Before Riverbank House, merely existing as an active alcoholic felt like a 24/7 job. Real employment or working towards any kind of a future interfered with my drinking. I lied, I cheated, I manipulated, and I stole, mainly from my parents and those closest to me. I felt worthless, hopeless and alone. Addiction destroyed every healthy relationship I had ever developed and burned almost every bridge between me and the future my parents had dreamed for me. My parents raised a musically talented extrovert with people skills and a sense of humor, but then addiction turned me into a hopeless drunk whose only concern was more alcohol. In the process, I hurt everyone around me.visualcage
By the end of each day I would go to sleep hoping that I wouldn’t wake up.
Today, thanks to the spiritual program I’ve developed at the Riverbank House, I’ve sustained over a year and a half of continuous sobriety. I wake up every day to the passionate life of self-improvement and growth and purpose. I have countless friends. My sense of humor has returned, and my fear and anxiety for the future has been transformed into optimism and curiosity.
Riverbank House feels like home. The staff never gives up. Whenever I’ve needed to talk, someone with experience and encouragement has always been available and equipped with appropriate suggestions and insight to tackle any crisis I’ve faced. The Riverbank community supports me — wherever I am in my recovery, and I will always cherish that example of love and compassion.
Today, the relationships lost as a result of my drinking have been repaired. The bond with my family is strong and healthy. My friendships have worth. I’ve fulfilled a dream I had prior to my addiction: editing and writing the music for a feature length documentary film.
And I give back today. I work full time at Riverbank House, helping other alcoholics and drug addicts one day at a time with the same compassion and encouragement that was extended to me as a resident.
Strength of community at Riverbank House is arguably one of the largest contributing factors to my success. I’ve been shown and invited into a brotherhood that lets me be part of something greater than myself. I’ve seen the alternative to alone and apart. In brotherhood, I’ve been taught what it means to belong.
Addiction Recovery's 1st Step
When chronic drug users and alcoholics separate from an addictive substance they often need help coping with withdrawal. Detox is a popular umbrella term in the lingo of addiction recovery services, but new terms are emerging. The Substance Abuse and Mental Health Services Administration defines crisis stabilization as
a direct service that assists with deescalating the severity of a person’s level of distress and/or need for urgent care associated with a substance use disorder.
Addiction recovery vocabulary can be confusing. Any time an alcoholic or drug addict (especially an opiate addict) slowly or abruptly stops using – whether voluntarily or due to circumstances – the addict will experience some form of withdrawal. When a person addicted to drugs or alcohol seeks recovery services for the symptoms of withdrawal, the process is called detox or crisis stabilization or medically managed withdrawal. So the services that fall under the umbrella term "detox" always involve withdrawal but withdrawal doesn’t always involve "detox".
What Detox Is And What It Isn't
According to the federal Department of Health and Human Services, important key characteristics of successful detox and crisis stabilization are:
- Detoxification in and of itself does not constitute complete substance abuse treatment.
- The detoxification process consists of three essential components: evaluation, stabilization, and fostering patient readiness for and entry into treatment.
- Detoxification can take place in a wide variety of settings and at a number of levels of intensity within these settings; placement needs to be appropriate to the patient’s needs.
- A successful detoxification process can be measured in part by whether an individual enters and remains in some form of substance abuse treatment after detoxification.
Drug or alcohol detox and crisis stabilization are good places to start the road to recovery from addiction, but it’s crucial that we understand they are only the beginning. Because drug addiction and alcoholism are chronic, life threatening diseases that require life-long management, recovery is a marathon rather than a sprint. And as a beginning to that marathon, prescription drug or alcohol or opiate detox is the part where a marathon runner puts on the sneakers.
Addiction Science Experts Agree
The Center on Addiction and Substance Abuse at Columbia University:
Detoxification is an important step in the recovery process, but it is not treatment for the disease....Drug and alcohol detox is only as effective as its follow-up care.
Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use....It is important to know that detoxification is not treatment; it is a first step that can prepare a person for treatment.
Detox alone with no follow-up is not treatment. Treating withdrawal is not the same as treating addiction.
