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Examining a national database of health insurance claims, researchers found that 91 percent of patients who suffered a nonfatal overdose of prescription opioid painkillers continued getting prescriptions for opioids following the overdose. And, the researchers found, overdose survivors who kept taking high dosages of an opioid—including morphine, oxycodone, and hydrocodone—were twice as likely to have another overdose within two years.

The findings, published in the Annals of Internal Medicine, follow news earlier this month from the Centers for Disease Control and Prevention that drug overdoses, opioid overdoses in particular, have reached epidemic levels. The fact that patients surviving opioid overdoses are still being prescribed opioids is “highly concerning,” the authors of the new study wrote.

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Aaron Carter is coming clean. The 29-year-old musician puts it all on the table during Thursday’s upcoming episode of The Doctors. In preview clips for the show, Aaron broke down in tears, talking about the criticism he has received for his gaunt appearance.

“I’m concerned about my overall health because people tell me I look like I have AIDs or I look like I have cancer or I look like I’m dying,” a tearful Aaron told one doctor on the show. 

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America’s opioid crisis is fueled by prescription painkillers. Medications such as oxycodone, fentanyl and morphine were responsible for nearly half of the 33,000 overdose deaths recorded in 2015, according to the Centers for Disease Control and Prevention.

How did Americans get their hands on so many opioid pills? A new study suggests that surgical patients have plenty go to around.

Among 810 people who were operated on and sent home with an prescription for opioids, more than two-thirds wound up with unused painkillers in the weeks after their procedures, according to a report published Wednesday in the journal JAMA Surgery.

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If you want a clear explanation of just how much of an outlier the US is in prescribing the powerful drugs that led to the opioid epidemic, consider this statistic given by Stanford drug policy expert Keith Humphreys last week (emphasis mine):

The biggest misconception is that the US is normal in how it handles prescription opioids. So let’s compare ourselves to another country. Japan, for example. Older population than us; you would think more aches and pains. Universal access to health care, so more opportunities to prescribe.

So consider the amount of standard daily doses of opioids consumed in Japan. And then double it. And then double it again. And then double it again. And then double it again. And then double it a fifth time. That would make Japan No. 2 in the world, behind the United States.

Every other developed country does at least as good or as poor a job as we do managing pain — while not using opioids at anywhere near the same level.

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 The nation’s opioid epidemic has unleashed a secondary outbreak: the rampant spread of hepatitis C.

New cases of the liver disease have nearly tripled nationwide in just a few years, driven largely by the use of needles among drug users in their 20s and 30s, spawning a new generation of hepatitis C patients. Because a treatment that cures the disease costs tens of thousands of dollars, is limited by insurance and Medicaid, and is mostly unavailable to people who are still using illicit drugs, there probably will be financial and public health ramifications for decades to come.

Here in West Virginia, which has the nation’s highest rates of overdose deaths and new hepatitis C and hepatitis B infections, public-health officials are attempting to identify as many new hepatitis carriers as possible — and are girding for decades of repercussions.

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The abuse of opioids is receiving growing public scrutiny. For example, The Economist mentioned the complex issues behind the factors and environments that facilitate the dependency on opioids in their weekly newspaper from April to May 2017. Likewise, in 2016, President Obama signed into law The Comprehensive Addition and Recovery Act (CARA)to address the epidemic of dependency on opioids. National Public Radio has aired at least ten stories on the various causes and dangers of opioid abuse. Equally concerning was a 2016 Wall Street Journalarticle titled “5 Things

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Introduction: Significant barriers, such as lack of professional guidelines, specialized training for interpretation of pharmacogenomics (PGx) data, and insufficient evidence to support clinical utility, prevent preemptive PGx testing from being widely clinically implemented. The current study, as a pilot project for the Right Drug, Right Dose, Right TimeeUsing Genomic Data to Individualize Treatment Protocol, was designed to evaluate the impact of preemptive PGx and to optimize the workflow in the clinic setting.

