rigorousintuition.ca

What I’d Say to the Drug Dealer Who Gave My Sister a Fatal Dose of Heroin

By Nadia Bowers

In 2015, 33,091 people died from opioid overdoses in the U.S. My sister was one of them. She passed away on July 31, 2015 at the age of 44. I often think about her last day and what her final moments were like. I also think about the person who gave her the drugs that ended her life. Below is what I might say to that person if we ever met.

DEAR DEALER,

Hey, man, what’s up? I’m saying “man” because most of the people who blew up my sister’s phone offering and seeking drugs were men. Men who had negative impacts on my sister’s life. Since I don’t know your name, I’ll just call you Dealer. You had the greatest and most negative impact on my sister’s life: You killed her.

In high school, at the height of the Just Say No movement in the late ‘80s, we were taught that kids who used drugs were pariahs, weak. They just couldn’t say no. But the people who sold the drugs, they had power. Drug dealers were dangerous, but also a little sexy. “I bet he’s like, a drug dealer.” But to call you a drug dealer here, with that same reverence, is naive, out of touch. I’m an adult now. I know better. I know addicts, and people in recovery; I’ve been around lots of drugs and have done my fair share. So, I’m familiar with your world, familiar enough to know that most people who call on you for their drugs probably refer to you as their dealer. Similar to how they refer to other helpful people in their lives: my mechanic, my hairdresser, my chiropractor, my dentist, my deli guy…my dealer.

What did you call my sister? My sister, Sasha, who I think you knew. I hope you didn’t call her Sash because that’s what a lot of people who loved her called her, and I find it hard to believe that you loved her. Did you call her by her name? Or, “lady?” How about, “hot mess,” when she was out of earshot? Or maybe you created a nickname for her like “purple,” the color of her car. The same car she was found in, slumped over, in the parking lot of a seafood restaurant off the side of the highway, according to the police report.

When she died, I was seven months pregnant, and when I gave birth the doctors gave me the same drug that killed her to ease my 46-hour labor. My husband had to pull my physician aside, and beg him not to tell me that he was about to inject me with the same drug that took my sister’s life. The drug you gave to her. The drug you mixed with heroin. The drug that’s 50 to 100 times more powerful than morphine. The one that stopped her breath, then her heart. Fentanyl.

I THINK ABOUT YOU ALL THE TIME. Almost every day. You’re the only one who knows some very important things about how my sister died, so I feel like I deserve to know you. I deserve at least five minutes of your time. You may be the last person who saw her alive, and I’m a little jealous. Are you still alive? I feel like you are. And I’m angry about that. But if I found out that you’re dead, I might be angry about that too. Sometimes, I think about hurting you.

MORE...http://time.com/5281371/dear-dealer-sis ... -overdose/

In high school, at the height of the Just Say No movement in the late ‘80s, we were taught that kids who used drugs were pariahs, weak.

'Just Say No' anti-drug campaign helped define Nancy Reagan's legacy

By Joe Mozingo, Sonali Kohli, Zahira Torres and Sonali Kohl

Mar 07, 2016

“From the early days of her husband's presidency, Nancy Reagan decided to focus on the anti-drug cause. She said she came up with the name of her campaign at a meeting with schoolchildren in Oakland, when a girl asked her, 'Mrs. Reagan, what do you do if somebody offers you drugs?'"

"Just say no," the first lady replied.”

http://www.latimes.com/local/california ... story.html

Record US fentanyl bust 'enough to kill 26 million people'


The heroin-ravaged city fighting back
Nearly 120lbs (54kg) of fentanyl, a powerful synthetic painkiller, has been seized by police in Nebraska - one of the largest busts in US history.

The drugs, seized last month, could kill over 26 million people, according to estimates by the US Drug Enforcement Administration (DEA).

Police found the fentanyl in a fake compartment of a lorry. The driver and a passenger were arrested.

Fentanyl is a synthetic opioid that is 30-50 times more potent than heroin.

It was the largest seizure of fentanyl in state history, Nebraska State Patrol said in a Twitter post on Thursday.

Police stopped Felipe Genao-Minaya, 46, and his 52-year-old passenger Nelson Nunez, both of New Jersey, on 26 April after spotting the pair driving on the shoulder of a motorway near the city of Kearney.

During the stop, a trooper "became suspicious of criminal activity" and searched the lorry to discover 42 foil-wrapped packages containing 118lbs (53kg) of fentanyl.

State troopers initially thought they had discovered a mix of narcotics and cocaine, but in Thursday's announcement officials said testing proved the drugs were "entirely fentanyl".

The two men were arrested on suspicion of possession of a controlled substance with intent to deliver and no Drug Tax stamp, according to a Nebraska State Patrol statement earlier this month.

They are being held in county jail on a $100,000 (£74,000) bond.


"My child died from it": One mum on the prescription painkiller being taken to get a high
What is fentanyl?

Fentanyl is a synthetic opioid that appears as a white powder, similar in size to grains of salt.

