Malibu Beach Recovery Center

Pharmaceutical companies are often accused of contributing to American’s overusing medications because of the companies’ ubiquitous advertising. But in a Wall Street Journal article, a 1990’s advocate of pain medication has done a 180-degree turn in his thinking, perhaps taking a bit of the blame for the ensuing prescription drug abuse epidemic.  

Dr. Russell Portenoy, a pain management specialist at Beth Israel Medical Center in NY (in fact, he’s department chair), initially said that painkillers like Percocet, Vicodin, and OxyContin—all derived from the opium poppy—could help people with chronic pain, and the drugs grew in popularity. But now he says he went too far and he didn’t warn people enough about the risk of becoming addicted. Sounding somewhat guilty, he says "We didn't know then what we know now."

The drugs are notoriously more addictive than previously thought, and not always the best solution for long-term pain. Unfortunately, not all doctors know that the tide has turned among early proponents of using these drugs for pain management!

Initially, Portenoy was a key promoter of opioids beyond being used mostly for cancer pain, and he actually said, along with some followers, that there were few overdoses and less than 1% of users become addicted. He wasn’t just kidding when he said recently that if only we’d known then what we know now.

It’s heartening to hear him come clean about his possible part in the current drug epidemic. He didn’t have to speak the truth. But then he mentions some good that came of his promotion, attributing his mother’s relief from arthritis pain to her 15 years of hydrocodone use.  It’s true that these meds help many people in the short-term and that not everyone becomes addicted, even with long-term use. Plus, pain is real and people in pain deserve relief.

But it’s frightening when one person, or a small group of people, wield so much power. People look up to their medical professionals and rely on them. Thank goodness for the movement in which patients are persuaded to take a more active role in their medical care and are more comfortable questioning their doctors.

It’s also frightening to learn what the drug companies did after doctors jumped on the bandwagon ofdangerously prescribing opioids. The article says that “In 1996, Purdue Pharma LP released OxyContin, a form of oxycodone in a patented, time-release form, and rivals followed suit.”  It seems that they paid the price, though. “In 2007, Purdue Pharma and three executives pleaded guilty to ‘misbranding’ of the drug as less addictive and less subject to abuse than other pain medicines and paid $635 million in fines.”

Portenoy was also president of the American Pain Foundation in the 1990s; thus, he had a perch from which to spread his message. Also, he had relationships with over 12 companies that produce opioids, and justifies it by saying, and I paraphrase, they benefit his educational and research missions, and partially, his pocketbook – “without producing in me any tendency to engage in undue influence or misinformation.”  

It’s hard to believe this stuff went on. This story is a blemish on the history of pain management.

New York City owns a disturbing statistic: prescriptions for oxycodone have doubled in the last three years, according to one of its narcotics prosecutors. The Wall Street Journal article referring to it as “the city’s prescription drug abuse epidemic” was so matter-of-fact it was scary. The article said that the figures equate “to one prescription for every eight people” in the city. I’m reminded of how The New York Times posted the number of casualties in a recent military conflict every day to illustrate the rising toll. The articles about oxycodone have the same effect—chilling.

Unfortunately, the problem has a ripple effect. Less than an hour from New York City, in Newark, NJ, police uncovered an oxycodone ring whose members included a doctor and a retired policeman. Twelve people. The Wall Street Journal article appeared on March 16; the NorthJersey.com article about Newark appeared on March 24.  The culprits face up to 20 years in prison.

I love the statement in the article on the NorthJersey.com site from a government staffer: “Doctors who illegally  prescribe  are often the first link in a chain of addiction and suffering,” said U.S. Attorney Paul J. Fishman. Horrific.  But they’re not the last.

The police had this group under surveillance for a year. You wonder how these criminals approached each other. How did they know who would be interested  in joining them? How  many people did they reach ? How many people who are cut off will just find another source? Will some go for treatment?

Both these states are known for so many good things.  The prescription pill epidemic is not one of them.

Los Angeles Civil and Criminal Defense Attorney Mary Masi contributed this interesting article.   Thanks, Mary.

      The measure of a society is to a degree reflected by how its vulnerable people are treated under the law. In the modern world, society is also measured by the character and prevalence of its crimes and misdemeanors.  Without a doubt, drug and alcohol related crimes are the most prevalent today. 

       Outlaws used to rob banks and railroad cars, but in October 2010 a pharmaceutical truck was robbed and the driver was kidnapped.  The thieves stole only vicodin and OxyContin, a painkiller thought of as synthetic heroin.  The crimes they are a changin’.

      Also in October, 52 people were arrested for organized crime racketeering involving Medicare fraud.  Some of them may face allegations of forged prescription sales involving OxyContin.  Racketeering for prescriptions? This is a cultural wake-up call without a snooze option.

     The modern news is filled with cases similar to those discussed above, and heaven knows our jails and prisons are filled with people who never would have done whatever sent them there had they not been under the influence.  Again, alcohol and drug related crimes and misdemeanors account for approximately 90% of American crimes committed.  How did this happen?

