Jury Finds Pharmacy Chains Contributed to Ohio’s Opioid Crisis

A federal jury in Ohio on Tuesday found that pharmacy giants Walgreens, CVS and Walmart contributed to the opioid crisis in that state, a verdict that could serve as a bellwether for thousands of similar cases pending from coast to coast. The decision is the first verdict returned by a jury that holds a pharmacy retailer responsible for its role in the devastating epidemic of opioid overdoses that has plagued the United States for decades.

In the lawsuit, Lake and Trumbell Counties in northeastern Ohio maintained that the pharmacy retailers had recklessly distributed more than 100 million opioid pain pills in the counties, leading to addiction, death and a strain on public services. Between 2012 and 2016, more than 80 million prescriptions painkillers were dispensed in Trumbull County alone, or about 400 pills for every resident. During the same period, approximately 61 million opioid painkillers were dispensed in Lake County.

“For decades, pharmacy chains have watched as the pills flowing out of their doors cause harm and failed to take action as required by law,” a committee of attorneys representing local governments in federal opioid lawsuits said in a statement. “Instead, these companies responded by opening up more locations, flooding communities with pills, and facilitating the flow of opioids into an illegal, secondary market.”

Counties Say Pharmacies Created a Public Nuisance

Attorneys for the plaintiffs argued that the actions of the pharmacies amounted to a public nuisance that cost the counties about $1 billion each to address. Mark Lanier, an attorney representing the counties, said that the pharmacies failed to hire or train enough employees and implement systems to prevent suspicious orders from being filled.

“The law requires pharmacies to be diligent in dealing drugs,” Lanier said. “This case should be a wake-up call that failure will not be accepted.” 

“The jury sounded a bell that should be heard through all pharmacies in America,” he added.

The suit originally also named pharmacy retailers Rite-Aid and Giant Eagle as plaintiffs in the case. Rite-Aid settled in August and agreed to pay Trumbull County $1.5 million in damages, while a settlement amount with Lake County has not been released. Giant Eagle agreed to settle late last month, although terms of that agreement were not disclosed.

The case, which was decided by a 12-person jury after a six-week trial, was returned in one of about 3,000 federal opioid lawsuits being supervised by U.S. District Judge Dan Polster in Cleveland. Adam Zimmerman, who teaches mass litigation at Loyola Law School in Los Angeles, said that the verdict could prompt other pharmaceutical retailers to settle their pending cases.

“It’s the first opioid trial against these major household names,” Zimmerman told the New York Times. “They have been the least willing group of defendants to settle, so this verdict is at least a small sign to them that these cases won’t necessarily play out well in front of juries.”

Pharmacy Chains Will Appeal Verdict

All three retailers have indicated that they will appeal the jury’s verdict. Walmart said in a statement that the plaintiffs’ attorneys sued “in search of deep pockets while ignoring the real causes of the opioid crisis—such as pill mill doctors, illegal drugs, and regulators asleep at the switch—and they wrongly claimed pharmacists must second-guess doctors in a way the law never intended and many federal and state health regulators say interferes with the doctor-patient relationship.”

Walgreens spokesperson Fraser Engerman characterized the case as an unsustainable effort “to resolve the opioid crisis with an unprecedented expansion of public nuisance law,” adding that the company “never manufactured or marketed opioids nor did we distribute them to the ‘pill mills’ and internet pharmacies that fueled this crisis.”

“As plaintiffs’ own experts testified, many factors have contributed to the opioid abuse issue, and solving this problem will require involvement from all stakeholders in our health care system and all members of our community,” CVS spokesperson Mike DeAngelis said in a statement after the verdict was announced.

The retail pharmacies are not alone in their criticism of the verdict. Dr. Ryan Marino, an assistant professor of the Departments of Emergency Medicine and Psychiatry at Cleveland’s Case Western Reserve University School of Medicine, says that focusing on blaming the pharmaceutical industry, prescribers, and pharmacies ignores the role that bad policies have played in the opioid crisis.

“If retail pharmacies are declared responsible, I ask that we also hold policymakers responsible for their role in driving people to foreseeable death and failing to act to prevent disordered substance use or addiction by failing to provide access to safety in addition to basic things like housing, education, employment, and income, which are well known to prevent addiction in the first place,” Marino wrote in an email to High Times. “The same old approaches have not helped this problem, and in fact, seem to be only making it worse.”

