The Opioid Crisis @hon440-opioidcrisis - Tumblr Blog

Glossary

Fentanyl - a very strong painkiller that is synthesized to resemble other opiates such as opium-derived morphine and heroin (Fookes 2021).

Naloxone - a medicine that rapidly reduces an opioid overdose (Young and Durak 2019).

Narcan - the brand name naloxone is sold under.

Opiates - chemical compounds that are extracted from natural plant matter, such as poppy sap and fibers (Alcohol and Drug Policy 2022).

Opioids - chemical compounds at least part synthetic, generally not derived from natural plant matter (Alcohol and Drug Policy 2022).

Opiophobia - the fear of prescribing opiate painkillers (Alcohol and Drug Policy 2022).

Oxycodone - the opioid substance that is the main ingredient in many pain medications (Fookes 2021).

OxyContin - the controlled release version of oxycodone used to treat long-term pain (Fookes 2021).

Pill mill - a doctor’s office, clinic, or other healthcare facility that routinely prescribes or dispenses controlled substances, without a medical necessity and outside the course of a normal professional practice (Young and Durak 2019).

Pseudoaddiction - the term coined in 1989 to describe how patients who use opioid painkillers to alleviate pain exhibit drug-seeking behavior that is misinterpreted as addiction (DeWeerdt 2019).

Psychosocial Interventions - non-pharmacological interventions focused on psychological or social factors that can improve symptoms, functioning, and quality of life (Dugosh et al. 2016).

Social-ecological framework - developed to understand the dynamic interrelations among various personal and environmental factors (Jalali et al. 2020).

Overview: The Path to Crisis

“Tackling the Opioid Epidemic.” 2019. AARP.

The opioid crisis, also referred to as the opioid epidemic, involves the overuse, misuse, and overdose deaths attributed to the class of drugs known as opioids. The abuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare (National Institute 2021). The Centers for Disease Control and Prevention (CDC) estimates that "the total ‘economic burden’ of prescription opioid misuse in the United States alone is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement” (National Institute 2021).

Opioids are a diverse class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (sold under the trade names OxyContin and Percocet), hydrocodone (Vicodin), codeine, morphine, and many others (National Institute 2021). Although these drugs may differ in legal status, each one poses a high risk for addiction and dependence. Ultimately, the potency and availability of these substances, despite the risk they pose for addiction and overdose, have made them infamous both as medical treatments and recreational drugs.

It is easiest to understand the extent and gravity of the opioid crisis with data. Since 2000, more than 500,000 Americans have died of opioid overdoses (U.S. Department of Health 2021). Moreover, as of 2019, more than 10 million people have misused prescription opioids (U.S. Department of Health 2021). Opioid-involved overdose deaths rose from 21,088 in 2010 to 47,600 in 2017, and by 2020 there were 68,630 overdose deaths (National Institute 2022). From a biological perspective, high doses of opioids depress respiratory function, which can lead to respiratory failure and ultimately death (Centers for Disease 2021). However, the reason the opioid crisis unfolded, thousands of people have died, and millions are addicted, is far more complex than biological forces.

As of November 2021, the CDC announced a horrific milestone: more than 75,000 people in the U.S. died of an opioid overdose during a 12-month period ending in April 2021 (Centers for Disease 2021). How did the opioid crisis reach this point? Why did it start in the first place? The path leading to the opioid crisis is not straightforward, and there are many factors to consider.

Without a doubt, the epidemic arose in part due to pharmaceutical manufacturers' aggressive and fraudulent marketing techniques. Pharmaceutical companies took advantage of doctors' well-intentioned efforts to improve pain management. However, pharmaceutical companies are not the only ones to blame for the current crisis. Doing so ignores issues at the root of the overdose crisis, issues including characteristics of the US healthcare system, regulatory regime, culture, and socio-economic trends (DeWeerdt 2019). By addressing these issues, one can understand why the opioid crisis started, who is most affected, and potentially how to stop the catastrophe.

“Opioids: Last Week Tonight with John Oliver.” 2016. Youtube.

In his first video on the opioid crisis, John Oliver, host of Last Week Tonight, gives an overview of the epidemic.

“1998 Purdue Pharma marketing video.” 2019. Youtube.

“Purdue Pharma OxyContin Commercial.” 2016. Youtube.