          Since the 1960s pop culture has reflected a degree of “cool” rebellion in the illegal use of drugs and excessive use of alcohol to get high.  Currently, one of the saddest modern trends is the self-imposed choking asphyxiation game.  In Wheat Ridge, Colorado a teenager was criminally charged with reckless endangerment when she performed the choking game on her friend Gabrielle Abuzhars.  What a cultural STOP sign!

         There are healthy alternatives to soothing and stimulating the oversized and often over-active human brain.  For openers, simple exercise works pretty well.   John J Ratey, MD,  Associate Clinical Professor of Psychiatry at Harvard Medical School authored the book “Spark: The Revolutionary New Science of Exercise and the Brain.”  He stated: “Be clear.  My analysis of the findings and testimonies and stories make it clear that exercise can play a huge role in the initial withdrawal, the initial and prolonged dealing with cravings, and offer a substitute activity addiction, like AA to help repopulate the frontal cortex choices of what and how to respond to eventual stressful situations, and losses.”    

           Statistically, Alcoholics Anonymous has the highest success rate in the long-term treatment of alcoholism and addiction.  It would appear to be a no-brainer that exercise and nutrition can play an important treatmentenhancementrole.  There are also other creative alternatives for treatment enhancement.  We as a society clearly need to use our healthy brains to develop more.  It sure would help if some of the alternatives were perceived as “cool.”    So, how exactly does a society make exercise, nutrition, and other healthier alternatives “cooler” than getting high?  How about if a few more rock stars and former bad girls were selected to do some Nike commercials? We can do it - one step at a time.  

 About the Author:

Mary Masi is a Los Angeles Criminal Defense Lawyer specializing in DUI and drug related cases and alternative sentencing.  In 2011, she also won dismissal of all fraud, conspiracy, and racketeering claims valued at over $100 million dollars for her clients in Los Angeles who were greatly relieved.  www.marymasilaw.com 

I know from an article I wrote on alcohol dementia for the Alzheimer’s Foundation Care ADvantage magazine (winter/spring 2010 issue, pg. 17), that when seniors drink excessively, it’s a whole different animal compared to young people drinking. For one thing, older people metabolize alcohol differently from their younger counterparts. In addition, the loved ones who may be in the best position to do something about it may be in denial about the extent of the problem. For example, an adult child might say, “Oh, let Dad have his drinks at night. He’s been grieving about Mom since she passed away.”

A “special report on older addicts” in a recent edition of AARP magazine quotes a report from SAMHSA as predicting that the “number of boomers with substance-abuse problem will double from 2.5 million in 199 to 5 million in 2020.” The article notes that the need for treatment will also double and blames it the proliferation of prescription medication use.

The article opened with the story of a 52-year-old man who was abusing alcohol and other drugs which devastated his family, including an 8-year-old son. The son becomes so enraged at his father’s drinking that he rips up a photo of the two of them, which propels his father to agree to rehab.

I don’t know about you, but I like having as many facts as possible about addiction, and this author comes through. She notes that doctors have become more aggressive in attempting to treat pain in the last few years, and many pain sufferers have benefitted. However, the pills cause euphoria, which contributes to the problem of addiction. One doctor even prescribed Oxycodone to a 50-year-old who had become addicted to it in the past and told the doctor so.

As Candy Finnegan also pointed out when I interviewed her, the article reminds readers that the intervention industry is not regulated so families have to do their research when selecting an interventionist. Families can contact rehab centers, who can usually recommend professionals, and should also ask anyone they’re thinking of hiring about his or her clinical experience. And even though one family in the article chose to include a young child in an intervention, the author includes a word of caution about doing this.

It’s an interesting—and cautionary—article. Wish I’d written it!

A mom called the other night from Simi Valley, one of L.A.’s bedroom communities.  She was crying, begging for help.  She had been up the previous night with her 22 year old son – we’ll call him Bill.  He was so addicted to OxyContin and Xanax that she would check on him several times each night to make sure he was still breathing.    The night before he was so sick, she was sure he was going to die.

Her son, she said, has been getting prescriptions from half a dozen local doctors for the past 3 years.  He would show them two folders of medical records he compiled from accidents that occurred several years ago.  They would give him 150- thirty milligram pills per month.

He was crushing and snorting at least five OxyContin each day – more if he could get them.  He once smoked pulverized pills for a short period of time; he had never actually swallowed one.  He did swallow his Xanax – at least 60 each month, all prescribed by the same doctors.  OxyContin and Xanax, by the way, were key ingredients in the lethal cocktail that killed actor Heath Ledger in 2008.

Bill doesn’t drink or use street drugs.  He insists he did not know OxyContin was highly addictive, that the doctors never told him.  Once he understood he started trying to get off prescription drugs by going “cold turkey” because the family did not have enough money to pay for a medically-supervised detox.  He ended up having seizures and putting his parents into panic mode.

Hard to believe that just three years ago U.S. Attorney John Brownlee won a major legal battle in Virginia against Purdue, the privately owned pharmaceutical which manufactures OxyContin. 