Successful recovery from addiction requires a continuum of care. Addiction treatment takes time. And sustained recovery from addiction or alcoholism requires a lifetime of maintenance, commitment, and vigilance.
The Massachusetts’ Department of Public Health just revised the official tally of drug overdose deaths from 2014 (it will likely be revised yet again) and the results reveal that four people a day are dying in the Commonwealth State. Vermont now investigates four drug-related fatalities a week.
Imagine the public response if ebola or tainted meat or rat poison were killing FOUR people a day in Massachusetts. Imagine the panic if a viral pandemic had taken the lives of nearly 2,500 throughout New England in a single year.
Massachusetts Governor Charlie Baker has made it his mission to address the opioid epidemic; but Governor Baker has also talked about “better analysis of where and why people succumb to the disease."
Why people succumb? Such a question is based on a flawed premise and we should all resist the urge to agree with and to legitimize that premise.
People do not become addicted to opioids. I want to repeat that statement: People do not become addicted to opioids.
Opioids addict people.
It’s not semantics or word games. If meat is tainted with salmonella, we don’t examine why people who ate the meat succumb to food poisoning. If people are exposed to and infected by ebola, we don’t set out to examine why they succumb to the process of infection.
Addiction and infection and poisoning share a primary component: they all require exposure to a poisoning agent. No exposure, no illness, no tragedy. Is there a moral component or personal choice involved in nonmedical opioid use? Perhaps there is, if that’s where it feels good to put your focus. But have the courage to follow that moral culpability backward up the chain, from the cold table in the medical examiner’s office, back up to the needle, back along to the dealer who made heroin available and cheap when the Oxycontin supply shriveled, further back along the chain to the people diverting Oxycontin to the illicit market for profit, all the way up to the coffers of Purdue Pharma, who in 1996 flooded the pharmaceutical market with Oxycontin while lying about its addictive risks. And then follow the chain right back to its inaugural link to the $14 BILLION fortune that just landed the Sackler family — owners of Purdue Pharma — on the Forbes 2015 Richest Families list.
If we’re going examine the where and why of the opiate apocalypse, the foundational premise of our questions should be sound. And if we resist active community response to the drug addiction epidemic based on claims of morality, we should face those claims head on and responsibly by examining the entire chain of culpability.
Meanwhile, it’s likely that Massachusetts will soon announce that 206 additional fatalities have been added to the 2014 tally of drug users who died before they had a shot at drug rehab and addiction treatment.
<a href="http://www.health.ri .gov/data/drugoverdoses/” onclick=”__gaTracker(‘send’, ‘event’, ‘outbound-article’, ‘http://www.health.ri.gov/data/drugoverdoses/’, ‘Rhode Island data’);”>Rhode Island data
There’s a new game that people play with television commercials: mute a pharmaceutical ad and guess what the drug treats. Erectile dysfunction (middle aged couple, arms around each other, walking the beach, sunset)? Depression (single middle aged woman, wrapped in an oversized sweater, walking the beach, cloudy day)? Fibromyalgia (more than middle aged woman, white, potting plants, grimace turns into smile)? Incontinence (more than middle aged woman, walking beach with male partner, picking up stray volleyball and throwing it back to kids, big smile)? In the heavily massmarketed world of prescription medications and people walking on the beach, I can’t tell you what an OxyContin user looks like. So how did OxyContin become so popular?
The answer is innovative, aggressive, very costly, criminally deceitful marketing.
