10. War on Drugs/Private Prisons
“I heard the voice of the fourth beast say, ‘Come and see.’ And, I looked, and behold a pale horse: and his name was Death, and Hell followed with him.”
―Revelations 6:7-8
What has become of plutocracy democracy now that the inmates are running the asylum?
· One in seven Americans lives below the poverty line; suicide rates are at a 30-year high; opioids and other drugs kill more each month than guns and car crashes; every seven minutes someone dies from an overdose; one child in eight lives with a drug-abusing parent.
Ø In 2017, of the record number 70,237 Americans who died from an overdose, 68% involved a prescription or illegal opioid. The number of overdose deaths has doubled in a decade, from 36,010 deaths in 2007.
Ø Since 1990, more Americans have died from opioid overdose deaths than American deaths in WWII (419,400)―MORE DEATHS THAN WORLD WAR II.
Ø Approximately 130 Americans die every day from drug overdose.
Ø Americans, today, have lifetime odds of dying from an opioid overdose (1 in 96) that are greater than dying from a car accident (1 in 103). The lifetime odds of dying from a gun assault are 1 in 285 and from an airplane crash 1 in 188,364.
Ø The death rate for opioids is now six times higher than it was in 1999.
Ø From 1997 to 2017, more than 200,000 people in the United States died from overdoses tied to all prescription opioids, according to federal data.
Ø Deaths linked to opioids had exploded 91% from 1999 to 2002.
Ø From 1996 to 2016, more than 7 million Americans have abused OxyContin.
Ø According to a study in JAMA Network Open, they found that counties that got more marketing [prescription opioids] the year before saw more painkiller prescriptions and more overdose deaths.
Ø The White House Council of Economic Advisors recently estimated the economic burden of drug overdose deaths, inclusive of the value of statistical lives lost, to be $504 billion in 2015.
Ø Drug over dose deaths in West Virginia and Ohio far out-pace the rest of the country.
Ø Deaths of despair are rising among Americans without a high school degree, accompanied by a measurable deterioration in economic and social wellbeing. According to Alan Krueger, “The increase in opioid prescriptions from 1999 to 2015 could account for about 43% of the observed decline in men’s labor force participation (LFP) during the same period.” He found that LFP fell in counties where more opioids were prescribed.
Ø In Washington State, sales from legal prescription opioids increased more than 500% between 1997 and 2011. In 2011, at its peak, more than 112 million daily doses of all Rx opioids were dispensed.
Ø Oklahoma Attorney General Mike Hunter (R), said the “Big Three” distributers (McKesson Corp., Cardinal Health Inc., and AmerisourceBergen Corp.) supplied more than 34 billion doses of opioids to Oklahoma and the rest of the U.S. between 2006 and 2012 and did not stop or report suspicious drug orders because they were making so much money. In that same time period, there were over 1.4 billion opioids distributed in Oklahoma alone. Current Oklahoma lawsuits state that the aforementioned companies funneled more opioids into communities throughout Oklahoma than could possibly have been expected to serve a legitimate medical need while ignoring red flags and suspicious orders.
Ø Rochester Drug Cooperative, New York pharmaceutical company flagged only 4 narcotics orders as suspicious from 2012 to 2016. During that time and into 2017, nearly 1.5 million orders were made in total―only 4 narcotic orders were flagged! Demand for oxycodone grew by 800% and demand for fentanyl grew by 2000%.