“Despite knowing that OxyContin contained high concentrations of oxycodone, had an abuse potential similar to that of morphine, and was at least as addictive as other pain medications on the market, Purdue, beginning in January of 1996, with the intent to defraud and mislead, marketed and promoted OxyContin as less addictive, less subject to abuse and diversion, and less likely to cause tolerance and withdrawal than other pain medications,” Brownlee told PBS Newshour in May 2007.  “Of the $600 million Purdue will pay, $130 million will be used to resolve civil suits brought by patients who say they became addicted to the drug…Over the years, OxyContin has legitimately helped many patients cope with pain, but its criminal abuse has been widespread. The drug has been connected with hundreds of deaths and arrests.”

Dr. Sidney Wolfe of the Public Citizen Health Research Group spoke during the same PBS Newshour.  He said:  “…Someone in the company, it wasn't robots, designed this program to mislead doctors into thinking that this drug was much safer than it was and get them to prescribe it preferentially over other drugs.”

What has changed since then?  Not much.

Bill’s mom earns $10/hour.  Her husband, a chef, is on disability.  He was injured serving relief workers during Katrina.  She told me she could raise enough money to pay something for a doctor, but that was all.  Someone had given her the name of Malibu Beach Recovery Center.   I don’t know why because we are small, boutique and expensive.  Not a good fit.   

Together with our marketer, I called frantically around to find a free or almost free facility where Bill could get detoxed.  He wanted help, but as everyone in this industry knows, an addict’s “window of willingness” is very short.  I told his mom – “We have to move fast.” There was nowhere cheap enough to go except American Hospital in Pomona, which has a 4-7 day waiting list.  

It was getting late.  The mom was calling every few minutes.  She was very frightened.  She was also on Day 22 of a forty day march.  Every evening she walks from one side of Simi Valley to the other -- 10 miles -- to raise awareness for Bill’s plight and that of virtually all of his friends, friends he has had since kindergarten.  They are all, she says, severely addicted to OxyContin -- if they aren’t already dead.  With 28 more days of marching still to go, she had organized a 100 mom “Not One More” Promise Walk for October 9, 2010.  The goal?  Make the mayor and city council members aware of what is happening right under their noses.

It was a just cause.  We’ve already had several young clients from Simi Valley and adjacent Moorpark.  The parents all say the same thing:  They moved to these “Leave It to Beaver” communities from the San Fernando Valley to give their kids better lives.  Instead they became OxyContin addicts. 

We found a way to take Bill in for 7 days and get him detoxed.  Our plan was to then transfer him to one of the long term free treatment programs that do exceptional work but do not provide medically supervised detox services.  Once detoxed he chose instead to move in with a sober friend and work in construction.  He just called to report he is hiking and rock climbing alot; he assured me that when he feels cravings for OxyContin he does some of the yoga breath work he learned from our lead exercise instructor Oleg Yevseyev.  I told him to call if he ever needs help again.

The OxyContin epidemic is not unique to Simi Valley and Moorpark.  Last May I travelled to Sacramento with some of our alumni to support passage of a funding bill for CURES (California’s real time online narcotic prescription data base). The parents who spoke at the press conference were all from one Northern California Senate District, that of Senator Mark DeSaulnier who authored the bill.  All of their children had died from OxyContin overdoses (one of them, April Rovero, went on to found the National Coalition Against Prescription Drug Abuse).

Nine months earlier I had several conversations with Lynette Ropp, a mom who lives in El Dorado County, yet another area of California where young people are dying from their addiction to this powerful drug which many parents describe as nothing more than synthetic heroin.  Matt’s presence at Malibu Beach Recovery Center made me think of her, and her efforts to get Purdue Pharma to pay the costs of getting her son detoxed and treated.

“I continue to watch my son battle with OxyContin addiction. I am totally exhausted,” she wrote to the head of Purdue Pharma. “This past year has been very sad and stressful, checking constantly to make sure he is still breathing...Seeing him with dark circles under his eyes, watching him mumble his words unable to articulate himself clearly at times. So worried he will die.  I called 911 at one point and he was taken by ambulance to the hospital for overdose.  The rehab the doctor referred him to was closed for misappropriation of funds.  He had been attending a outpatient program but slowly that tapered off...A couple weeks ago at a softball game (he plays in a league with long time childhood friends) he was unable to throw a softball 15 feet.  My sister attended the game with her children and reports that he struggled to spit out a piece of gum.  Stumbling and cussing, humiliating himself in front of friends and family.  It is painful to watch my child who was such a talented, vibrant young man be totally depressed and sick...He needs professional medical help.  I believe I have found the appropriate facility.  Unfortunately everything comes down to money. So I find myself again contacting your office asking for help…”

Purdue never did provide the funds Lynette’s son needed to get professional treatment.  Instead he went to jail for 9 months because of multiple legal charges related to his OxyContin habit.  He is now clean and sober thanks to the largesse of California tax payers.

So here’s my question.  We did our part.  But what about the doctors who by now know that OxyContin is highly addictive?   Shouldn’t they have to detox these kids for free?  And what is the responsibility of Purdue Pharma, which manufactures OxyContin and still allows it to be prescribed in such lethal quantities?    Why haven't they set aside a very large fund to help Bill, and Lynette Roup's son, and OxyContin addicts across the country get their lives back?