Both of these videos were released by Purdue Pharma in 1998 to market the painkiller OxyContin. Both videos feature several misleading claims, including the claim that “Less than 1% of patients become addicted to opioids.” In reality, over 21% of patients prescribed opioids misuse them and 8-12% develop an addiction (National Institute 2022).

“Purdue Pharma Sales Celebration ‘You Make Me Want to Sell OxyContin.” 2021. Youtube.

Although Purdue was aware OxyContin was addictive, they did not hesitate to celebrate the company’s immense profits from the drug.

The Pharmaceutical Industry

“OxyContin & the Opioid Epidemic.” 2022. Ethics Unwrapped.

Before the present epidemic, opioids were prescribed mainly for short-term uses such as pain relief after surgery or for people with advanced terminal conditions. At the time, many physicians were fearful of giving patients opioids because of their addictive nature (DeWeerdt 2019). However, in the 1980s, chronic pain increasingly became recognized as a problem that required adequate treatment (Dasgupta, Beletsky, and Ciccarone 2018). “Many states began to pass pain treatment acts, which removed the threat of prosecution for physicians who treated their patients’ pain with controlled substances” (DeWeerdt 2019). This, along with a letter to the editor published in the New England Journal of Medicine, contributed to the perception that opioids were safer and less addictive than previously thought (DeWeerdt 2019).

“Letter to the Editor.” 2019. The Washington Post.

Since it was published, this letter to the editor of the New England Journal of Medicine has been cited repeatedly by pharmaceutical companies.

The idea that opioids were addictive only when used recreationally and not when used to treat pain became widely accepted. As a result, prescriptions for opioids increased gradually throughout the 1980s and early 1990s (DeWeerdt 2019). But it wasn’t until the release of one product, in particular, OxyContin, that prescriptions soared, and the use of opioids to treat chronic pain became widespread. Manufactured by Purdue Pharma, OxyContin, similar to many other opioid products, was marketed heavily (DeWeerdt 2019). Purdue Pharma, along with other pharmaceutical companies, “lobbied lawmakers, sponsored continuing medical-education courses, funded professional and patient organizations*, and sent representatives to visit individual doctors” (DeWeerdt 2019). Throughout all of this, drug companies emphasized the safety, efficacy, and low potential for addiction of opioids.

Today, it is known that opioids are not an effective treatment option for chronic pain. Using opioids long-term is dangerous; people can develop a tolerance for the drugs and become more sensitive to pain (DeWeerdt 2019). Also, despite Purdue Pharma’s original claims, OxyContin is in no way less addictive than other opioid pain relievers. “The company even admitted it failed to disclose the addictive nature of OxyContin during a 2007 lawsuit” (Dasgupta et al. 2018). Unfortunately, for years doctors and patients had no idea drug companies were lying.

“Opioids II: Last Week Tonight with John Oliver.” 2019. Youtube.

John Oliver discusses how the pharmaceutical industry and prescription drug distributors recklessly contributed to the opioid crisis.

*These patient organizations include the American Pain Society and the American Academy of Pain Medicine. Coincidentally, the American Pain Society framed pain as a ‘fifth vital sign’ just months before Purdue released OxyContin.

#empireofpain

“Hundreds Protest Outside Purdue Stamford.” 2020. Daily Mail.

Dozens of protests and demonstrations have accused the pharmaceutical industry, the Food and Drug Administration (FDA), and the owners of Purdue Pharma, the Sackler family, for enabling the opioid crisis.

A Vulnerable System

“For Doctors, More Opioid Prescriptions Bring More Money.” 2018. CNN.

The structure of the U.S. healthcare system also enabled the opioid crisis. In the U.S., prescription opioids are a cheaper treatment option compared to pain-management approaches such as physical therapy. This is because health insurance plans consistently cover the former but not the latter.

In addition, the U.S. is one of a few countries that allow direct advertising of pharmaceuticals to consumers. Direct advertising encourages patients to ask their doctors for specific drugs. And, since doctors in private practice benefit financially from a high volume of satisfied patients, it makes sense that they wouldn’t want to turn down a patient who requested opioids. Besides, doctors had no reason to doubt pharmaceutical companies. “The incentives were there for doctors to prescribe more and more, particularly when they had already been convinced it was the right thing to do – the compassionate thing to do” (DeWeerdt 2019). What’s more, physicians do not receive good training in pain management, so when opioids like OxyContin emerged, it is not surprising they were overprescribed (DeWeerdt 2019).

