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Monday, December 09, 2019 {{ new Date().getDay() }}

Tag: opioid crisis

In Light Of COVID-19 Pandemic, U.S. Opioid Crisis Worsens

There's no doubt that the COVID-19 pandemic has disrupted the way in which most Americans go about their daily lives. We're working and learning from home, dealing with social isolation, and turning to technology for just about everything. Despite the fact that digital ordering and delivery had already grown 300 percent faster than dine-in traffic since 2014, our current health crisis has perpetuated a number of trends that were already on the rise.

Sadly, that doesn't merely apply to online restaurant orders and other deliveries. It's now clear that the opioid epidemic, which was already a major problem, has only gotten worse thanks to issues related to the novel coronavirus.

California is the world's fourth-largest producer of wine -- and alcoholism is the most widespread substance abuse disorder nationwide. Arguably, those struggling to maintain a healthy relationship with alcohol may have had an even tougher time during the pandemic, as is evidenced by skyrocketing sales, widespread job loss, and a number of other factors. But while alcohol consumption may be an issue for many, opioid misuse can often be even more devastating.

Even before the pandemic, the opioid-related health crisis was spiraling out of control. By 2017, healthcare providers in Ohio were writing 63.5 opioid prescriptions for every 100 people. And while Ohio historically had some of the highest rates of opioid abuse and opioid-related fatalities, it's far from the only state with an opioid problem.

In 2019, more than 70,000 Americans died as a result of drug overdoses. And while not every overdose is fatal or connected to opioids, it's clear that COVID-19 hasn't helped matters. A study published in JAMA Psychiatry earlier this month found that there were significantly higher rates of opioid overdose ED visits during the period March 2020 to October 2020 than the same period the year before. What's more, from mid-April 2020, the weekly rates of drug overdose ED visits had increased by up to 45 percent year-over-year. Overall emergency department visits for opioid overdoses increased by 28.8 percent from 2019 to 2020, according to the analysis. That data is even more substantive when it's made clear that emergency department visits, overall, saw major decreases in 2020 due to COVID-19 concerns.

These findings echo reports from the U.S. Centers for Disease Control and Prevention (CDC), which reported that overdose deaths increased by 38.4 percent during the year leading up to June 2020. Overall, more than 83,000 Americans died as a result during that period -- a sobering statistic during a year that was already filled with so much loss. The CDC maintains that the pandemic has accelerated those deaths, though the growing popularity of synthetic opioids has also played a role.

That's not surprising, according to experts. Health concerns, job loss, social isolation, increased sources of stress and fear, and other routine disruptions can make a society more susceptible to increased drug misuse. And since the pandemic forced many 12-step programs to suspend their operations for some time, that has left little support for those with addiction issues.

Addiction is clearly an issue that hits close to home for President Biden, as his son Hunter has been quite open about his struggles with substance abuse. But juxtaposed next to the ongoing COVID-19 pandemic, it's clear that the virus will likely take precedent. That said, if the nation is able to finally get the coronavirus under control, the opioid epidemic would be that much easier to tackle. Until that happens, however, it's unclear as to how bad both health concerns might become before they get better.

Justice Department Sues Walmart Over Allegations Of Illegal Opioid Sales

Reprinted with permission from ProPublica

More than two years after the federal government was preparing to indict Walmart on charges of illegally dispensing opioids, the U.S. Department of Justice is finally taking action. But it's seeking a financial penalty, not the criminal sanction prosecutors had pushed for.

On Tuesday, the Department of Justice brought a civil suit against Walmart in U.S. District Court in Delaware, accusing the retailing behemoth of illegally dispensing and distributing opioids, helping to fuel a health crisis that has led to the deaths of around half a million Americans since 1999.

The government accuses the company, which operates one of the biggest pharmacy chains in the country, of knowingly filling thousands of invalid opioid prescriptions, failing to alert the government to dangerous or excessive prescriptions, and pushing pharmacists to work faster and look the other way in order to boost corporate profits.

By law, pharmacists are prohibited from filling prescriptions they know are not for legitimate medical needs. "Walmart was well aware of these rules, but made little effort to ensure that it complied with them," the government said in its suit.

Walmart applied "enormous pressure" on pharmacists to fill prescriptions as fast as they could, while preventing them from halting prescriptions they knew came from bad doctors, the government said. When Walmart pharmacists warned headquarters in Bentonville, Arkansas, about doctors who operated "known pill mills," did "not practice real medicine" and had "horrendous prescribing practices," headquarters ignored their pleas, the lawsuit asserts.

Walmart denounced the suit. "The Justice Department's investigation is tainted by historical ethics violations, and this lawsuit invents a legal theory that unlawfully forces pharmacists to come between patients and their doctors, and is riddled with factual inaccuracies and cherry-picked documents taken out of context," the company said in a statement. In October, aware that a government suit was likely, Walmart took the highly unusual step of preemptively suing the Justice Department. The company argued that it did nothing wrong and, there, too, accused the government of acting unethically. According to Walmart, the federal prosecutors used the threat of a criminal case to try to negotiate higher civil penalties. (Prosecutors deny that claim.)

