The Big News

Startling data recently made public show the details of how pharmaceutical companies saturated the country with opioids. In the seven years from 2006 to 2012, America’s biggest drug companies shipped 76 billion oxycodone and hydrocodone pain pills (253 per person in the U.S.), and opioid-related deaths soared in communities where the pills flowed most.

The new revelations come from the Washington Post, which spent a year in court to gain access to a DEA database that “tracks the path of every single pain pill sold in the United States.” The database reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year-by-year, town-by-town. The data will be valuable to the accountability-seeking attorneys litigating cases—including a huge multi-district case in Ohio, where thousands of documents were filed Friday—that allege opioid manufacturers and distributors knowingly flooded the market as the overdose crisis raged and red flags were everywhere.

Here’s how distributors, pharmacies and manufacturers are responding so far.

The Post has also published the data at the “county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities.” Expect many reports from local journalists using the data to explain the causes and impact of the opioid crisis in their communities. The Post did its own local deep-dive, taking a close look this weekend at two Ohio counties that soon will be at the center of the big multi-district litigation. Barring a settlement, the two counties are scheduled to go to trial in October as the first case among the consolidated lawsuits brought by about 2,000 cities, counties, Native American tribes and other plaintiffs. But Judge Dan Aaron Polster, shown above, has said he still hopes the shadow of the trial will goad the sides to reach a national settlement that could award money to local governments across the country, and foreclose further opioid lawsuits.

Meanwhile, the CDC posted preliminary data suggesting that the number of Americans who died from drug overdoses finally fell 5% in 2018, after years of significant increases. We saw similar reports earlier, based on preliminary data from the first six months of 2018. This new data, while still preliminary, covers all of 2018, so it is firmer. And it is a rare positive sign. But it’s only one year and no cause for celebration or complacency—especially with continued funding for opioid crisis grants uncertain and the decline in deaths anything but uniform across the states (18 states still saw increases in 2018). Policymakers must be reminded that we’re still very much in the midst of the nation’s worst-ever addiction crisis—one from which it will take years to recover. Federal funding remains essential, as advocate Ryan Hampton points out in his latest piece making the case for the CARE Act, a Congressional bill that would invest $100 billion over the next 10 years.

This week’s featured media is a video of former Amabassador to Belgium Leonard Firestone, who co-founded the Betty Ford Center. He didn’t do a lot of interviews, so this one with Glenn Jorgenson, host of the South Dakota-based It’s Great to Be Alive TV series from the late 1970s and 1980s, is a unique one.

If you missed the premiere of  “The First Day,” a powerful, one-hour documentary that shows the evolved talk of former NBA-player-turned-recovery advocate Chris Herren, you can catch it again July 30 at 10.p.m. Eastern on ESPN. It is also now available for sale as a download. Herren has spoken to more than a million young people, and the film follows him on a dozen or so speaking engagements up and down the East Coast.

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Treatment Industry Issues and Reforms

We were in Washington, D.C., for a few days last week and met with 19 Congressional and Administration offices. We set out to help policymakers understand the importance of taking the next step in parity by aligning the privacy regulations for substance use disorder (SUD) treatment with the regulations for the treatment of all other health conditions. At present, SUD is singled out with separate but unequal regulations that inhibit coordinated, integrated care and innovation. Joining Nick Motu, Emily Piper, Jenni Lohse and me was a partner, Santo Cruz from CentraCare, the largest rural health care provider in Minnesota. Learn more →

While in Washington, we also discussed the following needs: more objective research reports and public education related to the risks and potential benefits of legalizing cannabis and cannabis-derived products, federal guidance to states on addiction treatment quality standards, continued opioid crisis grant funding, expanded medical education on addiction, and parity enforcement measures, among others.

Marijuana

A bipartisan group of senators wants to streamline the application process for researchers interested in studying marijuana; encourage the development of FDA-approved drugs derived from marijuana; clarify that doctors can discuss the benefits of cannabis with patients; and require HHS to submit a report on the health risks and potential benefits of marijuana; as well as one on barriers to cannabis research and how to overcome those obstacles. Learn more →

The Florida House of Representatives wants a say in a lawsuit challenging the constitutionality of state medical marijuana regulations. 

California is struggling to regulate marijuana.

More than three dozen attorneys general are urging federal regulators to partner with the states in protecting consumers from false advertising and potential harm from products containing cannabis or cannabis-derived compounds, including CBD.

