Painkiller: Hell Damnation Painkiller. Hell

Contents of the article

  • When your body comes under stress or experiences pain, neurochemicals called endorphins are produced in the brain
  • Endorphins were discovered 40 years ago
  • Endorphins are considered natural painkillers because they activate opioid receptors in the brain that help minimize discomfort

If you've ever taken out a bad day at the office on the nearest treadmill, you know that working up a good sweat can easily turn your day around. And by now you've probably heard that endorphins are the magic bullet behind that post-workout bliss. People love the feeling so much that "endorphin junkie" has even become synonymous with someone who's constantly chasing that exercise high. But while endorphins may get all the credit for your post-run buzz, there's actually a lot more going on behind the scenes. Here's what you need to know about endorphins — and why you might not be an endorphin junkie after all.

What Are Endorphins

When your body comes under stress or experiences pain (hello, burpees), neurochemicals called endorphins are produced in the brain's hypothalamus and pituitary gland, explains J. Kip Matthews, Ph.D, a sport and exercise psychologist. Endorphins, which are structurally similar to the drug morphine, are considered natural painkillers because they activate opioid receptors in the brain that help minimize discomfort, says Matthews. They can also help bring about feelings of euphoria and general well-being. "Endorphins are also involved in natural reward circuits related to activities such as feeding, drinking, sexual activity and maternal behavior," he says.

The idea that exercise creates a huge endorphin rush entered popular culture soon after endorphins were discovered 40 years ago, says Matthews. "Long-distance running was quite popular in the mid-1970s around the same time that endorphins were discovered. Anecdotally, there were a lot of reports of the so-called 'runner's high,'" he says. "By suppressing the experience of pain, a number of researchers put forth the idea that endorphins could be the source of this euphoric feeling after intense exercise." But was that really the case

The Blood-Brain Disconnect

Yes, blood plasma endorphin levels do increase in response to stressors and pain, research shows. For example, a 2003 study found that the more severe pain someone experience post-surgery, the higher their blood plasma endorphin levels. And research shows that exercise can have a similar effect, but research also suggests that endorphin levels might not increase at all until an hour after you've started working out. (Which doesn't explain why those 30-minute HIIT sessions still leave you feeling awesome.)

So what gives The problem with jumping to the conclusion that endorphins cause your "exercise high" is that in large-scale studies, scientists measure endorphins present in the blood — not the brain. Then, they make the assumption that if endorphin levels rise in the blood, then it must be because of an increase of endorphins in the brain, says Matthews. But their findings don't necessarily prove that. And it's the endorphins in your brain that would be causing that "high."

In fact, a recent German study found that, while endorphin levels are higher after a run, endorphins can't pass through the blood-brain barrier, which means they probably don't have much to do with experiencing an exercise high. What does affect the brain, researchers found, was a neurotransmitter called anandamide, which is elevated after exercise and can travel from the blood to the brain.

"While there have been some studies to show that exercise can lead to elevated endorphin levels in blood plasma, there have been no consistent findings that, indeed, exercise leads to that famous 'endorphin rush,'" Matthews says.

What's Really Going On

So if you aren't an endorphin junkie, then what are you Well, you might be a serotonin or norepinephrine junkie, according to Matthews. When you exercise, your brain increases production of these neurotransmitters, which send messages throughout your nervous system. In the case of exercise, those messages might be something along the lines of: "You're running! This is awesome! Cheer up!"

Studies have linked low levels of serotonin and norepinephrine to depression, which is a much more solid link to feelings of post-workout euphoria than the evidence for endorphins, says Matthews. And it's not just that exercise leads to an increase in serotonin and norepinephrine which may, in turn, reduce depression and stress. Exercise may actually help ward off depression and anxiety by enhancing the body's ability to respond to stressors, he says.

"What appears to be happening is that exercise affords the body an opportunity to practice responding to stress, streamlining the communication between the systems involved in the stress response," says Matthews. "The less active we become, the more challenged we are in dealing with stress."