In the brilliant article, “Poison Pill: How the American Opiate Epidemic Was Started By One Pharmaceutical Company,” Pacific Standard, February 23, 2015, (http://www.psmag.com/healthandbehavior/howtheamericanopiateepidemicwasstartedbyonepharmaceuticalcompany) Mike Mariani reports that Purdue Pharma, spent $200 million in 2001 alone to market OxyContin. The New York Times calls Purdue Pharma’s effort “the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller.” ( http://www.nytimes.com/2007/05/10/business/11drugweb.html?_r=1&)
Mariani points out that “Purdue's multifaceted marketing campaign pushed OxyContin out of the niche offices of oncologists and pain specialists and into the primary care bazaar, where prescriptions for the drug could be handed out to millions upon millions of Americans.” The campaign to push OxyContin was indeed multifaceted. Here’s a brief sketch of the strategy:
1. Promote OxyContin for NonCancer Pain
Mariani reports that “beginning around 1980, one of the more significant trends in pain pharmacology was the increased use of opioids for chronic noncancer pain. Like other pharmaceutical companies, Purdue likely sought to capitalize on the abundant financial opportunities of this trend. The logic was simple: While the number of cancer patients was not likely to increase drastically from one year to the next, if a company could expand the indications for use of a particular drug, then it could boost sales exponentially without any real change in the country's health demography. This was indeed one of OxyContin’s greatest tactical successes.”
Art Van Zee, MD, in his comprehensive 2009 article “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” published in American Journal of Public Health , reports that “Purdue “aggressively” promoted the use of opioids for use in the “nonmalignant pain market. A much larger market than that for cancerrelated pain, the non–cancerrelated pain market constituted 86% of the total opioid market in 1999. Purdue's promotion of OxyContin for the treatment of non–cancerrelated pain contributed to a nearly tenfold increase in OxyContin prescriptions for this type of pain, from about 670,000 in 1997 to about 6.2 million in 2002, whereas prescriptions for cancerrelated pain increased about fourfold during that same period.”
2. Market to Physicians and Call It Education
Van Zee’s research found that “from 1996 to 2001, Purdue conducted more than 40 national painmanagement and speakertraining conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these allexpensespaid symposia, where they were recruited and trained for Purdue's national speaker bureau. It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing, even though the physicians who attend such symposia believe that such enticements do not alter their prescribing patterns.” Purdue threw in lots of logo’ed coffee mugs, pens, and ball caps as well.
3. Keep A Database
According to Van Zee, “one of the cornerstones of Purdue's marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. Drug companies compile prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the entire country. One of the critical foundations of Purdue's marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country. The resulting database would help identify physicians with large numbers of chronicpain patients.” Van Zee also reports that, “Unfortunately, this same database would also identify which physicians were simply the most frequent prescribers of opioids and, in some cases, the least discriminate prescribers.”
4. Sales Rep Bonuses
Van Zee’s research also found that “a lucrative bonus system encouraged sales representatives to increase sales of OxyContin in their territories, resulting in a large number of visits to physicians with high rates of opioid prescriptions, as well as a multifaceted information campaign aimed at them. In 2001, in addition to the average sales representative's annual salary of $55 000...Purdue paid $40 million in sales incentive bonuses to its sales representatives that year.”
5. Target Primary Care Practitioners
The New York Times reports that “Purdue Pharma heavily promoted OxyContin to doctors like general practitioners, who had often had little training in the treatment of serious pain or in recognizing signs of drug abuse in patients.” (I added the bold in this section.) Van Zee reports that “Purdue promoted among primary care physicians a more liberal use of opioids...by 2003, nearly half of all physicians prescribing OxyContin were primary care physicians. Some experts were concerned that primary care physicians were not sufficiently trained in pain management or addiction issues. Primary care physicians, particularly in a managed care environment of time constraints, also had the least amount of time for evaluation and followup of patients with complicated chronic pain.“ Mariani makes the claim that by “Combining the physician database with its expanded marketing, it would become one of Purdue's preeminent missions to make primary care doctors less judiciouswhen it came to handing out OxyContin prescriptions.”
6. Offer “Starter” Coupons
While it’s not uncommon for pharmaceutical sales reps to provide physicians with an abundance of “sample” drugs, Purdue took the sample strategy even further, providing consumers, through physicians, with starter coupons good for anywhere from a seven to 30 day supply of free OxyContin. While a 30 day supply of any narcotic might raise concerns about developing drug dependence, OxyContin was promoted to doctors, and by extension patients, as a “safe” opioid.