Furthermore, studies show a link between pharmaceutical industry payments for opioids and physicians' prescription practices. Industry payments can be defined as payments made by pharmaceutical companies to physicians (Inoue et al. 2020). These payments include all non-research general payments per year, such as food and beverage, travel and lodging, speaker compensation, honoraria, consulting fees, gifts, and education materials (Inoue et al. 2020). “From 1996 to 2001, Purdue conducted over 40 national pain-management and speaker-training conferences across the country” (Van Zee 2009). Part of Purdue’s marketing strategy was to recruit and train physicians who attended these conferences for their national speaker bureau (Van Zee 2009). A study published in the Journal of Epidemiology and Community Health documented that “these types of pharmaceutical company symposiums and the industry payments these physicians received influenced physicians’ prescribing” (Inoue et al. 2020).

The Triple Wave Epidemic

“How The Opioid Settlement Could Truly Help The Addicted.” 2019. WBUR.

The opioid crisis has had three phases: the first phase was dominated by prescription opioids, the second by heroin, and the third and most recent phase by fentanyl. However, each of these opioids remains relevant to the current crisis. According to Keith Humphreys, a psychiatrist at Stanford University in California and a former White House drug-policy adviser, “We have three epidemics on top of each other. There are plenty of people using all three drugs. And there are plenty of people who start on one and die on another” (DeWeerdt 2019).

There was a steady increase in prescription opioid overdoses from the mid-1990s to about 2010, the first phase of the crisis. Due to patient privacy laws and a lack of coordination between U.S. states, users could accumulate several opioid prescriptions and then sell their excess pills. Instead of organized drug traffickers dominating the supply, users were responsible for the illicit trade of opioids. As a result, the epidemic spread rapidly. Eventually, when the prescription-opioid problem became clear, state and federal agencies made such drugs less accessible, physicians' guidelines for opioid prescription changed, and Purdue Pharma reformulated OxyContin to make it more difficult to crush and inhale. Although this did discourage prescription opioid misuse, it also caused many users to switch to heroin. Around the time prescription opioids became difficult to obtain, heroin supply increased, and its price dropped significantly. Interestingly, studies show the two drugs are linked, “People with a history of using prescription opioids are 13 times more likely to start using heroin than those with no history of prescription opioid misuse” (DeWeerdt 2019). Between 2010 and 2016, the second phase of the opioid epidemic, deaths from heroin overdoses increased almost fivefold (DeWeerdt 2019).

By 2013, the third phase of the opioid epidemic began taking shape. Heroin dealers who wanted to increase profits began to mix their products with fentanyl (DeWeerdt 2019). Since fentanyl is more potent than heroin, it is also more deadly. According to the CDC, between 2013 and 2016, overdose deaths from fentanyl increased by 88% per year (Hedegaard, Warner, and Miniño 2017). At each phase of the crisis, the number of users increased, and as a result, deaths sky-rocketed. The opioid crisis is far from over, and if a fourth wave were to emerge, thousands more lives would be lost.

“Three Waves of Opioid Crisis.” 2020. ATrain Education.

Who is Affected?

Racial attitudes and socio-economic trends not only facilitated the opioid epidemic but determined who would be most affected by the crisis. Purdue Pharma initially marketed OxyContin to suburban and rural White communities (DeWeerdt 2019). According to Helena Hansen, an anthropologist and psychiatrist at NYU Langone Health in New York City, the pharmaceutical company “took advantage of the prevailing image of a drug addict as an African-American or Hispanic person who lived in the inner city to head off potential concerns about addiction” (DeWeerdt 2019).

Purdue also marketed OxyContin to doctors who primarily served White patients as Whites were not thought to be at risk for addiction. Other factors such as “the prevalence of injury-prone hard labor jobs in rural communities and extensive job losses from the collapse of key rural industries such as coal mining,” resulted in White rural communities being hit the hardest by the opioid crisis (Rigg and Monnat 2015). The term “death of despair” was coined to describe the opioid-overdose deaths of White people in parts of the country where economic decline and de-industrialization are prevalent (DeWeerdt 2019). States such as West Virginia, Ohio, Kentucky, and New Hampshire, which are home to many rural White communities, have some of the highest opioid overdose death rates in the country (National Institute 2020). These states also have high under-employment and concentration of poverty (National Institute 2020). Without an effort to rebuild the social and economic fabric of rural communities, addiction will persist.