While the science about why you feel a rush after exercise may be complicated, that doesn't mean the runner's high isn't a very real feeling. And don't worry, we won't judge you if you still wear your "endorphin junkie" T-shirt to the gym Cucusoft DVD to iPhone Converter Suite

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If you’re looking for a great warm weather cocktail, make this Painkiller Drink recipe! Coconut, pineapple, rum, and orange- what’s not to love

These Painkiller Cocktails live up to their name. They definitely take away your pain- although I’m not sure if that’s due to the alcohol literally numbing your pain, or the fact that they are SO GOOD that you can’t possibly remain sad or mad while you’re drinking them.

The morning after experiementing with this drink and trying it out on my friends, I received the following text.

Well, I suppose I’m no angel.

This is my preferred drink when I go have lunch on the beach. I love coconut to begin with, and combined with rum and pineapple juice, I’m in total heaven.

I had a pineapple that was seeping juice all over my counter, which is never a good sign. I cut into it, and realized that pretty much the whole bottom half had gone bad, and I was going to have to do some creative cutting to salvage the usable parts of the top half.

Halfway through, I decided to infuse some rum for some sort of wonderful drink creation TBD. I threw the pieces in a large mason jar, poured in my rum and let it be for a couple days.

Once I ended up with toasted coconut leftover from the Samoa Rice Krispie Treat Bars, I knew EXACTLY what drink I was going to try and recreate using my infused rum. These drinks are a little slice of heaven that if you aren’t careful, can leave you feeling like a whole lotta hell. I make no apologies!

What’s in a Painkiller Drink

This cocktail is definitely one of my favorite warm weather drinks! It’s simple to make and is an easier, lower maintenance version of the Pina Colada- but no blender required! A classic combination of coconut, rum, orange and pineapple juice is usually used, but in this case I used a ready-made Pineapple Orange juice blend.

Notably, this drink is made traditionally with Pusser’s rum (and in fact is trademarked with their rum). It originated in the British Virgin Islands in the 1970s (not originally including Pusser’s rum), and has had a little bit of a rocky history since. If you want to read up on that, you can find a good write up here.

So, to sum up, its supposed to be made with Pusser’s rum, which I have never noticed in stores, nor am I a huge dark rum fan. I use white rum, usually Bacardi, since that’s what I typically stock in my bar cabinet. And that’s all I have to say about that.

What you’ll need for this recipe:

  • Cocktail mixer- This Cocktail Shaker Bar Set is perfect for mixing any cocktail you want to make!
  • Cocktail glasses- These glasses are perfect for serving your Painkiller cocktail in! This Beer Glass Set of 4 is the best for enjoying your drinks in!

If you love this Painkiller Drink recipe, make sure to try one of these cocktails:

 

If you're looking for a great warm weather cocktail, make these Painkiller Drinks! Coconut, pineapple, rum, and orange- what's not to love

  • 4 oz rum
  • 3 oz. pineapple-orange juice
  • 1 oz. creme de coconut
  • ice
  • nutmeg
  • toasted coconut, optional for garnish

In a cocktail shaker, combine the rum, juice and coconut with ice. Shake vigorously to mix, then pour into a cocktail glass. Sprinkle with nutmeg and serve iGetter 2 6 7


 

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Judas Priest "Painkiller" - Daily-Rock

The year OxyContin was introduced, Elizabeth Kipp, a 42-year-old stay-at-home mom, went to her doctor in Kansas City, Kan. She had struggled with back pain since age 14, when she was thrown from a horse while practicing for an equestrian competition.

In the intervening decades, she’d taken short-acting generic painkillers. On that day in 1996, her physician said he had something new for her to try.

He told her to take OxyContin every 12 hours. Kipp, who had a bachelor’s degree in plant science from the University of Delaware, said she followed his instructions precisely.

“I’m a scientist, very regimented,” she said.

For the first two or three hours, she experienced a “modicum of relief.” Then her pain roared back, accompanied by nausea, she said in an interview. Only the next pill would relieve her suffering.

She spent hours lying rigidly on her bed, waiting.

“I was watching the clock. ‘What time is it Oh, God, I have to medicate,' ” she said. “My whole nervous system is on red alert.”

When she complained to her doctor, he gave her stronger doses but kept her on the 12­-hour schedule, as Purdue instructs physicians to do. The change had little effect.

For a year and a half, she spent each day cycling through misery and relief. Sometimes, she said, she contemplated suicide.

“You want a description of hell,” Kipp recalled. “I can give it to you.”

She eventually checked herself into rehab and said she no longer takes painkillers.

