Episode 20: Cut Off

Jeff Louden gives the middle finger at an editorial board meeting. (Photo: Alexander Kim)

In 2015, Crackdown editorial board member, Jeff Louden, was on morphine pills for his chronic pain. The medication allowed Jeff to find some stability and avoid Vancouver's increasingly dangerous drug market. But, when Jeff's doctor unexpectedly cut down his medication, he turned to the street to outrun dopesickness. 

Five years later, Garth Mullins investigates what happened to Jeff.  What can it tell us about North America's so-called "overprescribing crisis?" 

Transcript

A free transcript of this episode is available here.  

Guests

• Jeff Louden is a member of Crackdown's editorial board and is from the Curve Lake First Nation. 

• Laura Shaver is a member of Crackdown's editorial board and is the President of the BC Association of People on Methadone. 

• Christy Sutherland is a family doctor, the medical director at the Portland Hotel Society, and the Physician Lead at the BC Centre on Substance Use [BCCSU]. 

• Helena Hansen is a doctor and Professor and Chair of Translational Social Science and Health Equity at UCLA.

• Bryan Quinby is the host of the podcast Street Fight. You can follow Bryan on Twitter here.  

• Stefan Kertesz is a physician and a Professor in preventative medicine at the University of Alabama at Birmingham. You can follow Dr. Kertesz on Twitter and listen to his podcast, On Becoming a Healer here. 

• Dawn Rae Downton is a writer and journalist. You can read her National Post article, "My Year on Death Row," here. 

Learning Outcomes

Crackdown episodes are frequently used as educational tools by teachers and community organizers. Please let us know if your class or group listens to our work!

Episode 20 is especially useful for exploring the following themes:

• Critical account of the so-called “overprescribing crisis” in North America

• Marketing of new medications to doctors by pharmaceutical companies

• Race and the development/marketing of medications

• Consequences of mass deprescribing trends

Works Cited

• Bohnert, Amy S. B. 2011. “Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths.” JAMA 305 (13). https://doi.org/10.1001/jama.2011.370.

• Case, Anne, and Angus Deaton. 2015. “Rising Morbidity and Mortality in Midlife among White Non-Hispanic Americans in the 21st Century.”  Proc Natl Acad Sci USA  112 (49). https://doi.org/10.1073/pnas.1518393112.

• College of Physicians and Surgeons of British Columbia. n.d. “Practice Standard: Safe Prescribing of Opioids and Sedatives.” Accessed October 5, 2020. https://www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf.

• Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. 2016. “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.” MMWR Recomm. Rep. 65 (1). https://doi.org/10.15585/mmwr.rr6501e1er.

• Downton, Dawn Rae. 2018. “My Year on Death Row: Inside Canada’s ‘Other Opioid Epidemic,’” August 23, 2018. https://nationalpost.com/feature/my-year-on-death-row.

• Dunn, Kate M. 2010. “Opioid Prescriptions for Chronic Pain and Overdose.”  Ann Intern Med  152 (2). https://doi.org/10.7326/0003-4819-152-2-201001190-00006.

• Executive Office of the President of the United States. 2011. “Epidemic: Responding to America’s Prescription Drug Abuse Crisis.” National Criminal Justice Reference Center. https://www.ncjrs.gov/pdffiles1/ondcp/rx_abuse_plan.pdf.

• Fischer, Benedikt, Wayne Jones, Mark Tyndall, and Paul Kurdyak. 2020. “Correlations between Opioid Mortality Increases Related to Illicit/Synthetic Opioids and Reductions of Medical Opioid Dispensing - Exploratory Analyses from Canada.” BMC Public Health 20 (1). https://doi.org/10.1186/s12889-020-8205-z.

• Garloch, Karen. 2017. “‘Dr. Feelgood: Dealer or Healer?’ Tells Story of Doctor Who Now Lives in Charlotte.” The Charlotte Observer, January 1, 2017. https://www.charlotteobserver.com/living/health-family/karen-garloch/article124076879.html.

• Glauser, Wendy. 2013. “Pharma Influence Widespread at Medical Schools: Study.” Canadian Medical Association Journal 185 (13). https://doi.org/10.1503/cmaj.109-4563.

