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WuMo by Wulff & Morgenthaler 072221

Drug companies keep merging. Why that’s bad for consumers and innovation.. 4/6/21

American Requiem By Chris Hedges

However inequitable its bias, capitalist democracy at least offered the possibility of incremental and piecemeal reform. Now it is a corpse.

November 06, 2020 "Information Clearing House" - Well, it’s over. Not the election. The capitalist democracy. However biased it was towards the interests of the rich and however hostile it was to the poor and minorities, the capitalist democracy at least offered the possibility of incremental and piecemeal reform. Now it is a corpse. The iconography and rhetoric remain the same. But it is an elaborate and empty reality show funded by the ruling oligarchs — $1.51 billion for the Biden campaign and $1.57 billion for the Trump campaign — to make us think there are choices. There are not.

The empty jousting between a bloviating Trump and a verbally impaired Joe Biden is designed to mask the truth. The oligarchs always win. The people always lose. It does not matter who sits in the White House. America is a failed state.

“The American Dream has run out of gas,” wrote the novelist J.G. Ballard. “The car has stopped. It no longer supplies the world with its images, its dreams, its fantasies. No more. It’s over. It supplies the world with its nightmares now.”

There were many actors that killed America’s open society.

THE CORPORATE OLIGARCHS who bought the electoral process, the courts and the media, and whose lobbyists write the legislation to impoverish us and allow them to accumulate obscene amounts of wealth and unchecked power.

THE MILITARISTS AND WAR INDUSTRY that drained the national treasury to mount futile and endless wars that have squandered some $7 trillion and turned us into an international pariah.

The CEOs, raking in bonuses and compensation packages in the tens of millions of dollars, that shipped jobs overseas and left our cities in ruins and our workers in misery and despair without a sustainable income or hope for the future.

THE FOSSIL FUEL INDUSTRY that made war on science and chose profits over the looming extinction of the human species.

THE PRESS that turned news into mindless entertainment and partisan cheerleading.

THE INTELLECTUALS who retreated into the universities to preach the moral absolutism of identity politics and multiculturalism while turning their backs on the economic warfare being waged on the working class and the unrelenting assault on civil liberties.

And, of course, THE FECKLESS AND HYPOCRITICAL LIBERAL CLASS that does nothing but talk, talk, talk.

If there is one group that deserves our deepest contempt it is the liberal elites, those who posture as the moral arbiters of society while abandoning every value they purportedly hold the moment they become inconvenient.

The liberal class, once again, served as pathetic cheerleaders and censors for a candidate and a political party that in Europe would be considered on the far-right. Even while liberals were being ridiculed and dismissed by Biden and by the Democratic Party hierarchy, which bizarrely invested its political energy in appealing to Republican neocons, liberals were busy marginalizing journalists, including Glenn Greenwald and Matt Taibbi, who called out Biden and the Democrats.

The liberals, whether at The Intercept or The New York Times, ignored or discredited information that could hurt the Democratic Party, including the revelations on Hunter Biden’s laptop. It was a stunning display of craven careerism and self-loathing.

The Democrats and their liberal apologists are, the election has illustrated, oblivious to the profound personal and economic despair sweeping through this country. They stand for nothing. They fight for nothing.

Restoring the rule of law, universal health care, banning fracking, a Green New Deal, the protection of civil liberties, the building of unions, the preservation and expansion of social welfare programs, a moratorium on evictions and foreclosures, the forgiveness of student debt, stiff environmental controls, a government jobs program and guaranteed income, financial regulation, opposition to endless war and military adventurism were once again forgotten.

Championing these issues would have resulted in a Democratic Party landslide.

But since the Democratic Party is a wholly owned subsidiary of corporate donors, promoting any policy that might foster the common good, diminish corporate profits and restore democracy, including imposing campaign finance laws, was impossible.

Biden’s campaign was utterly bereft of ideas and policy issues, as if he and the Democrats could sweep the elections by promising to save the soul of America. At least the neofascists have the courage of their demented convictions.

The liberal class functions in a traditional democracy as a safety valve. It makes piecemeal and incremental reform possible. It ameliorates the worst excesses of capitalism. It proposes gradual steps towards greater equality. It endows the state and the mechanisms of power with supposed virtues. It also serves as an attack dog that discredits radical social movements. The liberal class is a vital component within the power elite. In short, it offers hope and the possibility, or at least the illusion, of change.

The surrender of the liberal elite to despotism creates a power vacuum that speculators, war profiteers, gangsters and killers, often led by charismatic demagogues, fill.

It opens the door to fascist movements that rise to prominence by ridiculing and taunting the absurdities of the liberal class and the values they purport to defend. The promises of the fascists are fantastic and unrealistic, but their critiques of the liberal class are grounded in truth. Once the liberal class ceases to function, it opens a Pandora’s box of evils that are impossible to contain.

The disease of Trumpism, with or without Trump, is, as the election illustrated, deeply embedded in the body politic. It is an expression among huge segments of the population, taunted by liberal elites as “deplorables,” of a legitimate alienation and rage that the Republicans and the Democrats orchestrated and now refuse to address. This Trumpism is also, as the election showed, not limited to white men, whose support for Trump actually declined.

Fyodor Dostoevsky saw the behavior of Russia’s useless liberal class, which he satirized and excoriated at the end of the 19th century, as presaging a period of blood and terror. The failure of liberals to defend the ideals they espoused inevitably led, he wrote, to an age of moral nihilism. In "Notes From Underground," he portrayed the sterile, defeated dreamers of the liberal class, those who hold up high ideals but do nothing to defend them. The main character in 'Notes From Underground' carries the bankrupt ideas of liberalism to their logical extreme. He eschews passion and moral purpose. He is rational. He accommodates a corrupt and dying power structure in the name of liberal ideals. The hypocrisy of the Underground Man dooms Russia as it now dooms the United States. It is the fatal disconnect between belief and action.

“I never even managed to become anything: neither wicked nor good, neither a scoundrel nor an honest man, neither a hero nor an insect,” the Underground Man wrote. “And now I am living out my life in my corner, taunting myself with the spiteful and utterly futile consolation that it is even impossible for an intelligent man seriously to become anything, and only fools become something. Yes, sir, an intelligent man of the nineteenth century must be and is morally obliged to be primarily a characterless being; and a man of character, an active figure – primarily a limited being.”

The refusal of the liberal class to acknowledge that power has been wrested from the hands of citizens by corporations, that the Constitution and its guarantees of personal liberty have been revoked by judicial fiat, that elections are nothing more than empty spectacles staged by the ruling elites, that we are on the losing end of the class war, has left it speaking and acting in ways that no longer correspond to reality.

~ ~ ~
The “idea of the intellectual vocation,” as Irving Howe pointed out in his 1954 essay "This Age of Conformity," “the idea of a life dedicated to values that cannot possibly be realized by a commercial civilization — has gradually lost its allure. And, it is this, rather than the abandonment of a particular program, which constitutes our rout.”

The belief that capitalism is the unassailable engine of human progress, Howe wrote, “is trumpeted through every medium of communication: official propaganda, institutional advertising and scholarly writings of people who, until a few years ago, were its major opponents.”

“The truly powerless people are those intellectuals — the new realists — who attach themselves to the seats of power, where they surrender their freedom of expression without gaining any significance as political figures,” Howe wrote. “For it is crucial to the history of the American intellectuals in the past few decades — as well as to the relationship between ‘wealth’ and ‘intellect’ — that whenever they become absorbed into the accredited institutions of society they not only lose their traditional rebelliousness but to one extent or another they cease to function as intellectuals.”

Populations can endure the repression of tyrants, as long as these rulers continue to effectively manage and wield power. But human history has amply demonstrated that once those in positions of power become redundant and impotent, yet retain the trappings and privileges of power, they are brutally discarded.

This was true in Weimar Germany. It was true in the former Yugoslavia, a conflict I covered for The New York Times.

The historian Fritz Stern in "The Politics of Cultural Despair," his book on the rise of fascism in Germany, wrote of the consequences of the collapse of liberalism.

Stern argued that the spiritually and politically alienated, those cast aside by the society, are prime recruits for a politics centered around violence, cultural hatreds and personal resentments.

Much of this rage, justifiably, is directed at a liberal elite that, while speaking the “I-feel-your-pain” language of traditional liberalism, sells us out.

“They attacked liberalism,” Stern writes of the fascists emerging at the time in Germany, “because it seemed to them the principal premise of modern society; everything they dreaded seemed to spring from it; the bourgeois life, Manchesterism, materialism, parliament and the parties, the lack of political leadership. Even more, they sense in liberalism the source of all their inner sufferings. Theirs was a resentment of loneliness; their one desire was for a new faith, a new community of believers, a world with fixed standards and no doubts, a new national religion that would bind all Germans together. All this, liberalism denied. Hence, they hated liberalism, blamed it for making outcasts of them, for uprooting them from their imaginary past, and from their faith.”

We are in for it. The for-profit health care system, designed to make money — not take care of the sick — is unequipped to handle a national health crisis. The health care corporations have spent the last few decades merging and closing hospitals, and cutting access to health care in communities across the nation to increase revenue — this, as nearly half of all front-line workers remain ineligible for sick pay and some 43 million Americans have lost their employee-sponsored health insurance.

The pandemic, without universal health care, which Biden and the Democrats have no intention of establishing, will continue to rage out of control. Three hundred thousand Americans dead by December. Four hundred thousand by January. And by the time the pandemic burns out or a vaccine becomes safely available, hundreds of thousands, maybe a few million, will have died.

The economic fallout from the pandemic, the chronic underemployment and unemployment — close to 20 percent when those who have stopped looking for work, those furloughed with no prospect of being rehired and those who work part-time but are still below the poverty line are included in the official statistics — will mean a depression unlike anything we have seen since the 1930s.

Hunger in US households has already tripled since last year. The proportion of US children who are not getting enough to eat is 14 times higher than last year. Food banks are overrun. The moratorium on foreclosures and evictions has been lifted while over 30 million destitute Americans face the prospect of being thrown into the street.

There is no check left on corporate power.

The inevitable social unrest will see the state, no matter who is in the White House, use its three principle instruments of social control — wholesale surveillance, the prisons and militarized police — buttressed by a legal system that routinely revokes habeas corpus and due process, to ruthlessly crush dissent.

People of color, immigrants and Muslims will be blamed and targeted by our native fascists for the nation’s decline.

The few who continue in defiance of the Democratic Party to call out the crimes of the corporate state and the empire will be silenced.

The sterility of the liberal class, serving the interests of a Democratic Party that disdains and ignores them, fuels the widespread feelings of betrayal that saw nearly half the voters support one of the most vulgar, racist, inept and corrupt presidents in American history. An American tyranny, dressed up with the ideological veneer of a Christianized fascism, will, it appears, define the empire’s epochal descent into irrelevance.

Purdue Pharma agrees to plead guilty to federal criminal charges in settlement over opioid crisis, 10/21/2-0

Puerto Rico is in chaos, and some worry continued instability is a major threat

Puerto Rico is in chaos, and some worry continued instability is a major threat

[YES. Lock up Trump and all his criminal friends]

Five takeaways from the DEA’s pain pill database

For the first time ever, a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city — is being made public. The data was released as part of the largest civil action in U.S. history and provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which resulted in nearly 100,000 deaths from 2006 through 2012.

Here are The Post’s biggest takeaways:

1. The national database has never been released publicly.

The database is based on previously unreleased company data supplied to the DEA and reveals what each company knew about the number of pills it was shipping and dispensing, year by year, town by town. It is a virtual road map to the opioid epidemic. The drug companies, along with the DEA and the Justice Department, have fought furiously against the public release of the database, the Automation of Reports and Consolidated Orders System, known as ARCOS.

2. The companies flooded the nation with pills as the opioid epidemic raged.

A Washington Post analysis of the database shows that America’s largest drug companies distributed 76 billion oxycodone and hydrocodonepain pills across the country between 2006 and 2012 as the nation’s deadliest drug epidemic spun out of control.

About two dozen companies are being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids. The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies, and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.

3. A handful of companies manufactured and distributed most of the opioids.

Just six companies distributed 75 percent of the pills — oxycodone and hydrocodone — during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post.

Three companies manufactured about 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

4. The number of pills distributed skyrocketed over seven years.

The volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the same period.

The numbers of pills the companies sold during the seven-year time frame are staggering, far exceeding what has been previously disclosed in limited court filings and news stories.

The opioid epidemic began with prescription pills, spawned increased heroin use and then resulted in the current fentanyl crisis, which added more than 67,000 to the death toll from 2013 to 2017.

5. Some states and rural areas were saturated.

The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate from 2006 through 2012.

Rural areas with the greatest number of pills shipped per person per year were: Norton, Va., with 306; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175.

New opioid data spurs widespread condemnation, calls for action

The Washington Post recently published a massive database that tracks the distribution of opioids in the United States from 2006 to 2012, specifically where — and how many — drugs materialized. During that period, 76 billion prescription pain pills were manufactured and shipped to pharmacies all over the country, fueling a public health epidemic that killed 100,000 Americans in those seven years.

Drilling into the DEA’s pain pill database

Policymakers, media outlets and others are using this data to understand the sheer scope of the crisis, and many are demanding accountability.

Those who push poison into our kids and communities will be held to account

White House counselor Kellyanne Conway touted the president’s efforts to tackle the opioid crisis, arguing in a statement Monday that the Trump administration “has tackled it head on” while the Obama administration “ignored the growing drug crisis roiling this country.”

Conway said the White House is “watching as authorities name and shame those responsible” for the crisis.

“Those who push poison into our kids and communities will be held to account,” she said. “The sheer number of pills flooding numerous corners of this country while politicians looked the other way is an alarming disgrace that has cost thousands of lives and ruined many more.”

'Corporate greed:’ 2020 Democratic presidential candidates demand action

Senators and Democratic presidential hopefuls Elizabeth Warren (Mass.), Amy Klobuchar (Minn.) and Kamala D. Harris (Calif.), as well as former housing secretary Julián Castro and Montana Gov. Steve Bullock, tweeted about the data.

Warren and Castro accused Big Pharma of “corporate greed.” Warren also promoted her legislation to invest $100 billion over 10 years to combat the epidemic, which hasn’t gained any traction in Congress. Harris said, “It’s past time we hold pharmaceutical companies accountable.” Klobuchar called it “disturbing” and shared a quote from internal emails included in a court filing showing a drug company employee comparing the pills to “Doritos” that people “keep eating.”

Bullock focused his ire on the influence that Big Pharma’s deep pockets have on Washington.

Bullock tweet: As Big Pharma was spending Big Money to influence our elections, they were flooding our country with billions of opioids. We can’t turn a blind eye to how these companies cut big checks to wield political power.

'My Department of Justice will go after these folks'

Sen. Cory Booker (D-N.J.), who is also running for president, was asked about the data during a Washington Post Live event, specifically whether he’d want his Justice Department to prosecute drug companies.

"My Department of Justice will go after these folks, these pharmaceutical companies that have been fueling this opioid crisis, where it was an intentional strategy to juice the addiction of Americans to this drug, causing our life expectancy as a nation to go down,” Booker said. “This is criminal behavior, immoral behavior, and my DOJ will go after it."

'It got worse and worse and worse over time'

MSNBC’s Rachel Maddow dedicated a lengthy segment on Friday night to the searchable county-by-county opioid database. Maddow broke down some of the statistics for her viewers, saying “it got worse and worse and worse over time.”

“As the opioid crisis lit the country on fire and the death rates started skyrocketing and the country started freaking out about it, over the course of those seven years from 2006 to 2012, while 100,000 Americans were killed from those drugs, we can now tell they kept upping the number they were shipping every year,” Maddow said.

"By 2012, they were shipping on average 36 highly addictive pain pills for every man, woman and child and baby in the United States,” Maddow added.

McConnell challenger turns opioids data political

Amy McGrath, the Democrat hoping to unseat Senate Majority Leader Mitch McConnell in Kentucky, one of the states hit hardest by the opioid crisis, used the database Thursday to assail McConnell’s ties to drug companies.

Amy McGrath tweet:

Opioids are ravaging Kentucky and destroying our families.

The pharmaceutical industry flooded our state with almost 2 billion prescription pain pills over six years.

Mitch McConnell has taken $1.34 million from pharmaceutical companies.

Do the math

McConnell, who has been majority or minority leader since 2007, did not comment on The Post’s database. But about 90 minutes after McGrath’s tweet, he shared news that drug overdose deaths fell in Kentucky in 2018, the same year Congress passed its first comprehensive bipartisan opioid legislation and 12 years since the drug companies opened the floodgates.

Local media digs into data

Reporters from coast to coast used the database to expose the amount of prescription opioid pills that flowed to their communities.

For example, Kenny Choi of KPIX-TV in San Francisco tweeted:

These numbers are staggering from Alameda, San Francisco, Contra Costa County #bayarea #OpioidCrisis ?CHECK how many pain pills supplied in your county via @washingtonpost?

Christine Kennedy, a nurse and academic dean at the University of Virginia, shared a local newspaper article that, using the database, reported that a small pharmacy in a town of 1,000 people had acquired 7.7 million pills.

'Sociopathic fashion'

Experts who have been following the opioid crisis closely for years offered their view of what the database adds to the nation’s understanding of how and why it got so bad.

Keith Humphreys, a Stanford University professor who advised Presidents George W. Bush and Barack Obama on drug policy, said the database reminds him of the documents related to tobacco litigation, but worse.

"The number of people who conducted themselves in a sociopathic fashion was large but also the number of people who failed to do their jobs: doctors, pharmacists, regulators, DEA agents,” he said. “It really, unfortunately will, I think, confirm in the minds of people who think that nobody cares about them that, in fact nobody cares about them … the people who are supposed to watch over you."

Daniel Ciccarone, a professor at the University of California at San Francisco who studies drug abuse, said the database shows the complex nature of how this epidemic — which is now on its third wave with fentanyl — started.

"We love to know that there’s one problem with one culprit and one solution and it is simply not true in the opioid epidemic. In Wave 1 is it all Purdue Pharma? No. it’s Walgreens, it’s McKesson, all involved in excess prescribing and distribution of pills,” he said. “The epidemic itself is far more complicated."

Follow The Post’s investigation of the opioid epidemic

76 billion opioid pills: Newly released federal data unmasks the epidemic

America’s largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control, according to previously undisclosed company data released as part of the largest civil action in U.S. history.

The information comes from a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city. The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.

Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; ­Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

Purdue Pharma, which the plaintiffs allege sparked the epidemic in the 1990s with its introduction of OxyContin, its version of oxycodone, was ranked fourth among manufacturers with about 3 percent of the market.

The volume of the pills handled by the companies skyrocketed as the epidemic surged, increasing about 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the period.

Those 10 companies along with about a dozen others are now being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids. The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.

wpo

The database reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year by year, town by town. In case after case, the companies allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market, according to the lawsuits.

Plaintiffs have long accused drug manufacturers and wholesalers of fueling the opioid epidemic by producing and distributing billions of pain pills while making billions of dollars. The companies have paid more than $1 billion in fines to the Justice Department and Food and Drug Administration over opioid-related issues, and hundreds of millions more to settle state lawsuits.

But the previous cases addressed only a portion of the problem, never allowing the public to see the size and scope of the behavior underlying the epidemic. Monetary settlements by the companies were accompanied by agreements that kept such information hidden.

The drug companies, along with the DEA and the Justice Department, have fought furiously against the public release of the database, the Automation of Reports and Consolidated Order System, known as ARCOS. The companies argued that the release of the “transactional data” could give competitors an unfair advantage in the marketplace. The Justice Department argued that the release of the information could compromise ongoing DEA investigations.

Until now, the litigation has proceeded in unusual secrecy. Many filings and exhibits in the case have been sealed under a judicial protective order. The secrecy finally lifted after The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to documents and data from the case.

On Monday evening, U.S. District Judge Dan Polster removed the protective order for part of the ARCOS database.

Lawyers for the local governments suing the companies hailed the release of the data.

“The data provides statistical insights that help pinpoint the origins and spread of the opioid epidemic — an epidemic that thousands of communities across the country argue was both sparked and inflamed by opioid manufacturers, distributors, and pharmacies,” said Paul T. Farrell Jr. of West Virginia, co-lead counsel for the plaintiffs.

In statements emailed to The Post on Tuesday, the drug distributors stressed that the ARCOS data would not exist unless they had accurately reported shipments and questioned why the government had not done more to address the crisis.

“For decades, DEA has had exclusive access to this data, which can identify the total volumes of controlled substances being ordered, pharmacy-by-pharmacy, across the country,” McKesson spokeswoman Kristin Chasen said.

A DEA spokeswoman declined to comment Tuesday “due to ongoing litigation.”

Cardinal Health said that it has learned from its experience, increasing training and doing a better job to “spot, stop and report suspicious orders,” company spokeswoman Brandi Martin wrote.

AmerisourceBergen derided the release of the ARCOS data, saying it “offers a very misleading picture” of the problem. The company said its internal “controls played an important role in enabling us to, as best we could, walk the tight rope of creating appropriate access to FDA approved medications while combating prescription drug diversion.”

While Walgreens still dispenses opioids, the company said it has not distributed prescription-controlled substances to its stores since 2014. “Walgreens has been an industry leader in combatting this crisis in the communities where our pharmacists live and work, ” said Phil Caruso, a Walgreens spokesman.

Mike DeAngelis, a spokesman for CVS, said the plaintiffs’ allegations about the company have no merit and CVS is aggressively defending against them.

Walmart, Purdue and Endo declined to comment about the ARCOS database.

A Mallinckrodt spokesman said in a statement that the company produced opioids only within a government-controlled quota and sold only to DEA-approved distributors.

Actavis Pharma was acquired by Teva Pharmaceutical Industries in 2016, and a spokeswoman there said the company “cannot speak to any systems in place beforehand.”

A virtual road map

The Post has been trying to gain access to the ARCOS database since 2016, when the news organization filed a Freedom of Information Act request with the DEA. The agency denied the request, saying some of the data was available on its website. But that data did not contain the transactional information the companies are required to report to the DEA every time they sell a controlled substance such as oxycodone and hydrocodone.

The drug companies and pharmacies themselves provided the sales data to the DEA. Company officials have testified before Congress that they bear no responsibility for the nation’s opioid epidemic.

The numbers of pills the companies sold during the seven-year time frame are staggering, far exceeding what has been previously disclosed in limited court filings and news stories.

Three companies distributed nearly half of the pills: McKesson with 14.1 billion, Walgreens with 12.6 billion and Cardinal Health with 10.7 billion. The leading manufacturer was Mallinckrodt’s SpecGx with nearly 28.9 billion pills, or nearly 38 percent of the market.

The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate during this period.

Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175.

In that time, the companies distributed enough pills to supply every adult and child in the country with 36 each year.

The database is a virtual road map to the nation’s opioid epidemic that began with prescription pills, spawned increased heroin use and resulted in the current fentanyl crisis, which added more than 67,000 to the death toll from 2013 to 2017.

The transactional data kept by ARCOS is highly detailed. It includes the name, DEA registration number, address and business activity of every seller and buyer of a controlled substance in the United States. The database also includes drug codes, transaction dates, and total dosage units and grams of narcotics sold.

The data tracks a dozen different opioids, including oxycodone and hydrocodone, which make up three-quarters of the total pill shipments to pharmacies.

Under federal law, drug manufacturers, distributors and pharmacies must report each transaction of a narcotic to the DEA, where it is logged into the ARCOS database. If company officials notice orders of drugs that appear to be suspicious because of their unusual size or frequency, they must report those sales to the DEA and hold back the shipments.

As more and more towns and cities became inundated by pain pills, they fought back. They filed federal lawsuits against the drug industry, alleging that opioids from the companies were devastating their communities. They alleged the companies not only failed to report suspicious orders, but they also filled those orders to maximize profits.

As the hundreds of lawsuits began to pile up, they were consolidated into the one centralized case in U.S. District Court in Cleveland. The opioid litigation is now larger in scope than the tobacco litigation of the 1980s, which resulted in a $246 billion settlement over 25 years.

Where the virus grew

Judge Polster is now overseeing the consolidated case of nearly 2,000 lawsuits. The case is among a wave of actions that includes other lawsuits filed by more than 40 state attorneys general and tribal nations. In May, Purdue settled with the Oklahoma attorney general for $270 million.

In the Cleveland case, Polster has been pressing the drug companies and the plaintiffs to reach a global settlement so communities can start receiving financial assistance to mitigate the damage that has been done by the opioid epidemic.

To facilitate a settlement, Polster had permitted the drug companies and the towns and cities to review the ARCOS database under a protective order while barring public access to the material. He also permitted some court filings to be made under seal and excluded the public and press from a global settlement conference at the outset of the case.

Last June, The Post and the Charleston Gazette-Mail asked Polster to lift the protective order covering the ARCOS database and the court filings. A month later, Polster denied the requests, even though he had said earlier that “the vast oversupply of opioid drugs in the United States has caused a plague on its citizens” and the ARCOS database reveals “how and where the virus grew.” He also said disclosure of the ARCOS data “is a reasonable step toward defeating the disease.”

Lawyers for The Post and the Gazette-Mail appealed Polster’s ruling. They argued that the ­ARCOS material would not harm companies or investigations because the judge had already decided to allow the local government plaintiffs to collect information from 2006 through 2014, withholding the most recent years beginning with 2015 from the lawsuit.

"Access to the ARCOS Data can only enhance the public’s confidence that the epidemic and the ensuing litigation are being handled appropriately now — even if they might not have been handled appropriately earlier,” The Post’s lawyer, Karen C. Lefton, wrote in her Jan. 17 appeal.

The lawyers also noted the DEA did not object when the West Virginia attorney general’s office provided partial ARCOS data to the Gazette-Mail in 2016. That data showed that drug distribution companies shipped 780 million doses of oxycodone and hydrocodone into the state between 2007 and 2012.

On June 20, the 6th Circuit Court of Appeals in Ohio sided with the news organizations. A three-judge panel reversed Polster, ruling that the protective order sealing the ARCOS database be lifted with reasonable redactions and directed the judge to reconsider whether any of the records in the case should be sealed.

On Monday, Polster lifted the protective order on the database, ruling that all the data from 2006 through 2012 should be released to the public, withholding the 2013 and 2014 data.

Prescription tourists

The pain pill epidemic began nearly three decades ago, shortly after Purdue Pharma introduced what it marketed as a less addictive form of opioid it called OxyContin. Purdue paid doctors and nonprofit groups advocating for patients in pain to help market the drug as a safe and effective way to treat pain.

But the new drug was highly addictive. As more and more people were hooked, more and more companies entered the market, manufacturing, distributing and dispensing massive quantities of pain pills.

Purdue ending up paying a $634 million fine to the Food and Drug Administration for claiming OxyContin was less addictive than other pain medications.

Annual opioid sales nationwide rose from $6.1 billion in 2006 to $8.5 billion in 2012, according to industry data gathered by IQVIA, a health care information and consulting company.

Individual drug company revenues ranged in single years at the epidemic’s peak from $403 million for opioids sold by Endo to $3.1 billion in OxyContin sales by Purdue Pharma, according to a 2018 lawsuit against multiple defendants by San Juan County in New Mexico.

During the past two decades, Florida became ground zero for pill mills — pain management clinics that served as fronts for corrupt doctors and drug dealers. They became so brazen that some clinics set up storefronts along I-75 and I-95, advertising their products on billboards by interstate exit ramps. So many people traveled to Florida to stock up on oxycodone and hydrocodone, they were sometimes referred to as “prescription tourists.”


The route from Florida to Georgia, Kentucky, West Virginia and Ohio became known as the “Blue Highway.” It was named after the color of one of the most popular pills on the street — 30 mg oxycodone tablets made by Mallinckrodt, which shipped more than 500 million of the pills to Florida between 2008 and 2012.

When state troopers began pulling over and arresting out-of-state drivers for transporting narcotics, drug dealers took to the air. One airline offered nonstop flights to Florida from Ohio and other Appalachian states, and the route became known as the Oxy Express.

A decade ago, the DEA began cracking down on the industry. In 2005 and 2006, the agency sent letters to drug distributors, warning them that they were required to report suspicious orders of painkillers and halt sales until the red flags could be resolved. The letter also went to drug manufacturers.

Even just one distributor that fails to follow the law “can cause enormous harm,” the 2006 DEA letter said.

DEA officials said the companies paid little attention to the warnings and kept shipping millions of pills in the face of suspicious circumstances.

As part of its crackdown, the DEA brought a series of civil enforcement cases against the largest distributors.

The corporations to date have paid nearly $500 million in fines to the Justice Department for failing to report and prevent suspicious drug orders, a number that is dwarfed by the revenue of the companies.

But the settlements of those cases revealed only limited details about the volume of pills that were being shipped.

In 2007, the DEA brought a case against McKesson. The DEA accused the company of shipping millions of doses of hydrocodone to Internet pharmacies after the agency had briefed the company about its obligations under the law to report suspicious orders.

“By failing to report suspicious orders for controlled substances that it received from rogue Internet pharmacies, the McKesson Corporation fueled the explosive prescription drug abuse problem we have in this country,” the DEA’s administrator said at the time.

In 2008, McKesson agreed to pay a $13.25 million fine to settle the case and pledged to more closely monitor suspicious orders from its customers.

[Just the cost of doing business. Put people in JAIL]

That same year, the DEA brought a case against Cardinal Health, accusing the nation’s ­second-largest drug distributor of shipping millions of doses of painkillers to online and retail pharmacies without notifying the DEA of signs that the drugs were being diverted to the black market.


Cardinal settled the case by paying a $34 million fine and promising to improve its suspicious monitoring program.

Some companies were repeat offenders.

In 2012, the DEA began investigating McKesson again, this time for shipping suspiciously large orders of narcotics to pharmacies in Colorado. One store in Brighton, Colo., population 38,000, was ordering 2,000 pain pills per day. The DEA discovered that McKesson had filled 1.6 million orders from its Aurora, Colo., warehouse between 2008 and 2013 and reported just 16 as suspicious. None involved the Colorado store.

DEA agents and investigators said they had amassed enough information to file criminal charges against McKesson and its officers but they were overruled by federal prosecutors. The company wound up paying a $150 million fine to settle, a record amount for a diversion case.

Also in 2012, Cardinal Health attracted renewed attention from the DEA when it discovered that the company was again shipping unusually large amounts of painkillers to its Florida customers. The company had sold 12 million oxycodone pills to four pharmacies over four years.

In 2011, Cardinal shipped 2 million doses to a pharmacy in Fort Myers, Fla. Comparable pharmacies in Florida typically ordered 65,000 doses per year.

The DEA also noticed that Cardinal was shipping unusually large amounts of oxycodone to a pair of CVS stores near Sanford, Fla. Between 2008 and 2011, Cardinal sold 2.2 million pills to one of the stores. In 2010, that store purchased 885,900 doses — a 748 percent increase over the previous year. Cardinal did not report any of those sales as suspicious.

Cardinal later paid a $34 million fine to settle the case. The DEA suspended the company from selling narcotics from its warehouse in Lakeland, Fla. CVS paid a $22 million fine.

As the companies paid fines and promised to do a better job of stopping suspicious orders, they continued to manufacture, ship and dispense large amounts of pills, according to the newly released data.

“The depth and penetration of the opioid epidemic becomes readily apparent from the data,” said Peter J. Mougey, a lawyer for the plaintiffs from Pensacola, Fla. “This disclosure will serve as a wake up call to every community in the country. America should brace itself for the harsh reality of the scope of the opioid epidemic. Transparency will lead to accountability.”

Aaron Williams, Andrew Ba Tran, Jenn Abelson, Aaron C. Davis and Christopher Rowland contributed to this report.

FIGHTING FENTANYL Trump called the opioid epidemic a priority, but fentanyl deaths soar as resources fail to keep pace

WASHINGTON COURT HOUSE, OHIO — In a dungeon-like jail in the center of this depressed farming town, 18 women in orange-and-white-striped prison uniforms are crammed into a two-story cellblock. Many of them are withdrawing from fentanyl.

The jail, built in 1884 to hold 24, now houses 55 men and women, a number that can swell to as many as 90. The inmates are sprawled on metal bunk beds and mattresses that line the floors as they wait for court appearances or serve time on low-level drug offenses.

The medical exam room, used to treat minor ailments, is tucked into a broom closet beneath a concrete stairwell. With few drug treatment options, prisoners strung out on fentanyl go through days of withdrawal with little help, shivering and curled up on the beds and floors of the jail.

“It’s definitely our detox center right now. They just sit there, and they withdraw there,” Fayette County Deputy Health Commissioner Leigh N. Cannon said. “Treatment is where we need help. We keep hearing that money is coming, but we haven’t really seen it.”

The inmates here are at least alive — unlike so many drug users in this part of central Ohio, 40 miles southwest of Columbus. Fayette County has the seventh-highest number of fentanyl overdose deaths per capita in the nation, according to internal data from the Centers for Disease Control and Prevention obtained and analyzed by The Washington Post.

While the Trump administration has made the opioid epidemic a priority, people in communities across the country continue to die in record numbers from fentanyl, and health officials are struggling to provide treatment for tens of thousands more, like the men and women warehoused inside this jail.

President Trump has taken a number of steps to confront the crisis, stem the flow of fentanyl into the country from China and Mexico, and step up prosecutions of traffickers. Congress also has increased spending on drug treatment.

"Everyone here today is united by the same vital goal — to liberate our fellow Americans from the grip of drug addiction and to end the opioid crisis once and for all,” Trump said at a drug abuse summit in Atlanta on April 24. “It’s happening. It’s happening."

But health policy experts say drug treatment funding is not nearly enough, and the administration’s response was hobbled by the failure to appoint a drug czar in its chaotic first year and confusion over who was in charge of drug policy. The depth of the problem continues to overwhelm the government’s response, and the administration has yet to produce a comprehensive strategy that is legally required by Congress.

John P. Walters, director of the White House Office of National Drug Control Policy during the George W. Bush administration, said that after two years and a presidential commission to study the problem, the Trump administration is still struggling to confront the deadliest drug crisis in U.S. history and is not dedicating nearly enough federal resources.

"What other threat that is preventable is going to kill tens of thousands of Americans?” Walters said. “We’re spending much more money on terrorism, as we should, but we’re not spending a similar amount on the source of death to many more Americans right now."

In 2017, the first year of the Trump presidency, a record 28,869 people died from synthetic-opioid-related overdoses, a 46.4 percent increase from the year before. Most were from fentanyl, which is 50 times more powerful than heroin. Estimates for the first eight months of 2018, the most recent available, show that an additional 20,537 Americans died — a toll on pace to exceed the previous year’s.

“The scale of death here is really unprecedented, and so you have to judge the response against the scale of the problem,” said Joshua M. Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health. “You can have some progress, but it’s really insufficient if you are not up to the scale of the problem."

Sharfstein and other public health experts also note that the administration is seeking to repeal the Affordable Care Act and cut $1.5 trillion over 10 years from Medicaid. More than 500,000 people addicted to opioids could lose their drug treatment coverage if the ACA is repealed, according to the Kaiser Family Foundation. The proposed Medicaid cuts could further reduce coverage.

Trump officials said they are making progress against the epidemic on a range of fronts, including interdiction, prosecution and treatment, but they acknowledge that it remains a huge challenge.

“We didn’t get into this crisis overnight. We’re not going to get out overnight,” Kellyanne Conway, counselor to the president and the administration’s leading voice on the epidemic, said in an interview.

Conway said Trump views his handling of the crisis as a “legacy issue” and continually asks her for updates about what is taking place in the states.

"It can’t all be gloom and doom. You can’t just have the negative, harrowing, so-sad statistics of grief and loss and devastation. We have to start talking about solutions,” she said. “The battleship is starting to turn in the other direction."

The CDC data obtained by The Post documents for the first time the 10 places with the highest per capita fentanyl-related overdose death rates: five counties in Ohio, two in West Virginia and one in Kentucky and the cities of Baltimore and St. Louis. Local health officials told The Post they are still not receiving enough federal money to fund drug treatment programs to wean people off highly addictive opioids or launch prevention programs to warn people of the dangers of fentanyl.

In Cabell County, W.Va., the county with the highest fentanyl overdose death rate in the nation, there are long waiting lists for treatment.

"When somebody is saying, ‘I’m ready for treatment’ and they want help, they shouldn’t have to wait six months, six weeks or six days,” said Steve Williams, mayor of Huntington, the county seat of Cabell. “They should be able to get in a treatment program within six hours."