THE SUPPLY DRUG CHAIN
LEAST RESPONSIBLE:
o Physicians
o Pharmacists
o Press Ganey
o HCAHPS
o Hospital Administrators
o World Health Organization (WHO)
o Centers for Medicare and Medicaid Services (CMS)
o Agency for Healthcare Research and Quality (AHRQ)
MODERATELY RESPONSIBLE:
o Shareholder democracy
o Federal Drug Administration (FDA)
o Joint Commission
o Veterans Health Administration
MOST RESPONSIBLE:
o American Pain Society (APS)
o Center for Practical Bioethics (CPB)
o Retailers: CVS, Walmart, Rite-Aid, Walgreens, HBC and Discount Drug Mart
o Drug Distributors: McKesson Corp., Cardinal Health Inc., AmerisourceBergen Corp. (among the richest companies in America)
o Endo International and its subsidiaries Endo Pharmaceuticals and Par Pharmaceutical
o Teva Pharmaceuticals of Israel and its subsidiary Cephalon Pharmaceuticals
o Rochester Drug Cooperative (New York based and is the nation’s 6th largest drug distributor)
o Abbott Laboratories (partnership with Purdue Pharma to market OxyContin)
o Johnson & Johnson (maker of opioids Duragesic, Nucynta and supplier of raw ingredients for opioids to other companies, most notably, Purdue Pharma) and its subsidiary Janssen Pharmaceuticals
o Mallinckrodt Pharmaceuticals (largest generic opioid manufacturer)
o Insys Therapeutics, Pharmaceutical Company (maker of opioid Subsys)
o Purdue Pharma (maker of opioid OxyContin) and its international subsidiary Mundipharma
Presently, the US Senate Finance Committee is demanding that the following pain societies and advocacy groups disclose any and all payments received from opioid manufacturers:
o American Academy of Pain Medicine (AAPM)
o American Chronic Pain Association
o The American Society for Pain Management Nursing
o The American Society of Pain Educators
o The Federation of State Medical Boards
o The American Academy of Physical Medicine and Rehabilitation
o The Alliance for Patient Access
o The International Association for the Study of Pain
o Joint Commission
o American Pain Society
THE FIRST WAVE:
The story begins in December, 1995, when the FDA approved Purdue Pharma’s new drug for pain management in non-cancer related patients called Oxycontin. Dr. Curtis Wright, who led the 1995 FDA approval, then took a senior position in Purdue Pharma working in product development in 1998. This coincided with the American Pain Society’s (APS) campaign promoting “pain as the 5th vital sign.” David Haddox, who headed an APS committee that endorsed the increased use of opiates, later joined Purdue Pharma in 1999, as well. Soon thereafter, the Veterans Health Administration adopted that campaign as part of their national pain management strategy. In 2001, the Joint Commission issued a pain scale, framing pain management as a patient’s rights issue and stressed the safety of opioids. In a Joint Commission guide, sponsored by Purdue Pharma on pain management, it stated. “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.” The Center for Practical Bioethics (CPB) in Kansas City, Missouri, has on several occasions been investigated for its financial ties to the pain pill-opioid industry. The CPB has received substantial financial support from a variety of pain medication companies, including Purdue Pharma manufacturer of OxyContin.
In 2002, the Bush Administration launched the Hospital Quality Initiative, intended to improve quality of care through accountability and public disclosure. CMS then partnered with AHRQ, both agencies part of the US Department of Health and Human Services, to develop a survey for patients about hospital satisfaction to improve quality―enter Press Ganey and HCAHPS, the patient satisfaction survey used to determine hospital reimbursement rates which lead to overprescribing of opioids.
Aggressive marketing ensued in force―that is, malevolent authority―pushing doctors to prescribe more “addictive” painkillers.
· Hospital Administrators felt pressured to achieve scores of “excellent” on patient surveys, Press Ganey and HCAHPS, because CMS was now attaching significant reimbursement to patient satisfaction. Hospital physicians felt increased pressure to concentrate more on “excellent” patient satisfaction rather than patient-centered outcome.
· Abbott Laboratories went to hook in doctors and make OxyContin a billion-dollar blockbuster. The sales force bought takeout dinners for doctors and met them at bookstores to pay for their purchases. In memos, the sales team referred to the marketing of the drug as a “crusade,” and their boss called himself the “King of Pain.” Abbott Laboratories sales reps were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis. The sales reps from Abbott Laboratories and Purdue Pharma closely coordinated their efforts, met regularly to strategize, and shared marketing materials. Abbott Laboratories heavily incentivized its sales staff to push OxyContin, offering $20,000 cash prizes and luxury vacations to top performers. Their almost religious zeal to sell the drug is evident in the wide use of terminology from the Middle Ages Crusades: Sales reps were called “royal crusaders” and “knights” in internal documents, and they were supervised by the “Royal Court of OxyContin”—executives referred to in memos as the “Wizard of OxyContin,” “Supreme Sovereign of Pain Management,” and the “Empress of Analgesia.” The head of pain care sales, Jerry Eichhorn, was the “King of Pain” and signed memos simply as “King.”
· “As you continue to carry the OxyContin banner onto the field of battle, it’s important to keep highlighting OxyContin benefits to your doctors,” Abbott Laboratories urged its sales staff in a memo contained in the court records.
· Insys had a “kickback scheme”, paying off doctors (e.g., fake educational talks), a rap video to market their opioid Subys and even hired a stripper as a sales executive to give lap dances.
