Danny Cardwell's picture

    Corporate Thug Dealers

    I was reading an article about the drug epidemic in West Virginia when I learned a fact that put the size and scope of this problem in perspective:

    A Charleston Gazette-Mail investigation last year found that...drug wholesalers shipped over 780 million doses of opiate painkillers hydrocodone and oxycodone to the state, or roughly '433 pain pills for every man, woman and child in West Virginia.

    After finishing the article I jotted down some questions: If wholesalers are shipping the drugs into West Virginia through legal channels, at what point in the distribution network do they go from controlled substances (contained in government regulated environments) to the streets? The wholesalers aren't shipping these drugs into West Virginia on a whim, so who's ordering them? If a reporter could collect all of this information, why can't federal and state prosecutors?

    Breaking Bad was a huge success, but I don't know any street level guys who can turn opioids or synthetic opioid derivatives into Oxycodone or Hydrocodone, yet the victims of pharmaceutical malfeasance are the public face of this epidemic. The pharmaceutical companies that manufacture and distribute the drugs are rarely seen as equal participants in this crisis. If law enforcement doesn't get serious about locking up chief executives and doctors, poor whites throughout Appalachia will continue dying from the drugs that are flooding into their communities. If Isis or Black Lives Matter activists were doing this to rural America there would be a much more concerted effort to end the carnage.

    The reaction to this crisis by law enforcement in many counties has been feeble at best. Opioids are now easier to get than Marijuana. In the new war on drugs, courts have doubled down on punishing people of color involved in the crisis while simultaneously seeking treatment for whites who are the "victims". For the most part, law enforcement has completely ignored the white collar criminals making the money. As long as there's no consequences for those at the top of the supply chain we won't see any changes.  

    During the Vietnam War, U.S. soldiers were the victims of a similar get rich quick drug scheme. They were drowning in a pool of readily available heroin. The heroin they were using was coming from Afghanistan, and was some of the best dope in the world. How did heroin from the middle east find its way into a war zone in the far east? (For those interested, research the Golden Triangle and Air America.) Vietnam was a drug dealer's heaven: highly stressed young men with disposable income. This is similar to what we see in rural America, but with less money. There are pharmaceutical companies getting richer at the expense of the misery felt by too many poor people in the Appalachian mountains. I've heard more ineffective politicians address this issue than I can recall. They talk tough, but none of them are delivering. I'll take this new version of the war on drugs serious when I see coordinated raids on distribution sites, pharmacies, and clinics. When I see people pulled off of golf courses and out of hospitals I'll know America is serious about opioid addiction. Until then, I'll watch what passes for justice in the absence of justice.

    Here's the link to the article.





    A problem with this epidemic is that opiates are actually effective pain killers.  It seems to me they've been demonized without being properly replaced.  Addiction is a terrible thing, not minimizing that at all, but so is ineffective pain treatment.


    There has to be a better way to keep pharmaceutical companies from flodding states with opiates. More audits of pharmacies and doctors offices should be a starting place. One of last kids my wife signed up for head start was murdered by her mother a few weeks ago in a drug fueled rampage. Southwest Virginia and West Virginia are living hells for the people caught up in this trap. I'm cynical and very jaded by the way I've seen justice adjudicated in our area. There's almost a willful denial of the problem by some!

    Some states have databases available to pharmacists and physicians to see if a patient is getting multiple prescriptions from different doctors. The database also serves as a monitor on how many pai prescriptions a physician is writing. 


    Drug manufacturers ship drugs to pharmacies. Pharmacies order drugs in response to patient demand based on prescriptions. Physicians are responsible for 75% of drug addiction in the United States. Dr. Anna Lemke, a pain specialist, details how physicians prescribed large amounts of pain killers based on a pharmaceutical company meme that people in pain could not become addicted to pain medication in "Drug Dealer M.D.". The FDA is now cracking down on physicians, and for many people in pain, physician including pain specialists are reluctant to prescribe pain medications now.


    This kind of thing is why we invented government to try to be objective as to cost/benefit? Unfortunately in this republic a simplistic version of the Protestant work ethic still has too much effect on the cilvil servants and politicians working in that government, where suffering in this life is lauded in preference to the next life and the next generation. Fortunately for most of us in circumstances related,  there are brilliant people in professions in the hospice and pain management areas whose reformist thoughts are spread more quickly and effectively via the internet than they would have been spread in days gone by. We still have to have patience and suffer, but much less so than in the recent past. Let's be grateful for the moment in the progress achieved, that few in like, the death grip of cancer, are not being tortured to death with pain, even if they are still being tortured to death by pie-in-the-sky over treatment.

    Persistent pain makes a physician feel personal failure. Anesthesiologists were tasked with addressing this category of patients, creating the subspecialty of pain medicine. Refractory cancer made oncologists feel like failures. The subspecialty of hospice medicine resulted. Pain physicians realize the addiction problem and university centers are researching different, hopefully non-addictive therapies. Hospice specialists learn to comfort and talk to patients about how they want to face the end of life. Medicine adapts.The problem in small towns and pockets of urban American is that access to higher class pain care is lacking, thus addiction rates are high. Giving drugs is easy.

