Historical Factors that Led to The Current Opioid Crisis - A Guest Post By Patrick Bailey*

The opioid crisis has captured the attention of policymakers and the public. It is becoming increasingly apparent that this is a multidimensional societal challenge that requires a new approach. Such an approach should include patient and community level intervention. Access to care for mental health conditions, private alcohol rehab and substance abuse treatment is also important if we are to curb overdose deaths.

The history and events that led to the opioid crisis are explored in this article.

History of Opioid Abuse

As early as 1980 Carter’s White House had identified prescription opioid medication to be responsible for “as many as seven out of ten drug-related injury or death”. Yet the issue of the opioid prescription medication crisis was not brought to the limelight until two decades later. More and more people were looking to join private alcohol rehab and addiction recovery centers or were struggling with health complications.

In the 80s, before policymakers and the public understood the full adverse effects of this medication, there were virtually no regulations to stop opioid prescriptions. Propoxyphene was one of the most prescribed drugs in the 80s.

Propoxyphene was initially considered to be a weak opioid that could be used as an analgesic. It was later pulled out of the market after it was discovered that it could cause irregular heartbeats. By 2011, it was banned in the US and Canada.

Despite the obvious dangers of opioid medication and the impact they have in the community, opioid-related deaths continue to rise. The CDC reports that opioid overdose deaths have increased fivefold since 1980.

Overdose deaths are caused by drug abuse and misuse of prescription medication. In recent years, the CDC report points out that overdose deaths caused by prescription medication outnumber those from illicit drugs. The factors behind overdose deaths from prescription medication include:

● Insurance and Pharmacy benefit Policies

● Lack of oversight in the prescription of opioids

● Problems with provider clinical practices

The impact of prescription medication dependency is significant and far-reaching. It has complicated chronic conditions further, leads to addiction and financial loss. The impact was slowly starting to become apparent. But many in the health industry felt that new policies shouldn’t be so restrictive that they prevent patients in pain from accessing care.

But what happened between the 90s when cases of opioid adverse effects were being highlighted and the present day when it has become an epidemic? A series of events paints a picture of medical practitioners who were unwittingly giving way to profiteering pharmaceuticals.

Profit over People

When Insurance companies started to withdraw cover for opioid medication, pharmaceutical companies came up with ways to go round it. This included extended-release formulas, transdermal patches, and pain modulating implants. Many non-opioid pain medications were being questioned for their potential cardiovascular risk. At this point, pharmaceutical companies would start pushing back opioid pain medication much more ruthlessly.

In 2016, seven employees of Insys Therapeutics, Inc, including its former CEO, were arrested for running a scheme to defraud medical practices and practitioners. The department of justice claims that the former executives conspired to push a fentanyl-based drug to health care providers.

The executives went ahead to develop a scheme that involved many conspiring practitioners. They would give kickbacks to professionals in the healthcare industry to push their fentanyl-based drugs to non-cancer patients. The report alleges that some practitioners were bribed to change the patient’s diagnosis.

Fentanyl is a powerful analgesic that can be used to help people cope with chronic pain. But it is 50 times more powerful than heroin. If not properly prescribed, it can lead to serious complications and often death. This drug alone handles "nearly half of all overdose deaths".

Disease of Despair

However, even as opioid pain prescriptions decreased by 13% between 2011 and 2016, overdose deaths continued to rise. This may be attributed to the entry of drugs such as fentanyl which are less bulky and easier to distribute.

However, some researchers feel that the focus on drug distribution and incarceration also contributes to overdose deaths. This single focus reduces response to prescription opioid overdose and complications. Understanding how addiction to opioid prescription medication starts is limited.

Another issue is access to treatment. Treatment requires an understanding of what addiction is and why it happens. Factors such as underlying mental conditions, physical health, lack of employment, are some of the factors that ought to be considered.

Access to mental health treatment, substance abuse, and private alcohol rehab is critical for addressing the issue conclusively. Patients require access to alternative pain medication that is effective. One of the nonopioid drugs that has been proposed is Buprenorphine.

Unfortunately, the drug can also cause dependency. It demands due to caution when prescribing to those with opioid addiction. Congress is yet to approve the drug for addiction to prescription medication.

Meanwhile, the opioid crisis continues to affect the poor disproportionately. Lack of access to professional care can increase the risk of opioid-related complications. The environment where many of the poor live, makes them more susceptible to mental health conditions.

The rate of death is the same in both urban and rural counties. But the report shows a clear difference in poor counties and counties with high rates of divorce and separation. Addiction is a social and psychological illness that needs more than tough laws to curb.

The opioid problem has grown exponentially over the last decade. Partly because of the lack of effective oversight on pharmaceutical companies, and partly because of an economy that puts profit over people. The main problem is that we have failed to acknowledge the multifaceted nature of the problem.

