Emerging News in Chronic Pain Communities
Richard Lawhern
Subject Matter Expert in public policy for regulation of opioid pain relievers and physicians who prescribe them. 25 years experience and thousands of contacts in social media support groups for people in pain.
Colleagues and friends,
Those familiar with my work are aware that I frequently promote the work of others who serve chronic pain communities. Thus, today's newsletter, summarizing work of Dr Stephan Kertesz, and comments of Pharmacist Steve Ariens, among others.
See below.
From: Kertesz, Stefan G <skertesz@uabmc.edu >
Recently I offered a short piece on advocacy. This is a piece where I reflected on my challenges learning to handle my own fears as I pursued a path of advocacy in relation to the devastating mistreatment of patients with long-term pain on opioids in the US. Countless people came after me, mostly in ways I don't lay out in the piece. I was not pleased with myself that I allowed those folks the power to rattle me.
Separately : Something on the US Supreme Court (also from Dr Kertesz)
I spoke to STATNews about the Supreme Court decision stopping, for now, resolution of the Sackler/Purdue bankruptcy dispute. I respect that bereaved families want restitution and even revenge. However, as I say below, what got us into "got us into this crisis and what will get us out of it is a whole lot bigger than the execution of a revenge plan against owners of a company".
Long before Oxycontin was on the market, American medicine - in concert with CMS- negotiated and embraced health care remuneration approaches that reward quick fixes (quick visits, rapid prescriptions and costly procedures) and punish time spent listening to patients and learning their problems and coming up with solutions.
When we read that very few US physicians wish to treat addiction, and even more are abandoning patients with pain, keep in mind it's fixable, but not being fixed, because US medicine, health systems and CMS prefer it that way.
STAT is paywalled, but the following extracts provide a useful summary.
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Upending Purdue Pharma’s settlement does little to help today’s opioid crisis, advocates say
By Lev Facher, STATNews
June 28, 2024
Link
The drug policy world has been left torn by the Supreme Court’s ruling on Thursday that Purdue Pharma’s bankruptcy deal could not move forward if it included legal protections for the company’s billionaire owners.
In one camp are those who were eager to see the agreed-upon $6 billion settlement put to work preventing and treating opioid addiction. In the other are those who found the prospect of shielding the Sackler family from civil lawsuits to be indefensible.
But there is a third camp, too: One that argues Purdue, its infamous pain drug OxyContin, and the overall scandal are of little relevance to today’s overdose epidemic, in which fentanyl, methamphetamine, and other illicit drugs combine to kill over 110,000 Americans each year.
“I won’t argue against the emotional stance of a bereaved parent who lost a child to OxyContin,” said Stefan Kertesz, an addiction doctor and professor of medicine at the University of Alabama-Birmingham. “But what got us into this crisis and what will get us out of it is a whole lot bigger than the execution of a revenge plan against owners of a company.”
With Thursday’s ruling, Purdue and many of the state attorneys general who sued the company pledged to restart negotiations on a new settlement agreement. But the clean slate is leading advocates to ponder whether pursuing justice for the dead, accountability for the Sacklers, and prevention of future deaths are fully compatible goals.
Since the opioid crisis captured the nation’s attention, the Sacklers have been the focus of countless books, television shows, and protests advocating that the family name be removed from numerous art museums and university buildings.
Even as the Sacklers rose to infamy, however, the drug crisis was morphing from OxyContin to heroin and, later, from heroin to fentanyl. Meanwhile, the U.S. has sharply cut its opioid prescribing rates — which Kertesz and many pain patients now argue has caused a secondary crisis by driving Americans from regulated, predictable pain drugs to unregulated, volatile opioids like fentanyl.
“Where we are today is that the vast majority of people are not dying from prescription opioids,” said Sara Whaley, a researcher focused on substance use policy at the Johns Hopkins School of Public Health. “Our crisis is very much the illicitly manufactured synthetic opioids, like fentanyl.”
The funding landscape has also changed as other pharmaceutical companies, drug wholesalers, and pharmacies have also agreed to settle claims relating to their roles in the opioid crisis. Those settlements total roughly $50 billion, some of which is now flowing to governments and community organizations.
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While pursuing justice for the Sacklers may be cathartic, Kertesz argued, it is unclear whether the Sacklers’ status as a national pariah is motivating the type of systemic change needed — or whether, in his view, it simply constitutes another “quick fix.”
Instead, Kertesz said, the country requires a sweeping overhaul of its health system, including an emphasis on listening to patients and using long-proven tools like the addiction medication buprenorphine to help prevent future overdose deaths.
