Of Money and Mummies

The roots of the Sackler empire are based upon the fraudulent marketing techniques of their blockbuster drug, Oxycontin which is directly responsible for staggering numbers of needless deaths.

I recently visited the Metropolitan Museum of Art in New York City. There, you will find the Sackler Wing which contains treasures from the age of the Egyptian pharaohs. You will also find Arthur M. Sackler galleries at the Smithsonian Institute ,Harvard and Beijing University. Many people do not know the Sackler name apart from their association with these lofty cultural institutions.

Arthur M. Sackler has been referred to as a marketing genius and the godfather of the modern-day drug advertising industry.  He developed  drug marketing techniques such as: direct to consumer advertising , sponsoring luxurious all expense paid medical education courses for doctors, glamorizing drugs as a quick fixes, and  paying for "scientific" studies backing the need for and/or efficacy of the particular drug being studied.

Arthur Sackler, who was already rich, made a fortune marketing and selling Librium and Valium. Later, younger brothers Mortimer and Raymond  joined Arthur in acquiring a little known drug company called the Purdue Frederick Company. Arthur died in 1987 at the age of 73.  In 1996 the family owned company, now known as Purdue Pharma introduced it’s new blockbuster drug, Oxycontin.

Oxycontin is a very powerful, long acting narcotic which is should only be prescribed for  serious pain. Purdue Pharma  recognized even before the drug was marketed that they would face stiff resistance from doctors who were concerned about the potential for  OxyContin to be abused by patients or cause addiction.

Taking a chapter from brother Arthur’s drug marketing playbook, Mortimer and Raymond embarked on the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller. Purdue Pharma marketed  OxyContin to doctors like general practitioners, who often had little training in the treatment of serious pain or in recognizing signs of drug abuse in patients. One of their techniques was to fly physicians in to conferences about the "inadequate treatment of pain" and the need for doctors to aggressively prescribe narcotics like Oxycontin to their patients.

Just a few years after the drug’s introduction in 1996, annual sales reached $1 billion.

 In reality, Oxycontin proved to be a powerfully addictive drug. Some users  including teenagers, soon discovered that chewing an OxyContin pill or crushing one and then snorting the powder or injecting it with a needle produced a high as powerful as heroin. By 2000, parts of the United States, particularly rural areas, began to see skyrocketing rates of addiction and crime related to use of the drug. The drug came to be known among certain circles as "hillbilly heroin"

 A  comprehensive review of the problem appeared in the journal Pain Physician http://www.painphysicianjournal.com/2006/october/2006;9;287-321.pdf

CDC and DEA data included in the review suggested that from 1997-2004 there was a:

> 556% increase in the sales of oxycodone;

> 500% increase in therapeutic grams of oxycodone used,

> 568% increase in the non-medical use of OxyContin (especially among young people)

 > 129% increase in opioid-related deaths [without heroin or cocaine]:

Using this data, the author extrapolated that the number of deaths from Oxycontin could surpass the deaths from 911 and the Iraq war combined!

 By 2007 the government caught up with Purdue which resulted in  three current and former executives pleaded guilty  to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused. Purdue paid over $600 million in criminal and civil penalties.

Photographs by Don Petersen for The New York Times

From left, Howard R. Udell, the top lawyer for Purdue Pharma; Dr. Paul D. Goldenheim, the company’s former medical director; and Michael Friedman, Purdue’s president.

The last chapter of the Oxycontin saga has not been written. Despite their assertions to the contrary, Purdue Pharma has not cleaned up their act. Read between the lines on Partners Against Pain and you’ll see some of Arthur’s old tricks still being used.

There is much more to be written about Purdue Pharma and their dirty and deadly deeds. However, I was just so struck by seeing the Sackler name associated with such a venerable institution as the Metropolitan Museum of Art that I thought you should know what this family did to deserve having a wing of a famous art museum named after them.

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Drugged Driving in America

The data relating to drivers under the influence of drugs is very worrisome. A 2007 Survey by the National Highway Traffic Safety Administration (NHTSA) found that 16.3% of all nighttime weekend drivers were drug positive.

According to Gil Kerlikowske, Director of the Office of National Drug Control Policy:

"This troubling data shows us for the first  time, the scope of drugged driving in America, and reinforces the need to reduce drug abuse. Drugged driving, like drunk driving is a matter of public safety and health. It puts us all at risk and must be prevented."

Interestingly, a new NHTSA survey found that drunk drivers are on the decline. In 1973, 7.5% of drivers surveyed had a blood alcohol level of 0.8% or higher. In the latest survey, that figure had fallen to 2.2%.