Some drug manufacturers and distributors including Johnson & Johnson have also opted to settle cases brought against them for their alleged contributions to the opioid crisis, which has killed more than 500,000 Americans over the past twenty years. Kevin Roy, chief public policy officer at addiction solutions advocacy group Shatterproof, said that Tuesday’s verdict could prompt other pharmacies to consider a settlement.

“It’s a signal that the public, at least in select places, feels that there’s been exposure and needs to be remedied,” Roy said.

Roy noted, however, that the different courts hearing opioid cases have not been consistent in their judgments and that the details of public nuisance laws vary from state to state. Earlier this month, a California judge ruled in favor of drug manufacturers in a case brought by the city of Oakland and three counties. And in Oklahoma on November 9, the state Supreme Court overturned a 2019 verdict for $465 million against Johnson & Johnson.

“There’s been a variety of different decisions lately that should give us reason to be cautious about what this really means in the grand scheme,” Roy said.

Just how much Walgreens, CVS and Walmart will have to pay Trumbull and Lake Counties remains to be seen. The judge is expected to issue a decision on damages to be awarded in the case in the spring.

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Hulu’s Dopesick Hammers Purdue Pharma for Role in Opioid Crisis

Last week, NPR TV critic and adjunct professor at Duke University Eric Deggans hosted a Twitter Spaces discussion on Hulu’s Dopesick—asking hard questions such as whether or not Purdue Pharma and the Sackler family are responsible for their roles in the opioid crisis.

The Sackler family’s private company Purdue Pharma introduced OxyContin® in 1996—ushering a new era of powerful painkillers. Documents made public last year show how Purdue Pharma actively pushed for more prescriptions of painkillers.

Has the opioid crisis improved? Absolutely not. The U.S. Centers for Disease Control and Prevention reported a “record high” of drug overdoses in the 12-month period ending in March 2021—overwhelmingly led by opioids. It’s a complex problem, as opioid restrictions due to the crisis also prevent people with actual pain from receiving their meds.

The limited series on Hulu was created by Danny Strong and stars Michael Keaton, Rosario Dawson, Peter Sarsgaard and William Jack Poulter. Keaton stars as Dr. Samuel Finnix, who caught in the middle of a crisis between drug manufacturers and patients. The limited series is inspired by the New York Times bestseller Dopesick: Dealers, Doctors and the Drug Company that Addicted America, written by author Beth Macy.

Macy’s book and the corresponding Hulu series tackle the opioid crisis with a specific focus on Purdue Pharma. The first three episodes of the eight-episode series were released on October 13, 2021, and the latest episode aired Wednesday.

Who’s to Blame for the Opioid Crisis?

The New Yorker tore into the Sackler family’s reputation in 2017calling the Sacklers “the family that built an empire of pain,” adding that through their “ruthless” marketing of painkillers, millions have died.

In recent years, there has been a massive reckoning. Last year, the Department of Justice announced that Purdue Pharma agreed to plead guilty in federal court in New Jersey to a three-count felony, reaching a whopping $8 billion settlement. 

“The abuse and diversion of prescription opioids has contributed to a national tragedy of addiction and deaths, in addition to those caused by illicit street opioids,” said Deputy Attorney General Jeffrey A. Rosen. “With criminal guilty pleas, a federal settlement of more than $8 billion, and the dissolution of a company and repurposing its assets entirely for the public’s benefit, the resolution in today’s announcement re-affirms that the Department of Justice will not relent in its multi-pronged efforts to combat the opioids crisis.”

The Sacklers themselves were ordered to pay $4.5 billion, but were able to absolve themselves from some of the allegations. Judge Robert Drain, of the U.S. Bankruptcy Court in White Plains, New York called the results bittersweet, because so much of the Sackler’s fortune was diverted to offshore banking accounts.

Then earlier this year, Johnson & Johnson and the “big three” distributors—McKesson, AmerisourceBergen and Cardinal Health—agreed to pay a total sum of $26 billion for their roles in the opioid crisis.

The flux of opioids, eventually leading to fentanyl and other painkillers can be traced to Purdue Pharma’s brand of oxycodone. 

Cast as the Villain

At first glance, there doesn’t seem to be much accountability on the end of Big Pharma juggernauts like the Sacklers. “Abusers [of OxyContin] aren’t victims,” Richard Sackler wrote in a 2001 email. “They are the victimizers.”