In Ohio, deaths from fentanyl have ravaged vast sections of the state. In 2015, there were 1,255 synthetic-opioid-related deaths, most from fentanyl. By the end of 2017, that number had nearly tripled to 3,572.

In rural counties of Ohio, federal money recently appropriated by Congress has started to arrive, but health officials there say it is not enough.

"The situation four years ago was looking desperate. Today, it’s looking dire,” said Scott Gehring, president of the Community Health Alliance, a drug treatment facility in Butler County, Ohio, which has the ninth-highest fentanyl overdose death rate in the nation. “People are sicker. More people are dying."

In the run-up to the 2016 presidential election, Trump promised to halt the flow of heroin into the United States. He mentioned that drug, not fentanyl, at least 57 times during his speeches and appearances, and he tied the crisis to the need to build a wall along the border with Mexico. On the campaign trail, Trump was moved by the people he met who had lost family members to the epidemic, Conway said. As he left one stop, someone called out: “Please follow through on the drugs and opioids. You promised.”

Trump also said addiction was a deeply personal issue for him. His older brother, Fred Jr., who suffered from alcoholism, died in 1981 at age 43.

On March 29, 2017, two months after his inauguration, Trump invited then-New Jersey Gov. Chris Christie to the White House.

Christie had told Trump that his administration was inheriting an out-of-control opioid epidemic that blew up with the arrival of fentanyl during the Obama administration — between 2013 and 2017, more than 67,000 people died from the synthetic drug.

The opioid epidemic had begun in the late 1990s when a generation of Americans became addicted to prescription pain pills. After the government started to crack down on doctors, pain clinics, and drug manufacturers and distributors in the mid-2000s, addicts turned to heroin and then fentanyl.

What is fentanyl? The powerful painkiller is the leading cause of overdose deaths in America.

Fentanyl, a powerful painkiller developed nearly 60 years ago, has triggered the deadliest drug epidemic in American history. Synthetic opioids like fentanyl have claimed the lives of more than 67,000 people — more than the number of U.S. military personnel killed during the Vietnam, Iraq and Afghanistan wars combined.

One of the greatest dangers of fentanyl is its potency. A few grains of the drug can cause an overdose. Deaths from the drug began to climb in 2013, when traffickers began to mix street heroin with illicit fentanyl. In just a few years, fentanyl began to rival heroin as the deadliest opioid in the United States, prompting the Centers for Disease Control and Prevention to issue a nationwide public health advisory. The alert received little national attention.

In just a few years, the synthetic painkiller became the deadliest drug ever to hit U.S. streets. Manufactured in Chinese and Mexican labs, illicit fentanyl has played a significant role in reducing the overall life expectancy of Americans. It is so powerful, just a few flecks the size of grains of salt can cause acute respiratory failure and rapid death.

Obama administration officials were slow to address the fentanyl epidemic. The administration saw fentanyl as an add-on to the overall opioid crisis, rather than a singular danger that required a strategy of its own because it was so deadly and was coming into the country largely unimpeded through the mail. Senior White House and Justice Department officials, motivated by a desire to rectify racial inequality in sentencing, emphasized drug treatment over incarceration, and drug prosecutions fell off as fentanyl coursed through sections of the country.

By the time Trump came into office, the dangers of fentanyl were well known. The Drug Enforcement Administration and the CDC had issued numerous warnings. The fatal overdose rate was staggering.

“I said to [Trump] that I thought there was a lack of urgency to the way President Obama’s administration had dealt with this issue, and that as a result, the problem had gotten worse,” Christie recalled in an interview. “We needed to go after this in a really aggressive way.”

Trump signed an executive order establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

He put the New Jersey governor in charge.

“Let’s do it,” the president told Christie that day.

At the Justice Department, Trump’s first attorney general, Jeff Sessions, launched his own assault on fentanyl.

For Sessions, fentanyl could be met only by the kind of tough law-and-order tactics he deployed as a federal prosecutor in Alabama during the “War on Drugs” of the 1980s and 1990s. While a member of the U.S. Senate for 20 years, Sessions was one of the few lawmakers to rail against bipartisan efforts to roll back the harsh drug sentencing policies of that era.

Sessions promised to make fentanyl a signature issue after his first trip to New Hampshire, a state that had experienced one of the highest fentanyl-related death rates in the country. He attended a “youth summit” on opioids at Manchester’s downtown arena with Gov. Chris Sununu (R) on March 7, 2017.

"One of the most dramatic moments for me was the first trip to New Hampshire where Governor Sununu had 8,000 high school students gathered and 50 mothers stood before them holding large pictures of their children who died from drug overdoses,” Sessions said in an interview.

On May 12 that year, in one of his first actions, Sessions reversed what had become known as the “Holder Memo.” The 2013 document written by then-Attorney General Eric H. Holder Jr. directed federal prosecutors to stop pursuing low-level, nonviolent drug charges that would trigger mandatory minimum prison sentences. Over decades, U.S. drug policy had resulted in long prison terms and increased incarceration for first-time offenders, most of them young black men, and Holder wanted to reverse what he saw as a historic injustice.

Sessions directed his prosecutors to give high priority to drug cases, particularly aiming at fentanyl. Those found guilty would face the most severe penalties possible, according to a memo he sent to each U.S. attorney.

In July 2017, the Justice Department shut down the largest dark-web distributor of illicit drugs. Called AlphaBay, the site allowed users to sell and buy drugs, including fentanyl. At the time of the takedown, there were 250,000 listings for illegal drugs and toxic chemicals on the site, according to the Justice Department.

That fall, the department brought its first criminal charges against Chinese nationals accused of selling fentanyl to Americans over the Internet in cases that were filed in federal courts in North Dakota and Mississippi.

Sessions used an emergency declaration to make all chemical variants of fentanyl, known as analogues, illegal on a temporary basis; Congress must pass legislation to make the ban permanent. Chinese and Mexican chemists and drug traffickers in the United States had been evading the law by tweaking the chemical compounds that make up fentanyl and producing products that don’t fit the precise chemical formula for a banned substance.

Sessions also ramped up federal prosecutions of all fentanyl offenses and sent additional prosecutors to 10 areas in the country with the highest number of overdoses.

Christie, however, was growing frustrated with Sessions’s exclusive focus on law enforcement actions. He said he called the attorney general several times, inviting him to speak at the commission’s public hearings. Instead, Sessions sent his deputy attorney general.

Sessions said he has long believed in prevention and treatment programs, but as the attorney general, he was responsible for focusing on drug trafficking cases.

"I didn’t find him helpful at all on the issue,” Christie said. “He only had one tune, which was enforcement. He didn’t want to talk about the other parts of the issue. I wanted him to engage on treatment, on drug courts, and he had no interest in engaging in that. So, after a while, I just stopped calling because, what was the use?

"He was a one-trick pony."

'Reinventing the wheel’

During Trump’s first months in office, the administration shunted aside its White House Office of National Drug Control Policy. The office, whose director is known as the “drug czar,” is responsible for coordinating anti-drug efforts across 16 federal agencies and producing the National Drug Control Strategy, an annual drug policy plan mandated by Congress.

Former Trump administration officials said the White House did not trust the career staffers at the office. One former official, who spoke on the condition of anonymity to discuss internal deliberations, said the president and his aides wanted to “transcend the drug czar” and “raise the issue to a higher level."

White House officials treated the drug czar’s office as a backwater. They staffed it with political operatives who had little or no drug policy experience and installed a 24-year-old campaign worker as the deputy chief of staff. Senior staffers with years of experience were sidelined. In May 2017, the administration proposed cutting the office’s budget by 95 percent.

Ohio’s Butler County has the ninth-highest number of fentanyl-related overdose deaths per capita in the United States, according to CDC data. Four other Ohio counties are in the top 10.

No one was immediately nominated to become the drug czar. As the Trump presidency entered its seventh month, there was no permanent official in charge of coordinating drug policy across myriad federal agencies — the CDC, the National Institute on Drug Abuse, the Justice Department and the Department of Homeland Security.

Lawmakers on Capitol Hill were growing impatient with the administration’s lack of plans to confront the opioid epidemic. On July 26, the House Oversight and Reform Committee summoned then-acting drug czar Richard Baum, who had been in his job for four months, to explain why he had not submitted a comprehensive plan to operate and fund the office.

“Any idea when it might be submitted?” Rep. Gerald E. Connolly (D-Va.) asked Baum.

"I don’t want to give you a timeline,” Baum replied. “But I can tell you this. I’ve studied the issue very closely.”

“Likewise, we need a strategy,” Connolly said. “Any idea when a strategy will be submitted to the Congress?”

“We’re developing a strategy now,” Baum said.

The opioid overdose death rate, by then almost entirely fueled by illicit fentanyl, continued to climb. In 2017, fentanyl for the first time became the leading cause of overdose deaths in America.

Distributors, pharmacies and manufacturers respond to previously unreleased DEA data about opioid sales

A yearlong legal battle waged by The Washington Post and HD Media, publisher of the Charleston Gazette-Mail in West Virginia, resulted in a ruling Monday releasing government data tracking sales of billions of opioid pills in the U.S. from 2006 to 2012.

The data in the Drug Enforcement Administration’s Drug Automation of Reports and Consolidated Orders System, known as ARCOS, reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year-by-year, town-by-town.

Lawsuits against the drug companies now allege they allowed some of the highly addictive drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.

The Post on Tuesday asked opioid distributors, pharmacies and manufacturers to respond to information contained in the database. The paper also asked them to respond to three major allegations made by plaintiffs in ongoing lawsuits:

1. That your company helped fuel the opioid epidemic by manufacturing, distributing or dispensing hundreds of millions of pain pills?

2. That your company along with other companies conspired to flood the nation with opioids?

3. That your company failed to report suspicious orders to the DEA and filled those orders to maximize profits?

The Post also asked for comment from the Healthcare Distribution Alliance, an industry trade group.

These were their public statements to The Post:

DISTRIBUTORS

AmericansourceBergen:

“Broadly providing retroactive DEA data to plaintiffs’ law firms solely for litigation purposes offers a very misleading picture regarding efforts being made around diversion. This data has never previously been given to anyone outside DEA, and therefore has not been available to inform the order monitoring programs and decision-making of distributors like AmerisourceBergen.

"After providing daily order reports to DEA, distributors such as AmerisourceBergen have at no time been privy to how this information was used by DEA, despite consistently seeking guidance on how to most effectively walk the tightrope of providing access to needed, FDA-approved medications while playing a role – however limited, given lack of interaction with patients – in combating the diversion of these same medications.

“Only recently did DEA share any of this data with distributors or manufacturers, when it was compelled to through the passage of the SUPPORT Act in late 2018 to make limited information from the database available to distributors.

"The fact that our market share of these controlled substances seems to be far smaller than our total market share is a testament to the fact that our controls played an important role in enabling us to, as best we could, walk the tight rope of creating appropriate access to FDA approved medications while combatting prescription drug diversion."

Cardinal Health:

"Cardinal Health is an intermediary in the pharmaceutical supply chain and plays an important but limited and specific role: to provide a secure channel to deliver medications of all kinds from the hundreds of manufacturers that make them to our thousands of hospital and pharmacy customers licensed to dispense them to patients, and to work diligently to spot, stop and report suspicious orders of medications.

"Cardinal Health is proud to operate a constantly adaptive and rigorous system to combat controlled substance diversion. We have learned from our experience and the threats the pharmaceutical supply chain faces, and as a result our anti-diversion program today is stronger and more effective as it continues to evolve. We have increased the size of our anti-diversion team, including bringing in personnel with additional regulatory, pharmaceutical, and law enforcement experience. We have developed an analytical model to evaluate our pharmacy customers, assigned threshold ordering limits to them, created a centralized database to store and track data on customers and orders, and enhanced policies and procedures for anti-diversion personnel. Over the years, we have trained thousands of our people on anti-diversion practices. Our people operate in good faith, our goal is to get it right, and we have stopped suspicious orders for the shipment of hundreds of millions of dosage units of controlled substances over the last decade.

“As we fulfil our role in the closed supply chain, we are in full compliance with all applicable federal and state laws, which include the requirement to report to state and federal regulators those orders deemed suspicious, despite there being only vague guidance from the Drug Enforcement Administration on what constitutes an unusual, or suspicious, order.

"We report those suspicious orders to state boards of pharmacy and to the DEA, but we do not know what these government entities do with those reports, if anything. Distributors have no law enforcement power and, unlike the regulators which oversee and regulate the manufacture, distribution, prescribing and dispensing of controlled substances, cannot stop physicians from writing prescriptions for medication nor take unilateral action to block DEA- and state-licensed pharmacies’ ability to dispense medication.

"Cardinal Health shares the judgment of top policymakers that too many prescriptions have been written for too many opioid pills over the past decade, a trend that began with changes in the medical community’s attitudes toward managing pain. The DEA, the only entity with the ability to limit production of prescription opioids as it sets an annual quota of the amount allowed to be manufactured, also until recently continuously raised these annual production quotas. From 2006 to 2014, the DEA’s authorized quota rose 140%. Thus, the quantity of opioid pills sold is a direct reflection of the number of prescriptions written by healthcare providers and filled by licensed dispensers, neither of which wholesale distributors can influence.

"Cardinal Health cares deeply about the opioid epidemic and takes seriously our commitment, in cooperation with everyone else in the prescription drug supply chain – state and federal government regulators, pharmaceutical manufacturers, doctors and other healthcare providers, insurers and pharmacies – to find and support solutions to this national challenge.

"In addition, Cardinal Health will continue, as we have for over a decade, to make a meaningful difference by raising awareness about the dangers of overprescribing and actively supporting efforts to address it. We also will continue to vigorously defend ourselves in all opioid-related legal matters."

McKesson Corp.:

"As the ARCOS data demonstrates, McKesson has consistently disclosed controlled substance transactions to the DEA. For decades, DEA has had exclusive access to this data, which can identify the total volumes of controlled substances being ordered, pharmacy-by-pharmacy, across the country.

“McKesson distributes prescription opioids and other medications in response to orders placed by state-licensed and DEA-registered pharmacies, and those pharmacies may only dispense these medications to patients with a valid prescription written by a government-licensed health care provider.

"The allegations made by the plaintiffs are just that – allegations. They are unproven, untrue and greatly oversimplify the evolution of this health crisis as well as the roles and responsibilities of the many players in the pharmaceutical supply chain. Any suggestion that McKesson influenced the volume of opioids prescribed or consumed in this country would reflect a misunderstanding of our role as a distributor."

PHARMACIES

CVS:

“The plaintiffs’ allegations about CVS in this matter have no merit and we are aggressively defending against them. The fact is that we are committed to the highest standards of ethics and business practices, including complying with all federal and state laws governing the dispensing of controlled substance prescriptions.

“We are also dedicated to helping reduce prescription drug abuse and diversion. We have stringent policies, procedures and tools to help ensure that our pharmacists properly exercise their professional responsibility to evaluate controlled substance prescriptions before filling them.

“Over the past several years, we have taken numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic. This includes millions of hours training our pharmacy teams about responsibilities and best practices regarding controlled substances.

“When reviewing information in the ARCOS database about CVS, it is important to keep the following in mind for context:

“We did not, and still do not, distribute Schedule II controlled substances such as oxycodone and fentanyl. We only distribute Schedule III-V controlled substances to our retail pharmacies.

“CVS Pharmacy is one of the two largest retail pharmacies in the nation. During the covered time period of 2006-2012, CVS had an average market share of over 18% for all retail prescriptions dispensed in the country. During those last two years, our market share for all retail prescriptions dispensed nationally was 20-21%.

"We dispensed over 4.2 billion retail prescriptions during that time period and opioid medications were a very small percentage of that total.

“Pharmacies dispense medication, including controlled substances, to patients who have authorized prescriptions written by doctors, physicians and other prescribers."

Walgreens:

"Walgreens pharmacists are highly trained professionals committed to dispensing legitimate prescriptions that meet the needs of our patients. Walgreens has not distributed prescription controlled substances since 2014 and before that time only distributed to our chain of pharmacies. Walgreens has been an industry leader in combatting this crisis in the communities where our pharmacists live and work."

Walmart:

Declined to comment.

MANUFACTURERS

Actavis Pharma:

“Teva acquired Actavis in 2016 and cannot speak to any systems in place beforehand. I can also not confirm any of your statistics without more specificity on medicines, locations and additional detail.

“That said, overall, generic medicines automatically replace branded medicines at the pharmacy with absolutely no influence from Teva. Teva has not conspired, failed to report suspicious orders or contributed to the abuse of opioids in the U.S. in any way. We maintain a comprehensive and robust system to prevent suspicious orders from ever entering the market.”

Endo Pharmaceuticals:

"Regarding the lawsuit, it is Endo’s policy not to comment on current litigation. Our comments regarding the topic of opioids can be found on our website. In the letter, Endo states:

“Since its founding as a family business in 1920, Endo has evolved into a generics and specialty branded pharmaceutical company whose products help millions of patients lead healthier lives. We are deeply concerned about the opioid abuse crisis, a public health challenge unprecedented in scope, severity and complexity. We believe this crisis can only be solved through intensive collaboration among the multiple stakeholders involved in our healthcare system.

"The U.S. Food and Drug Administration (FDA) has worked to balance access to pain care medications for appropriate patients while aggressively mitigating the risks of opioid abuse. Endo supports these efforts and has taken parallel actions. Since our new Executive Leadership Team began working together in September 2016, Endo voluntarily stopped promoting opioid products to healthcare professionals and eliminated the Company’s entire pain product salesforce. Endo also voluntarily withdrew Opana® ER from the market, discontinued the research and development of new opioid products and implemented additional anti-diversion measures, including product serialization aimed at thwarting counterfeiting and theft to protect patient safety.

"While we are proud of Endo’s actions, neither we nor any other single actor can solve the opioid abuse crisis. Instead, any solution must be multifaceted and consider not only the product supply chain, but also individual risk factors and other factors affecting utilization decisions, together with scientific, legislative and regulatory measures, training, treatment and education. Criminal trafficking of opioids (including heroin and fentanyl), illegal Internet sales and importation must also be addressed. Finally, the legitimate access needs of the millions of patients suffering from acute or chronic pain who rely on opioid medications must be considered. We remain committed to working collaboratively and proactively on a comprehensive solution to the opioid abuse crisis and to continuing Endo’s longstanding mission of improving patients’ lives."

Mallinckrodt:

“The Drug Enforcement Administration determines the total quantity of Schedule II opioids needed each year to meet legitimate medical, scientific and research needs in the U.S. Our DEA registrant company, SpecGx LLC, cannot and does not produce more opioids than the annual limit set for the company by the DEA. SpecGx sells only to DEA-approved distributors and other entities, who are themselves registered with and monitored by the DEA. In addition, through its ARCOS database, DEA monitors the flow of these DEA controlled substances from their point of manufacture through commercial distribution channels to point of sale or distribution at the dispensing/retail level.

"Mallinckrodt has for years been at the forefront of preventing prescription drug diversion and abuse, and has invested millions of dollars in a multi-pronged program to address opioid abuse. Those efforts include the purchase and donation of nearly two million drug disposal pouches, and working with policymakers, community leaders, law enforcement and industry partners to ensure the responsible use of pain medication and preventing unused medications from ending up in the wrong hands. The company will continue to support these efforts. For more information on Mallinckrodt’s work to combat prescription drug abuse and misuse, please visit www.mallinckrodt.com/solutions [mallinckrodt.com]."

Purdue Pharma:

“We have no further comment on the release of the ARCOS data beyond what was stated in our brief.

“Purdue Pharma vigorously denies the claims brought forth in the MDL, which are based on mischaracterizations and allegations we believe are without merit. We are confident in the strength of our legal arguments, and will continue to defend ourselves in the litigation.”

TRADE GROUP:

Healthcare Distribution Alliance:

“The ARCOS data show that distributors have consistently reported sales of opioid-based medications, along with the quantity of the order and the identity of the receiving pharmacy to the DEA. Distributors only recently received access to the full set of data with information about the total shipment of opioid medicines a particular pharmacy received from all distributors. The DEA has been the only entity to have all of this data at their fingertips and it could have used the information to consistently monitor the supply of opioids and when appropriate, proactively identify bad actors. Unlike the DEA, distributors have no authority to stop physicians from writing prescriptions, nor can they take unilateral action to halt pharmacies’ ability to dispense medication.”

Drilling into the DEA’s pain pill database

For the first time, a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — by manufacturers and distributors to pharmacies in every town and city — has been made public.

The Washington Post sifted through nearly 380 million transactions from 2006 through 2012 that are detailed in the DEA’s database and analyzed shipments of oxycodone and hydrocodone pills, which account for three-quarters of the total opioid pill shipments to pharmacies. The Post is making this data available at the county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities.

These records provide an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which resulted in nearly 100,000 deaths during the seven-year time frame ending in 2012.

A county-level analysis of the cumulative data shows where the most oxycodone and hydrocodone pills were distributed across the country over that time: more than 76 billion in all.


The Post gained access to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System, known as ARCOS, as the result of a court order. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to the database, which the government and the drug industry had sought to keep secret.

The version of the database published by The Post allows readers to learn how much hydrocodone and oxycodone went to individual states and counties, and which companies and distributors were responsible.

Find the data for where you live

Interactive info... see article

For Bexar County, Texas, these results were shown:

From 2006 to 2012 there were 326,745,638 prescription pain pills, enough for 28 pills per person per year, supplied to Bexar County, Tex.

96,900,460 of the pills were distributed by Walgreen Co and 145,091,620 were manufactured by Actavis Pharma, Inc.

NEIGHBORCARE PHARMACY SERVICES INC, SAN ANTONIO pharmacy received the highest number of pills. Walgreens.

The Post believes this is a critically important set of data, which is why we are making it public and accessible to readers and other journalists. We think there are hundreds of stories within this data set and need your help to understand what it means to you and your community.

The Post analysis shows that the volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. Yearly county-level maps show how the influx of pills spread.

Just six companies distributed 75 percent of the pills — oxycodone and hydrocodone — during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post.

[table]
Three companies manufactured about 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

[table]
Comparing county-level maps of opioid overdose deaths and pill shipments reveal a virtual opioid belt of more than 90 counties stretching southwest from Webster County, W.Va., through southern Virginia and ending in Monroe County, Ky. This swath includes 18 of the top 20 counties ranked by per-capita prescription opioid deaths nationwide and 12 of the top 20 counties for opioid pills distributed per capita.


As lawyers zero in on drug companies, a reckoning may be coming

For two decades, as 200,000 opioid overdose deaths piled up across America, there was always someone else to blame. Families blamed drug companies. Drug companies blamed doctors. Everyone blamed the government.

More than half the public continues to see drug addiction as a moral failing, blaming substance abusers themselves for the epidemic, at least in part, according to recent polling.

But now the effort to hold someone to account for the worst drug crisis in U.S. history is narrowing to a few dozen drug companies whose day in court has come or will soon arrive. Virtually every state and nearly 2,000 towns, cities and counties have demanded those firms, which include some of America’s most trusted brands, be forced to pay up to help stop the epidemic.

"It is a drug company crisis, and it begins and should end with them,” Oklahoma attorney Bradley Beckworth told a judge this week in the first state drug trial of the opioid era. The state is seeking $17.5 billion from the health care conglomerate Johnson & Johnson to address the costs of addiction.

Five years after the earliest lawsuits were filed, that trial concluded Monday, with a judge expected to decide by the end of August whether the company had a major role in the epidemic. Test cases of how municipalities may fare in federal court — involving two Ohio counties — are scheduled for trial in October.

Lined up behind them are 48 more trials in state courts around the country, with start dates beginning early next year, according to Mike Moore, an attorney aiding four of those states.

As that litigation proceeds, negotiations for a possible nationwide settlement are continuing. Moore is hopeful there will be an all-encompassing deal this year, though he predicts it will be nowhere near the size of the $206 billion agreement in the landmark 1998 settlement with tobacco companies.

"I think people are coming to their senses,” said Moore, who led the legal battle in that case. “People are realizing that this is a public health crisis and not so much about litigation and lawyers. It needs to be treated as ‘we have a public health crisis.'"

Though the litigation is following the trail blazed by the tobacco and asbestos cases of the last century, plaintiffs are seeking even more staggering sums: $17.5 billion in sparsely populated Oklahoma; $7.2 billion for Cuyahoga and Summit counties in Ohio; $483 billion for a nationwide settlement, according to an expert witness for plaintiffs cited by Reuters.

Nora Freeman Engstrom, a professor at Stanford University Law School who is closely monitoring the litigation, said such demands may be unrealistic.

"The tobacco manufacturers came to the settlement table backed by massive financial resources,” she said. “Opioid manufacturers’ pockets are shallow by comparison. You can’t get blood from a turnip, and at a certain point, financial limitations will affect settlement options."

Tobacco revenue exceeded $93 billion in 2016. U.S. sales of prescription opioids peaked at around $8 billion to $9 billion earlier this decade, according to industry data.

The economic damages from tobacco use were also far greater than for opioid abuse. If the same payout-to-damages ratio from that agreement were applied to opioids, a global settlement might fall in the range of $30 billion to $55 billion, according to a recent analysis by Nephron Research, an independent health care investment research firm.

On Monday, The Washington Post published previously undisclosed government data that revealed the breadth of the epidemic of legal opioid use. A handful of companies saturated the country with 76 billion pain pills between 2006 and 2012, fueling the prescription opioid epidemic, the data shows.

The numbers reveal “clear heinous, criminal distribution that has visibly contributed, if not caused, the crisis our country is facing with opioid use disorder,” the anti-drug group Shatterproof said in a statement. “Sadly, we cannot change the past. We can only focus on the millions of Americans who now have OUD and their families, and create strategies and actions that will prevent this for generations to come.”

Purdue Pharma ranked fourth on the government database of manufacturers of products containing oxycodone and hydrocodone. Johnson & Johnson is not on the list of companies that made those products from 2006 to 2012.

By the end of summer, there may be some indication of whether the companies will have to help abate the drug crisis. In the first state case to come to trial, Oklahoma Attorney General Mike Hunter (R) asked a judge to make Johnson & Johnson pay as much as $17.5 billion over 30 years to stem the epidemic through treatment, education, prevention and other measures.

Oklahoma already has settled out of court with two other defendants, securing $270 million from Purdue, most of which went toward a treatment and research center, and $85 million from Teva Pharmaceuticals.

Purdue said at the time of the March settlement that it sees “this agreement with Oklahoma as an extension of our commitment to help drive solutions to the opioid addiction crisis.”

Teva said it “has not contributed to the abuse of opioids in Oklahoma in any way” when it settled in May.

West Virginia, which has the nation’s highest rate of opioid overdose deaths, has also settled with some of the drug distribution companies that poured opioids into the state, recouping $84 million in recent years.

But those results don’t mean settlements or court victories for plaintiffs are likely. Johnson & Johnson and many drug manufacturers and distributors populate the Fortune 500 list of America’s largest companies. They have steadfastly denied culpability for the drug crisis and have the resources to wage protracted legal battles.

Johnson & Johnson, for example, has paid a small army of attorneys since Oklahoma filed its lawsuit in 2017, opting to battle the state in a seven-week trial that just ended in a Norman courtroom.

“Johnson & Johnson has been, in a bunch of cases, not afraid to litigate,” said Alexandra Lahav, professor at the University of Connecticut School of Law. “This is not the only mass tort they’re dealing with, and they have been pretty aggressive in their litigation strategy,” she said, citing the company’s defense against lawsuits from women who claimed that asbestos in the company’s talc products gave them cancer.

As Purdue and Teva reached out-of-court settlements with Oklahoma (both denied wrongdoing), Johnson & Johnson took its chances at trial. It rejected state claims that it had minimized the risks of its opioid products and that it was a “kingpin" supplier of raw narcotic ingredients for other manufacturers.

"When you’re right, you fight,” the company’s lead attorney, Larry Ottaway, told Judge Thad Balkman more than once during the trial.

The major manufacturers, distributors and dispensers of opioids, including Johnson & Johnson, have offered a variety of defenses: They sell legal, highly regulated painkillers to willing customers; the Drug Enforcement Administration sets annual quotas for the quantities each company can produce; doctors sparked the epidemic by overprescribing opioids to address their patients’ pain.

Whichever side loses may be inclined to appeal.

Moore, for one, believes that public revelations of the astonishing numbers of painkillers shipped to communities across the United States will put added pressure on companies to settle.

"What they have done over all these years is now front-page news,” he said. “There’s no place to hide. It is the oversupply that caused the opioid epidemic. No doubt."

Lahav is not so sure. At the moment, she said, there is too little information from the Oklahoma or Ohio cases to predict anything. And every case involves different plaintiffs, companies, legal theories and laws.

In May, a North Dakota judge threw out a government lawsuit against Purdue, rejecting the same legal theory that Oklahoma used in its trial.

“Everybody’s got their own laws. They’ve got their own lawyers, and they’ve got their own agendas,” she said. “It’s really an interesting thing how they’re going to herd all these cats together.”

The biggest civil trial in U.S. history will start with these Ohio counties

PARMA, Ohio — At Knuckleheads Bar & Grill, the subject on a sweltering Saturday afternoon was the drug crisis. More specifically, the recent disclosure that the CVS across the street received more pain pills — 6.4 million — over a seven-year period than any other drugstore in Cuyahoga County.

“Location, location, location,” said Mike Gorman, 37, who was drinking and hanging out with friends. “It’s right near the highway, which makes it easy to access” from Cleveland.

And there was the homeless encampment just beyond the CVS, over by the train tracks, behind the strip mall. It’s popular with heroin users, the regulars at the sports bar said.

“It’s a terrible thing, but I don’t blame CVS,” Gorman said, contending that drug companies made large profits and encouraged doctors to prescribe opioids.

The CVS in this white working-class suburb of Cleveland is a three-hour drive and, culturally, even farther from the southern Ohio section of Appalachia that has become widely associated with the opioid epidemic.

But last week’s revelation that drug companies saturated the United States with 76 billion pain pills over seven years shows that no corner of the country escaped the drug crisis. Two other drugstores in this city of 80,000 placed second and fifth on the Drug Enforcement Administration’s list of Cuyahoga County locations. Wholesalers shipped opioids at 5.4 million and 3.7 million doses respectively to those. The list was disclosed by The Washington Post last week.

Cuyahoga County and nearby Summit County soon will be at the center of the most important legal test of how much responsibility drug companies bear for the opioid epidemic. Barring a settlement, the two counties are scheduled to go to trial in October as the first case among the consolidated lawsuits brought by about 2,000 cities, counties, Native American tribes and other plaintiffs.

U.S. District Judge Dan Polster, who is presiding over the consolidated case in Cleveland, selected the counties to represent the legal arguments that other plaintiffs have made. The two counties alone are asking for billions of dollars from companies to help stem the crisis.

In a statement to The Post Sunday, Mike DeAngelis, senior director for corporate communications at CVS, defended the company’s actions.

“In the period of time covered by the ARCOS data (2006-2012), our shipments of hydrocodone combination products comprised only 2% of the prescription drugs we shipped to our pharmacies,” he said. “As soon as the DEA reclassified these drugs as Schedule II in October 2014, we stopped distributing them immediately.

“The DEA possesses data on every single shipment of hydrocodone combination products we shipped to our pharmacies. It did not identify a single shipment to a single CVS Pharmacy in Cuyahoga or Summit Counties as improper.”

In a court filing released Friday, lawyers for the two counties accuse some of the biggest names in the drug industry of creating a “public nuisance” that endangered the health of residents by failing to control the drug flow, even when they knew, or should have known, that some painkillers were being diverted to illegal use.

"There can be little doubt that the opioid crisis — the epidemic of opioid availability and use — significantly interferes with the public health and constitutes a public nuisance in both Cuyahoga and Summit counties,” they argued in a request that Polster rule in their favor on that issue even before trial.

To bolster that argument, they offered an array of statistics that may be critical in the case. In 2016, they said, the death rate from pharmaceutical opioids in Cuyahoga County was 3.26 times higher than the national average. In 2017, county emergency rooms treated an estimated 9,191 people with drug-related health problems, a 21 percent increase over the previous year.

As the government cracked down on the diversion of pills to the black market, heroin and fentanyl took their place. By March 2016, two people died of a heroin or fentanyl overdose in Cuyahoga County every day, the lawyers alleged.

In Summit County, whose biggest city is Akron, the surge in overdose deaths was so rapid that the county medical examiner brought in a mobile morgue in 2017 to handle the bodies, the plaintiffs wrote.

The rate of infants born addicted to opioids there rose from 2.9 per 1,000 births between 2004 and 2008 to 13.6 per 1,000 births between 2011 and 2015, they alleged.

The defendants in the case include giant drug distribution companies such as McKesson, Cardinal Health, AmerisourceBergen, Walgreens and Walmart, and manufacturers such as Purdue Pharma and Mallinckrodt.

The companies have generally blamed the epidemic on overprescribing by doctors, over-dispensing by pharmacies and on drug abuse by customers. The companies say they were working to supply patients in desperate need of pain relief with legal, highly regulated drugs.

"We maintain stringent policies, procedures and tools to help ensure that our pharmacists properly exercise their professional responsibility to evaluate controlled substance prescriptions before filling them,” DeAngelis, the CVS spokesman, said Sunday. “Keep in mind that doctors have the primary responsibility to make sure the opioid prescriptions they write are for a legitimate purpose.

“Over the past several years, we have taken numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic that has resulted in a 30% reduction in the amount of controlled substances that our retail pharmacies dispense."

The public nuisance argument is the same one made by the state of Oklahoma in a seven-week trial against Johnson & Johnson that concluded last week. The state asked a judge to make the company pay as much as $17.5 billion over 30 years to clean up the drug crisis. Cleveland County District Judge Thad Balkman said he would rule around the end of August.

Another 48 states have sued drug companies and are lined up behind Oklahoma in a legal track that runs parallel to the enormous federal “multi-district litigation” in Ohio.

The intersection where CVS and Knuckleheads sit is typical for the outskirts of Cleveland, whose border is just a few hundred feet away. It has strip malls occupied by discount stores, and a mom-and-pop lunch counter threatened by the Burger King down the road.

Knuckleheads itself, like its patrons, appears transported here from Cleveland in the exodus to the suburbs that began decades ago. It is a squat stone building with signs promising cheap domestic beer, bar food and a Cleveland Indians game on TV. The men inside drain pints of Budweiser and Miller Lite between smoke breaks in the alley behind a black metal side door.

The pharmacist on duty at the CVS on Saturday declined to comment on the volume of pills sold there, citing company policy.

But Frank Cimperman, 58, Knuckleheads’ owner, said he believes “it’s only number one because of the highway, and because you can get a prescription filled there 24 hours a day.”

Drugstores with easy access to highways have drawn authorities’ interest in the past, including two CVS stores in Sanford, Fla., that were raided and shut down by the DEA in 2012.

At a Rite Aid in the Clark-Fulton neighborhood of Cleveland, an inner-city community of low-income whites and Hispanics, pharmacy manager Ben Swartz was surprised to learn that his branch ranked third in Cuyahoga County on the DEA database.

“Wow,” said Swartz, whose store received 4.8 million pills between 2006 and 2012. But he said he is confident that in recent years stricter practices have been put into place.

“We vet all the prescriptions that come in here,” he said. Extra measures, including verifying diagnoses with doctors, are used for about one in 10 prescriptions, he said.

"We look for prescribing trends,” Swartz said. “If a doctor’s giving everyone the same drug in the same quantities, we won’t associate with them. We also scrutinize prescriptions for high strength and high quantities, and people using multiple pharmacies and multiple prescribers."

Preliminary data from the U.S. Centers for Disease Control and Prevention released last week showed that drug overdose deaths nationally declined about 5 percent in 2018, the first drop in decades. While deaths from fentanyl are skyrocketing, fatalities from prescription opioids are falling, the data show.

Residents on the blocks surrounding the Rite Aid spoke of a high rate of heroin use in the area. One person, who spoke on the condition of anonymity because he did not want to be identified as disparaging the area, said the sidewalk in front of an abandoned factory a block south was a “shooting gallery” until two years ago.

“We used to find hundreds of needles on the sidewalk here,” he said. “But I haven’t seen any in two years, so I think it’s getting better.”

Internal drug company emails show indifference to opioid epidemic

In May 2008, as the opioid epidemic was raging in America, a representative of the nation’s largest manufacturer of opioid pain pills sent an email to a client at a wholesale drug distributor in Ohio.