What are opioids and what are the risks?
Why opioids are such an American problem
Just 2mg of fentanyl - or a few grains of table salt - is a lethal dosage for most people, and even exposure can cause a fatal reaction, according to the DEA.

According to DEA estimates, the 118lbs could kill about 26 million people.

Like heroin and other opioids, fentanyl causes drowsiness, nausea and confusion, and overdoses can result in respiratory failure and death.

In the US, it is approved as an anaesthetic and for pain relief, but because of its high profit margin for traffickers, it has become a large part of America's opioid crisis.

The Center for Disease Control (CDC) reported that between 2015 and 2016, the rate of drug overdose deaths involving synthetic opioids such as fentanyl had doubled.

Medical examiners ruled in 2016 that US musician Prince died from an accidental overdose of the drug.
http://www.bbc.com/news/world-us-canada-44244688

On the left, a lethal dose of heroin; on the right, a lethal dose of fentanyl.

The opioid crisis just keeps getting worse, in part because new types of drugs keep finding their way onto the streets. Fentanyl, heroin’s synthetic cousin, is among the worst offenders.

It’s deadly because it’s so much stronger than heroin, as shown by the photograph above, which was taken at the New Hampshire State Police Forensic Laboratory. On the left is a lethal dose of heroin, equivalent to about 30 milligrams; on the right is a 3-milligram dose of fentanyl, enough to kill an average-sized adult male.

Fentanyl, according to the Centers for Disease Control and Prevention, is up to 100 times more potent than morphine and many times that of heroin.
https://www.statnews.com/2016/09/29/why ... an-heroin/

Scientists discover opioids in Seattle’s Puget Sound mussels
https://www.ajc.com/news/national/scien ... 46dqHdiTI/

Environmental Crisis Looms as the Effects of the Opioid Epidemic Grow

By Angela Morrison • Dec 11, 2017

As America confronts the opioid crisis, environmental scientists are warning about a related problem. Chemicals from pain-killers and other drugs often end up in lakes and rivers, creating what some scientists say could be a deadly cocktail for fish and other wildlife.

“What we use in our everyday lives goes down the drain and ends up somewhere," says Emma Rosi, an aquatic ecosystem ecologist at the Cary Institute in New York.

The effect of used and unused drugs
Rosi's team studies a long trail of chemicals from opioids, antidepressants and even illicit drugs, such as cocaine. They get into the environment through human urine and feces. Sometimes unused medications are flushed down toilets and drains.

The compounds eventually reach streams, lakes and rivers.

"Anything that people are using in their everyday lives," Rosi says. "So when we think about the opioid crisis, which has a huge impact on people’s lives, there’s another side of it: Those drugs ... are ending up in the waste stream and getting out into the environment as well, with unknown ecological consequences."

It’s a problem across the Great Lakes region. Researchers have found nicotine in Lake Michigan, caffeine in waters in northwest Ohio and pharmaceuticals in Illinois' Calumet River and Wisconsin's Fox River.

Unhappy fish
In the Niagara River, which leads to Niagara Falls, elevated levels of antidepressants were found in fish brains. Researcher Alicia Perez-Fuentetaja from SUNY and Buffalo State College's Great Lakes Center and Diana Aga from the University at Buffalo worked on the project.

Perez-Fuentetaja says these chemicals are designed to affect human behavior and that means fish could be affected as well.

"People ask me, 'Are they happy?' It’s like, no. I don’t think antidepressants make people happy either. I think that people don’t care so much about things and that’s exactly what happens to fish," she says.

Perez-Fuentetaja says fish might become less aware of the risks around them and expose themselves to dangers. They also might become disinterested in reproduction or eating.

​The impact on aquatic insects
Rosi's research has a different aim. It shows that compounds from amphetamines and other biologically active drugs may cause aquatic insects to emerge sooner, giving them an extended life cycle.

Keeping these compounds out of the environment has become a priority for some communities.

In the Buffalo area, for example, there are dozens of drop off sites for unused drugs. They’re taken to a central facility where machines grab large barrels of discarded drugs to be burned and used for energy

Erie Co. Health Commissioner Gale Burstein says this process helps keep Lake Erie and other waters clean.

“So this is trying to be as green as possible and to help prevent these drugs from getting into our water system and into our soil," she says. "Our water treatment plants, their filtration systems, cannot rid us of all the pharmaceuticals that are flushed down the drains or flushed down the toilets.”

Burstein says these drop off sites allow anyone to help keep drugs out of the Great Lakes ecosystem.

http://wksu.org/post/environmental-cris ... w#stream/0

Internal Documents: Purdue Pharma Knew OxyContin’s Risks, Pushed It Anyway

Marketing records made public for the first time show the opioid maker was repeatedly warned about addiction and fatalities—but focused on telling doctors how to profit from it.

By Fred Schulte

Purdue Pharma left almost nothing to chance in its whirlwind marketing of its new painkiller OxyContin.

From 1996 to 2002, Purdue pursued nearly every avenue in the drug supply and prescription sales chain—a strategy now cast as reckless and illegal in more than 1,500 federal civil lawsuits from communities in Florida to Wisconsin to California that allege the drug has fueled a national epidemic of addiction.

