The final part of our American healthcare series, painKiller brings together everything we've learned the past two weeks and beyond in Ashes Ashes to explore how the opioid crisis was created and how it is perpetuated to fulfill a single ultimate goal: profit. Pharmaceutical companies, the insurance industry, hospitals, doctors, and politicians - all which ostensibly exist to serve the public have instead mostly contributed to our modern day hellscape of pain, addiction, and increasingly death.

This isn't a show about how the end of the world is looming, this is a look at the ugly truth of collapse affecting people all around us right now.

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This is part three of a three part series on the American healthcare system:

  1. Episode 45 - Bill of Health
  2. Episode 46 - Pill of Sale
  3. Episode 47 - painKiller

Chapters

  • 4:40 Pharma companies create misuse
  • 11:25 Pill Mills
  • 13:42 The modern day problem
  • 19:09 Chronic pain
  • 24:18 Physician frustration
  • 30:16 Making sense of it all
  • 43:21 What can we do?

(Sorry this transcript sucks. We'll try and manually edit it whenever we get the time!)


David Torcivia:

I'm David Torcivia.

Daniel Forkner:

[0:00] I'm Daniel Forkner.

David Torcivia:

[0:03] And this is Ashes Ashes, a show about systemic issues, cracks in civilization, collapse of the environment, and if we're unlucky, the end of the world.

Daniel Forkner:

[0:13] But if we learn from all of this, maybe we can stop that. The world might be broken, but it doesn't have to be.

Lori:

[0:20] Hi I am Lori and I'm from Arkansas. Actually worked in the healthcare field I worked in it when kind of the opiate thing really started you know when the when the pharmaceutical companies were pushing the doctors to prescribe opiates, and I work in the emergency room where we are constantly kind of curious as to why every patient that came in left with Vicodin and so I saw that really begin, and then of course my personal experience started when I was putting the pain management 13 years ago, until I seen it change I've seen it I've been through it as they come out and and declare this a crisis when actually you know pulling back on the the narcotic prescriptions is 2 is what's causing more problems it's what's bending chronic pain patients to the street you know where they're having the turn to heroin because they can no longer get the medicines they need and they were formally prescribed you know and then we have overdoses due to Fentanyl, and so I kind of seen it all happen.

Daniel Forkner:

[1:24] We just heard from Lori and will be hearing from her throughout this episode as we trace the history of what is referred to as the opioid crisis in America. David this is the final chapter of our three-part series on the American Healthcare System part one being bill of health where we discussed the direction Healthcare in America has gone from one of social goods one of prophets part 2 pill of sale is where we talked about pharmaceutical companies and of course we encourage all of you to check these episodes out if you haven't heard them yet but for now stick with us.

David Torcivia:

[1:58] This episode in particular is what really drove us to produce those other two episodes in honestly a lot of the ones we've had so far in the show, because the opioid crisis and yes it absolutely is a crisis in fact more people die from these drug overdoses and died from gun violence including suicides in the u.s. in the past year, in 2016 in a single year. Deaths from this opioid crisis were more than the total combined US military deaths of the Vietnam War and the Iraq War combined. So this should be clear it's absolutely a national crisis and what brought this crisis on there so many of the topics that we address in the show the American Healthcare System the way are doctors and hospitals run the pharmaceutical industry in the group incentives that exist in that field that allow these companies to take advantage of people and deny them the treatment they need my making them simply too expensive the global trade that exist around the world, allowing these dangerous drugs to flood from one country to another, the work conditions that push people to force themselves to work through pain acquiring these drugs in the first place there are so many elements of the story and it's really like Daniel mentioned a microcosm of our world today and the crisis and collapse that we are absolutely all facing every single day.

Daniel Forkner:

[3:18] And although some of the underlying causes that have led to this crisis are not unique to America. We have for so long taking a very unique approach to drug use in this country in ways that really exacerbate these types of problems. And it has truly created a unique situation that no other country has come close to facing. Every single day close to 200 people die from an opioid overdose a number that is expected to climb. The United States consumes more opioids than any other country in the world and buying enormous margin power per capita of daily opioid dose is almost 67% higher than the second highest consuming country. And close to 100% higher than the Third. Of course David like so many of our topics the biggest impacts fall disproportionately on the poor and vulnerable classes of our society, a paper published Justice year and the journal Medical Care looked at the Nationwide pool of disable Medicare beneficiaries and they found that, Lower County median household income higher unemployment rates and less income in equality were all consistently associated with more opioid prescriptions, with higher daily Doses and of course correlating with that are much higher rates of opioid overdose fatalities.

David Torcivia:

[4:41] In part 2 of the series bill of sale we go in-depth on pharmaceutical companies in America what it's worth pointing out the role they have played in specifically spurring the opioid misuse in this country.