* Author Bio: Patrick Bailey is a professional writer mainly in the fields of mental health, addiction, and living in recovery. He attempts to stay on top of the latest news in the addiction and the mental health world and enjoys writing about these topics to break the stigma associated with them.

Patirck can be reached at the following address: baileypatrick780@gmail.com

The Kindest Cut Of All?

Given the butcher's blade Doug Ford and his trained seals are taking to crucial services and programs in Ontario, perhaps the following best reflects the widespread disenchantment people are expressing with the government they helped elect.

Our Timid Canadian Revenue Agency

Over a year ago I posted about the sad record of the CRA in pursuing offshore tax cheats as revealed by the Panama Papers. It seems that little has changed since then.

In a Policy Options article, Senator Percy Down asks, Why can’t the Canada Revenue Agency catch tax cheats?

Recently, on the third anniversary of the release of the Panama Papers, we learned that other countries have recovered more than $1.2 billion in fines and back taxes:

Australia has recouped $92 million.
-Spain is counting $164 million in its coffers.
-The United Kingdom has recovered $252 million.
-Even Iceland, with a population of roughly 350,000 people, was able to recover $25.5 million.

Of the 894 Canadians (individuals, corporations and trusts) revealed by the Panama Papers to have accounts, the Canada Revenue Agency hasn’t recovered a dollar.

While the CRA talks a good game, its results tell a different story:

The agency talks tough every time there is a public leak of information from some bank or law firm operating in a tax haven. Nevertheless, not one person has been charged with overseas tax evasion, much less convicted, fined or sentenced since the 2006 information leak we know the most about, from a bank in Liechtenstein, where 106 Canadian-held accounts were found to contain more than $100 million.

In fact, as reported by the Auditor General, the CRA “waived referrals for potential criminal investigation to gather information.” In other words, the agency promised not to charge the people involved in that tax scheme in exchange for them explaining to the CRA how it actually worked and agreeing to pay what they owed.

This strange acquiescence to tax evasion is contrasted by other jurisdictions that have worked hard to discourage such criminality:

Compare this to Australia, for example, where not only are back taxes and penalties paid, but individuals are charged with committing a crime and in many cases convicted, fined and jailed, and the country uses those convictions to warn citizens that it is serious about tax evasion.

“As a result of Project Wickenby’s focus on preventing the abusive use of secrecy havens,” a 2012 audit of an Aussie anti-tax evasion task force noted, “Australia is presently less attractive for international tax fraud and evasion than it otherwise would have been. After a slow start, the project has achieved substantial results from its activities, which contribute to protecting Australia’s revenue base.”

And make no mistake. We are all paying for the Canada Revenue Agency's laxity:

Because Canada has not recovered any money, three things have happened. One, we don’t have that money to fund our priorities without incurring a deficit; two, the rest of us have to make up the shortfall by paying more taxes; and three, Canadians are wondering why we have a two-tier justice system for tax evasion. Try to cheat on your domestic taxes, and the CRA will likely find you, charge you, convict you and force your repayment. Hide your money overseas, and you likely will never be charged or convicted. The odds are good you will get away with it, and your federal government allows this double standard to continue.

Like the Harper government before it, the Trudeau administration seems to be using the CRA for its own purposes. Is it too much of a leap to conclude that one of those purposes is to protect its friends in high places?

To The Obsequious Go The Spoils

And no one is more obsequious than Lord Tubby Black.



H/t Michael De Adder

A Crazed Autocrat

Bleed, bleed, poor country!
Great tyranny, lay thou thy basis sure,
For goodness dare not check thee.
- Macbeth, Act 4, Scene 3


H/t Patrick Corrigan

The above quote from Macbeth, along with Patrick Corrigan's editorial cartoon, serve as pungent reminders of the carnage taking place in Ontario under the 'leadership' of Premier Doug Ford. Like Macbeth, Ford's vision can be described only in the bleakest of terms, with destruction at its very core.

Aided and abetted by an assembly of sycophants elected on Ford's coattails and slavishly devoted to him in the hopes, no doubt, of securing the leader's favour, they preside over the wholesale destruction of programs with nary a peep beyond the rousing standing ovations they give his every word in the legislature.

One ardently hopes for a day of reckoning.

Until that day comes, however, perhaps there is some measure of comfort to be derived from knowing that increasingly large numbers of people recognize Ford for the ruthless, vengeful, crazed autocrat that he is, aided and abetted by a feckless Conservative caucus:

From yesterday's print edition of The Star come these missives:

MPPs show lack of vision

Re Local Tory MPPs back Ford over city cuts, May 13

It is depressing to read the comments (or refusal to comment) from the 10 Toronto Progressive Conservative MPPs on how the Ford government’s funding cuts will affect the city.

We deserve better from our elected representatives than blind obedience to the party line and rote repetition of Ford’s major talking points.