‘It’s Bonus Time in the Neighborhood!’

Before OxyContin, doctors had viewed narcotic painkillers as dangerously addictive and primarily reserved their long-term use for cancer patients and the terminally ill. Purdue envisioned a bigger market.

“We do not want to niche OxyContin just for cancer pain,” a marketing executive explained to employees planning the drug’s debut, according to minutes of the 1995 meeting.

The company spent $207 million on the launch, doubling its sales force to 600, according to a court declaration. Sales reps pitched the drug to family doctors and general practitioners to treat common conditions such as back aches and knee pain. Their hook was the convenience of twice-a­-day dosing.

With Percocet and other short-acting drugs, patients have to remember to take a pill up to six times a day, Purdue told doctors. OxyContin “spares patients from anxious ‘clock­watching,’” a 1996 news release said.

Sales reps showered prescribers with clocks and fishing hats embossed with “Q12h.” The company invited doctors to dinner seminars and flew them to weekend junkets at resort hotels, where they were encouraged to prescribe OxyContin and promote it to colleagues back home.

A clock that Purdue distributed to doctors and healthcare professionals to promote OxyContin. (Liz. O. Baylen / Los Angeles Times)

The marketing succeeded in ways that astonished even Purdue executives. OxyContin didn’t just replace MS Contin revenues. It dwarfed them.

By the third year, sales were more than double MS Contin’s peak, according to sworn testimony by a Purdue executive. By the fifth, OxyContin was generating annual revenue of more than $1 billion. Sales would continue to climb until 2010, when they leveled off at $3 billion.

Purdue’s owners, the Sackler family, were already rich — the family name adorns a wing of the Metropolitan Museum of Art and several galleries in the British Museum. The success of OxyContin brought a whole new level of wealth. Forbes magazine last year estimated the Sacklers’ worth at $14 billion, which, the magazine noted, put the family ahead of American dynasties such as the Mellons and Rockefellers.

OxyContin’s impact on the practice of medicine was similarly transformative. Other drug companies began marketing their own narcotic painkillers for routine injuries. By 2010, one out of every five doctor’s visits in the U.S. for pain resulted in a prescription for narcotic painkillers, according to a Johns Hopkins University study.

OxyContin accounted for a third of all sales revenue from painkillers that year, according to industry data.

’96’98’00’02’04’06’08’10’12’14012$3 billionOxyContin Sales, 1996-2014@latimesgraphicsSource: IMS National Sales Perspectives

Rates of addiction and overdose have soared alongside the rise in prescriptions. News coverage of these problems in Appalachia and New England in the late 1990s made OxyContin notorious. Purdue dispatched representatives to Virginia, Maine and elsewhere to defend its drug. They blamed misuse of OxyContin and insisted their pill was a godsend for pain sufferers when taken as directed.

“A lot of these people say, ‘Well, I was taking the medicine like my doctor told me to,’ and then they start taking them more and more and more,” Purdue senior medical director, Dr. J. David Haddox, told a reporter in 2001. “I don’t see where that’s my problem.”

The U.S. Justice Dept. launched a criminal investigation, and in 2007 the company and three top executives pleaded guilty to fraud for downplaying OxyContin’s risk of addiction. Purdue and the executives were ordered to pay $635 million. The case centered on elements of Purdue’s marketing campaign that suggested to doctors that OxyContin was less addictive than other painkillers.

In the years after the settlement, Purdue funded programs to prevent pharmacy robberies and keep teenagers from stealing relatives’ pills. The company eventually rolled out a tamper-resistant version of the painkiller that was harder to crush and snort.

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But in all the scrutiny of Purdue and OxyContin, the problem of the drug wearing off early was not addressed.

Purdue sales reps who spent their days visiting doctors to talk up OxyContin heard repeatedly that the drug didn’t last. In reports to headquarters, they wrote that many physicians were prescribing it for three or even four doses a day.

Company officials worried that if OxyContin wasn’t seen as a 12-hour drug, insurance companies and hospitals would balk at paying hundreds of dollars a bottle.

Some already were.

Dr. Lawrence Robbins started prescribing OxyContin at his Chicago migraine clinic shortly after it hit the market. The neurologist recalled in an interview that “70 to 80%” of his patients reported that the drug “just lasts four, five, six, seven hours.” Robbins started telling people to take it more frequently. But insurance carriers often refused to cover the pharmacy bill for more than two pills a day, he said.

