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tv   Fault Lines  Al Jazeera  January 22, 2015 5:30pm-6:01pm EST

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washington, ray suarez. >> the united states is in the midst of the worst drug addiction epidemic in its history. but it's not a crisis of illegal drugs. it's one of prescription painkillers - oxycodone, hydrocodone, and other legal narcotics, all related to opium. collectively they are called opioids. >> these are the opioid painkillers. and prescriptions for drugs like these have more than quadrupled over the last 15 years - to the extent that the us now consumes more than 80 percent of the global supply of these drugs.
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>> overdoses from prescription opioid drugs now kill nearly seventeen thousand americans every year. that's one overdose death every thirty minutes. >> the overdose rate which might have been 1 or 2 a month in our emergency department is now more like 3 or 4 or 5 if not more than that, in a 24-hour period. >> that's a massive increase. >> massive. >> over the past 10 years, we've had more than 125,000 americans lose their lives to painkiller overdose deaths. >> the food and drug administration recently approved a powerful new opioid painkiller called zohydro - over the objections of its own medical advisors and dozens of lawmakers. >> i thought we had learned our lesson with oxycontin. how can you say with any degree of confidence that zohydro won't be abused?you're going to have people die.
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>> this week fault lines looks at the battle over the most popular drugs in america - opioid painkillers. >> there is big controversy tonight involving a new narcotic painkiller. >> the drug about to hit the market is called zohydro. but many are now asking is it even needed, and did the fda ignore warnings by approving it? >> at the heart of the debate, whether or not the drug may be too powerful and potentially addictive. >> in october 2013 the food and drug administration did something unusual. it approved a new painkiller called zohydro despite the fact that its own advisory committee had rejected the drug. >> i was quite surprised... you invite us in and then you tell us, "forget it." >> zohydro is a pure hydrocodone
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drug that comes in doses up to ten times higher than vicodin. the advisory committee feared that it could create a new generation of addicts. >> the entire prescription drug epidemic was launched basically from high dose oxycodone. many of us felt that a high dose hydrocodone product would end up in the same place. >> few areas have been more impacted by this epidemic than the state of maine. here more long-acting opioid painkillers are prescribed per capita than in any other state. it's led to one of the highest addiction rates in the country - and a related surge in the use of heroin. in portland, this ambulance team responds to an opioid-related call nearly every day. >> it's about 10 o'clock on friday night. from what we're hearing,
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there's a 25 year-old male in there, who could have had a seizure due to an overdose. >> the responders found this man lying on a bathroom floor, unconscious and barely breathing. a syringe and a small bag of heroin were at his bedside. they were able to revive him by administering a drug that counters the effects of opioid overdose. >> now we're seeing it so frequently and they're people that you'd never expect. it's not the junkie, it's the 25 year old kid. what we're finding is that they can't get the prescription medication that they used to get - they can't get vicodin or oxy. so what they do instead is they buy heroin. >> opioids are pretty much drugs that come from opium. you create oxycodone and hydrocodone from opium in the same way that you create heroin from opium.
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and when you look at the effect that hydrocodone or oxycodone or heroin produce... it's pretty much indistinguishable. >> we've driven about 20 minutes out of portland, and we're on our way to meet somebody who started using legal, prescription opioids as a teenager but quickly transitioned onto heroin. >> jack asked us not to use his real name. he is 32 years old. >> once you've done it. you know i've done it for so long that i need it to feel normal. you know what i mean? once i start doing heroin, like i comprehend better. i can focus better. >> he has been using opioids - first prescription painkillers and now heroin - for more than half of his life.
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it's eleven in the morning and he is preparing his first injection of the day. >> ah, that felt good.
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>> what does it feel like? >> feels good. big warm feeling right through your whole body. like it just runs right through your whole body instantly. makes you feel great. forget about everything. got any aches and pains, it's gone instantly. >> jack started taking painkillers when he was 13. he bought them from friends at school- first vicodin, then oxycontin. >> they were so popular around here it wasn't even funny. you go anywhere and you get an oxy 80. >> and were you crushing them up? >> started sniffing 'em first and then i started injecting 'em shortly right after. >> the transition from that, to taking heroin is that a pretty easy transition to make? >> once somebody does oxys people that you would never ever
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think of doing drugs end up the same way i am, you know what i mean?just went to the doctor's, got it prescribed, and now they're addicted to heroin. >> have you met people like that? >> oh yeah. i know a lot of people like that. people that you would never think of doing drugs ever. ever. and now they're just like me. >> in the last five years, heroin use has nearly doubled across the us. four out of five heroin users switched to the drug after first taking prescription opioids. this is wellspring a recovery house in bangor maine for people struggling with substance abuse. >> so how many we could start from this side have moved from prescription drugs to heroin? [hands go up] everybody.