Kaiser Health News is releasing years of Purdue’s internal budget documents and other records to offer readers a chance to evaluate how the privately held Connecticut company spent hundreds of millions of dollars to launch and promote the drug, a trove of information made publicly available here for the first time.

All of these internal Purdue records were obtained from a Florida attorney general’s office investigation of Purdue’s sales efforts that ended late in 2002.

I have had copies of those records in my basement for years. I was a reporter at the South Florida Sun-Sentinel, which, along with the Orlando Sentinel, won a court battle to force the attorney general to release the company files in 2003. At the time, the Sun-Sentinel was writing extensively about a growing tide of deaths from prescription drugs such as OxyContin. We drew on the marketing files to write two articles, including one that exposed possible deceptive marketing of the drug. Now, given the disastrous arc of prescription drug abuse over the past decade and the stream of suits being filed—more than a dozen on some days—it seemed time for me to share these seminal documents that reveal the breadth and detail of Purdue’s efforts.

Asked by Kaiser Health News for comment on the OxyContin marketing files and the suits against the company, Purdue Pharma spokesman Robert Josephson issued a statement that reads in part:

“Suggesting activities that last occurred more than 16 years ago, for which the company accepted responsibility, helped contribute to today’s complex and multi-faceted opioid crisis is deeply flawed. The bulk of opioid prescriptions are not, and have never been, for OxyContin, which represents less than 2% of current opioid prescriptions.”

The marketing files show that about 75 percent of more than $400 million in promotional spending occurred after the start of 2000, the year Purdue officials told Congress they learned of growing OxyContin abuse and drug-related deaths from media reports and regulators. These internal Purdue marketing records show the drugmaker financed activities across nearly every quarter of medicine, from awarding grants to health care groups that set standards for opioid use to reminding reluctant pharmacists how they could profit from stocking OxyContin pills on their shelves.

Purdue bought more than $18 million worth of advertising in major medical journals that cheerily touted OxyContin. Some of the ads, federal officials said in 2003, “grossly overstated” the drug’s safety.

The Purdue records show that the company poured more than $8 million into a website and venture called “Partners Against Pain,” which helped connect patients to doctors willing to treat their pain, presumably with OxyContin or other opioids.

It made and distributed 14,000 copies of a video that claimed opioids caused addiction in fewer than 1 percent of patients, a claim Food and Drug Administration officials later said “has not been substantiated.”

Purdue hoped to grow into one of the nation’s top 10 drug companies, both in sales and “image or professional standing,” according to the documents; OxyContin was the means to that end.

Purdue first marketed the drug for cancer pain, but planned to expand that use to meet its multimillion-dollar sales goals. In 1998, the market for treating cancer with opioids stood at $261 million, compared with $1.3 billion for treating other types of pain, the Purdue reports note.

Purdue’s OxyContin sales objectives were clearly stated in the earliest marketing plan in the records, for 1996. It sought $25 million in sales and to generate 205,000 prescriptions. By the next year, its goals had tripled: $77.9 million in sales and to generate 600,000 prescriptions.

Purdue bombarded doctors and other health workers with literature and sales calls. Records show that in 1997 the company budgeted $300,000 for mailings to doctors who prescribed opioids liberally, based on sales data that drug companies purchase. The mailers recommended OxyContin for “pain syndromes,” including osteoarthritis and back pain. It added $75,000 for mailings “to keep in touch with our best customers for OxyContin to ensure they continue prescribing it.”

Sales agents made thousands of visits to general practice doctors and others who had little training or experience using potent opioids, according to a 2003 Government Accountability Office audit. The OxyContin slogan in 1999 was: “The One to Start With and the One to Stay With.” OxyContin earned Purdue about $2.8 billion in revenue from the start of 1996 through June 2001, according to the Justice Department.

In May 2000, Purdue’s hope to conquer the arthritis market hit a snag when the FDA criticized an ad for OxyContin in the New England Journal of Medicine. The FDA said the ad, which Purdue Pharma agreed to stop using, overstated the drug’s benefits for treating all types of arthritis without pointing out risks.

News reports of abuse and overdose deaths also were surfacing. Purdue’s 2001 marketing document noted that OxyContin had “experienced significant challenges” the year before because of abuse and unlawful diversion in Maine, Ohio, Virginia, Louisiana, and Florida. OxyContin pills contain oxycodone, an opioid as potent as morphine and maybe more so. Abusers quickly figured out they could crush the pills and snort or inject the dust.

In response, Purdue’s 2001 marketing budget included funding to help doctors recognize patients who were in need of “substance abuse counseling” and do more to “prevent abuse and diversion.” It added $1.2 million in spending for what it called “anti-diversion” efforts in 2002, according to the internal records.

Potent Sales Force

In 2002, the Florida attorney general’s office was one of the first law enforcement agencies to investigate Purdue. The state ended its probe after Purdue agreed to pay Florida $2 million to help fund a data system to monitor narcotics prescriptions. It did not admit to any wrongdoing in the settlement.