Over the years, he wrote insurance companies more than 25 times on behalf of patients who he believed needed OxyContin more frequently than every 12 hours, he said. In some cases, the insurers relented. When others did not, Robbins switched the patients to another drug.

Robbins said he had no choice: “If they are having a real struggle with opioid withdrawal, sure, you have to do something.”

For Purdue, doctors like Robbins were a problem that had to be confronted.

“I am concerned that some physicians are using OxyContin on a q8h schedule rather than a q12h schedule,” a regional manager in Atlanta, Windell Fisher, wrote in November 1996 — 11 months after OxyContin went on sale.

In the memo, Fisher told a district sales manager what to do:

“Where this is occurring you need to train the representative on how to deal with it, convincing the physician that there is no need to do this, and that 100% of the patients in the studies had pain relief on a q12h dosing regimen.”

By 2000, it was clear that chiding memos to sales reps weren’t enough. Data analyzed by company employees showed that one in five OxyContin prescriptions was for use every eight hours, or even more frequently.

Purdue held closed-door meetings to retrain its sales force on the importance of 12-hour dosing, according to training documents, some included in sealed court files and others described in FDA files.

“These numbers are very scary,” managers warned sales reps during one workshop.

“Managed care plans are beginning to refuse to fill prescriptions,” they were told in another presentation. Reps were ordered to visit doctors and “refocus the clinician back to q12h.” Doctors needed to be reminded “on every call,” they were told.

“There is no Q8 dosing with OxyContin,” one sales manager told her reps, according to a memo cited in an FDA filing. She added that 8­-hour dosing “needs to be nipped in the bud. NOW!!”

If a doctor complained that OxyContin didn’t last, Purdue reps were to recommend increasing the strength of the dose rather than the frequency. There is no ceiling on the amount of OxyContin a patient can be prescribed, sales reps were to remind doctors, according to the presentation and other training materials.

Boosting the dosage could extend the duration to some degree, but it didn’t guarantee 12 hours of relief. Higher doses did mean more money for Purdue and its sales reps. The company charged wholesalers on average about $97 for a bottle of the 10-milligram pills, the smallest dosage, while the maximum strength, 80 milligrams, ran more than $630, according to 2001 sales data the company disclosed in litigation with the state of West Virginia. Commissions and performance evaluations for the sales force were based in part on the proportion of sales from high-dose pills.

A West Virginia supervisor told one of his highest performing sales reps in a 1999 letter that she could “blow the lid off” her sales and earn a trip to Hawaii if she persuaded more doctors to write larger doses.

In an August 1996 memo headlined “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!” a manager reminded Tennessee reps that raising dosage strength was the key to a big payday.

“He who sells 40mg” ­­ the largest pill available at the time ­­ “will win the battle,” the manager wrote.

By 2004, Purdue was seeing “a trend away from prescribing OxyContin” more frequently than every 12 hours, according to a company filing with the FDA.

In the training materials reviewed by The Times, little was said about the effect of higher doses on patient health. Those on higher doses of opioids are more likely to overdose, according to numerous research studies. An analysis of the medical records of more than 32,000 patients on OxyContin and other painkillers in Ontario, Canada, found that one in 32 patients on high doses fatally overdosed.

“In other words,” the lead researcher, David Juurlink, said in an interview, “they are more likely to die as a result of their medication than almost anything else.”

‘Death was looking real good to me’

As a varsity athlete at the University of Central Florida and later a public school teacher, Burgess MacNamara was used to following rules.

That changed in 1999 when he had knee surgery and his doctor put him on OxyContin. MacNamara, then a 27­-year-old gym teacher at an elementary school near Orlando, was familiar with painkillers. He’d been given Percocet and Vicodin for sports injuries, but he said OxyContin was unlike anything he’d ever experienced.

“The first six hours, it is awesome,” he said. Then the effect began to “teeter off” and he became preoccupied with his next dose: “That’s all you think about. Your whole day revolves around that.”

MacNamara said he soon began taking pills early.

“I can’t even tell you the times I actually waited 12 hours,” he said. “There weren’t many of them.”