    Edit to add:

    Dr Lembke gave an interview on NPR detailing how she recognized the problem


    I watched a bit of TV over the weekend and was amazed at how many commercials I saw for this drug that is supposed to help people taking opiods with the serious constipation issues they often develop.  And the main guy in the recurring commercial is this good looking construction supervisor, looking full of health and vigor and explaining that he needed this drug because the doctor had him on opioids due to a back injury.  It's like is this the new Marlboro man of 2017?  

    Nice work Danny.

    Thanks! I appreciate you taking the time to read and engage this post.

    Thanks for an important, as per usual, piece Danny.  The incidence of depression in the heartland is off-the-charts.  Counties in West Virginia and hardscrabble cities on Detroit's periphery are suffering from suicide rates that are 5 to 10 times or perhaps even higher than those in Chicago's northeast suburbs and on both coasts.  Addiction to painkillers symptomizes a hollowed-out nation where institutions are not to be trusted and 60% of the populace believes with reason that today's children will be even worse off than their parents are now.

    Thanks for commenting. You had a very good Halcast today. I wathed it in two parts. Keep pushing!


    Had kidney stones a while back. ER docs gave me about ten oxycodones, which made me vomit. So they added Tan or Tam-something to control the nausea. Got another stone, got ten more oxys. I only used them when the stones were moving through the ureter, which felt like someone was twisting a knife in the small of my back. One day I used them for an attack in the morning at work, and I felt really good the rest of the day. Next day I felt crappy, my neck was sore, and I found myself wishing I could take another oxy. That was an eye-opener.

    Got a third stone, a big one, and was referred to the urologist. I told him I preferred to pass the stone rather than do the $10K operation, but that I was almost out of oxys. He said we''ll schedule it just in case you can't, and here's a prescription. Filled that and it was for about 25 or 30 oxys. (!) Told the wife, and she joked, I wonder what you could get on the street. About twenty years, I said. 

    I did pass that stone, and haven't had another. But I think I have an idea how oxy gets around.

    Thanks for being open enough to respond in such an honest manor. My home town is turning into a sewer. My heart breaks for the people caught in this hell.

    Sadly, while drug addiction is increased throughout the country, it has a devastating effect on small town America. Small town America voted for Trump. Trumpcare will likely decrease federal funding for drug addiction treatment. 


    At this stage, I don't think Republicans care.

    Edit to add:

    Will the current situation regarding healthcare change attitudes about voting for the party that believes in government aiding the public (will there be more Democratic votes in 2018?)

    I watched Chris Hayes last night and it was heartbreaking to hear what's happening in McDowell. There's no way we can accept this as the new normal.

    There is no evidence of a country that successfully provides healthcare based on a free market model. 


    People do not rush to the United States from Canada etc, to get healthcare because US healthcare is too expensive.


    Facts regarding healthcare may eventually sneak through.

    The Washington Post is (finally?) using some ink on this catastrophe.  Some West Virginians have filed suit against drug wholesalers and distributors:

    “The purpose of these lawsuits is to make the economic cost of willfully violating the law so significant that we force the wholesalers to abide by the law,” said Paul Farrell Jr., who filed the lawsuits in West Virginia and plans to file lawsuits on behalf of five other counties in the state next week.

    The suits are among the first of their kind in the country. They accuse the companies of creating a hazard to public health and safety by shipping inordinate quantities of opioids into the state in violation of a West Virginia law. The law was originally designed to permit the demolition of run-down buildings that posed a public nuisance and threatened the safety of a community.

    The lawsuits name McKesson Corp., Cardinal Health and AmerisourceBergen — which distribute 85 percent of the nation’s drugs. Also named are Walgreens, CVS and others.

    This piece in Sunday's WP is heart-wrenching, all of these sick, hopeless folks in WVputting their hope in coal jobs that won't come back.  This is one of those must-reads:

    Heartburn is just the latest problem for Clyde, a patient Keisha sees every three months. Like so many in this corner of Appalachia, he used to have a highly paid job at a coal mine. Company insurance covered all of his medical needs. Then he lost the job and ended up here, holding a cane and suffering not only from heartburn but diabetes, arthritis, diverticulitis, high blood pressure and high cholesterol.

    Because of the ACA, Clyde’s visit is covered by Medicaid. Before the law, most West Virginians without children or disabilities could not qualify for Medicaid, no matter how poor they were. The ACA — better known here as Obamacare — expanded the program to cover more people, such as Clyde, who can depend on Keisha to fix his heartburn without having to worry about the cost.

    As for the other problems in his life, he has put his hopes in Trump, who came to West Virginia saying he would bring back coal and put miners back to work. When Trump mentioned repealing Obamacare, Clyde wasn’t sure what that might mean for his Medicaid. But if he had a job that provided health insurance, he reasoned, he wouldn’t need Medicaid anyway, so he voted for Trump, along with 74 percent of McDowell County.


    And I noted with interest that the House bill takes care that people like Clyde don't turn against them in the short term. If you are on Medicaid now, you would get to stay on Medicaid until you start making a certain amount of money, until Medicare kicks in if need be, as long as you continually re-up.. The rules changes will only affect new people who would have, under Obamacare, newly qualify for Medicaid. And those who had to leave it because of income changes could not re-up if t heir income fell again. It's a long term phase out.

    Edit to add: one thing I have seen few point out that this would get rid of the game where one gets Medicaid coverage for the nursing home or home care for grandma that Medicare won't pay for.

    From today's Washington Post, Americans are largest users of opioids in the world.

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