painkillers, crept up. But the tipping point, for Ohio and the country, came over the past couple of years, when illicit fentanyl, an opioid up to 100 times more powerful than morphine, started making its way into the heroin supply. Since then, says Dr. Thomas Gilson, the medical examiner for nearby Cuyahoga County, the deaths have been coming “like a tidal wave.”

About five years ago, Ohio noticed a major uptick in the number of parents using heroin. More recently, elected officials have learned more about the parasitic way that opioids co-opt the brain and the complex pull of addictions attitudes have softened, with most realizing, there is no good guy or bad guy, once addiction takes hold. The long term problems are often multiplied many times over by lack of short term treatment.

Gov. John Kasich, a notorious budget hawk, made national news when he pushed Medicaid expansion through Ohio’s conservative Legislature. “When you die and get to the meeting with St. Peter,” he told one lawmaker, “he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor.” He made news yet again last week, when he signed a 2018 budget that will, for the first time in years, increase the state’s funding for children’s services. Yet the $30 million boost in funding over two years, which will pay foster parents and provide counseling for the kids, won’t make up for the $55 million increase in child placement costs over the past three years. Other than county pilot programs, “No policy or state investment has focused specifically on the children flooding into county agency custody as a result of the opioid epidemic,” concluded a report by the Public Children Services Association of Ohio this spring.

Meanwhile, federal funding for children’s services decreased by 16 percent between 2004 and 2014. That’s due in part to an arcane law stipulating that the largest pot of federal money for children’s services applies only to kids from below a certain income threshold. In many states, that threshold is about half the poverty level—in Ohio, it’s roughly $14,000 per year for a family of four. But the opioid epidemic has afflicted families of all stripes. “A few years ago, I was constantly just in homes that were clearly in poverty,” says Mongenel. Now she’s struck by her new clients’ well-kept houses: “You pull up to it and it’s like, ‘Really?’”

The director of one Ohio county stated “that more caseworkers are quitting than ever before, unable to reconcile the overwhelming caseload with the paltry salary, which starts at $28,500..’”

Another addiction case is Amber, a 16-year-old whose mother, Emily, was in and out of rehab for a year, while Emily cycled in and out of rehab. In December, officials got the phone call that Emily had been found dead, slumped over in a motel bed, and a social services worker had to break the news to Amber that they had run out of chances, her mother had died.  Today, Amber lives in a what is her new home, a bustling house with nine other foster kids.

Then there is Jake, another 6-year-old with boy-band looks who lived for months in a motel over the 2017 winter with his two younger siblings, taking courses online and playing video games, while his mom went out to use. “He just wanted her to go into rehab and get right,” he told a reporter earlier this year, “If that could be my birthday present or my Christmas present, that’s what it would be.”

Lisa is a 10-year-old, introduced to Ohio social services for the first time in a conference room at her elementary school, the agency rep told her “We’re from children’s services have you ever heard of that before?” Lisa nodded and replied “they’re the people who go to her friend’s house once a month to make sure everything is okay,” in a matter of fact way.

Lisa was asked, “Do you have enough to eat?” and “Do you like where you’re staying?” and Do you know what drug use is?”  but it wasn’t mentioned that CPS had just visited Lisa’s house and found her father strung out on heroin in the bedroom they share. Lisa’s bed was a pink sleeping bag on a piece of foam surrounded by pill bottles.

Children in Lisa’s situation are subject to incredible psychological stress. There’s the immediate trauma of living with an unstable parent or being taken from family and sometimes from school and friends. But there’s also the long-term impact. Dozens of studies have found that kids who undergo traumatic events early in life are more likely to suffer mental and physical repercussions later on, be it substance abuse, depression, heart disease, or cancer. Among the 10 so-called Adverse Childhood Experiences, or ACEs, are emotional abuse, physical abuse, separation from parents, and parental substance abuse.

“Every time a child gets into a scary or dangerous situation, it activates their stress response,” explains Dr. Nadine Burke Harris, a pediatrician and founder of the Center for Youth Wellness, which focuses on the developmental effects of childhood trauma. “The repeated activation of their stress response is what leads to the biological condition that we in pediatrics are now calling toxic stress.” Looking at the brains of kids of drug users, Burke Harris says, one would expect to see the signs associated with other types of trauma: an enlarged amygdala, the brain’s fear center; decreased functioning of the nucleus accumbens, the brain’s pleasure and rewards center; and less activity in the prefrontal cortex, which oversees a child’s ability to control impulses and pay attention.