(Christopher Berkey for the Los Angeles Times)

“Death was looking real good to me. ”

MacNamara began taking OxyContin in 1999, after a knee surgery.

Within a month, he was crushing and snorting the pills. Within a year, he was forging prescriptions. He eventually tried heroin, which was cheaper, and other drugs. MacNamara was arrested for forging prescriptions, possession of controlled substances, stealing pills from a school clinic and other drug-fueled crimes. He lost his teaching career and spent 19 months behind bars.

“Death was looking real good to me,” recalled MacNamara, who said he has been sober for the last two and a half years.

‘I was more or less a zombie’

As OxyContin’s popularity grew, a handful of scientists outside Purdue published research raising questions about the 12-hour claim. Scientists affiliated with the Oklahoma University College of Medicine found in 2002 that nearly 87% of those prescribed OxyContin at a school pain clinic were taking it more frequently than every 12 hours. The reason, researchers wrote, was “perceived end-of-dose failure.”

A separate study underwritten by a Purdue competitor, Janssen Pharmaceutica, reached a similar conclusion. Researchers surveyed chronic pain patients treated with OxyContin and reported that less than 2% said the drug lasted 12 hours and nearly 85% said it wore off before eight, according to a 2003 journal article detailing the research.

In the real world practice of medicine, some doctors turned away from OxyContin entirely. San Francisco public health clinics stopped dispensing the painkiller in 2005, based in part on feedback from patients who said it wore off after eight hours. The clinics switched to generic morphine, which has a similar duration and costs a lot less.

“What I had come to see was the lack of evidence that it was any better than morphine,” Dr. Mitchell Katz, then head of the San Francisco public health department, said in an interview.

“What I had come to see was the lack of evidence that it was any better than morphine,” Dr. Mitchell Katz, then head of the San Francisco public health department, said in an interview. (Christina House / For The Times)

Patients began filing lawsuits in the early 2000s that accused Purdue of overstating OxyContin’s duration, among other complaints. One of the plaintiffs was a retired Alabama businessman named H. Jerry Bodie.

His doctor had Bodie on 30 milligrams of OxyContin every eight hours for chronic back pain. A Purdue sales rep persuaded him to switch Bodie to a higher dose every 12 hours, according to a judge's summary of the evidence.

Bodie returned to his doctor repeatedly, saying the drug wasn’t working, according to their sworn testimony. The doctor kept raising the dose, eventually putting Bodie on 400 milligrams a day.

“I was more or less just a zombie,” Bodie said in a deposition.

Bodie’s lawsuit ­­and hundreds of others filed by OxyContin users and their families ­­ never got before a jury. Purdue got suits dismissed by asserting, among other defenses, a legal doctrine which shields drug companies from liability when their products are prescribed by trained physicians. Purdue settled other lawsuits on confidential terms.

In these legal battles, the company successfully petitioned courts to have evidence sealed, citing the need to protect trade secrets. The sealed materials included internal memos to members of the Sackler family and others, FDA correspondence, testimony from executives and sales reps’ reports.

They remain sealed to this day. The Times reviewed thousands of pages of them.

In the fall of 2004, in a remote courthouse in Appalachia, the 12-hour dosing issue came close to a public airing. The West Virginia attorney general was pressing a lawsuit against Purdue demanding reimbursement of “excessive prescription costs” paid by the state through programs for the poor and elderly. The state accused the company of deceptive marketing, including the 12­-hour claim.

Frances Hughes, then the state’s chief deputy attorney general, said the last allegation grew out of investigators’ interviews with addicts and their families. In describing problems with OxyContin, many said the drug wore off hours early.

“What was happening was that they were taking more than they were prescribed because the pain medication wasn’t working,” Hughes recalled in an interview.

Purdue’s legal team made numerous attempts to get the suit dismissed or moved from state to federal court, where the company had succeeded in getting many cases tossed out. All these efforts failed.

Purdue had one final shot at avoiding trial: A motion for summary judgment. The judge hearing the case in rural McDowell County was Booker T. Stephens, son of a local coal miner and the first African American elected to the West Virginia circuit court.

To make this critical argument, the company tapped Eric Holder Jr., who had been the nation’s first African American deputy attorney general. On Oct. 13, 2004, the man who would become President Obama’s attorney general argued that West Virginia prosecutors didn’t have sufficient evidence to warrant a trial.