But Deggans’ discussion asked whether or not the Sacklers should be cast as villains, given the complexity of the situation. He was joined in the Twitter Spaces discussion with NPR addiction correspondent Brian Mann, Dopesick author Beth Macy, Dopesick series creator Danny Strong and others.

“There’s so much we need to do, and a lot of it falls right under the umbrella… of unraveling the War on Drugs,” Macy said. “We [should] start treating people less like criminals, stop hammering abusers like Richard Sackler told us to do, and start treating these folks as people with a genuine medical condition, which is what they are.”

In Hulu’s series, Richard Sackler and his family are portrayed as the main villains, however the series does mix up some fact with fiction. Deggans contends that reality is a bit more complex, and that the opioid crisis cannot be analyzed in black and white.

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Heroin handed out for free on Vancouver’s Downtown Eastside

On Wednesday, the members of the Drug User Liberation Front aka DULF handed out free heroin, cocaine, and methamphetamine on the Downtown Eastside of Vancouver, BC. It’s the third time that the organization has taken the issue of safe supply into its own hands. Overdose death was declared a provincial emergency back in 2016 and […]

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Ayahuasca In the Fight Against Drug Addiction

Drug addiction is a major issue in the modern world with sky-high numbers for deaths due to drugs throughout the world each year. Very little in the standard medical world has provided an answer to the question of how to break a drug addiction, and recidivism rates for addicts have always remained high. New research into the medical properties of ayahuasca indicates it might be an answer in the fight against drug addiction.

Psychedelics are becoming popular once again, and THC, which is often considered a psychedelic, is one of the most in-demand. These days there are options when it comes to THC. You can go with standard delta-9, or opt for less psychoactive effect and less anxiety with delta-8 THC. Want to give it a shot? Check out these great Delta-8 THC deals, and try the ‘other’ THC.

The US drug overdose issue

Some people will attribute any use of drugs to there being a drug problem. Consider that for decades, marijuana smoking was treated the same as heroin use, though today it’s clear that it doesn’t deserve that treatment. Trying to determine who has a drug issue is moot in the end, as it almost doesn’t matter. One of the ways to judge a drug issue is by the problems that come out if it, with the biggest ones being drug-related violence and deaths. So rather than worry about how many people are using drugs in a way that might be defined as problematic, let’s instead look at drug deaths to gauge the issue.

There are plenty of different national and international reporting agencies about drugs, often with different numbers coming out, though they tend to be in the same direction. It’s also hard to get full global statistics, so sometimes the best possible option is to investigate particular locations to see trends.

According to the CDC, the first three months of 2020 saw approximately 19,416 drug overdose deaths in the US alone. The same period from one year earlier had about 16,682, nearly three thousand less. In the CDC’s US Centers for Disease Control and Prevention’s National Center for Health Statistics report from October of 2020, the agency also approximated 75,500 overdose deaths between March 2019 and March 2020.

drug addiction

The grand majority of overdose deaths in the US are related to the opioid crisis, the massive widespread addiction to synthetic opiate drugs which has been increasing to incredible heights, particularly because of over-prescription, and the inclusion of new drugs like OxyContin and fentanyl. Even the CDC itself says the initial wave of the opioid epidemic started “with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.” The CDC goes on to say that the second wave began in 2010 and was related to heroin overdoses, and that the third wave starting in 2013 with an increase in synthetic non-prescription opioid use.

The CDC likes to claim this is related to illicit fentanyl, but this undermines the fact that while the CDC also likes to claim a decrease in prescribing rates in 2019, this decrease still amounts to over 153 million opioid prescriptions doled out that year at an average rate of 46.7 prescriptions per 100 people.

To be clear, when going through the numbers for specific counties, also put out by the CDC, there are actually plenty of individual counties where there were over 100 prescriptions written per 100 people. So, I think it suffices to say that any recent issues with opioid deaths are just as much at the hands of pharmaceutical companies (and the US governmental agencies that allow this to happen) as the illicit market that sprouted from this pharmaceutical one. Regardless of who is responsible, this is now the situation.

If it was only about opiates, that would be problem enough, but it’s not. According to Statistica, regarding US deaths related to cocaine poisoning from 2009-2019, the number has gone up from approximately 3,822 deaths in 2009 to about 15,883 in 2019. This, of course, does show a large increase that cannot be attributed to pharmaceutical companies at all. It also brings up the question of how much these deaths are related to additives rather than cocaine itself, as the drug is often cut with other drugs like methamphetamine.

