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thewebofslime · 5 years

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The filing is a centerpiece of an agreement to settle thousands of cases against the company for its role in the opioids crises. But it is expected to be vigorously contested by many states. Image Purdue Pharma’s headquarters in Stamford, Conn., on Thursday.CreditCreditFrank Franklin Ii/Associated Press By Jan Hoffman and Mary Williams Walsh Published Sept. 15, 2019 Updated Sept. 16, 2019, 12:56 p.m. ET 249 Purdue Pharma, maker of OxyContin, the drug widely seen as igniting the opioid crisis, filed for Chapter 11 bankruptcy on Sunday night, a move at the center of the company’s efforts to shield itself and its owners from more than 2,600 federal and state lawsuits. The terms of the filing, which include a proposed resolution of most of those cases, are expected to be fiercely contested by a group of states — led by Massachusetts and New York — that have refused to settle with Purdue and are intent on pursuing the company’s owners, the Sacklers, considered one of the wealthiest families in the United States. A showdown in bankruptcy court in White Plains could come as early as this week. Restructuring the company through bankruptcy was at the heart of a tentative settlement agreement reached last week between the company and thousands of cities and counties that have sued it in federal court for its role in the opioid epidemic. Twenty-four states and five United States territories have also accepted the agreement. Purdue’s board of directors voted Sunday evening to approve the settlement in principle. “This unique framework for a comprehensive resolution will dedicate all of the assets and resources of Purdue for the benefit of the American public,” Steve Miller, chairman of Purdue’s board of directors, said in a statement. “This settlement framework avoids wasting hundreds of millions of dollars and years on protracted litigation, and instead will provide billions of dollars and critical resources to communities across the country trying to cope with the opioid crisis. ” Sign Up for NYT Parenting From the team at NYT Parenting: Get the latest news and guidance for parents. We'll celebrate the little parenting moments that mean a lot — and share stories that matter to families. SIGN UP Purdue hopes to restructure completely, with an expectation that the Chapter 11 bankruptcy will prompt an automatic stay of current civil litigation against the company over the opioid epidemic. The details of the settlement proposal have been reported in recent weeks: the Sacklers would give up ownership of the company and pay $3 billion cash to the plaintiffs over seven years. They would also have to sell their Britain-based drug company, Mundipharma. The proceeds from that sale could add “substantial further monetary contributions” to the settlement pot, according to a company statement released Sunday night. You have 4 free articles remaining. Subscribe to The Times Purdue would be restructured into an entity known as a public benefit trust. Profits from its production of OxyContin and other drugs would pay the plaintiffs’ claims, and also support research and development of medicines to treat addiction and overdoses, which would be donated to the public. The new company would abide by restrictions on the marketing and sales of opioids. The worth of the settlement has been a subject of contention. In its statement announcing the filing, Purdue said it assessed the value at $10 billion. But the states that have opposed the deal have disparaged those numbers, saying they are highly speculative and based on optimistic calculations that may take years to realize. The opposing states also object to the deal because its structure allows the Sacklers, through Mundipharma, to participate in the drug manufacturing business until it is sold. These states note that the resolution of the lawsuits will be paid in part from ongoing sales of OxyContin in the United States and abroad — rather than all of it from the Sacklers themselves. Editors’ Picks After Sept. 11, Twin Towers Onscreen Are a Tribute and a Painful Reminder Giuliani Divorce: It’s Ugly, It’s Operatic. What Did You Expect? The Sly Superpower of ‘Hustlers’ The states that have not signed on to the settlement deal, including Massachusetts, New York, New Jersey, Connecticut, Pennsylvania, California, Illinois, Virginia, Delaware, North Carolina and others, as well as the District of Columbia, are almost uniformly those that have sued the Sacklers in addition to Purdue, or are about to. What remains unclear is whether the individual Sacklers who have been sued will benefit from the automatic stay of litigation that will most likely be accorded to their company. In a statement, the Sackler family expressed “deep compassion for the victims of the opioid crisis,” concluding: “We are hopeful that in time, those parties who are not yet supportive will ultimately shift their focus to the critical resources that the settlement provides to people and problems that need them.” The 24 states that have signed onto the deal, including Tennessee, Florida, West Virginia and Texas, as well as the municipal plaintiffs in nearly 2,300 cases consolidated in federal court, have said they wanted to secure guaranteed money from a bankruptcy that seemed inevitable. They want to begin addressing opioid-gouged public funds, they say, and to end litigation, which itself is crushingly expensive. The possibility of bankruptcy had been in the works since at least the summer of 2018, when Purdue named Steve Miller, a restructuring specialist who is widely known by his nickname, “the Turnaround Kid,” to chair its board and hired the law firm Davis, Polk & Wardwell, which has a large bankruptcy practice. The filing itself comes scarcely 48 hours after an announcement late Friday afternoon by the New York attorney general, Letitia James, that her office had uncovered almost a billion dollars in previously undisclosed wire transfers from Purdue to private accounts held by one of the Sacklers. The discovery came from just one of 33 subpoenas the state issued recently to financial institutions and advisers that have done business with the Sacklers. The dismantling of a corporation to resolve litigation is not without precedent. The signature example is the Manville Personal Injury Settlement Trust, set up in 1988 from the 1982 bankruptcy restructuring of Johns Manville, the asbestos manufacturer, to resolve hundreds of thousands of claims for mesothelioma and other lung diseases. Another notable example is Dow Corning, a maker of silicone breast implants, which sought bankruptcy protection in 1995 to address thousands of lawsuits. But the Purdue case is, in some respects, unique. The list of Purdue’s creditors consists overwhelmingly of the state and federal litigants. But the many thousands of claims that Johns Manville and Dow Corning had to settle were brought by individuals. Here, each of the 2,600 cases against Purdue represents thousands, and often, millions of citizens. Because the plaintiffs are governments, the states objecting to the proposal are expected to argue that their police authority to protect their citizens permits them to override the bankruptcy protections claimed by the Sacklers. But bankruptcy courts are federal; whether state law would be persuasive is unclear. Many other questions remain. The federal bankruptcy judge must decide whether the objections by the opposing states are sufficient to scuttle the deal or whether those states will have to be bound by the deal as well. Other nettlesome issues include the order in which the plaintiffs and their private lawyers will be paid, the respective amounts and, eventually, how those funds will be allocated to address the disaster. New York and other states have said in their filings that OxyContin, and opioids developed, distributed and sold by other companies, laid waste to hundreds of thousands of lives, depleting governmental resources. But throughout the two-decade-long public health crisis, the states say, the Sackler family transferred billions of dollars from Purdue to shell corporations and private accounts. These moves amount to “fraudulent conveyance,” the states say, a claim that may pierce the bankruptcy shield against litigation. Moreover, many states say, the Sacklers have violated individual states’ consumer protection and fraud laws, which could give them the authority to pursue the Sacklers in their own courts.