In my opinion, one of the reasons for the decline in drunk driving is the public awareness campaigns by organizations such as MADD. Another reason is strict enforcement of DUI laws.

The data suggests that drugged driving may prove to be even a bigger threat to public safety than drunk driving. Fortunately, organizations like Parents Against Prescription Drug Abuse (PAPDA)  and Stop Drugged Driving are stepping up to the plate to raise awareness of our nation’s prescription drug epidemic.

We must call upon law enforcement to increase screening of drivers who are suspected of being under the influence of drugs and for strict prosecution of those who are found to be driving while drugged.

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Is Big Pharma’s next blockbuster Viagra for the brain?

I was recently walking through La Guardia airport in a typical traveler’s daze when a prominently displayed magazine cover jumped out at me.The title was "Pills to make you smarter".

I was hooked. I had to read more. Make no mistake. I wasn’t in the market for a magazine in the first place. I was already heavily laden with the six issues of my local bar publication that I had been intending to read. And frankly, if I was going to buy a magazine it was pretty tempting to succumb to the urge to find out what exactly is going on with Lindsey Lohan. But the magazine marketing geniuses made a first time purchaser of Scientific American out of me.

The article, "Turbocharging the brain", queries: "Will a pill at breakfast improve concentration and memory-and will it do so without long term detriment to your health"? The article chronicles the fascinating scientific developments in cognitive enhancement drugs to treat Alzheimers and other dementias. But, it also raises a very disturbing question. Will these drugs ultimately be marketed and sold to healthy people as "lifestyle enhancement" drugs?

Currently, neuroethicists are debating this issue in the neuroscientific community. I certainly am not qualified to enter that debate. However, this is what I do know. With the advent of direct to consumer marketing, the big pharmaceutical companies have spoon fed us a steady diet of propoganda that there is a pill for everything that ails us. We are the "super size me" generation who believes that more is better. Multi-billion dollar industries have profited from our desire to eat more, be stronger, look better, and perform better in the bedroom.

The temptation to "super size" our brains could create an enormous demand for these "smart drugs", or as some have referred to them "viagra for the brain". As one neuro ethicist put it "Within the pharmaceutical field, people recognize that a successful cognitive enhancer could be the best selling pharmaceutical of all time".  We needn’t say more at this point. With the potential for hundreds of billions of dollars to be made, the pharmaceutical industry will find a way to use their slick marketing machines to convince us that we "need" these drugs. They will pay scientists and physicians to write articles in esteemed medical journals advocating their use and minimizing any potential side effects. Mark my words. It may not be in my lifetime, but this will come to fruition.

So, at the end of the day, the pharmaceutical industry will continue to wield enormous power over us. Some futurists have concocted the symbol "H1" to denote an enhanced version of humanity. Think of all the "lifestyle enhancement " drugs that can be peddled to the super-sized human.  The question is what does this make us as human beings, what would a society of super-sized humans look like and would you want to live in it?

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Appearance on Dan Rather Reports Tonight, October 27th!

Please tune in for a special Dan Rather Reports episode tonight , Tuesday October 27th at 8:00 PM EST on HDNet . The episode will feature the growing national pill mill problem by profiling Ken and Esther Scarborough of Beaumont, Texas, whose 25-year-old son, Christopher, died an accidental death caused from combined drug toxicity on September 23, 2007.  

I represent the Scarborough family and will also appear on the episode to discuss prescription drug diversion throughout the U.S.

VIEWING DETAILS:

  • Where: HDNet Dan Rather Reports
  • Live:  Viewing details at HDnet
  • Recording: download the episode on iTunes

 

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What is a pill mill?

A pill mill is a doctor’s office or medical clinic whose purpose is not to treat sick or injured patients, but instead to reap enormous profits through the illegal diversion of prescription drugs. Law enforcement estimates that there may be tens of thousands of these pill mills currently operating in the United States.

While not all pill mills look alike, they can often times be spotted by the crowds of people gathering in their parking lots or the makeshift banner advertising "pain management" or "pain clinic". Pill mill doctors rarely have any pain management credentials, usually do not have hospital privileges, see 80-100 patients per day and typically only accept cash.

Pill mills work in conjunction with shady pharmacies and unethical pharmacists who are willing to turn a blind eye to apparent non-therapeutic prescribing practices.  Remember, the prescriptions are only worth the paper they are written on until a willing pharmacist agrees to dispense the drugs.