Drug overdose issues worldwide

Drug addiction is hardly a US invention (even if the US has done well to dominate the field). Take this article from December 2020 from the BBC concerning Scotland. According to the article, Scotland is actually the epicenter of the European drug crisis with the most deaths on average in Europe. The article stipulates the issue with underreporting in some countries, and makes the statement that of reported numbers, Scotland is highest. The 2018 reports had already put the drug issue as a public emergency, with 2019 numbers coming out late due to corona and other issues. The 2019 numbers show a 6% rise to 1,264 deaths.

If this number sounds small, consider that the population of Scotland is approximately 5,463,300, which brings the death rate to .023%. That’s actually slightly higher than the US! There were about 75,500 deaths from March to March, 2018 to 2019, and approximately 330 million people in the US, making for an overdose rate of .022%. While Scotland also attributes the majority of overdoses to opiates, it registered a growing amount of benzodiazepine overdoses, and multi-drug overdoses as well.

ayahuasca drug addiction

Then there’s Canada, where in three months of 2020, April-June, there were 1,628 opioid-related deaths. This is a 54% increase from the same months in 2019, and a 58% increase from January-March of the same year. If we were to take that number and multiply by four to get a rough yearly estimate for a year at those rates, we’re looking at 6,512 deaths out of a population of about 37,590,000, or .017%. From January to June 2020, 86% of overdose deaths in Canada happened in British Colombia. 75% of overdose deaths in general in Canada in that same time period were related to fentanyl.

Much like with Scotland pointing out multiple drugs used in overdose scenarios, it was also found in Canada that 52% of accidental overdoses involving opiates, also involved a stimulant. Between January to June of 2020, 70% of deaths related to stimulants involved cocaine, while 48% involved methamphetamines. In that same time period, 84% of the deaths related to stimulants, also involved an opiate.

In a place like Australia, which as of yet hasn’t been hit as hard, the 2018 drug-related overdose death toll was 1,740 out of a country of approximately 25.2 million people that year, making for a rate of .0069. This is way lower than the other countries mentioned, but it should be noted that 2/3 of these over-doses were related to opiates. However, when looking at the drug class that showed up most often – whether by itself or in combination – it was not opiates, but benzodiazepines. According to the Australian Institute of Health and Welfare, “Over the past decade, drug-induced deaths were more likely to be due to prescription drugs than illegal drugs, and there has been a substantial rise in the number of deaths with a prescription drug present.”

On a broader scale, according to OurWorldInData, which uses the UN’s Global Burden of Disease report, over 750,000 deaths worldwide were attributed to illicit drugs in 2017. And this with underreporting from many countries. As a comparison, this number is nearly twice the global homicide rate which sits at about 400,000, although this number is also likely to be way off.

Of course, just to mess with those numbers a bit, it’s also estimated that approximately three million deaths a year are attributable to alcohol use. This encompasses more than just overdoses, but is highly significant in that alcohol is considered a leading risk factor for early death and disability for those 15-49, and is responsible for as much as 10% of deaths in this age group. This makes the opioid epidemic look like nothing. Yet we barely talk about it at all.

What is ayahuasca?

Standard methods of drug addiction therapy have not proven terribly effective. One of the ways we know this is by the sheer number of people with addictions, which indicates new cases being added with few being deleted. There also wouldn’t be a massive market for addiction medicine specialists, rehab centers, or drug maintenance if these things were not a part of an expansive field that also brings in a lot of money.

So, if you’re reading a report telling you that talk therapy, rehab centers, and group counseling are useful, consider that the addiction rehab industry was worth approximately $42 billion in the US alone last year, and is growing quickly. Does it really sound like these methods are working, or just working to bring in money?

And this brings us to medical psychedelics, and the use of ayahuasca. Though the background story of ayahuasca is a bit hazy, it has been used plenty both in history and today, and has been reviewed in medical testing. Ayahuasca is a tea made from the combination of two plants: Psychotria viridis and the Banisteriopsis caapi vine.

ayahuasca ceremony

Though both plants have their own effects, when put together the DMT from the former and the beta-carbolines in the latter (also known as MAO inhibitors, which stop the DMT from being broken down), trigger a powerful psychoactive response. Though the use of ayahuasca might not match all the stories told at ayahuasca retreats, it was certainly used in different places in history. In today’s world, the user ingests the tea, and has a hallucinogenic experience, often with the help of a guide.