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Dr. Thomas Andrew, the chief medical examiner of New Hampshire, retired last month. Bodies from overdose deaths have overwhelmed medical examiners across the country. Credit Todd Heisler/The New York Times

CONCORD, N.H. — In the state morgue here, in the industrial maze of a hospital basement, Dr. Thomas A. Andrew was slicing through the lung of a 36-year-old woman when white foam seeped out onto the autopsy table.

Foam in the lungs is a sign of acute intoxication caused by an opioid. So is a swollen brain, which she also had. But Dr. Andrew, the chief medical examiner of New Hampshire, would not be certain of the cause of death until he could rule out other causes, like a brain aneurysm or foul play, and until after the woman’s blood tests had come back.

With the nation snared in what the government says is the worst drug epidemic in its history, routine autopsies like this one, which take more than two hours, are overtaxing medical examiners everywhere.

“It’s almost as if the Visigoths are at the gates, and the gates are starting to crumble,” Dr. Andrew said. “I’m not an alarmist by nature, but this is not overhyped. It has completely overwhelmed us.”

The mother of Declan Donnelly has spoken of her heartache over Ant McPartlin‘s battle with addiction. Anne Donnelly, who said she sees Ant as “like a son”, spoke to North News and Pictures about Ant’s recent stay in rehab, and admitted she hadn’t realised he had been suffering until she read about it in the news. “When I found out what he had been going through I was quite upset that he had been in that much pain,” she said. “We didn’t know how he was doing until we read about it. He has done so well, and we are all so proud of him. We are all so happy with the news. I’m really proud of Ant,” she added.

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To help bolster its campaign against an epidemic of opioid abuse that now kills about 90 people a day, the U.S. Food and Drug Administration (FDA) last year called for help from an independent advisory panel. The resulting report, released today by the National Academies of Sciences, Engineering, and Medicine, makes some strong prescriptions. Among its assorted recommendations—from supporting state syringe exchange programs to increasing federal funding for neurobiology research—the panel suggests that FDA dramatically expand the types of evidence it requires from companies to show that an opioid is safe and effective, both before and after it gets market approval. The new framework would require companies to provide complex data on a drug’s public health impact—potentially including its ability to ensnare people at high risk of addiction as well as shift the dynamics of the illegal drug market

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The Food and Drug Administration issued new warnings Wednesday about the dangers of combining medication for opioid addiction with anti-anxiety medicines and other drugs that also slow breathing and brain activity.

The FDA warned that mixing such drugs can cause difficulty breathing, coma or death, so it should be done with caution.

The agency said a growing number of people fighting opioid addiction with methadone or buprenorphine also take other prescription drugs that slow action of the central nervous system. The warning lists several dozen brand-name and generic drugs that could be risky, including Ambien and Lunesta for insomnia, Valium and Xanax for anxiety, muscle relaxers Soma and Zanaflex and antipsychotic drugs Abilify, Invega, Saphris and others.

The agency stressed that treating opioid addiction with medication can outweigh those risks and is crucial to curbing the U.S. opioid epidemic, along with counseling, rehabilitation and other support.

“Careful management of the patient and coordination of care is recommended,” rather than denying use of methadone or buprenorphine, FDA Commissioner Scott Gottlieb wrote in a statement issued with the warning.

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A former employee of the Drug Enforcement Administration (DEA) said in a new interview on Sunday that efforts to stem the growing opioid epidemic in the U.S. were derailed by pressure from large pharmaceutical companies and Congress.

Joe Rannazzisi told CBS’s “60 Minutes” that major distributors, including Cardinal Health, McKesson and AmerisourceBergen, allowed drugs to be obtained by rogue pharmacies and pain clinics, which then prescribed them to Americans “who had no legitimate need for those drugs.”

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Within hours of entering the world, little Sebastiana Manuel’s entire body froze in a rigid spasm. Her neck twisted, her face turned blue, and one side of her body stiffened as if someone were yanking her violently. She screamed.