Victor Borelli, a national account manager for Mallinckrodt, told Steve Cochrane, the vice president of sales for KeySource Medical, to check his inventories and "[i]f you are low, order more. If you are okay, order a little more, Capesce?”

Then Borelli joked, “destroy this email.?.?.Is that really possible? Oh Well...”

Previously, Borelli used the phrase “ship, ship, ship” to describe his job.

Those email excerpts are quoted in a 144-page plaintiffs’ filing along with thousands of pages of documents unsealed by a judge’s order Friday in a landmark case in Cleveland against many of the largest companies in the drug industry. A Drug Enforcement Administration database released earlier in the week revealed that the companies had inundated the nation with 76 billion oxycodone and hydrocodone pills from 2006 through 2012. Nearly 2,000 cities, counties and towns are alleging that the companies knowingly flooded their communities with opioids, fueling an epidemic that has killed more than 200,000 since 1996.

The filing by plaintiffs depict some drug company employees as driven by profits and undeterred by the knowledge that their products were wreaking havoc across the country. The defendants’ response to the motion is due July 31.

In January 2009, Borelli told Cochrane in another email that 1,200 bottles of oxycodone 30 mg tablets had been shipped.

“Keep ’em comin’!” Cochrane responded. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are...”

Borelli responded: “Just like Doritos keep eating. We’ll make more."

Borelli and Cochrane did not return calls for comment Friday night.

"In a statement Friday night, a spokesman for Mallinckrodt sought to distance the company from Borelli’s email: “This is an outrageously callous email from an individual who has not been employed by the company for many years. It is antithetical to everything that Mallinckrodt stands for and has done to combat opioid abuse and misuse.

An attorney for KeySource Medical on Saturday declined to comment, citing ongoing litigation.

The Controlled Substances Act requires drug companies to control against diversion, and to design and operate systems to identify “suspicious orders,” defined as “orders of unusual size, orders deviating substantially from a normal pattern, and orders of unusual frequency.” The companies are supposed to report such orders to the DEA and refrain from shipping them unless they can determine the drugs are unlikely to be diverted to the black market. The plaintiffs, in the filing, allege that the companies ignored red flags and failed at every level.

At Cardinal Health, one of the nation’s largest drug distributors, then-CEO Kerry Clark in January 2008 wrote in an email to Cardinal senior officials that the company’s “results-oriented culture” was perhaps “leading to ill-advised or shortsighted decisions,” the filing contends.

In the previous 18 months, Cardinal had been hit with nearly $1 billion in “fines, settlements, and lost business as a result of multiple regulatory actions,” the filing alleges, including the suspension of licenses at some of its distribution centers for failing to maintain effective controls against opioid diversion.

Cardinal Health did not immediately return a request for comment Friday night.

On Aug. 31, 2011, McKesson Corp.’s then-director of regulatory affairs, David B. Gustin, told his colleagues he was concerned about the “number of accounts we have that have large gaps between the amount of Oxy or Hydro they are allowed to buy (their threshold) and the amount they really need,” according to the filing, which cites Gustin’s statements. “This increases the ‘opportunity’ for diversion by exposing more product for introduction into the pipeline than may be being used for legitimate purposes.”

According to the filing, he had earlier noted to his colleagues that they “need to get out visiting more customers and away from our laptops or the company is going to end up paying the price ... big time.”

Another McKesson regulatory affairs director responded: “I am overwhelmed. I feel that I am going down a river without a paddle and fighting the rapids. Sooner or later, hopefully later I feel we will be burned by a customer that did not get enough due diligence,” according to the filing.

McKesson is the largest drug distributor in the United States. It distributed 14.1 billion oxycodone and hydrocodone pills from 2006 to 2012, about 18 percent of the market, according to the DEA database.

"Suggesting that these two employees’ emails from nearly a decade ago are evidence of wrongdoing ignores the context in which McKesson and our employees were operating,” McKesson spokeswoman Kristin Chasen said in a statement Friday. “Doctors around the country were writing millions of additional opioid prescriptions year over year. Our regulator, the DEA, consistently raised the annual quota of pills that could be produced and distributed, which was a clear statement that the increase in prescriptions was appropriate, expected, and medically necessary. To imply that distributors should have second-guessed or overruled those decisions by the government and the medical community reflects a fundamental misunderstanding of our role. For decades, McKesson has consistently reported opioid transactions to the DEA. We have also invested heavily in further strengthening our anti-diversion program."

Until Friday, the documents had been sealed under a protective order issued by U.S. District Judge Dan Polster. The order was lifted a year after The Washington Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, filed a lawsuit for access to the documents and a DEA database tracking opioid sales, known as the Automation of Reports and Consolidated Orders System, or ARCOS.

The drug companies and the DEA strenuously opposed the release of the data and the documents, and Polster agreed with them. But a three-judge panel of the U.S. Court of Appeals for the 6th Circuit in Ohio ordered that some of the information should be released with reasonable redactions and the database should be made public.

By consolidating cases from around the nation, the Cleveland case, for the first time, provides specific information about how and in what quantity the drugs flowed around the country, from manufacturers and distributors to pharmacies. The case also brings to light internal documents and deliberations by the companies as they sought to promote their products and contend with enforcement efforts by the DEA.

The local and state government plaintiffs in the case argue that the actions of some of America’s biggest and best-known companies — including Mallinckrodt, Cardinal Health, McKesson, Walgreens, CVS, Walmart and Purdue Pharma — amounted to a civil racketeering enterprise that had a devastating effect on the plaintiffs’ communities.

The case is a civil action under the Racketeer Influenced and Corrupt Organizations (RICO) Act, making use of a law originally developed to attack organized crime.

In statements to The Post on Tuesday in response to the release of the DEA database, the drug companies issued broad defenses of their actions during the opioid epidemic. They have said previously that they were trying to sell legal painkillers to legitimate pain patients who had prescriptions. They have blamed the epidemic on overprescribing by physicians and also on corrupt doctors and pharmacists who worked in “pill mills” that handed out drugs with few questions asked. The companies also said they should not be held responsible for the actions of people who abused the drugs.

The companies said that they were diligent about reporting their sales to the DEA and that the agency should have worked with them to do more to fight the epidemic, a point former DEA agents dispute. The companies also note that the DEA set the quotas for opioid production.

“We report those suspicious orders to state boards of pharmacy and to the DEA but we do not know what those government entities do with those reports, if anything,” Cardinal Health said in a statement.

The companies issued statements rejecting the plaintiffs’ allegations.

McKesson said in its statement: “The allegations made by the plaintiffs are just that — allegations. They are unproven, untrue and greatly oversimplify the evolution of this health crisis as well as the roles and responsibilities of the many players in the pharmaceutical supply chain."

Mallinckrodt said the company “has for years been at the forefront of preventing prescription drug diversion and abuse, and has invested millions of dollars in a multipronged program to address opioid abuse."

'Kingpin within the drug cartel'

One of the biggest points of contention in the lawsuit is whether the nation’s largest drug companies did enough to identify suspicious orders of opioids. What exactly constitutes a suspicious order is at the heart of the case.

The DEA has long said there should be no confusion because the agency has given frequent guidance and briefings to the industry, and repeatedly defined what constitutes a suspicious order.

The plaintiffs argue that the companies failed to “design serious suspicious order monitoring systems that would identify suspicious orders to the DEA” and shipped the drugs anyway.

"Their failure to identify suspicious orders was their business model: they turned a blind eye and called themselves mere ‘deliverymen’ with no responsibility for what they delivered or to whom,” according to the plaintiffs’ filing.

Between 1996 and 2018, the plaintiffs alleged in the filing, drug companies shipped hundreds of millions of opioid pills into Summit and Cuyahoga counties in Ohio, filling orders that were suspicious and “should never have been shipped."

“They made no effort actually to identify suspicious orders, failed to flag orders that, under any reasonable algorithm, represented between one-quarter and 90 percent of their business, and kept the flow of drugs coming into Summit and Cuyahoga Counties,” the plaintiffs’ lawyers wrote.

In 2007, the DEA told Mallinckrodt that the numeric formula it used to monitor suspicious orders was insufficient, the filing contended. It alleges the company’s suspicious order monitoring program from 2008 through 2009 consisted of solely verifying that the customer had a valid DEA registration and that the order was accurately logged into the DEA’s tracking database.

From 2003 to 2011, Mallinckrodt shipped a total of 53 million orders, flagged 37,817 as suspicious but stopped only 33 orders, the plaintiffs’ filing states.

A Mallinckrodt employee said in a deposition that the DEA had described the company as the “kingpin within the drug cartel” in a meeting with the agency in July 2010, according to a footnote in the filing.

In 2011, the filing cites a Justice Department document in which the DEA alleged that Mallinckrodt “sold excessive amounts of the most highly abused forms of oxycodone, 30 mg and 15 mg tablets, placing them into a stream of commerce that would result in diversion.”

According to the DEA, the filing states, “even though Mallinckrodt knew of the pattern of excessive sales of its oxycodone feeding massive diversion, it continued to incentivize and supply these suspicious sales,” and never notified the DEA of the suspicious orders.

In a settlement with the DEA, Mallinckrodt agreed that from Jan. 1, 2008, through Jan. 1, 2012, “certain aspects of Mallinckrodt’s system to monitor and detect suspicious orders did not meet the standards” outlined in letters from the DEA deputy administrator for diversion control.

Mallinckrodt was the nation’s leading manufacturer of oxycodone and hydrocodone, with 28.8 billion pills from 2006 to 2012, 37.7 percent of the market, according to the DEA database. It has since created a subsidiary for its generic opioids called SpecGx.

The Post reported in 2017 that federal prosecutors said 500 million of the company’s 30 mg oxycodone pills wound up in Florida between 2008 and 2012 — 66 percent of all oxycodone sold in the state. Pills at that dosage are among the most widely abused.

Prosecutors said the company failed to report suspicious orders, and Mallinckrodt that year settled the case by paying a $35 million fine.

“Mallinckrodt’s actions and omissions formed a link in the chain of supply that resulted in millions of oxycodone pills being sold on the street,” then-Attorney General Jeff Sessions said at the time.

McKesson Corp., the nation’s largest opioid distributor, doled out 14.1 billion oxycodone and hydrocodone pills from 2006 to 2012, about 18 percent of the market, according to the newly released DEA database. (Kris Tripplaar/Sipa USA)

'Business as usual'

The same year that Mallinckrodt paid its fine, McKesson, the nation’s largest drug distributor, was fined a record $150 million by the Justice Department.

According to allegations in the new court filing, McKesson frequently increased the amount of opioid pills it sent to its pharmacy customers.

“McKesson has a long history of absolute deference to retail national account customers when it comes to [opioid] threshold increases,” the plaintiffs argue in their filing, citing a deposition of McKesson’s senior director of distribution operations.

McKesson had set limits on the amount of opioids its customers could order, the filing contends, but those limits were often lifted.

"In August 2014, DOJ noted that McKesson appeared to be willing to approve threshold increases for opioids for the flimsiest of reasons,” the filing contends.

For shipments to pharmacies in Summit and Cuyahoga counties, McKesson did not report a single suspicious order between May 2008 and July 2013, the filing says. During that time, McKesson filled 366,000 opioid orders in those two counties.

McKesson reached its settlement with the government in January 2017 for allegations of failing to report suspicious orders. It was the second time the company was fined over suspicious orders. Nine years earlier, it paid $13 million.

The government said in 2017 that McKesson “failed to design and implement an effective system to detect and report ‘suspicious orders.’?” The company shipped more than 1.6 million orders of opioid pills between 2008 and 2013 but reported just 16 as suspicious, according to the Justice Department.

However, “before the ink of the settlement agreement was even dry,” the new filing argues , McKesson was already reassuring customers who were concerned that the flow of opioids would be curtailed that it would remain “business as usual” at the company. McKesson sent more than 68 million doses of oxycodone and hydrocodone to those counties between 2006 and 2012, according to DEA tracking data analyzed by The Post.

Gustin, McKesson’s former director of regulatory affairs, was recently indicted in federal court in Kentucky on a charge of illegally distributing opioids. His attorney wrote in a court filing that the allegations against his client stem from his job at McKesson and “seem to focus on the manner by which he performed his former position as Director of Regulatory Affairs.”

Gustin’s lawyer and the prosecutor in the case did not return calls for comment.

The southwest Virginia city of Norton, with a population of about 4,000, saw millions of prescription opioids arrive in seven years, with the city’s CVS pharmacy receiving 1.3 million opioids from 2006 through 2012, according to the DEA database. (Charles Mostoller for The Washington Post)

Pickers and packers

The plaintiffs in the Cleveland case alleged that CVS, the nation’s largest pharmacy chain, did not implement required controls to identify suspicious orders from 2006 until early to mid-2009.

The CVS compliance coordinator said that her title “was only for reference and not her real job position and that the only thing she ever did related to suspicious order monitoring was to update the [Standard Operating Procedures Manual],” the plaintiffs allege.

A system that CVS used to monitor suspicious orders was known as “Pickers and Packers,” according to the filing.

The pickers and packers were workers in the distribution centers who would pick and pack opioid orders. A CVS official testified that the company did not have any written policies, guidance or training programs to teach the pickers and packers how to detect suspicious orders, according to the filing.

“Instead, the Pickers and Packers would identify orders based on a gut feeling or a crude rule of thumb that essentially can be summarized that they believed the order was simply too large,” the filing states. “One of the Pickers and Packers .?.?. testified that she was trained by another Picker and Packer in 1996 and that as a rule a Picker and Packer should not send out more than 12 of the small bottles, six of the larger bottles and two or three of the largest bottles. She used this rule of thumb for her entire career."

CVS’s system flagged few orders, the filing contends : A CVS distribution center in Indianapolis flagged two orders per year from 2006 through 2014.

CVS rejected the plaintiffs’ arguments.

“As part of our response in this case, we will be presenting the expert opinion of a former high-ranking DEA official who concluded independently that our systems were compliant and that the plaintiffs’ analysis is unfounded,” CVS spokesman Mike DeAngelis said.

Obvious signs of diversion

Walgreens used a formula to identify thousands of pharmacy orders as suspicious but shipped them anyway, the filing alleges. The orders were reported to the DEA after they had been shipped, according to agency documents quoted in the filing.

“Suspicious orders are to be reported as discovered, not in a collection of monthly completed transactions,” the DEA wrote in an immediate suspension order issued against Walgreens in 2012. “Notwithstanding the ample guidance available, Walgreens has failed to maintain an adequate suspicious order reporting system and as a result, has ignored readily identifiable orders and ordering patterns that, based on the information available throughout the Walgreens Corporation, should have been obvious signs of diversion."

In one case, Walgreens’s suspicious order report to the DEA was 1,712 pages long and contained six months’ worth of orders, including reports on 836 pharmacies in more than a dozen states and Puerto Rico, the filing alleges.

The filing also alleges that Walgreens stores could “place ad hoc ‘PDQ’ (“pretty darn quick”) orders to controlled substances outside of their normal order days and outside of the [suspicious order monitoring] analysis and limits.”

The Post has previously reported that Kristine Atwell, who managed distribution of controlled substances for the company’s warehouse in Jupiter, Fla., sent an email on Jan. 10, 2011, to corporate headquarters urging that some of the stores be required to justify their large quantity of orders.

"I ran a query to see how many bottles we have sent to store #3836 and we have shipped them 3271 bottles between 12/1/10 and 1/10/11,” Atwell wrote. “I don’t know how they can even house this many bottle[s] to be honest. How do we go about checking the validity of these orders?”

A bottle sent by a wholesaler generally contains 100 pills.

Walgreens never checked, the DEA said. Between April 2010 and February 2012, the Jupiter distribution center sent 13.7 million oxycodone doses to six Florida stores, records show, many times the norm, the DEA said.

Walgreens ranked second among distributors in the nation, with 13 billion pills and 16.5 percent of the market for oxycodone and hydrocodone from 2006 through 2012, the DEA database shows. It stopped distributing opioids to its stores in 2014, but continues to dispense controlled substances.

As part of a settlement with the DEA in June 2013, Walgreens said that its “suspicious order reporting for distribution to certain pharmacies did not meet the standards identified by DEA.” The company paid an $80 million fine to the government.

In a statement to The Post earlier in the week, Walgreens defended its operations, saying, “Walgreens has been an industry leader in combating this crisis in the communities where our pharmacists live and work."

Internal drug company emails show indifference to opioid epidemic

As lawyers zero in on drug companies, a reckoning may be coming

For two decades, as 200,000 opioid overdose deaths piled up across America, there was always someone else to blame. Families blamed drug companies. Drug companies blamed doctors. Everyone blamed the government.

More than half the public continues to see drug addiction as a moral failing, blaming substance abusers themselves for the epidemic, at least in part, according to recent polling.

But now the effort to hold someone to account for the worst drug crisis in U.S. history is narrowing to a few dozen drug companies whose day in court has come or will soon arrive. Virtually every state and nearly 2,000 towns, cities and counties have demanded those firms, which include some of America’s most trusted brands, be forced to pay up to help stop the epidemic.

"It is a drug company crisis, and it begins and should end with them,” Oklahoma attorney Bradley Beckworth told a judge this week in the first state drug trial of the opioid era. The state is seeking $17.5 billion from the health care conglomerate Johnson & Johnson to address the costs of addiction.

"I think people are coming to their senses,” said Moore, who led the legal battle in that case. “People are realizing that this is a public health crisis and not so much about litigation and lawyers. It needs to be treated as ‘we have a public health crisis.’”

Though the litigation is following the trail blazed by the tobacco and asbestos cases of the last century, plaintiffs are seeking even more staggering sums: $17.5 billion in sparsely populated Oklahoma; $7.2 billion for Cuyahoga and Summit counties in Ohio; $483 billion for a nationwide settlement, according to an expert witness for plaintiffs cited by Reuters.

Gilead delayed safer HIV drug to extend monopoly profits, advocates allege

The opioid epidemic is no mistake. It is the result of complicity and greed., 4-25-19

The insulin story, a perfect example of corporations stealing the wealth of most of us, 2-26-19 Kos

I used the example of Pharmaceutical companies inflating the price of insulin to show how our economic system by design steals so much from everyday Americans that it stops the ability of most to build wealth. Instead, it systematically ensures it leaves most without wealth.

PLEASE Listen to the entire video. We must get more in-depth analysis, my friends.

While the insulin rip off is one example, it occurs in every segment of our economy. Indentured servitude by the masses is the outcome if we continue on the current path.


Recently I blogged about the advent of the standalone emergency rooms using their pricing power and dubious practices to rip off Americans in an article titled "These stories show legalized theft, the reason we need Medicare for All" that everyone should read. [see below]

There is a basic tenet we must recognize in our economic system that the article "Why our economic system is designed to keep most people broke by robbing us legally" explains. [see below]

Ultimately, those with unregulated and unlimited pricing power on products and services you must have, can ensure one can never accumulate wealth. They own you. They can extort from you.

The above reality defines our economy. And the proof is a continual decline in the wealth of the masses as the few gets a more significant percentage. Unchanged, math prevails. Welcome to indentured servitude.

Why our economic system is designed to keep most people broke by robbing us legally

Our economic system is designed to rob the masses of all of their income thus preventing the growth of our wealth. We are doomed if we do not fix it.


Gouging Americans for a life or death drug has consequences as noted at MedPage Today.

... Grant is now buying the insulin online from a Canadian pharmacy, which charges $295 for a 90-day supply, including shipping. For comparison, last week he looked up the price of a 90-day supply of Humalog at Express Scripts. "It would cost me $1,489 with my insurance."

Jeremy Greene, MD, PhD, professor of medicine at Johns Hopkins University in Baltimore and a practicing physician, has heard similar stories. "Over the past decade in my clinic, when I asked patients why they were not taking the insulin as prescribed, I frequently heard that the cost of insulin is prohibitive," he told the committee. Although Greene first thought maybe he was just prescribing an expensive name-brand insulin instead of a cheaper generic one, "I was surprised to hear that generic insulin simply did not exist."

Instead, three pharmaceutical manufacturers -- sanofi-aventis, Novo Nordisk, and Eli Lilly -- control 99% of the nearly $27 billion global insulin market, even though none of the main agents used are protected by patents, said Greene. "A recent survey found that one of four type 1 diabetics admitted to rationing insulin at least once due to cost in the past year … Humalog was $21 a vial in 1996 and by 2017, it cost $275 for a 1-month supply … This has real consequences for Americans living with diabetes."

It is easy to understand why the increasing price of drugs has life or death consequence in the immediacy. What is not immediately apparent is how this mechanism, this economic system by design is intended to rob you blind.

Insulin is an old medicine, over 100 years old. There is no patent on it. Worse as noted in the article above, it was virtually placed in the public domain. Therefore it should be one of the cheapest drugs on the market. There is a virtual monopoly in companies selling the product. They determine the price. The private sector determines how much they will force you to pay for a drug you must have.

Pricing of any product in our economic system is based on a corrosive concept known as "Whatever the market will bear." And what will the market bear? All of your income plus your total creditworthiness, how much you can borrow.

Sadly, the reality is that corporations whose fiduciary responsibility is to their shareholders and their huge undeserved salaries, will keep raising prices until people are simply unable to afford what they are selling. If it is something they must have, Americans will spend up to their limit to get it.

The tenets of the current economic system are predicated on this behavior that effectively prevents us from saving. It makes us entities that are nothing but conduits of our income used to create the increasing wealth of a few, those who determine prices, the Plutocrats.

In the past when we made taxes very high on income after a few million, there was no incentive for the legal robbery of the American people through predatory pricing because the ill-gotten gains were recycled right back to "we the people" via taxes.

As politicians on the take started reducing and eliminating taxes, the results are clear. Our colleges are more expensive than they should. Schools are underfunded. Our infrastructure is deteriorating. 80% of Americans are living paycheck to paycheck. But a few people get extremely wealthy, not on their worth or work, but their manipulation of prices, their pricing power.

Is this the life we want? Is this even living? We should learn from these Danish women and work toward a society more like theirs.

These stories show legalized theft, the reason we need Medicare for All.

The Houston Chronicles' excellent article titled "Cracking the Code: How facility procedure codes can become weapons" is a must-read. It illustrates just one cog in the health industrial complex's method of ripping people off, the grand pilfer.

[photo of free standing emergeny room] Her dizziness for which they were incompetent to diagnose appropriately still resulted in a $15,000 bill. What profession allows that kind of billing without guaranteed success or satisfaction?

Theft #1 - Sarah Hirsch was teaching a second-period art class at Manvel High School in November when she felt as if the room was spinning. It was unnerving enough that she went to the school nurse’s office to lie down and soon felt better. But when she stood, the dizziness came back.

The cause of Hirsch’s symptom was never determined, but the doctor who saw her the next day quickly discovered fluid in her ears, a common cause of dizziness that usually requires no immediate treatment. Yet, by the time she left the Montrose Emergency Center, a free-standing emergency room, Hirsch had accumulated more than $15,000 in charges that included two CAT scans, an electrocardiogram, two urine tests, blood work, and an IV of saline solution to prevent dehydration — even though she was told she was not dehydrated.

She now owes $13,794.49 because insurance covered less than 10 percent of the charges since it was out-of-network.

Theft #2 - He hit his head, used superglue to fix his wound, and then two days later stepped into a facility just to make sure. He ended up with a $1,200 dollar bill for a 20-minute visit.

In January 2018, Richard Kelley tried to step over his sprawled Labrador retriever just as the dog stood up. The Tomball construction manager went tumbling into the corner of a granite countertop, opening a cut to his temple.

Kelley, 63, was in pain and bleeding, but not hurt badly. He applied some do-it-yourself doctoring to the wound and closed it with Super Glue. He wasn’t disoriented and did not feel nauseous.

Still, his wife, Maxine, was worried about infection. Two days later, Kelley agreed to have the cut checked. He couldn’t get an appointment with his doctor, so he tried the Memorial Hermann Convenient Care Center nearby. He didn’t know anything about it, but the receptionist promised no waiting.

A few minutes later, the doctor felt along Kelley’s eye socket and cheekbone and declared nothing broken. He asked Kelley about concussion warning signs.

“Richard, I don’t think stitches are going to help you any,” Kelley said the doctor told him. The nurse applied a few Steri-strips across the cut and Kelley was done. The whole deal, from walking in to walking out, took about 20 minutes, he said.

In March, the couple got a bill from Memorial Hermann. They owed $1,188.75 for the facility fee described as emergency care.

Theft #3 - All he needed was a tetanus shot he would have gotten for free at Walgreen. It cost him $1,900 + $200 copay = $2,100.

These corporations running free-standing emergency rooms are not doing anything illegal. They are playing by the tenets of our economic system. All of those who think Medicare for All would result in the takeover of America's healthcare should ask themselves how well is the private system working.

Those private urgent care centers and private emergency rooms popping up in strip marts are nothing more than profit centers for major corporations. They sell healthcare services like any product, by mostly lying or highlighting the aspects you want to hear.

If a corporation is selling clothes, shoes, electronic equipment, or other trinkets, who cares if prices or description are less than accurate or untruthful. We have a choice to purchase or not, be gullible or not.

When it comes to healthcare there is something fundamentally immoral to apply that same model. If folks do not want government control of healthcare, then open the door for controlled non-profits whose goals are good healthcare for all via Single-Payer Medicare for All.

My goal is to continue to highlight the immorality of our healthcare system and grander, our economic system that by design hurt most of us to benefit a few. I hope most will read these articles in that context. I had my own experience with one of those "legal theft" free-standing emergency rooms. I've lived it. And my wife has lived through the basic thievery of our healthcare system as well.

At least 25% of diabetes patients rationing insulin as drug costs continue to skyrocket, 2-26-19

One of the many hopes of a Medicare-for-all program is that in giving our government a larger share of the medical “market” (for lack of a better term), Americans—collectively—will be able to negotiate down the skyrocketing costs of medicine. Every day brings tragic stories of Americans young and old, of all racial backgrounds, dying after rationing their insulin—the result of explosive increases in the costs of the drug. While some people’s diabetes treatments have risen from $24 to $80 per vial over the past decade, others face much more prohibitive prices.

Big Pharma is hurting drug innovation - Mariana Mazzucato October 17

[Mariana Mazzucato is the director of the UCL Institute for Innovation and Public Purpose and the lead author in a new report on health innovation.]

The global pharmaceutical industry is no longer innovating. Research shows that 78 percent of patents approved by the U.S. Food and Drug Administration correspond to medications already on the market, while those disease areas not considered growth markets are ignored. From 2000 to 2011, only 4 percent of newly-approved products globally were designed to treat neglected diseases that affect lower- and middle-income countries.

Part of the problem is how pharmaceuticals use the patent system. Instead of creating new drugs, they extend existing patents beyond the initial 20-year protection set by the United States and use gimmicks, such as overly-wide patents, to block knowledge creation and issue patents for what is essentially the same drug. Losec, for example, which is produced by AstraZeneca to treat heartburn and ulcers, was later tweaked and placed under a new name. This enabled the company to issue a new patent for the barely modified medication, effectively extending the company’s monopoly on this type of drug well beyond the period granted by the original patent.

What’s more, while taxpayers are largely footing the bill for drug research, pharmaceuticals are reaping all the gains. Sofosbuvir, which treats hepatitis C, emerged from over 10 years of U.S. taxpayer-funded research — through the Department of Veterans Affairs and the National Institutes of Health. But when the private biotech company Gilead Sciences later acquired the drug, it priced a 12-week course of pills at $84,000 in the U.S. market. By the end of 2017, Sofosbuvir had generated over $50 billion in sales.

Sofosbuvir is not an exception. The U.S. taxpayer has funded research for every single one of the 210 new drugs that the FDA approved between 2010-16. Yet the companies that have access to this research are increasingly viewing pharmaceuticals in the same way that banks view their financial product — opportunities for short-term returns.

Large pharma companies spend more on share buybacks to boost share prices (and stock options — the main way that executives get paid) than on research and development. Pfizer, for example, spent $139 billion on share buybacks and dividends in the past decade — and just $82 billion on research and development in the same period. (The chief executive’s pay was also a reported $27.9 million in 2017.)

The solution? Apply the same mission-oriented approach used in national defense to health care. The military has historically used public funds to solve problems by interacting dynamically with the private sector, albeit with government direction, with the goal of benefiting the taxpayer.

The mission-oriented approach is what got us to the moon. It also got us the Internet, the microchip, the micro hard drive and voice-recognition software. Those latter inventions came through the United States’s Defense Advanced Research Projects Agency (DARPA), which has what it calls a “singular and enduring mission” to make pivotal investments in breakthrough technologies for national security.

If governments acted with the same urgency and strategic deliberation toward improving health as they do when it comes to national defense, we might be able to transform health care and deliver the next generation of medical breakthroughs to reach the people who need them the most.

A more empowered HHS — one better focused on achieving solutions to public health needs — could also strike better deals. For example, it could put pressure on companies, given the benefits that they receive from public funds, to reinvest profits back into innovation rather than using their gains for share buybacks. It could encourage a restructuring of the patent system to stimulate innovation rather than block it. Patents should not be so wide as to stymie all research on a particular illness.

HHS should also push for more transparency among the different actors bearing the cost of research and development. This would make the collective process of value creation more obvious and thus encourage a more informed discussion of pricing as well as research and development financing. Lastly, the government must create the conditions to ensure new drugs remain affordable and easily accessible. While the 1980 Bayh-Dole Act permits the government to cap the prices of publicly-financed drugs, it has never exercised this right.

It is clear that the pharmaceutical business model is one that pursues profits rather than public health objectives. In making forecasts for the biotech and pharmaceutical sector, Goldman Sachs analysts even asked, “Is curing patients a sustainable business model?” Profit-making has become so entrenched in the drug industry that it requires a fundamental transformation — one that compels it to deliver public value and spark genuine market-invigorating innovation. We can do this only if we begin to focus on what really matters: putting patients over profits. As the opioid crisis shows, breakdowns in this system can quickly become a national security issue. Let’s treat matters of health as such.

Is Your Doctor Being Paid by Big Pharma? Here’s How You Can Tell

How much money does Big Pharma spend to schmooze your doctors and push its latest “solutions”? The stats and facts in the infographic below will astound you.

Worse, in many cases your trusted doctor isn’t even given the truth about the drugs he or she prescribes, as the giants of Big Pharma also spend exorbitant amounts of money to hide damning research and payoff lawsuits that result from their dishonesty and negligence.

In fact, a lawsuit against the manufacturers of Invokana, a drug prescribed to lower blood sugar and improve glycemic control in adults with type 2 diabetes, alleges that “the manufacturer failed to warn patients and physicians of the increased risks of kidney failure, heart attacks, and ketoacidosis,” noting that “if the manufacturer had given proper warnings, doctors would have prescribed a medication other than Invokana for patients with type 2 diabetes.”

And the sad truth is that this happens all the time. Despite the fact that there are many natural alternatives to common drugs, physicians rarely veer from “solutions” endorsed by the Big Pharma execs who offer them lavish gifts and vacations.

Is Your Doctor Being Paid by Big Pharma? Here’s How You Can Tell

In 2015, the Centers for Medicare and Medicaid services made public all payments gifted to physicians and teaching hospitals. This includes all lunches, vacations, payments and perks dating back to the year 2013.

To search for your physician or hospital, simply visit the site Open Payments Data [https://openpaymentsdata.cms.gov/] and use their search function to browse the numbers.

They launched the site as part of a national transparency program that aims to give the public a more honest picture of how their healthcare providers’ practices and treatment recommendations might be influenced.

This is especially valuable in the face of so many “drug mishaps.” One could argue that if a physician received a hefty monetary payment from a drug company, he or she might be inclined to prescribe it, even without a reliable understanding of the medication.

So how safe are your medications, really?

One may never know until it’s too late, but we recommend knowing the answers to these 15 questions before filling any prescription. [http://www.liveinthenow.com/article/15-questions-you-need-to-ask-your-doctor-before-filling-that-prescription]

For more on how Big Pharma conglomerates snowball doctors and patients alike, check out our article Should You Always Do What Your Doctor Says? [http://www.liveinthenow.com/article/should-you-always-do-what-your-doctor-says]

In the meantime, here is the promised infographic on exacly how Big Pharma is spending big bucks to influence your physicians’ prescribing practices.


How You Should Sleep if You Want to Avoid Memory Problems

Conclusion: Now, the latest discovery linking certain sleep habits to brain health has found that sleeping on your side may be better than sleeping on your back or stomach, because it helps the brain remove damaging wastes more effectively.

Chances are your sleeping posture is something you think very little about. But a study recently published in The Journal of Neuroscience finds there’s one in particular that may be better than the rest for decreasing the risk of Alzheimer’s disease.

As we’ve reported in the past, when you sleep, the brain is diligently involved in removing toxins that accumulate during the day. This function is vitally important because the buildup of harmful chemicals can lead to Alzheimer’s and Parkinson’s disease. In fact, the link between brain toxins and neurodegenerative illness is so strong that such disorders have been called “dirty brain diseases.”

Big pharma company ADMITS to falsifying vaccine data Big pharma scandal: Chinese vaccine maker falsifies data and sells mystery vaccine to children

Big pharma at its worse: 15 staff members detained due to tainting of Chinese vaccine and pharmaceutical drugs

The Word Pharmaceutical Conceals A DARK SECRET Has Drug-Driven Medicine Become A Form of Human Sacrifice?

Posted on: Monday, July 30th 2018 Written By: Sayer Ji, Founder

"Unless we put medical freedom into the Constitution the time will come when medicine will organize itself into an undercover dictatorship. To restrict the art of healing to doctors and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic." - Attributed to Dr. Benjamin Rush, Signer of the Declaration of Independence

Benjamin Rush accurately foretold a grave possibility facing Americans today, namely, that the art and science of healing be restricted to a select class of allopathic physicians, who have the sole legal right to recommend and administer medicines, and whose pharmacopeia excludes – as a matter of principle – all the healing foods, vitamins and herbs which have been used safely and effectively for countless millennia in the prevention and treatment of disease.

We have entered an era where medicine no longer bears any resemblance to the art and science of healing. The doctor no longer facilitates the body's innate self-healing capabilities with time, care, good nutrition and special help from our plant allies. To the contrary, medicine has transmogrified into a business enterprise founded on the inherently nihilistic principles of pure, unbridled capitalism, with an estimated 786,000 Americans dying annually from iatrogenic or medically-caused deaths.*

Turning Disease Into Gold With The Drug-Based Printing Press

Many modern diseases are, in fact, created by fiat (not unlike modern currencies): age-old symptoms of nutritional deficiency or chemical poisoning are repackaged and renamed in Latin and Greek as would-be monolithic disease entities, and subsequently rolled out to the consumer as new markets; each disease representing a veritable gold mine of "treatable" symptoms; each symptom providing justification for the prescription of a new set of patented, toxic drug-commodities.

The "medicines" themselves are often devoid of intrinsic value, being nothing more than rebranded and re-purposed chemicals, intended (though all too often failing) to be administered in sub-lethal concentrations. Indeed, many of these chemicals are too toxic to be legally released into the environment, and should never be administered intentionally to a human who is already sick. You need look no farther than a typical drug package insert to find proof that the side effects of most drugs far outnumber their purported beneficial effects.

These chemicals, in fact, are so highly leveraged against their true value (or lack thereof), that they can sell for as much as 500,000% percent from cost! For example, this chemo drug [ipilimumab (trade name YERVOY®)] costs 4,000 times more than gold by weight. Only medical/pharmaceutical and financial institutions (e.g. Federal Reserve) are legally empowered to generate the illusion that they are creating something of value out of nothing of value, on this scale. This manipulation of perceived value, which is the basis for the global dominance of the drug-based medical model, is not unlike how financial institutions created toxic derivative products (e.g. Credit Default Swaps), essentially creating the illusion of financial wellbeing and prosperity, at the very moment that they were planting the seeds of death within the global economy; ruining the lives of countless millions in the process.

The Undercover Medical Dictatorship

Within our present dominant medical system, healing has not simply been forgotten but intentionally exorcized as it represents the antithesis of perpetual profitability which requires the incurability of the human body. Were the truth be told, and the body's self-regenerative capabilities acknowledged, the entire superstructure of drug-based medicine and hundreds of billions of dollars in revenue it generates annually, would crumble overnight. When a handful of turmeric has more chemotherapeutic activity than any drug yet to receive FDA approval, or an enzyme from pineapple is superior to a 40 year old blockbuster chemotoxic agent, one begins to understand why the hundreds of studies proving natural substances can destroy cancer are never discussed. You can't compete with free, effective and safe in a medical marketplace dominated by expensive, ineffective and unsafe drugs.