Pharma Cos Create Misuse

Lori:

[4:54] I definitely feel like they're there's a lot of misrepresentation out there I I feel like people that don't take opiates not relying on them for pain control I don't think that they'd understand.

[5:05] Really anything about how all of this just has transpired I don't think that they're being sold pill that there's an opiate crisis to the point that it's painkillers that are killing people that it's been prescribed medications that are killing people that's not what's killing people it's the fact that the pharmaceutical companies pushed unnecessary use of of them in the 90s and early 2000 that's what I was working in the medical field and they push the doctors to prescribe them and they were over prescribed that much is true but the way that they chose to deal with it is they just decided to stop everything and hope everything, and I think that the pharmaceutical companies now they're not hurting they're making up for there any loss that they may have suffered in less prescribing of other pain meds. By being in the recovery business now you know they're making up for their loss and Suboxone and methadone, it's really sick what the pharmaceutical companies have gone and I think there's so many people out there that definitely do not understand just how much of a role they played in this.

[6:12] You know and I think that they don't understand that there are people that have true need for you to opiate medication, because it's honestly right now the best thing that's offered to people and pains to help them you know they haven't come out with anything else in the pharmaceutical companies did that on purpose when all this started because they created addicts because that was guaranteed customers every month they knew what they were doing.

Daniel Forkner:

[6:40] If you haven't heard it you might want to listen to our episode number 11 designing deception, in which we discuss Edward Bernays the rise of public relations in the way that companies get us to consume their products not necessarily buy direc Lee marketing them although that is part of the process but more importantly by influencing Community leaders and indirectly shaping our entire lifestyle. And the way the pharmaceutical companies win about flooding the public with opioids follows this formula to a T. One of the biggest impacts they had came from influencing the way doctors went about their practice and for this these companies pulled out all the stops, first of course is a way that these companies marketed to doctors and people who would eventually take opioids for various reasons. Not only did pharmaceutical company sponsor research that would make the claim that is now thus credited that people with addiction could be cured through higher doses of the same medications and a pretty crazy right David. Will they also regularly sent representatives to doctors offices to show them misleading charts and material showing that when it came to pain medication the risk or low. Addiction rates were minimal and the benefits were high.

David Torcivia:

[7:57] Will end up being have you ever wondered why the say you going to the doctor there checking your temperature of your pulse but then they also asked you. How much pain are you in on a scale from 1 to 10 in this isn't something else always around this is a relatively recent development and that's because Purdue Pharma the big villain in today's episode helped the American pain Society established the idea. Pain management within the medical community service ideas that pain itself is the fifth Vital sign the others being pools temperature blood pressure and breathing so what's this idea too cold. We can see if people are in any sort of General Pain and as soon as we know somebody's in pain well that's a pain prescription that we can sell.

Daniel Forkner:

[8:38] I got the same time there were statements made by the American pain Society alongside the American Academy of pain which became incorporated into prescription standards under the Federation of State Medical boards which oversees every single State Medical Board in the country and these new standards created the situation where doctors that denied patient opioid prescriptions could be disciplined and sanctioned. While there were no consequences at all for over-prescribing them.

David Torcivia:

[9:07] All of this doesn't sound sleazy enough will Purdue Pharma also Market their drugs as being healthy not just for adults but for teenagers and children as well. In one study paid for by Purdue Pharma Norbit to measure a child's level of pain Physicians for encouraged to play a game in which children are presented for poker chips representing hurt and told to pick up how many hertz do they have. Positions of course we're caution not together children the option of zero hurt because we're all in some pain all the time right and that means one more pill we can sell.

Daniel Forkner:

[9:39] I certainly a David especially after all these topics. And so in true Edward Bernays fashion this broad public relations campaign caused doctors who previously would never have agreed to prescribe opiates for anything less than serious cancer treatment or end-of-life care, to now prescribe them for General Pain complaints. And promoting these false scientific claims and other marketing tactics Purdue Pharma the company would plead guilty to a felony charge in 2006 and would pay over 600 million dollars in fines. Although the executive directly responsible for much of the criminal activity received mirror misdemeanors themselves. And these types of lawsuits have continued just this year 6 States filed new suit against Purdue Pharma and many other companies are also on the hook for these irresponsible marketing claims and practices.

David Torcivia:

[10:35] And it doesn't take a genius to realize, at this marketing had dramatic effects in exactly how doctors were interacting with their patients their pain and their prescriptions very quickly we found many doctors. Over-prescribing drugs we learn this problem we we made some changes we might have overreacted and made things even worse but we'll get to that later on this episode but for someone like Lori with massive amounts of chronic pain taking opioids may be the best option for her, before others the risks may not justify their use but the ways that these pharmaceutical companies marketed these drugs, gave bar too many physician delusions that they can be prescribed really and safely, while doctors with loose moral standards realize they could actually make lots and lots of money by what is essentially dealing opioids.