At first her doctor wasn’t too concerned; some newborns have seizures. But Sebastiana’s kept coming every few hours. And the way her arms and legs stiffened during each episode was unusual. When her mother Dolores Sebastian tried to breast-feed her, she wouldn’t eat. After the baby’s body convulsed more than a dozen times in her first night, an ambulance rushed her from the local hospital in Fallbrook, Calif., where she was born, to the only advanced-care children’s hospital in the area, Rady Children’s Hospital in San Diego.

But even the specialists there were baffled by Sebastiana’s symptoms. As doctors hooked up her brain to monitors and conducted test after test from her crib in the neonatal intensive care unit (NICU), Dolores and her husband Pascual Manuel couldn’t touch or hold their baby. The nurses used one of Dolores’ shirts as a pillow so Sebastiana could still smell her mother’s scent and know that she was there.

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Godsmack frontman Sully Erna has partnered with the Mark Walhberg Youth Foundation, established by actor Mark Wahlberg, to raise awareness of opioid addiction. Together, they created a video for Erna’s song “Different Kind of Tears” that features parents speaking out about losing their children to opioids.

“Most of the charity work I have done is based around helping out inner-city kids to begin with — since I was that kid myself once — and especially since the opioid problem is now so severe in my hometown of Lawrence, Massachusetts,” says Erna in a statement. “This song and video echo the feelings of struggle and loss people experience with this addiction and yearns to be heard.”

Jim Wahlberg, executive director of the Mark Wahlberg Youth Foundation, adds, “This video addresses one of the most serious health issues facing our society today. Addiction touches every culture, every family and ultimately every one of us. I’m grateful for the opportunity to work with a very talented musician on this important project.”

“Different Kind of Tears” is a track from Erna’s latest solo album, Hometown Life.

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Pain and pleasure rank among nature’s strongest motivators, but when mixed, the two can become irresistible. This is how opioids brew a potent and deadly addiction in the brain.

Societies have coveted the euphoria and pain relief provided by opioids since Ancient Sumerians referred to opium poppies as the “joy plant” circa 3400 B.C. But the repercussions of using the drugs were ever present, too. For centuries, Chinese patients swallowed opium cocktails before major surgeries, but by 1500, they described the recreational use of opium pipes as subversive. The Chinese emperor Yung Cheng eventually restricted the use of opium for medical purposes in 1729.

Less than 100 years later, a German chemist purified morphine from poppies, creating the go-to pain reliever for anxiety and respiratory conditions. But the Civil War and its many wounds spawned mass addiction to the drugs, a syndrome dubbed Soldier’s Disease. A cough syrup was concocted in the late 1800s — called heroin — to remedy these morphine addictions.

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The largest drug distributor in the US has been accused by the Teamsters union of a pivotal role in the country’s opioid epidemic.

The union is urging shareholders to force a public reckoning this week, a move prompted by one member’s heartrending account of the death of his son.

This comes after the company paid the largest financial settlement of its kind amid lawsuits accusing it of “flooding” the country with prescription painkillers.

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Thirteen years into this HSA experiment, health savings accounts are still wildly misunderstood. Are they employer-sponsored health plans, spending accounts, checking accounts, savings accounts, investment accounts, or is it now most appropriate to refer to them as a retirement savings vehicle?

Here’s what HSAs are not: employer-sponsored health plans, despite the fact that many employers assist in establishing them for employees and contribute to the accounts. HSAs are best thought of as individually owned tax-exempt trust or custodial accounts available to individuals covered by what the IRS considers to be an HSA-eligible health plan. That’s pretty cut and dry, however it’s easy to see why there is still so much confusion. After all, an HSA shares many of the characteristics of the accounts listed above, and it’s up to the individual to decide how best to use the account.

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More than 400 people, upwards of 120 individuals involved in prescribing and distributing narcotics, have been charged in connection with healthcare fraud and opioid scams totaling $1.3 billion in false billing.

Announcing the charges on Thursday, Atty. Gen. Jeff Sessions calls it the “largest healthcare fraud takedown operation in American history.”

Six Michigan physicians are among those charged in connection with a scheme to prescribe unnecessary opioids.

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Sessions said in announcing the arrests.

 

“Their actions not only enrich themselves, often at the expense of taxpayers, but also feed addictions and cause addictions to start.”