If this degeneration into quackery and snake-oil salesmanship which is modern drug-driven medicine were simply a lesson in what bad things can happen when health care is no longer a basic human right but strictly a profit-driven commodity, perhaps Americans could find it within themselves to once again free themselves from the shackles of oppression. After all, do we not consider ourselves the very originators of freedom, independence and democracy? Have we not such great faith in these principles that we practically trip all over ourselves (crushing entire countries as we fall) in our Promethean effort to export these values overseas whether we are invited to do so or not? Would we stand for less, when it comes to our own health freedom?

Sadly, the "undercover dictatorship" Benjamin Rush foretold is not simply a homegrown one we can root out from the inside, as it were. Although the American Medical Association (AMA) and the Food and Drug Administration (FDA) behave as if they are at the top of this pyramid of power relations, they serve far lower on the hierarchy. While the government of the United States and American corporate lobbying groups may appear to be behind the FDA's shameless pandering to the interests of the drug companies, transnational corporations and organizations -- and a hand full of elite governing them -- are in fact pulling the strings.

The United States no longer enjoys global economic and cultural hegemony. We are now embedded in an international playing field where multinational and transnational organizations like the drug company Pfizer, or the World Health Organization (WHO) and the World Trade Organization (WTO), have power and influence that overshadows the US or any other particular government or nation-state. These larger organizations blur the divisions traditionally drawn between public and private institutions, insofar as their agendas and mandates are consistent with global economic imperatives which do not account for the self-proclaimed sovereignty of any particular nation-state's constitution or laws above its own.

For example, the United States may soon no longer be able to allow the over-the-counter sale of many dietary supplements, due to our membership in the World Trade Organization and its ratification of the Codex Alimentarius. We already have prescription-only-vitamins on the US market, and a very dangerous precedent has already been set with the criminalization of herbs like cannabis, and more recently ephedra.

Pharmageddon: The Death of Natural Medicine

What is so remarkable about the present state of affairs, is that it may have been predicted long ago, as evidenced by this passage in Revelations:

"At the end of times the merchants of the world will deceive the nations through their Pharmacia." (sorcery) - Rev 18:23

Some believe we are now on the precipice of a medical end-of-times or "Pharmageddon," if you will, where medicine is no longer directly associated in any way with healing, rather, is a form of mass control and a highly organized means of defrauding the public of both its wealth and health, simultaneously.

After all, is there any greater absurdity than a medical model that treats the symptoms of disease with sub-lethal dosages of toxic chemicals and in which there is no attempt to uncover, understand or remove the causes of those imbalances?

After all, what disease has ever been found to be caused by a lack of a drug?

Is acid reflux caused by a lack of proton-pump inhibitors?

Is heart disease caused by a lack of statin drugs?

Is osteoporosis caused by a lack of Fosamax?

Absolutely not! Then why would anyone consider it sound practice to use potentially toxic chemicals as a first-line treatment for conditions that are not caused by a lack of a chemical? To the contrary many diseases are caused exactly by culminative exposures to chemicals that not unlike drugs are biologically alien to the body. i.e we are treating poisoning with poisons!

Can we dignify this approach by calling it medicine? Or, is it more accurately described as a form of sorcery?

Pharmaceuticals and Human Sacrifice

The sole reliance on Pharmaceuticals reveals quite a lot about the largely subconscious agenda underpinning modern medical practice. The Greek word Pharmakon has a wide range of meanings, with "drug" being the most widely recognized one. But the root of this word usage goes back much farther:

"A παρμακωσ in Ancient Greek religion was a kind of human scapegoat (a slave, a cripple or a criminal) who was chosen and expelled from the community at times of disaster (famine, invasion or plague) or at times of calendrical crisis, when purification was needed." [Wikipedia]

The sacrificial dimension of the παρμακωσ carries on in the nostrums and potions later named after this ritualistic object:

"The term "pharmakos" later became the term "pharmakeus" which refers to "a drug, spell-giving potion, druggist, poisoner, by extension a magician or a sorcerer."A variation of this term is "pharmakon" (φαρμακον) a complex term meaning sacrament, remedy, poison, talisman, cosmetic, perfume or intoxicant." From this, the modern term "pharmacology" emerged," [Wikipedia]

Calling pharmaceutically-based medicine sacrifice-based, is not just metaphor. Animal sacrifice, in fact, undergirds the entire evidence-based model of drug development and testing, requiring millions of animals be tortured and destroyed every year. In juxtaposition to Ayurveda, traditional Chinese medicine and countless other traditional, nature-based medical systems, which used living, healthy bodies as the model for preventing and treating disease in the sick, Western medicine took another, quite radically different path in an obsession with pathology.

The karma, if you will, of this divergent path often leads patients, especially later in life, to be cut open themselves on an operating table, or poisoned to death, with the very same chemicals and procedures that the animal testing once done in their name, justifies.

The reality is that medical practice, and the science that informs it, is as much mythos as logos, and one no longer has to look to religion for the absolutist claim to truth. Medical science has laid claim to the body in the same way that religions once laid claim to the soul. The physician today -- albeit a glorified "applied pharmacologist" -- has become the "priest of the body," capable of influencing the course of life or death by the quality, or combinations, of nostrums (s)he is able to apply to the problem (i.e. patient) at hand.

Just as monotheism depends on there being "one God," modern medical science depends on the "evidence-based" concept that there is ONE truth, and ONE right way to apply it. This, by implication, gives absolute power to those who would claim to know the difference.

The European Union Versus US Food and Drug Administration — One Protects Consumers; the Other Ignores Them So-called “silver” dental fillings are really mercury fillings, and their use needs to stop — for health reasons, for environmental reasons, for workplace safety reasons and for social justice reasons

Consumers for Dental Choice successfully facilitated a total ban on dental amalgam for children under 15 and pregnant and nursing women within the European Union, effective July 1, 2018

August 2017, the Minamata treaty to phase down dental mercury became legally binding. The U.S. is legally bound to begin enforcement, yet the FDA has not yet taken definitive action

To end amalgam use worldwide, demand mercury-free dental fillings from your dentist and full reimbursement from your insurance company. Sign the DEMAND Your Choice petition and donate to Consumers for Dental Choice today

The Organic Corporate Takeover The Organic Trade Association (OTA), which says its mission is to promote and protect organic, has corporate members that seemingly do not belong, like chemical giant BASF, a dicamba manufacturer and a major player in genetically modified organisms (GMOs)

Cargill, another GMO and concentrated animal feeding operation (CAFO) giant, is also an OTA member

The apparent conflict between promoting organic standards while at the same time accepting members who blatantly ignore them for most of their products has led to tension among some OTA members

OTA appears to be increasingly succumbing to corporate control and has supported measures against GMO labeling as well as supports the allowance of controversial hydroponic-like container growing systems under the organic label

Pharma Hiding Antibiotic Disaster

The majority of antibiotics in the U.S. aren’t used in health care settings for humans; they’re used in industrial agriculture, primarily in low, steady doses for purposes of “disease prevention”

In countries like the Netherlands, health and agricultural agencies release two sets of antibiotics data — one for human usage and resistance and one for livestock — every year

The data is clear and concise, in stark contrast to what is revealed in piecemeal fashion in the U.S.

In the U.S., however, there is no comprehensive collection of such data, despite the fact that knowing where and how antibiotics are being misused is necessary to stop the spread of antibiotic resistance

Antibiotic-resistant disease is a major health threat around the globe, such that illnesses once easily treatable with the drugs are now becoming deadly. The cause of the antibiotic-resistance epidemic is quite straightforward: overuse of antibiotics. “Resistant bacteria are more common in settings where antibiotics are frequently used: health care settings, the community and food animal production,” the U.S. Centers for Disease Control and Prevention (CDC) states1 — and the latter category is of utmost importance.

In countries like the Netherlands, health and agricultural agencies release two sets of antibiotics data — one for human usage and resistance and one for livestock — every year. The data is clear and concise, in stark contrast to what is revealed in piecemeal fashion in the U.S. As reported in Wired:

“They [the data sets] are remarkably real-time, fine-grained, and coherent across categories — so much that, in the wake of a 2005 European Union ban on one type of farm antibiotic use, the Dutch data could show that drug-resistant infections linked to food didn't drop as expected. That gave the government the proof it needed to recruit farmers into voluntary cuts in farm drug use. Antibiotic use dropped 60 percent in three years — and that time, they saw a drop in human infections.”

In the U.S., however, there is no comprehensive collection of such data, despite the fact that knowing where and how antibiotics are being misused is necessary to stop the spread of antibiotic resistance. Data on human antibiotics usage is compiled by a private company and available only for a steep fee. Pharmaceutical manufacturers keep track of veterinary antibiotic sales, which are then reported to the U.S. Food and Drug Administration (FDA) as part of the Animal Drug User Fee Act (ADUFA).

The ADUFA requires drug companies to pay a fee to the FDA to help cover new-drug approvals and also requires them to release some agricultural data.

The FDA has released a limited summary of ADUFA data each year since 2009, but only in recent years has it been disclosed how antibiotics are dispensed on farms or how they’re used in different livestock species. Meanwhile, ADUFA is up for reauthorization in 2018, and some have tried to insert provisions that would allow drug companies latitude to use animal drugs without showing proof of their effectiveness for five years.

As Matthew Wellington, antibiotics program director for the organization U.S. PIRG, told Wired, “The lack of data is a problem because we know that antibiotics are vastly misused in agriculture, but we need more information on exactly how they are used to put in place the best stewardship practices possible … The less clear that data is, the harder time public health advocates and elected officials will have in creating best practices.”

Antibiotics Have Been Tied to Industrial Agriculture From the Beginning

Today we’re seeing the catastrophic consequences of this practice. Seventy percent of the antibiotics used in the U.S. are used by industrial agriculture for purposes of growth promotion and preventing diseases that would otherwise make their concentrated animal feeding operations (CAFOs) unviable. Low doses of antibiotics are added to feed as a matter of course, not only to stave off inevitable infectious diseases but also because they cause the animals to grow faster on less food.

FDA Allows Big Ag to Continue Using Antibiotics Virtually Unrestricted

Meanwhile, in November 2017 the World Health Organization (WHO) called on farmers and the food industry to stop the use of antibiotics for growth promotion and disease prevention in healthy animals. WHO explained, “The new … recommendations aim to help preserve the effectiveness of antibiotics that are important for human medicine by reducing their unnecessary use in animals"

They cited a 2017 study published in The Lancet Planetary Health, which found reducing antibiotic use in food-producing animals reduced antibiotic-resistant bacteria in the animals by up to 39 percent and may similarly reduce such bacteria in humans, particularly those who are directly exposed to food-producing animals.

According to WHO, use of all classes of medically important antibiotics should be reduced in food-producing animals, while their use for growth promotion and disease prevention without diagnosed illness should be completely restricted.

Antibiotic Resistance May Kill 100 Million by 2030

Fight Antibiotic Resistance by Avoiding CAFO Meat

I encourage you to either buy direct from a trusted farm or look for the American Grassfed Association (AGA) logo, a much-needed grass fed standards and certification for American-grown grass fed meat and dairy.19 The standard allows for greater transparency and conformity20 and is intended to ensure the humane treatment of animals and meet consumer expectations about grass fed meat, including beef and pork, and dairy, while being feasible for small farmers to achieve.

An AGA logo on a product lets you know the animals were fed a lifetime diet of 100 percent forage, were raised on pasture (not in confinement) and were not treated with hormones or antibiotics.21 In addition, the AGA logo on your meat and dairy ensures the animals were born and raised on American family farms.22 As antibiotic resistance continues to worsen, and with CAFOs representing ground zero for their overuse, avoiding CAFO animal products is perhaps now more important than ever.

Email from INH - Angela SalernoAdd contact: Just When You Thought Big Pharma Couldn't Sink Any Lower...

Big Pharma’s Cruel Price Gouging

Imbruvica is manufactured in a partnership by two pharmaceutical companies, Janssen and Pharmacyclics. Before the trial could start, the firms announced a complicated new pricing structure.

They effectively tripled the price of the drug so they wouldn’t lose revenue from cancer patients taking fewer pills. The consumer group called it a heartless scheme to make money off the backs of desperate cancer patients.

Dr. Mark J. Ratain is an oncologist at the University of Chicago Medicine. He’s also a member of the Value in Cancer Care Consortium. He and other cancer doctors were furious when they heard about the price gouging. “That got us kind of p---ed off,” he said.

“We were just in the early stages of planning [a clinical trial] and getting it organized, and thinking about sample size and funding, and we caught wind of what the company was doing.”

Dr. Stacie Dusetzina is an associate professor of cancer research at Vanderbilt University Medical Center in Nashville. She called the pricing scheme “disturbing.”

“It appears to be a program being implemented, possibly to save some of the profits they’d be losing if dose reductions are really rapidly going to start coming down the pike,” she said.”

In a joint statement, the drug manufacturers pointed to the fact that they were offering Imbruvica in lower-dose pills. Of course, they didn’t mention that they had tripled the cost. They called their pricing policy “a new innovation” to help patients with “improved packaging.”

Big Pharma Creates Fake Cancer Patients to Boost Profits Falsifying medical records… Giving cash kickbacks to doctors… Deceiving insurance companies… And making millions of dollars off the scheme.

It’s Big Pharma sinking ever lower. And this time they got caught.

They’ve been slammed with federal indictments and class action lawsuits that reveal massive fraud

TOP STORY -- 314 ActionAdd contact: yet ANOTHER victory for Big Pharma 5/22/18


FIRST he appointed pharmaceutical industry insiders to lead the Department of Health and Human Services AND head his drug price reform plan.

THEN Big Pharma shattered lobbying record after lobbying record in the hopes of pressuring Trump to protect their interests.

NOW Trump is breaking his own campaign promise and refusing to allow Medicare to negotiate drug prices -- which would save us money and SAVE LIVES!

Millions of Americans struggle to afford their prescription drugs. It’s never been more URGENT to allow Medicare to negotiate for lower prices.

Yet, more than 2,500 drugs have increased in price by more than double digits since Trump became president -- and now, he won’t let Medicare step in!!

Pfizer CEO gets 61% pay raise—to $27.9 million—as drug prices continue to climb In a recent three-week span, the company hiked 116 drug prices as much as 9.46 percent.

email from Amerucans for Tax Fairness, 12/9/17

A new Americans for Tax Fairness report shows how the pharmaceutical industry will get an $80 billion tax break under the Trump tax scam while continuing to price gouge the American people.

If 'ald Trump and Congressional Republicans pass their massive tax cuts largely benefiting the richest 1% and wealthy corporations, a big winner will be the pharmaceutical industry, which wields enormous power through a small army of corporate lobbyists.

And, in 2016, the Pharma Big 10 had $506 billion in untaxed profits stashed offshore. These profits soared by two-thirds since 2011, as drug prices skyrocketed.

Senator Bernie Sanders said:

“This important new report highlights what we already know—pharmaceutical companies are gouging the public with outrageous prescription drug prices, while dodging tens of billions of dollars in U.S. taxes on their offshore profits. But instead of doing anything to rein in these tax dodgers, the Republican tax plan rewards drug companies with massive tax cuts on their current and future offshore profits. These corporations can no longer be allowed to rip off Americans, who already pay the highest prescription drug prices in the world. Instead of giving big pharmaceutical companies that are sheltering their profits overseas a massive tax break, we must demand that they pay their fair share of taxes so that we can rebuild the disappearing middle class.”

Chuck Norris Files Massive Lawsuit Against Big Pharma After Popular Drug Nearly Killed His Wife On November 1 [2017], Chuck Norris and his wife Gena Norris announced a massive lawsuit against eleven different drug companies, including McKesson and Bracco, claiming they are responsible for nearly killing Gena.


How the Opioid and Heroin Epidemic Was Created by Big Pharma By Sally Painter

The growing heroin addiction in America is at epidemic levels. Is there a connection between prescribed opioid abuse and the heroin use being on the rise? Some people have connected the dots between the over-prescribed pain-killer and the addiction that ensued and those addicts turned to heroin.

OxyContin Rise as Number One Painkiller Prescribed

According to a recent article written by Mike Mariani (The Week), the rise of the highly addictive painkiller OxyContin was rapid and took over the market like no other painkiller had.

In his examination of the opioid’s phenomenal success from its approval and subsequent 1996 introduction onto the healthcare marketplace, Mariani reports that Purdue Pharma sold $45 million worth of OxyContin during its first year. He explains that the sales figure rose to $1.1 Billion by 2000 and in 2010, the sales expanded to a whopping $3.1 Billion. He points out this signified a market dominance of 30% of all painkillers.

This dominance in the market wasn’t easily explained. Mariani reports that there were rumors concerning the wide range of uses the FDA (Federal Drug Administration) approved for the drug, such as “post-operative pain” to arthritis. Almost any type of pain was eligible to be treat with the popular painkiller. Mariani describes how concerns were also raised about the relationships between Purdue Pharma and the physicians since doctors favored prescribing OxyContin over other available pain killers.

In his article, Mariani states that with a more than doubled sales force by 2000, Purdue Pharma offered annual bonuses of $70,000+ to sales reps. He reports that some sales reps earned as much as $250,000 in annual bonuses.

So why was OxyContin such a hit with doctors? Mariani states that it was the company’s marketing campaign that by 2001 was budgeted at $200 Million. He also points out that the company built a database that detailed the prescribing habits of doctors. Armed with this data, the sales force was able to target the highest-painkiller-prescribing doctors.

Mariani refers to a Los Angeles Times report, that stated as early as 2002 “Purdue Pharma had identified hundreds of doctors who were prescribing OxyContin recklessly, yet they did little about it.” He describes how Purdue Pharma’s mission was to, “make primary care doctors less judicious when it came to handing out OxyContin prescriptions.”

Mariani points out that the addictive qualities of OxyContin made it a valuable street drug, especially when the FDA allowed it to be sold at higher doses than the original 80mg. Once the industry was forced to acknowledge the highly addictive properties of the drug, crackdown on physicians over-prescribing did little to help those already addicted. Many people believe that with the absence of OxyContin prescriptions to feed their addiction, those caught up in the Big Pharma net of the prescription painkiller turned to heroin.

Was Heroin the Next Step Up from OxyContin Addiction?

The CDC reports that 45% of heroin addicts are “also addicted to prescription opioid painkillers”. 9 of the 10 people using heroin reported using one other drug (2). According to the CDC, the face of heroin addiction has morphed indiscriminately among both genders of all age groups and income levels. Over the last 10 years, the use of heroin has doubled among 18-25 year olds.

As disturbing as these statistics are, it gets worse. The CDC states that heroin addicts are also “abusing multiple other substances, especially cocaine and prescription opioid painkillers.” With the epidemic of heroin addiction, cases of overdose-related deaths is also on the rise. The death rate quadrupled between 2002 and 2013

Originally published on TopSecretWriters.com

Comment from CG: Big Pharma is a bigger criminal than anyone except the banks and the oil industry. Their CEOs should be jailed and publicly flogged.

Slavehood 2017 By Peter Koenig [an economist and geopolitical analyst. He is also a former World Bank staff and worked extensively around the world in the fields of environment and water resources. He lectures at universities in the US, Europe and South America.] May 04, 2017 "Information Clearing House"

When in the 18th and 19th Century African slaves did not ‘behave’, they were cruelly beaten sometimes to death as a deterrent for others. They were deprived of food for their families. Their women were raped. They were traded to even harsher white masters. Their lives were worth only what their labor could produce. They were treated as subjects, devoid of human warmth.

Today we have become all slaves; slaves to the powers of mafia bankster of finance; slaves to the western lie-propaganda; to the lobbies and their giant all dominating corporations – to the war-industry, because we happily believe what we are told about ever-increasing terrorism that needs to be fought with eternal wars; slaves to the environment-destructive hydrocarbon industry; to the pharma-industry; to the Monsanto-ized agroindustry; to senseless consumerism – and foremost – and summing it all up: to greed, endless greed that drives endless growth, nurturing endless competition fomenting adversity, destroying solidarity, instead of amical cooperation for a harmonious human cohabitation.

As people of western nations, we are enslaved to an all-engulfing neoliberal fascism – to a predatory economy. Corporate lie propaganda drip-feds our brains. We haven’t even noticed it. We are enslaved to so-called ‘leaders’, put in office by obscure foreign masters of deceit – the ever-stronger corporate controlled propaganda machine – the six all controlling Zion-Anglo media, whom we believe whatever lie they vomit – because it is more comfortable to believe a lie than to confront the truth – that’s self-imposed slavehood.

That’s how far we have gone. Because we are clearly on an almost irreversible downward track – sliding and running towards our own demise – into darkness – the darkness of chaos and bloody wars, endless wars against self-invented terrorism; wars that keeps our western economy running – and our armchair politics alive. Wars that kill and slaughter millions and millions – but all in ‘far-away’ lands. We are told we are protected. Our police and military watch over us. The new gods – money and military.

Although ‘pride’ was never an appropriate term to integrate our soul and minds, as we the western powers – have for centuries enslaved, raped, exploited and slaughtered the indigenous people, those who have for millennia, for history of mankind survived and passed on our human genes from one murderous civilization to another, always in the hope that the new one would see the light.

We can only hope that the patience of these native people, the survivors, our saviors – will prevail, that before we disappear in darkness, in the void of a manmade blackhole, we will awake, open our eyes and seek the light – become finally human, the term we have fraudulently applied to ourselves – the western civilization.

Independent thinking has become a crime, as it impedes the advancement of slavehood. Education is designed to kill individual thinking and the wide range of inventiveness – because it’s dangerous – for those who enslave and control us. ‘New-speak’ education has to make us thinking what the system wants us to think. That’s what western education has become in the last 50 years – a farce to keep us as non-thinking idiots.

Idiots are easily enslaved and exploited and sent to wars – to steal foreign resources to satisfy the greed of a few. We love to be cannon fodder, as we were told – enslaved – to believe that good patriots love to die for their country. We are blinded and avoid seeing that we are dying fighting to satisfy puppet leaders’ greed for power and money – whose power is nothing more than that allowed them by the Masters who control the world and who pull the strings on their marionettes.

End Pharma Liability Shield Endangering Public Health and Human Rights Health freedom and the civil liberties of Americans are at risk with yet another CDC-proposed public health law, paired with an expanding global vaccine market.

Another sign that autonomy and civil liberties are being threatened in America is the recently proposed change to public health law published by the U.S. Centers for Disease Control (CDC) that allows federal officials to use police power to apprehend, isolate and involuntarily quarantine travelers simply suspected of being at risk for getting measles or other infections until they sign a contract agreeing to application of “public health measures,” like vaccination. A big reason they can get away with it is that nobody is accountable in a civil court of law when people are harmed by public health laws.

Curbing civil liberties under the guise of protecting the public health and national security has become big business. In 1982, when the pharmaceutical industry threatened to stop producing government licensed and recommended vaccines for children unless vaccine manufacturers got a product liability shield, Congress gave Big Pharma most of what it wanted in the National Childhood Vaccine Injury Act of 1986. It was tort reform legislation sold to parents and the American public on the backs of children legally required by states to get federally recommended vaccines to attend school.

Even though by Nov. 1, 2016, $3.5 billion had been awarded to more than 3,500 vaccine victims through the federal vaccine injury compensation program (VICP) created under the 1986 law, two out of three claims have been denied throughout the entire history of the law’s implementation. Most of the compensation awards today are for adults injured by flu vaccine - not for children required to get vaccines to go to school.

While the government denies compensation to many children, whose lives have been destroyed by state mandated vaccines, in the past five years liability free drug companies have joined forces with politically powerful medical trade groups to change state vaccine laws. They are lobbying state legislatures to severely restrict the medical exemption and eliminate the non-medical religious, philosophical and conscientious belief exemptions for children attending school.

Email from "Joshua Corn" 12/14/16

A Senate Finance Committee investigation showed that the maker of Avandia® intentionally hid reliable scientific data clearly showing that their drug significantly increases the risk of congestive heart failure, heart attack, stroke and death. Avandia® has caused up to 100,000 heart attacks to date by some estimates.

And get this: Doctors are still prescribing this dangerous drug today!

Many people think prescription medications are safe, but the fact is, properly prescribed drugs kill one person every 19 minutes, according to some statistics.

You may say, “Avandia® is just one drug out of thousands, and most of them are safe.” Remember Vioxx®? Fen-Phen®? My point is that you certainly can’t trust the drug companies to care about your health.

How PE Firms Are Flipping Drugs in Price-Gouging Scheme that Cannibalizes the Entire US Economy They '’t care. And they’re not required to care.

The ravenous price increases that pharmaceutical companies slap on their medicines are part of the reason the US health care system is eating an ever larger slice of consumer, corporate, and government spending, and why the rest of the economy has trouble moving forward. Some of the price increases have turned into scandals with plenty of mouth-wagging by politicians.

Mylan got raked over the coals in Congress for raising the price of its autoinjector EpiPen seven-fold since buying it in 2007. Last year, Turing Pharmaceuticals, under Martin Shkreli, got into hot water over raising the price of just-acquired Daraprim 50-fold.

Private equity firms have figured this out. You can make a ton of money with a basic formula: Fund a newly created outfit that buys the rights to a prescription drug with little or no competition and with stagnant or declining sales, jack up the price of the drug, then flip the company at an enormous profit.

This has become the latest way of wringing out the American economy without contributing anything to it, and at the expense of everyone else. So Bloomberg dug into the role private equity firms play in these schemes.

The DEA Didn’t Talk To Kratom Users Before Pushing A Ban. Here’s What They Would’ve Said.

“Oxycontin, morphine, fentanyl, Darvocet.”

Deanna McNair, 36, pauses before ticking off the rest of the drugs she’s been prescribed for pain following a series of car accidents and subsequent surgeries.

“Percocet, Opana, Norco, metha'e,” she continues. “Not all at the same time, of course.”

Then there are the muscle relaxers, antidepressants and medications McNair had to take just to treat the side effects of her other prescriptions.

The panoply of pharmaceuticals was a necessity for McNair. Over a period of 13 years, she underwent five lumbar surgeries and one cervical surgery. Three vertebrae in her lower back are now fused, as is one in her neck.

“The drugs helped with the pain, but not with getting back to life,” McNair said. “They make you loopy, they make you tired, they make you nod out when you’re taking them.”

The prescription regimen left McNair unable to drive. She could no longer focus in class, so she put her education on hold. Despite being dependent on opioids for pain relief, McNair said she was luckier than many people. She never got addicted, and eventually stopped taking the painkillers when she felt she no longer needed them.


A teacup of kratom powder, made from the leaves of Mitragyna speciosa, a Southeast Asian tree related to coffee. The DEA plans to make kratom a Schedule I drug as early as the end of September.

Then McNair discovered the herbal supplement kratom. Now that’s all she takes.

“I’ve been able to replace all the prescription medicines,” McNair said.

Kratom is made from the leaves of Mitragyna speciosa, a Southeast Asian tree related to coffee. People have been using it in Asia for centuries and perhaps longer, and laborers today still chew the leaves for energy.

In the 20th century, kratom, which contains alkaloids that activate opioid receptors, gained popularity in Thailand as a replacement for opium. Although most opioids have sedative qualities, low to moderate quantities of kratom actually serve as a mild stimulant.

McNair takes capsules filled with the powdered plant matter a few times a day. The kratom works quickly to address her pain, while giving her energy and focus, she said. McNair is taking classes again, and she’s happy to have gotten her life back.

Stories like McNair’s aren’t uncommon.

Kratom has been gaining popularity in the West over the past few years, attracting attention from prospective patients and drug warriors alike. People most frequently use kratom as a treatment for chronic pain and a variety of other symptoms, including anxiety, depression and opioid addiction.

Many kratom advocates suffer from debilitating disorders, like fibromyalgia, or severe joint pain stemming from past injuries or surgeries. Others carry only psychological pain. Most users have spent years searching for a way to effectively treat their conditions, a quest that more often than not involves a variety of prescription drugs.

Some say the pills [pharmaceuticals/opioids] didn’t work at all. Others say they did, but at an extreme cost, including acute side effects, crippling dependency or addiction.

Kratom is different, they claim, and provides many of the same benefits without the downsides. Thousands of kratom users now gather online to share their experiences and coordinate bulk purchasing of raw kratom powder from farmers in Asia.

But the federal government seems to think kratom is too good to be true. The Drug Enforcement Administration announced last month that it was moving to place kratom in Schedule I -- alongside heroin and LSD -- as soon as Sept. 30. Drugs in this category are considered to have no known medical benefit and a high potential for abuse. They also carry harsh legal penalties for possession and distribution.

The DEA argues this move is necessary because kratom hasn’t been approved as a medical treatment by any federal regulatory agency. Isolated reports also suggest that a small though growing number of Americans are doing harm to themselves by abusing the herb. In the six years from January 2010 to December 2015, U.S. poison centers handled 49 cases associated with kratom that involved “life-threatening signs or symptoms, with some residual disability.” It’s unclear how significant a role, if any, the kratom itself played in these episodes, as many incidents involved people who had taken multiple substances. But the DEA used the finding as a basis to conclude that the herb poses an “imminent hazard to public safety.”

Kratom advocates are now crying foul at the federal government’s rush to make them criminals without ever having sought their input or any sort of public comment. They accuse the DEA of cherry-picking data and misrepresenting kratom’s potential for harm, while failing to differentiate between natural forms of the herb and the legitimately concerning “gas station” kratom products, which may be mislabeled or contain unknown adulterants.

Users also say the DEA ignored emerging science that could support anecdotal evidence of the herb’s therapeutic benefits. One doctor has even suggested that the alkaloids in kratom could help lead to the development of safer alternatives to the narcotic painkillers that have helped fuel the opioid epidemic.

As the kratom community shares its own experiences in an attempt to fill in the gaps deliberately left by the DEA, a few themes become clear.

Most kratom users are not fanatics of quack medicine. Some may be deeply skeptical or distrustful of pharmaceuticals, but not without reason. Many people who have turned to kratom only did so after years of failed attempts to find effective treatment through more traditional avenues. Kratom works for them where those methods failed.

For some, the herb seems to border on a miracle drug. For others, it’s simply a cheaper, milder, all-natural alternative to the pills they’d gotten from doctors. Many believe more broadly that they should be free to choose their own treatment without government intrusion, a point of view that clearly puts them at odds with the DEA.

Kratom users are also convinced that the herb has a low potential for acute harm -- a view supported by preliminary research -- and believe people are misstating the risks associated with addiction and dependency.

Most users claim that taking too much kratom, or raw kratom ingested on its own, at least, will lead only to nausea and vomiting. And while most users claim kratom is not physically addictive, they admit it can lead to dependency.

But many of the people who use kratom have serious underlying medical conditions that require some form of treatment. If they weren’t dependent on kratom, they say, they’d be dependent on something else. Because kratom doesn’t drive them to other drug-seeking behavior or leave them with intense withdrawal symptoms, they see it as a preferable substitute to prescription opioids.

Users also believe the sudden move to ban kratom exposes the federal government’s hypocrisy when it comes to addressing the suffering unleashed by the opioid epidemic. The White House and members of Congress have been vocal about encouraging doctors to prescribe fewer opiates, but now the DEA is banning an herbal alternative that has already allowed many people to get off of such narcotic painkillers, or to avoid them completely.

Kratom has also been used to wean people off heroin or other prescription maintenance treatments for opioid addiction. Users are quick to point out that pharmaceutical companies must be pleased by the DEA’s move to kill off an affordable competitor.

Above all, however, kratom users are passionate about having found a treatment that works for them. And now, they’re distraught about being forced to choose between continuing to use kratom criminally, returning to pharmaceuticals or potentially ending treatment altogether.

Hightower: How Can a CEO Feel Good About Price Gouging to Get Rich? Gouging people on the price of a life-saving medicine in order to jack up CEO pay.

Corporate price gouging is never nice. But gouging people on the price of medicines they rely on to stay alive is worse than not nice -- it's predaceously evil.

And if you think corporate morality can't go lower than that, how about gouging people on the price of a life-saving medicine in order to jack up the personal pay of a drug maker's CEO? That's the bottom level of grotesque immorality where Heather Bresch dwells.

SEE Pharmaceutical Industry and Prices

SEE Drug Prices in U.S.



NSAIDS

What Do You Really Know About Scary Ibuprofen Side Effects? Ibuprofen is one of the most popular pain relievers in the pharmacy. Do you read labels and stay alert for ibuprofen side effects? Learn about symptoms to watch for!

Ibuprofen Side Effects:

Heartburn, abdominal pain, nausea, vomiting
Ulcers, bleeding ulcers, perforated ulcers
Headache, dizziness, drowsiness, disorientation
Skin rash, sensitivity to sunlight, itching
Fluid retention, HIGH BLOOD PRESSURE
HEART FAILURE, heart attack, stroke
Irregular heart rhythms (AFib)
Ringing in ears, hearing changes
Visual disturbances
LIVER DAMAGE, KIDNEY DAMAGE

Overdosing on NSAIDs:

A new study suggests that many people exceed the daily limit of OTC ibuprofen (Pharmacoepidemiology & Drug Safety, Jan. 26, 2018). They may also take two different NSAIDs during the same day, without realizing it.

Someone might be relying on Motrin IB for a backache during the day and Aleve PM to get to sleep at night. The Motrin IB contains ibuprofen and the Aleve contains naproxen. Both are NSAIDs.

Another example: someone may be taking Advil for a headache and also taking Dristan Sinus for nasal congestion. The two products contain ibuprofen, so it would be like doubling the dose. That could also lead to an increased risk of ibuprofen side effects.

Are We Taking Some Medicines for Too Long?

NSAIDs

Available both over the counter and in prescription strength, nonsteroidal anti-inflammatory drugs (NSAIDs) have long carried warnings about potential heart attack and stroke risks. Earlier this month, though, the FDA decided to strengthen warnings on those medications, which include ibuprofen and naproxen.

After looking at new safety information, the agency determined the risks are greater than first thought, and are seen even with short-term use and in people without a history of heart disease.

“The risk appears greater at higher doses,” according to the FDA. “Use the lowest effective amount for the shortest possible time.”

Talk to your doctor before you stop taking NSAIDs or if you feel you need them for an extended period, experts say. Ask why you’re taking the drug and if there are other options.

Sleeping Pills

Whether or not they are anticholinergics, prescription and over-the-counter sleeping pills are not for long-term, nightly use.

“You can build up a tolerance to them and then the same dose will no longer be effective,” Chou says. This can make sleeping even harder.

Statins

For many people, the potential risks that statins bring do not outweigh the main benefit: prevention of heart disease. For instance, “We may need to reduce your risk or prevent a second heart attack,” Marciniak says.

In rare cases, statins can hurt your liver. You should call your doctor if you are unusually tired, have lost your appetite, or have right upper abdominal discomfort, dark urine, or yellowing of your skin or the whites of your eyes.

Some people who take statins say they had mild memory loss after starting the drug, but researchers say there is not enough evidence to support a connection between the two. Side effects such as muscle pain may also be common.

Popular Heartburn Meds Tied to Heart Attack Risk brands like Zantac, Pepcid and Tagamet... When stomach acids are blocked, the body is less able to absorb certain nutrients, including magnesium, calcium and vitamin B12... Some research has also suggested the medications can interact with the clot-preventing drug Plavix, lowering its effectiveness.

Lyrica and Weight Gain | Can It Be Reversed? Nerve pain (neuropathy) can be incredibly challenging. FDA-approved drugs can have unexpected side effects including fatigue, dizziness and brain fog. Lyrica and weight gain is another complication.


Generic Drugs

Elizabeth Warren: It’s time to let the government manufacture generic drugs

Forty-seven states and the Justice Department are investigating a price-fixing conspiracy that’s driving up the cost of generic drugs in the United States. One investigator called it “most likely the largest cartel in the history of the United States.” This crisis calls for action. That is why I’m introducing legislation to authorize the public manufacture of generic drugs wherever drug companies have warped markets to drive up prices.

Drug companies use the “free market” as a shield against any effort to reduce prices for families. But they’re not operating in a free market; they’re operating in a market that’s rigged to line their pockets and limit competition. The entire pharmaceutical industry in reality runs on government-granted monopolies, mostly in the form of long-term patent protections.

This system, intended to compensate drug companies for innovation costs, should be closely scrutinized. One of its few remaining virtues is supposed to be that when these exclusive monopolies run out, market competition kicks in to produce cheap, generic versions for consumers. Sounds great — but it isn't working.

Antibiotics, steroids, heart medications, thyroid pills — nearly 90 percent of American prescriptions are written for generics. But the generic drug market is fundamentally broken.