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bountyofbeads · 5 years

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I suffer from chronic pain due to multiple car wrecks, botched neck surgery, fibromyalgia and a partial bowel obstruction and have been treated for 20 years for the pain by a reputable pain group tied to our largest health care system in North Carolina. But in the last year, due to the opioid crisis and new guidelines from the federal government, they have cut my medicines back by more than 50% and considering cutting further. That has created it's own problems with my health. I feel that those of us who truly suffer from chronic pain and follow the rules have become sacrifical lambs in this opioid epidemic. I don't have all the answers but we need a voice in the discussion.

Below this article is another article looking at problem for those of us who have this issue and it's effecting us. It's well worth the read.

Purdue Pharma reaches tentative deal in federal opioid lawsuits

By Aaron C. Davis, Lenny Bernstein, Joel Achenbach and Scott Hingham | Published September 11 at 1:50 PM ET |

Washington Post | Posted September 11, 2019 6:31 PM ET |

Purdue Pharma, manufacturer of blockbuster painkiller OxyContin, has reached a tentative settlement with 22 states and more than 2,000 cities and counties that sued the company over its role in the opioid crisis of the past two decades, people close to the deal said Wednesday.

The executive committee of lawyers representing cities, counties and other groups in a federal lawsuit against Purdue and other drug companies is recommending the deal be accepted. But some state attorneys general, who sued Purdue and its owners, the Sackler family, in state courts are still opposed to a deal.

Under terms of a plan negotiated for months, the Sacklers would relinquish control of Stamford, Conn.-based Purdue Pharma. The company would declare bankruptcy and be resurrected as a trust whose main purpose would be to combat the opioid epidemic.

If the deal becomes final, it would be the first comprehensive settlement in the broad legal effort to hold drug companies accountable for their role in the opioid epidemic. To date, Purdue has also settled with one state, Oklahoma, for $270 million, and won a victory when a North Dakota judge threw out the state case against the company.

The deal also would mark the demise of Purdue, the company widely blamed for its role in driving the prescription opioid epidemic as it spread in the late 1990s and the first years of this century. In 2007, Purdue and three of its executives pleaded guilty to criminal charges of misleading doctors and the public about the safety of OxyContin and paid a $635 million fine.

On Wednesday, the divide over the settlement broke down largely along party lines, with most Republican state attorneys general in favor of it and Democrats largely opposed.

Pennsylvania’s Democratic attorney general, Josh Shapiro, who tried to negotiate a settlement he could accept, opposes the final deal and has vowed to sue the Sacklers personally. Another Democratic opponent, North Carolina attorney general, Josh Stein, said Wednesday he would do the same.

“These people are among the most responsible for the trail of death and destruction the opioid epidemic has left in its wake,” Stein said.

But Ohio’s Republican attorney general, Dave Yost, backs the agreement. “The proposed settlement with Purdue provides the greatest certainty for all Ohioans to receive relief as quickly as possible in light of rumored bankruptcy,” said a spokeswoman for Yost.

The deal was said to be worth $10 billion to $12 billion, including a $3 billion payment from the Sacklers. It also would include at least $1.5 billion from the sale of the family’s international drug conglomerate, Mundipharma, according to documents and people close to the talks.

The federal plaintiffs and many attorneys general apparently felt the proposal was as good as they could get. The lawyers for the cities and counties agreed to recommend that the municipalities “move forward in support of the current proposal, subject to satisfactory documentation of the essential terms and final documents,” said Paul J. Hanly, Jr., Paul T. Farrell Jr. and Joseph F. Rice, three of the leaders of that group. “We feel good progress has and will continue to be made.”

But some states objected that the Sacklers were not contributing enough cash from their personal fortunes, built almost entirely on the sale of OxyContin and taken out of the company in recent years, according to court papers filed by some states.

Connecticut Attorney General William Tong said he remained opposed to any deal because of that.

“The scope and scale of the pain, death and destruction that Purdue and the Sacklers have caused far exceeds anything that has been offered thus far,” he said in a statement.

Another major concern is that the deal relies in significant measure on the assumed value of Purdue’s assets and the sale of a subsidiary. States opposing it fear these values may be overestimated, and some of settlement money may never materialize.

It was not clear Wednesday whether the Sacklers had agreed to increase their personal contribution to the settlement or whether other terms had changed.

Still pending is the mammoth federal case in Cleveland against other drug companies, known as a “multidistrict litigation” or MDL, where the lawsuits from cities, counties, Indian tribes, hospitals and other groups have been consolidated. Judge Dan Aaron Polster has presided over that litigation, urging the parties to settle before trial so that money can be funneled quickly into drug treatment, emergency care, law enforcement and other local needs.

