Only officials drunk on alcohol money would call opioids the 'biggest health crisis'

The maker of OxyContin, Purdue Pharma, and the company’s controlling Sackler family agreed March 26 to pay $270 million to settle an Oklahoma lawsuit claiming they helped create the opioid crisis with aggressive marketing of the painkiller. “The $270 million is less than what the lawyering would have cost Purdue. The did the 'right' thing,” says author Scott Stevens.

This is the first settlement emerging from wave of nearly 2,000 lawsuits against Purdue threatening to push the company a bankruptcy safe-haven, says the author of Look What Dragged the Cat In: The Rise of an Opioid Crisis. In the book, presented in hardcover at academic conferences in Europe in 2018 and now available in e-book, Stevens demonstrates how the neither the drugmaker – nor doctors – are to blame in the 'ab irato' lawsuits. “Are their hands clean? No. But they didn't create this crisis, or the two it's spawned (benzodiazepines and methamphetamine),” according to Stevens.

Oklahoma Attorney General Mike Hunter announced the settlement, calling the crisis “this nightmarish epidemic” and “the worst public health crisis in our state and nation we’ve ever seen.” Stevens responds, “First, the death toll from opioids in Oklahoma is about 400. They're all tragic. No question. Alcohol kills at least 1,300 a year in that state. If opioids are an epidemic, alcohol is a pandemic that costs their state $4.5 billion a year, and the U.S. 90,000 lives and $250 billion a year.” His numbers are according to the Centers for Disease Control and Prevention (CDC). “We don't call out the real problem because the alcohol business is an an advertiser, a campaign contributor, and an adored and endorsed part of our culture.”

The fifth book by Wisconsin author, Scott Stevens, calls out the beverage alcohol business and a 'buzz' culture, not pharmaceutical companies and doctors, as the culprits behind the opioid crisis. Stevens says, “If you examine how many opioid-related deaths are alcohol-related, the answer is that they all are. Two thirds of illicit drug users point to alcohol as their first drug, and all of us learn to self-prescribe from alcohol.”

The book was released Aug. 23, 2018 at the International Conference on Addiction Therapy & Clinical Reports in Paris, France, capping two-years of research by the author into the escalation of opioid overdoses. “It's the same root cause of every drug 'crisis' we've observed. Cocaine in the 1980s, heroin again in the 1970s and before that the 1920s, and between the two prior heroin crises, a methamphetamine crisis in the 1950s,” says Stevens. “The thread cinching all of them together is alcohol: The drug we don't call a drug or treat as the deadly drug it is. We encourage use of this drug, then when users can't get where they want with alcohol, they up the ante with other, harder drugs. No runner runs a marathon as their first race out.”

The book examines the self-regulation of alcohol-industry ads, the pricing, and availability of alcohol. “There really is a straight-line relationship between the opioid crisis with the gateway drug, alcohol.”

The World Congress on Addiction Science in London in Sept. 2018, as well as the 2018 International Conference on Clinical Psychology in Amsterdam, also were forums for launch of Stevens' work. He's now doing radio and conferences in support of the e-book launch of the book March 26.

Stevens has no ties to the pharmaceutical industry, nor does he practice medicine, yet he finds only moderate culpability for either profession in the rise of the opioid situation. “They were accomplices to some degree, but we fail to look deeper. What causes problems is one. We just have this fear of tagging the alcohol business because of our glorification of drinking.” The book points out that society also has a notion that anything resembling reining in the alcohol business looks like Prohibition, generally considered a failure. Americans also don't 'want to believe alcohol is a drug or a problem outside of car wrecks, cirrhosis, and disease of alcoholism. “We're told we can drink responsibly when there is no responsible way to drink a toxin and known carcinogen. Buying into the glamour of the drug seduced Americans right into opioids.”

Americans defend the gateway drug, says the author. Among his solutions is a strategy like the anti-smoking campaign that began with the Master Settlement Agreement for tobacco companies in the 1990s. “We defend drinking as some sort of rite. All we're doing by guarding drinking as a personal choice is sacrificing our own children for a product with zero life-extending or life-saving properties.”


Stevens is author of five alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He Chaired the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France, where Look What Dragged the Cat In was officially launched. He's also the Chair for Addiction Science 2018, in London, UK.