Yet handwritten notes of a state investigator’s interview with a former Purdue sales manager for West Virginia and western Pennsylvania named Bill Gergely, then 58, suggested otherwise. The notes were part of the documents released by the state.

Gergely, who worked for the company from 1972 until 2000, said Purdue executives told sales staff at a launch meeting that OxyContin “was non-habit forming,” according to the undated investigator’s notes. Gergely said Purdue gave its sales force material—some of which was not approved by the FDA—for “education,” the notes show. He told the investigator that Purdue had a bonus system and paid well; the last year he worked for Purdue, Gergely earned $238,000.

As Purdue charged ahead with OxyContin, prescription pills overtook illegal drugs like heroin and cocaine as killers in Florida, according to medical examiner files. In May 2002, the South Florida Sun-Sentinel documented nearly 400 pill deaths in three South Florida counties the previous two years, based on an examination of autopsy and police records.

Half the deaths involved drugs that contained oxycodone, according to medical examiner records. But it was not always clear in these records that it was OxyContin because oxycodone was an ingredient in many other narcotic pills. In 70 of the deaths, however, police or medical examiner records specifically identified OxyContin as one of the drugs. Though some people who died bought pills on a thriving black market, many were under the care of doctors for what appeared, at least at some point, to be legitimate injuries, according to medical examiner files.

Purdue did not challenge the accuracy of the newspaper’s reporting. It countered that the articles “did a disservice” to the company and patients who take their medicine “according to the directions of their doctors.” While the company said its executives “deeply regret the tragic consequences that have resulted from the misuse and abuse of our pain medicine… advances in the treatment of pain should not be limited or reversed because some people illegally divert, abuse or misuse these drugs.”

To its sales force, the internal Purdue records show, Purdue blamed bad press for cutting into sales. “The media’s attention to abuse and diversion of OxyContin tablets has provided state Medicaid plans and some HMOs, concerned about the effect the product is having on their budget, an excuse to look for ways to limit the prescribing of OxyContin tablets,” the 2002 marketing document said.

But five years after its legal battle with Florida officials, Purdue made a startling admission in federal court in Virginia. The company pleaded guilty in 2007 to felony charges of “misbranding” OxyContin “with the intent to defraud or mislead.” The company paid $600 million in fines and other penalties. Among the deceptions it confessed to was directing its salespeople to tell doctors the drug was less addictive than other opioids.

Three Purdue Pharma executives pleaded guilty to misdemeanor criminal charges for their roles in the marketing scheme. The three men paid a total of $34 million in fines and penalties, court records show. Accepting Purdue’s plea deal, U.S. District Judge James P. Jones noted that federal prosecutors believed the Purdue case of 2007 would send a “strong deterrent message to the pharmaceutical industry.”

A Costly Reckoning?

Ten years on, the 1,500-plus lawsuits, filed mostly on behalf of cities, counties and states, could prove to be a costly reckoning for the opioid industry. The suits are demanding payback from Purdue and other drugmakers for the sky-high costs of treating addiction and other compensation, much as the litigation against Big Tobacco in the late 1990s.

Other drug makers named as defendants in most of the suits include those that Purdue considered to be its top competitors in the pain sector: Janssen Pharmaceuticals, Teva Pharmaceutical Industries, Endo International PLC and Mallinckrodt PLC.

Federal officials estimate the economic cost of opioid abuse topped $500 billion in 2015 alone. Since 1999, at least 200,000 people have died in the U.S. from these overdoses, according to the Centers for Disease Control and Prevention. More than 52,000 of those died in 2015 alone, more than were killed in car crashes and gun homicides combined, the suits contend.

A case filed in April by Baltimore County in Maryland makes an argument common to many of the suits:

“From the mid-’90s to the present, manufacturing defendants aggressively marketed and falsely promoted liberal opioid prescribing as presenting little to no risk of addiction, even when used long term for chronic pain. They infiltrated academic medicine and regulatory agencies to convince doctors that treating chronic pain with long-term opioids was evidence-based medicine when, in fact, it was not.

“Huge profits resulted from these efforts—as did the present addiction and overdose crisis.”

Purdue has not yet filed a response to the allegations in the suit.

Other drug manufacturers “emulated Purdue’s false marketing strategy” and sold billions of dollars of prescription opioids “as safe and efficacious for long term use, knowing full well that they were not,” Wisconsin’s Oneida County alleges in its November 2017 federal court suit. Purdue also has not yet filed a response to the allegations in this suit.

But Purdue spokesman Josephson told KHN: “We share public officials’ concern about the opioid crisis, and we are committed to working collaboratively toward meaningful solutions. We vigorously deny these allegations and look forward to the opportunity to present our defense.”

One California doctor who was sentenced to 25 years in prison for overprescribing OxyContin is also suing Purdue. Masoud Bamdad alleges that the company’s representatives made sales calls and gave him “deceitful, misleading and over-hyped information,” which he relied on to prescribe the drug, in some cases with deadly consequences for his patients, according to the suit, which is pending. Purdue has asked that the case be stayed while judges decide if it should be consolidated with others filed against the company. In February, Purdue announced that it would no longer promote opioids to doctors.