So, how is ayahuasca useful in the fight against drug addiction?

Ayahuasca in the fight against drug addiction

Ayahuasca is not the first psychedelic to be looked at for addiction, as many studies were performed on LSD for alcoholism last century. The best way to get an idea of how ayahuasca can be used for drug addiction, is to see how it performs in medical testing. The following is a list of general research related to ayahuasca for drug addiction:

  • In 2013, the Multidisciplinary Association for Psychedelic Studies (MAPS) published this study about ayahuasca-assisted therapy for problematic drug addiction, in rural British Colombia. The results found were that: “…participants may have experienced positive psychological and behavioral changes in response to this therapeutic approach, and that more rigorous research of ayahuasca-assisted therapy for problematic substance use is warranted.”
  • In Chapter six of Ayahuasca and the Treatment of Drug Addiction, from 2014, the authors state that more systematic studies must be done with improved methodology, but that long term studies have shown the ability to discontinue drugs among users in Brazil, and that therapy centers using ayahuasca claim to have higher success rates.
  • In the 2019 systematic review: Ayahuasca: Psychological and Physiologic Effects, Pharmacology and Potential Uses in Addiction and Mental Illness, the study authors found that “Research into medical use of ayahuasca indicates potential as a treatment in addictions, depression and anxiety [7], with a variety of other possible medical uses, though these require more research”
cannabis psychedelic
  • In the book Psychedelic Medicine by Dr. Jacques Mabit, there is a section called ‘Ayahuasca in the treatment of Addictions’, and not only does Mabit  make the case for ayahuasca use for addiction therapy, but he points out regarding the two plants used to make the tea, “This specific symbiotic action, which modern science identified just a few decades ago, has been empirically known for at least 3000 years by the Indigenous groups of the western Amazon, according to archaeological evidence (Naranjo P., 1983)”, reminding us that while these topics are fought over in modern medicine today, ancient populations seemed to understand them just fine.

Conclusion

That there is a massive drug problem in the world is by now a fact, so long as a person considers unnecessary deaths related to drug use as a problem. This is seen in overdose deaths worldwide, with growing issues related to opiates, and a long-standing issue with alcohol.

As the drug-addiction therapy industry grows exponentially, signaling major issues with both over-prescription and recidivism, new avenues should be explored to get people the help they need. In light of cannabis making its way from ‘hated’ to a ‘medical darling’, its no surprise that psychedelics are following suit. With a host of new research, and plenty of historical evidence, ayahuasca is being looked at as the new weapon in the fight against drug addiction. With the current and growing dilemma with opiates, this is one of the most promising things to come along.

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Resources

Psychedelic-Assisted Therapy, and How It Works
Cannabis Election Results – What Just Became Legal in the United States

William O’Shaughnessy & The Start of Cannabis Medicine
Desert Tripping – A Closer Look at Peyote: Spiritual, Medicinal, & Controversial
What is DELTA 8 THC (FAQ: Great resource to learn about DELTA 8THC)

Is Cannabis Good for Young Brains?
MDMA – The New Way to Treat PTSD
The CBD Flowers Weekly newsletter (your top resource for all things smokable hemp flowers). How to choose Delta-8 THC flowers?  A Complete Look At Cannabis and Depression
The Medical Cannabis Weekly newsletter (International medical cannabis business report)
Florida Bill Aims to Legalize Medical Magic Mushrooms
The Delta 8 Weekly Newsletter (All you need to know about Delta 8 thc) and the Best Delta 8 THC Deals. Best Delta-8 THC Vape Bundles – Winter 2021 The New Rise of Medical Psychedelics
Cannabis and the South: How Things Change The New Rise of Medical Psychedelics Ask A Doctor – General CBD/PTSD Discussion
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Plant Power: Everyday Plants That Activate the Endocannabinoid System Nature’s Magic – The Health Benefits of Psilocybin Mushrooms Merry Cannabis! Christmas and Marijuana

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COVID-19: Vancouver’s Downtown Eastside – a potential powder keg for coronavirus cases

Vancouver’s downtown eastside is facing unique and unprecedented challenges as a result of the COVID-19 global pandemic. Marginalization, misinformation, and a lack of resources to prevent and monitor the spread of the potentially deadly illness are just some of the barriers facing the already vulnerable community.  With many cases confirmed in surrounding areas, frontline workers […]

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