“Opioid Summaries by State.” 2020. National Institute on Drug Abuse.

This is not to say racial minorities or people who live in urban settings have not been affected. In fact, the characteristics of the epidemic are shifting. A recent study published in the American Journal of Public Health found that “non-Hispanic Black individuals in four U.S. states experienced a 38% increase in the rate of opioid overdose deaths from 2018 to 2019, while the rates for other race and ethnicity groups held steady or decreased” (National Institute 2021). The study concludes that overdose deaths in Black communities have increased due to heroin and illicit fentanyl (National Institute 2021). As for the urban vs. rural differences in prescription opioid misuse, a study published in the International Journal of Drug Policy documented that urban adults are more likely than their rural counterparts to engage in misuse because of their higher use of other substances (Rigg and Monnat 2015). As the opioid crisis evolves, it seems patterns associated with the epidemic are also shifting.

“Age-adjusted Drug Overdose Death Rates, By Race and Hispanic Origin: United States, 2019 and 2020.” 2021. CDC.

Other factors that can influence opioid misuse and should be taken into account are highlighted in a study published in the Health Research Policy and Systems Journal. As part of their study, the authors created a social-ecological framework for the opioid crisis. The framework includes factors associated with opioid misuse at the individual, interpersonal, communal, and societal levels (Jalali et al. 2020). Although the framework is separated into four sections, the authors acknowledge that the levels are interconnected (Jalali et al. 2020). Ultimately, the authors conclude that “the opioid crisis is a multi-faceted and ever-evolving issue, which requires the consideration of numerous interacting factors to develop effective interventions” (Jalali et al. 2020).

“Social-ecological Framework of the Opioid Crisis.” 2020. Health Research Policy and Systems.

This social-ecological framework demonstrates major factors associated with opioid misuse at the individual, interpersonal, communal, and societal levels.

In short, although research shows certain populations have been more severely impacted than others, the opioid epidemic affects people in all demographics and across the country. Even those who do not use or abuse opioids can experience the effects of the crisis if opioid abuse is common in their area or among their family and friends.

“The Four-Sentence Letter Behind the Rise of Oxycontin.” 2020. Rutgers Center of Alcohol and Substance Use Studies.

These are some of the advertisements and marketing materials Purdue Pharma created for OxyContin. Advertisements for prescription opioids targeted a specific population: White, middle-aged adults.

An Epidemic Amidst a Pandemic

“Pandemic Responsible for Increased Drug and Alcohol Use.” 2021. Whispering Oaks Lodge.

As the COVID-19 pandemic spread across the country, more Americans died of opioid overdoses in one year than ever before. There were over 75,000 opioid overdose deaths in the 12-month period that ended in April 2021 (Centers for Disease 2021). To put it into perspective, there were more opioid overdoses in the 12 months than car crashes and gun fatalities respectively (Rabin 2021). Experts, such as Dr. Nora Volkow, director of the National Institute of Drug Abuse, point to the “initial pandemic lockdowns and subsequent fraying of social networks, along with the rise in mental health disorders like anxiety and depression,” as reasons for the surge in overdoses (Rabin 2021). There was also the postponement of treatment for substance abuse disorders as health care providers nationwide were asked to redirect their attention to coronavirus patients (Rabin 2021).

With no support system and the closing of schools and workplaces, more people began seeking out opioids. Interestingly, about 70 percent of deaths recorded were among men between the ages of 25 and 54 (Rabin 2021). Also important to note is that although the opioid crisis has primarily impacted White Americans, a growing number of Black Americans were affected during the 12 months (Rabin 2021). Undoubtedly, the COVID-19 pandemic has altered the path of the opioid crisis.

Addiction has no bias. It doesn’t matter what your socioeconomic status is, or your race, or how well you raised your children. When we realize that we need to love those who struggle with this chronic illness until they can love themselves, that is when we will see real change.