What is most striking in the joint statement from the PC MPPs is the total lack of vision of the kind of city and province we are building for the future. We need our representatives to focus equally on long-range core values as on short term “efficiencies.”

That vision is sadly lacking, at least as demonstrated by the constipated views expressed by the Toronto PC MPPs.

Howard Gladstone, Toronto

Congratulations to your reporters for helping expose the hypocrisy that is rife in the government ranks.

Seemingly, the 10 Toronto MPPs think that a surprise $178-million (city manager’s estimate) reduction in funds from the province is no big deal.

They ran on a campaign of finding efficiencies in the provincial government. I don’t think that the 40 per cent of voters who backed them assumed they would just pass the buck to cities and municipalities.

Etobicoke-Lakeshore MPP Christine Hogarth thinks the problem can be solved by charging the well-off for yoga classes. Is that the best idea she can come up with?

Don Valley North MPP Vincent Ke says it’s not cuts. Really!

Scarborough-Agincourt MPP Aris Babikian blames the labour unions for stirring up protest against the cuts. I didn’t know senior citizens were unionized. York Centre MPP Roman Baber thinks that cuts to social services and child care services of $101 million is not a problem. Considering he thought that 64 and 37 added up to less than 100, remedial arithmetic should be on his agenda.

Of course, their leader is no better. Premier Doug Ford insults Mayor John Tory with a gibe about wasting time over a sign instead of finding efficiencies, as the premier obsesses over bucka-beer and stickers on gas pumps while giving large tax breaks to the rich.

I guess you don’t need a backbone just to stand up, hoot and clap in the legislature. I’m sure their constituents expect more.

Robin Bunner, Utopia, Ont.

“Ford’s office quickly let the Star know the MPPs would respond with a joint statement.” That response sums up the entire Ford party strategy and the fundamental failing of our major parties. The instant the polls close, each delegate becomes a mere repeater of party sound bites, incapable of independent thought or speech and too timid to convey any message from the voters to the government.

Paul Collier, Toronto

It is not surprising that these MPPs follow the party line and that the response to the Star resulted in not one MPP replying directly, or that Premier Doug Ford’s office replied with a joint statement.

If they all stand up in unison to applaud everything Ford says, then it is not surprising at all. I am sure they fear for their jobs.
The Star perhaps should have dealt more directly with the constituents in their ridings and perhaps received more honest feedback.
It is a sad state of affairs when the people most affected by these so-called efficiencies do not have more support from their MPP.

Alison Herrington, Oshawa

I find Scarborough-Agincourt MPP Aris Babikian’s dismissal of protests at constituency offices as union-led to be not only untrue but amusing.

The weekly protests at my MPP’s office are organized by an ad hoc, diverse group that is calling itself Common Ground. And the seniors who protested library cuts at Niagara West MPP Sam Oosterhof’s office weren’t union led.

On the other hand, there is a group being led by their boss. The Tory caucus issuing joint statements and joining in obligatory standing ovations look like a group dancing to the tune of the premier’s office bosses.

Peggy Stevens, Newmarket

Ultimately, Macbeth is overthrown by a coalition of brave people willing to confront the tyrant. Sadly, until the vox populi grows to a roar, the day of deliverance for Ontario seems far-off indeed.

Your Climate, Your Choice

That's the name of a new series which, in the coming weeks, will look at and evaluate the climate-change platforms of each of our political parties. Last night's segment was on the Green Party, and since it is first in the series, I cannot tell whether the tone will be the same in succeeding segments. I did think Donna Friesen seemed to be looking for practical and financial weaknesses in the Greens' approach, but that may indeed be the template for this series.

Start at the 12-minute mark to begin the report:

UPDATED: A Masterful Revision

An antidote to the Ford regime's propaganda, thanks to Braeson Holland:

Fixed a few things in @FordNation's climate change attack ad 👇🌎👇#cdnpoli #onpoli pic.twitter.com/Lzwjkdr3AH

— Braeson Holland (@braesonholland) May 15, 2019

UPDATE: Meanwhile, another redoubtable Star letter-writer offers this assessment of Doug the Thug's duplicity and mendacity:

Cartoon about Doug Ford’s missing facts was right on the money

Missing facts cartoon, Moudakis, May 15

Your editorial cartoon decrying Premier Doug Ford’s missing facts is right on the money. The only way to fight lies and half truths is with facts.

This is exactly the reason that bullies and truth benders such as Donald Ford (should be his new name) depict the media as the enemy: it provides contrary opinions and perspective using facts instead of rhetoric.

And the media has the ability to be a conduit of information, our only means of educating the masses. Unless they don’t read. And it is costly to buy commercial time on television unless one uses our own tax money to spread lies and half truths. Evil genius. Our wonderful province is in crisis and clearly in the hands of the wrong people.

David Ottenbrite, Cambridge