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Activism in the Opioid Crisis

Activism in the Opioid Crisis. 3-2-19. Brief overview of opioid crisis Levels of activism to fight back Broader lessons for activism in medical school. Overview. Opioid Crisis. A Brief Overview. Heroin treatment admissions : 2003-2013.

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Activism in the Opioid Crisis

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  1. Activism in the Opioid Crisis 3-2-19

  2. Brief overview of opioid crisis • Levels of activism to fight back • Broader lessons for activism in medical school Overview

  3. Opioid Crisis A Brief Overview

  4. Heroin treatment admissions : 2003-2013 SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 01.23.15.

  5. Death rates from overdoses of heroin or prescription opioid pain relievers (OPRs), by age group SOURCE: CDC. Increases in Heroin Overdose Deaths — 28 States, 2010 to 2012 MMWR. 2014, 63:849-854 4

  6. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over) 5

  7. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over) 6

  8. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over) 8

  9. Primary non-heroin opiates/synthetics admission rates, by State (per 100,000 population aged 12 and over) 10

  10. Rates of Opioid Sales, OD Deaths, and Treatment, 1999–2010 8 Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10,000 7 6 5 Rate 4 3 2 1 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year CDC. MMWR 2011

  11. Industry-funded organizations campaigned for greater use of opioids • Pain Patient Groups • Professional Societies • The Joint Commission • The Federation of State Medical Boards 13

  12. How the opioid lobby frames the problem: Source: Slide presented by Dr. Lynn Webster at FDA meeting on hydrocodone upscheduling, Jan 25th, 2013.

  13. How the opioid lobby frames the problem: Source: Slide presented by Dr. Lynn Webster at FDA meeting on hydrocodone upscheduling, Jan 25th, 2013.

  14. Why the lockstep increase in opioid prescriptions-deaths? Answer=> Sacklers & Purdue lied about how addicting Oxy was. CDC: “in PCP settings, 3-26% of patients show opioid dependence…pain clinic settings, prevalence of addiction ranged from 2% to 14% ” NEJM: Rates of carefully diagnosed addiction= 8% or less Rates of misuse, abuse, and addiction-related aberrant behaviors= 15 to 26%

  15. Industry also lied about material facts & data Executives (including members of the Sackler family) knew in 1999 the addictive capacity of OxyContin- over a year earlier than they claimed under oath in Congress. In 1999, a Purdue-funded study of patients who used OxyContin for headaches found that the addiction rate was 13 %- when taking as prescribed. Purdue continued after this study to claim to doctors that the addiction rate was less than 1% In a study conducted by Purdue, roughly half the women required more medication before the twelve-hour mark and experienced withdrawal symptoms. The study was never published.  No clinical trails were conducted on the addictive properties of OxyContin. The F.D.A. examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterward. Within two years, he had taken a job at Purdue. https://www.marketwatch.com/story/purdue-pharma-execs-knew-about-opioid-addiction-risks-long-before-publicly-admitting-them-court-papers-claim-2018-10-24 https://www.google.com/url?q=https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain&source=gmail&ust=1550540014051000&usg=AFQjCNElat_khIPuCuNrhKmI1s2JCXUYNw

  16. With the realities of addiction and overdose becoming apparent, Richard [Sackler] suggested blaming the patients rather than the company’s drug. “[W]e have to hammer on the abusers in every way possible,” he wrote in a confidential email. “They are the culprits and the problem. They are reckless criminals.” https://arstechnica.com/science/2019/01/family-behind-oxycontin-called-addicts-criminals-while-pushing-pills/

  17. At OxyContin’s launch party, Richard was optimistic about the drug’s market potential, saying that“the launch of OxyContin Tablets will be followed by a blizzard of prescriptions that will bury the competition. The prescription blizzard will be so deep, dense, and white...” https://arstechnica.com/science/2019/01/family-behind-oxycontin-called-addicts-criminals-while-pushing-pills/

  18. The Many Tentacles of Purdue • 1999-2011 Purdue donates $6+ million to MGH, gaining access to the brand and the ability to “suggest curriculum” for MedEd. This includes MGH enthusiastically renewing ties with Purdue in 2009, after Purdue employees plead guilty to false advertising of opioids (with help from Rudy Giuliani). • Similar acts at Tufts, including adding a Purdue employee as adjunct associate prof in 2011. Source: STAT News. https://www.statnews.com/2019/01/16/purdue-pharma-cemented-ties-to-universities-hospitals/

  19. The Many Tentacles of Purdue • Purdue/Sackler ties remain at many, many medical schools & hospitals. • Nan Goldin and PAIN are addressing these ties in the art world • Sign their petition (join 41k+) at Change.org to ask museums & galleries to remove the Sackler names. • Fewer people are addressing the Sackler/Purdue ties to the medical world, which are legion.

  20. Working directly for change

  21. Summary • The U.S. is in the midst of a severe epidemic of opioid addiction • To bring the epidemic to an end: • We must prevent new cases of opioid addiction • We must ensure access to treatment for people already addicted

  22. Levels of activism Immediate => Societal

  23. Harm Reduction

  24. What can we do to save lives in immediate threat ? Naloxone (Narcan) Supervised/Safe injection sites Needle Exchanges

  25. Medical Treatment

  26. How can we help drug users beyond moments of immediate crisis? Medically assisted treatment (MAT) Role of healthcare providers in different settings

  27. Broader Systemic Changes

  28. How can we change the systems drug users find themselves in? Role of big pharma in poor health outcomes Case study: Purdue Pharma & the opioid crisis Broader systemic change (universal health care!)

  29. Advocacy as a medical student

  30. Working directly for change in our communities: our experience • Working with administration and through official channels to address institutional Sackler affiliation • Changing approaches to direct action in partnership with community orgs • Efforts to develop a broad coalition to amplify our message

  31. Strategies and principles of local change • Language to use when working with institutions/administration • Understanding institutional priorities and values • Broadening coalition across medical schools, activist groups • Including diverse voices, i.e. community groups, providers, drug users

  32. Working directly for change in our communities: our experience Goals: • Name change • Curriculum change • Researching and funding harm reduction, MAT, etc • Re-evaluation of institutional relationships with donors

  33. Working directly with lawmakers Capitalize on unique role of students and doctors

  34. Thank you!Email: paul.w.frazel@gmail.comEmail: helen.zhou@nyullmc.org

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