As part of the crackdown, Sessions says nearly 300 healthcare providers are being suspended or banned from participating in federal healthcare programs.

In Florida, a rehabilitation facility is alleged to have recruited addicts with gift cards and visits to strip clubs, which led to $58 million in false treatments and tests.

According to a Department of Justice press release, another illegal clinic in Houston allegedly handed out prescriptions for cash. One physician at this clinic allegedly gave out 12,000 opioid prescriptions for over 2 million illegal doses of painkillers.

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Plunkett, who is 69 years old, has had 18 surgeries. He has artificial knees, an artificial shoulder and has had operations on his back. The Bay Area News Group said he takes 13 pills for his various issues: six in the morning and seven at night. A year ago, Almond wrote Plunkett contracted Bell’s Palsy, a temporary facial paralysis that caused one side of Plunkett’s face to droop. That disappeared, then bad headaches started, and Plunkett’s physician thinks that’s related to the Bell’s Palsy.

“My life sucks,” Plunkett told the Bay Area News Group. “It’s no fun being in this body right now. Everything hurts.”

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Lady Gaga announced on Twitter that she will be unable to perform at the Rock in Rio music festival in Brazil due to health concerns, and later elaborated that she’s been hospitalized over severe pain.

“Brazil, I’m devastated that I’m not well enough 2 (sic) come to Rock In Rio. I would do anything 4 u (sic) but I have to take care of my body right now,” she wrote. “I ask for your grace and understanding, and promise that I will come back and perform for you soon,” she continued in a follow-up tweet.

A 10-year-old boy from a drug-ridden Miami neighborhood apparently died of a fentanyl overdose last month, becoming one of Florida’s littlest victims of the opioid crisis, authorities say. But how he came into contact with the powerful painkiller is a mystery.

Fifth-grader Alton Banks died June 23 after a visit to the pool in the city’s Overtown section. He began vomiting at home, was found unconscious that evening and was pronounced dead at a hospital. Preliminary toxicology tests showed he had fentanyl in his system, authorities said.

“We don’t believe he got it at his home,” Miami-Dade State Attorney Katherine Fernandez Rundle said Tuesday. “It could be as simple as touching it. It could have been a towel at the pool.”

She added: “We just don’t know.”

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The opioid epidemic is a national crisis. But what does that mean? To answer that, Yahoo News traveled to Middletown, Ohio — a city once considered as ordinary as its name, more recently known for an explosion in opioid use — and explored quantitative research about drugs, health care, and national public opinion. This is a problem so serious that it requires big data, so human that it needs a face. Here is what we found:

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Many people get surprised upon finding out a mother suffers from drug or alcohol abuse. It’s as if the shame and guilt are worse for moms, simply because they’re often viewed as selfless individuals who put their family above everything else. Moms, however, are just as vulnerable as everyone else. In fact, many of them fall victim to a new drug epidemic. An increasing number of moms are addicted to prescription medications.

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Trinity County is the state’s fourth-smallest, and ended last year with an estimated population of 13,628 people.

Its residents also filled prescriptions for oxycodone, hydrocodone, and other opioids 18,439 times, the highest per capita rate in California.

Places like West Virginia, Ohio and rural New England have become synonymous with prescription painkiller abuse, a scourge blamed for more than 183,000 deaths from 1999 through 2015.

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The new study suggests the US needs to curb excessive opioid prescribing and improve access to pain management techniques.

The United States needs to curb excessive opioid prescribing and improve access to pain management techniques, suggests a new government study.

Researchers found that more than one third of U.S. adults were prescribed the medications in 2015 and many also misused the drugs.

“A very large proportion and large number of adults use these medications in a given year,” said study author Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse in Bethesda, Maryland. “I was still a bit surprised that 38 percent or about 92 million people used prescription opioids in 2015.”

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Nashville Mayor Megan Barry said Sunday that her only child, 22-year-old Max Barry, has died of an apparent drug overdose.

An emotional statement released by the mayor and her husband, Bruce Barry, said their son died in Denver on Saturday night.