Image byTom Baker, used with permission.

Blame the opioid maker? Right church, wrong pew

A new article appearing in VOX notes that one member of the Sackler family, longtime overseers of Purdue Pharma, is helping the treatment industry clean up what the opioid crisis cat dragged in. Richard Sackler, former president of Purdue Pharma, is listed on the patent application for a new form of buprenorphine. Buprenorphine (trade names Buprenex, Butrans, Probuphine, and Belbuca) is an opiod agonist used in the medication-assisted treatment (MAT) for opioid addiction.  The new product is a fast-dissolving wafer, designed to keep those administered the dose from cheeking the medication and sharing/selling it.

On one hand, 'Shouldn't we be applauding ANY help going to those who need it?' is the easy question. That question is buried under the emotion of a very traumatic crisis, however. One editorial on the article went so far as to call Sackler the 'devil incarnate,' And the spin on the article is that Purdue helped spawn the opioid crisis with its drug, OxyContin, and Stackler made bank on that drug and now seeks to profit from cleaning up the mess.

Not so fast. OxyContin and Purdue are not the drugmakers that created this crisis. The drugmakers that created this crisis, every crisis before it, and the crises emerging now, are not in the pharmaceutical industry. The drugmakers who have groomed us for drug use, drug abuse, and drug addiction make the gateway drug, alcohol.

Two thirds of drug abusers identify alcohol as the first drug they used, according to an American Addiction Centers 2018 survey. The rest of us learned to take drugs from our cultural acceptance and endorsement of drug use aka drinking. What we ignore, we permit, what we permit, we condone.

The blame-game, legislation, lawsuits, etc. target Big Pharma, sketchy doctors, China, and dope dealers. Right church, wrong pew. Look What Dragged the Cat In details how the opioid crisis (spoiler: it's a crisis, not an epidemic) really emerged (spoiler: it wasn't the Sacklers) and how we can use the tragedy of this crisis to prevent the next one.


Stevens is author of five alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He Chaired the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France, where Look What Dragged the Cat In was officially launched. He's also the Chair for Addiction Science 2018, in London, UK.

Image by Santalucia Art Inc., used with permission.

Busting the flashy car for 75 mph to let the 250 mph Peterbilt pass

The public relations approach to hiding an alcohol pandemic

In opioid news this week, state attorneys general across the country are stepping up their game against the opioid crisis. Awhile back, the AGs sent letters to insurers, asking them to do more to curb the opioid epidemic. Now, they say they're expanding an ongoing investigation into pharmaceutical companies make or distributing opioids. That's according to MedPage Today. The publication also reports the Substance Abuse and Mental Health Services Administration (SAMHSA) offered up an additional $144 million in grants for preventing and treating opioid addiction … a crisis costing the economy $78.5 billion a year.

That's correct. Opioid use and addiction costs the U.S. $78.5 billion.  

Alcohol use and addiction costs the U.S. $250 billion a year, using the same measurements of health care costs, lost productivity, and legal system expenses.

We focus on an epidemic, so we don't have to focus on a pandemic. The 75 mph 'vette gets the ticket. The 250 mph Peterbilt gets a pass. Classic PR.

The public relations tactician works it something like this: 

Pick a drug – One that is sold only by prescription, generating profit for a few, wealthy souls vs. a drug sold nearly everywhere in the U.S., generating profit (and tax revenue… but not as much as you think) for every restaurant, bar, retailer, grocer, hotel, gas station, henhouse, outhouse, and doghouse where it's sold. Villify alcohol? Not on your life.

Draft in support – According to FollowTheMoney.org, Big Pharma contributed $163 million to local, state, and federal candidates in 2016… alcohol interests (manufacturers, distributors, retailers) donated $219 million. Don't bite the hand.

Choose an opponent you can outspend – BusinessInsider.com put beverage alcohol spending at $421 million in a single calendar quarter. Every one of those ads tells Americans we can drink a toxin and known carcinogen 'responsibly.' You're not going to run with these big dogs. Stay on the porch.