Eric Holder, later the Attorney General, appeared in 2004 for Purdue Pharma in a West Virginia court case. (Francine Orr / Los Angeles Times)

Stephens disagreed. He ruled that there was enough evidence that a jury could find Purdue had made deceptive claims about OxyContin, including how long it lasted.

“Most of the patients in the clinical trials required additional medication, so called ‘rescue medications,’ that accompanied their 12-hour OxyContin dose,” the judge wrote in his Nov. 5, 2004 ruling. “Plaintiff’s evidence shows Purdue could have tested the safety and efficacy of OxyContin at eight hours, and could have amended their label, but did not.”

His decision meant that for the first time, questions about OxyContin's duration would be aired at a trial. Sealed evidence would be laid out in public for class-action attorneys, government investigators, doctors and journalists to see.

On the eve of trial, Purdue agreed to settle the case by paying the state $10 million for programs to discourage drug abuse. All the evidence under seal would remain confidential.

A week later, Judge Stephens ordered one more document withdrawn from public view: His Nov. 5 ruling that there was enough evidence against Purdue to warrant a trial. The Times reviewed a copy of the ruling.

The settlement did not require Purdue to admit any wrongdoing or change the way it told doctors to prescribe the drug.

A four-part series investigation into legal drugs and their deadly outcomes

(Liz O. Baylen / Los Angeles Times)

‘A significant competitive advantage’

While Purdue’s litigators were working in courthouses around the country to fend off civil suits, its regulatory attorneys in Washington, D.C., made a blunt admission to the FDA: The 12-hour dosing schedule is, at least in part, about money.

The issue arose in a regulatory dispute that attracted little attention. The Connecticut attorney general had complained to the FDA that doctors prescribing OxyContin every eight hours, rather than the recommended 12, were unintentionally fueling black market use of the drug.

In a 2004 letter to the FDA, Purdue lawyers responded that the company had no evidence that eight­-hour prescribing contributed to abuse or was unsafe. They went on to make a case far different than the one Purdue sales reps were making to doctors. Eight-hour dosing, the attorneys wrote, could “optimize treatment” for some patients and should level out the narcotic roller coaster.

Nonetheless, they said the company planned to continue telling doctors OxyContin was a 12-hour drug. The lawyers gave a list of reasons: Purdue hadn’t submitted studies to the FDA to support more frequent dosing, the FDA had approved OxyContin as a 12­-hour drug, and 12-hour dosing was more convenient for patients.

Their final reason: It was better for business.

“The 12 hour dosing schedule represents a significant competitive advantage of OxyContin over other products,” the lawyers wrote.

‘Is it just me or does oxycontin not even last 8 hours’

In the years that followed, attacks on the 12-hour claim largely dropped from the agenda of Purdue’s critics. The federal investigation was over. Class-action attorneys moved on to other drugs.

For many patients, the problem never went away.

OxyContin “does a great job of keeping me out of a wheelchair and moving...for 8 hours. Then I start going into withdrawal,” one patient wrote on an online message board in 2004.

“Is it just me, or does oxycontin not even last 8 hours,” another asked in 2008.


“I thought I had to be nuts,” one woman from Florida wrote in 2013 after learning that others also found the drug wore off early. “I am really falling apart from the anxiety.”

Earlier this year, a man posting to a chat board for pain patients said he got six to eight hours of relief from OxyContin, but hadn't been able to convince his doctor to prescribe it more frequently.

"I find it misleading how a product can be marketed as lasting 12 hours when it doesn't," he wrote of his experience.

For a brief moment three years ago, it seemed the problems with 12-hour dosing might get wider attention. The FDA had called for public input on how to make painkiller labels safer. Dr. David Egilman, a Brown University professor of family medicine who had served as a plaintiff’s expert in unsuccessful suits against Purdue, saw it as an opportunity to alert agency officials to problems with OxyContin’s 12-hour claim.

Egilman, an expert in warning labels, had worked on hundreds of product liability cases ranging from asbestos to microwave popcorn. He had developed a reputation as a plaintiff’s advocate driven to expose corporate wrongdoing.

Some judges said he went too far. In a 2007 case against the drugmaker Eli Lilly, for example, a judge found that Egilman leaked confidential documents about the controversial antipsychotic medication Zyprexa to a New York Times reporter. He agreed to pay the company $100,000. In the OxyContin cases, Purdue had attacked his ethics and qualifications.