Today, 40 percent of generic drugs are made by a single company, and the majority are manufactured by only one or two companies. With so little competition for generics, drug makers can push up prices and squeeze consumers without consequence. As a result, prescription drug prices are crushing families. Millions of Americans are skipping required doses and putting their health at risk because they can’t afford to renew their prescriptions.

Promoting competition used to be a central goal of economic policymaking. Today, in market after market, competition is dying as a handful of giant companies gain more and more market share. And as these companies get bigger, they create a vicious cycle, spending millions more on politics and lobbying to rig the rules, crushing potential competitors and further insulating themselves from legal or market accountability.

It doesn’t have to be this way. Aggressive enforcement of laws protecting competition is just the beginning. In the prescription drug market, the next step should be public manufacturing.

The Affordable Drug Manufacturing Act would allow the Department of Health and Human Services to step in where the market has failed. HHS would manufacture or contract for the manufacture of generic drugs in cases in which no company is manufacturing a drug, when only one or two companies manufacture a drug and its price has spiked, when the drug is in shortage, or when a medicine listed as essential by the World Health Organization faces limited competition and high prices.

Public manufacturing will be used to fix markets, not replace them. The Affordable Drug Manufacturing Act would allow the government to manufacture generic drugs at lower costs or contract with manufacturers to produce the drugs at competitive prices. And if a potential manufacturer thinks it can do better, the bill provides that the license to manufacture the drug is continually offered for sale, with the only condition being that the buyer would agree to keep selling the product to consumers at competitive prices.

Sound radical? It isn’t. The federal government already contracts with private manufacturers to produce stockpiles of drugs critical to protecting and treating Americans in the event of a biological, chemical or nuclear attack. My proposal would use similar tools to address the public health crisis resulting from unaffordable medicines.

There’s more to do to bring down high drug prices. Medicare should aggressively negotiate with drug companies. We should crack down on rampant abuse of the patent and regulatory system. We should import drugs from countries that sell the same medicines, with the same safety standards, but that charge their citizens a fraction of our costs. And I’ve already introduced legislation to make sure that no family will ever pay out of pocket more than a modest amount per month to fill its prescriptions. But in the battle for sustainable, affordable medicines, public manufacturing of generic drugs can be a critical tool.

The giant drug companies fighting to protect and expand their monopoly handouts will hate this idea. But Congress doesn’t work for them. And so long as these companies continue to game the system, we should insist on competitive markets that actually work for consumers.

What Are Authorized Generic Drugs and Are They Better? Have you ever had problems with generic drug substitutes? If so, have you ever asked for authorized generic drugs? Learn what they are and why they might be better.

The trouble with generic drugs is that many of the ingredients are now made in China without a lot of FDA oversight. Finished pills are often manufactured in India, Thailand, Slovakia, Brazil, Mexico and goodness knows where else. We have questions about FDA monitoring. That’s why authorized generic drugs intrigue us. Sadly, many health professionals have no idea what they are.

Why Is It So Hard To Get Authorized Generic Drugs?

Q. I want to share my experience trying to purchase an “authorized generic” drug. Our doctor did not know what that phrase meant, nor did any of the pharmacists we talked to.

I found online the label information for the authorized generic and supplied that to CVS. CVS ordered the drug using the NDC code, but that was over a month ago and it is still not in stock.

Walgreen could not find the NDC code in their computer. In the meantime, we had to go ahead and buy the brand-name drug–over $500 for a 30-day supply. Why is this so difficult?

What Are Authorized Generic Drugs?

When a brand name medicine loses its patent, the original manufacturer sometimes strikes a deal with a generic drug maker. That allows the generic company to sell the exact same formulation, made from the same “recipe.” Sometimes the authorized generic is made on the same production line as the brand name drug.

As you discovered, most health professionals are unaware of this category. That may be in part because the generic drug industry, pharmacies and the FDA have promoted the idea that generic drugs in general are just as good as their brand name equivalents.

National Drug Code Directory The NDC code is like an ISBN.



Dry Mouth

Your Mouth and Your Health Some studies show that people with gum disease are more likely have heart disease than those with healthy gums.

Diabetes can reduce the body’s resistance to infection. Elevated blood sugars increase the risk of developing gum disease. What's more, gum disease can make it harder to keep blood sugar levels in check. Protect your gums by keeping blood sugar levels as close to normal as possible. Brush after each meal and floss daily. See your dentist at least twice a year.

dry mouth (called xerostomia). Saliva helps protect teeth and gums from bacteria that cause cavities and gingivitis. So a perpetually dry mouth is more susceptible to tooth decay and gum disease.

Medications That Cause Dry Mouth

People under stress produce high levels of the hormone cortisol, which wreaks havoc on the gums and body. Stress also leads to poor oral care; more than 50% of people don't brush or floss regularly when stressed. Other stress-related habits include smoking, drinking alcohol, and clenching and grinding teeth (called bruxism).






Vaccines

Top Reasons You Can’t Trust Your Doctor [about vaccines]

STORY AT-A-GLANCE

Increasingly, parents are left feeling belittled or threatened by their children’s doctors should they so much as question the U.S. Centers for Disease Control and Prevention’s (CDC) vaccination schedule

There are stories from across the U.S. of people who have been dismissed from medical practices or yelled at by their physicians over questions regarding vaccination or personal decisions of whether or not to vaccinate

It’s a doctor’s job to inform his or her patients so they’re able to make an educated decision about their medical care; it’s not a doctor’s job to make that decision for the patient

Physicians and pharmaceutical companies that people are expected to blindly trust when it comes to vaccinations are the same ones who are implicated in creating a deadly opioid epidemic and who, via medical errors, are a leading cause of death in the U.S.

Aluminum in Vaccines Cause Autism Posted on: Thursday, July 12th 2018 Written By: Dr. Jeffrey Dach, MD

The most alarming public health issue is the relentless increasing autism epidemic. New Jersey reports 1 in 34 children, and about 5 percent of Eight-Year-Old boys affected as of 2014.(10) If this rate continues, half of all children born in 2025 will be autistic according to Stephanie Seneff PhD.

Our government health agencies, academic medicine and public health institutions have been silent on this question of what is causing the autism epidemic. They merely shrug their shoulders and say "we don’t know", quickly adding, "It is certainly not vaccines".

The Vaccine-Autism Video the CDC, Big Pharma Doesn't Want You To See by GreenMedInfo Reporter

Top Doctors Reveal Vaccines Turn Our Immune System Against Us

GMI Posted on: Tuesday, November 13th 2018 Written By: Celeste McGovern

The research is hard to ignore, vaccines can trigger autoimmunity with a laundry list of diseases to follow. With harmful and toxic metals as some vaccine ingredients, who is susceptible and which individuals are more at risk?

But something strange is happening in the world of immunology lately and a small evidence of it is that the Godfather of Autoimmunology is pointing to vaccines – specifically, some of their ingredients including the toxic metal aluminum – as a significant contributor to the growing global epidemic of autoimmune diseases. The bigger evidence is a huge body of research that's poured in in the past 15 years, and particularly in the past five years. Take for example, a recent article published in the journal Pharmacological Research in which Shoenfeld and colleagues issue unprecedented guidelines naming four categories of people who are most at risk for vaccine-induced autoimmunity.

"On one hand," vaccines prevent infections which can trigger autoimmunity, "On the other hand, many reports that describe post-vaccination autoimmunity strongly suggest that vaccines can indeed trigger autoimmunity. Defined autoimmune diseases that may occur following vaccinations include arthritis, lupus (systemic lupus erythematosus, SLE) diabetes mellitus, thrombocytopenia, vasculitis, dermatomyosiositis, Guillain-Barre syndrome and demyelinating disorders. Almost all types of vaccines have been reported to be associated with the onset of ASIA."

"Throughout our lifetime the normal immune system walks a fine line between preserving normal immune reactions and developing autoimmune diseases," says the paper. "The healthy immune system is tolerant to self-antigens. When self-tolerance is disturbed, dysregulation of the immune system follows, resulting in emergence of an autoimmune disease. Vaccination is one of the conditions that may disturb this homeostasis in susceptible individuals, resulting in autoimmune phenomena and ASIA."

Who is "susceptible" is the subject of the paper entitled, "Predicting post-vaccination autoimmunity: Who might be at risk?" It lists four categories of people: 1) those who have had a previous autoimmune reaction to a vaccine, 2) anyone with a medical history of autoimmunity, 3) patients with a history of allergic reactions, 4) anyone at high risk of developing autoimmune disease including anyone with a family history of autoimmunity, presence of autoantibodies which are detectable by blood tests and other factors including low vitamin D and smoking.

Ebook: Vaccines and Brain Health

PDF doc is in Documents

What Do Vaccines Have to Do With Brain Health?

A GOOGLE SEARCH FOR ‘VACCINE SAFETY’ will return an overwhelming amount of conflicting, and often emotionally-charged, rhetoric about vaccines. Objective, scientifically-validated information about the risks and benefits of vaccines can be difficult to identify. As a passionate believer in the power of informed consent, I feel that we have a right to know the full breadth of available data so that we’re empowered to make our own decisions about our bodies and our children.

To make your own judgment, it’s important to understand how vaccines work, who is recommending them, and why - and to ask questions. Because no one should be threatened by the process of further inquiry.

A new model of depression as an inflammation-mediated evolutionary mismatch, as opposed to a serotonin deficiency, is introduced and supported by a number of scientific studies.

Since vaccines were designed before the discovery of DNA, the understanding of epigenetics, and the relevance of chronic inflammation as a disease driver, the inflammation that is deliberately caused by vaccines should be independently examined as a risk factor for inflammation-linked diseases, especially as vaccineinduced immune responses are fundamentally different from those generated by natural infection.2

I suggested that the current one-size-fits-all approach to vaccination needs further scientific study, especially in terms of disease protection claims and brain-related adverse effects. Emerging science has called into question the effectiveness of vaccines, including the documentation of outbreaks in highly to completely-vaccinated populations4 and the finding that disease-causing microbes are quickly evolving to escape vaccine-induced immunity.5 Importantly, women, who are underrepresented in scientific study groups and more prone to autoimmunity, may incur an increased risk of adverse effects from vaccines.

Since the publication of my review article, another study emerged that linked vaccines to psychiatric disorders.7 Analyzing data from thousands of children, researchers found that children who had been diagnosed with OCD, anorexia, anxiety, tics, or ADHD were more likely to have received a prior vaccination than their matched controls.

Perhaps even more compelling is an April 2017 scientific article, the first of its kind, that compared age-matched vaccinated and unvaccinated children to determine if there were significant differences in the diagnoses of acute and chronic illnesses. Researchers polled the parents of over 650 homeschooled children, aged either 6 or 12. In this mostly-Caucasian group, 39% of children were unvaccinated, 31% partially vaccinated, and 30% fully vaccinated. Using sophisticated statistical analyses to control for other variables, researchers determined the likelihood of acute and chronic illnesses with respect to vaccination status.

In terms of acute illnesses, vaccinated children were significantly less likely to have had chicken pox, whooping cough (pertussis), and rubella (though the rubella incidence was not significant). Vaccinated children were more likely to have suffered from otitis media (ear infection) and pneumonia, and there was no difference between vaccinated and unvaccinated groups in terms of Hepatitis A and B, high fever, measles, mumps, meningitis, influenza, and rotavirus.

Now here’s where it gets interesting. Vaccinated children were significantly more likely to have been diagnosed with a variety of chronic diseases. Perhaps most alarmingly, children who had received vaccines had higher incidences of neurodevelopmental disorders, including learning disabilities, ADHD, and Autism Spectrum Disorder, at a rate of 10.5% compared to 3.1% of unvaccinated children. Here is a full table of increased chronic illness due to vaccines:

The Study

Chronic Illness

% Vaccinated

% Unvaccinated
Allergic Rhinitis
10.4%

0.4%

Other Allergies
22.2%

6.9%

Eczema, Dermatitis
9.5%

3.6%

Learning Disability
5.7%

1.2%

ADHD
4.7%

1.0%

All neurodevelopment
10.5

3.1%

All chronic diseases
44.0%

25.9%

Why am I writing this article, which will cover the fundamental mechanisms of vaccines as well as current studies? I wish to provide an objective, scientific foundation for open dialogue on a topic that affects all of us.

Vaccines Are Designed to Promote Inflammation

VACCINES AS WE KNOW THEM were born about 200 years ago, when Edward Jenner, widely considered the father of vaccination, took pus from a cowpox lesion on a young dairymaid’s hand and injected it into an 8-year-old farmhand to ‘protect’ him from smallpox. Subsequently, the boy developed a fever and lost his appetite for 9 days. Two months later (in July 1796), Jenner injected the boy with smallpox and noted that he did not develop disease.8 Jenner then concluded that this type of inoculation trains the immune system to be ready to fight off impending threats.

Amazingly, the way vaccines are made today is
not much different from two hundred years ago.

Fundamentally, vaccines are designed to cause inflammation. Following Jenner logic, most vaccines contain a part of the “threat”, called an antigen, combined with chemicals that stimulate the immune system, called adjuvants.

However, independent science is revealing that the immune system is far more complex than we realize. Specifically, there are three emergent scientific discoveries that should completely change the game: the microbiome, exosomes, and the role of psychology or beliefs in medical outcomes

Finally, the influence of our emotions and beliefs on immunity cannot be overstated. Both rigorous science15 and powerful experiences have confirmed the mind-body connection and the power of placebo. When people believe that they will heal, they do: the placebo effect has been shown to resolve depression, mend broken bones,16 and extend the life of cancer patients.17 The mandatory nature of vaccination implies that we cannot trust our bodies to fight off disease, and this fear-based implication erodes the very beliefs that enable true health.

The Current Vaccine Development Process and Schedule are Predicated On Outdated Science

Furthermore, the vaccine schedule is a one-size-fits-all approach that has never (not once) been studied in its ever-growing entirety. Additionally, vaccine formulations have never been studied against a true placebo for FDA approval.

To suggest that a pharmaceutical product should be delivered to all persons regardless of age, weight, health status, and history is to ignore all of the advances of modern science that suggest that biochemical individuality is the key to health and wellness

The current vaccine schedule requires multiple inflammatory chemicals to be injected with little to no time in between, with people (especially babies!) often getting multiple shots in a single office visit. This barrage of antigens and inflammatory chemicals can over-activate the psychoneuroimmune system for years. Amazingly, the MMR vaccine package inserts clearly state that coadministration with other vaccines has not been studied.

Many Vaccine Ingredients are Known Toxins

LET’S REVISIT THE FLU VACCINE, which millions of people of all ages are advised to get each year. What exactly is being injected into people’s muscles?

Vaccines contain ingredients, called antigens, which cause the body to develop immunity. Vaccines also contain very small amounts of other ingredients – all of which play necessary roles either in making the vaccine, or in ensuring that the vaccine is safe and effective.

All the flu vaccine components are potentially toxic; thimerosal is a mercurybased31 preservative, formaldehyde is a known carcinogen, gelatin and egg proteins are allergens, antibiotics are literally designed to kill cells, and I can’t even imagine how muscle cells respond to an influx of straight sugar.

The most common vaccine ingredient, aluminum, is in at least 18 vaccines, including the HepB vaccine that’s ‘required’ for infants. Even though aluminum salts have been injected into people since the 1920s, a 2015 scientific review paper confirmed that we still don’t know how they work.32 Aluminum stays in the body for several years, and it has been linked to chronic fatigue and cognitive decline,33 among other disorders. A pubmed search for ‘aluminum’ and ‘human toxicity’ returns over 4200 studies.

A 2011 study states that aluminum is a risk factor for autoimmunity, long-term brain inflammation, and associated neurological complications.34 In fact, aluminum has been so frequently documented as triggers for autoimmunity that a new term has been coined: Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA).35 Autoimmunity is intimately connected to depression, as these conditions are both symptoms of a misfiring immune system. In fact, a study of 3.5 million people showed that having an autoimmune disorder increased the risk of a mood disorder by a staggering 45%!36

Further, we do know that these aluminum particles can reach the brain.37

Mercury, another of the most common vaccine ingredients, is a known neurotoxin. The ‘safe dose’ of mercury recommended by the EPA is 2 parts per billion (ppb) per liter of drinking water. Amazingly, the flu vaccine contains 50,000 ppb of mercury! 38 Even in very low concentrations, mercury can be toxic to brain cells. In one study, a dose of 0.5 ppb was enough to kill human brain cells.39 A person who complies with the current vaccine requirements will develop a staggering toxic burden, since mercury is in several vaccines, including whooping cough, tetanus, meningococcal, and Hepatitis B.

Vaccines contain a multitude of other toxins that can cross the blood-brain barrier, like formaldehyde, monosodium glutamate (MSG), detergents,40 and foreign proteins that can set off a variety of unpredictable immune responses. Further, several vaccines contain ‘weakened’ versions of viruses, which can activate latent viruses that are otherwise normally harmless.41 Activation of these latent viruses has been linked to schizophrenia and bipolar disorder.42

Antibiotics in vaccines may be the most worrisome component. Antibiotics can kill beneficial bacteria in the microbiome, which orchestrates 70-80% of immune responses.43 Preliminary studies suggest that antibiotic-containing vaccines change the microbiome for the worse. In one study, researchers found that injecting mice with a human flu vaccine led to colonization by harmful bacteria, like Staph aureus. 44 And if you’re pregnant, exposure to antibiotics can increase the chances of your baby developing diseases like IBS, asthma, obesity, and diabetes later in life. Everything is connected, and many of these metabolic diseases coincide with psychiatric diagnoses like depression.

Louis Pasteur, famous for his work in pasteurization and vaccination, later regretted his war on microbes.

As much as I’d love to tell you that the benefits of vaccines are worth the risk, the scientific evidence suggests otherwise. Despite the aggressive vaccine schedule for infants, America has an abysmal infant mortality rate, with 1 in 143 babies dying before age 1.

We are number 4 in infant morality, after Chile and the Slovak Republic.

Scientific evidence is mounting that shows the link between vaccines and suddeninfant death syndrome (SIDS). Most infants die of SIDS at age 2-4 months, when babies are subjected to 11 shots containing 16 different vaccines.

In terms of modern infections, the flu vaccine is notoriously ineffective, with the current estimate of 48% effectiveness against a few strains of many

One study showed that receiving the influenza vaccine actually hampers your immunity, 45 and another showed that this vaccine made people more susceptible to a worse version of the flu, H1N1 (swine flu).46

Further, several studies have shown that disease outbreaks occur in highly or completely vaccinated populations47, 48 and that vaccines can accelerate the evolution of existing microbes49 in a similar way that rampant antibiotic use creates antibiotic-resistant bacteria. Perhaps most strikingly, recent studies suggest that the immune response created by vaccines is incomplete, leading to increased infection risk.50, 51, 52

Overall, scientific data has confirmed the risks, but not benefits, of vaccines. Furthermore, over $3B has been payed out to vaccine-injured adults and children since 1989, and vaccine injuries are likely grossly underreported. It was in 1986 that pharmaceutical companies demanded protection from the government if they were to continue to manufacture vaccines that were incurring so many lawsuits at that point, arguing that they would be financially disabled by the continued consumer wrath.

Because of subsequent legislation, you can no longer hold a pharmaceutical company, nor your doctor, responsible for injuries or even death that may occur as a result of vaccination.

Despite the hundreds of studies that show the toxic effects of vaccine components and counter-indicate vaccination, more and more vaccines are being governmentally mandated. Our current vaccine schedule has TRIPLED in 25 years.

National Vaccine Information Center

GreenMedInfo: How the CDC Uses Fear to Increase Demand for Flu Vaccines

Fearless Parents. Thinking... for a change

International Medical Council on Vaccination

Hormones Matter:

The Earth is Floxed []

(“Floxed” is short-hand for suffering from fluoroquinolone toxicity – an adverse reaction to cipro/ciprofloxacin, levaquin/levofloxacin, avelox/moxifloxacin or any of the other fluoroquinolone antibiotics. Fluoroquinolone toxicity manifests as a multi-symptom, often chronic, disease.)

Living without Antibiotics: Natural Remedies for Common Illnesses

Three years ago I nearly died from a sepsis infection. An antibiotic called Levaquin saved my life. That same antibiotic, which is in the fluoroquinolone class, poisoned me from head to toe. I am still trying to recover from the damage it did to my connective tissue, nervous and digestive systems. I thought as long as I stayed away from fluoroquinolone antibiotics I would be ok. Not so. Two years ago I had strep throat and was prescribed amoxicillin. After a few days, the antibiotic produced a meningitis-like reaction which subsequently worsened my Levaquin-induced symptoms.

All antibiotics disrupt our microbiome, a delicate environment of bacteria affecting our immune, nervous, digestive, and endocrine systems. Antibiotics are over-prescribed and big gun fluoroquinolone antibiotics meant to kill anthrax are used for non-life threatening infections. As such, we are creating all sorts of antibiotic-resistant germs and microbial imbalances. In response to these dilemmas, doctors may soon be forced to limit prescribing fluoroquinolones for certain infections.

Here are some general recommendations I found helpful for overcoming any bacterial or viral infection:

1. Remove sugar and processed foods from your diet. They feed bad bacteria and viruses. Your virus or infection will just love you for feeding them, making them stronger and more virulent.

2. Take probiotics. When I feel the first sign of a cold coming on I take a probiotic capsule. The good probiotic bacteria will work with your body’s good bacteria to fight the virus, essentially crowding it out. Keep in mind, antibiotics kill bad bacteria and good bacteria. Antibiotics do not kill viruses. If you take an antibiotic for a virus, in my opinion, you are making the virus stronger because you are wiping out the good bacteria needed to help your immune system fight the virus.

3. Exercise a little, not a lot. When you are sick your body needs to conserve energy to fight the illness. Exercising at your usual pace during an illness puts added strain on your adrenals and immune system. You don’t have to stop exercising completely, just go lightly.

4. Rest and rest often. So many people I know catch a cold, continue to burn the midnight candle either at work or socially, end up with an infection, and are prescribed an antibiotic because they’ve dug themselves into an infectious grave they could have easily avoided by resting. Sleep. Rest some more.

5. Avoid stress, be patient and practice acceptance. Accept you have this illness, that it will take time to heal, and be kind to your body. Stress will make it worse. Practice whatever stress relieving activities work for you, ex. meditation, gentle yoga, applying essential oils, baths, relaxing in a quiet place, etc.

6. Avoid smoking and alcohol. I think this is self-explanatory.

7. Up vitamin and mineral intake, particularly vitamin C. Since your body is working over time, it is likely to be in need of extra vitamins and minerals. There are many different vitamin and mineral supplements but finding one with a high vitamin c content is crucial. You could also get IV vitamin and antioxidant cocktails. Since I no longer get a flu shot, a few IV vitamin C sessions stopped the flu in its tracks last year. See a functional medicine practitioner for these.

8. Try my cold/flu buster cocktail. I swear by this cocktail. Using organic fresh produce: juice 1 teaspoon each of ginger and turmeric root, add squeezed juice from 1/2 lemon and one teaspoon of apple cider vinegar (ACV), a few sprinkles of cayenne pepper, and blend with 8 ounces of your choice of watered down juices, ex. orange, carrot, beet, and/or apple. I drink one or two a day till I feel optimal.










Pharmacy Mistakes

Bad Thyroid Dose [of Levothyroxine] Causes Nasty Symptoms

Over 100 million prescriptions for levothyroxine are dispensed each year in the U.S. Too often, mistakes are made. A bad thyroid dose can cause problems!

Pharmacists and pharmacy technicians make an unbelievable number of mistakes. It is the dirty little secret that most patients never hear about. And the profession of pharmacy is not anxious to study it. It fell to ABC News 20/20 to fund research into pharmacy errors. A study published in the Journal of the American Pharmacists Association (March-April, 2009) revealed that of 100 prescriptions dispensed, one out of every five had an error. This newspaper column reader reports what happened to her when she mistakenly received a bad thyroid dose.

Q. I had a prescription for levothyroxine filled in February and just now noticed that it was for 25 mcg [micrograms]. It should have been 75 mcg.

My internist raised the dose to 100 mcg when my TSH came back as 4.99. CVS made a dispensing mistake. (The pharmacist admitted it.) As a result, I have been taking a third of the prescribed dose.

Do I have any recourse besides letting you know that others should check all their prescriptions carefully? I am happy to have lived through this nightmare.










Opioid Crisis [Latests First]

A lot went wrong with the tobacco settlement. Let’s not make the same mistakes with opioids., 10-8-19

Leana S. Wen is an emergency physician and a visiting professor at George Washington University Milken Institute School of Public Health. She was Baltimore health commissioner from 2015 to 2018 and chief executive of Planned Parenthood Federation of America from November 2018 until July.

When I was health commissioner in Baltimore, my single greatest frustration was inaction around the opioid epidemic.

Every day, more than 130 Americans die from opioid overdose, and Baltimore has not been spared. In 2017, nearly 700 city residents died from this preventable tragedy. Even though I had written a blanket prescription that made the opioid antidote naloxone readily available, limited funding forced first responders to ration this lifesaving medication. Science is unequivocal that addiction is a disease that can be treated. But in Baltimore, and throughout the United States, only a fraction of patients with addiction are getting the treatment they need.

So many more lives could be saved.

Thankfully, we now have an opportunity to secure this funding. Last month, an Oklahoma judge ordered Johnson & Johnson to pay the state $572 million for deceptive marketing practices that fueled the crisis. Purdue Pharma has tentatively reached a $12 billion deal with 24 states and nearly 2,000 cities and counties, and more than 20 state attorneys general are pressing for an even larger settlement. Thousands of other cases are pending against multiple pharmaceutical companies. Taken together, all this could reach the scale of resources needed to treat and prevent opioid addiction once and for all.

All to the good. But there’s one more big hurdle: Will settlement funding be used for its intended purpose?

Recent history is not reassuring. The 1998 Tobacco Master Settlement Agreement shows what can happen when funding decisions on public health matters do not employ a public health approach. That settlement required major cigarette companies to pay an estimated $246 billion over 25 years. The payouts were supposed to be used to fight tobacco-related disease, but only 2.4 percent of revenue collected ended up being spent on prevention and cessation. Instead, states have used funds to subsidize tax cuts and cover budget gaps. In North Carolina, money was even used to help tobacco farmers grow more tobacco.

To prevent a similarly egregious diversion, today’s policymakers should commit — at the outset — to a strong public health framing for the opioid settlement. This starts with tight controls to guarantee that all funds support evidence-based methods of prevention and treatment.

Three key points:

First, there is broad medical consensus that the gold standard for opioid addiction treatment is medication-assisted treatment, combined with psychosocial counseling and other wraparound services such as supportive housing. Rapid “detox” programs do not work, and, in fact, lead to higher rates of overdose deaths. Yet, these detox programs still get government funding, and many states force people to comply with these methods. That needs to change.

Second, resources should be allocated based on severity. In a disease outbreak or natural disaster, funding should be aimed at hardest-hit areas. The Ryan White HIV/AIDS Program, for example, employs a formula that takes into account HIV prevalence and proportionally distributes funding. To ensure efficacy, a similar formula should be used for opioid funding.

Third, that formula must include the core public health principle of equity. Specifically, this means that policymakers must ensure that funds go not just to areas with high rates of prescription opioid usage, but also to places hit hard by heroin and other street opioids.

This critical point brings me back to Baltimore, so I want to elaborate a bit. We know that prescription opioid overuse fueled the street drug epidemic. Patients with opioid addiction frequently switch to heroin because it is cheaper and can be easier to obtain. Effectively addressing the epidemic requires taking stock of the problem as a whole.

A funding distribution that focuses only on one face of the disease would violate public health best practices. It would also worsen racial disparities. Already, many in my city and around the country are angry that opioid addiction was not deemed an epidemic until decades after it claimed the lives of countless people in minority communities.

When the face of addiction was black and brown — and associated with heroin — addiction was seen as a crime and a moral failing; when it became white and associated with pills, addiction became understood as a disease. To be sure, it is an important development that much-needed resources are finally coming to address this crisis. But unless street drugs are given equal weight to prescription opioids, the response will not only be ineffective, it will perpetuate systemic injustice and structural racism that have long undergirded opioid addiction.

The decisions soon to be made in our courts, legislatures and statehouses will answer critical questions. Even now, do our policymakers fully grasp the scale and breadth of their constituents’ suffering? Will they do what’s needed to end this epidemic once and for all?

OxyContin-pushing Sackler billionaires demand ‘the benefit of bankruptcy without the burdens’, 9-20-19

Drug companies seek removal of judge in landmark opioid case, 9-14-19

Drug industry lawyers facing more than 2,000 lawsuits over their alleged roles in the opioid epidemic demanded Saturday that the federal judge overseeing the case step aside, questioning his impartiality because he has consistently urged both sides to settle the case.

The request comes after a series of stinging rulings against the companies by U.S. District Judge Dan Polster in the historic trial slated to begin Oct. 21.

Opioids Aren't the Problem - If we want to save lives, we have to change the way we talk about drugs.

As overdoses soared, nearly 35 billion opioids — half of distributed pills — handled by 15 percent of pharmacies

The Opioid Files - ‘We was addicted to their pill, but they was addicted to the money’, 8-8-19

SLIDE SHOW

In southwest Virginia, those devastated by the opioid crisis are demanding accountability after a previously unreleased government database reveals just how many drugs flooded their towns.

This is a remote part of America. But it was not out of reach of the drug industry.

Over seven years, the database shows, drug companies shipped a combined 74 million opioid pills to the city of Norton, Va., and the three surrounding counties — enough for 106 pills per resident every year.

nternal emails reveal some of the companies were aware of a growing addiction crisis, but the pills just kept coming.

Jason Boyd, a father of four, has been in recovery for 12 years, with some relapses. He works part-time at McDonald’s. In high school, Boyd and his friends started experimenting with prescription pain pills. They were never hard to find. By his 20s, he was addicted.

"We was addicted to their pill, but they was addicted to the money because that’s what it is about. The definition of murder is when you sit and you plan about how killing somebody. Well that’s pretty much the definition of what they done. They sit back and say, ‘All right, this is addictive,’ but it’s same thing as just sitting there saying, ‘Well we will murder a whole bunch people and make millions of dollars off of it.'"

"It’s just a daggone shame that it has come to this — for all these people to die – before they start even looking into it, you know? I mean, how can you sleep at night knowing that you helped, pushed all these thousands of — millions of — pills to people and destroy lives?"

People here are familiar with pain. Coal miners tell stories of explosions they survived. Disability rates are high. This was a place where the purveyors of pain pills found a ready market.

In 1996, Purdue Pharma introduced OxyContin, a slow-release form of oxycodone. The company marketed the pill aggressively to doctors, contending it was less likely to result in addiction. But people became addicted. And the pills migrated to the streets.

'He’s got this drug they’re calling Oxy'

Richard Stallard was on the Southwest Virginia Drug Task Force, based in Big Stone Gap, until he retired in 2016. He busted drug dealers for more than two decades, much of that time working undercover.

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No one knows why some people become quickly addicted to opioids while others don’t. What’s certain is that opioid addiction changes a person’s brain. People who are addicted say the drug becomes the main focus of their life, more important than family or faith, so all-consuming that they would steal money, jewelry and anything else of value to pay for the drugs they crave.

A war inside your mind’

Chassidy Carver is a nurse in Wise, Va. She’s also recovering from addiction. She became hooked on opioids when a doctor prescribed them to treat the pain from kidney stones. She was addicted for 14 years.

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Most people got their pills from local mom-and-pop pharmacies in small towns. To get a pill, they first had to see a doctor and get a prescription. Pharmacists noticed a pattern in opioid prescriptions: Small doses were becoming large doses.

Some doctors have been arrested and convicted of crimes related to prescription fraud. But the crackdown on shady doctors and so-called “pill mills” did not end the drug epidemic.

‘They all drank the Kool-Aid’

Greg Stewart is a retired pharmacist in Lee County, Va. As the opioid crisis exploded, Stewart and fellow pharmacist Dennis Parker started to refuse to fill prescriptions for pain pills.

Purdue Pharma says, “OxyContin has always had FDA-approved labeling disclosing that the medication has a risk of addiction” and that promotional materials “were submitted to the FDA for review.”

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Purdue says it stopped using a sales force to promote opioids in February 2018. By then, people with addictions had found other drugs to replace the pills. Heroin came in from big cities. Much of the heroin is now laced with fentanyl, which is 50 times more potent. The biggest problem in the area now is methamphetamine, which is cheaper and easier to find.

‘I’m amazed I am alive.’

Christina Roark is recovering from addiction. She became hooked in her early 30s after taking pain pills prescribed to her husband, who had injuries from his time in the military.

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Towns and cities across America are fighting back against the drug industry, seeking billions of dollars in damages to treat addiction and rebuild their communities. The city of Norton, Va., along with Wise, Lee and Russell counties, are part of a massive civil lawsuit involving nearly 2,000 communities, now in federal court in Cleveland.

At the center of that lawsuit is a previously unreleased Drug Enforcement Administration database, called ARCOS, which became public through legal action by The Washington Post and HD Media, owner of the Charleston Gazette-Mail in West Virginia.

The database shows America’s largest drug companies distributed 76 billion oxycodone and hydrocodone pain pills across the country from 2006 through 2012. As the opioid epidemic surged, so did the number of pills.

‘A lot of people in this community have died.’

As district director of the Virginia Department of Health in this part of the state, Sue Cantrell has been on the front lines of the crisis from the beginning. After she sounded the alarm for years about the toll of opioids, the revelations confirmed what she had long suspected.

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Even for those who get sober, finding jobs and security is a constant struggle. They find comfort in each other. They want to rebuild their lives. They want to spread the message that there’s a life beyond addiction. There’s hope.

Prosecutors bring rare criminal charges against Ohio opioid distributor, 7-18-19

Federal prosecutors in Cincinnati filed criminal charges Thursday against an opioid distributor and two of its former executives, accusing them of conspiring with doctors and pharmacies to pour millions of addictive pain pills into Ohio, West Virginia and Kentucky.

The indictment of Miami-Luken, its former president and its former compliance officer was the second time in three months that federal prosecutors have used criminal laws against a drug distributor in their efforts to stem the prescription opioid epidemic. That is a more aggressive posture than the Justice Department has adopted since 2007, when it began using civil and administrative actions to enforce laws against drug distributors.

"There’s a need, in my opinion, to devote sufficient charges right here and now to stop the dying,” U.S. Attorney Benjamin C. Glassman said.

The single count of the grand jury indictment accused former Miami-Luken president Anthony Rattini and former compliance officer James Barclay of knowingly distributing powerful narcotic painkillers for other than medical reasons. The company itself, which went out of business late last year, also was charged.

Two West Virginia pharmacists, Devonna Miller-West and Samuel R. Ballengee, who owned small-town drugstores that allegedly received millions of pills, were also charged. All face as much as 20 years in prison.

The Washington Post could not reach the four people indicted via telephone or email, or identify their attorneys. Richard Blake, an Ohio attorney, said he represents the defunct company.

The indictment says Miami-Luken ignored “obvious signs” that drugs were being diverted to illegal users and dealers between 2011 and 2015. Prosecutors said the company sent 4.9 million pills to Miller-West’s drugstore in Oceana, W.Va., where the population is 1,394.

Miami-Luken sent more than 6 million pills between 2008 and 2014 to Ballengee’s Tug Valley Pharmacy in Williamson, W.Va., where about 2,800 people live, according to the charges. The pharmacy is now closed.

Glassman said investigators found “many overdose deaths that could arguably be linked to the conduct” of people accused in the conspiracy, but did not obtain enough evidence to charge anyone.

The conspirators “unlawfully enriched themselves” by “distributing and dispensing large amounts of opioids to known pill mills,” prosecutors charge. The conduct continued, the indictment alleges, even after warnings from the Drug Enforcement Administration.

Some of the drugs went to other unnamed pharmacists and physicians, the indictment alleges. Starting in 2008, for example, the company sent more than 750,000 pills to a physician despite knowing the doctor was under DEA investigation for illegal drug distribution.

In 2016, The Post reported that a Wheelersburg, Ohio, physician ordered large amounts of oxycodone from Miami-Luken the company did not investigate, according to the DEA.

Miami-Luken was a midsize drug distributor that shipped pharmaceuticals to more than 200 locations in Ohio, West Virginia, Kentucky, Indiana and Tennessee, some of the states hardest hit by the opioid epidemic.

In April, the U.S. attorney in New York brought criminal charges against Rochester Drug Cooperative, another opioid distributor, in the first use of that tactic against a middleman in the drug supply chain.