A new study found that marijuana smokers discipline their kids more. It also found that 92 percent of past-year pot smokers also drank alcohol in the past year. I’m not sure there’s much to conclude from this research but what I did find interesting were several references in the article to people who believe they are better parents stoned. If that’s indeed a real thing, it’s a sure sign of how out-of-whack perceptions have gotten regarding marijuana.

Opioids Delta Air Lines says naloxone, the medication used to treat opioid overdoses, will be available in emergency medical kits on flights beginning this fall.

The decision comes after a passenger tweeted that a man died aboard a Delta flight last weekend. Hard to fathom why naloxone isn’t already on all flights. Last year, we joined the Association of Flight Attendants in urging the FAA to require it. No one should have to die before airlines take this common-sense step. Learn more →

Oklahoma's lawsuit against Johnson & Johnson went to the judge, who will decide later this summer whether to hold the drugmaker accountable for the state's opioid epidemic. Oklahoma is seeking more than $17.5 billion to abate the costs of opioid addiction. Purdue Pharma and Teva Pharmaceutical settled their part of the Oklahoma case. But they and other drugmakers and distributors face some 2,000 similar lawsuits by states and local municipalities.

The Louvre in Paris has removed the name of the Sackler family from its walls, becoming the first major museum to erase its public association with the philanthropist family linked with the opioid crisis in the United States. Here are some other entities that have cut ties. Meanwhile, the Wall Street Journal highlighted how the public backlash is tearing apart the Sackler family.  

A look at how racial inequity is playing out in the opioid crisis.

Auditors in Maryland are questioning how effectively and appropriately the state has invested grant funding in addiction treatment.

Rhode Island appears to have experienced a second straight year of declining overdose deaths in 2018. One success there has been the state’s program to prevent ex-inmate relapses and deaths.

There’s nothing more alternative and punk rock today than advocating for “both/and” solutions, so we think this op-ed from Keith Humphreys on drug policy is pretty rad.

NIDA Director Nora Volkow writes about the importance of prevention in addressing the opioid crisis.

This study shows that teens who misuse prescription opioids are more likely to initiate heroin use.

In a story very much related to our Big News above, the U.S. Department of Justice indicted drug distributor Miami-Luken Inc. this week—a rare criminal charge alleging that the company flooded rural towns in Ohio, West Virginia and Kentucky with painkillers to profit off the opioid crisis.

Government scientists are starting to peek into the brains of people caught in the nation's opioid crisis to see if medicines like methadone do more than ease the cravings and withdrawal.

Some members of Congress are looking to eliminate the training requirement (known as the data waiver) for buprenorphine prescribers. It is certainly true that it makes little sense to require a waiver to prescribe a partial opioid medication, while nothing additional is needed to prescribe powerful full-opioid pain medications. If medical education on addiction were anywhere near sufficient, it would make perfect sense to ditch the waiver. As it is, though, we should not be cutting back any kind of physician education on addiction. The waiver training represents the bulk of addiction education for many physicians. It is only eight hours long, which is minimal and unlikely to eliminate many people from pursuing. They get a minimal understanding of this complex disease, and some of the difficulties associated with treatment. It should also be noted that most opioid use disorder patients use more than one substance, which is commonly neglected in these discussions; prescribing the medication alone is not adequate for most patients. Plus, the data suggests that it is not the waiver that is limiting the access to buprenorphine. Even the doctors who complete the training rarely are prescribing buprenorphine to as many patients as they could be. In fact, many waivered medical providers aren’t prescribing buprenorphine at all. The lack of access parallels the lack of training for physicians and the institutionalized stigma that exists throughout our entire healthcare system. We should be moving toward a medical education system that makes the waiver training obsolete, but we are not there yet.

In one of the nation's poorest counties, a local church is trying to help by building a community of tiny homes to support those in recovery.

A conversation about the future of pain management.

Alcohol

Here’s a summer tip to share… Although the exact cause is still being determined, studies show that alcohol can increase your risk of sunburn. Learn more →

For males with a genetic predisposition to alcohol use disorder, being in a romantic relationship appears to reduce the risk.

Unlike several other schools, LSU will be allowing beer and wine sales at football games under the SEC's revised alcohol policy.

Health-care organizations warn that the U.K. will continue on an "alarming trajectory" of alcohol-related ill health and deaths unless the government prioritizes plans to tackle the issue.

More unusual deaths in the Dominican Republic appear to be alcohol-related.

This mom says being sober in the middle of a wine-mom culture is isolating.