Because the lawsuits from across the U.S. contain similar allegations, many of them have been consolidated in Ohio—as a multi-district litigation. Some days, federal court dockets log a dozen or more new cases. Many of the suits run a hundred pages or more and allege that deceptive opioid marketing schemes continue to this day.

The manufacturers, in a joint court motion late last year, contend that opioids “serve a critical public health role in providing relief to patients suffering from pain that is often debilitating” and that they are being wrongly blamed.

They also point out that the FDA approved all of their products as “safe and effective.”

This month, the manufacturers filed motions to dismiss several of the cases, arguing that the county governments lack a legal basis for their claims. In seeking to blame the drugmakers, these lawsuits ignore “the criminal acts of third parties, the crucial role of health care providers, and the thorny public policy questions surrounding the problem of opioid abuse,” reads a motion to dismiss a case filed by Monroe County, Mich., against Purdue Pharma and other drug companies.

Dan Polster, the federal judge handling the cases, told an overflow crowd in his courtroom that the opioid epidemic has become so severe, that it is cutting the average life expectancy of Americans.

“I’m pretty ashamed that this has occurred while I have been around,” he said in January, adding “I think we all should be.”

Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
https://www.thedailybeast.com/how-ameri ... itter_page

Federal authorities arrested the billionaire founder and owner of Insys Therapeutics Thursday on charges of bribing doctors and pain clinics into prescribing the company’s fentanyl product to their patients.

The Department of Justice (DOJ) charged John Kapoor, 74, and seven other current and former executives at the pharmaceutical company with racketeering for a leading a national conspiracy through bribery and fraud to coerce the illegal distribution of the company’s fentanyl spray, which is intended for use as a pain killer by cancer patients. The company’s stock prices fell more than 20 percent following the arrests, according to the New York Post.

Kapoor stepped down as the company’s CEO in January amid ongoing federal probes into their Subsys product, a pain-relieving spray that contains fentanyl, a highly-addictive synthetic opioid. Fentanyl is more than 50 times stronger than morphine, and ingesting just two milligrams is enough to cause an adult to fatally overdose.

The series of arrests came just hours after President Donald Trump officially declared the country’s opioid epidemic a national emergency. Drug overdoses led to 64,070 deaths in 2016, which is more than the amount of American lives lost in the entire Vietnam War.

As the opioid crisis has developed, more and more states have begun holding doctors and opioid manufacturers accountable for over-prescribing and over-producing the highly-addictive painkillers.

“We will be bringing some major lawsuits against people and companies that are hurting our people,” Trump said Thursday. He also spoke about a program similar to Nancy Reagan’s “Just Say No” initiative.

“More than 20,000 Americans died of synthetic opioid overdoses last year, and millions are addicted to opioids. And yet some medical professionals would rather take advantage of the addicts than try to help them,” Attorney General Jeff Sessions said in a statement. “This Justice Department will not tolerate this. We will hold accountable anyone – from street dealers to corporate executives — who illegally contributes to this nationwide epidemic. And under the leadership of President Trump, we are fully committed to defeating this threat to the American people.”

Madelyn Ellen Linsenmeir Obituary



- - Our beloved Madelyn Ellen Linsenmeir died on Sunday, October 7. While her death was unexpected, Madelyn suffered from drug addiction, and for years we feared her addiction would claim her life. We are grateful that when she died she was safe and she was with her family.

Maddie was born on March 31, 1988, in Burlington, Vermont, where she grew up and lived on and off throughout her adult life; she also spent time in Sarasota, Florida; Keene, New Hampshire; and Boulder, Colorado.

Madelyn was a born performer, and had a singing voice so beautiful it would stop people on the street. Whether she was on stage in a musical or around the kitchen table with her family, when she shared her voice, she shared her light. She was a member of FolKids of Vermont, a dance and musical troupe that toured the world. Maddie visited Russia and Thailand with the group, and as part of their exchange program hosted kids from other countries at home in Vermont. She loved to ski and snowboard, and she swam on the YMCA swim team, winning medals at the New England regionals.

When she was 16 she moved with her parents from Vermont to Florida to attend a performing arts high school. Soon after, she tried OxyContin for the first time at a high school party, and so began a relationship with opiates that would dominate the rest of her life.

It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie—when they saw her addiction they stopped seeing her. And what a loss for them. Because Maddie was hilarious, and warm, and fearless, and resilient. She could and would talk to anyone, and when you were in her company you wanted to stay. In a system that seems to have hardened itself against addicts and is failing them every day, she befriended and delighted cops, social workers, public defenders, and doctors, who advocated for and believed in her till the end. She was adored as a daughter, sister, niece, cousin, friend, and mother, and being loved by Madelyn was a constantly astonishing gift.

Maddie loved her family and the world. But more than anyone else, she loved her son, Ayden, who was born in 2014. She transformed her life to mother him. Every afternoon in all kinds of weather, she would put him in a backpack and take him for a walk. She sang rather than spoke to him, filling his life with song. Like his mom, Ayden loves to swim; together they would spend hours in the lake or pool. And she so loved to snuggle him up, surrounding him with her love.

