PHS 2101 Lecture Notes - Lecture 14: Drug Enforcement Administration, Opioid Epidemic, Purdue Pharma
14 May 2019
School
Department
Course
Professor
—How did we get here, where are we going and what do we do?
Opioids are used for pain through a therapeutic use.
Misuse, abuse, overdose of deaths.
Diversion, overprescribed, addiction, dependance, tolerance
1. Addiction: craving for the drug
2. Not everyone who takes opioids becomes addicted or tolerant
Doctors: marketing says low risk
1. Pain is relative → the way we treat pain has changed
Research
1. What are things that make people addicted
2. nature/nuture
3. How do doctors become more aware of who has more addictive risk
Purdue Pharma: OxyContin
1. Beuphronine: used to treat addiction
a. Making huge profit
DEA: Drug Enforcement Administration
1. Government agency
FDA: Food and Drugs Admin - final
1. Require manufacturers to complete clinical trials and present data
2. While it does not test drugs, they receive reports → could have done something in post
marketing
a. Epidemic doesn’t come from one bad factor
Distributors: make delivery of drugs
1. Cardinal health
2. Amerisource
Linden Barber: Legal Counsel with DEA
Everybody is a participant in this unless theyre not
What region has this most impacted?
1. Rural communities
2. Can be associated with poverty → also hitting affluent communities
3. Overdoses are occurring across the economic spectrum
4. While it may have been true that it has a higher rate in colored communities, no longer
true
5. 1908s: War on Drugs → mass incarceration crisis
Leading Causes of Death in U.S. 2017
1. Adult poisonings: usually drug-related
a. Overdoses of illegal drugs
b. Legal drugs taken for nonmedical reasons
c. Poisoning from legal drugs taken in error or at the wrong dose
d. Unanticipated effects from prescription drugs for medical and non-medical
reasons
The Demographics
1. Heroin and synthetic opioids facing a strong trajectory after experiencing a plateau
2. High rates in non-hispanic whites
3. It wasn’t a routine thing for someone to go home with 30 day supply of narcotics
Endorphins
Historical Comparison of Opioid Abuse in U.S.
20th century
21st century
1. Morphine, heroin, cocaine, crack
2. Illicit street drugs, criminal
3. Urban inner city
4. 1980: 6100 deaths
5. 1980 Incarceration 40,900
a. War on drugs: Just say NO
b. Racially disparate application
of drug laws
6. Detox treatment for addicts,
incarceration
1. modified/synthetic and Rx opioids:
oxycontin, fentanyl, carfentanyl
2. Pain patients, middle aged, middle
class, affluent
3. Rural, suburban, urban
4. 2017 >64,000 deaths
5. 2015 Incarceration 469,545
a. 94% serving time for drug
felonies are black and
Hispanic (1980-2016)
6. Medical assisted treatment of Opioid
Use Disorder: naloxone,
buprenorphine, suboxone,
methadone: Diversion Courts
Harm Reduction: drug misuse/abuse is not a crime, treated it as a chronic disease and took a
medical approach.
1. Recognizes that some people are addicted to drugs → need rehab to try and get them
off of it
2. Needle exchanges
3. Safe shooting spaces
Document Summary
Opioids are used for pain through a therapeutic use. Diversion, overprescribed, addiction, dependance, tolerance: addiction: craving for the drug, not everyone who takes opioids becomes addicted or tolerant. Doctors: marketing says low risk: pain is relative the way we treat pain has changed. Research: what are things that make people addicted, nature/nuture, how do doctors become more aware of who has more addictive risk. Purdue pharma: oxycontin: beuphronine: used to treat addiction, making huge profit. Distributors: make delivery of drugs: cardinal health, amerisource. Everybody is a participant in this unless theyre not. The demographics: heroin and synthetic opioids facing a strong trajectory after experiencing a plateau, high rates in non-hispanic whites. It wasn"t a routine thing for someone to go home with 30 day supply of narcotics. Illicit street drugs, criminal: morphine, heroin, cocaine, crack. Hispanic (1980-2016: medical assisted treatment of opioid. Use disorder: naloxone, buprenorphine, suboxone, methadone: diversion courts.