Under federal law, those wholesalers are required to monitor the flow of controlled substances and alert the DEA when they identify suspicious purchases that could indicate pills are being diverted to the black market. But many companies ignored that responsibility as profits soared, authorities allege.

The Post and “60 Minutes” reported in 2017 that DEA investigators wanted criminal charges filed against executives of the largest drug distributor, McKesson Corp., after they built a case against the firm involving suspicious orders from drugstores across the country. But they were rebuffed by federal prosecutors and the Justice Department, which settled with the company and fined it $150 million.

The Post revealed this week that previously undisclosed DEA data shows drug distributors saturated the country with 76 billion opioid pills between 2006 and 2012, many more than previously known.

Five takeaways from the DEA’s pain pill database

For the first time ever, a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city — is being made public. The data was released as part of the largest civil action in U.S. history and provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which resulted in nearly 100,000 deaths from 2006 through 2012.

Here are The Post’s biggest takeaways:

1. The national database has never been released publicly.

The database is based on previously unreleased company data supplied to the DEA and reveals what each company knew about the number of pills it was shipping and dispensing, year by year, town by town. It is a virtual road map to the opioid epidemic. The drug companies, along with the DEA and the Justice Department, have fought furiously against the public release of the database, the Automation of Reports and Consolidated Orders System, known as ARCOS.

2. The companies flooded the nation with pills as the opioid epidemic raged.

A Washington Post analysis of the database shows that America’s largest drug companies distributed 76 billion oxycodone and hydrocodonepain pills across the country between 2006 and 2012 as the nation’s deadliest drug epidemic spun out of control.

About two dozen companies are being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids. The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies, and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.

3. A handful of companies manufactured and distributed most of the opioids.

Just six companies distributed 75 percent of the pills — oxycodone and hydrocodone — during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post.

Three companies manufactured about 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

4. The number of pills distributed skyrocketed over seven years.

The volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the same period.

The numbers of pills the companies sold during the seven-year time frame are staggering, far exceeding what has been previously disclosed in limited court filings and news stories.

The opioid epidemic began with prescription pills, spawned increased heroin use and then resulted in the current fentanyl crisis, which added more than 67,000 to the death toll from 2013 to 2017.

5. Some states and rural areas were saturated.

The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate from 2006 through 2012.

Rural areas with the greatest number of pills shipped per person per year were: Norton, Va., with 306; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175.

New opioid data spurs widespread condemnation, calls for action

The Washington Post recently published a massive database that tracks the distribution of opioids in the United States from 2006 to 2012, specifically where — and how many — drugs materialized. During that period, 76 billion prescription pain pills were manufactured and shipped to pharmacies all over the country, fueling a public health epidemic that killed 100,000 Americans in those seven years.

Drilling into the DEA’s pain pill database

Policymakers, media outlets and others are using this data to understand the sheer scope of the crisis, and many are demanding accountability.

Those who push poison into our kids and communities will be held to account

White House counselor Kellyanne Conway touted the president’s efforts to tackle the opioid crisis, arguing in a statement Monday that the Trump administration “has tackled it head on” while the Obama administration “ignored the growing drug crisis roiling this country.”

Conway said the White House is “watching as authorities name and shame those responsible” for the crisis.

“Those who push poison into our kids and communities will be held to account,” she said. “The sheer number of pills flooding numerous corners of this country while politicians looked the other way is an alarming disgrace that has cost thousands of lives and ruined many more.”

'Corporate greed:’ 2020 Democratic presidential candidates demand action

Senators and Democratic presidential hopefuls Elizabeth Warren (Mass.), Amy Klobuchar (Minn.) and Kamala D. Harris (Calif.), as well as former housing secretary Julián Castro and Montana Gov. Steve Bullock, tweeted about the data.

Warren and Castro accused Big Pharma of “corporate greed.” Warren also promoted her legislation to invest $100 billion over 10 years to combat the epidemic, which hasn’t gained any traction in Congress. Harris said, “It’s past time we hold pharmaceutical companies accountable.” Klobuchar called it “disturbing” and shared a quote from internal emails included in a court filing showing a drug company employee comparing the pills to “Doritos” that people “keep eating.”

Bullock focused his ire on the influence that Big Pharma’s deep pockets have on Washington.

Bullock tweet: As Big Pharma was spending Big Money to influence our elections, they were flooding our country with billions of opioids. We can’t turn a blind eye to how these companies cut big checks to wield political power.

'My Department of Justice will go after these folks'

Sen. Cory Booker (D-N.J.), who is also running for president, was asked about the data during a Washington Post Live event, specifically whether he’d want his Justice Department to prosecute drug companies.

"My Department of Justice will go after these folks, these pharmaceutical companies that have been fueling this opioid crisis, where it was an intentional strategy to juice the addiction of Americans to this drug, causing our life expectancy as a nation to go down,” Booker said. “This is criminal behavior, immoral behavior, and my DOJ will go after it."

'It got worse and worse and worse over time'

MSNBC’s Rachel Maddow dedicated a lengthy segment on Friday night to the searchable county-by-county opioid database. Maddow broke down some of the statistics for her viewers, saying “it got worse and worse and worse over time.”

“As the opioid crisis lit the country on fire and the death rates started skyrocketing and the country started freaking out about it, over the course of those seven years from 2006 to 2012, while 100,000 Americans were killed from those drugs, we can now tell they kept upping the number they were shipping every year,” Maddow said.

"By 2012, they were shipping on average 36 highly addictive pain pills for every man, woman and child and baby in the United States,” Maddow added.

McConnell challenger turns opioids data political

Amy McGrath, the Democrat hoping to unseat Senate Majority Leader Mitch McConnell in Kentucky, one of the states hit hardest by the opioid crisis, used the database Thursday to assail McConnell’s ties to drug companies.

Amy McGrath tweet:

Opioids are ravaging Kentucky and destroying our families.

The pharmaceutical industry flooded our state with almost 2 billion prescription pain pills over six years.

Mitch McConnell has taken $1.34 million from pharmaceutical companies.

Do the math

McConnell, who has been majority or minority leader since 2007, did not comment on The Post’s database. But about 90 minutes after McGrath’s tweet, he shared news that drug overdose deaths fell in Kentucky in 2018, the same year Congress passed its first comprehensive bipartisan opioid legislation and 12 years since the drug companies opened the floodgates.

Local media digs into data

Reporters from coast to coast used the database to expose the amount of prescription opioid pills that flowed to their communities.

For example, Kenny Choi of KPIX-TV in San Francisco tweeted:

These numbers are staggering from Alameda, San Francisco, Contra Costa County #bayarea #OpioidCrisis ?CHECK how many pain pills supplied in your county via @washingtonpost?

Christine Kennedy, a nurse and academic dean at the University of Virginia, shared a local newspaper article that, using the database, reported that a small pharmacy in a town of 1,000 people had acquired 7.7 million pills.

'Sociopathic fashion'

Experts who have been following the opioid crisis closely for years offered their view of what the database adds to the nation’s understanding of how and why it got so bad.

Keith Humphreys, a Stanford University professor who advised Presidents George W. Bush and Barack Obama on drug policy, said the database reminds him of the documents related to tobacco litigation, but worse.

"The number of people who conducted themselves in a sociopathic fashion was large but also the number of people who failed to do their jobs: doctors, pharmacists, regulators, DEA agents,” he said. “It really, unfortunately will, I think, confirm in the minds of people who think that nobody cares about them that, in fact nobody cares about them … the people who are supposed to watch over you."

Daniel Ciccarone, a professor at the University of California at San Francisco who studies drug abuse, said the database shows the complex nature of how this epidemic — which is now on its third wave with fentanyl — started.

"We love to know that there’s one problem with one culprit and one solution and it is simply not true in the opioid epidemic. In Wave 1 is it all Purdue Pharma? No. it’s Walgreens, it’s McKesson, all involved in excess prescribing and distribution of pills,” he said. “The epidemic itself is far more complicated."

Follow The Post’s investigation of the opioid epidemic

76 billion opioid pills: Newly released federal data unmasks the epidemic

America’s largest drug companies saturated the country with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012 as the nation’s deadliest drug epidemic spun out of control, according to previously undisclosed company data released as part of the largest civil action in U.S. history.

The information comes from a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — from manufacturers and distributors to pharmacies in every town and city. The data provides an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which has resulted in nearly 100,000 deaths from 2006 through 2012.

Just six companies distributed 75 percent of the pills during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post. Three companies manufactured 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; ­Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

Purdue Pharma, which the plaintiffs allege sparked the epidemic in the 1990s with its introduction of OxyContin, its version of oxycodone, was ranked fourth among manufacturers with about 3 percent of the market.

The volume of the pills handled by the companies skyrocketed as the epidemic surged, increasing about 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the period.

Those 10 companies along with about a dozen others are now being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties alleging that they conspired to flood the nation with opioids. The companies, in turn, have blamed the epidemic on overprescribing by doctors and pharmacies and on customers who abused the drugs. The companies say they were working to supply the needs of patients with legitimate prescriptions desperate for pain relief.

wpo

The database reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year by year, town by town. In case after case, the companies allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market, according to the lawsuits.

Plaintiffs have long accused drug manufacturers and wholesalers of fueling the opioid epidemic by producing and distributing billions of pain pills while making billions of dollars. The companies have paid more than $1 billion in fines to the Justice Department and Food and Drug Administration over opioid-related issues, and hundreds of millions more to settle state lawsuits.

But the previous cases addressed only a portion of the problem, never allowing the public to see the size and scope of the behavior underlying the epidemic. Monetary settlements by the companies were accompanied by agreements that kept such information hidden.

The drug companies, along with the DEA and the Justice Department, have fought furiously against the public release of the database, the Automation of Reports and Consolidated Order System, known as ARCOS. The companies argued that the release of the “transactional data” could give competitors an unfair advantage in the marketplace. The Justice Department argued that the release of the information could compromise ongoing DEA investigations.

Until now, the litigation has proceeded in unusual secrecy. Many filings and exhibits in the case have been sealed under a judicial protective order. The secrecy finally lifted after The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to documents and data from the case.

On Monday evening, U.S. District Judge Dan Polster removed the protective order for part of the ARCOS database.

Lawyers for the local governments suing the companies hailed the release of the data.

“The data provides statistical insights that help pinpoint the origins and spread of the opioid epidemic — an epidemic that thousands of communities across the country argue was both sparked and inflamed by opioid manufacturers, distributors, and pharmacies,” said Paul T. Farrell Jr. of West Virginia, co-lead counsel for the plaintiffs.

In statements emailed to The Post on Tuesday, the drug distributors stressed that the ARCOS data would not exist unless they had accurately reported shipments and questioned why the government had not done more to address the crisis.

“For decades, DEA has had exclusive access to this data, which can identify the total volumes of controlled substances being ordered, pharmacy-by-pharmacy, across the country,” McKesson spokeswoman Kristin Chasen said.

A DEA spokeswoman declined to comment Tuesday “due to ongoing litigation.”

Cardinal Health said that it has learned from its experience, increasing training and doing a better job to “spot, stop and report suspicious orders,” company spokeswoman Brandi Martin wrote.

AmerisourceBergen derided the release of the ARCOS data, saying it “offers a very misleading picture” of the problem. The company said its internal “controls played an important role in enabling us to, as best we could, walk the tight rope of creating appropriate access to FDA approved medications while combating prescription drug diversion.”

While Walgreens still dispenses opioids, the company said it has not distributed prescription-controlled substances to its stores since 2014. “Walgreens has been an industry leader in combatting this crisis in the communities where our pharmacists live and work, ” said Phil Caruso, a Walgreens spokesman.

Mike DeAngelis, a spokesman for CVS, said the plaintiffs’ allegations about the company have no merit and CVS is aggressively defending against them.

Walmart, Purdue and Endo declined to comment about the ARCOS database.

A Mallinckrodt spokesman said in a statement that the company produced opioids only within a government-controlled quota and sold only to DEA-approved distributors.

Actavis Pharma was acquired by Teva Pharmaceutical Industries in 2016, and a spokeswoman there said the company “cannot speak to any systems in place beforehand.”

A virtual road map

The Post has been trying to gain access to the ARCOS database since 2016, when the news organization filed a Freedom of Information Act request with the DEA. The agency denied the request, saying some of the data was available on its website. But that data did not contain the transactional information the companies are required to report to the DEA every time they sell a controlled substance such as oxycodone and hydrocodone.

The drug companies and pharmacies themselves provided the sales data to the DEA. Company officials have testified before Congress that they bear no responsibility for the nation’s opioid epidemic.

The numbers of pills the companies sold during the seven-year time frame are staggering, far exceeding what has been previously disclosed in limited court filings and news stories.

Three companies distributed nearly half of the pills: McKesson with 14.1 billion, Walgreens with 12.6 billion and Cardinal Health with 10.7 billion. The leading manufacturer was Mallinckrodt’s SpecGx with nearly 28.9 billion pills, or nearly 38 percent of the market.

The states that received the highest concentrations of pills per person per year were: West Virginia with 66.5, Kentucky with 63.3, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7. West Virginia also had the highest opioid death rate during this period.

Rural areas were hit particularly hard: Norton, Va., with 306 pills per person; Martinsville, Va., with 242; Mingo County, W.Va., with 203; and Perry County, Ky., with 175.

In that time, the companies distributed enough pills to supply every adult and child in the country with 36 each year.

The database is a virtual road map to the nation’s opioid epidemic that began with prescription pills, spawned increased heroin use and resulted in the current fentanyl crisis, which added more than 67,000 to the death toll from 2013 to 2017.

The transactional data kept by ARCOS is highly detailed. It includes the name, DEA registration number, address and business activity of every seller and buyer of a controlled substance in the United States. The database also includes drug codes, transaction dates, and total dosage units and grams of narcotics sold.

The data tracks a dozen different opioids, including oxycodone and hydrocodone, which make up three-quarters of the total pill shipments to pharmacies.

Under federal law, drug manufacturers, distributors and pharmacies must report each transaction of a narcotic to the DEA, where it is logged into the ARCOS database. If company officials notice orders of drugs that appear to be suspicious because of their unusual size or frequency, they must report those sales to the DEA and hold back the shipments.

As more and more towns and cities became inundated by pain pills, they fought back. They filed federal lawsuits against the drug industry, alleging that opioids from the companies were devastating their communities. They alleged the companies not only failed to report suspicious orders, but they also filled those orders to maximize profits.

As the hundreds of lawsuits began to pile up, they were consolidated into the one centralized case in U.S. District Court in Cleveland. The opioid litigation is now larger in scope than the tobacco litigation of the 1980s, which resulted in a $246 billion settlement over 25 years.

Where the virus grew

Judge Polster is now overseeing the consolidated case of nearly 2,000 lawsuits. The case is among a wave of actions that includes other lawsuits filed by more than 40 state attorneys general and tribal nations. In May, Purdue settled with the Oklahoma attorney general for $270 million.

In the Cleveland case, Polster has been pressing the drug companies and the plaintiffs to reach a global settlement so communities can start receiving financial assistance to mitigate the damage that has been done by the opioid epidemic.

To facilitate a settlement, Polster had permitted the drug companies and the towns and cities to review the ARCOS database under a protective order while barring public access to the material. He also permitted some court filings to be made under seal and excluded the public and press from a global settlement conference at the outset of the case.

Last June, The Post and the Charleston Gazette-Mail asked Polster to lift the protective order covering the ARCOS database and the court filings. A month later, Polster denied the requests, even though he had said earlier that “the vast oversupply of opioid drugs in the United States has caused a plague on its citizens” and the ARCOS database reveals “how and where the virus grew.” He also said disclosure of the ARCOS data “is a reasonable step toward defeating the disease.”

Lawyers for The Post and the Gazette-Mail appealed Polster’s ruling. They argued that the ­ARCOS material would not harm companies or investigations because the judge had already decided to allow the local government plaintiffs to collect information from 2006 through 2014, withholding the most recent years beginning with 2015 from the lawsuit.

"Access to the ARCOS Data can only enhance the public’s confidence that the epidemic and the ensuing litigation are being handled appropriately now — even if they might not have been handled appropriately earlier,” The Post’s lawyer, Karen C. Lefton, wrote in her Jan. 17 appeal.

The lawyers also noted the DEA did not object when the West Virginia attorney general’s office provided partial ARCOS data to the Gazette-Mail in 2016. That data showed that drug distribution companies shipped 780 million doses of oxycodone and hydrocodone into the state between 2007 and 2012.

On June 20, the 6th Circuit Court of Appeals in Ohio sided with the news organizations. A three-judge panel reversed Polster, ruling that the protective order sealing the ARCOS database be lifted with reasonable redactions and directed the judge to reconsider whether any of the records in the case should be sealed.

On Monday, Polster lifted the protective order on the database, ruling that all the data from 2006 through 2012 should be released to the public, withholding the 2013 and 2014 data.

Prescription tourists

The pain pill epidemic began nearly three decades ago, shortly after Purdue Pharma introduced what it marketed as a less addictive form of opioid it called OxyContin. Purdue paid doctors and nonprofit groups advocating for patients in pain to help market the drug as a safe and effective way to treat pain.

But the new drug was highly addictive. As more and more people were hooked, more and more companies entered the market, manufacturing, distributing and dispensing massive quantities of pain pills.

Purdue ending up paying a $634 million fine to the Food and Drug Administration for claiming OxyContin was less addictive than other pain medications.

Annual opioid sales nationwide rose from $6.1 billion in 2006 to $8.5 billion in 2012, according to industry data gathered by IQVIA, a health care information and consulting company.

Individual drug company revenues ranged in single years at the epidemic’s peak from $403 million for opioids sold by Endo to $3.1 billion in OxyContin sales by Purdue Pharma, according to a 2018 lawsuit against multiple defendants by San Juan County in New Mexico.

During the past two decades, Florida became ground zero for pill mills — pain management clinics that served as fronts for corrupt doctors and drug dealers. They became so brazen that some clinics set up storefronts along I-75 and I-95, advertising their products on billboards by interstate exit ramps. So many people traveled to Florida to stock up on oxycodone and hydrocodone, they were sometimes referred to as “prescription tourists.”


The route from Florida to Georgia, Kentucky, West Virginia and Ohio became known as the “Blue Highway.” It was named after the color of one of the most popular pills on the street — 30 mg oxycodone tablets made by Mallinckrodt, which shipped more than 500 million of the pills to Florida between 2008 and 2012.

When state troopers began pulling over and arresting out-of-state drivers for transporting narcotics, drug dealers took to the air. One airline offered nonstop flights to Florida from Ohio and other Appalachian states, and the route became known as the Oxy Express.

A decade ago, the DEA began cracking down on the industry. In 2005 and 2006, the agency sent letters to drug distributors, warning them that they were required to report suspicious orders of painkillers and halt sales until the red flags could be resolved. The letter also went to drug manufacturers.

Even just one distributor that fails to follow the law “can cause enormous harm,” the 2006 DEA letter said.

DEA officials said the companies paid little attention to the warnings and kept shipping millions of pills in the face of suspicious circumstances.

As part of its crackdown, the DEA brought a series of civil enforcement cases against the largest distributors.

The corporations to date have paid nearly $500 million in fines to the Justice Department for failing to report and prevent suspicious drug orders, a number that is dwarfed by the revenue of the companies.

But the settlements of those cases revealed only limited details about the volume of pills that were being shipped.

In 2007, the DEA brought a case against McKesson. The DEA accused the company of shipping millions of doses of hydrocodone to Internet pharmacies after the agency had briefed the company about its obligations under the law to report suspicious orders.

“By failing to report suspicious orders for controlled substances that it received from rogue Internet pharmacies, the McKesson Corporation fueled the explosive prescription drug abuse problem we have in this country,” the DEA’s administrator said at the time.

In 2008, McKesson agreed to pay a $13.25 million fine to settle the case and pledged to more closely monitor suspicious orders from its customers.

[Just the cost of doing business. Put people in JAIL]

That same year, the DEA brought a case against Cardinal Health, accusing the nation’s ­second-largest drug distributor of shipping millions of doses of painkillers to online and retail pharmacies without notifying the DEA of signs that the drugs were being diverted to the black market.


Cardinal settled the case by paying a $34 million fine and promising to improve its suspicious monitoring program.

Some companies were repeat offenders.

In 2012, the DEA began investigating McKesson again, this time for shipping suspiciously large orders of narcotics to pharmacies in Colorado. One store in Brighton, Colo., population 38,000, was ordering 2,000 pain pills per day. The DEA discovered that McKesson had filled 1.6 million orders from its Aurora, Colo., warehouse between 2008 and 2013 and reported just 16 as suspicious. None involved the Colorado store.

DEA agents and investigators said they had amassed enough information to file criminal charges against McKesson and its officers but they were overruled by federal prosecutors. The company wound up paying a $150 million fine to settle, a record amount for a diversion case.

Also in 2012, Cardinal Health attracted renewed attention from the DEA when it discovered that the company was again shipping unusually large amounts of painkillers to its Florida customers. The company had sold 12 million oxycodone pills to four pharmacies over four years.

In 2011, Cardinal shipped 2 million doses to a pharmacy in Fort Myers, Fla. Comparable pharmacies in Florida typically ordered 65,000 doses per year.

The DEA also noticed that Cardinal was shipping unusually large amounts of oxycodone to a pair of CVS stores near Sanford, Fla. Between 2008 and 2011, Cardinal sold 2.2 million pills to one of the stores. In 2010, that store purchased 885,900 doses — a 748 percent increase over the previous year. Cardinal did not report any of those sales as suspicious.

Cardinal later paid a $34 million fine to settle the case. The DEA suspended the company from selling narcotics from its warehouse in Lakeland, Fla. CVS paid a $22 million fine.

As the companies paid fines and promised to do a better job of stopping suspicious orders, they continued to manufacture, ship and dispense large amounts of pills, according to the newly released data.

“The depth and penetration of the opioid epidemic becomes readily apparent from the data,” said Peter J. Mougey, a lawyer for the plaintiffs from Pensacola, Fla. “This disclosure will serve as a wake up call to every community in the country. America should brace itself for the harsh reality of the scope of the opioid epidemic. Transparency will lead to accountability.”

Aaron Williams, Andrew Ba Tran, Jenn Abelson, Aaron C. Davis and Christopher Rowland contributed to this report.

FIGHTING FENTANYL Trump called the opioid epidemic a priority, but fentanyl deaths soar as resources fail to keep pace

WASHINGTON COURT HOUSE, OHIO — In a dungeon-like jail in the center of this depressed farming town, 18 women in orange-and-white-striped prison uniforms are crammed into a two-story cellblock. Many of them are withdrawing from fentanyl.

The jail, built in 1884 to hold 24, now houses 55 men and women, a number that can swell to as many as 90. The inmates are sprawled on metal bunk beds and mattresses that line the floors as they wait for court appearances or serve time on low-level drug offenses.

The medical exam room, used to treat minor ailments, is tucked into a broom closet beneath a concrete stairwell. With few drug treatment options, prisoners strung out on fentanyl go through days of withdrawal with little help, shivering and curled up on the beds and floors of the jail.

“It’s definitely our detox center right now. They just sit there, and they withdraw there,” Fayette County Deputy Health Commissioner Leigh N. Cannon said. “Treatment is where we need help. We keep hearing that money is coming, but we haven’t really seen it.”

The inmates here are at least alive — unlike so many drug users in this part of central Ohio, 40 miles southwest of Columbus. Fayette County has the seventh-highest number of fentanyl overdose deaths per capita in the nation, according to internal data from the Centers for Disease Control and Prevention obtained and analyzed by The Washington Post.

While the Trump administration has made the opioid epidemic a priority, people in communities across the country continue to die in record numbers from fentanyl, and health officials are struggling to provide treatment for tens of thousands more, like the men and women warehoused inside this jail.

President Trump has taken a number of steps to confront the crisis, stem the flow of fentanyl into the country from China and Mexico, and step up prosecutions of traffickers. Congress also has increased spending on drug treatment.

"Everyone here today is united by the same vital goal — to liberate our fellow Americans from the grip of drug addiction and to end the opioid crisis once and for all,” Trump said at a drug abuse summit in Atlanta on April 24. “It’s happening. It’s happening."

But health policy experts say drug treatment funding is not nearly enough, and the administration’s response was hobbled by the failure to appoint a drug czar in its chaotic first year and confusion over who was in charge of drug policy. The depth of the problem continues to overwhelm the government’s response, and the administration has yet to produce a comprehensive strategy that is legally required by Congress.

John P. Walters, director of the White House Office of National Drug Control Policy during the George W. Bush administration, said that after two years and a presidential commission to study the problem, the Trump administration is still struggling to confront the deadliest drug crisis in U.S. history and is not dedicating nearly enough federal resources.

"What other threat that is preventable is going to kill tens of thousands of Americans?” Walters said. “We’re spending much more money on terrorism, as we should, but we’re not spending a similar amount on the source of death to many more Americans right now."

In 2017, the first year of the Trump presidency, a record 28,869 people died from synthetic-opioid-related overdoses, a 46.4 percent increase from the year before. Most were from fentanyl, which is 50 times more powerful than heroin. Estimates for the first eight months of 2018, the most recent available, show that an additional 20,537 Americans died — a toll on pace to exceed the previous year’s.

“The scale of death here is really unprecedented, and so you have to judge the response against the scale of the problem,” said Joshua M. Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health. “You can have some progress, but it’s really insufficient if you are not up to the scale of the problem."

Sharfstein and other public health experts also note that the administration is seeking to repeal the Affordable Care Act and cut $1.5 trillion over 10 years from Medicaid. More than 500,000 people addicted to opioids could lose their drug treatment coverage if the ACA is repealed, according to the Kaiser Family Foundation. The proposed Medicaid cuts could further reduce coverage.

Trump officials said they are making progress against the epidemic on a range of fronts, including interdiction, prosecution and treatment, but they acknowledge that it remains a huge challenge.

“We didn’t get into this crisis overnight. We’re not going to get out overnight,” Kellyanne Conway, counselor to the president and the administration’s leading voice on the epidemic, said in an interview.

Conway said Trump views his handling of the crisis as a “legacy issue” and continually asks her for updates about what is taking place in the states.

"It can’t all be gloom and doom. You can’t just have the negative, harrowing, so-sad statistics of grief and loss and devastation. We have to start talking about solutions,” she said. “The battleship is starting to turn in the other direction."

The CDC data obtained by The Post documents for the first time the 10 places with the highest per capita fentanyl-related overdose death rates: five counties in Ohio, two in West Virginia and one in Kentucky and the cities of Baltimore and St. Louis. Local health officials told The Post they are still not receiving enough federal money to fund drug treatment programs to wean people off highly addictive opioids or launch prevention programs to warn people of the dangers of fentanyl.

In Cabell County, W.Va., the county with the highest fentanyl overdose death rate in the nation, there are long waiting lists for treatment.

"When somebody is saying, ‘I’m ready for treatment’ and they want help, they shouldn’t have to wait six months, six weeks or six days,” said Steve Williams, mayor of Huntington, the county seat of Cabell. “They should be able to get in a treatment program within six hours."

In Ohio, deaths from fentanyl have ravaged vast sections of the state. In 2015, there were 1,255 synthetic-opioid-related deaths, most from fentanyl. By the end of 2017, that number had nearly tripled to 3,572.

In rural counties of Ohio, federal money recently appropriated by Congress has started to arrive, but health officials there say it is not enough.

"The situation four years ago was looking desperate. Today, it’s looking dire,” said Scott Gehring, president of the Community Health Alliance, a drug treatment facility in Butler County, Ohio, which has the ninth-highest fentanyl overdose death rate in the nation. “People are sicker. More people are dying."

In the run-up to the 2016 presidential election, Trump promised to halt the flow of heroin into the United States. He mentioned that drug, not fentanyl, at least 57 times during his speeches and appearances, and he tied the crisis to the need to build a wall along the border with Mexico. On the campaign trail, Trump was moved by the people he met who had lost family members to the epidemic, Conway said. As he left one stop, someone called out: “Please follow through on the drugs and opioids. You promised.”

Trump also said addiction was a deeply personal issue for him. His older brother, Fred Jr., who suffered from alcoholism, died in 1981 at age 43.

On March 29, 2017, two months after his inauguration, Trump invited then-New Jersey Gov. Chris Christie to the White House.

Christie had told Trump that his administration was inheriting an out-of-control opioid epidemic that blew up with the arrival of fentanyl during the Obama administration — between 2013 and 2017, more than 67,000 people died from the synthetic drug.

The opioid epidemic had begun in the late 1990s when a generation of Americans became addicted to prescription pain pills. After the government started to crack down on doctors, pain clinics, and drug manufacturers and distributors in the mid-2000s, addicts turned to heroin and then fentanyl.

What is fentanyl? The powerful painkiller is the leading cause of overdose deaths in America.

Fentanyl, a powerful painkiller developed nearly 60 years ago, has triggered the deadliest drug epidemic in American history. Synthetic opioids like fentanyl have claimed the lives of more than 67,000 people — more than the number of U.S. military personnel killed during the Vietnam, Iraq and Afghanistan wars combined.

One of the greatest dangers of fentanyl is its potency. A few grains of the drug can cause an overdose. Deaths from the drug began to climb in 2013, when traffickers began to mix street heroin with illicit fentanyl. In just a few years, fentanyl began to rival heroin as the deadliest opioid in the United States, prompting the Centers for Disease Control and Prevention to issue a nationwide public health advisory. The alert received little national attention.

In just a few years, the synthetic painkiller became the deadliest drug ever to hit U.S. streets. Manufactured in Chinese and Mexican labs, illicit fentanyl has played a significant role in reducing the overall life expectancy of Americans. It is so powerful, just a few flecks the size of grains of salt can cause acute respiratory failure and rapid death.

Obama administration officials were slow to address the fentanyl epidemic. The administration saw fentanyl as an add-on to the overall opioid crisis, rather than a singular danger that required a strategy of its own because it was so deadly and was coming into the country largely unimpeded through the mail. Senior White House and Justice Department officials, motivated by a desire to rectify racial inequality in sentencing, emphasized drug treatment over incarceration, and drug prosecutions fell off as fentanyl coursed through sections of the country.

By the time Trump came into office, the dangers of fentanyl were well known. The Drug Enforcement Administration and the CDC had issued numerous warnings. The fatal overdose rate was staggering.

“I said to [Trump] that I thought there was a lack of urgency to the way President Obama’s administration had dealt with this issue, and that as a result, the problem had gotten worse,” Christie recalled in an interview. “We needed to go after this in a really aggressive way.”

Trump signed an executive order establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

He put the New Jersey governor in charge.

“Let’s do it,” the president told Christie that day.

At the Justice Department, Trump’s first attorney general, Jeff Sessions, launched his own assault on fentanyl.

For Sessions, fentanyl could be met only by the kind of tough law-and-order tactics he deployed as a federal prosecutor in Alabama during the “War on Drugs” of the 1980s and 1990s. While a member of the U.S. Senate for 20 years, Sessions was one of the few lawmakers to rail against bipartisan efforts to roll back the harsh drug sentencing policies of that era.

Sessions promised to make fentanyl a signature issue after his first trip to New Hampshire, a state that had experienced one of the highest fentanyl-related death rates in the country. He attended a “youth summit” on opioids at Manchester’s downtown arena with Gov. Chris Sununu (R) on March 7, 2017.

"One of the most dramatic moments for me was the first trip to New Hampshire where Governor Sununu had 8,000 high school students gathered and 50 mothers stood before them holding large pictures of their children who died from drug overdoses,” Sessions said in an interview.

On May 12 that year, in one of his first actions, Sessions reversed what had become known as the “Holder Memo.” The 2013 document written by then-Attorney General Eric H. Holder Jr. directed federal prosecutors to stop pursuing low-level, nonviolent drug charges that would trigger mandatory minimum prison sentences. Over decades, U.S. drug policy had resulted in long prison terms and increased incarceration for first-time offenders, most of them young black men, and Holder wanted to reverse what he saw as a historic injustice.

Sessions directed his prosecutors to give high priority to drug cases, particularly aiming at fentanyl. Those found guilty would face the most severe penalties possible, according to a memo he sent to each U.S. attorney.

In July 2017, the Justice Department shut down the largest dark-web distributor of illicit drugs. Called AlphaBay, the site allowed users to sell and buy drugs, including fentanyl. At the time of the takedown, there were 250,000 listings for illegal drugs and toxic chemicals on the site, according to the Justice Department.

That fall, the department brought its first criminal charges against Chinese nationals accused of selling fentanyl to Americans over the Internet in cases that were filed in federal courts in North Dakota and Mississippi.

Sessions used an emergency declaration to make all chemical variants of fentanyl, known as analogues, illegal on a temporary basis; Congress must pass legislation to make the ban permanent. Chinese and Mexican chemists and drug traffickers in the United States had been evading the law by tweaking the chemical compounds that make up fentanyl and producing products that don’t fit the precise chemical formula for a banned substance.

Sessions also ramped up federal prosecutions of all fentanyl offenses and sent additional prosecutors to 10 areas in the country with the highest number of overdoses.

Christie, however, was growing frustrated with Sessions’s exclusive focus on law enforcement actions. He said he called the attorney general several times, inviting him to speak at the commission’s public hearings. Instead, Sessions sent his deputy attorney general.

Sessions said he has long believed in prevention and treatment programs, but as the attorney general, he was responsible for focusing on drug trafficking cases.

"I didn’t find him helpful at all on the issue,” Christie said. “He only had one tune, which was enforcement. He didn’t want to talk about the other parts of the issue. I wanted him to engage on treatment, on drug courts, and he had no interest in engaging in that. So, after a while, I just stopped calling because, what was the use?

"He was a one-trick pony."

'Reinventing the wheel’

During Trump’s first months in office, the administration shunted aside its White House Office of National Drug Control Policy. The office, whose director is known as the “drug czar,” is responsible for coordinating anti-drug efforts across 16 federal agencies and producing the National Drug Control Strategy, an annual drug policy plan mandated by Congress.

Former Trump administration officials said the White House did not trust the career staffers at the office. One former official, who spoke on the condition of anonymity to discuss internal deliberations, said the president and his aides wanted to “transcend the drug czar” and “raise the issue to a higher level."

White House officials treated the drug czar’s office as a backwater. They staffed it with political operatives who had little or no drug policy experience and installed a 24-year-old campaign worker as the deputy chief of staff. Senior staffers with years of experience were sidelined. In May 2017, the administration proposed cutting the office’s budget by 95 percent.

Ohio’s Butler County has the ninth-highest number of fentanyl-related overdose deaths per capita in the United States, according to CDC data. Four other Ohio counties are in the top 10.

No one was immediately nominated to become the drug czar. As the Trump presidency entered its seventh month, there was no permanent official in charge of coordinating drug policy across myriad federal agencies — the CDC, the National Institute on Drug Abuse, the Justice Department and the Department of Homeland Security.

Lawmakers on Capitol Hill were growing impatient with the administration’s lack of plans to confront the opioid epidemic. On July 26, the House Oversight and Reform Committee summoned then-acting drug czar Richard Baum, who had been in his job for four months, to explain why he had not submitted a comprehensive plan to operate and fund the office.

“Any idea when it might be submitted?” Rep. Gerald E. Connolly (D-Va.) asked Baum.

"I don’t want to give you a timeline,” Baum replied. “But I can tell you this. I’ve studied the issue very closely.”

“Likewise, we need a strategy,” Connolly said. “Any idea when a strategy will be submitted to the Congress?”

“We’re developing a strategy now,” Baum said.

The opioid overdose death rate, by then almost entirely fueled by illicit fentanyl, continued to climb. In 2017, fentanyl for the first time became the leading cause of overdose deaths in America.

Distributors, pharmacies and manufacturers respond to previously unreleased DEA data about opioid sales

A yearlong legal battle waged by The Washington Post and HD Media, publisher of the Charleston Gazette-Mail in West Virginia, resulted in a ruling Monday releasing government data tracking sales of billions of opioid pills in the U.S. from 2006 to 2012.

The data in the Drug Enforcement Administration’s Drug Automation of Reports and Consolidated Orders System, known as ARCOS, reveals what each company knew about the number of pills it was shipping and dispensing and precisely when they were aware of those volumes, year-by-year, town-by-town.

Lawsuits against the drug companies now allege they allowed some of the highly addictive drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.

The Post on Tuesday asked opioid distributors, pharmacies and manufacturers to respond to information contained in the database. The paper also asked them to respond to three major allegations made by plaintiffs in ongoing lawsuits:

1. That your company helped fuel the opioid epidemic by manufacturing, distributing or dispensing hundreds of millions of pain pills?