After having Ayden Maddie tried harder and more relentlessly to stay sober than we have ever seen anyone try at anything. But she relapsed and ultimately lost custody of her son, a loss that was unbearable.

During the past two years especially, her disease brought her to places of incredible darkness, and this darkness compounded on itself, as each unspeakable thing that happened to her and each horrible thing she did in the name of her disease exponentially increased her pain and shame. For 12 days this summer she was home, and for most of that time she was sober. For those 12 wonderful days, full of swimming and Disney movies and family dinners, we believed as we always did that she would overcome her disease and make the life for herself we knew she deserved. We believed this until the moment she took her last breath. But her addiction stalked her and stole her once again. Though we would have paid any ransom to have her back, any price in the world, this disease would not let her go until she was gone.

Maddie is survived by her son, Ayden; her parents Maureen Linsenmeir and Mark Linsenmeir; her sister Kate O'Neill and Kate's partner, Marshall Fong; her sister Maura O'Neill and Maura's partner, Tim Painting; her aunts Beth Dow and Susan Dow and Beth's partner, Charlie Allison; her beloved cousin Sloan Collins; and many other aunts, uncles, and cousins, including the Conants, Cahills, and Camisas. She is predeceased by her grandparents, Madelyn and Roland Keenan, Mary Ellen and Herman Dow, and Reginald Linsenmeir.

Please join us for a memorial service honoring Maddie's life on Sunday, October 21, at 2 p.m., at the First Unitarian Universalist Society sanctuary at 152 Pearl Street in Burlington. In lieu of flowers, please consider donating to the Turning Point Center, a place where Maddie spent time and felt supported. Donations can be made via their website, http://www.turningpointcentervt.org.

If you yourself are struggling from addiction, know that every breath is a fresh start. Know that hundreds of thousands of families who have lost someone to this disease are praying and rooting for you. Know that we believe with all our hearts that you can and will make it. It is never too late.

If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support.

If you work in one of the many institutions through which addicts often pass—rehabs, hospitals, jails, courts—and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.

We take comfort in knowing that Maddie is surrounded by light, free from the struggle that haunted her. We would have given anything for her to experience that freedom in this lifetime. Our grief over losing her is infinite. And now so is she.

Published in The Burlington Free Press on Oct. 14, 2018
https://www.legacy.com/obituaries/burli ... =190469930

Did the fashion industry ever really move away from ‘Heroin Chic’?

by Niamh ODonoghue 31 August 2018

It isn’t fashionable to be high, so why are designers still glamorizing drugs, writes Niamh O’Donoghue

When Calvin Klein entered rehab in the 80s for prescription-drug and alcohol addiction it signalled the beginning of a great change in the fashion industry. Klein was – and still is – one of the most celebrated and successful American fashion designers and his choice to go public with his addiction flagged a new level of awareness; one the industry didn’t even know it needed yet. Less than twenty years later, the infamous Heroin Chic emerged; a look popularized in mid-1990s fashion and characterized by pale skin, dark circles underneath the eyes, a very skinny body, dark red lipstick and angular bone structure. It was synonymous with supermodels Kate Moss and Naomi Campbell (lest we forget about Janice Dickinson, Drew Barrymore, Marc Jacobs, Paris Hilton), and the world couldn’t get enough of it. Arguably the most controversial trend, it romanticised, popularised and convoluted the role that drugs played in society.

With the exception of John Galliano losing his job as chief designer by Dior in March 2011, few fashion personalities have suffered any major consequences from their experimentation with drugs. We idolized Kate Moss, shunned her when photos appeared of her snorting coke, and readily embraced her again not long after. Celebrity culture – as well as the lifestyle and pressures associated with fame and fashion – rapidly accelerated the industry into a hotbed melting pot of drug and alcohol abuse. In turn, it left a bad taste in the public’s mouth that behind the curtain of every runway show is a schizophrenic mess of makeup artists, designers and models maintaining their light figures with heavy partying and a buffet of substances.

“In the world of high fashion, it's no longer fashionable to be high”

Designers were basing their entire collections around the Heroin Chic craze, poking fun at the fashion industry while marvelling in profits afforded by a pre-crash economy. But the death of industry idol Kurt Cobain and renowned fashion photographer Davide Sorrenti in the early 90s turned the craze into paranoia. Magazines started to take notice. The industry was forced to change its trajectory for the welfare of models and designers. In 1997, thirteen established designers – including including John Galliano, Stella McCartney, John Rocha, Reynold Pearce and Andrew Fionda – signed a statement expressing their concern at "the waste of human potential caused by substance addiction", objecting to the industry's use of the strung-out "heroin look" to promote fashion (independent.co.uk, October 1997). The late 90s arguably marked the end of Heroin Chic and celebrated the arrival of healthier-looking models like Gisele – when abs were in greater demand than gaunt clavicles.