When FDA officials convened the hearing in a suburban Maryland hotel ballroom Feb. 8, 2013, Egilman was out of the country. He submitted a PowerPoint presentation to be played in his absence.

In the five­-minute presentation, Egilman accused Purdue of ignoring its own science for financial reasons and sending patients on a dangerous roller coaster of withdrawal and relief.

“In other words,” he said, “the Q12 dosing schedule is an addiction producing machine.”

Egilman noted that he had reviewed confidential Purdue documents and sealed testimony of company executives through his work as an expert witness. But, he said, because of court orders sought by Purdue, he was barred from revealing what he’d read in those documents or giving them to the FDA. (He also declined to share the records with The Times.)

A snowstorm was bearing down on the East Coast that day, and the hearing room was nearly deserted. When the presentation concluded, there was a brief pause, and then the FDA moderator moved on to the next speaker.

Neither Purdue nor the agency ever responded to Egilman’s presentation.

‘The higher you go, the more likely you are to die’

OxyContin is still hugely popular. Doctors wrote 5.4 million prescriptions for the painkiller in 2014, and according to a Purdue spokesman, 80% were for 12-hour dosing.

After years of the company telling doctors to answer complaints about duration with greater strengths of OxyContin, many patients are taking the drug at doses that public health officials now consider dangerously high.

At The Times’ request, scientists at the University of Arkansas for Medical Sciences analyzed OxyContin prescriptions in a database of insurance claims covering about 7 million patients across the country.

Purdue Pharma is headquartered in Stamford, Conn. (Liz O. Baylen / Los Angeles Times)

In 2014, the analysis found, more than 52% of patients taking OxyContin longer than three months were prescribed doses greater than 60 milligrams a day. Guidelines issued this year by the Centers for Disease Control and Prevention urged physicians to “avoid” or “carefully justify” prescriptions of that strength.

Told of the Arkansas analysis, Dr. Debra Houry, director of the CDC’s National Center for Injury Prevention and Control and a leader of the agency’s response to the opioid epidemic, called it “really concerning.”

“The higher you go, the more likely you are to die,” she said.

To this day, physicians frequently contact Purdue with questions about dosing. Only 12-hour dosing has been proved safe, the company tells them.

Contact the reporter.

Design and development by Lily Mihalik and Evan Wagstaff. Graphics by Armand Emamdjomeh, Eben McCue and Raoul Ranoa. Stephanie Ferrell also contributed to this project OO Defrag Pro v16.0 Build 151 Final

Painkiller Hell Damnation : Patches Updates Addons .


President  Trump speaks about combating the opioid crisis in Manchester, N.H., in March. (Mandel Ngan/AFP)

Support for Donald Trump in the 2016 presidential election was greatest in the counties with the highest rates of chronic prescription opioid use, according to a new study published this week in the journal JAMA Network Open.

The study found that Trump received about 39 percent of the 2016 vote in the 638 counties with the lowest rates of long-term (90-day supply or more) Medicare opioid prescriptions but about 60 percent of the vote in the 693 counties with the highest rates of long-term opioid use. All told, on a scale from zero to 100, where zero indicates no correlation and 100 indicates perfect correlation, the relationship between chronic opioid use and the 2016 presidential vote scored a 42.


Goodwin et al., “Association of Chronic Opioid Use With Presidential Voting Patterns in U.S. Counties in 2016."

These maps from the study, illustrating the raw rates of long-term opioid use and the 2016 Trump vote share at the county level, illustrate some of the correlation. Certain areas of the country, including parts of the Mountain West and a wide swath of Appalachia, stand out on both maps. There are areas of discordance, however, including much of the Northern Plains (low opioid rates, high Trump support) and Deep South (high opioid rates, low Trump support).

The numbers don't at all suggest that opioid use was a causal factor in the 2016 presidential vote. Rather, "individual and county-level socioeconomic measures explained much of the association between the presidential vote and opioid use," the report found. Those measures included income, disability coverage, insurance and unemployment rates.