The case against Walmart originated in the summer of 2016, with an investigation of two Texas doctors, Howard Diamond and Randall Wade, who were prescribing opioids on a vast scale. Federal prosecutors in the Eastern District of Texas eventually brought cases against the pair, accusing them of contributing to multiple deaths. The doctors were subsequently convicted of illegal distribution of opioids, with Wade sentenced to 10 years in prison and Diamond to 20 years. That case uncovered evidence that led prosecutors to investigate Walmart itself.

In 2018, Joe Brown, the Trump-appointed U.S. attorney in the Eastern District of Texas, sought to criminally indict the company over its opioid practices, as detailed in a ProPublica story in March. During this period, as Walmart tried to fend off a criminal case, its lawyers expressed willingness to discuss a civil settlement. The company "stands ready to engage in a principled and reasoned dialogue concerning any potential conduct of its employees that merits a civil penalty," Jones Day partner Karen Hewitt wrote in August 2018 to the head of the criminal division of the Justice Department.

The Texas prosecutors were unswayed by Walmart's arguments. Joined by the head of the Drug Enforcement Administration, Brown's team traveled to Justice Department headquarters in Washington to make an impassioned plea to bring the criminal case.

But Trump appointees at the highest levels of the department — including the deputy attorneys general at different times, Rod Rosenstein and Jeffrey Rosen — stymied the attempt, dictating that Walmart could not be indicted. (Rosen recently was named acting attorney general.) When prosecutors sought to criminally prosecute a Walmart manager, top officials in the Trump Justice Department prevented that, too.

The Justice Department then dragged out civil settlement negotiations. The delays prompted Josh Russ, the head of the civil division in the Eastern District of Texas who had urged bringing a civil suit years ago, to resign in protest. "Corporations cannot poison Americans with impunity. Good sense dictates stern and swift action when Americans die," Russ wrote in his resignation letter in October 2019.

This week's suit largely echoes the allegations that the Eastern District of Texas had made in seeking a criminal case. Legal officials can in some circumstances pursue the same allegations either criminally or civilly, with a higher burden of proof for prosecutors and stiffer potential penalties for defendants when it comes to criminal cases.

In the new suit, prosecutors said Walmart pharmacists routinely filled prescriptions from known "pill mill" doctors. Sometimes those doctors explicitly told their patients to go to Walmart pharmacies, the complaint alleges. Walmart filled prescriptions from doctors even when its pharmacists knew that other pharmacies had stopped filling prescriptions from those doctors.

The suit also details that Walmart's compliance unit based out of its headquarters collected "voluminous" information that its pharmacists were regularly being served invalid prescriptions, but "for years withheld that information" from its pharmacists.

In fact, the compliance department often sent the opposite message. When a regional manager received a list of troubling prescriptions from headquarters, he asked, "Does your team pull out any insights from these we need to highlight?"

In an email cited in the suit, which was first reported by ProPublica, a director of Health and Wellness Practice Compliance at Walmart, responded, "Driving sales and patient awareness is a far better use of our Market Directors and Market manager's time."

Walmart headquarters regularly put pressure on pharmacists to work faster. Managers pushed pharmacists because "shorter wait times keep patients in store," that this was a "battle of seconds" and that "wait times are our Achilles heel!" according to the suit. Pharmacists said the pressure and Walmart's thin staffing "doesn't allow time for individual evaluation of prescriptions," the suit says.

In May, two months after ProPublica published its story, Brown, the U.S. attorney who had pushed for criminal prosecution of Walmart, left his job abruptly. His resignation letter cited the need to "win the fight against opioid abuse in order to save our country" and added that "players both big and small must meet equal justice under the law." Brown did not return a call seeking comment.

Doris Burke contributed reporting.

Pandemic Substance Abuse: Will a Second Wave Make Matters Worse?

Even before the coronavirus came to the U.S., we were already facing a nationwide health crisis: addiction and substance abuse. As it was, 18 million Americans said they had misused prescription drugs at least once within the last year. And with the stress of the pandemic -- and all of the turmoil that has happened as a result, including mass job layoffs and widespread closures -- it's no wonder that alcohol consumption and substance use are on the rise. Now that cases are continuing to increase across the country and we lay in wait for a second wave, many experts worry that the problem will get a lot worse before it gets better.

Despite the fact that 22.5 percent of small businesses fail within their first year, there's no doubt that the pandemic has made temporary and permanent business closures much more common than before. Without much financial assistance to speak of, it's no wonder that countless businesses have either shuttered their doors for good or are still on the brink of collapse. Subsequently, at the height of the pandemic, millions of Americans found themselves out of work, with only one small stimulus payment (if that) and a short period of increased unemployment benefits to stay afloat.