CPS and affiliated social services agencies across the United States are now becoming much more familiar with the latest addiction research on ACEs and impacts on young children. They know that a child with four or more ACEs is twice as likely as other kids to develop cancer and ten times more likely to inject drugs themselves. When they encounter someone like Lisa, they are torn between mitigating one ACE, exposure to parental substance abuse, and catalyzing another: separating a child from her parents. Which is what makes these conversations so heart-wrenching.

For county and state professionals, one of the most difficult things about managing opioid cases is how unpredictable they can be, never knowing how a client’s drug-addicted parent will do after detox. Some thrive and are quickly reunited with their families. Others can’t pull themselves out of the black hole of addiction.

One positive outcome amid the many negatives, is the mother of Matt, the diabetic teenager, Kelly had sailed through detox and been sober for nearly a month, her daughter Brianna had moved back in to help her mom. In the fall Brianna is leaving for college—training to be a social worker, Kelly joked “I’m going to be her first case,” and added “When I was using, I would sleep half the day away” and wake up feeling sick from heroin cravings, she said. “Now I’ve been setting my alarm. I wake up early, enjoy my coffee, open the blinds, and let in the sunshine.” On her walks to town, she said, she crossed the street and looked straight ahead to avoid catching a glimpse of her dealer’s house, an ever-present temptation.  Brianna and Matt often visit Kelly at an addiction treatment center.

Every 19 minutes, an opioid addicted baby is born in America., while many of us are well aware of the repercussions of addiction in adults, but very little is understood about the impact it has on infants. After months of being fed opioids through the mother, these babies suffer through excruciating pain.

Imagine, then, how it feels for a baby. Infants who have been exposed to opioid painkillers like morphine, codeine, oxycodone, methadone treatment or street drugs such as heroin while in utero are literally cut off from the drugs when they are born. Within their first 72 hours of life, about half of the babies who have been exposed begin having withdrawal symptoms.

The medical term for this is neonatal abstinence syndrome, or NAS, and rates of babies born with it are rising along with the exponential increase of painkiller use and abuse.

A recent analysis by the Centers for Disease Control estimated that nearly six out of every 1,000 infants born in the U.S. are now diagnosed with NAS. However, experts say that rate is likely higher, as not all states regularly collect such data.

In the USA, Opioid use by women in rural areas is driving the increasing numbers. Tennessee is part of a cluster of states, including Alabama and Kentucky, experiencing some of the highest rates of NAS births. In East Tennessee the problem is particularly acute: Sullivan County alone reported a rate of 50.5 cases of NAS per 1,000 births, the highest rate in the state for five years running.

Tennessee is currently the only state in the country that equates substance abuse while pregnant with aggravated assault, punishable by a 15-year prison sentence. Eighteen other states consider it to be child abuse, and three say its grounds for civil commitment. Four states require drug testing of mothers and 18 require that healthcare professionals report when drug abuse is suspected. There are also 19 states that have created funding for targeted drug treatment programs for pregnant women.

Opponents of the punishment philosophy claim that punishing addicted pregnant women will not stop them from abusing drugs – instead it will stop them from seeking prenatal care. Many also claim that these policies would unfairly punish mothers for drug use compared to fathers. Organizations, such as the American Civil Liberties Union (ACLU) and the American Congress of Obstetricians and Gynecologists (ACOG), have encouraged a treatment over punishment approach for pregnant mothers with drug addictions.

Opioid use by women in rural areas is driving the increasing numbers. Tennessee is part of a cluster of states, including Alabama and Kentucky, experiencing some of the highest rates of NAS births. In East Tennessee the problem is particularly acute: Sullivan County alone reported a rate of 50.5 cases of NAS per 1,000 births, the highest rate in the state for five years running.

In Canada, in the past decade, the number of babies exposed to opioids in the womb has increased 16-fold in Ontario. And according to Ontario’s Provincial Council for Maternal and Child Health (PCMCH), more than 950 infants were born to opioid-addicted mothers last year. Just over half of them will live the toughest days of their lives in their first week outside the womb.

Until the governments at the federal, state and local levels can all agree on a long term viable solution to the opioid crisis and the impact on school age children, infants born addicted and society as a whole, the opiate drug crisis will linger for generations long into the future.

 

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