Some pill mills may have the appearance of a legitimate medical practice. However, the encounter will typically be very brief. Oftentimes, there will be very little medical history, little or no physical examination, no laboratory or diagnostic studies performed.  Some pill mills routinely write prescriptions for a drug cocktail, which is a combination of Lorcet or Vicodin, Soma and Xanax. This combination of drugs is commonly referred to as a "party pack", "Holy Trinity" or in some parts of the country a "Las Vegas Cocktail".

A legitimate pain management practice may also dispense narcotic pain medications, but only after a thorough physical examination, detailed understanding of the patient’s medical history, and diagnostic tests. Typically, medical treatment such as physical therapy, injections, surgical procedures and psychotherapy are provided in conjunction with the prescription. 

Some pill mill operators have become smarter about flying under the radar screen and have adopted ways of looking more like legitimate medical practices.

Partially gathered by the CBS Evening news and myself, here are some tell tale signs of a typical pill mill:

  • It accepts cash only
  • You may or may not be seen by a physician
  • No physical exam required or performed
  • No medical records or X-rays are needed
  • Prior medical records not required
  • You ask for the medications rather than the doctor deciding what you need
  • The same drugs and combinations of drugs are prescribed over and over to most patients
  • There is scant medical documentation
  • You’re directed to "their” pharmacy
  • They treat pain with pills only
  • They give you a set number of pills and tell you specific date to come back for more
  • Huge quantities of drugs are prescribed at one time
  • They may have security guards
  • They may have a line of people outside or in the waiting room
  • They may accept out of town or out of state patients
  • Patients may arrive in carloads

Again, pill mills come in all shapes and sizes and some are better at hiding their true colors. However, there are a staggering number of pill mills that are operating right under the noses of law enforcement, medical licensing boards and other government regulatory agencies. Law enforcement is well aware of these types of clinics, but little has been done to eradicate them.  Meanwhile, enormous fortunes are being made and people continue to die from prescription drug addiction.

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The epidemic of prescription drug overdose deaths.

With the recent rash of celebrity overdose deaths, Americans are becoming increasingly aware of the prescription drug addiction epidemic which is ravaging this country and claiming the lives of her citizens.

According to the CDC,

The mortality rates from unintentional drug overdose (not including alcohol) have risen steadily since the early 1970s, and over the past ten years they have reached historic highs.

The CDC also added that drug overdose deaths are now 4 to 5 times higher than the death rates during the black tar heroin epidemic in the mid-1970s and more than twice what they were during the peak years of crack cocaine in the early 1990s. Currently, people in the 45-54 age group now die of drug overdoses more often than from traffic crashes.

The most common drugs found on autopsy in drug overdose deaths are called narcotics, usually prescription painkillers called opioids.  OxyContin , Vicodin  and  Lortab are examples of opioid painkillers. Methadone is also now widely used as a painkiller in addition to its use for treatment of addiction. Another drug commonly associated with drug overdose deaths is a group of drugs called sedatives like Xanax and Valium. Soma, a powerful muscle relaxer is often in the mix.

According to the U.S. Drug Enforcement Agency, more than 6 million Americans are  currently abusing prescription drugs—that is more than the number of Americans abusing cocaine, heroin, hallucinogens and inhalants combined. With more current users, we can expect the mortality rates from prescription drug overdose deaths to continue to rise.

The victims are not what many might perceive as a bum living under a bridge. These are our sons and daughters, parents, teachers and neighbors. It affects everyone from the high profile celebrity to the ordinary American.

A multi-pronged approach is needed to address this problem. But, recognition of the problem is a good place to start. It is unfortunate that it took several high profile cases to bring the problem into the public’s eye. But, now that we know, we cannot turn a blind eye. The time is now to begin a dialogue about how to best address this killer epidemic.

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Prescription Drug Overdose Statistics

Unless I am suffering from an extreme case of insomnia, I don’t enjoy studying statistics. Reading them is usually like watching paint dry. However, the old adage "statistics don’t lie" really is true, particularly, when they are from a credible source.

Below is a chart from the CDC showing the increase in prescription pain killer overdose deaths from 2001-2005.

Prescription Opioid Analgesic Deaths Nationwide, 2001-2005

Graph showing the number of prescription opioid analgesic deaths nationwide for the years 2001-2005.

Since 2001, the National Forensic Lab  Information system (NFLIS) has produced estimates of the number of drug items and drug cases analyzed by state and local laboratories from a national representative sample of laboratories. NFLIS provides a unique source of information on the nation’s
drug problem by providing detailed and timely information on drug evidence secured in law
enforcement operations across the country. The results of the NFLIS 2008 survey are complete.