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but it actually with everyone started with a prescription from the doctor. >> jamie had never used opioid painkillers until he was 21 years old, and he got injured. >> i got crushed over the stern of a lobster boat. i got released from the hospital with a script for dilaudid 8. so i started taking them and it was over. my life was completely gone after that i lost everything. my home, my vehicle you know all the money i had. >> once people became dependent on painkillers they said they'd do almost anything to get them. >> one time, i was hurting so bad that i ended up punching a 4 x 4 and breaking all three of these fingers and this bone to get pain meds from my doctor. >> so you hurt yourself in order to go to a doctor? >> i had 9 teeth pulled out of my head for prescriptions. >> i've been in groups of people where they've taken like bats to their wrists
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to snap them easily. >> how many people know of someone who's died of an overdose?[hands go up] everybody >> catch more "faultlines" episodes on demand or at
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chronic pain. david duhrkoop is one them. for over 20 years, he has been in nearly constant discomfort since injuring his back in an accident. >> it becomes almost like a partner that you walk around with all day. and you don't like that partner very much. but uh you've got them there and they're with you 24 hours a day. i think about being out of pain every day of my life. >> in the late 1990s david was part of the first wave of people prescribed oxycontin for chronic pain. >> i was told that there was a new medication that came out and it was primarily for cancer patients but they were trying it for chronic pain patients. you know if the doctor prescribed it, it's got to be good. i remember on the bottle it says 'do not bite or crush this medication.'
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well, why not? what happens if you do? well i found out you get the full effect of 12 hours of medication you know in 15 minutes and from then on you know the devil's gotcha. >> it was only after years of addiction treatment that david was able to drop oxycontin. he now gets by on two morphine pills a day. >> that's the question on the table. is 'how long should a doctor prescribe medication?' and, at what point are you doing more harm than good?' >> opioids are very important medications for easing suffering at the end of life. and they're very good at relieving pain on a short-term basis. but if you look at the bulk of the opioid prescribing in the united states, it's for very common chronic conditions like low-back pain...
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>> doctor andrew kolodny is an addiction specialist who advocates for reform in opioid drug policies. he says the manufacturers of oxycontin encouraged a shift in the medical thinking about opioids. >> there's no need for anyone to suffer in pain anymore. >> this pill that's the time-release pill solves all the problems. >> see what it's like when you're not in pain anymore. take these medications. >> when purdue pharma launched oxycontin, they launched a marketing campaign and an educational campaign to convince the medical community that we had been under-prescribing opioids. >> there's no question that our best strongest medicines are the opioids. >> to convince us that we had been allowing patients to suffer needlessly because of what they called an overblown fear of addiction. >> the culture actually of the time was lets treat everyone with opioids at whatever dose necessary and if some doesn't work we'll give a
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higher dose. many of the patients i would have to keep increasing the dose that brought them up to doses that i didn't feel were safe. i consider it a population-wide experiment on american citizens that let's just give them all opiates. >> here in seattle doctor david tauben is part of a group of physicians who are changing their approach to treating pain. >> okay, so when i just slightly press does that hurt? >> it's a response to a staggering reality: in 2010, doctors prescribed enough opioid painkillers to medicate every american adult around the clock for an entire month. >> our oath as physicians is to do no harm and i think we've done harm. >> okay, so you've been on opioids for how long? >> uh, since august '08 >> how do i use opioids in my chronic pain practice? i use it occasionally. the primary treatment for chronic pain is management by
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the patient, management by the team using non-drugs, non-pharmacological and non-technological solutions. we need to flip the paradigm to opioids being a late resort. but we certainly shouldn't introduce more patients into something that we recognize has been a bit of a failed experiment. >> wayne merrill got caught up in the opioid painkiller experiment. >> wayne was an exceptional father. he really was. >> five years ago, kathleen bowley married wayne, and they started a family here in southern maine. >> i couldn't have asked for a better partner. we shared the same value system. we just felt into it very easily. it was easy. wayne worked as a meat cutter at a butcher shop.
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one day he fell at work, and was prescribed vicodin and percoset for the pain. several months later he injured his arm at work again, and his doctor prescribed him oxycontin. >> i was in the waiting room and the doctor came out and said we had to give him something stronger this time because he's built up a tolerance. and i thought that was peculiar, but i just nodded and responded to the doctor and that was that. he's the doctor, he's in charge he's the expert. it took me about 9 months to figure out what was going on with him and the prescription pills. i was working from home one day and he came home around 2 o'clock that afternoon and he was so messed up. i mean he couldn't even put a sentence together. and he told me later on that he took 10 vicodin that day. this was by 2 o'clock. if he didn't have the opiates in his system, he could not function as a human being. he couldn't. he'd totally changed.
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he was so angry. like the person i married and spent four or five years with was gone completely gone. >> eventually, kathleen decided to separate from wayne. one month ago, she was contacted by his family. >> his mother picked up the phone and she said katie, wayne's dead. it was very cut and dry. and, i said i have to go i'll call you back. i dropped to the floor. she told me what she knew from the detectives that showed up at her work place and brought her into a back room and showed her pictures of wayne. >> wayne was found dead in the backseat of a car, in the parking lot of a local hospital. >> i blamed him for a long time. i looked at it as a choice which was i think ignorant in my part.