Pill Mills

Daniel Forkner:

[11:25] The most infamous example of course comes from Florida's pill Mills and it is impossible to exaggerate just how many opioids have been sold out of these walk-in clinics in pharmacies in Florida.

David Torcivia:

[11:38] Pill Mill that is a ridiculous name and I think we really need to clarify because it's silly as that sounds he's are really the factories that got this opioid crisis kicked off so so let's talk about what these.

Daniel Forkner:

[11:51] Okay David well it was loose regulations in the state that made them possible in the first place and essentially what it was is a person could just walk up to a pain clinic, with some cash in hand of course complain about experiencing some pain and then walk out with 600 pills, and because Florida did not have a prescription monitoring database at this time it was possible to go from Doctor to doctor to feel the same prescription over and over. Florida was buying up and distributing so many opioids the people as far north as Ohio would drive down and vans on the oxy Express to bring back drugs from Florida, in Kentucky up to 60% of all the illegal oxycodone came straight from Florida, in fact David by 2010 just about every single state east of the Mississippi River was sourcing the bulk of their opioids from Florida.

David Torcivia:

[12:41] 40% of the country's entire supply of oxy was sold in Florida between 2009 and 2010 and of the country's 50 highest oxy selling clinics 49 of them were in Florida. And it's very very clear that the pharmacies in clinic that sold these drugs knew that they were acting as a legal drug smugglers, for example a single Walgreens pharmacy and yes it seems big change to any small town of just 12,000 people. 2.2 million doses of Oxycodone in 2011 to 6 highest purchased by Florida Walgreens in 2011 was over 1.1 million doses. For comparison in the same year the average used Pharmacy bought just 73000 doses in an entire year. Amalfi's pharmacies for buying went way way beyond the local community need and it's impossible that they did not know this, these pharmacies were Distributing more drugs in their entire local population could possibly ever hope to consume.

The Modern Day Problem

Daniel Forkner:

[13:43] It eventually around 2011 David Florida did tighten its regulations which made it harder for the pill Mills to operate. And it made it harder to get unnecessary prescriptions, this did have an immediate effect the number of pill Mills declined and the rates of prescriptions for opioids also declined. But unfortunately this is kind of how we arrived at the Monstrous epidemic we have today. Cutting people off from a dependency without offering any support merely pushes people to find alternatives on the streets there black market dealers. And if you haven't heard it yet check out episode 31 no entry specifically at the 14 minute 24 second mark, where we touch on how walls the purport to stop crime and drug smuggling actually just exacerbate these problems and how the American War on Drugs and Prohibition in general. Really just makes everything worse the economics of drug dealing really only makes sense when it's criminalized and that's also where the dangers of drug use Skyrocket as well.

Lori:

[14:46] I think the true opiate crisis is fentanyl in heroin. And I think that it's pain patients being forced to the streets to get relief for real pain and then dying do that you know Fentanyl, cut heroin, there's no true education is so what's really going on and what's your really buying when you're when you go in other pressed pills on the street there Fentanyl, people don't realize that, so you can take a pain patient that's been cut off from their medications or even cut down other medication they go to get something from the street they get a crushed pill and Anna.

David Torcivia:

[15:24] Lori makes a great point, if you look at the rates of Overdose deaths in this country and you conclude that the problem is that people were given an opioid till we are not really seeing the full picture and what goes on behind the scenes, if someone has an opioid dependency whether there's someone like Lori was a real need or simply someone develop a recreational dependency and you suddenly yank that Supply away from them without any alternative and without any support. Only option is to turn to a dealer was going to sell them something they cannot trust that they're not familiar with and that likely contains a much higher concentration because the simple economics of drug dealing. Obviously a recipe for disaster.

Lori:

[16:08] I think that more chair needs to be given the specially to patients that have been in pain management and have lost their pain management or the medication, these are the people that end up on the streets by heroin laced with fentanyl and having no understanding of the fact that they could die. When I was told that my cancer was stage 3 I kind of didn't know how to process that information, it was scary it was frightening I don't know really what to do, I've never done any drugs other than take my prescribed medication and smoke marijuana I don't drink alcohol I don't have any history of any other drug use, for one week after I found out that my cancer was stage 3 I kind of got very self-destructive and I tried heroin for the first time. And I was underwhelmed so I tried it one more time and I overdosed and I died, and I had to be brought back with Narcan CPR and then had to be given nitroglycerin three times cuz I almost had a heart attack after being brought back. And that Narcan their brought me back with an oxy and I was prescribed by my doctor it's hot in here you know he never even tried to act like that before second time I OD'd do this.