· Purdue Pharma reminded Tennessee sales reps that raising dosage strength was the key to a big payday in a memo titled: “$$$$$$$$$$$$$Its Bonus Time in the Neighborhood!” Purdue Pharma aggressively coerced sales reps to persuade physicians to write larger doses. Richard Sackler, CEO of Purdue Pharma personally shadowed sales reps “to make sure his orders were followed.” In 2012, Purdue Pharma threatened to fire all sales reps in the Boston area due to decreasing prescriptions written. According to one 2009 case, government officials learned from a Purdue Pharma sales manager that he wrote to a company official that Purdue Pharma was promoting opioids to an illegal pill mill. He wrote, “I feel very certain this is an ‘organized drug ring’.” He added, “Shouldn’t the DEA be contacted about this?” Richard Sackler noted in an Email on October 23, 1996, that “Physicians who attended the dinner programs or the weekend meetings wrote more than double the number of new Rxs for OxyContin compared to the control group.” Dr Paul Goldenheim, Purdue Pharma’s medical director Emailed sales and marketing executive Michael Friedman on January 16, 1997 informing him that “We are swamped,” and proposes adding another physician to the OxyContin effort, including “the massive non-cancer pain program. We have a tiger by the tail, and I wonder if we should add more muscle. Let’s discuss over liver sushi!” In a Purdue Pharma memo dated January 25, 1999, told their sales reps that “Your priority is to Sell, Sell, Sell OxyContin.” On March 13, 2000, Purdue Pharma sent its sales force 50 copies of the APS pain treatment guidelines to use in promoting OxyContin to physicians. Richard Sackler wanted to invite APS because of their “good relationship.” The memo said, “The guidelines can be an effective tool for selling our products.” Purdue Pharma had 78 sales reps assigned to Kentucky alone who promoted OxyContin. According to Purdue Pharma’s 83-page launch plan for OxyContin, dated September 27, 1995, it describes the 351 sales force as “our most valuable resource.” It details how Purdue Pharma had sweeping plans to reach hospitals, doctors, nurses, patients, distributors, pharmacy benefit managers and pharmacists: Upon OxyContin’s approval, Purdue Pharma intended to send a fax “to every retail pharmacy in the United States” that would “list the reasons why pharmacies will profit by stocking this new product.” According to a filing by Massachusetts Attorney General Maura Healey, Richard Sackler pushed to market OxyContin as a “non-narcotic” in other countries although it’s an opioid. In 2019, two members of Congress accused Purdue Pharma of corruptly influencing the World Health Organization (WHO) into encouraging the use of opioids.
· “Holding pharmacy chains accountable for not meeting the law in implementing measures to actively prevent diversion and abuse of prescription opioids. Pharmacies saw the devastating consequences of this public health crisis firsthand and we will show they did little to nothing to address them.” Lawyers for the State of Ohio said, regarding pending lawsuits in Ohio
THE SECOND WAVE:
The second wave began in 2010 when authorities became aware of the worsening situation and physicians became stricter when it came to prescribing opioids, thereby cutting off the supply of opioids for addicted Americans. Addicts then started using “street” heroin, instead. Between 2002 and 2013, heroin-related overdoses increased by 286%.
THE THIRD WAVE:
The third wave began in 2013 when synthetic opioids―fentanyl―hit the streets. Two milligrams of fentanyl, an incredibly small amount, can be fatal for most people. It is also significantly cheaper to manufacture than heroin, and heroin is often laced with fentanyl as a result.
“You can go to prison for accidentally killing ‘one’ person with your car. That’s the minimum standard. The idea that you can run a company and cause societal-level devastation and walk away from that relatively unscathed is mind-boggling.”
―Rick Caypool, research director at Public Citizen told Vox
“If [Purdue’s owners] have the perception―and it’s the correct perception―that ‘people like us [Purdue Pharma executives] just don’t go to jail, we just don’t, so the worst that’s going to happen is you take some reputational stings and you’ll have to write a check,’ that seems like a recipe for nurturing criminality.”
―Keith Humphreys, drug policy expert at Stanford University
“We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are the reckless criminals.”
―Richard Sackler, CEO Purdue Pharma, aka “the Angel of Death”, The MEMO
“I heard the voice of the fourth beast say, ‘Come and see.’ And, I looked, and behold a pale horse: and his name was Death, and Hell followed with him.”