Nationally, reports of alprazolam, hydrocodone, oxycodone, clonazepam, and morphine experienced significant increases from 2001 through 2008. Alprazolam reports almost doubled during this time, while reports of hydrocodone increased 201%, morphine increased 197%, oxycodone increased 178%, and clonazepam increased 70%. Regionally, reports of hydrocodone, oxycodone, and morphine increased significantly in all census regions from 2001 through 2008. Reports of alprazolam and clonazepam increased significantly in the Midwest, South and Northeast.

We cannot look at these statistics and deny that we have a massive  prescription drug addiction problem in this country.

So, why until recently has the prescription drug epidemic been off the radar screen of most people?

  • Is it because it is a man-made/ home-grown problem that no one wants to accept responsibility for?
  • Is it because some powerful people and powerful corporations  are contributing to the problem?

It is easy to demonize the shady drug dealer selling street drugs on the corner, but some people are reluctant to accept that there are thousands of prescription drug dealers operating every day in this country who have been granted a license to do so. The agencies who are charged with the responsibility for monitoring and regulating them are failing to address the problem. If the do catch a doctor or pharmacist abusing their DEA license, they frequently get off with a mere slap on the hand.

If you deal drugs in a white lab coat or behind a pharmacy counter should  that make you immune from accountability? Why shouldn’t we treat all drug dealers alike, regardless of their educational or socio-economic status?

Statistics don’t lie. Knowledge is power.

We can no longer stick our heads in the sand and deny the existence of the prescription drug addiction epidemic that has hit this country. Shout it from the mountaintops. Educate your friends and family. Ask your local law enforcement and  elected officials what they are doing to address the problem.

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Prescription Drug Diversion is Profitable

According to the U.S. Drug Enforcement Agency, more than 6 million Americans are currently abusing prescription drugs.

This begs the question: Where are these estimated 6 million people getting a steady supply of prescription drugs to feed their addiction?

Unfortunately, the pharmaceutical and healthcare industry itself is largely to blame. There is built in profit motive for doctor’s who prescribe, pharmacists who fill and companies that distribute prescription drugs.

In order to prescribe or dispense controlled substances, healthcare providers are required to obtain a license issued by the Drug Enforcement Agency. By law, persons who maintain a DEA license  must not divert or assist in the diversion of drugs for illicit purposes.

Many healthcare providers are vigilant in preventing the diversion and abuse of
controlled substances.  However, there are physicians, pharmacists and others in the distribution chain who become involved in diverting prescription drugs for financial gain. The most common method is through "pill mills". This involves setting up a clinic where doctors see large volumes of patients, ask few questions and prescribe large quantities and combinations of controlled substances.

The prescriptions themselves are only worth the paper they are written on until a pharmacist agrees to fill them. Pharmacists have an independent duty to ensure that prescriptions are written for a valid medical purpose and to refuse to fill them if they are not. Unfortunately, there are pharmacies who are perfectly willing to turn their heads and fill prescriptions which they know, or should know are not written for a valid medical purpose.

The wholesale distributor who supplies the pharmacy with it’s controlled substances also has a duty to know their customer. Wholesalers need to develop  systems for evaluating and monitoring the flow of controlled substances. Unfortunately, there is a financial disincentive to do so in the minds of some wholesalers because they and their sales staff are compensated based upon the volume of drugs they distribute.

Likewise, the manufacturer of the narcotics is in the business of selling drugs. They have become increasingly sophisticated at educating the public about the perceived need for their drugs. Many of us have grown up in the era where there is a pill for anything and everything. Let’s face it: prescription drugs are  a multiple billion dollar industry. 

I don’t pretend to be an expert in economics, but it seems that some rather favorable market conditions exist. There is certainly a market for the drugs ….. 6 million and growing according to the DEA.  There is certainly ample supply. There are financial opportunities for virtually everyone involved in manufacturing, distributing, dispensing and prescribing the controlled substances. 

In my view, until we make diverting prescription drugs unprofitable, the problem will continue to claim the lives of our citizens. Greed has created a lot of this problem. Business opportunities abound. As long as money is flowing, people will continue to place their pocketbooks over their conscience.

Civil lawsuits have always been the great equalizer. In this country, an individual or group of individuals can take on our most powerful citizens and corporations in order to expose wrongdoing. The culprits need to be exposed and held accountable. Throughout history, lawsuits have forced tobacco companies, HMO’s, automobile manufacturers, and others to change their practices. The prescription drug industry has not been publicly outed or held accountable for the fortunes they have reaped over the diversion of prescription drugs. Now is the time for change.

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