Julia Picetti, founder of the Jane Aubrey Opioid Addiction Recovery Home

Current Treatments

Other than the risk of overdose, opioid users are subject to several health risks. Persons addicted to opioids are likely to transmit various blood-borne viruses such as human immunodeficiency virus (HIV) and hepatitis B and C (Dugosh et al. 2016). This is just one of the reasons why treatment for opioid addiction is so important. Currently, the treatments available include psychosocial interventions and medication-assisted treatment (Dugosh et al. 2016).

“Psychosocial Therapies Found to Boost Immune Function.” 2020. Psychiatric News.

The goal of psychosocial intervention is to help patients remain abstinent by controlling urges to use drugs. Psychosocial treatment also “serves to assist patients in coping with the emotional strife that often accompanies addiction” (Dugosh et al. 2016). Psychosocial interventions may be delivered in an inpatient or outpatient setting and in various formats. For example, there is individual, group, and couples counseling, cognitive-behavioral therapy, contingency management, 12-step facilitation therapy, motivational interviewing, family therapy, and others (Dugosh et al. 2016). In 2018, the medical journal The Lancet went so far as to recommend psychological treatment as a first-line intervention for chronic low back pain before pharmacological treatment (Rabin 2021). However, finding the right pain counseling requires considerate effort on the part of the patient.

As for medications, there are currently three that the FDA has approved to treat opioid addiction: methadone, buprenorphine, and naltrexone (Park and Otte 2019). Methadone can be used as a “detoxification medication to suppress withdrawal and cravings and as a maintenance medication to help reduce opioid use” (Park and Otte 2019). Buprenorphine, similar to methadone, can be used during both the detoxification and maintenance stages of treatment for opioid addiction (Park and Otte 2019). Finally, naltrexone is not a detoxification medication but is well suited for maintenance (Park and Otte 2019). This is because “naltrexone blocks opioid receptors in the brain, so the subjective effects of ingested opioids are significantly reduced if not eliminated” (Park and Otte 2019.

Despite the moderate success of current medications and interventions, the way addiction is treated is not working, at least not for everyone. Relapse rates among heroin users exceed 59% within the first week and about 80% within the first month (Rabin 2021). In addition, barriers such as access and affordability prevent current treatments from achieving their full potential. Currently, there is simply not enough high-quality care available. People with addiction often have to wait weeks or months before they have access to treatment. And even if someone can find access to high-quality treatment, it is not always affordable. It can costs thousands of dollars to receive good care, which is not always covered by insurance if the person even has health insurance. Therefore, the search for treatments that promise better efficacy must continue for the opioid crisis to improve.

“Fighting Opioid Addiction: As Long As it Takes.” 2017. Youtube.

In her TedTalk, Julia Picetti, founder of the Jane Aubrey Opioid Addiction Recovery Home, discusses what she believes is wrong with substance abuse treatment programs and provides potential solutions to combat the opioid crisis.

#FIGHTopioidaddiction #aslongasittakes

New and Alternative Treatments

Recent research has uncovered new potential treatment options for opioid addiction. These new potential treatment options include different drugs and intervention methods, along with alternative forms of pain management.

“Non Opioid Pain Relief: Different Paths to Pain Management.” 2022. AmTrust Financial.

Schedule one drugs that are becoming de-stigmatized and legalized, such as LSD, psilocybin, and marijuana, have the potential to decrease opioid abuse. Studies show that marijuana is a safer alternative to opioids (Genereaux 2019). Firstly, the chances of becoming addicted to marijuana are much lower than for opioids (Genereaux 2019). Furthermore, “cannabis is currently the only known drug that can effectively manage pain with no risk of lethality if too large of a dose is taken” (Genereaux 2019). Similarly, hallucinogens, although not researched as much as marijuana, show some promise in the treatment of addictive disorders. For example, studies show that LSD counters alcohol addiction (Genereaux 2019). Therefore, although more research needs to be done, it is theorized that hallucinogens could also serve as a useful tool for opioid addicts. Unfortunately, because hallucinogens such as LSD and psilocybin remain in schedule one, they are incredibly difficult to study. It may be a while before it is known for certain whether hallucinogens are an effective treatment for opioid misuse.

Apart from research on schedule one drugs, new intervention plans may be beneficial in fighting the current crisis. Intervention plans at the pharmacist level could be a unique way of combating prescription opioid abuse. “Pharmacists act as intermediaries between prescribers and patients, giving them a unique role and responsibility regarding this current epidemic” (Genereaux 2019). “Pharmacists can watch for excessive prescriptions from prescribers and note signs of opioid abuse in patients coming in to fill prescriptions” (Genereaux 2019).