Addiction isn’t a trend

Despite moving forward almost twenty years, the associations of drug abuse haven't gone away yet. In 2012, Mary-Kate and Ashley Olsen designed an uber-luxury Nile crocodile leather backpack that was scattered with a colourful prescription drug motif. Created by renowned artist Damien Hirst, only 12 of the exuberantly expensive (an astronomical $55,000 each) bags were ever made. It is almost as if it was created out of pure irony, especially considering the Olsen twins' own addiction issues – not to mention trying to sell an item for the price of a small house after a global economic crash.

Just two years ago, Moschino was forced to pull its AW16 collection – which included clothes and handbags that look like prescription pill bottles – from retailers over protests that it glamorised and normalised addiction. Retrospectively, it did, and in an age where brands are ubiquitous, there needs to be a level of responsibility for distasteful actions. Alexander Wang's AW16 collection also embodied the trend with oversized jackets clad in marijuana print. And Raf Simons’ most recent AW18 collection is riddled with drug references. Titled ‘Youth in Motion’, the collection deals with notions of excess and the effects of overindulgence and called attention to the spiralling world of drugs and hedonism. Yves Saint Laurent’s Black Opium fragrance was investigated by the UK Advertising Standards Authority for glamorising drugs – the list goes on.

Despite all this, the industry continues to support and idolise labels and designers. And part of the problem, I believe, is our perceived association of what addiction should look like. We don't associate a Chanel tweed jacket with a person struggling with addiction; nor do we a successful designer, painter or CEO (Coco Chanel's opioid addiction was finally addressed in An Intimate Life by Lisa Chaney in 2011). Industry pressure is still a prevailing beast, with pressure to design; pressure to sell; pressure to be the next 'It' brand. Maybe the answer is to slow down? There's also the case for casual recreational drug use that was recently highlighted by the #DoYouUseCocaine harm reduction campaign that highlighted cocaine use in Ireland is back to Celtic Tiger levels.

Fashion will continue to be a space for experimentation and even poking fun, it comes with the nature of the industry as a free-spirited, unbound entity. But today's consumers want more collections faster and cheaper, adding to the burgeoning stress already felt by designers, models and industry workers. When it come's to drugs though, it isn't about art, it's about life and death as the world sorely learned with YSL, Coco Chanel, Alexander McQueen, Calvin Klien...Although Heroin Chic was the trend that defined the 90s, and even though fashion’s enchantment with thinness has surpassed, it remains to be seen whether the industry will get over its fascination with drugs any time soon.

https://www.image.ie/fashion/fashion-in ... ner-126777

Press Announcements

Statement from FDA Commissioner Scott Gottlieb, M.D., on agency’s approval of Dsuvia and the FDA’s future consideration of new opioids

November 2, 2018

The crisis of opioid addiction is an issue of great concern for our nation. Addressing it is a public health priority for the FDA. The agency is taking new steps to more actively confront this crisis, while also paying careful attention to the needs of patients and physicians managing pain. As part of these considerations, there’s been an important and robust public debate leading up to the regulatory decision on Dsuvia that merits a response. I want to take this opportunity to address some of the concerns that were raised, and more broadly, how I believe the FDA should consider the approval of new opioid pain medications that can help fill targeted medical needs.

Looking beyond this particular drug approval, I believe that we should consider whether we should be doing more to evaluate each candidate opioid, not just as an independent review decision, but rather also to consider each novel opioid drug in the context of the overall therapeutic armamentarium that’s available to patients and providers. As we look at the public health implications of each new approval, we should evaluate whether we need to take additional steps to systematically consider new opioids relative to the comparative benefit and risks of other opioids already on the market. We should consider whether we could do more in weighing approvals to ensure that new opioids are sufficiently better than existing drugs to justify their addition to the market in the context of the current crisis of abuse.

In this particular case, Dsuvia is a sublingual (under the tongue) formulation of sufentanil that’s delivered through a disposable, pre-filled, single-dose applicator. The medicine is restricted to use in certified medically-supervised health care settings ‒ such as hospitals, surgical centers and emergency departments ‒ for administration by a health care professional. Dsuvia, which was previously approved by the European Medicines Agency in July under the brand name Dzuveo, has some unique features in that the drug is delivered in a stable form that makes it ideally suited for certain special circumstances where patients may not be able to swallow oral medication, and where access to intravenous pain relief is not possible. This includes potential uses on the battlefield. For this reason, the Department of Defense (DoD) worked closely with the sponsor on the development of this new medicine. This opioid formulation, along with Dsuvia’s unique delivery device, was a priority medical product for the Pentagon because it fills a specific and important, but limited, unmet medical need in treating our nation’s soldiers on the battlefield. The involvement and needs of the DoD in treating soldiers on the battlefield were discussed by the advisory committee.

MORE: https://www.fda.gov/NewsEvents/Newsroom ... 624968.htm

The Dsuvia battle centers on sufentanil, one drug in a family of highly addictive opioids that is five to 10 times more powerful than its parent drug, fentanyl. Synthetic versions of fentanyl are the focus of the street-level fight against an opioid epidemic that kills 115 Americans per day.

https://www.bizjournals.com/sanjose/new ... l-fda.html

FDA Goes Ahead With Approval of Sufentanil Despite Controversy

The US Food and Drug Administration (FDA) has approved sufentanil sublingual tablets (Dsuvia, AcelRx Pharmaceuticals) for management of severe acute pain in adults in certified, medically supervised healthcare settings.