7. Minimize Risk of Addiction
Mariani writes that right from its launch, Purdue set out to distinguish OxyContin from its competition. “The cornerstone of its marketing campaign was the drug's incredibly low risk of addiction, an enviable characteristic made possible by its patented timerelease formula. Through an array of promotional materials, including literature, brochures, videotapes, and Web content, Purdue proudly asserted that the potential for addiction was very small, at one point stating it to be "less than 1%.”” Sales representatives told some doctors that the drug didn't even produce a buzz, according to USA Today.
The New York TImes reports that “Among other things, company sales officials were allowed to draw their own fake scientific charts, which they then distributed to doctors, to support that misleading abuserelated claim.” Van Zee reports that Purdue “trained its sales representatives to carry the message that the risk of addiction was “less than one percent.” and that “a consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancerrelated pain.” He goes on to explain that while research has established that 3% to 16% of the general population will experience some form of addiction within their lifetime, no credible study had determined the rate of “iatrogenic” addiction occurring during longterm opioid use for noncancer pain. “Iatrogenic” means “caused by medical treatment,” in this context, presumably as opposed to “caused by recreational use of illegal drugs.”
8. Hope the FDA Is Both Gullible and Cooperative
Mariani writes that “The timerelease conceit even worked on the FDA, which stated that "Delayed absorption, as provided by OxyContin tablets is believed to reduce the abuse liability of a drug." Armed with the timerelease formula and misleading statistics about the risk of addiction, Purdue positioned the drug as a relatively safe choice.”
The New York Times reports that “when the painkiller was first approved, F.D.A. officials allowed Purdue Pharma to state that the timerelease of a narcotic like OxyContin “is believed to reduce” its potential to be abused.”
Van Zee reports that “When OxyContin entered the market in 1996, the FDA approved its original label, which stated that iatrogenic addiction was “very rare” if opioids were legitimately used in the management of pain.” But then, in July 2001, “to reflect the available scientific evidence, the label was modified to state that data were not available for establishing the true incidence of addiction in chronicpain patients.” Iatrogenic means “caused by medical treatment.” Presumably, in this context, iatrogenic addiction differs from “caused by recreational or illegal use” addiction.
In 2007, in one of the largest federal criminal and civil cases ever against a drug company, Purdue Frederick Company, the parent of Purdue Pharma, pled guilty to and was fined $600 million for felony “misbranding” OxyContin. “Misbranding” is a broad statute that makes it a crime to mislabel a drug, fraudulently promote it or market it for an unapproved use. At the same time, three Purdue executives individually pled guilty to misbranding and were fined a total of $34.5 million. Announcing the federal verdict in 2007, The New York Times reported that “Purdue Pharma acknowledged in the court proceeding today that “with the intent to defraud or mislead,” it marketed and promoted OxyContin as a drug that was less addictive, less subject to abuse and less likely to cause other narcotic side effects than other pain medications.”
Similar cases against Purdue Pharma most notably in Kentucky are slowly winding their way through the court system.
The marketing strategy of Purdue Pharma relied heavily on systemic vulnerabilities. The FDA is understaffed and underfunded, and it cannot possibly keep up with its responsibility for the review and approval of pharmaceutical marketing materials. Many primary care physicians lack the specific training to monitor patients for addiction, and the managed care system squeezes the time and attention of even the most devoted healthcare providers. Sophisticated incentives and Big Brotherlike databases subliminally sway and influence prescribing habits, and criminally deceptive marketing materials promise physicians an opportunity to ease suffering a promise that preys on the very organic, benevolent motivations of healers.
OxyContin has made its way to the streets, and addiction has made its way into so many lives. Parents fight to accept powerlessness while at the same time fighting the cruel stigma attached to addiction. Stigma? Really? Where is the outrage? Where is the public awareness of and objection to evil, corporate, greed based manipulation of our entire healthcare system? Where is the compassion for prescribing physicians made complicit in an astonishing fraud that harmed rather than healed? We might all be more awake if we weren’t so massmarketed into a good night’s sleep, courtesy of Big Pharma.
Reprinted with permission from www.whenweloveanaddict.com. Copyright 2015 Kay Ryan
Drug Addiction Making BILLIONS for One Family
On July 1, Forbes Magazine’s announced its 2015 list of “Richest U.S. Families,” and a few hours later the New Hampshire Chief Medical Examiner announced its tally of 132 drug overdose death thus far in 2015.