Alternative methods of pain management have also been gaining credibility. Studies have shown that mindfulness and meditation are effective ways of managing pain (Genereaux 2019). Therapies such as massage therapy, occupational therapy, and physical therapy have also been identified as non-opioid alternatives to manage pain (Genereaux 2019). Although current opioid addiction treatments are helpful, alternative methods should be explored, especially since overdose deaths are increasing.

#opioidalternatives

Conclusion: What You Can Do

The opioid epidemic isn’t a problem one person can take on alone. A nationwide effort is the only way to overcome the crisis. With that being said, knowing the dangers, signs, and symptoms of opioid abuse (sleepiness, slow heart beat, cold skin, and difficulty breathing) can save someone’s life. Spreading awareness and talking openly about the crisis to remove the stigma of addiction is also imperative. Becoming informed about the crisis, and promoting the use of overdose-reversing drugs, such as naloxone, may also help. Making naloxone widely available can dramatically reduce the risk of death from overdose (Young and Durak 2019). Home of New Vision, a non-profit organization based in Ann Arbor, Michigan, recently installed a vending machine that dispenses free naloxone in the city’s public library (Ainsworth 2022). Even a simple act like this one can save countless lives.

“Narcan Made Available Via Vending Machine in Southern Indiana.” 2022. Youtube.

Here is another example of a Narcan vending machine in Southern Indiana that dispenses free naloxone.

One may also prompt policymakers to combat the opioid epidemic. Policymakers can take actions that reduce opportunities for misuse of prescription opioids. These include: setting prescriber limits, cracking down on pill mills, encouraging insurance companies to cover non-drug pain therapies, and providing funding for opioid treatment for people who are uninsured or underinsured (Young and Durak 2019). Although the opioid crisis is too large to take on alone, individuals can contribute to the fight to end opioid abuse.

If you believe you or a loved one is struggling with opioid addiction, please reach out and seek help. Or please call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Hotline at 1-800-662-4357 to find substance abuse treatment and information.

Remember Purdue Pharma?

“Purdue Pharma Headquarters.” 2022. The New York Times.

What happened to Purdue Pharma? In 2019, Purdue filed for bankruptcy due to nearly 3,000 lawsuits accusing the company of contributing to the public health crisis (McCrackin 2021). Although the company initially denied its involvement in the opioid epidemic, in late 2020, Purdue agreed to plead guilty to criminal charges related to its marketing of the addictive painkiller OxyContin. Purdue also agreed to a settlement of $4.5 billion (McCrackin 2021). However, the bankruptcy settlement was overturned by Judge Colleen McMahon of the U.S. District Court for the Southern District of New York (Hoffman 2021). McMahon stated that the settlement should not go forward because it “releases the company’s owners, members of the billionaire Sackler family, from liability in civil opioid-related cases” (Hoffman 2021). Although the Sacklers did not file for personal bankruptcy protection, they had made immunization from opioid claims an absolute requirement in exchange for the $4.5 billion (McCrackin 2021).

After months of deliberation, a new agreement was reached and is awaiting approval. The new deal includes an increase of at least $1 billion in the amount the Sacklers would pay (Hoffman 2022). In addition to the family’s money, Purdue itself will contribute “through cash and revenue from future sales, payments expected to amount to $1.5 billion by 2024, with far more to come” (Hoffman 2022). Although Purdue was formally dissolved the company re-emerged as Knoa Pharma, which still produces OxyContin (McCrackin 2021). Finally, in the new agreement, the Sacklers still have immunization from opioid claims. Although the deal attempts to hold the pharmaceutical industry accountable, many people may still be disappointed that members of the Sackler family did not acknowledge wrongdoing or any personal responsibility for the public health crisis.

What do you think? Should the Sacklers be held accountable or is the new agreement reasonable?

“Opioids III: The Sacklers: Last Week Tonight with John Oliver.” 2021. Youtube.

In the final video of the series, John Oliver does a deep dive into the Sackler family.

“The Crime of the Century.” 2021. HBO.

If you would like to learn more about the opioid crisis, this two-part HBO documentary, available on Kanopy, is a great resource.