The federal trial is scheduled to begin in mid-October with two test cases, Cuyahoga and Summit counties, as the first plaintiffs. Meanwhile, the more than 40 lawsuits against drug companies are wending their way through state courts. A growing number of states also have sued the Sackler family personally.

Oklahoma, the first state case to go to trial, last month won a $572 million verdict against Johnson & Johnson. In addition to settling with Purdue before the trial, it reached an agreement with Teva Pharmaceuticals, a generic drugmaker, for $85 million.

Although the state cases are not in Polster’s jurisdiction, he has urged a broad settlement that includes them.

“There’s an incredible incentive to make a deal before bankruptcy, because that would make the process much less expensive for the states and cities,” said Adam Zimmerman, a professor at Loyola Law School in Los Angeles. If Purdue sought bankruptcy protection without a settlement, “we might see any kind of arrangement tied up in bankruptcy court for a very long time. It could be years,” he added.

Yost, who wants the states to control the legal effort against the pharmaceutical industry, has asked a federal appeals court to delay or halt the federal trial. Another 13 states and the District of Columbia have filed briefs in support of that effort, according to Yost’s office.

Yost criticized using two Ohio counties as “bellwether” cases, saying they represent only a tiny portion of the state’s 88 counties.

“The rest of Ohio — and Ohio itself — is being left behind in the MDL lawsuit in Cleveland,” he said late last month. “The hardest-hit counties of Appalachia and the vast majority of the state are being asked to take a number and wait — and that wait could delay or prevent justice.”

Zimmerman characterized the conflict as a struggle for control of the legal process.

“I think the main motivation [for Yost] has to do with who holds the balance of power with respect to negotiating a global settlement,” he said. “This is kind of a Hail Mary.”

The prescription drug epidemic has taken more than 200,000 lives via overdoses since 1999, according to federal statistics. Another 200,000 deaths are blamed on overdoses from heroin and illegal fentanyl smuggled into the country from China and Mexico.

The trials target drug manufacturers, distributors and retailers, and there are divisions among the defendants as well as among the states. Manufacturers, for example, have raised different legal arguments than distributors.

Opioid crackdown forces pain patients to taper off drugs they say they need

By Joel Achenbach and Lenny Bernstein| Published September 10 at 10:54 AM ET | Washington Post | Posted September 11, 2019 6:54PM ET |

Carol and Hank Skinner of Alexandria, Va., can talk about pain all day long.

Carol, 77, once had so much pain in her right hip and so little satisfaction with medical treatment she vowed to stay in bed until she died.

Hank, 79, has had seven shoulder surgeries, lung cancer, open-heart surgery, a blown-out knee and lifelong complications from a clubfoot. He has a fentanyl patch on his belly to treat his chronic shoulder pain. He replaces the patch every three days, supplementing the slow-release fentanyl with pills containing hydrocodone.

But to the Skinners’ dismay, Hank is now going through what is known as a forced taper. That’s when a chronic pain patient has to switch to a lower dosage of medication. His doctor, Hank says, has cut his fentanyl dosage by 50 percent — and Hank’s not happy about it. He already struggles to sleep through the night, as Carol can attest.

“He’s moaning, he’s groaning, he’s yelling out in pain,” Carol says.

“Why am I being singled out? I took it as prescribed. I didn’t abuse it,” Hank says.

He is part of a sweeping change in chronic pain management — the tapering of millions of patients who have been relying, in many case for years, on high doses of opioids. With close to 70,000 people in the U.S. dying every year from drug overdoses, and prescription opioids blamed for helping ignite this national catastrophe, the medical community has grown wary about the use of these painkillers.

Chronic pain patients form a vast constituency in America, and millions of them take opioids for relief. Changes in medical guidance covering opioids have left many of them frustrated, confused and sometimes howling mad. They feel demonized and yanked around.

Hank Skinner has been tapered gradually over the course of the year. The situation is worse for people forced to cut back their medication too quickly. Even medical experts who advocate a major reduction in the use of opioids for chronic pain have warned that rapid, involuntary tapering could harm patients who are dependent on these drugs.