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he's like, but i have to have this medication to survive, to get through each day. >> in 2010 doctor michael von korff published the first study that directly linked high doses of prescribed opioids to increased risk of overdose. it may seem obvious, but it went against the conventional thinking about painkiller addiction. >> the problem was posed as there's good patients and bad patients. this sort of thinking persists today, that if you can sort out who the good patients are, that have legitimate pain, from the bad patients who are drug seekers and uh and, and addicts, then that long-term use of opioids can be safe. and i think what we've learned is that life isn't that simple.
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>> the last thing the drug companies wanted anybody to think was that this was a prescribing problem. they were okay with thinking it's a substance abuse problem. that the problem is in the patient. >> doctor gary franklin is a medical official in washington state. he was one of the first people to sound the alarm about the adverse effects of opioid prescribing. >> somebody would come into our system with a low back sprain, and be dead three years later from an unintentional overdose of opioids. i was shocked. i mean it was the saddest thing i had ever seen in many years in my job. >> franklin has worked to implement guidelines that limit the prescribing of opioid drugs in washington. since the rules went into effect overdose deaths in the state have dropped by more than a quarter. >> these are avoidable deaths. >> there's a sea change going on in practice and i think that the regulatory agent the fda in particular,
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rather than being out in front of the sea change, is being carried along. >> we would not be dealing with this problem today had the fda been doing its job properly going back to 1996. >> with well over 100,000 deaths this is the worst manmade epidemic in history. when i say manmade i mean made by organized medicine. >> catch more "faultlines" episodes on demand or at
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>> if you want free press in the new democracy let the journalists live. >> as the painkiller epidemic has spread drug company profits from opioids have soared. >> over the last ten years revenues from opioid painkillers have more than doubled. in 2012, the figure was over nine billion dollars. as the market for opioids grew so did the incentive to get new, more lucrative painkillers approved by this federal agency, the fda. in 2002, a group of academics and fda staff began hosting private meetings with drug companies -- to develop new ways of testing the safety and effectiveness of painkillers. the meetings were held in five-star hotels in the washington dc area - and funded by over a dozen pharmaceutical companies, who paid hundreds of thousands of dollars to attend. >> the benefit for the drug
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companies who participated was enormous. getting a drug approved can result in billions of dollars for that company that gets the drug on the market. >> details about the meetings became public only in 2013 after emails were obtained in a public records request. >> in one of the emails you have one of the drug companies sort of questioning the fee that they had to pay. and the response to the drug company was: "you're getting a lot for your money. you get to influence fda thinking. you get to sit at a small table with fda." >> one key person who sat on the steering committee for these meetings was doctor bob rappaport - the head of the fda division that regulates painkiller drugs. >> this is the voice of doctor rappaport at the fda hearing on the drug application for zohydro.
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>> throughout the hearing, rappaport repeatedly instructed the committee to focus narrowly on whether zohydro worked to relieve pain rather than whether it would worsen the opioid epidemic. >> they did redirect us a few times when we were getting a little more concerned about individual safety.
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>> when the committee voted against approval rappaport rebuked them for unfairly penalizing the drug company. >> it's hard not to learn from history. we're supposed to learn from history and try not to repeat our mistakes. >> there is not a legal basis by which fda can say we don't need another opioid because we've already had a lot of bad experience. >> doctor judith kramer voted against zohydro. but she says the fda's powers are limited. >> the fda is required by law to fairly and uniformly apply the law. the people that were saying safety's not adequate,
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were saying ôi'm no longer comfortable just following what you have to follow by the law. you have to do it, but we've got to have more information.' >> fault lines repeatedly requested an interview with the fda about the opioid epidemic. >> we've been speaking to the fda for weeks now, trying to get an interview that they'll make available and we just received a response. they say: unfortunately, we are going to have to take a pass on your on-camera interview request at this time. >> in an email the agency said it approved zohydro because the medical benefits of a pure hydrocodone product outweigh its risks. it said that it takes the issue of opioid addiction seriously, but that removing treatment options from the market would unfairly penalize pain patients. since the fda approved zohydro twenty-eight state attorney generals and dozens of members
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of congress have asked the agency to reverse its decision. all six new england governors have called for zohydro to be blocked. >> as a mother of teenagers, as a clinician it's the young kids, it's the new it's the new exposures that i'm worried about. >> this is probably a lost generation of people who have been on opioids and have become dependent. we still have a huge way to go. we've only begun to dig out of this thing. not one more person should be dying from an unintentional overdose of painkillers prescribed by your doctor. >> beyond the verdict and on the streets >> there's been another teenager shot and killed by the police >> a fault lines special investigation >> there's a general distrust of this prosecutor >> courageous and in depth... >> it's a target you can't get rid of... >> the untold story...
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