#purduepharma #thesacklers

References

Peer Reviewed Journals

Dasgupta, Nabarun, Leo Beletsky, and Daniel Ciccarone. 2018. “Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.” American Journal of Public Health 108(2):182-186.

DeWeerdt, Sarah. 2019. “Tracing the US Opioid Crisis to its Roots.” Nature 573(7773):S10-S12.

Inoue, Kosuke, Jose Figueroa, John Orav, Yusuke Tsugawa. 2020. “Association Between Industry Payments for Opioid Products and Physicians’ Prescription of Opioids: Observational Study with Propensity-score Matching.” Journal of Epidemiology and Community Health 74(8):647-654.

Jalali, Mohammad, Michael Botticelli, Rachael Hwang, Howard Koh, and Kathryn McHugh. 2020. “The Opioid Crisis: A Contextual, Social-Ecological Framework.” Health Research Policy and Systems 18(1):1-9.

Park, Kinam, Andrew Otte. 2019. “Prevention of Opioid Abuse and Treatment of Opioid Addiction: Current Status and Future Possibilities.” Annual Review of Biomedical Engineering 21(2):61-84.

Rigg, Khary K., Shannon M. Monnat. 2015. “Urban vs. Rural Differences in Prescription Opioid Misuse Among Adults in the United States: Informing Region Specific Drug Policies and Interventions.” International Journal of Drug Policy 26(5):484-491.

Van Zee, Art. 2009. “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.” American Journal of Public Health 99(2):221-227.

References

Websites

Ainsworth, Amber. 2022. “Free Narcan vending machine installed at Ann Arbor District Library Downtown.” Detroit, MI: Fox 2 Detroit.

Alcohol and Drug Policy Commission. 2022. “Opiates or Opioids– What's the Difference?” Salem, OR: Alcohol and Drug Policy Commission.

Centers for Disease Control and Prevention. 2021. “Drug Overdose Deaths in the U.S. Top 100,000 Annually.” Atlanta, GA: Centers for Disease Control and Prevention.

Dugosh, Karen, Amanda Abraham, Brittany Seymour, Keli McLoyd, Mady Chalk, and David Festinger. 2016. “A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.” Journal of Addiction Medicine 10(2):91-101.

Fookes, Carmen. 2021. “Oxycodone vs OxyContin– What’s the Difference?” Washington, DC: Drugs.com.

Genereaux, Nicholas. 2019. "The Opioid Crisis: Biological, Psychological and Sociological Factors in the Etiology and Future Mitigation of Opioid Addiction." Knoxville, TN: Chancellor’s Honors Program Projects.

Hedegaard, Holly, Margaret Warner, and Arialdi M. Miniño. 2017. “Drug Overdose Deaths in the United States, 1999–2016.” Atlanta, GA: Centers for Disease Control and Prevention.

Hoffman, Jan. 2021. “Judge Overturns Purdue Pharma’s Opioid Settlement.” New York, NY: The New York Times.

Hoffman, Jan. 2022. “Sacklers and Purdue Pharma Reach New Deal With States Over Opioids.” New York, NY: The New York Times.

McCrackin, Carmen. 2021. “$4.5 Billion Purdue Pharmaceutical Bankruptcy Settlement Overturned.” Orlando, FL: Addiction Center.

National Institute on Drug Abuse. 2021 “Disparities in Opioid Overdose Deaths Continue to Worsen for Black People, Study Suggests.” North Bethesda, MD: National Institute on Drug Abuse.

National Institute on Drug Abuse. 2021. “Opioid Overdose Crisis.” North Bethesda, MD: National Institute on Drug Abuse.

National Institute on Drug Abuse. 2020. “Opioid Summaries by State.” North Bethesda, MD: National Institute on Drug Abuse.

National Institute on Drug Abuse. 2022. “Overdose Death Rates.” North Bethesda, MD: National Institute on Drug Abuse.

Rabin, Roni C., 2021. “Overdose Deaths Reached Record High as the Pandemic Spread.” New York, NY: The New York Times.

U.S. Department of Health and Human Services. 2021. “What is the U.S. Opioid Epidemic?” Washington, DC: U.S. Department of Health and Human Services.

Young, Christen L., Abigail Durak. 2019. “How Do We Tackle the Opioid Crisis?” Washington, DC: Policy 2020 Brookings.

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