There is little doubt among medical experts that opioids have been prescribed at unsound and dangerous levels, particularly in their misuse for chronic pain. But at this point there’s no easy way to dial those dosages back. Long-term use of opioids creates dependency. Tapering can cause extreme pain from drug withdrawal, regardless of the underlying ailment.

The United States is now in the midst of a “national experiment” as misguided as the one it conducted 20 years ago, when doctors put millions of patients on opioids with little understanding of the consequences, says Tami Mark, senior director of behavioral health financing and quality measurement for RTI International, a North Carolina think tank. She has conducted one of the few formal studies of “forced tapering” of opioid patients.

“This national effort at ‘de-prescribing’ is again being undertaken with limited research on how best to taper people off opioid medications,” Mark says. “You can’t just cut off the spigot of a highly addictive medication that rewires your brain in complex ways and not anticipate negative public health consequences.”

Many people who rely on these drugs are scared. In interviews and correspondence with The Washington Post in recent days, chronic pain patients have described their anxiety about the national reversal on opioids. They say they’re not drug addicts or criminals, they’re just people in pain who were following the doctor’s orders.

And then the orders changed.

“I’m scared. I’m scared of the pain. Because it’s coming back now, little by little,” says Nicole Acuña, 41, of Flemington, N.J., who has severe back and neck pain from arthritis and has so far been tapered from 120 milligrams of oxycodone a day to 105, with more tapering coming.

Other chronic pain patients complain of how hard it is to get any pills at all. Pain management clinics have closed. Many doctors have stopped prescribing opioids altogether, and some patients have become “opioid refugees,” traveling long distances to find anyone willing to write a script.

Valerie Nordstrom, 56, of Sandia, Tex., who has been on opioids since a novice driver ran a red light and slammed into her car during her lunch hour eight years ago, is furious that her 30-day opioid prescription can’t be transferred to a different state. That caused her to miss being with her daughter recently when she gave birth.

“I’m angry. I’m hurt. I’m not out there selling my pills. I’m not out there doing anything other than what they’re prescribed for,” Nordstrom said.

Sarah Ward, 37, of Chattanooga, Tenn., has been taking opioids since having complications from ankle surgery in 2011. Last year she was tapered to zero, because her insurance company wouldn’t pay for the drug testing required by the pain clinic.

So she hurts, a lot: “I describe my pain as walking in lava while on fire being dipped in acid and my bones being pulverized by a jackhammer. That’s what it feels like every single second.”

‘An experiment gone wrong’

Pain is not easily measured. The main way doctors gauge the degree of pain is to ask a patient how it rates on a scale of 1 to 10.

In the 1980s and early 1990s, influential researchers and doctors began pushing the idea that opioids had been underused because of their association with street heroin — the drug of “junkies.” They spoke of pain as the fifth vital sign, a measure of health as important as blood pressure, pulse, temperature and respiration. Pain relief became accepted as a fundamental human right.

This philosophical evolution did not take place in a vacuum. A handful of research studies in the 1990s seemed to support a benign view of opioids as a chronic pain treatment, but the research was often funded by drug companies. Some of the most vocal advocates for opioids were doctors who accepted fees from drug companies for speeches.

Some of those companies marketed their opioids aggressively and made false claims about their safety and effectiveness. Pharmaceutical company representatives were regular visitors to the offices of general practitioners, by tradition buying lunch for everyone on the staff.

Documents cited in a massive lawsuit by the state of Oklahoma against Johnson & Johnson showed the company targeted physicians that prescribed high volumes of opioids: “Our objective is to convince them that DURAGESIC is effective and safe to use in areas such as chronic back pain, degenerative joint disease, and osteoarthritis,” the company wrote.