Still, correcting for those factors didn't remove the relationship between the Trump vote and opioid use entirely. “Adjusting for county-level socioeconomic measures in linear regression models explained approximately two-thirds of the association of opioid rates and presidential voting rates,” the authors write. That last third remains something of a mystery.

These findings dovetail with other research that has come out since the election. A December 2016 study found, for instance, that “Trump over-performed the most in counties with the highest drug, alcohol and suicide mortality rates.” Again, much of that relationship could be explained by the prevalence of working-class voters and measures of economic distress.

Similarly, an analysis by the Economist found that measures of local health predicted much of the swing toward Trump at the county level.

One thing that does seem clear is that Trump was successful at appealing to voters from counties hit particularly hard by the opioid crisis, due in part to his hard-line stance on drug issues. Trump has made law enforcement efforts, including his proposed border wall with Mexico, the centerpiece of his anti-drug policy agenda.

Most drug policy experts agree, however, that helping users get treatment, lessening the demand for drugs and reducing the harms associated with drug use are the best ways to combat the opioid crisis Русская рыбалка 1.6

Painkiller (Judas Priest song) - Wikipedia

From injury to disease, pain is a very common ailment or symptom that can take down the toughest of the tough. It’s so prevalent that we are seeing a major epidemic with opiate dependency. Unfortunately, with so many needing to find relief, it’s leading to a large portion of our population becoming dependent on a chemical bandage, often just masking the problem, rather than fixing the cause.

Unfortunately, it’s getting so widespread that the medical field view many of those in real need as “seekers”. So, instead of getting relief from tangible pain, people are being turned away. As a result, they are finding it illegally, and pain clinics and rehabs are popping up all over, trying to combat the addiction.

Wild Lettuce as a Healthy Alternative

Wild Lettuce (Photo Source)

Lactuca Virosa is the scientific term for it, and many people have used it in place of addictive prescription pain medicine. It’s a leafy and tall plant, with small yellow buds, and could be grown right out your door. More commonly found in North America and England, it’s a cousin to the lettuce we typically see at the grocery store. It’s also referred to as bitter lettuce, or more appropriately for the purpose discussed here, opium lettuce.

The reason it’s referred to as opium lettuce, is due to the pain relieving and sedative effects that it has been known to produce through a white substance found in the stem and leaves.

(Photo Source)

This milky substance is called lactucarium. And, while it doesn’t contain any opiates, it has similar side effects when used –  it acts directly on the central nervous system (CNS) to lessen the feeling of pain, just like morphine.

Even though it seems to be the best kept secret, it has a history of being used as an alternative to pain relief.

Related: How To Make Pemmican, The Ultimate Survival Food (Video Tutorial)

Historical Use

Back in the 19th century, wild lettuce was already being used by some as a substitute to opium. But, it was in the 70’s that it started to gain significant popularity by those wanting a more natural remedy. Individuals were starting to use it for both pain relief, as well as recreational purpose.

In the earlier days, people using wild lettuce prepared it a couple different ways. One way was to cook the plant in a pan of water and sugar mix, until it reduced to a thick syrup-like consistency. While this was an effective form, it was quite bitter even with the sugar added. The most common form however, was drying the stem and leaves to use as an herbal tea.

The tea remains popular today. But, it’s also being dried for smoking, or vaporizing. If you don’t care to grow it yourself, it can also be purchased as a dried herb, extract, or resin substance.

Other Benefits

Here are the more popular reasons people are gravitating towards this natural pain killer and medicinal plant:

  • Migraines – People who use it for this purpose claim that they experience fewer migraines than they did prior to starting the herb.
  • Insomnia – A frequent use of wild lettuce is by people who have trouble sleeping. It produces a relaxed and euphoric feeling, helping a person fall asleep easier, without the addictive qualities of commonly prescribed sleeping aids.
  • Anxiety – Wild lettuce can act as a mild sedative, allowing people with anxiety to find a reprieve from the stress it causes.
  • Asthma and Cough –  Wild lettuce has antitussive properties, which alleviates or suppresses a cough. Also, asthmatic patients who have used opiates notice more episodes if they go through opiate withdrawal. So, the use of wild lettuce instead of prescription opiates, could be a better option for them.

In addition to the above benefits, wild lettuce produces a euphoric state, similar to opiates, even though it does not contain any actual opiate… so it’s perfectly legal Adobe Audition CS6 Classroom in a Book

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