The U.S. health system “helped create health care payment schemes that punish time spent listening to patients and learning their problems while rewarding quick visits and high tech,” he said. “Those were policy decisions organized medicine negotiated, long before Purdue Pharma came along to exploit them. And reality is, no one is trying to fix them.”
Still, the Supreme Court’s 5-4 decision to derail Purdue’s settlement process leaves in flux a sum of $6 billion that can’t yet be used for treatment, prevention, or naloxone distribution. It also delays sizable payments to thousands of individual plaintiffs who sued Purdue on the part of lost loved ones.And while today’s drug crisis bears little resemblance to the one Purdue helped fuel long ago, it’s easy to draw a line from one to the next, Whaley said....
article continues
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Next, something from Pharmacist Steve Ariens:
I have always been troubled by the Sackler's agreement. Purdue Pharma was a corporation, and the corporation structure is supposed to protect the stockholder's assets separate from any of the corporation's losses/liabilities.
Right now, Rite Aid is going thru bankruptcy, and the DOJ/DEA is going after fining them because a handful of their former pharmacists became whistleblowers and claimed that Rite Aid was "loose" in filling opioids & other controlled meds. I think that at the time this whistleblower lawsuit all started, Rite Aid had about 2500 stores. That means that they had between 5,000-6,000 pharmacists on staff. Who believes that within those numbers there would not be at least a handful of opio-phobic pharmacists and if they were successful in Rite Aid being sued, those whistleblowers would share in a percent of what the DOJ/DEA recoup from Rite Aid.
People who owned Rite Aid stock will lose the value they have invested in their stock. Why hasn't the DOJ been going after the other assets of the people who owned Rite Aid stock, to pay whatever the DOJ ends up fining Rite Aid? Because it is against the law.
As I remember, during the 2007-2009 bank crisis, there were some corporations where people who owned bonds in those companies- their bonds were cancelled and normally bond holders are in line with creditors.
Because Purdue Pharma was a closely held corporation, our legal system was able to do a "end run" around their corporate structure and was going after the Sackler's personal assets.
I just wondered what the Sacklers were "threatened" with if they didn't agreed to hand over some of their personal assets to settle this, in this manner. I get the same feeling as I did with the agreement with the 3 major drug wholesalers and the 3 large chain pharmacies with all those state AG's?
IMO, those corporations agreed to discriminate against pts who have a valid need for being prescribed a controlled med. What were the execs of those corporations threatened with to agree to participate in broadly denying disabled pts with their medically necessary medications?
IMO, this issue with the Sacklers is just another "canary in the coal mine" as the indicator of how "off the rails" our judicial system is.
Article continues
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And last but not least:
Be aware that I also have a new article going through the final stages of scheduling by the editors of STAT News, titled "Doctors 'overprescribing' opioids isn't the cause of the overdose epidemic — and it never was" This piece has been edited from an article soon to be published on Daily Remedy, and both are derivative from my earlier Podcast on KevinMD:
Opioid prescribing, pain management, and patient advocacy [PODCAST]
We delve into the complexities of opioid prescribing, pain management, and the opioid crisis with our guest, Richard A. Lawhern. As a patient advocate, Richard brings a unique perspective to the table. Join us as we discuss the discrepancies in data handling by organizations like the CDC, the implications of these discrepancies on public perception and policy decisions, and the role of patient advocacy in shaping discussions around pain management. Together, we'll explore the nuances of this critical issue and uncover the truths behind the numbers.
Stat News has a circulation of 2.3 million unique readers per month.
Go in Peace and Power
Red
AI Integrator & Enthusiast | Senior Subject Matter Expert - .NET, Azure, Cloud | Coding Consultant
4moDoctors’ have actually played little part in causing America’s ongoing addiction issues, yet have been targeted right along with their patients. Efforts to fix the "opioid crisis" have seen doctors dragged before medical boards, their licenses suspended, and jail sentences handed out. Their patients and beyond have suffered from sharp cuts to medications crucial to their existence, some have even lost their fight to live under such tortuous conditions. Despite acknowledgements from the CDC regarding their mistakes, their revised guidelines continue to encourage harmful practices that target innocents in the name of saving addicts. Unsurprisingly, overdose deaths have continued to skyrocket, with current government policies echoing prohibition era tactics with similar results. Chronic pain is complex and has long-term effects that are still not well understood. My own journey as a patient with intractable chronic pain crossed paths with the CDCs policies in 2017, resulting in a hellish 3.5 year forced taper that even after 4 years of recovery continues to have a profoundly negative impact on my life and health. Adequate pain management isn't a "nice to have," and treating it as such has done immeasurable harm.