Daniel Forkner:

[17:23] It's a David like you mentioned in the beginning of the episode more people died from an opioid overdose in 2016 bendy total us deaths during the Vietnam and Iraq war combined. Was devastating is that was we had even more deaths in 2017, because as it has become increasingly difficult to get opioid prescriptions more people are turning to synthetic and illicit forms of opioids like Fentanyl and heroin which are much much more dangerous.

David Torcivia:

[17:52] And this is where the global trade comes into play digital difficult to manufacturer you really sort of need a pharmaceutical industry in order to produce these. Pharmaceutical Industries with loser ideas of what is okay to produce exist in other parts of the world in namely in fentanyl case China huge amounts of these drugs are produced, turn the simple powder and then are shipped either directly in the mail or by drug Runners take Canada Mexico and United States itself pill Mills were often in residential buildings in suburbs and cities turn these into very potent drugs. These pills they look just like anything you'd buy from a pharmacy but these are just made in the kitchen somewhere and nobody knows exactly what the concentration of the fentanyl in it, how strong it is and how easily it can possibly cause an overdose which is why we've seen the huge explosion in debts take off because of people like Daniel mentioned turn from treating their addiction over the counter with a typical opioid that they had been buying from these pill Mills for years to having to be forced to purchase them on the streets well. They have no ability to test the concentration they have no ability to know what they're getting into and that Sentinel is extremely potent and unfortunately in many cases leads to overdose, and can happen very quickly as Lori experience.

Daniel Forkner:

[19:10] David let's take a step back for a minute because with the exception of cancer and end-of-life Care the number one reason that opioids are prescribed in the first place is for chronic pain.

Chronic Pain

Lori:

[19:22] I was putting the pain management do to a I broke my jaw in three places when I was 13 years old and it wasn't fixed properly. And so I have a malformed condyle on one side I need a bilateral joint replacement in my jaw as well as half of my mandible replaced, I'm not even supposed to chew anything harder than mashed potatoes or Josh is severely injured and causing a lot of pain, that's why I was originally put into pain management over the 13 years I've been in pain management I've had new problems I have cancer now. I was diagnosed with renal cell carcinoma 4 years ago and I've been fighting that for years. Delta discovered that I had serious back issues of herniated disc and spinal stenosis and it said to have a lot of reasons for pain, and so I haven't had as much trouble you know, getting my medications is a lot of people hat but I've seen a lot of people get cut off on their medication get them cut down to a point that's pretty much ridiculous and I've seen a lot of that take place.

Daniel Forkner:

[20:34] There is some debate about whether opioids are the most effective treatment for long-term chronic pain one highly cited paper published in 2015 in the journal annals of internal medicine. Examined adults with long-term chronic pain and concluded that there was little evidence to support that doses of opioids could effectively manage pain long-term but they did contribute to other health risks. But as Lori pointed out the way pharmaceutical companies have manipulated the game. Well there never really was any alternative for doctors faced with treating chronic pain patients. And at the same time pain management it really isn't covered in a comprehensive way in medical school which leaves many Physicians unprepared for these patients, not to be clear that does not mean that opioids are not effective for some people it just means we don't fully understand the long-term benefits and it's clear that the risks, if we truly understood them would rule out the treatment for many people but regardless of whether opioids are the best treatment for chronic pain. We should take a step back and ask. Why do we have so many chronic pain cases in the first place the CDC found just last month using data from 2016. That / 1/5 of the entire US population has chronic pain so where's it coming.

David Torcivia:

[21:55] Will Daniel the highest rates are found in women veterans adults who are unemployed after previously working and of course those living in poverty and rural areas, and if we look at the rates of Overdose deaths will unsurprisingly we find correlations in certain lines of work Massachusetts Department of Health just published a study this August that found a link between opioid overdose related deaths and those who work in dangerous jobs like construction Roofing carpentry pipe-laying painting in fact in the state of Massachusetts overdose deaths are occurring six times higher in construction related fields and in the general Workforce not only do these workers perform labor that can be tough on the body and cause frequent injuries but it often have low job security are denied sickly are paid low wages and yes of course lack health insurance given these factors. Only option for these workers when they are dealing with injuries and pain is to take opioids so they can keep working so they can keep taking home a paycheck so they can avoid being fired, and do their best to avoid the pain instead of really treating the problems that caused it in the first place.

Daniel Forkner:

[23:04] It was really sick about this situation is that pharmaceutical companies not only knew this but really capitalized on it. It's actually how Purdue Pharma got their drug Oxycontin off the ground in 1996. They chose small towns in Virginia and West Virginia to launch their brand so to speak because of the high number of manual labor jobs in logging coal mining and steel working in those areas they marketed their drugs as way to treat injuries common to these types of jobs the company even offered the first bottle of pills for free.