There seems to be is a connection between the $14 billion fortune of one Connecticut family on the Forbes list and the funeral costs facing 132 families retrieving a loved one’s body in New Hampshire.
The Sackler family, dubbed “The OxyCotin Clan” by Forbes, owns 100% of Purdue Pharma, the tiny Connecticut company that developed, introduced, and then viciously marketed OxyContin. According the February 23, 2015 article “Poison Pill: How the American opiate epidemic was started by one pharmaceutical company,” after unprecedented, meteoric sales of just one drug, by 2010, “a single private, family-owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.”
Does it then logically follow that the Sackler family initially controlled nearly one third of the OxyContin that found its way onto the street?
The History of OxyContin
Oxycodone a generic narcotic painkiller has been around since the 1910s, but in 1995, the Sacklers patented a special sustained release coating that would deliver the effects of oxycodone over 12 hours. They called it OxyContin.
The advantages of OxyContin over regular, generic oxycodone? Basically, every-four-hours dosing became every-12hours dosing. That’s it. Total practical benefit of the supposed miracle painkiller OxyContin.
Drug addiction, the Sackler way.
The early marketing of OxyContin as a drug offering little risk of addiction -- a claim driven by profits so large that it catapulted the Sacklers to their $14 billion fortune -- lulled physicians in small towns throughout America to distribute a supposedly benign tool to ease the suffering of factory workers with bad backs and roofers with bad shoulders and truck drivers with diabetes and little old ladies recovering from knee replacement. Because Sackler marketing encouraged a much broader application of its “safe” opioid product, to a market beyond cancer pain management, primary care doctors felt armed to address the chronic pain complaints of patients and quadrupled pain killer prescriptions of all types in the first decade of the 21st century.
The American Journal of Public Health reports that with the introduction of OxyContin, between 1997 and 2002, fentanyl prescriptions increased by 226%. Morphine prescriptions increased by 73%. And generic, every-four-hourdosing oxycodone prescriptions increased by 402%. Doctors, now able to ease immediate suffering, became desensitized to the implications of long-term prescription narcotic use. In one of healthcare’s greatest bait and switch schemes, OxyContin was marketed to alleviate temporary or chronic suffering for the individual, yet by deliberately minimizing the risks of addiction, OxyContin instigated long-term suffering for the tens of thousands eventually felled by a nationwide epidemic of addiction and death.
The Connection Between OxyContin and Heroin
The American Journal of Public Health explains that the jump from 316,000 OxyContin prescriptions written in 1996 to the 14 million prescriptions written between 2001 and 2002, “correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.” OxyContin, simply because there was so much of it, “trickled down from pharmacies and hospitals and became a street drug,” explains "Poison Pill." This “trickle down” cascade is also known as “diversion,” meaning the drug finds a detour from the legal intention of a doctor’s prescription pad to the pocket of a street customer willing to face the risk of addiction in exchange for a Saturday night of euphoria.
The Oxy high carries a big bang. Four years after the FDA approved an 80mg version of the pill, it approved a 160mg tablet specifically for opioid tolerant patients. "Poison Pill" concludes that
These high milligram pills were probably one of biggest reasons that OxyContin became such a popular street drug. Recreational users and addicts could crush, sniff, and inject the pill for a powerful high that, as promised, lasted over eight hours. The euphoric effects and potential for abuse were comparable to heroin.
Abundant, accessible, and much less expensive than OxyContin, heroin use has merged with prescription drug abuse to create the exploding opioid epidemic of addiction, crime, incarceration, rehabs, homelessness, heartbroken parents, and premature death. "Poison Pill" calls this merging of prescription and street opioids an evolution, that, much like a virus, mutates and spreads to better invade its hosts or victims.
Call it a virus, a mutation, an epidemic, a public health crisis, a tragedy. The New Hampshire Medical Examiner calls it a tally. Forbes Magazine calls it a fortune.
Republished with permission from www.whenweloveanaddict.com.
Copyright 2015 Kay Ryan