―Revelations 6:7-8
What has become of plutocracy democracy now that the inmates are running the asylum?
Deaths of Despair!
· 70,000 Americans die annually from drug use, another 88,000 from alcohol abuse and 47,000 from suicide. More die from these three causes every two weeks than died in 18 years of war in Afghanistan and Iraq.
· One in seven Americans lives below the poverty line; suicide rates are at a 30-year high; opioids and other drugs kill more each month than guns and car crashes; every seven minutes someone dies from an overdose; one child in eight lives with a drug-abusing parent.
War on Drugs
Ø In 2017, of the record number 70,237 Americans who died from an overdose, 68% involved a prescription or illegal opioid. The number of overdose deaths has doubled in a decade, from 36,010 deaths in 2007.
Ø Since 1990, more Americans have died from opioid overdose deaths than American deaths in WWII (419,400)―MORE DEATHS THAN WORLD WAR II.
Ø Approximately 130 Americans die every day from drug overdose.
Ø Americans, today, have lifetime odds of dying from an opioid overdose (1 in 96) that are greater than dying from a car accident (1 in 103). The lifetime odds of dying from a gun assault are 1 in 285 and from an airplane crash 1 in 188,364.
Ø The death rate for opioids is now six times higher than it was in 1999.
Ø From 1997 to 2017, more than 200,000 people in the United States died from overdoses tied to all prescription opioids, according to federal data.
Ø Deaths linked to opioids had exploded 91% from 1999 to 2002.
Ø From 1996 to 2016, more than 7 million Americans have abused OxyContin.
Ø According to a study in JAMA Network Open, they found that counties that got more marketing [prescription opioids] the year before saw more painkiller prescriptions and more overdose deaths.
Ø The White House Council of Economic Advisors recently estimated the economic burden of drug overdose deaths, inclusive of the value of statistical lives lost, to be $504 billion in 2015.
Ø Drug over dose deaths in West Virginia and Ohio far out-pace the rest of the country.
Ø Deaths of despair are rising among Americans without a high school degree, accompanied by a measurable deterioration in economic and social wellbeing. According to Alan Krueger, “The increase in opioid prescriptions from 1999 to 2015 could account for about 43% of the observed decline in men’s labor force participation (LFP) during the same period.” He found that LFP fell in counties where more opioids were prescribed.
Ø In Washington State, sales from legal prescription opioids increased more than 500% between 1997 and 2011. In 2011, at its peak, more than 112 million daily doses of all Rx opioids were dispensed.
Ø Oklahoma Attorney General Mike Hunter (R), said the “Big Three” distributers (McKesson Corp., Cardinal Health Inc., and AmerisourceBergen Corp.) supplied more than 34 billion doses of opioids to Oklahoma and the rest of the U.S. between 2006 and 2012 and did not stop or report suspicious drug orders because they were making so much money. In that same time period, there were over 1.4 billion opioids distributed in Oklahoma alone. Current Oklahoma lawsuits state that the aforementioned companies funneled more opioids into communities throughout Oklahoma than could possibly have been expected to serve a legitimate medical need while ignoring red flags and suspicious orders.
Ø Rochester Drug Cooperative, New York pharmaceutical company flagged only 4 narcotics orders as suspicious from 2012 to 2016. During that time and into 2017, nearly 1.5 million orders were made in total―only 4 narcotic orders were flagged! Demand for oxycodone grew by 800% and demand for fentanyl grew by 2000%.
WHO IS RESPONSIBLE?