That alone could have been enough to convince individuals to turn to drugs or alcohol as a coping mechanism, but there was also the upending of routines to contend with. Although we know that people who participate in regular physical activity have up to a 30 percent lower risk of depression, most gyms and health clubs were forced to close during the early months of the pandemic in order to reduce risk. Social opportunities, in-person classes, and other activities were either canceled or moved online, with special events delayed for months or even years. Even support groups and Alcoholics Anonymous meetings were either made remote or postponed for the time being. Without much to do other than stay home, we saw drinking and drug use skyrocket.

Alcohol sales went through the roof during March and April, but now we're also seeing evidence that drug abuse has followed suit, both in Canada and in the United States. Experts say that the isolation needed to slow the spread of COVID-19 creates a perfect storm for drug misuse and overdoses.

An October briefing from the American Medical Association stated, "In addition to the ongoing challenges presented by the COVID-19 global pandemic, the nation's opioid epidemic has grown into a much more complicated and deadly drug overdose epidemic." The brief also noted that opioid overdose rates had increased in 40 states since the beginning of the pandemic.

Of course, the holiday season can be an especially difficult time for those who struggle with alcoholism and drug addiction. And as we prepare for a devastating second wave of COVID-19, many experts have major concerns about the effect that another round of shut-downs might have on individuals who need addiction treatment and support.

Some have even pointed out that President-Elect Biden will actually be facing two public health crises when he takes office in the United States in January. Not only have 276,000 Americans died from COVID-19, but more than 76,000 U.S. residents died from drug overdoses between April 2019 and April 2020 (the highest number ever recorded in a 12-month period). And while drug addiction is a topic with which Biden is quite familiar, that may not be much comfort to those who are affected first-hand by this disease -- particularly because the plan to curb COVID might include more stringent closures of or lowered accessibility to the services most needed by those with substance use disorders.

In the end, Americans and others around the world really have no choice but to weather the storm and try to hang on until COVID can be brought under control. But that sentiment may not provide much peace of mind for those who are in recovery or family members who worry about a loved one who's struggling.

There’s Little Joy In Trump’s Economy

The American people have been ordered to celebrate the 10-year anniversary of the economic recovery. Note the lack of balloons, however, and that the marching bands have their feet up.

President Donald Trump, of course, is a brass section unto himself. He’s been trumpeting the “Trump economy,” even though nearly eight of those 10 years were under Barack Obama.

Consider this recent presidential tweet: “More people are working today in the United States, 158,000,000, than at any time in our Country’s history. That is a Big Deal!”

That is a good thing, but a big deal? No. First off, there are more people in the U.S. than ever before. More to the point, only 20,000 nonfarm payrolls were added last month. That prompted this sober headline from CNBC: “Job creation grinds to a near-halt in February.”

Stock investors have enjoyed a very nice run (as they did in the Obama years). But down in the trenches of blue-collar America, things aren’t nearly as hot. Factory workers are finding plenty of jobs, and their wages are creeping up. But solidly middle-class paychecks, once the pride of our manufacturing economy, have not returned.

The happy message clashes with reports that a record number of Americans died in 2017 from alcohol, drugs and suicide. These largely self-inflicted tragedies have been called “deaths of despair.”

Of course, it’s not only about money. The loss of strong families has left many troubled people bereft of help, love and solace when hopelessness takes over.

But add in threats to the government benefits important to working Americans, and you have major-league anxiety. Of special concern is the Affordable Care Act, which the Trump administration is doing its best to dismantle. For many families facing health crises, medical coverage is all that stands between making do and destitution.

Candidate Trump played the self-made billionaire, promising to do for struggling Americans what he did for himself. (Actually, his father gave him $413 million in today’s dollars.) Upon being elected, he continued to do for himself, while delivering daily pep talks to working folk.

His tax cut sent nearly all the benefits to the top incomes. The savings for the lower incomes were meager and designed to expire shortly.

It can’t be said that the tax cuts did nothing to goose the larger economy. They did, but that magic is about to expire. And by the way, it was all done with borrowed money.

The trade war spectacle has taken a bite out of the economy’s animal spirits. The marquee event is the battle with China. One hopes that Trump will succeed in stopping China’s very unfair trading practices: illegal government subsidies, biased regulations and theft of intellectual property.

But his announcement that China may guarantee purchases of U.S. soybeans sets off a long yawn. The Chinese were importing enormous shiploads of soybeans before Trump launched the trade war.

As a commodity trader told Bloomberg News, “The markets are a little tired of some of the ups and downs and the eight or 12-hour news cycle of tweets.” Oh, yes, the trade deficit — a Trumpian obsession — is now the highest in 10 years.

Trump routinely deafened Twitter with his promise of 4 percent growth in the economy. The gross domestic product hasn’t even passed 3 percent for any year. Better times, meanwhile, are not yet to come.

Economists see the economy softening, and the manufacturing sector seems to know it. “SC businesses brace for eventual recession,” says a pessimistic headline in The (Charleston, South Carolina) Post and Courier.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at fharrop@gmail.com.To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators webpage at www.creators.com.