2. That your company along with other companies conspired to flood the nation with opioids?

3. That your company failed to report suspicious orders to the DEA and filled those orders to maximize profits?

The Post also asked for comment from the Healthcare Distribution Alliance, an industry trade group.

These were their public statements to The Post:

DISTRIBUTORS

AmericansourceBergen:

“Broadly providing retroactive DEA data to plaintiffs’ law firms solely for litigation purposes offers a very misleading picture regarding efforts being made around diversion. This data has never previously been given to anyone outside DEA, and therefore has not been available to inform the order monitoring programs and decision-making of distributors like AmerisourceBergen.

"After providing daily order reports to DEA, distributors such as AmerisourceBergen have at no time been privy to how this information was used by DEA, despite consistently seeking guidance on how to most effectively walk the tightrope of providing access to needed, FDA-approved medications while playing a role – however limited, given lack of interaction with patients – in combating the diversion of these same medications.

“Only recently did DEA share any of this data with distributors or manufacturers, when it was compelled to through the passage of the SUPPORT Act in late 2018 to make limited information from the database available to distributors.

"The fact that our market share of these controlled substances seems to be far smaller than our total market share is a testament to the fact that our controls played an important role in enabling us to, as best we could, walk the tight rope of creating appropriate access to FDA approved medications while combatting prescription drug diversion."

Cardinal Health:

"Cardinal Health is an intermediary in the pharmaceutical supply chain and plays an important but limited and specific role: to provide a secure channel to deliver medications of all kinds from the hundreds of manufacturers that make them to our thousands of hospital and pharmacy customers licensed to dispense them to patients, and to work diligently to spot, stop and report suspicious orders of medications.

"Cardinal Health is proud to operate a constantly adaptive and rigorous system to combat controlled substance diversion. We have learned from our experience and the threats the pharmaceutical supply chain faces, and as a result our anti-diversion program today is stronger and more effective as it continues to evolve. We have increased the size of our anti-diversion team, including bringing in personnel with additional regulatory, pharmaceutical, and law enforcement experience. We have developed an analytical model to evaluate our pharmacy customers, assigned threshold ordering limits to them, created a centralized database to store and track data on customers and orders, and enhanced policies and procedures for anti-diversion personnel. Over the years, we have trained thousands of our people on anti-diversion practices. Our people operate in good faith, our goal is to get it right, and we have stopped suspicious orders for the shipment of hundreds of millions of dosage units of controlled substances over the last decade.

“As we fulfil our role in the closed supply chain, we are in full compliance with all applicable federal and state laws, which include the requirement to report to state and federal regulators those orders deemed suspicious, despite there being only vague guidance from the Drug Enforcement Administration on what constitutes an unusual, or suspicious, order.

"We report those suspicious orders to state boards of pharmacy and to the DEA, but we do not know what these government entities do with those reports, if anything. Distributors have no law enforcement power and, unlike the regulators which oversee and regulate the manufacture, distribution, prescribing and dispensing of controlled substances, cannot stop physicians from writing prescriptions for medication nor take unilateral action to block DEA- and state-licensed pharmacies’ ability to dispense medication.

"Cardinal Health shares the judgment of top policymakers that too many prescriptions have been written for too many opioid pills over the past decade, a trend that began with changes in the medical community’s attitudes toward managing pain. The DEA, the only entity with the ability to limit production of prescription opioids as it sets an annual quota of the amount allowed to be manufactured, also until recently continuously raised these annual production quotas. From 2006 to 2014, the DEA’s authorized quota rose 140%. Thus, the quantity of opioid pills sold is a direct reflection of the number of prescriptions written by healthcare providers and filled by licensed dispensers, neither of which wholesale distributors can influence.

"Cardinal Health cares deeply about the opioid epidemic and takes seriously our commitment, in cooperation with everyone else in the prescription drug supply chain – state and federal government regulators, pharmaceutical manufacturers, doctors and other healthcare providers, insurers and pharmacies – to find and support solutions to this national challenge.

"In addition, Cardinal Health will continue, as we have for over a decade, to make a meaningful difference by raising awareness about the dangers of overprescribing and actively supporting efforts to address it. We also will continue to vigorously defend ourselves in all opioid-related legal matters."

McKesson Corp.:

"As the ARCOS data demonstrates, McKesson has consistently disclosed controlled substance transactions to the DEA. For decades, DEA has had exclusive access to this data, which can identify the total volumes of controlled substances being ordered, pharmacy-by-pharmacy, across the country.

“McKesson distributes prescription opioids and other medications in response to orders placed by state-licensed and DEA-registered pharmacies, and those pharmacies may only dispense these medications to patients with a valid prescription written by a government-licensed health care provider.

"The allegations made by the plaintiffs are just that – allegations. They are unproven, untrue and greatly oversimplify the evolution of this health crisis as well as the roles and responsibilities of the many players in the pharmaceutical supply chain. Any suggestion that McKesson influenced the volume of opioids prescribed or consumed in this country would reflect a misunderstanding of our role as a distributor."

PHARMACIES

CVS:

“The plaintiffs’ allegations about CVS in this matter have no merit and we are aggressively defending against them. The fact is that we are committed to the highest standards of ethics and business practices, including complying with all federal and state laws governing the dispensing of controlled substance prescriptions.

“We are also dedicated to helping reduce prescription drug abuse and diversion. We have stringent policies, procedures and tools to help ensure that our pharmacists properly exercise their professional responsibility to evaluate controlled substance prescriptions before filling them.

“Over the past several years, we have taken numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic. This includes millions of hours training our pharmacy teams about responsibilities and best practices regarding controlled substances.

“When reviewing information in the ARCOS database about CVS, it is important to keep the following in mind for context:

“We did not, and still do not, distribute Schedule II controlled substances such as oxycodone and fentanyl. We only distribute Schedule III-V controlled substances to our retail pharmacies.

“CVS Pharmacy is one of the two largest retail pharmacies in the nation. During the covered time period of 2006-2012, CVS had an average market share of over 18% for all retail prescriptions dispensed in the country. During those last two years, our market share for all retail prescriptions dispensed nationally was 20-21%.

"We dispensed over 4.2 billion retail prescriptions during that time period and opioid medications were a very small percentage of that total.

“Pharmacies dispense medication, including controlled substances, to patients who have authorized prescriptions written by doctors, physicians and other prescribers."

Walgreens:

"Walgreens pharmacists are highly trained professionals committed to dispensing legitimate prescriptions that meet the needs of our patients. Walgreens has not distributed prescription controlled substances since 2014 and before that time only distributed to our chain of pharmacies. Walgreens has been an industry leader in combatting this crisis in the communities where our pharmacists live and work."

Walmart:

Declined to comment.

MANUFACTURERS

Actavis Pharma:

“Teva acquired Actavis in 2016 and cannot speak to any systems in place beforehand. I can also not confirm any of your statistics without more specificity on medicines, locations and additional detail.

“That said, overall, generic medicines automatically replace branded medicines at the pharmacy with absolutely no influence from Teva. Teva has not conspired, failed to report suspicious orders or contributed to the abuse of opioids in the U.S. in any way. We maintain a comprehensive and robust system to prevent suspicious orders from ever entering the market.”

Endo Pharmaceuticals:

"Regarding the lawsuit, it is Endo’s policy not to comment on current litigation. Our comments regarding the topic of opioids can be found on our website. In the letter, Endo states:

“Since its founding as a family business in 1920, Endo has evolved into a generics and specialty branded pharmaceutical company whose products help millions of patients lead healthier lives. We are deeply concerned about the opioid abuse crisis, a public health challenge unprecedented in scope, severity and complexity. We believe this crisis can only be solved through intensive collaboration among the multiple stakeholders involved in our healthcare system.

"The U.S. Food and Drug Administration (FDA) has worked to balance access to pain care medications for appropriate patients while aggressively mitigating the risks of opioid abuse. Endo supports these efforts and has taken parallel actions. Since our new Executive Leadership Team began working together in September 2016, Endo voluntarily stopped promoting opioid products to healthcare professionals and eliminated the Company’s entire pain product salesforce. Endo also voluntarily withdrew Opana® ER from the market, discontinued the research and development of new opioid products and implemented additional anti-diversion measures, including product serialization aimed at thwarting counterfeiting and theft to protect patient safety.

"While we are proud of Endo’s actions, neither we nor any other single actor can solve the opioid abuse crisis. Instead, any solution must be multifaceted and consider not only the product supply chain, but also individual risk factors and other factors affecting utilization decisions, together with scientific, legislative and regulatory measures, training, treatment and education. Criminal trafficking of opioids (including heroin and fentanyl), illegal Internet sales and importation must also be addressed. Finally, the legitimate access needs of the millions of patients suffering from acute or chronic pain who rely on opioid medications must be considered. We remain committed to working collaboratively and proactively on a comprehensive solution to the opioid abuse crisis and to continuing Endo’s longstanding mission of improving patients’ lives."

Mallinckrodt:

“The Drug Enforcement Administration determines the total quantity of Schedule II opioids needed each year to meet legitimate medical, scientific and research needs in the U.S. Our DEA registrant company, SpecGx LLC, cannot and does not produce more opioids than the annual limit set for the company by the DEA. SpecGx sells only to DEA-approved distributors and other entities, who are themselves registered with and monitored by the DEA. In addition, through its ARCOS database, DEA monitors the flow of these DEA controlled substances from their point of manufacture through commercial distribution channels to point of sale or distribution at the dispensing/retail level.

"Mallinckrodt has for years been at the forefront of preventing prescription drug diversion and abuse, and has invested millions of dollars in a multi-pronged program to address opioid abuse. Those efforts include the purchase and donation of nearly two million drug disposal pouches, and working with policymakers, community leaders, law enforcement and industry partners to ensure the responsible use of pain medication and preventing unused medications from ending up in the wrong hands. The company will continue to support these efforts. For more information on Mallinckrodt’s work to combat prescription drug abuse and misuse, please visit www.mallinckrodt.com/solutions [mallinckrodt.com]."

Purdue Pharma:

“We have no further comment on the release of the ARCOS data beyond what was stated in our brief.

“Purdue Pharma vigorously denies the claims brought forth in the MDL, which are based on mischaracterizations and allegations we believe are without merit. We are confident in the strength of our legal arguments, and will continue to defend ourselves in the litigation.”

TRADE GROUP:

Healthcare Distribution Alliance:

“The ARCOS data show that distributors have consistently reported sales of opioid-based medications, along with the quantity of the order and the identity of the receiving pharmacy to the DEA. Distributors only recently received access to the full set of data with information about the total shipment of opioid medicines a particular pharmacy received from all distributors. The DEA has been the only entity to have all of this data at their fingertips and it could have used the information to consistently monitor the supply of opioids and when appropriate, proactively identify bad actors. Unlike the DEA, distributors have no authority to stop physicians from writing prescriptions, nor can they take unilateral action to halt pharmacies’ ability to dispense medication.”

Drilling into the DEA’s pain pill database

For the first time, a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — by manufacturers and distributors to pharmacies in every town and city — has been made public.

The Washington Post sifted through nearly 380 million transactions from 2006 through 2012 that are detailed in the DEA’s database and analyzed shipments of oxycodone and hydrocodone pills, which account for three-quarters of the total opioid pill shipments to pharmacies. The Post is making this data available at the county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities.

These records provide an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which resulted in nearly 100,000 deaths during the seven-year time frame ending in 2012.

A county-level analysis of the cumulative data shows where the most oxycodone and hydrocodone pills were distributed across the country over that time: more than 76 billion in all.


The Post gained access to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System, known as ARCOS, as the result of a court order. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, waged a year-long legal battle for access to the database, which the government and the drug industry had sought to keep secret.

The version of the database published by The Post allows readers to learn how much hydrocodone and oxycodone went to individual states and counties, and which companies and distributors were responsible.

Find the data for where you live

Interactive info... see article

For Bexar County, Texas, these results were shown:

From 2006 to 2012 there were 326,745,638 prescription pain pills, enough for 28 pills per person per year, supplied to Bexar County, Tex.

96,900,460 of the pills were distributed by Walgreen Co and 145,091,620 were manufactured by Actavis Pharma, Inc.

NEIGHBORCARE PHARMACY SERVICES INC, SAN ANTONIO pharmacy received the highest number of pills. Walgreens.

The Post believes this is a critically important set of data, which is why we are making it public and accessible to readers and other journalists. We think there are hundreds of stories within this data set and need your help to understand what it means to you and your community.

The Post analysis shows that the volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. Yearly county-level maps show how the influx of pills spread.

Just six companies distributed 75 percent of the pills — oxycodone and hydrocodone — during this period: McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart, according to an analysis of the database by The Washington Post.

[table]
Three companies manufactured about 88 percent of the opioids: SpecGx, a subsidiary of Mallinckrodt; Actavis Pharma; and Par Pharmaceutical, a subsidiary of Endo Pharmaceuticals.

[table]
Comparing county-level maps of opioid overdose deaths and pill shipments reveal a virtual opioid belt of more than 90 counties stretching southwest from Webster County, W.Va., through southern Virginia and ending in Monroe County, Ky. This swath includes 18 of the top 20 counties ranked by per-capita prescription opioid deaths nationwide and 12 of the top 20 counties for opioid pills distributed per capita.


As lawyers zero in on drug companies, a reckoning may be coming

For two decades, as 200,000 opioid overdose deaths piled up across America, there was always someone else to blame. Families blamed drug companies. Drug companies blamed doctors. Everyone blamed the government.

More than half the public continues to see drug addiction as a moral failing, blaming substance abusers themselves for the epidemic, at least in part, according to recent polling.

But now the effort to hold someone to account for the worst drug crisis in U.S. history is narrowing to a few dozen drug companies whose day in court has come or will soon arrive. Virtually every state and nearly 2,000 towns, cities and counties have demanded those firms, which include some of America’s most trusted brands, be forced to pay up to help stop the epidemic.

"It is a drug company crisis, and it begins and should end with them,” Oklahoma attorney Bradley Beckworth told a judge this week in the first state drug trial of the opioid era. The state is seeking $17.5 billion from the health care conglomerate Johnson & Johnson to address the costs of addiction.

Five years after the earliest lawsuits were filed, that trial concluded Monday, with a judge expected to decide by the end of August whether the company had a major role in the epidemic. Test cases of how municipalities may fare in federal court — involving two Ohio counties — are scheduled for trial in October.

Lined up behind them are 48 more trials in state courts around the country, with start dates beginning early next year, according to Mike Moore, an attorney aiding four of those states.

As that litigation proceeds, negotiations for a possible nationwide settlement are continuing. Moore is hopeful there will be an all-encompassing deal this year, though he predicts it will be nowhere near the size of the $206 billion agreement in the landmark 1998 settlement with tobacco companies.

"I think people are coming to their senses,” said Moore, who led the legal battle in that case. “People are realizing that this is a public health crisis and not so much about litigation and lawyers. It needs to be treated as ‘we have a public health crisis.'"

Though the litigation is following the trail blazed by the tobacco and asbestos cases of the last century, plaintiffs are seeking even more staggering sums: $17.5 billion in sparsely populated Oklahoma; $7.2 billion for Cuyahoga and Summit counties in Ohio; $483 billion for a nationwide settlement, according to an expert witness for plaintiffs cited by Reuters.

Nora Freeman Engstrom, a professor at Stanford University Law School who is closely monitoring the litigation, said such demands may be unrealistic.

"The tobacco manufacturers came to the settlement table backed by massive financial resources,” she said. “Opioid manufacturers’ pockets are shallow by comparison. You can’t get blood from a turnip, and at a certain point, financial limitations will affect settlement options."

Tobacco revenue exceeded $93 billion in 2016. U.S. sales of prescription opioids peaked at around $8 billion to $9 billion earlier this decade, according to industry data.

The economic damages from tobacco use were also far greater than for opioid abuse. If the same payout-to-damages ratio from that agreement were applied to opioids, a global settlement might fall in the range of $30 billion to $55 billion, according to a recent analysis by Nephron Research, an independent health care investment research firm.

On Monday, The Washington Post published previously undisclosed government data that revealed the breadth of the epidemic of legal opioid use. A handful of companies saturated the country with 76 billion pain pills between 2006 and 2012, fueling the prescription opioid epidemic, the data shows.

The numbers reveal “clear heinous, criminal distribution that has visibly contributed, if not caused, the crisis our country is facing with opioid use disorder,” the anti-drug group Shatterproof said in a statement. “Sadly, we cannot change the past. We can only focus on the millions of Americans who now have OUD and their families, and create strategies and actions that will prevent this for generations to come.”

Purdue Pharma ranked fourth on the government database of manufacturers of products containing oxycodone and hydrocodone. Johnson & Johnson is not on the list of companies that made those products from 2006 to 2012.

By the end of summer, there may be some indication of whether the companies will have to help abate the drug crisis. In the first state case to come to trial, Oklahoma Attorney General Mike Hunter (R) asked a judge to make Johnson & Johnson pay as much as $17.5 billion over 30 years to stem the epidemic through treatment, education, prevention and other measures.

Oklahoma already has settled out of court with two other defendants, securing $270 million from Purdue, most of which went toward a treatment and research center, and $85 million from Teva Pharmaceuticals.

Purdue said at the time of the March settlement that it sees “this agreement with Oklahoma as an extension of our commitment to help drive solutions to the opioid addiction crisis.”

Teva said it “has not contributed to the abuse of opioids in Oklahoma in any way” when it settled in May.

West Virginia, which has the nation’s highest rate of opioid overdose deaths, has also settled with some of the drug distribution companies that poured opioids into the state, recouping $84 million in recent years.

But those results don’t mean settlements or court victories for plaintiffs are likely. Johnson & Johnson and many drug manufacturers and distributors populate the Fortune 500 list of America’s largest companies. They have steadfastly denied culpability for the drug crisis and have the resources to wage protracted legal battles.

Johnson & Johnson, for example, has paid a small army of attorneys since Oklahoma filed its lawsuit in 2017, opting to battle the state in a seven-week trial that just ended in a Norman courtroom.

“Johnson & Johnson has been, in a bunch of cases, not afraid to litigate,” said Alexandra Lahav, professor at the University of Connecticut School of Law. “This is not the only mass tort they’re dealing with, and they have been pretty aggressive in their litigation strategy,” she said, citing the company’s defense against lawsuits from women who claimed that asbestos in the company’s talc products gave them cancer.

As Purdue and Teva reached out-of-court settlements with Oklahoma (both denied wrongdoing), Johnson & Johnson took its chances at trial. It rejected state claims that it had minimized the risks of its opioid products and that it was a “kingpin" supplier of raw narcotic ingredients for other manufacturers.

"When you’re right, you fight,” the company’s lead attorney, Larry Ottaway, told Judge Thad Balkman more than once during the trial.

The major manufacturers, distributors and dispensers of opioids, including Johnson & Johnson, have offered a variety of defenses: They sell legal, highly regulated painkillers to willing customers; the Drug Enforcement Administration sets annual quotas for the quantities each company can produce; doctors sparked the epidemic by overprescribing opioids to address their patients’ pain.

Whichever side loses may be inclined to appeal.

Moore, for one, believes that public revelations of the astonishing numbers of painkillers shipped to communities across the United States will put added pressure on companies to settle.

"What they have done over all these years is now front-page news,” he said. “There’s no place to hide. It is the oversupply that caused the opioid epidemic. No doubt."

Lahav is not so sure. At the moment, she said, there is too little information from the Oklahoma or Ohio cases to predict anything. And every case involves different plaintiffs, companies, legal theories and laws.

In May, a North Dakota judge threw out a government lawsuit against Purdue, rejecting the same legal theory that Oklahoma used in its trial.

“Everybody’s got their own laws. They’ve got their own lawyers, and they’ve got their own agendas,” she said. “It’s really an interesting thing how they’re going to herd all these cats together.”

The biggest civil trial in U.S. history will start with these Ohio counties

PARMA, Ohio — At Knuckleheads Bar & Grill, the subject on a sweltering Saturday afternoon was the drug crisis. More specifically, the recent disclosure that the CVS across the street received more pain pills — 6.4 million — over a seven-year period than any other drugstore in Cuyahoga County.

“Location, location, location,” said Mike Gorman, 37, who was drinking and hanging out with friends. “It’s right near the highway, which makes it easy to access” from Cleveland.

And there was the homeless encampment just beyond the CVS, over by the train tracks, behind the strip mall. It’s popular with heroin users, the regulars at the sports bar said.

“It’s a terrible thing, but I don’t blame CVS,” Gorman said, contending that drug companies made large profits and encouraged doctors to prescribe opioids.

The CVS in this white working-class suburb of Cleveland is a three-hour drive and, culturally, even farther from the southern Ohio section of Appalachia that has become widely associated with the opioid epidemic.

But last week’s revelation that drug companies saturated the United States with 76 billion pain pills over seven years shows that no corner of the country escaped the drug crisis. Two other drugstores in this city of 80,000 placed second and fifth on the Drug Enforcement Administration’s list of Cuyahoga County locations. Wholesalers shipped opioids at 5.4 million and 3.7 million doses respectively to those. The list was disclosed by The Washington Post last week.

Cuyahoga County and nearby Summit County soon will be at the center of the most important legal test of how much responsibility drug companies bear for the opioid epidemic. Barring a settlement, the two counties are scheduled to go to trial in October as the first case among the consolidated lawsuits brought by about 2,000 cities, counties, Native American tribes and other plaintiffs.

U.S. District Judge Dan Polster, who is presiding over the consolidated case in Cleveland, selected the counties to represent the legal arguments that other plaintiffs have made. The two counties alone are asking for billions of dollars from companies to help stem the crisis.

In a statement to The Post Sunday, Mike DeAngelis, senior director for corporate communications at CVS, defended the company’s actions.

“In the period of time covered by the ARCOS data (2006-2012), our shipments of hydrocodone combination products comprised only 2% of the prescription drugs we shipped to our pharmacies,” he said. “As soon as the DEA reclassified these drugs as Schedule II in October 2014, we stopped distributing them immediately.

“The DEA possesses data on every single shipment of hydrocodone combination products we shipped to our pharmacies. It did not identify a single shipment to a single CVS Pharmacy in Cuyahoga or Summit Counties as improper.”

In a court filing released Friday, lawyers for the two counties accuse some of the biggest names in the drug industry of creating a “public nuisance” that endangered the health of residents by failing to control the drug flow, even when they knew, or should have known, that some painkillers were being diverted to illegal use.

"There can be little doubt that the opioid crisis — the epidemic of opioid availability and use — significantly interferes with the public health and constitutes a public nuisance in both Cuyahoga and Summit counties,” they argued in a request that Polster rule in their favor on that issue even before trial.

To bolster that argument, they offered an array of statistics that may be critical in the case. In 2016, they said, the death rate from pharmaceutical opioids in Cuyahoga County was 3.26 times higher than the national average. In 2017, county emergency rooms treated an estimated 9,191 people with drug-related health problems, a 21 percent increase over the previous year.

As the government cracked down on the diversion of pills to the black market, heroin and fentanyl took their place. By March 2016, two people died of a heroin or fentanyl overdose in Cuyahoga County every day, the lawyers alleged.

In Summit County, whose biggest city is Akron, the surge in overdose deaths was so rapid that the county medical examiner brought in a mobile morgue in 2017 to handle the bodies, the plaintiffs wrote.

The rate of infants born addicted to opioids there rose from 2.9 per 1,000 births between 2004 and 2008 to 13.6 per 1,000 births between 2011 and 2015, they alleged.

The defendants in the case include giant drug distribution companies such as McKesson, Cardinal Health, AmerisourceBergen, Walgreens and Walmart, and manufacturers such as Purdue Pharma and Mallinckrodt.

The companies have generally blamed the epidemic on overprescribing by doctors, over-dispensing by pharmacies and on drug abuse by customers. The companies say they were working to supply patients in desperate need of pain relief with legal, highly regulated drugs.

"We maintain stringent policies, procedures and tools to help ensure that our pharmacists properly exercise their professional responsibility to evaluate controlled substance prescriptions before filling them,” DeAngelis, the CVS spokesman, said Sunday. “Keep in mind that doctors have the primary responsibility to make sure the opioid prescriptions they write are for a legitimate purpose.

“Over the past several years, we have taken numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic that has resulted in a 30% reduction in the amount of controlled substances that our retail pharmacies dispense."

The public nuisance argument is the same one made by the state of Oklahoma in a seven-week trial against Johnson & Johnson that concluded last week. The state asked a judge to make the company pay as much as $17.5 billion over 30 years to clean up the drug crisis. Cleveland County District Judge Thad Balkman said he would rule around the end of August.

Another 48 states have sued drug companies and are lined up behind Oklahoma in a legal track that runs parallel to the enormous federal “multi-district litigation” in Ohio.

The intersection where CVS and Knuckleheads sit is typical for the outskirts of Cleveland, whose border is just a few hundred feet away. It has strip malls occupied by discount stores, and a mom-and-pop lunch counter threatened by the Burger King down the road.

Knuckleheads itself, like its patrons, appears transported here from Cleveland in the exodus to the suburbs that began decades ago. It is a squat stone building with signs promising cheap domestic beer, bar food and a Cleveland Indians game on TV. The men inside drain pints of Budweiser and Miller Lite between smoke breaks in the alley behind a black metal side door.

The pharmacist on duty at the CVS on Saturday declined to comment on the volume of pills sold there, citing company policy.

But Frank Cimperman, 58, Knuckleheads’ owner, said he believes “it’s only number one because of the highway, and because you can get a prescription filled there 24 hours a day.”

Drugstores with easy access to highways have drawn authorities’ interest in the past, including two CVS stores in Sanford, Fla., that were raided and shut down by the DEA in 2012.

At a Rite Aid in the Clark-Fulton neighborhood of Cleveland, an inner-city community of low-income whites and Hispanics, pharmacy manager Ben Swartz was surprised to learn that his branch ranked third in Cuyahoga County on the DEA database.

“Wow,” said Swartz, whose store received 4.8 million pills between 2006 and 2012. But he said he is confident that in recent years stricter practices have been put into place.

“We vet all the prescriptions that come in here,” he said. Extra measures, including verifying diagnoses with doctors, are used for about one in 10 prescriptions, he said.

"We look for prescribing trends,” Swartz said. “If a doctor’s giving everyone the same drug in the same quantities, we won’t associate with them. We also scrutinize prescriptions for high strength and high quantities, and people using multiple pharmacies and multiple prescribers."

Preliminary data from the U.S. Centers for Disease Control and Prevention released last week showed that drug overdose deaths nationally declined about 5 percent in 2018, the first drop in decades. While deaths from fentanyl are skyrocketing, fatalities from prescription opioids are falling, the data show.

Residents on the blocks surrounding the Rite Aid spoke of a high rate of heroin use in the area. One person, who spoke on the condition of anonymity because he did not want to be identified as disparaging the area, said the sidewalk in front of an abandoned factory a block south was a “shooting gallery” until two years ago.

“We used to find hundreds of needles on the sidewalk here,” he said. “But I haven’t seen any in two years, so I think it’s getting better.”

Internal drug company emails show indifference to opioid epidemic

In May 2008, as the opioid epidemic was raging in America, a representative of the nation’s largest manufacturer of opioid pain pills sent an email to a client at a wholesale drug distributor in Ohio.

Victor Borelli, a national account manager for Mallinckrodt, told Steve Cochrane, the vice president of sales for KeySource Medical, to check his inventories and "[i]f you are low, order more. If you are okay, order a little more, Capesce?”

Then Borelli joked, “destroy this email.?.?.Is that really possible? Oh Well...”

Previously, Borelli used the phrase “ship, ship, ship” to describe his job.

Those email excerpts are quoted in a 144-page plaintiffs’ filing along with thousands of pages of documents unsealed by a judge’s order Friday in a landmark case in Cleveland against many of the largest companies in the drug industry. A Drug Enforcement Administration database released earlier in the week revealed that the companies had inundated the nation with 76 billion oxycodone and hydrocodone pills from 2006 through 2012. Nearly 2,000 cities, counties and towns are alleging that the companies knowingly flooded their communities with opioids, fueling an epidemic that has killed more than 200,000 since 1996.

The filing by plaintiffs depict some drug company employees as driven by profits and undeterred by the knowledge that their products were wreaking havoc across the country. The defendants’ response to the motion is due July 31.

In January 2009, Borelli told Cochrane in another email that 1,200 bottles of oxycodone 30 mg tablets had been shipped.

“Keep ’em comin’!” Cochrane responded. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are...”

Borelli responded: “Just like Doritos keep eating. We’ll make more."

Borelli and Cochrane did not return calls for comment Friday night.

"In a statement Friday night, a spokesman for Mallinckrodt sought to distance the company from Borelli’s email: “This is an outrageously callous email from an individual who has not been employed by the company for many years. It is antithetical to everything that Mallinckrodt stands for and has done to combat opioid abuse and misuse.

An attorney for KeySource Medical on Saturday declined to comment, citing ongoing litigation.

The Controlled Substances Act requires drug companies to control against diversion, and to design and operate systems to identify “suspicious orders,” defined as “orders of unusual size, orders deviating substantially from a normal pattern, and orders of unusual frequency.” The companies are supposed to report such orders to the DEA and refrain from shipping them unless they can determine the drugs are unlikely to be diverted to the black market. The plaintiffs, in the filing, allege that the companies ignored red flags and failed at every level.

At Cardinal Health, one of the nation’s largest drug distributors, then-CEO Kerry Clark in January 2008 wrote in an email to Cardinal senior officials that the company’s “results-oriented culture” was perhaps “leading to ill-advised or shortsighted decisions,” the filing contends.

In the previous 18 months, Cardinal had been hit with nearly $1 billion in “fines, settlements, and lost business as a result of multiple regulatory actions,” the filing alleges, including the suspension of licenses at some of its distribution centers for failing to maintain effective controls against opioid diversion.

Cardinal Health did not immediately return a request for comment Friday night.

On Aug. 31, 2011, McKesson Corp.’s then-director of regulatory affairs, David B. Gustin, told his colleagues he was concerned about the “number of accounts we have that have large gaps between the amount of Oxy or Hydro they are allowed to buy (their threshold) and the amount they really need,” according to the filing, which cites Gustin’s statements. “This increases the ‘opportunity’ for diversion by exposing more product for introduction into the pipeline than may be being used for legitimate purposes.”

According to the filing, he had earlier noted to his colleagues that they “need to get out visiting more customers and away from our laptops or the company is going to end up paying the price ... big time.”

Another McKesson regulatory affairs director responded: “I am overwhelmed. I feel that I am going down a river without a paddle and fighting the rapids. Sooner or later, hopefully later I feel we will be burned by a customer that did not get enough due diligence,” according to the filing.

McKesson is the largest drug distributor in the United States. It distributed 14.1 billion oxycodone and hydrocodone pills from 2006 to 2012, about 18 percent of the market, according to the DEA database.

"Suggesting that these two employees’ emails from nearly a decade ago are evidence of wrongdoing ignores the context in which McKesson and our employees were operating,” McKesson spokeswoman Kristin Chasen said in a statement Friday. “Doctors around the country were writing millions of additional opioid prescriptions year over year. Our regulator, the DEA, consistently raised the annual quota of pills that could be produced and distributed, which was a clear statement that the increase in prescriptions was appropriate, expected, and medically necessary. To imply that distributors should have second-guessed or overruled those decisions by the government and the medical community reflects a fundamental misunderstanding of our role. For decades, McKesson has consistently reported opioid transactions to the DEA. We have also invested heavily in further strengthening our anti-diversion program."

Until Friday, the documents had been sealed under a protective order issued by U.S. District Judge Dan Polster. The order was lifted a year after The Washington Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, filed a lawsuit for access to the documents and a DEA database tracking opioid sales, known as the Automation of Reports and Consolidated Orders System, or ARCOS.

The drug companies and the DEA strenuously opposed the release of the data and the documents, and Polster agreed with them. But a three-judge panel of the U.S. Court of Appeals for the 6th Circuit in Ohio ordered that some of the information should be released with reasonable redactions and the database should be made public.

By consolidating cases from around the nation, the Cleveland case, for the first time, provides specific information about how and in what quantity the drugs flowed around the country, from manufacturers and distributors to pharmacies. The case also brings to light internal documents and deliberations by the companies as they sought to promote their products and contend with enforcement efforts by the DEA.

The local and state government plaintiffs in the case argue that the actions of some of America’s biggest and best-known companies — including Mallinckrodt, Cardinal Health, McKesson, Walgreens, CVS, Walmart and Purdue Pharma — amounted to a civil racketeering enterprise that had a devastating effect on the plaintiffs’ communities.

The case is a civil action under the Racketeer Influenced and Corrupt Organizations (RICO) Act, making use of a law originally developed to attack organized crime.

In statements to The Post on Tuesday in response to the release of the DEA database, the drug companies issued broad defenses of their actions during the opioid epidemic. They have said previously that they were trying to sell legal painkillers to legitimate pain patients who had prescriptions. They have blamed the epidemic on overprescribing by physicians and also on corrupt doctors and pharmacists who worked in “pill mills” that handed out drugs with few questions asked. The companies also said they should not be held responsible for the actions of people who abused the drugs.

The companies said that they were diligent about reporting their sales to the DEA and that the agency should have worked with them to do more to fight the epidemic, a point former DEA agents dispute. The companies also note that the DEA set the quotas for opioid production.

“We report those suspicious orders to state boards of pharmacy and to the DEA but we do not know what those government entities do with those reports, if anything,” Cardinal Health said in a statement.

The companies issued statements rejecting the plaintiffs’ allegations.

McKesson said in its statement: “The allegations made by the plaintiffs are just that — allegations. They are unproven, untrue and greatly oversimplify the evolution of this health crisis as well as the roles and responsibilities of the many players in the pharmaceutical supply chain."

Mallinckrodt said the company “has for years been at the forefront of preventing prescription drug diversion and abuse, and has invested millions of dollars in a multipronged program to address opioid abuse."

'Kingpin within the drug cartel'

One of the biggest points of contention in the lawsuit is whether the nation’s largest drug companies did enough to identify suspicious orders of opioids. What exactly constitutes a suspicious order is at the heart of the case.

The DEA has long said there should be no confusion because the agency has given frequent guidance and briefings to the industry, and repeatedly defined what constitutes a suspicious order.

The plaintiffs argue that the companies failed to “design serious suspicious order monitoring systems that would identify suspicious orders to the DEA” and shipped the drugs anyway.

"Their failure to identify suspicious orders was their business model: they turned a blind eye and called themselves mere ‘deliverymen’ with no responsibility for what they delivered or to whom,” according to the plaintiffs’ filing.

Between 1996 and 2018, the plaintiffs alleged in the filing, drug companies shipped hundreds of millions of opioid pills into Summit and Cuyahoga counties in Ohio, filling orders that were suspicious and “should never have been shipped."

“They made no effort actually to identify suspicious orders, failed to flag orders that, under any reasonable algorithm, represented between one-quarter and 90 percent of their business, and kept the flow of drugs coming into Summit and Cuyahoga Counties,” the plaintiffs’ lawyers wrote.

In 2007, the DEA told Mallinckrodt that the numeric formula it used to monitor suspicious orders was insufficient, the filing contended. It alleges the company’s suspicious order monitoring program from 2008 through 2009 consisted of solely verifying that the customer had a valid DEA registration and that the order was accurately logged into the DEA’s tracking database.

From 2003 to 2011, Mallinckrodt shipped a total of 53 million orders, flagged 37,817 as suspicious but stopped only 33 orders, the plaintiffs’ filing states.

A Mallinckrodt employee said in a deposition that the DEA had described the company as the “kingpin within the drug cartel” in a meeting with the agency in July 2010, according to a footnote in the filing.

In 2011, the filing cites a Justice Department document in which the DEA alleged that Mallinckrodt “sold excessive amounts of the most highly abused forms of oxycodone, 30 mg and 15 mg tablets, placing them into a stream of commerce that would result in diversion.”

According to the DEA, the filing states, “even though Mallinckrodt knew of the pattern of excessive sales of its oxycodone feeding massive diversion, it continued to incentivize and supply these suspicious sales,” and never notified the DEA of the suspicious orders.

In a settlement with the DEA, Mallinckrodt agreed that from Jan. 1, 2008, through Jan. 1, 2012, “certain aspects of Mallinckrodt’s system to monitor and detect suspicious orders did not meet the standards” outlined in letters from the DEA deputy administrator for diversion control.