David Torcivia:

[23:38] Talk about taking a plate directly on the drug dealers handbook.

Daniel Forkner:

[23:42] Exactly and doctors who had never prescribed opiates for anything but the most serious illnesses are now being approached by people requesting them and the representatives from Purdue were telling doctors that there were no serious risks to the drug, well Virginia continues to feel a disproportionate share the burden of this National problem. More opioids are prescribed per person in the city of Martinsville Virginia than anywhere else in the country the average doctor in that City and the surrounding County prescribe almost, times as many opioid each year than the average doctor in most other us County.

Physician Frustration

David Torcivia:

[24:19] Will the astute listener will realize that well patients aren't the only one struggling with these realities doctors of course are too. As we mentioned the American approach to drug use is basically entirely me and rather than try and provide help and support for those who need it most would rather just throw the users in jail and blame the doctors for prescribing the pills and then call it a day. Many doctors are now feeling pressured to stop prescribing opioids even for patients they believe truly need them for fear of being sanctioned or even criminalized as part of a new Crackdown effort by the government to Halt all this rabbit over-prescribing.

Lori:

[24:58] I've seen my doctor you know my doctor has admitted to me how hard all of this is on him. You know and how you know da the government CDC but you know they're all just really making it hard for positions that are real pain management positions.

Daniel Forkner:

[25:17] We're seeing a general Trend going on really across the healthcare system in which Physicians are getting burned out and they're really unhappy in their work. A paper published in August by the University of California school of medicine found it position burnout increased to 54% by 2014 which was a 9% increase over and above what other us workers experience. No burnout in this case is defined as lacking a sense of accomplishment feelings of cynicism and a lack of enthusiasm for work. David I find it particularly sad if our doctors don't feel a sense of accomplishment because I mean a lot of people to go into medical school I think they go into it with this feeling that they're going to improve people's lives that they're going to help save people I mean yes there's a stereotype of people going into medicine for the money but a large percentage of people do it because they want to.

David Torcivia:

[26:12] Well to make a different.

Daniel Forkner:

[26:14] Yeah exactly but unfortunately once they get into their actual practice many of them don't get that sense of accomplishment. Dallas paper site five major causes for these Trends the rising price of drugs which we talked a little bit about in part 2, as well as Hospital ownership of Healthcare Systems productivity standards complexity imposed by the Affordable Care Act, a new electronic health records was take up more and more of a physician's time without actually improving patient care.

David Torcivia:

[26:44] But most notably continuity of care in American Healthcare has been breaking down. Continuity of care meeting a physician cares for the same patients over time and ultimately developed a relationship with them has been a historical Mainstay of healthcare, and what has for so long in a motivating force to tracking people to the healthcare profession from the study. Continuity of care historically provided the necessary bonds that were generated the early career feelings of scientifically-based benevolence that attracted most doctors Into The Healing Arts.

[27:22] But this is rapidly breaking down and the doctor-patient relationship is now more of an insurance company client relationship. Not only are doctors like Lori stress complying with government demands to cut back certain prescription insurance companies themselves often Define what care a doctor is and is not allowed to administer because those financial reasons that we discussed in part one bill of health. This all affects continuity of care patients change doctors more frequently than ever in part because employers change insurance companies often which means a position a patient was seen consumer become out-of-network and they are forced to switch and also because since fewer positions are going into private practice patients are being assigned to various doctors based on the Winds of the hospital and Healthcare System.

Daniel Forkner:

[28:14] This is such a significant factor to me David and I know we're getting a little bit off topic here from the opioid situation but. When you think about what a doctor has been historically you someone that got to know you some of that formed a relationship with you maybe new your family and therefore could give you the care you needed because they understood your history they understood, how you might react to certain treatment and I think most people want their care to be like. But we find ourselves in a situation in America where people are not given the choice necessarily of the doctors they see, but yet we're giving this illusion that we have this infinite Choice again the insurance complexity is presented to us as, a free market in which we can choose anything we want in our our freedom is Limitless here but again, I think it's important to emphasize the point here that what people truly want is not a foe Market of five different payment options for insurance while having restricted care they what people truly want is the ability to go see any doctor they want in any facility they want without having to worry about whether or not it contractually permissible.

Juanne:

[29:24] The doctor said all she needs this past and I had the test so there's that and another lie. Perpetuated we have total freedom when it comes to choosing doctors here okay I lived in Toronto promotion my working life and I changed jobs pretty regularly because I switched career courses a couple of times I went to a clinic. And I had one doctor there until he retired and then another doctor took over his practice and I switched jobs oh God I can't tell you the number of times I switched jobs and I kept going to that clinic I never had, anybody tell me who I could go and stay in terms of my family doctor the government wouldn't dare tell me who I can go in.