“Early this morning, we received news that no parents should ever have to hear. Our son Max suffered from an overdose and passed away. We cannot begin to describe the pain and heartbreak that comes with losing our only child. Our son was a kind soul full of life and love for his family and friends,” the statement said. “Our family would greatly appreciate your thoughts and prayers, and would respectfully ask for privacy as we mourn the loss of our child and begin to understand a world without his laughter and love in our lives.”

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CINCINNATI (AP) — Ohio‘s opioid epidemic will be a prime topic for the first meeting of an organization for pain doctors.

The Ohio Society of Interventional Pain Physicians expects hundreds of medical professionals to take part in the gathering that will begin Friday in Cincinnati as they focus on pain management topics.

Among the speakers are journalist Sam Quinones, whose book “Dreamland: The True Tale of America’s Opiate Epidemic” covers the spread of painkiller “pill mills” in Portsmouth, Ohio.

Also speaking will be Dr. Kent Harshbarger, the Montgomery County coroner whose caseload has seen a dramatic increase in opioid overdoses.

Ohio has been one of the states hardest-hit by overdose deaths from heroin and other opioids.

Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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The opioid epidemic is claiming thousands of American lives on an annual basis, and it’s also having a detrimental impact on the U.S. economy, according to a new study from Princeton University economist Alan Krueger.

The study found that a 20 percent drop in men’s labor-force participation could be linked to an increase in opioid prescriptions between 1999 and 2015.

“Labor-force participation has fallen more in areas where relatively more opioid pain medication is prescribed, causing the problem of depressed labor-force participation and the opioid crisis to become intertwined,” Krueger wrote.

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To satisfy her dependence on prescription opioids, Christine Drinnan visited 10 doctors in the last few months of her life, six in the 10 days immediately preceding her death from painkillers taken by millions of Australians every year.

In and out of rehabilitation over the years, Ms Drinnan had been admitted to hospital 15 times for overdoses caused by her addiction to these drugs, including three times in the months before her death.

A father who lost his daughter to an overdose after seven months of sobriety. A paramedic who has witnessed the ravaging effects of withdrawal. A lawmaker whose life changed the day a grieving mother opened his eyes to how close drugs lurk to his own life. A tough-on-crime prosecutor who didn’t know his sister was using heroin.

These people have seen first-hand the toll the opioid and heroin epidemic is taking on Indiana: The 136 percent increase in drug poisoning deaths; the 3,000 hospital emergency room visits a year for nonfatal drug overdoses. The surge in the number of children being removed from their homes because of parental substance abuse.

And yet, many continue to believe the crisis is someone else’s problem.

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The number of prescriptions for opioids written by health-care providers declined between 2012 and 2015, the government reported Thursday, introducing a glimmer of progress in efforts to quell the worst drug epidemic in U.S. history.

The Centers for Disease Control and Prevention said prescriptions for highly addictive painkillers such as oxycodone dropped 13.1 percent over the three-year period, from 81.2 per 100 people to 70.6.

Opioid prescriptions news article

On Monday, the President’s Commission on Combating Drug Addiction and the Opioid Crisis released a draft of its findings and an agenda that experts say offers some good steps, but could go further.

Created by President Trump’s executive order and helmed by New Jersey Gov. Chris Christie, the commission has spent the past several months hearing testimony from expert witnesses, individuals, and local leaders on the challenges of widespread addiction. Now, the group has released a preliminary report on the state of the country’s opioid epidemic, and on its recommendations for next steps, including a federal state of emergency.

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Mallinckrodt LLC, a major manufacturer of oxycodone, agreed to a $35 million settlement with the U.S. Department of Justice and the Drug Enforcement Administration (DEA) for alleged violations of the Controlled Substances Act, according to the agencies.

The company was accused of failing “to meet its obligation to detect and notify” the agencies of suspicious orders for controlled substances and to correctly maintain records requirements at its plant in Hobart, N.Y. The agencies also claimed that the pharmaceutical company supplied “an increasingly excessive quantity of oxycodone pills” to distributors, who sold them to pharmacies and pain clinics, without alerting the DEA.