Capitalize on ignorance – Fewer than 1 in 10 Americans know that alcohol kills three times as many people as opioids (89,000/yr. vs. 30,000/yr). Less than 1 in 4 know that alcohol's a carcinogen and a third of the 22,000 annual alcohol-related U.S. cancer deaths occurred in people who had downed one and a half drinks a day or less. Alcohol is legal. Legal equals 'safe' in our society. Except for those nasty drunk drivers, binge-drinking college kids and hard-core, red-nosed alcoholics, this isn't a drug: It's responsible and fun in moderation. Opiates and opioids are controlled substances, illegal without a prescription, and have a high risk of addiction and/or overdose. Nevermind the medicinal relief in chronic pain situations: Opioids are definitely the baddie.

Don't make them think, either – There is a short line between opioid use and overdose death. Drinking alcohol is more like stepping out onto the highway and waiting for the Peterbuilt to hit you: It could take years or decades. Too many dots to connect – and other causes to which to pin the death while you're waiting. Brevity is better in our 'always-on' planet. A recent Pew Internet study in the US suggests that people benefit from instant access to a wealth of information from numerous sources, but their attention span and desire for in-depth analysis is consequently diminished. That's how we got the term bounce rate. “If you start a message and I can't see the end from the beginning, I will find it elsewhere… and bounce.” Opioid tragedies tell what time it is… alcohol deaths tell how to build a watch.

Sell the sizzle, not the steak – There are 91 deaths a day from opioid overdose. Opiates and opioids take lives in a single-dose for some people. And sadly, the lives are often kids and young adults that society wouldn't have picked out as a drug user. The old newsroom saying was, “If it bleeds, it leads.” Crass and cynical? Yes. Accurate? Pretty close. Stories of an honor student dying are tragedies with great images on par with hurricanes, school shootings, and blazes… compared to someone dying a death from alcohol-related illness like heart attack, stroke or cancer.

Wag the dog – We have a genuine health crisis. The opioid problem is real and tragic and a worthwhile fight. Now, if we turn a genuine health crisis and spin it up to an epidemic… maybe we don't have to talk about a pandemic or other health crises like fetal alcohol spectrum disorders (FASDs) which are now more prevalent than autism. It's the sleight of hand performed by politicians, PR wags, confidence men, and magicians for millennia: Watch what I do with this hand, while the other takes your wallet. Or your health. 

And, most importantly of all, don't make enemies – According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month. Even if you went with the lowest figure, 56 percent of adults used alcohol in the last thirty days. That's 137 million adults. By American Society of Addiction Medicine (ASAM) stats, 2.5 million adults have substance use disorder involving prescription pain relievers or heroin. You've got a good shot at convincing me something is bad if you're not doing it. You're even more effective telling me something is bad if I'm not doing it.

It's not the back bumper of the Peterbilt that hits you

What we've got here, is failure to communicate: There's a drug acceptance problem in the U.S. There's not just an opioid overdose crisis. There isn't only an alcohol pandemic. There isn't a weed legalization debate. The problem is cultural in the way we normalize drug use, stigmatize those who've become ill from them, and throw too little money, too late, at treatment instead of prevention. Did any alcoholic become alcoholic without taking the first drink? Is any case of alcohol-related injury or illness possible without a first drink? Giving a 'gateway drug' a free pass negates prevention efforts on other drugs we find less 'responsible.'

No amount of PR is going to paper over it for long before it becomes fiscally unsustainable.

Scott Stevens, is the author of four alcohol books including the December 2016 release, I Can’t See The Forest With All These Damn Trees In The Way: The Health Consequences of Alcohol. Get the new BookLocker title now on Amazon (viewbook.at/prehab), alcohologist.com, and everywhere you buy books.  Click Alcopocalypse for the author’s 2017 Alcohol Awareness Month whitepaper. Image by  Peter Lecko, used with permission.

Selling care: Patient brokering in addiction treatment

Ambulance-chasing. Society generally looks on with disgust at the attorney who markets directly to the accident victim in the hours after the ink on the police blotter dries. The practice isn't illegal, but it brings up the subject of ethics. A similar practice has smoldered silently in the addiction care business for the last decade and will be leading to more scrutiny – and crackdown – over the second half of 2016.

Treatment centers provide a service (detox, intensive outpatient, inpatient, partial hospitalization, or some combination of elements) for a fee, which is charged to the client or the client's insurer. It's America. Lawyers charge a fee in a time of need. Mutual fund companies charge a fee to manage the retirement money upon which you'll develop a need. Lawyers are regulated. Fund companies and their sales reps are regulated and supervised. The practice is largely unregulated in the treatment industry.