Daniel Forkner:

[30:13] That was Jen from part one of the series so David we're coming to the end of this episode and it's not a very long episode relative to some of our other shows butt,

Making Sense [30:23] I think it's a part 3 this really ties together many of the issues we discussed in part 1 and part 2 and of course like you mentioned so many of the other topics we illustrate and, I think it's important to simplify this down to what perhaps is really going on and it seems very clear that after pharmaceutical companies flooded the market with these highly addictive and very potent drugs we realized that there was a problem, but our response was the usual American one Crackdown on the user's throw them in jail restrict access punish doctors for over-prescribing and see if we can just prohibit our way out of the problem. Which in turn made things infinitely worse. People who relied on these drugs were now turn to the streets where dealers could Supply them with very expensive and highly concentrated drugs like Fentanyl and heroin with varying doses to the people didn't necessarily know what they were going to get, and for those who recognize that they have a dependency and wanted a way out well where we there to offer treatment where we there to offer support where we there to say it's okay. Or where we they're blaming them pointing the finger at them telling them to get their life together calling them pill heads.

[31:37] In fact I think once in deter even said it one point that those who OD are part of natural selection doing its work. The American approach to this is not one of understanding and certainly not one of compassion.

David Torcivia:

[31:50] But how much of this problem is because of the American approach in the first place. As we talked about 4 hours at this point the way the American Health System is structured that problems like are opioid crisis are not only caused by the system but they're inevitable because of it the way that we incentivize doctors to benefit pharmaceutical companies and insurance companies in hospitals over the patients that they are all sworn to protect first and foremost has broken our system fundamentally, it should be no surprise then that the pharmaceutical industry exists mostly to exploit the misery and suffering of others as much as they make claim, to be out there researching looking for new drugs to improve our health so much of this is really just about how can we create an ongoing stream of Revenue and opioids and particular are one such perfect example of.

[32:41] Hawk these pills to doctors force them to prescribe it by tricking them into thinking they're much more benign than they actually are that they're healthy even they're good for teenagers they're perfect for children that we need to start prescribing people on pain in a way that we never even talked about or thought about before, and take into account the way that our economy is structured the way that we force people to work when it should be at home resting when is the beginning treatment in responsible ways in physical therapy and things that actually treat the problems that cause these pains in the first place. Force them to work through the pain and offer them only one alternative we're going to hurt you we're going to get you addicted but you won't feel the pain at least for a little bit. Yes you have a new problem yes you have to pay for this when your insurance at least for now will cover this if you lose it later will you know you can always turn to the streets where the pills are available and they're still in Parts supplied by the same pharmaceutical companies, made available through pill Mills and irresponsible doctors but wait legislators have caught on to what is happening in instead of punishing the companies that pushed this that created this problem in the first place with turn instead to making it even harder for doctors tipx this problem to give patients once more what they believe they truly need and instead make them feel the repercussions of being perceived of overprescribing.

[33:59] We tightened the faucet and in the process denied people this drug that we had gotten them addicted to buy our gross incentives in the first place and now.

[34:09] Are more words are filling up their many counties will never had this many dead bodies before they literally don't have room for them they're building additions to this, passing bills and bonds for taxpayers in order to hold more bodies of their constituents if they are supposed to be protecting in the first place this is a system that is out of control, and ends up causing the direct loss. Tens of thousands of American lives and that number is going to climb over the next decade to be over a hundred thousand people dying to these overdoses annually. Under optimistic projections and it's because what we even knows we had a problem that we are attempting to find Solutions we've done so little to actually make a difference. And I've been fortunate enough actually to work on some of these CDC campaigns to raise awareness of what is going on with the oxy crisis with the opioid crisis, in the focus of these campaigns are mostly on education the fact that these pills are addictive in the first place, but that's not the problem we understand the addiction inherent in these things but people feel like they're forced to take them. The turn to them and this drug crisis is unlike all the other ones we've seen so far, and yes this country is constructed most of its drug crisis through irresponsible legislation and the action of the government in treating them or persecuting them or creating the problem no to drive boats. It's true but for the most part those were focused on minorities and the media never responded well to that but now.

[35:36] The opioid crisis by large is affecting yes still those in poverty. But many many more white people in three other drug prices have before and it's called people's attention. Escrow says that is the media's trumpeting is opioid crisis talking about the pump type it into Google you'll see opioid crisis how many articles are written about this, and for good reason again this is double the amount of people who are killed by guns every year in the United States this is more people than were lost in the Vietnam and Iraq war combined annually. It is a crisis absolutely but the fact that we only pay attention to what it is because of people the color of their skin or dying is part of the problem that we have in the first place.