In 1996, Purdue Pharma introduced and heavily promoted OxyContin, a slow-release formulation of oxycodone that soon was bringing in more than $1 billion of revenue annually — and then $2 billion. The company claimed OxyContin would be less likely than fast-acting opioids to be abused or lead to addiction.

That underestimated human ingenuity. People discovered that they could crush a pill and snort it for an immediate, powerful high. Or they could mix the crushed powder with water and inject it.

In a plea deal in federal court in 2007, Purdue Pharma and three executives pleaded guilty to deceptive marketing of the drug and paid $635 million in fines. But by that point an entire generation of pain doctors had been trained to view opioids as a safe, effective, relatively nonaddictive treatment for chronic pain from common ailments such as bad backs, torn rotator cuffs, headaches and arthritis — and millions of pain patients had become dependent on opioids.

“You practice according to what you’re taught and according to the textbooks you read and according to the lectures you go to,” said Jane Ballantyne, who came to the United States in 1986 from Britain, trained as a pain specialist and became chief of the pain program at Massachusetts General Hospital. “You don’t really have time to look into it deeply. As soon as I began looking it into it more deeply, it was clear the evidence is weak.”

What she and many others found was that opioids simply didn’t work very well when it came to relieving pain over long periods of time. Patients developed tolerances and needed greater dosages. Opioid patients weren’t thriving in general.

“It was an experiment gone wrong,” Ballantyne said.

A flood of opioids

In July, The Post published a Drug Enforcement Administration database that revealed drug companies had flooded the U.S. with 76 billion oxycodone and hydrocodone pills in a seven-year period, from 2006 to 2012. The database was unsealed after The Post and HD Media of West Virginia, publisher of the Charleston Gazette-Mail, won a legal battle in connection with a lawsuit against drug companies filed by roughly 2,000 cities, counties and other local jurisdictions and pending in federal court in Cleveland.

Other government records show that individual opioid prescriptions in the United States peaked at 255 million in 2012. After that, the numbers fell steadily, to 199 million by 2017.

As the dosages dropped, drug deaths didn’t, because the epidemic mutated. Some people addicted to the opioid high turned to street heroin when they couldn’t get pills. A surge of heroin into the United States was followed by an even deadlier arrival of illicit fentanyl. In 2017 in the United States, 47,000 people died of opioid overdoses — more than the death toll from traffic accidents, and more than all the gun deaths, including by suicide.

The drug industry now faces a reckoning. A state judge in Oklahoma ruled on Aug. 26 that drugmaker Johnson & Johnson must pay $572 million to the state for the company’s role in the opioid epidemic. The next day came the news that Purdue Pharma has offered to settle state and local lawsuits by paying up to $12 billion and filing for bankruptcy.

Most of the drug companies targeted in lawsuits have mounted a vigorous legal defense, and some have released statements defending their actions and denying that they are the source of today’s opioid drug epidemic. Although the companies do not speak with one voice, in general they have argued that they were manufacturing and selling legal drugs that have legitimate medical uses, and the companies have sometimes blamed the crisis on overprescribing by doctors, illicit diversion to street markets and abuse by patients or recreational drug users.

By October of last year, 33 states had imposed some kind of legal limit on opioid prescribing. In January of this year, Medicare Part D enacted a limit for some new opioid patients. Veterans Affairs reduced the number of patients receiving opioids by 52 percent between 2012 and 2019. Under orders from the DEA, the pharmaceutical industry cut the quantity of opioids it produced by 38 percent between 2016 and 2018.

In March 2016, the U.S. Centers for Disease Control and Prevention published a new guideline on the prescribing of opioids for chronic pain. It proved confusing.

The guideline said doctors should not increase an opioid dose to more than 90 MME (morphine milligram equivalents). But many patients already were taking far more than 90 MME, and doctors — thinking the CDC number was a hard cap — were tapering them back to 90.