THE SUPPLY DRUG CHAIN
LEAST RESPONSIBLE:
o Physicians
o Pharmacists
o Press Ganey
o HCAHPS
o Hospital Administrators
o World Health Organization (WHO)
o Centers for Medicare and Medicaid Services (CMS)
o Agency for Healthcare Research and Quality (AHRQ)
MODERATELY RESPONSIBLE:
o Shareholder democracy
o Federal Drug Administration (FDA)
o Joint Commission
o Veterans Health Administration
MOST RESPONSIBLE:
o American Pain Society (APS)
o Center for Practical Bioethics (CPB)
o Retailers: CVS, Walmart, Rite-Aid, Walgreens, HBC and Discount Drug Mart
o Drug Distributors: McKesson Corp., Cardinal Health Inc., AmerisourceBergen Corp. (among the richest companies in America)
o Endo International and its subsidiaries Endo Pharmaceuticals and Par Pharmaceutical
o Teva Pharmaceuticals of Israel and its subsidiary Cephalon Pharmaceuticals
o Rochester Drug Cooperative (New York based and is the nation’s 6th largest drug distributor)
o Abbott Laboratories (partnership with Purdue Pharma to market OxyContin)
o Johnson & Johnson (maker of opioids Duragesic, Nucynta and supplier of raw ingredients for opioids to other companies, most notably, Purdue Pharma) and its subsidiary Janssen Pharmaceuticals
o Mallinckrodt Pharmaceuticals (largest generic opioid manufacturer)
o Insys Therapeutics, Pharmaceutical Company (maker of opioid Subsys)
o Purdue Pharma (maker of opioid OxyContin) and its international subsidiary Mundipharma
Presently, the US Senate Finance Committee is demanding that the following pain societies and advocacy groups disclose any and all payments received from opioid manufacturers:
o American Academy of Pain Medicine (AAPM)
o American Chronic Pain Association
o The American Society for Pain Management Nursing
o The American Society of Pain Educators
o The Federation of State Medical Boards
o The American Academy of Physical Medicine and Rehabilitation
o The Alliance for Patient Access
o The International Association for the Study of Pain
o Joint Commission
o American Pain Society
THE FIRST WAVE:
The story begins in December, 1995, when the FDA approved Purdue Pharma’s new drug for pain management in non-cancer related patients called Oxycontin. Dr. Curtis Wright, who led the 1995 FDA approval, then took a senior position in Purdue Pharma working in product development in 1998. This coincided with the American Pain Society’s (APS) campaign promoting “pain as the 5th vital sign.” David Haddox, who headed an APS committee that endorsed the increased use of opiates, later joined Purdue Pharma in 1999, as well. Soon thereafter, the Veterans Health Administration adopted that campaign as part of their national pain management strategy. In 2001, the Joint Commission issued a pain scale, framing pain management as a patient’s rights issue and stressed the safety of opioids. In a Joint Commission guide, sponsored by Purdue Pharma on pain management, it stated. “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.” The Center for Practical Bioethics (CPB) in Kansas City, Missouri, has on several occasions been investigated for its financial ties to the pain pill-opioid industry. The CPB has received substantial financial support from a variety of pain medication companies, including Purdue Pharma manufacturer of OxyContin.
In 2002, the Bush Administration launched the Hospital Quality Initiative, intended to improve quality of care through accountability and public disclosure. CMS then partnered with AHRQ, both agencies part of the US Department of Health and Human Services, to develop a survey for patients about hospital satisfaction to improve quality―enter Press Ganey and HCAHPS, the patient satisfaction survey used to determine hospital reimbursement rates which lead to overprescribing of opioids.
Aggressive marketing ensued in force―that is, malevolent authority―pushing doctors to prescribe more “addictive” painkillers.
· Hospital Administrators felt pressured to achieve scores of “excellent” on patient surveys, Press Ganey and HCAHPS, because CMS was now attaching significant reimbursement to patient satisfaction. Hospital physicians felt increased pressure to concentrate more on “excellent” patient satisfaction rather than patient-centered outcome.
· Abbott Laboratories went to hook in doctors and make OxyContin a billion-dollar blockbuster. The sales force bought takeout dinners for doctors and met them at bookstores to pay for their purchases. In memos, the sales team referred to the marketing of the drug as a “crusade,” and their boss called himself the “King of Pain.” Abbott Laboratories sales reps were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis. The sales reps from Abbott Laboratories and Purdue Pharma closely coordinated their efforts, met regularly to strategize, and shared marketing materials. Abbott Laboratories heavily incentivized its sales staff to push OxyContin, offering $20,000 cash prizes and luxury vacations to top performers. Their almost religious zeal to sell the drug is evident in the wide use of terminology from the Middle Ages Crusades: Sales reps were called “royal crusaders” and “knights” in internal documents, and they were supervised by the “Royal Court of OxyContin”—executives referred to in memos as the “Wizard of OxyContin,” “Supreme Sovereign of Pain Management,” and the “Empress of Analgesia.” The head of pain care sales, Jerry Eichhorn, was the “King of Pain” and signed memos simply as “King.”
· “As you continue to carry the OxyContin banner onto the field of battle, it’s important to keep highlighting OxyContin benefits to your doctors,” Abbott Laboratories urged its sales staff in a memo contained in the court records.