[36:17] This is wholly different because the people in this crisis so often feel like they can't reach out because of the way that we treated drug users in the media before. Behind their addictions this is your piano teacher this is your plumber. This is the person who serves you food everyday and has aching feet and was forced to take opioids to stay working and find themselves addicted and buying them off the street afterwards when they can find their pills no longer. This is something that affects families the middle-class even the rich find their numbers slowly falling because of these overdoses these are your neighbors, and if we remember that and remember that's how we need to proceed all drug users as people within our community for desperately out there looking for help and not treat them as an other then we can actually start working towards a solution. These are victims of a healthcare system of a pharmaceutical system of an economic system that is out of control and more than happy to chew people up. Spit them out leave them lying without a spot in the morgue because there is a profit to be extracted from that individuals like.

Daniel Forkner:

[37:26] David you mentioned the addictiveness of these drugs and I think a diction is a topic that really deserves its own episode there's a lot that goes into it, it's perhaps out of the scope of this three-part series but, I do want to mention that when we spoke is purely on the amount of drugs or accessibility of drugs within a community. We're not seeing the underlying causes of addiction we have to look at the well-being of people in those communities to really understand what's going on. And Johann Hari who was written a couple books on depression and addiction specifically he's provided some Clues as to how we have misunderstood addiction not just in America but around the world.

[38:07] Beginning of the 80s there were a series of studies carried out to measure the addictiveness of cocaine and Other Drugs in rats the researchers put rats in cages and inside those cages were water bottles laced with cocaine, what they found is that once the rats got a little taste of the cocaine they would drink from that bottle over and over until they died. This happened time and time again and it helped inform us of the dangers of addictive drugs. However there was one researcher his name was Bruce Alexander he thought that the environment in which the rats live, which at the time was an isolated and small cage with nothing in it but drugs might have been playing an important role it so he designed a new experiment and they called it rap part. Not in this experiment rat still had unlimited 24-hour access to drugs morphine in this case a powerful opiate. But instead of being stuck in a cage the rats were free to roam around play with toys and most importantly interact with each other have sex and do all the things a social creature likes to do, in this environment the rate of morphine consumption among rats dropped dramatically almost 25 times less than the Caged rats, and there were no overdose fatalities that occurred.

[39:27] Of this experiment and others like it have led researchers to conclude that it was not the drug itself that was dangerous for the rats but it was isolation and the breakdown of all the things that make up a quality of life for a rat. And are we so different I think there are a lot of clues in the Life circumstances of the people this opioid issue impact the most. Just look at how Purdue Pharma got its signature drug off the ground by targeting people in low-income injury-prone industries that have low job security. These are people who by definition lack of support.

[40:04] And that I think is really what this comes down to look every individual has a unique circumstance in life with unique needs not everyone needs the same support but we have a society in 10-ton dismantling every form of support every form of solidarity every form of community. When almost half the country has nothing in savings has experienced declining Financial stability for decades, and struggles to maintain a roof over their head and food on the table when people everywhere are stuck in the so-called gig economy where there is no such thing as sick leave or workers compensation where your boss is an iPhone app, and you're only colleagues are people you've never met who are all being rated against you, and went under these types of conditions the door is flung open for large profiteering companies to Target our most pressing vulnerabilities and weaknesses, is it any Wonder we have mental health and dependency problems is it any Wonder people turns the only thing available to them to help manage their pain.

[41:05] This issue goes beyond unscrupulous doctors this issue will not be solved by throwing poor and vulnerable Americans in prison, this is you can only begin to turn around when we Haul the systemic violent assault on the mental physical emotional, and communal health of every American and if we do that maybe we can stop the assault on the rest of the world as well and David you mentioned. That the victims of this broken system are hiding their ashamed to have their dependency found out. When I talked to Lori I asked her I asked her if her friends and her family and her community support her in this time of struggling. The time where she's facing cancer chronic pain from a surgery gone wrong and other health issues in her life this is what she said.

Lori:

[41:55] Talk about it with a lot of people in my life most people in my life don't even know to what extent I seek out new management or her involved. Because I'll be afraid to tell them because there's a stigma. You know I think a lot of people if they see anyone that takes these pills as I've heard pill heads and I've Heard lots of just really derogatory things that about people that that are even in pain. People that are doing it the right way the way you're supposed to do it you know I've been in pain management for 13 years I've never gotten in trouble by my doctor or been fired from a physician and I'll try to do things the right way. I'll talk about it cuz I know I'll beat your ass.

Daniel Forkner:

[42:41] Next we ask Lori how would you want someone to support you how would you want your friends and family to approach you.

Lori:

[42:49] I really wish that they would come to me with it at least an understanding that I'm in pain. That they can't find them you know that they don't understand and I would like for them to be supportive of that and that would open the door for me being able to talk to him about other things including how I manage that thing.