Mallinckrodt was the nation’s leading manufacturer of oxycodone and hydrocodone, with 28.8 billion pills from 2006 to 2012, 37.7 percent of the market, according to the DEA database. It has since created a subsidiary for its generic opioids called SpecGx.

The Post reported in 2017 that federal prosecutors said 500 million of the company’s 30 mg oxycodone pills wound up in Florida between 2008 and 2012 — 66 percent of all oxycodone sold in the state. Pills at that dosage are among the most widely abused.

Prosecutors said the company failed to report suspicious orders, and Mallinckrodt that year settled the case by paying a $35 million fine.

“Mallinckrodt’s actions and omissions formed a link in the chain of supply that resulted in millions of oxycodone pills being sold on the street,” then-Attorney General Jeff Sessions said at the time.

McKesson Corp., the nation’s largest opioid distributor, doled out 14.1 billion oxycodone and hydrocodone pills from 2006 to 2012, about 18 percent of the market, according to the newly released DEA database. (Kris Tripplaar/Sipa USA)

'Business as usual'

The same year that Mallinckrodt paid its fine, McKesson, the nation’s largest drug distributor, was fined a record $150 million by the Justice Department.

According to allegations in the new court filing, McKesson frequently increased the amount of opioid pills it sent to its pharmacy customers.

“McKesson has a long history of absolute deference to retail national account customers when it comes to [opioid] threshold increases,” the plaintiffs argue in their filing, citing a deposition of McKesson’s senior director of distribution operations.

McKesson had set limits on the amount of opioids its customers could order, the filing contends, but those limits were often lifted.

"In August 2014, DOJ noted that McKesson appeared to be willing to approve threshold increases for opioids for the flimsiest of reasons,” the filing contends.

For shipments to pharmacies in Summit and Cuyahoga counties, McKesson did not report a single suspicious order between May 2008 and July 2013, the filing says. During that time, McKesson filled 366,000 opioid orders in those two counties.

McKesson reached its settlement with the government in January 2017 for allegations of failing to report suspicious orders. It was the second time the company was fined over suspicious orders. Nine years earlier, it paid $13 million.

The government said in 2017 that McKesson “failed to design and implement an effective system to detect and report ‘suspicious orders.’?” The company shipped more than 1.6 million orders of opioid pills between 2008 and 2013 but reported just 16 as suspicious, according to the Justice Department.

However, “before the ink of the settlement agreement was even dry,” the new filing argues , McKesson was already reassuring customers who were concerned that the flow of opioids would be curtailed that it would remain “business as usual” at the company. McKesson sent more than 68 million doses of oxycodone and hydrocodone to those counties between 2006 and 2012, according to DEA tracking data analyzed by The Post.

Gustin, McKesson’s former director of regulatory affairs, was recently indicted in federal court in Kentucky on a charge of illegally distributing opioids. His attorney wrote in a court filing that the allegations against his client stem from his job at McKesson and “seem to focus on the manner by which he performed his former position as Director of Regulatory Affairs.”

Gustin’s lawyer and the prosecutor in the case did not return calls for comment.

The southwest Virginia city of Norton, with a population of about 4,000, saw millions of prescription opioids arrive in seven years, with the city’s CVS pharmacy receiving 1.3 million opioids from 2006 through 2012, according to the DEA database. (Charles Mostoller for The Washington Post)

Pickers and packers

The plaintiffs in the Cleveland case alleged that CVS, the nation’s largest pharmacy chain, did not implement required controls to identify suspicious orders from 2006 until early to mid-2009.

The CVS compliance coordinator said that her title “was only for reference and not her real job position and that the only thing she ever did related to suspicious order monitoring was to update the [Standard Operating Procedures Manual],” the plaintiffs allege.

A system that CVS used to monitor suspicious orders was known as “Pickers and Packers,” according to the filing.

The pickers and packers were workers in the distribution centers who would pick and pack opioid orders. A CVS official testified that the company did not have any written policies, guidance or training programs to teach the pickers and packers how to detect suspicious orders, according to the filing.

“Instead, the Pickers and Packers would identify orders based on a gut feeling or a crude rule of thumb that essentially can be summarized that they believed the order was simply too large,” the filing states. “One of the Pickers and Packers .?.?. testified that she was trained by another Picker and Packer in 1996 and that as a rule a Picker and Packer should not send out more than 12 of the small bottles, six of the larger bottles and two or three of the largest bottles. She used this rule of thumb for her entire career."

CVS’s system flagged few orders, the filing contends : A CVS distribution center in Indianapolis flagged two orders per year from 2006 through 2014.

CVS rejected the plaintiffs’ arguments.

“As part of our response in this case, we will be presenting the expert opinion of a former high-ranking DEA official who concluded independently that our systems were compliant and that the plaintiffs’ analysis is unfounded,” CVS spokesman Mike DeAngelis said.

Obvious signs of diversion

Walgreens used a formula to identify thousands of pharmacy orders as suspicious but shipped them anyway, the filing alleges. The orders were reported to the DEA after they had been shipped, according to agency documents quoted in the filing.

“Suspicious orders are to be reported as discovered, not in a collection of monthly completed transactions,” the DEA wrote in an immediate suspension order issued against Walgreens in 2012. “Notwithstanding the ample guidance available, Walgreens has failed to maintain an adequate suspicious order reporting system and as a result, has ignored readily identifiable orders and ordering patterns that, based on the information available throughout the Walgreens Corporation, should have been obvious signs of diversion."

In one case, Walgreens’s suspicious order report to the DEA was 1,712 pages long and contained six months’ worth of orders, including reports on 836 pharmacies in more than a dozen states and Puerto Rico, the filing alleges.

The filing also alleges that Walgreens stores could “place ad hoc ‘PDQ’ (“pretty darn quick”) orders to controlled substances outside of their normal order days and outside of the [suspicious order monitoring] analysis and limits.”

The Post has previously reported that Kristine Atwell, who managed distribution of controlled substances for the company’s warehouse in Jupiter, Fla., sent an email on Jan. 10, 2011, to corporate headquarters urging that some of the stores be required to justify their large quantity of orders.

"I ran a query to see how many bottles we have sent to store #3836 and we have shipped them 3271 bottles between 12/1/10 and 1/10/11,” Atwell wrote. “I don’t know how they can even house this many bottle[s] to be honest. How do we go about checking the validity of these orders?”

A bottle sent by a wholesaler generally contains 100 pills.

Walgreens never checked, the DEA said. Between April 2010 and February 2012, the Jupiter distribution center sent 13.7 million oxycodone doses to six Florida stores, records show, many times the norm, the DEA said.

Walgreens ranked second among distributors in the nation, with 13 billion pills and 16.5 percent of the market for oxycodone and hydrocodone from 2006 through 2012, the DEA database shows. It stopped distributing opioids to its stores in 2014, but continues to dispense controlled substances.

As part of a settlement with the DEA in June 2013, Walgreens said that its “suspicious order reporting for distribution to certain pharmacies did not meet the standards identified by DEA.” The company paid an $80 million fine to the government.

In a statement to The Post earlier in the week, Walgreens defended its operations, saying, “Walgreens has been an industry leader in combating this crisis in the communities where our pharmacists live and work."

Internal drug company emails show indifference to opioid epidemic

As lawyers zero in on drug companies, a reckoning may be coming

For two decades, as 200,000 opioid overdose deaths piled up across America, there was always someone else to blame. Families blamed drug companies. Drug companies blamed doctors. Everyone blamed the government.

More than half the public continues to see drug addiction as a moral failing, blaming substance abusers themselves for the epidemic, at least in part, according to recent polling.

But now the effort to hold someone to account for the worst drug crisis in U.S. history is narrowing to a few dozen drug companies whose day in court has come or will soon arrive. Virtually every state and nearly 2,000 towns, cities and counties have demanded those firms, which include some of America’s most trusted brands, be forced to pay up to help stop the epidemic.

"It is a drug company crisis, and it begins and should end with them,” Oklahoma attorney Bradley Beckworth told a judge this week in the first state drug trial of the opioid era. The state is seeking $17.5 billion from the health care conglomerate Johnson & Johnson to address the costs of addiction.

"I think people are coming to their senses,” said Moore, who led the legal battle in that case. “People are realizing that this is a public health crisis and not so much about litigation and lawyers. It needs to be treated as ‘we have a public health crisis.’”

Though the litigation is following the trail blazed by the tobacco and asbestos cases of the last century, plaintiffs are seeking even more staggering sums: $17.5 billion in sparsely populated Oklahoma; $7.2 billion for Cuyahoga and Summit counties in Ohio; $483 billion for a nationwide settlement, according to an expert witness for plaintiffs cited by Reuters.










Covid-19

COVID-19 – The Fight for a Cure: One Gigantic Western Pharma Rip-Off By Peter Koenig March 24, 2020

A few days ago, Dr. Tedros, the Director General of the World Health Organization (WHO) repeated what he said already a few weeks ago, that there are about 20 pharmaceutical laboratories throughout the world that are developing a vaccine for the novel coronavirus, named COVID-19, also called 2019-nCOV, or SARS-CoV-2.

For the layman, it is just a stronger mutation of the Severe Acute Respiratory Syndrome (SARS) virus, that broke out in 2002 / 2003, also in China. To be sure, a mutation made in a laboratory. In a US high-security biological warfare laboratory. In other words, both SARS and COVID-19 - among many other bio-war agents - were made in the US.

And now, the chaotic western-style race of private corporations for a vaccine wanting to outdo one another, has begun.

Who is first to develop a vaccine? - It's a fierce competition to establish a patent, a monopoly - for a possibly multi trillion-dollar business. Its western neoliberal capitalism at its very worst - or best, depending on the angle from where one looks.

There are no words to describe this chaotic fever for profit over human wellbeing. It has nothing to do with health, with healing sick and suffering, possibly dying people. It's all about money. Hundreds of billions, if not trillion of profit for the pharmaceutical oligarch and their associated research laboratories and enterprises. And even more so, if the WHO-declared "pandemic" (sic) will prompt a forced vaccination campaign, enhanced by military and police surveillance.

Let's put COVID-19 in context. As of 23 March 2020 (18:33 GMT), and according to WHO statistics, reported worldwide cases are 372,572; deaths 16,313; recovered 101,373 - a death rate of 4.37%. However, these figures must be considered with caution. In many countries, especially developing economies, accurate testing may be a problem. Test kits are often not available, or not reliable. So, may people who go to the doctor with some flu symptoms are possibly falsely diagnosed as COVID-19 victims, as it serves the publicity hype.

Miscalculations and false reporting may even occur in the United States. Mr. Robert Redfield, CEO of the US Center for Disease Control (CDC), testified before Congress that CDC does no longer carry out regular tests, that these were carried out at State-level and only in extreme cases. See also this reference form the LA Times of California measures and directives.

L.A. County gives up on containing coronavirus, tells doctors to skip testing of some patients

By comparison, the US CDC estimates that in the 2019 / 2020 flu season in the US alone, some 38 to 54 million people may catch the common flu, and 23,000 to 59,000 may die from it. The vast majority of these deaths will be elderly people above 70-years of age and many of them with pre-health conditions and /or pre-existing respiratory problems. This is pretty much the same disease and death pattern as with COVID-19. Expanding these common flu figures linearly on a worldwide scale would result in hundreds of thousands of flu deaths. In the particularly strong 2017-2018 US flu season, an estimated 60,000 people died from the flu in the US alone. The reader may himself judge whether WHO was justified declaring COVID-19 a "pandemic" - or whether there may have been - just perhaps - another agenda behind it?

The vaccine that might eventually be applied to COVID-19, may most likely no longer be valid for the next coronavirus outbreak - which, also according to Mr. Redfield, CDC, will most probably occur. A later virus may most certainly have mutated. It's quite similar to the common flu virus. In fact, the annually reoccurring common flu virus contains a proportion of 10% to 15% (some times more) of coronaviruses.

The effectiveness of the annual flu vaccines is on average less than 50%, not to mention all the potential harmful side effects, they carry along. COVID-19 is very similar to influenza. Will a corona virus vaccine be equally weak in protecting a potential patient from a future infection?

Cooperation instead of competition, doesn't occur in the west. It's all profit-driven.

With a number of different vaccines from different pharma giants coming on the market, who will tell the patient which one is the best, most suitable for the patient's condition? It smells like an utter chaotic scam.

The real question is – are vaccines – or a vaccine – even necessary? Maybe – maybe not.

The production of vaccines is pushed for profit motives and for an important political agenda for a New World Order - that has been planned to change human life as we know it, or thought we knew it. See further explanations below.

Vaccines don't heal, they may prevent the virus from hitting as hard as it might otherwise do, or not at all, depending on the age, physical and health condition of a person. Worldwide statistics show that usually a person up to the age of 40 or 50, who is infected by the COVID-19, has none or only slight symptoms, nothing to worry about.

Should symptoms show up, staying home, resting and using traditional, age-old medicine, the same that might be used for the common flu, might be enough to get rid of the virus. This might resolve the disease within one or two weeks. Then, the person will be naturally "vaccinated" against this strand of coronavirus. Elderly people above 65 or 70 may be more at risk and special attention may be in order - separated from crowds, isolation during a two-week quarantine (the incubation period), while the rest of society goes on with life as normal as possible, thereby reducing the huge cost to society.

China has brought the COVID-19 pandemic under control without a vaccine, but using common sense and traditional, rather inexpensive medication. What are these regular medicines that are effective and have helped to bring COVID-19 under control in China, without a vaccine?

The "Children's Health Defense" (the Children's Defense Fund – CDF), an American NGO, founded 1973 by Robert F. Kennedy, Jr., depicts the current power struggle in France between health official and the country's leading experts in virology, as representative for the worldwide fight between corporate pharma supported by (bought) governments and international organizations, such as WHO - and renowned scientists. If laid open, it is an eye-opener. See full CDF study.

Does the Coronavirus Pandemic Serve a Global Agenda? - Health Authorities Remain Silent on Efficient Covid-19 Treatment

French Professor Didier Raoult, who is one of the world's top 5 scientists on communicable diseases, argued that the approach of mass quarantine is both inefficient and outdated and that large-scale testing and treatment of suspected cases achieves far better results.

Early on, Dr. Raoult suggested the use of hydroxychloroquine (Chloroquine or Plaquenil), a well-known, simple, and inexpensive drug, also used to fight Malaria, and that has shown efficacy with previous coronaviruses such as SARS. By mid-February 2020, clinical trials at his institute and in China already confirmed that the drug could reduce the viral load and bring spectacular improvement. The Chinese scientists published their first trials on more than 100 patients and announced that the Chinese National Health Commission would recommend Chloroquine in their new guidelines to treat Covid-19.

In addition, China and Cuba are working together with the use of Interferon Alpha 2B, a highly efficient anti-viral drug developed in Cuba some 39 years, but little known to the world, because of the US imposed embargo on anything from Cuba. Interferon has also proven to be very effective in fighting COVID-19 and is now produced in a joint-venture in China.

Chinese researchers in cooperation with Cuban scientists are also developing a vaccine which may soon be ready for testing. In contrast to the west, working exclusively on profit-motives, the Chinese-Cuban vaccine would be made available at low cost to the entire world.

Other simple, but effective remedies include the use of heavy doses of Vitamin C, as well as Vitamin D3, or more generally the use of Micronutrients essential to fight infections, include vitamins A, B, C, D, and E.

Another remedy that has been used for thousands of years by ancient Chinese, Romans and Egyptians, are Colloidal silver products. They come in forms to be administered as a liquid by mouth, or injected, or applied to the skin. Colloidal silver products are boosting the immune system, fighting bacteria and viruses, and have been used for treating cancer, HIV/AIDS, shingles, herpes, eye ailments, prostatitis - and COVID-19.

Yet another simple and inexpensive remedy, to be used in combination with others, is menthol-based "Mentholatum". It's used for common flu and cold symptoms. Rubbed on and around the nose, it acts as a disinfectant and prevents germs to enter the respiratory track.

Northern Italy and New Orleans report that an unusual number of patients had to be hospitalized in Intensive Care Units (ICU) and be put 24x7 on a 90% strength respirator, with some of them remaining unresponsive, going into respiratory failure. The reported death rate is about 40%. The condition is called acute respiratory distress syndrome, ARDS. That means the lungs are filled with fluid. When this description of ARDS episodes applies, Dr. Raoult and other medical colleagues recommend COVID-19 patients to "sleep sitting up" until they are cured. This helps drain the liquid out of the lungs. The method has been known to work successfully since it was first documented during the 1918 Spanish Flu epidemic.

As you may expect, if you look up any of these alternative cures on internet - internet controlled by Google and the Big Corporatocracy, including the pharmaceuticals, will logically advise you against using them. At best they will tell you that these products or methods have not proven effective, and at worst, that they may be harmful. Don't believe it. None of these products or methods are harmful. Remember, some of them have been used as natural remedies for thousands of years. And remember, China has successfully come to grips with COVID-19, using some of these relatively simple and inexpensive medications.

Unfortunately, few doctors are aware of these practical, simple and inexpensive remedies. They are safe and more often than not successful. The media, under pressure from the pharma giants and the compliant government agencies, have been requested to censoring such valuable information. The negligence or failure, to make such easily accessible remedies public knowledge is killing people.

Now, let's cut to the chase, to what's behind it all - behind the extraordinary monstrous media propaganda hype that is bringing down the entire (western) world's socioeconomic system, creating untold misery, famine, and death. A misery with suffering potentially by orders of magnitude worse than the Big Depression of 1928 / 1929 and the subsequent years.

If anybody had any doubts up to now, where the virus originated, the truth was dropped surreptitiously, a slip of the tongue or on purpose, by Secretary of State, Mike Pompeo, when he addressed the Nation on 21 March on COVID-19, he said, "This is not about retribution, we are in a live exercise here…", meaning military exercise, or a war game.

President Trump by Pompeo's side was whispering, "you should have let us know". Whatever that means. It's hard to believe that Mr. Trump didn't know. But these are the vagaries of American politics, even on a death-serious subject like the new coronavirus breakout. See here with a brief video. See this also.

short video

404 page gone--I wonder why

This live (military) exercise has unimaginable worldwide implications which may completely transform our lives. It's economic warfare. Almost every country on this planet is on some kind of a lock-down, a quarantine of sorts for an as of yet undetermined period, with businesses closed, shops and restaurants shot, construction sites halted, people working from home if they can, being in the streets is forbidden, in many countries under police and military surveillance, with cases of people being beaten up and hand-cuffed, if they have no good explanation.

The President Macron-inspired French police is especially known for its uncontrolled brutality fighting the Yellow Vests. They have already demonstrated their same despise for their fellow citizens, when they are in the streets, even food shopping, without a special permit.

Borders are shot, airlines are grounded, tourism comes to a screeching halt, basically from one day to the other, stranded throughout the world. With a few exceptions, Germany and France are rare ones, they organize return flights for their citizens abroad. Otherwise, with uncertain flight departures, over-booked and over-crowded flights, the stranded tourists have hardly a chance to return home soon.

The socioeconomic cost is astronomical. In the multi-quadrillion, or quintillion; numbers with so many zeros they make you dizzy. This calamity can only partly be valued with numbers, and not now, as the world's lock-down continues - with a social cost that cannot be valued. The dive of the stock market by about 30% - a typical bonanza for forward speculators and Big Finance, Big Banking, with multi-trillion-dollar losses for the small investors.

Millions, if not hundreds of millions of small and medium size businesses going broke, unemployment going rampant, in the hundreds of millions, throughout the world, and the poorest of the poor, especially in developing countries, who are either unemployed or survive on small hourly or day-to-day jobs - they have no income, cannot buy the basics for survival - some of them may die from famine, others may commit suicide, others convert to crime. This is Greece by a factor of thousand, or worse.

Then, there is a moral and societal breakdown from a forced quarantine, for which there is no clear end in sight. This creates fear and anxieties, frustration and anger. For many it's like solitary confinement - all of which is bad for health, and lowers the immune defense system. Just what those who pull the strings want.

So, whom does this live (military) exercise serve? - First one would assume its destined to break China's back, as China is the up-and-coming economic power. It is true, China's economy has suffered enormously, with about 60% to 70% of all production stopped for the first two months this year, the time of the COVID-19 outbreak and peak, meaning a significant plunge of China's GDP, maybe as much as 40% for January and February 2020.

However, China has the corona virus now firmly under control. And China being China, her economy is recovering fast and may soon be back to what it was in December 2019. In fact, despite the significant impact of COVID-19, China's economy may soon overtake that of the self-styled empire, the United States of America. China's currency the yuan, is solidly backed by a strong economy and by gold, and is slated to become the world's chief reserve currency, replacing the US-dollar, which had that role for the last 100 years. When that happens, the US hegemony is doomed.

It's more. This attack on China is actually backfiring big time. China is the supply chain for almost everything for the west. To increase corporate profits, the US and other western countries have outsourced almost everything to low-cost labor China. This concerns not only high technology electronics, but also medication and medical equipment. About 80% and ingredients to produce medication come from China. For antibiotics the proportion is about 90%. With much of Chinese production halted for almost 2 months, the delivery lag is enormous.

A plan has been on the drawing board for the last few years, dictated by the obscure clan, or "Deep Dark State", and designed by its minions, who expect to be generously rewarded in one way or another. Or, you may put it this way, the absence of punishment and torture is also a form of reward.

Universal Vaccination

First, there is an enormous drive towards universal vaccination, because vaccination will be the cornerstone of all that follows, namely a universally imposed electronic identification of every person on the planet. And what is best suited to force down a vaccination program? - A pandemic, of course, with people being made more scared every day. The fear factor is key. It is being increased by a time-undetermined quarantine and by a constant drip-by-drip indoctrination of bad news on the COVID-19 front. Every day the pace of increasing numbers of infected people and those who died, accelerates, increasing fear and anxiety.

The time will come, when people will literally scream for help. They want a police and military state to protect them - from the virus, I guess - and they want to be vaccinated. They don't care nor ask what is the cocktail that is being injected in their body and what its long-term implications may be. For example, the vaccination cocktail could serve to reduce women and men's fertility, or cause long-term neurological defects that can even be passed on to next generations. People with fear just want to sleep at ease, being vaccinated. They don't care - nor do they want to know - that along with the vaccine could be a nano-chip injected that will contain all their personal data, from health records to bank accounts - and can be electronically remote-controlled.

It goes without saying, our monetary system is planned to be fully electronic, no more cash - cash is poison - or as WHO's Director General recently warned, not verbatim, but with that meaning, cash is dangerous for infections, paper money and coins may carry deadly viruses - thereby paving the way for full digitization of our monetary system. This has, indeed, already been tested over the past few years, mainly in Scandinavian countries, where entire department stores refuse to accept cash. In response to the WHO DG's recommendation, some shops and restaurants in Germany refuse to accept cash.

The universal vaccination and electronic ID go together and will first be tested in a few developing countries. Bangladesh is one of them. The vaccination program is the platform for the mega-changes the New World Order (NOW), or the One World Order (OWO) wants to bring about. This, in addition to the enormous money-making bonanza.

An almost unknown agency called Agenda ID2020 is behind all this, monitoring, directing and adjusting the implementation of the various programs - that are supposed to eventually lead to Full Spectrum Dominance. For more details, see also the recent article on the dangers of Agenda ID2020.

The Coronavirus COVID-19 Pandemic: The Real Danger is "Agenda ID2020" - What is the infamous ID2020? It is an alliance of public-private partners, including UN agencies and civil society. It’s an electronic ID program that uses generalized vaccination as a platform for digital identity. Global Research

Behind this elaborate and complex network of things, appears time and again, one prominent name: Bill Gates, the Bill and Melinda Gate's Foundation. Bill Gates has been funding vaccination programs in Africa for decades. And Bill Gates and the Rockefellers make no secret that one of their ultimate goal for planet earth is a drastic population reduction.

Abstract of Agenda ID2020

Agenda ID2020 - is an alliance of public-private partners, including UN agencies and civil society. It's an electronic ID program that uses generalized vaccination as a platform for digital identity. The program harnesses existing birth registration and vaccination operations to provide newborns with a portable and persistent biometrically-linked digital identity.

GAVI, the Global Alliance for Vaccines and Immunization, identifies itself on its website as a global health partnership of public and private sector organizations dedicated to "immunization for all". GAVI is supported by WHO, and needless to say, its main partners and sponsors are the pharma-industry.

The ID2020 Alliance at their 2019 Summit, entitled "Rising to the Good ID Challenge", in September 2019 in New York, decided to roll out their program in 2020, a decision confirmed by the WEF in January 2020 in Davos. Their digital identity program will be tested with the government of Bangladesh. GAVI, the Vaccine Alliance, and "partners from academia and humanitarian relief" (as they call it), are part of the pioneer party.

Is it just a coincidence that ID2020 is being rolled out at the onset of what WHO calls a Pandemic? - Or is a pandemic needed to 'roll out' the multiple devastating programs of ID2020?

How the Vaccination Research and Production is supposed to work.

How will this elaborate and complex business of creating vaccines and implementing vaccine campaign work? As most official activities that basically are government responsibilities are privatized and outsourced, they become complex, chaotic at times and inefficient. In the case of the west, the US pretends to take the lead, but will also assign responsibilities to European pharma-labs.

The National Institute of Health (NIH) has overall responsibility for national health research and program implementation. NIH's Director is Anthony Fauci. The Institute was created in 1955. Under NIH, the National Institute of Allergy and Infectious Diseases (NIAID), one of 27 institutes, reporting to NIH, is responsible for vaccination programs. NIAD's mission is to conduct basic and applied research to better understand, treat and prevent infectious, immunologic and allergic diseases. NIAD has outsourced the vaccination program to the Coalition for Epidemic Preparedness Innovations (CEPI).

CEPI was formed by the WEF (World Economic Forum) in Davos in January 2017. It was founded by the Bill and Melinda Gates Foundation (BMGF) and the London-based Welcome Trust, created in 1936, but including now as members several European countries and the European Union (EU). The BMGF made a first infusion to CEPI of US$ 460 million. CEPI also receives funding from Norway and India and is also heavily supported by the pharma-industry.

According to CEPI's website, CEPI has appealed for US$ 2 billion to support the development of a vaccine for COVID-19 and to expand the number of vaccine candidates to increase the chances of success and to fund the clinical trials for these candidate vaccines. CEPI's ambition is to have at least three vaccine candidates, which could be submitted to regulatory authorities for licensing for general use/use in outbreaks.

"Governments around the world will need to invest billions of euros more in coronavirus vaccine development, to take forward some promising candidates that are emerging. - It's a very risky business - everything is being done in parallel, you're not building on the expertise of others - but good progress is being made," said Melanie Saville, director of vaccine research and development at CEPI.

CEPI has already some preselected international pharma corporations to research and work on a COVID-19 vaccine. They include the biotech "Moderna" in Seattle, not far from the Microsoft Headquarters - also a Bill Gates creation; the biotech lab Inovio, the University of Queensland, Australia, and the Germans, BioNTech and CureVac.

From the outset it looks that Moderna, CureVac and BioNTech are best suited to produce fast a vaccine, because according to a Health and Science report, published on March 17, 2020, “all three of these firms specialize in messenger RNA (mRNA) therapeutics. These mRNA molecules are used to instruct the body to produce its own immune response to fight a range of different diseases. This type of vaccine can potentially be developed and produced more quickly than traditional vaccines.”

Enters GAVI - the Global Alliance for Vaccines and Immunization has also been created by the Bill and Melinda Gates Foundation. It is a global health partnership of public and private sector organizations, dedicated to "immunization for all". GAVI is supported by WHO, and needless to say, its main partners and sponsors are the pharma-industry. GAVI has already announced it needs billions of dollars to support its COVID-19 vaccination program. In June 2020, the UK Government will sponsor a donor conference in support of GAVI' COVID-19 vaccination program, expecting to raise US$ 7.3 billion.

From this maze of overlapping organizations, activities and unclear responsibilities, the money-flow is likely going to be a crisscross that nobody can follow. Accountability on a large scale will be lost.

As to the output - hopefully a vaccine - or several vaccines. For the layman and potential patient, it will be a matter of luck (or bad luck) what cocktail of biological substances will be injected into his or her body. In any case, the long-term outcome, is unpredictable. Remember, Bill Gates has been pursuing during the last fifteen or twenty years his own very special agenda. It is unlikely he will abandon it now. Rather COVID-19 and the ensuing vaccination program will allow him to enhance it.

Concluding - it is amply clear that this is a huge money-making and public-rip-off proposition by the pharma industry. What makes this multi-billion-dollar scam even worse, is that it has an official rubber-stamp, by being supported by western governments and international organizations, foremost WHO, UNICEF and the World Bank.

This may be the last opportunity for the elite, the 0.1%, to shuffle social capital and worker funded assets from the bottom to the top, before we enter an era of total control through electromagnetic fields (EMF), managed by the minions of the 0.1% and with 5G / 6G technology, where we, the remaining humans may have become mere tele-guided robots.It is by now a pipe dream to believe that the world may continue as it did until the end of the last decade. It would be too much of a coincidence that Agenda ID2020 started activating its evil programs exactly at the beginning of the decade 2020. Unfortunately, it is also a far-away dream that China and Cuba could lead the way for finding a cure for the most likely recurring coronavirus in one mutation or another – including but not exclusively, using traditional methods and remedies that have proven successful in the current battle to control COVID-19.

There are draconian measures on the way, and we may just pray that they fail, or that we, the people, awake in time and in sufficient numbers - a critical mass - and find back to our innermost voice and soul - solidarity for each other that gives us strength to fight this Luciferian monster.

Peter Koenig is an economist and geopolitical analyst. He is also a former World Bank staff and worked extensively around the world in the fields of environment and water resources. He is the author of Implosion – An Economic Thriller about War, Environmental Destruction and Corporate Greed - fiction based on facts and on 30 years of World Bank experience around the globe. He is also a co-author of The World Order and Revolution! – Essays from the Resistance.

[info on Peter Koenig

Peter Koenig, Author at Global ResearchGlobal Research ...

Peter Koenig is an economist and geopolitical analyst. He is also a former World Bank staff and worked extensively around the world in the fields of environment and water resources. He writes regularly for Global Research, ICH, RT, Sputnik, and other internet sites. from 21st Century

Peter Koenig

Peter Koenig is an economist and geopolitical analyst. He is also a former World Bank staff and worked extensively around the world in the fields of environment and water resources. He writes regularly for Global Research, ICH, RT, Sputnik News, the Voice of Russia / Ria Novosti, TeleSur, The Vineyard of The Saker Blog, and other internet sites.

He is the author of Implosion - An Economic Thriller about War, Environmental Destruction and Corporate Greed - fiction based on facts and on 30 years of World Bank experience around the globe. He is also a co-author of The World Order and Revolution - Essays from the Resistance.[

Implosion: An Economic Thriller about War, Environmental Destruction and Corporate Greed Paperback – January 11, 2008 by Peter Koenig

"In this riveting economic thriller, Paul Jordon, a renegade World Banker,and Moni Cheng, an Andean woman who leads a socio-environmental nongovernmental organization in the Peruvian Amazon, endure kidnappings, bombings, and deadly chases in their fight against boundless capitalism, destructive economic policies, and corporate greed that are wreaking worldwide social injustice and destroying the globe's richest zones of biodiversity. Together, Jordon and Cheng expose corporate ruthlessness, military brutality, and Machiavellian economic policies of the foremost financialivory towers of Washington, the World Bank, and the International Monetary Fund. With other visionaries from around the globe, Jordon and Cheng untiringly disseminate truth and candid information about the calamities caused by this cruel machinery. And against all odds, they mobilize the power of the people. Richly detailed, grounded in actual events and statistics, and complete withnotes from author and former World Bank economist Peter Koenig, Implosion is both an unsettling, gripping novel and a powerful commentary on the realities of the modern world's corporatocracy.

Koenig's Blog

COVID-19: Further Evidence that the Virus Originated in the US, Global Research

As readers will recall from the earlier article (above), Japanese and Taiwanese epidemiologists and pharmacologists have determined that the new coronavirus could have originated in the US since that country is the only one known to have all five types - from which all others must have descended. Wuhan in China has only one of those types, rendering it in analogy as a kind of "branch" which cannot exist by itself but must have grown from a "tree".

The Taiwanese physician noted that in August of 2019 the US had a flurry of lung pneumonias or similar, which the Americans blamed on 'vaping' from e-cigarettes, but which, according to the scientist, the symptoms and conditions could not be explained by e-cigarettes. He said he wrote to the US officials telling them he suspected those deaths were likely due to the coronavirus. He claims his warnings were ignored.

Immediately prior to that, the CDC totally shut down the US Military's main bio-lab at Fort Detrick, Maryland, due to an absence of safeguards against pathogen leakages, issuing a complete "cease and desist" order to the military. It was immediately after this event that the 'e-cigarette' epidemic arose.

Screenshot from The New York Times August 08, 2019

We also had the Japanese citizens infected in September of 2019, in Hawaii, people who had never been to China, these infections occurring on US soil long before the outbreak in Wuhan but only shortly after the locking down of Fort Detrick.

Then, on Chinese social media, another article appeared, aware of the above but presenting further details. It stated in part that five “foreign” athletes or other personnel visiting Wuhan for the World Military Games (October 18-27, 2019) were hospitalised in Wuhan for an undetermined infection.

The article explains more clearly that the Wuhan version of the virus could have come only from the US because it is what they call a “branch” which could not have been created first because it would have no ‘seed’. It would have to have been a new variety spun off the original ‘trunk’, and that trunk exists only in the US. (1)

There has been much public speculation that the coronavirus had been deliberately transmitted to China but, according to the Chinese article, a less sinister alternative is possible.

If some members of the US team at the World Military Games (18-27 October) had become infected by the virus from an accidental outbreak at Fort Detrick it is possible that, with a long initial incubation period, their symptoms might have been minor, and those individuals could easily have 'toured' the city of Wuhan during their stay, infecting potentially thousands of local residents in various locations, many of whom would later travel to the seafood market from which the virus would spread like wildfire (as it did).

That would account also for the practical impossibility of locating the legendary "patient zero" - which in this case has never been found since there would have been many of them.

Next, Daniel Lucey, an infectious disease expert at Georgetown University in Washington, said in an article in Science magazine that the first human infection has been confirmed as occurring in November 2019, (not in Wuhan), suggesting the virus originated elsewhere and then spread to the seafood markets. "One group put the origin of the outbreak as early as 18 September 2019." (2) (3)

Larry Romanoff is a retired management consultant and businessman. He has held senior executive positions in international consulting firms, and owned an international import-export business. He has been a visiting professor at Shanghai’s Fudan University, presenting case studies in international affairs to senior EMBA classes. Mr. Romanoff lives in Shanghai and is currently writing a series of ten books generally related to China and the West. He can be contacted at: 2186604556@qq.com. He is a frequent contributor to Global Research.

Notes

(1) https://mp.weixin.qq.com/s/CjGWaaDSKTyjWRMyQyGXUA

(2) https://science.sciencemag.org/content/367/6477/492.full

(3) Science; Jon Cohen; Jan. 26, 2020 https://www.sciencemag.org/news/2020/01/wuhan-seafood-market-may-not-be-source-novel-virus-spreading-globally

(4) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

(5) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext

(6) http://wjw.wuhan.gov.cn/front/web/showDetail/2020011109036

(7) http://wjw.wuhan.gov.cn/front/web/showDetail/2020011509040

(8) https://sciencespeaksblog.org/2020/01/25/wuhan-coronavirus-2019-ncov-qa-6-an-evidence-based-hypothesis/

(9) http://virological.org/t/clock-and-tmrca-based-on-27-genomes/347

(10) http://applications.emro.who.int/emhj/v19/Supp1/EMHJ_2013_19_Supp1_S12_S18.pdf

ADD:

Email from NorthStar Nutritionals, 11-20-18: UNBELIEVABLE! Big Pharma hijacks popular memory-boosting supplement

BREAKING NEWS: In an unprecedented move, the FDA and Big Pharma are conspiring to take one of the most popular memory boosting supplements off the market...

Not because it's unsafe or ineffective... in fact, it's just the opposite.

According to our sources, this supplement is under investigation for development into a memory-enhancing prescription drug!

In fact, it's already gone through phase I and II clinical trials... which means it's just one round of tests away from becoming Big Pharma's next moneymaker.

[And, of course, the FDA will ban the saile as a supplement}


Send comments to co@dadbyrn.com, Professor Colby Glass, MLIS, PhDc, Prof. Emeritus