The ambulance chaser in the addiction care business solicits business in 12-step meetings and detox facilities and even emergency rooms. There are reputable recovery coaches and other addiction paraprofessionals in the service of those struggling with substance abuse who also attend to those venues and offer suggestions. When they are paid by a treatment entity to deliver those struggling heads to the facility's beds is the point in which the practice becomes predatory.

Take for example, Alcoholic Joe. Joe turns up in the emergency department, unconscious due to acute intoxication. (e.g., he's beyond drunk) A responsive ER staff will inquire about what he's had, how much, and how frequently. Maybe even a social worker or staff associate will address the possibility that Joe has a substance use disorder and suggest courses of action beyond the hospital's capability. Other resources may be given to Joe, if he inquires. He takes it to heart (or his wife does) and Joe goes to a 12-step meeting.

So far, so good. When Joe bumps into a counselor, a self-styled recovery guru or a fellow at the meeting, the conversation sometimes turns to treatment. If the person steering the conversation toward a facility is getting paid $1,000 or $5,000 a head to steer Joe toward that facility – and never discloses he or she is on the dole – is where the industry is getting its latest black eye.

It's not unfamiliar territory for the healthcare biz. Rewind the tape back to the early 90's when physicians were accepting elaborate junkets from pharmaceutical companies and medical device makers. The public bristled when the kickback exposed that the patient might not be getting the best medication or device for his condition, just possibly the medication or device offered by the company with the sweetest “conference” destination. In the early 2000's a similar practice in the mutual fund business was discontinued when fund companies were found to have influence over brokers who might not be offering the most suitable investment for the client, just the funds that landed on the “preferred list” because of the extras offered the broker or brokerage firm.

As the opioid epidemic continues to grow within the shadow of the alcohol pandemic, more treatment centers are opening. Which can only be considered a good thing if they are treating the patient and not the one who provided the patient. As start-up facilities – and some established ones – struggle to keep cashflow manageable, a pay-per-client (heads-in-beds) can be an attractive alternative to shelling out for a marketer's salary and benefits. A captive marketer is going to work for one facility or group of facilities. He or she may not have a component of their compensation based on the census of the facility (e.g. percentage of beds filled at a given time). But they are, in theory, still driven by getting the right fit between the client and the facility. Many even network with other centers' marketing staff and refer business to the right fit based on the cost, insurance and most importantly the client's needs. When a consultant makes a referral without accountability to the facility or for the outcome of the treatment for that client, but for what it appears to be the financial gain of a $5,000 payday over a $1,000 payday, the treatment industry's self-policing has a weakness.

There is no inference that every per-client marketer or treatment facility that employs the tactic is sketchy. As with any enterprise, there are scrupulous and unscrupulous sales people. This industry is no exception even though it is commonly referred to as a helping profession which comes in contact with families and clients during a real and human and emotionally charged crisis.

In the early part of this decade, healthcare officials as well as federal agencies have had the practice show up on their radars. In some cases, the fit between the client and facility or program was so poor, litigation ensued. In extreme cases, people have relapsed and/or died while in the care of a program. Not that the relapse is uncommon with the disease of addiction to alcohol or other drugs… it's not a welcome outcome in or shortly after treatment.

For now, the status quo is under greatest scrutiny in California and Florida, two treatment industry hotbeds. However the status quo remains as a practice that is not illegal – like ambulance chasing – just potentially unethical until greater oversight and guidance is provided. For the time being, it pays to ask a question if and how a person is being compensated for making a recommendation of one facility over another.

The entire 26 episode HD The A-Files: Alcohol A-Z series is available on disc, along with fact sheets, for helping professions. Visit alcohologist.com for a replay of CBS Sports' Power Up Your Health featuring Scott Stevens.  Another interview is on Alcohol Awareness.  Syndicated radio program Savvy Central Radio did this interview, too. Lucy Pireel's "All That's Written" included a feature called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud and the first for Adding Fire to the Fuel also can be found on www.alcohologist.com. Download the FREE Alcohology app in the Google PlayStore today. Stevens also is the public relations officer with AddictedMinds.com