The Anesthetic and Analgesic Drug Products Advisory Committee voted 10-3 in favor of sufentanil sublingual tablets last month, as reported by Medscape Medical News.

However, in a release, Public Citizen, a nonprofit consumer advocacy organization, and Raeford Brown, MD, head of the FDA's Anesthetic and Analgesic Drug Products Advisory Committee, claim the panel made the wrong call and that the vote to approve the drug was rigged.

"It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly," said Sidney Wolfe, MD, founder and senior adviser of Public Citizen's Health Research Group.

"It will be taken by medical personnel and others for whom it has not been prescribed. And many of those will overdose and die. It is likely, if not certain, that Dsuvia will be banned after 'enough' such deaths occur and the inevitable House oversight hearings are held investigating why the FDA approved this opioid with no unique benefit but unique harms," Wolfe added.

In the same release, Brown stated he was "very disappointed with the decision of the agency to approve Dsuvia.

"This action is inconsistent with the charter of the agency. As I discussed with representatives of the agency today, the lack of efficacy data and the sponsor's inadequate response to safety concerns have not been addressed since the FDA's complete response letter was sent in 2017.

"Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect. I will continue to hold the agency accountable for their response to the worst public health problem since the 1918 influenza epidemic," said Brown.

More Potent Than Fentanyl

Sufentanil is a synthetic opioid analgesic that is five to 10 times more potent than its analogue, fentanyl (multiple brands) and 1000 times more potent than morphine. It's currently marketed for intravenous and epidural anesthesia and analgesia.

The sublingual formulation of sufentanil is designed for rapid pain relief. Its onset of action is as little as 15 minutes, and it provides about 3 hours of analgesia.

Dsuvia contains 30 μg sufentanil. It comes in single-dose, prefilled applicator for sublingual administration by healthcare professionals in hospitals, surgical centers, and emergency departments.

https://www.medscape.com/viewarticle/904330

Veteran overdoses of highly addictive painkillers



Opioid drug abuse has killed more Americans than the Iraq, Afghanistan and Vietnam wars combined, and U.S. veterans and advocates this Veteran’s Day are focusing on how to help victims of the crisis.


Veterans are twice as likely as non-veterans to die from accidental overdoses of the highly addictive painkillers, a rate that reflects high levels of chronic pain among vets, particularly those who served in the wars in Iraq and Afghanistan, according to federal data..

http://shannonandassociates.net/veteran ... -the-iraq/

Emotions affect how pain feels, as soldiers know only too well

Army recruitment: fear is a friend not foe. Matt Brock, CC BY-NC-SA

Pain is one of the most powerful weapons of war. Western Front soldier and poet Siegfried Sassoon dubbed war a “sausage machine” because it tore through and crushed tissues and organs, and dismembered limbs. Popular novels and films also routinely portray the horrors of combat; men hit by shell fragments or high-velocity bullets screech, convulse violently, before uttering a last “fucking hell!” or “I don’t want to die” before croaking; wounded men wail in unison, cup spilt intestines and grind teeth. They are no longer truly men, they are barely human.

But such horrifying evocations of pain are in striking contrast to the ways many soldiers in past conflicts describe the sensation of being wounded. In fact, war-wounded men are more likely to say that the initial sensation of being hit by a missile is similar to being struck with a stone or a lump of mud. My research uncovered one pilot who observed that being struck by a shard of shrapnel “felt like a prodding finger”, while another admitted that his only thought was “that’s funny … I’ve been wounded”. A fighter pilot whose shoulder was shattered by a 20mm shell described the feeling as nothing more than a sense of being “gone” and “completely disassociated” from his arm as “a monkey on a stick”. Other soldiers simply recalled that they felt nothing except intense relief. “I do believe I’m going to survive this war after all,” said one.

Such perplexing responses to wounding in combat have been observed throughout history. Even the ancient Roman philosopher Lucretius recorded how when “the scythed chariots, reeking with indiscriminate slaughter, suddenly chop off the limbs” of men, the “eagerness of the man’s mind” means that “he cannot feel the pain” and “plunges afresh into the fray and the slaughter”. Or, as influential surgeon A. Copland Hutchinson decreed in Some Practical Observations in Surgery in 1816, every soldier and seaman whose limbs he had to amputate without anaesthetics told him, “at the time of their being wounded, they were scarcely sensible of the circumstance, till informed of the extent of their misfortune by the inability of moving their limb”.

Most war surgeons simply explained the absence of pain as due to the men’s “great excitement”. Agitation, elation, enthusiasm, ideological fervour: all these states of mind diminished (or even eliminated) suffering. Others claimed that the “psychological effect” of the “booming of the guns” was similar to the “continued drumming of the dervish dance” – in other words, the deafening sounds of battle had a hypnotic effect.
http://theconversation.com/emotions-aff ... well-25889