 “In the midst of one of the worst drug abuse crises in American history, the Department of Justice has the responsibility to ensure that our drug laws are being enforced and to protect the American people,” Attorney General Jeff Sessions said in a statement. “Part of that mission is holding drug manufacturers accountable for their actions.”

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In one of the latest examples of the growing opioid epidemic, researchers found a seven-fold increase in the proportion of drivers killed while under the influence of prescription opioids since 1995.

Researchers at Columbia University examined drug testing results for 36,729 drivers in California, Hawaii, Illinois, New Hampshire, Rhode Island and West Virginia who died within an hour of being in a car crash.

“The opiate epidemic is primarily defined by deaths from overdoses, but its health impact goes beyond those overdose fatalities,” said Guohua Li, the study’s senior author and director of the Center for Injury Epidemiology and Prevention at Columbia University. Li said he expects the increased proportion of fatal crashes involving prescription opioids to apply to this year as well.

In a paper published last month in the American Journal of Public Health, researchers found that the prevalence of drivers with prescription opioids detected in their systems at the time of death surged from 1.0% in 1995 to 7.2% in 2015.

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CHICAGO — Safety advocates and state health officials are formally calling on the Food and Drug Administration to ban high-dose opioid painkillers to prevent accidental overdose deaths among patients and people who abuse drugs.

A petition filed Thursday asks the FDA to ban opioid pills that, when taken as directed, would add up to a daily dose of more than 90 milligrams of morphine. The Centers for Disease Control and Prevention has said that level is dangerous for most patients and doesn’t improve pain control or the ability to function.

The petitioners claim toddlers and preschoolers who get their hands on the pills and teenagers who experiment with drugs would be less likely to overdose and die if the high-dose pills were off the market.

The petition was signed by leaders of the Association of State and Territorial Health Officials, Physicians for Responsible Opioid Prescribing, the National Safety Council and the American College of Medical Toxicology.

“The existence of these products implies that they’re safe. They’re not,” said Dr. Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and an outspoken advocate for opioid reform.

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The US Department of Justice just took what it calls its biggest action against opioid-related fraud ever.

The department announced Thursday that it’s charged 120 people with opioid-related crimes. That includes doctors who were allegedly running pill mills in which they unscrupulously prescribed opioids to patients. It also includes fraudulent treatment centers, which attract customers with promises of treatment for their addiction and then offer shoddy, ineffective services — if any at all.

“Too many trusted medical professionals, like doctors, nurses, and pharmacists, have chosen to violate their oaths and put greed ahead of their patients,” Attorney General Jeff Sessions said. “Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start.”

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South Carolina has become the latest state to accuse a drug manufacturer of exacerbating its opioid drug crisis by using deceptive marketing, with the state’s top prosecutor suing the maker of OxyContin.

Attorney General Alan Wilson on Tuesday announced the state had sued Purdue Pharma, accusing the maker of OxyContin and other opioid drugs of violating South Carolina’s Unfair Trade Practices Act.

“While we vigorously deny the allegations, we share South Carolina officials’ concerns about the opioid crisis and we are committed to working collaboratively to find solutions,” Purdue Pharma responded in a statement.

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It was a botched play. The kid hit me in my back. I started coughing up blood.

It was my junior season in college and I played through it. I was pretty much lying to the trainers about how much pain I was in. I knew I wouldn’t be able to redshirt; I would have lost the rest of the season. With maybe five games left, I hurt my shoulder. That’s when I got prescribed Percocet.

It was like heaven. It numbed everything. When I was on the pills, I felt like I was a step ahead on the field. Dialed in. I don’t know how to explain it. It was out-of-body. I would eat a bunch of pills before the games to take the edge off, and more after the games because I was drained. I’d go to the training room, take a few, and then take an ice bath. I didn’t feel anything.

It wears off, and you think, ‘I need more of this.’

Within months I was an addict, and then an addict out of control – lying, selling, stealing – just to pay for my next fix. At one point I was taking 30 pills a day.