Health Care Reform and Parity

The Administration moved this week to shift more of patients’ chronic illness costs to insurers. It’s always interesting to read stories about chronic illnesses that make no mention of substance use disorders.
Learn more →

Beginning in 2021, Connecticut insurance providers will have to submit annual reports detailing their coverage of mental health and substance use services so that regulators can better monitor for parity compliance.

We’ve shared here that UnitedHealth Group faces a couple of notable lawsuits charging parity violations. This week: a profile on how the insurance giant's power and prowess continues to grow.

Joe Biden rolled out his proposal for expanding the Affordable Care Act.

What Medicare-for-All may mean for Medicaid.

A federal judge upholds a Trump short-term health insurance alternative to 'Obamacare.'

Advocate Spotlight Fifty years ago, Buzz Aldrin became the second man to walk on the moon. As the nation commemorated the golden anniversary of Apollo 11 last weekend, Aldrin’s later life as a recovery advocate got some attention again. Learn more →

Thrive Global is profiling people who became entrepreneurs after initiating recovery.

Our friend and fellow advocate Brandy Brink is the founder of WEecovery, a new downtown community center in Mankato, Minnesota, for people in recovery.

Miscellaneous Musings

A new study in Massachusetts further validates that stigma associated with opioid use disorder extends to the health care community, where a minority of providers are trained in addiction, find treating opioid use disorder satisfying, or want to work with patients who have opioid use disorder. Learn more →

• The Minnesota State Fair is removing a planned new food following a petition over the use of syringes.

• At Hazelden Betty Ford in St. Paul, we have a new intensive outpatient treatment program that focuses on the LGBTQ+ community, an important and generally underserved population that experiences a significantly higher rate of addiction than the general population.

• A fun, new “On This Day” Twitter account—@recoveryalmanac— aims to share the history of recovery in America, one day at a time, while also noting key developments in public policy and addiction health care. This week, look for #OTD posts commemorating the signing of the Comprehensive Addiction & Recovery Act, Bill Wilson and Marty Mann’s testimony before Congress, the founding of the Society of Americans for Recovery (SOAR), and the first AA International Convention. (Disclosure: this is a pet project of my own!)

• Among the U.S. Senators proposing significant new funding to address the opioid crisis is Sen. Jeff Merkley from Oregon, whose bill is called the “Opioid Treatment Surge Act.”

• In a new, first-of-its-kind study, researchers asked heroin users what they would like to be called.

• The advocacy director for a syringe program in Ohio has been arrested for relapsing.

• Our friend and fellow advocate Donald McDonald has taken to rewriting headlines on our topics. This one—“Framing addiction as a disease: Research shows that message might backfire”—he edited as “Framing addiction exclusively as a disease: Research shows that message may be less effective than the more accurate 'complex causes' definition.”

• …Knowing he has no editor to enforce brevity, Donald also suggested replacing this headline—More Kids Are Getting Placed In Foster Care Because Of Parents' Drug Use—with this much more explanatory one: “More kids are getting placed in foster care because of inadequate implementation of evidence-based prevention initiatives; discriminatory health care coverage gaps; major obstacles to appropriate addiction treatment and recovery support services; inadequate attention toward preventing adverse childhood experiences and building resilient communities; moral objections to harm reduction resources; mostly lip service paid to social determinants of health; and discrimination against people experiencing the deadliest public health emergency in American history.” His point in such an exercise—at least part of it, I presume—is to illustrate that addiction is a much more complex issue, in terms of explanations and solutions, than most journalists, policy makers or members of the public know. To make progress, we need to get people to think about addiction differently—as truly, a health problem—and that starts with talking about it differently.

• In his latest blog post, William White writes about moving Beyond Recovery Exceptionalism: “What is needed within the recovery advocacy movement is not a handful of highly visible charismatic leaders, but thousands of people in recovery stepping together into the light to affirm the reality and transformative power of recovery.”

• Congrats to Laurie M. from West Virginia—another trivia winner from a previous edition. She earned herself a fancy Hazelden Betty Ford Advocacy pen. This week’s trivia question: Who co-founded the Betty Ford Center with Ambassador Leonard Firestone? Send me the correct answer and you might earn a pen, too!

• What else do you think? Send me a note, and have a great week!

• I’m on vacation in the Black Hills of South Dakota this week, so look for the next Update on Aug. 2, the day before hazelfest. If you can join us for our favorite annual event in Center City, be sure to get advance-price tickets at hazelfest.org!