Daniel Forkner:

[43:12] If we can stop stigmatizing people then maybe we can expand awareness and education for how to save them.

What Can We Do?

David Torcivia:

[43:22] It's a heavy episode Daniel but let's talk about 1 or 2 days really small practical things that we can really make that possible and end in generally start to save p. Another Nations around the world we seen a huge expansion of methadone clinics at methadone treatment and this is actually something that's sort of a controversial Topic in the opioid Community methadone itself is an opioid. Has the same effects as the oxy or something similar it is a you can overdose on it but it is controlled and deployed in very safe amounts and they were places is unsafe prediction of who knows what people are getting off the street and instead make sure that they're getting something clean and pure and have a safe way to do it, well also receiving clinical support Community Counseling therapy and other treatments that extend beyond solely this drug that is being deployed, of course this could also be seen as another way that these pharmaceutical companies have created a pipeline of addiction of people who consistently daily consume another one of the drugs are they produced in order to profit off once again these addictions. Pharmaceutical companies have recognized the profit potential in these methadone clinics, and have devised the way that they can carry this product pipeline straight to the home Purdue Pharmaceuticals that same company that first brought us Oxycontin and kicked off lot of this problems will they recently patented a brand new drug. Edoko buprenorphine.

[44:48] This drug is very similar to methadone is another opioid you can take it home though your doctor prescribes that you take it every other day and it prevents you from going into opioid withdrawals. Prevent you from looking for other drugs that might not be at safe to take but it is still no peeling you're still addicted you're still feeling the you for you just maybe less so it's very difficult to overdose on it.

[45:09] This is another pipeline a prophet that Purdue has built in order to keep people addicted to they can keep squeezing them for money. And without the community support that occurs in these clinics methadone doesn't make you get any better you're just addicted to something else and something that since is provided by the pharmaceutical industry is arguably considered safe, and down in very specific ways to prevent you from overdosing but you diction is still there it's not treated it's the community support that comes together that actually makes a difference, and that's the thing that's lacking in so many places especially here in the United States and that's why the stigmatization is so important if we can get past the idea that be the drug addicts if these are people who are doing something that is harming them and what are not that's true I mean absolutely taking these drugs overdosing on them is not good for you when you remember that something push them to do that they felt like they had no choice and they ended up down this path and just because they made a wrong decision even if that was the only decision left of them doesn't mean that we cut them off it means that we need to come to them and support them even more because if we were in that situation that's what we would want that's what we would need and that's what Lori is sitting here telling us, she says this is what, I need as somebody who's suffering from this has been suffering this from so long was live this life and if we can't listen to that and we haven't learned anything at all over the course of all these episodes.

[46:34] Beyond that there are things you can do very specifically within your community that sell these overdoses are happening constantly over the course of this show. Almost eight people will have died in the United States alone those death though they're all preventable. There's a simple drug that can be given to somebody who is overdosing that can save their life give them enough time to be brought to hospital where they can be treated and prevented from dying from this overdose. It drug called naloxone or the brand name Narcan is available all across this country you can buy over the counter many places like CVS in almost every single state there are places where you can be trained in order how to use this deployed and even receive training to give to other people. This is something is very simple to do I've done it and what you were training this you can help other people learn to some of these trainers you can even get free Narcan yourself to distributive places where people will be in the most need for. You know what junkie teach him how to use this give them a prescription it might save their life force black with somebody they know. You know a hardcore bar you know a public library some place that people might go and overdosed in the bathroom make sure that the people who work there are trained in this, and have this drug available to them so that they can save a life this is a simple thing it's easy to do we can save, so many lives every year with this if we collectively as a community come together and realize that we need to take our health and the health of those around us into our own hands.

[47:59] It's not enough to turn and look the other way because these people are drug addicts that time is done these are not the other these are our friends or neighbors evil eye doctors. And we need to be collectively responsible for all of us together as always that's a lot to think about but think about it we hope you will. You can read so much more about all of this on a website as well as a full transcript of this episode at ashes ashes. O RG.

Daniel Forkner:

[48:26] A lot of time and research goes into making these episodes possible and we will never use ads to support the show. So if you like it and would like us to keep going you are listener can support us by giving us a review sharing this with a friend or hitting that five star button on the iTunes podcast app. Also we do have an email address it's contact at ashes ashes. Org send us your thoughts will read them every one of them even if sometimes we don't get back in a timely fashion we will avenge.

David Torcivia:

[48:57] I'm feeling a person Lee called out.

Daniel Forkner:

[49:00] But we do appreciate it we love hearing from you.

David Torcivia:

[49:04] You can also find us on all your favorite social media networks at ashes ashes cast next week we got a timely episode as all of us Americans turn to the polls we hope you'll tune in but until then this is Ashes Ashes.