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The state of Washington and the City of Seattle filed separate lawsuits today against Purdue Pharma, maker of controversial opioid pain medication OxyContin, alleging that the drug company lied to doctors, regulators, and the public about the efficacy and safety of a drug that many place at the center of the ongoing opioid epidemic.

“In 2015, opioid overdoses killed 718 Washingtonians, more than either car accidents or firearms,” reads the complaint [PDF] filed today by Washington state Attorney General Bob Ferguson. “These deaths are attributable to a flood of prescription opioids into the state over the last two decades.”

The lawsuit, which involves other Purdue-made opioids in addition to Oxy, alleges that “Purdue aggressively marketed what was essentially an uncontrolled experiment on the American public,” and that the drug company lacked “reliable evidence that opioids are effective at relieving chronic pain in the long term.”

On September 8, 1854, acting on the advice of Dr. John Snow, London municipal authorities removed the pump handle from the Broad Street well in an effort to halt a major outbreak of cholera. Although an anesthesiologist by profession, Snow had methodically mapped the homes of new cases of cholera. He found that many clustered around the Broad Street pump.

Snow’s findings, still regarded as a classic example of epidemiology, established the principle: “that the most important information to have about any communicable disease is its mode of communication.” Dr. Snow did not establish the biologic mechanism of cholera or devise an effective treatment for those stricken with the disease; instead, his research indicated that the disease was transmitted through contaminated water. His methods demonstrated how the root cause of an emerging public health problem could be determined through epidemiological observation. It was later determined that a cholera-contaminated diaper had been washed near the pump.

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Clyde McClellan used to require a drug test before people could work at his Ohio pottery company, which produces 2,500 hand-cast coffee mugs a day for Starbucks and others.

Now, he skips the tests and finds it more efficient to flat-out ask applicants: “What are you on?”

At Homer Laughlin China, a company that makes a colorful line of dishware known as Fiesta and employs 850 at a sprawling complex in Newell, W.V., up to half of applicants either fail or refuse to take mandatory pre-employment drug screens, said company president Liz McIlvain.

“The drugs are so cheap and they’re so easily accessible,” McIlvain, a fourth-generation owner of the company, said. “We have a horrible problem here.”

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Opioid abuse is also hurting America’s job market.

Use of opioids has become a key factor in why “prime age” workers, mostly men, are unable or unwilling to find work, according to a new report by Goldman Sachs (GS).

A declining share of adult Americans are working or looking for work, according to Labor Department data. The trend has been a persistent weak spot for American jobs. The latest government report on jobs is due on Friday.

A shrinking labor force — compared to the overall adult population — tends to hold back growth for the economy and wages, both of which have grown anemically in recent years.

The labor market participation rate for American men between the ages of 25 and 54 has fallen 10% since its peak in 1954. It currently stands at 88.4%, slightly higher than an all-time low of 87.9% in 2014.

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If nothing is done, we can expect a lot of people to die: A forecast by STAT concluded that as many as 650,000 people will die over the next 10 years from opioid overdoses — more than the entire city of Baltimore. The US risks losing the equivalent of a whole American city in just one decade.

That would be on top of all the death that America has already seen in the course of the ongoing opioid epidemic. In 2015, more than 52,000 people died of drug overdoses in America — about two-thirds of which were linked to opioids. The toll is on its way up, with an analysis of preliminary data from the New York Times finding that 59,000 to 65,000 likely died from drug overdoses in 2016.

If you want to understand how we got here, there’s one simple explanation: It’s much easier in America to get high than it is to get help.

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It took three months to find Jamie Clay, the young, raven-haired addict at the center of my front-page article on the opioid-dependent babies of rural Kentucky.

First, I called hospital associations in states like Tennessee and Kentucky, where large numbers of opioid-dependent babies are born, to try to find rural hospitals that would be open to having a reporter visit.

Some hospitals never returned my calls and emails. Others wrote back to say they weren’t interested. A few were. I tracked down physicians and nurses who care for babies born dependent on opioids; I asked each if they had patients I could interview: mothers-to-be who were hooked on opioids or being treated for addiction who were willing to talk to me. Nobody would.

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