· Insys had a “kickback scheme”, paying off doctors (e.g., fake educational talks), a rap video to market their opioid Subys and even hired a stripper as a sales executive to give lap dances.
· Purdue Pharma reminded Tennessee sales reps that raising dosage strength was the key to a big payday in a memo titled: “$$$$$$$$$$$$$Its Bonus Time in the Neighborhood!” Purdue Pharma aggressively coerced sales reps to persuade physicians to write larger doses. Richard Sackler, CEO of Purdue Pharma personally shadowed sales reps “to make sure his orders were followed.” In 2012, Purdue Pharma threatened to fire all sales reps in the Boston area due to decreasing prescriptions written. According to one 2009 case, government officials learned from a Purdue Pharma sales manager that he wrote to a company official that Purdue Pharma was promoting opioids to an illegal pill mill. He wrote, “I feel very certain this is an ‘organized drug ring’.” He added, “Shouldn’t the DEA be contacted about this?” Richard Sackler noted in an Email on October 23, 1996, that “Physicians who attended the dinner programs or the weekend meetings wrote more than double the number of new Rxs for OxyContin compared to the control group.” Dr Paul Goldenheim, Purdue Pharma’s medical director Emailed sales and marketing executive Michael Friedman on January 16, 1997 informing him that “We are swamped,” and proposes adding another physician to the OxyContin effort, including “the massive non-cancer pain program. We have a tiger by the tail, and I wonder if we should add more muscle. Let’s discuss over liver sushi!” In a Purdue Pharma memo dated January 25, 1999, told their sales reps that “Your priority is to Sell, Sell, Sell OxyContin.” On March 13, 2000, Purdue Pharma sent its sales force 50 copies of the APS pain treatment guidelines to use in promoting OxyContin to physicians. Richard Sackler wanted to invite APS because of their “good relationship.” The memo said, “The guidelines can be an effective tool for selling our products.” Purdue Pharma had 78 sales reps assigned to Kentucky alone who promoted OxyContin. According to Purdue Pharma’s 83-page launch plan for OxyContin, dated September 27, 1995, it describes the 351 sales force as “our most valuable resource.” It details how Purdue Pharma had sweeping plans to reach hospitals, doctors, nurses, patients, distributors, pharmacy benefit managers and pharmacists: Upon OxyContin’s approval, Purdue Pharma intended to send a fax “to every retail pharmacy in the United States” that would “list the reasons why pharmacies will profit by stocking this new product.” According to a filing by Massachusetts Attorney General Maura Healey, Richard Sackler pushed to market OxyContin as a “non-narcotic” in other countries although it’s an opioid. In 2019, two members of Congress accused Purdue Pharma of corruptly influencing the World Health Organization (WHO) into encouraging the use of opioids.
· “Holding pharmacy chains accountable for not meeting the law in implementing measures to actively prevent diversion and abuse of prescription opioids. Pharmacies saw the devastating consequences of this public health crisis firsthand and we will show they did little to nothing to address them.” Lawyers for the State of Ohio said, regarding pending lawsuits in Ohio
THE SECOND WAVE:
The second wave began in 2010 when authorities became aware of the worsening situation and physicians became stricter when it came to prescribing opioids, thereby cutting off the supply of opioids for addicted Americans. Addicts then started using “street” heroin, instead. Between 2002 and 2013, heroin-related overdoses increased by 286%.
THE THIRD WAVE:
The third wave began in 2013 when synthetic opioids―fentanyl―hit the streets. Two milligrams of fentanyl, an incredibly small amount, can be fatal for most people. It is also significantly cheaper to manufacture than heroin, and heroin is often laced with fentanyl as a result.
“You can go to prison for accidentally killing ‘one’ person with your car. That’s the minimum standard. The idea that you can run a company and cause societal-level devastation and walk away from that relatively unscathed is mind-boggling.”
―Rick Caypool, research director at Public Citizen told Vox
“If [Purdue’s owners] have the perception―and it’s the correct perception―that ‘people like us [Purdue Pharma executives] just don’t go to jail, we just don’t, so the worst that’s going to happen is you take some reputational stings and you’ll have to write a check,’ that seems like a recipe for nurturing criminality.”
―Keith Humphreys, drug policy expert at Stanford University
“We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are the reckless criminals.”
―Richard Sackler, CEO Purdue Pharma, aka “the Angel of Death”, The MEMO
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