Hundreds of doctors and other experts, including three former U.S. drug czars, signed a letter to the CDC in March of this year saying that the guideline had been widely misinterpreted, and the CDC concurred. In an article in the New England Journal of Medicine, the guideline authors acknowledged that medical experts don’t really know what happens to people forced to taper suddenly from high dosages: “We know little about the benefits and harms of reducing high dosages of opioids in patients who are physically dependent on them.”

In a remarkable study of Vermont Medicaid patients who used large daily doses of opioids for at least 90 consecutive days, Mark’s team found that half the patients were cut off with just a single day’s notice and 86 percent were discontinued in less than 21 days. Though 60 percent had an opioid use disorder before tapering, fewer than 1 percent of the patients in the study were given anti-addiction medication such as buprenorphine when their opioids were taken away. Predictably, 49 percent of them were hospitalized or visited an emergency room after they were cut off.

“People shouldn’t be forced to taper,” Mark said.

Stefan Kertesz, an addiction medicine specialist at the University of Alabama at Birmingham, said some patients forced to taper will suffer anhedonia, the inability to feel pleasure.

“Some people will be fine. Some people will actually thank you and say, ‘I feel a little more awake now,’ ” said Kertesz, one of the leaders of the group that petitioned the CDC to clarify its pain opioid guidelines. “The cases that draw my concern are the cases where the patient says, ‘I don’t think I can survive what you’re going to do to me.’ ”

When researchers surveyed 194 primary care clinics in Michigan in 2018, they found that 79 of them would not accept new patients taking opioids, according to a study published last month in JAMA Network Open.

“We’ve entered a new era of opiophobia,” said Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute who is critical of the way some chronic pain patients are being treated. Some “have the kind of pain that’s unbearable. Every day of your life. Unbearable. And those are the people who are suffering. And their doctors are terrified.”

Ballantyne, the pain specialist, is now a professor of anesthesiology and pain medicine at the University of Washington and also president of Physicians for Responsible Opioid Prescribing. She is among the most influential leaders of the movement to cut down the country’s dependency on opioids. The United States still is the world leader in the reliance on opioids.

But even she says that “the pendulum did swing too rapidly.” Some patients who have been taking high doses of opioids for a long time may be better off sticking to what’s worked for them, she said. The most important change in medical practice — one adopted by Veterans Affairs— is to cut down on “new starts,” the patients taking opioids for the first time for ailments that might not require that kind of painkiller.

There’s no simple fix to the drug epidemic, no simple rule that can apply to every patient. So many of the big questions about opioids and chronic pain can be answered only with palms facing straight up: It just depends.

“Unfortunately, very few things in medicine are quite that clear, and pain management is certainly not one of them,” says Suzanne Amato Nesbit, a clinical pharmacist at Johns Hopkins Hospital in Baltimore and the president of the American College of Clinical Pharmacy.

For Hank and Carol Skinner, medical care has been one long struggle, sometimes a comedy of errors. They joke that the hospital is their second home.

Carol has had her own bizarre experiences with opioids. At one point during the ordeal with her infected right hip she took a high dose of morphine that caused her to hallucinate. She thought she saw the neighbor’s house on fire and called 911. At least a dozen firetrucks showed up. She could swear she saw the firefighters walking atop her fence like gymnasts on a balance beam. She cut her dosage and then later went off opioids for good.

They don’t like the term “opioid crisis.” But they also know the stuff that Hank needs every day can be dangerous. He’s careful never to leave one of his fentanyl patches lying around where a child might pick it up.

And there’s another shadow hanging over their home: Hank’s great-nephew overdosed on heroin, possibly laced with illicit fentanyl, earlier this year, they say. His name was Kevin Samuel Crathern. He was 26. The Skinners say the young man’s parents decided to scatter his ashes along his favorite trail in Yosemite National Park.

Meryl Kornfield and Kanyakrit Vongkiatkajorn contributed to this report.

#opiodcrisis #opiodaddiction #Opioids #opioid crisis #health care reform #public health #health #health & fitness #u.s. news #politics and government #republican politics #us politics #politics

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