• Hansen, Helena, and Julie Netherland. 2016. “Is the Prescription Opioid Epidemic a White Problem?” Am J Public Health 106 (12). https://doi.org/10.2105/ajph.2016.303483.

• James, Jocelyn R., JoAnna M. Scott, Jared W. Klein, Sara Jackson, Christy McKinney, Matthew Novack, Lisa Chew, and Joseph O. Merrill. 2019. “Mortality After Discontinuation of Primary Care–Based Chronic Opioid Therapy for Pain: A Retrospective Cohort Study.” J GEN INTERN MED 34 (12). https://doi.org/10.1007/s11606-019-05301-2.

• Jick, Hershel. 1970. “Comprehensive Drug Surveillance.” JAMA 213 (9). https://doi.org/10.1001/jama.1970.03170350023005.

• Joseph, Andrew, and Shraddha Chakradhar. 2020. ““Faced with Fears of OxyContin Misuse, Sales Reps Touted Its Safety.”  STAT News , January 9, 2020. https://www.statnews.com/2020/01/09/prescriber-fears-oxycontin-misuse-purdue-pharma-sales-reps-misleadingly-played-up-safety/.

• Kaplovitch, Eric, Tara Gomes, Ximena Camacho, Irfan A. Dhalla, Muhammad M. Mamdani, and David N. Juurlink. 2015. “Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.”  PLoS ONE  10 (8). https://doi.org/10.1371/journal.pone.0134550.

• Kertesz, Stefan G., Ajay Manhapra, and Adam J. Gordon. 2020. “Nonconsensual Dose Reduction Mandates Are Not Justified Clinically or Ethically: An Analysis.” J Law Med Ethics 48 (2). https://doi.org/10.1177/1073110520935337.

• Los Angeles Times. 2016. “OxyContin Press Release, 1996,” May 5, 2016. https://documents.latimes.com/oxycontin-press-release-1996/.

• Lupick, Travis. 2018. “Downtown Eastside’s Dr. Christy Sutherland Named One of Canada’s Top Family Physicians of 2018.” The Georgia Straight, October 22, 2018. https://www.straight.com/life/1154481/downtown-eastsides-dr-christy-sutherland-named-one-canadas-top-family-physicians-2018.

• Mark, Tami L., and William Parish. 2019. “Opioid Medication Discontinuation and Risk of Adverse Opioid-Related Health Care Events.” Journal of Substance Abuse Treatment 103. https://doi.org/10.1016/j.jsat.2019.05.001.

• Markon, Jerry. 2007. “Pain Doctor Is Guilty of Drug Trafficking.” Washington Post, April 28, 2007. https://www.washingtonpost.com/wp-dyn/content/article/2007/04/27/AR2007042702204.html.

• Merrill, Richard A. 1999. “Modernizing The FDA: An Incremental Revolution.” Health Affairs 18 (2). https://doi.org/10.1377/hlthaff.18.2.96.

• Michael G. Michael G. DeGroote National Pain Centre. 2010. “Canadian Guideline For Opioid Use For Pain.”    National Opioid Use Guideline Group   . April 30, 2010. http://nationalpaincentre.mcmaster.ca/opioid_2010/.

• National Center for Injury Prevention and Control. 2018. “2018 Annual Surveillance Report of Drug-Related Risks and Outcomes.” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

• Netherland, Julie, and Helena Hansen. 2017. “White Opioids: Pharmaceutical Race and the War on Drugs That Wasn’t.” BioSocieties 12 (2). https://doi.org/10.1057/biosoc.2015.46.

• Oliva, Elizabeth M, Thomas Bowe, Ajay Manhapra, Stefan Kertesz, Jennifer M Hah, Patricia Henderson, Amy Robinson, Meenah Paik, Friedhelm Sandbrink, and Adam J Gordon. 2020. “Associations between Stopping Prescriptions for Opioids, Length of Opioid Treatment, and Overdose or Suicide Deaths in US Veterans: Observational Evaluation.” BMJ. https://doi.org/10.1136/bmj.m283.

• Perry, Samuel, and George Heidrich. 1982. “Management of Pain during Debridement: A Survey of U.S. Burn Units.” Pain 13 (3). https://doi.org/10.1016/0304-3959(82)90016-1.

• “Purdue Pharma LP v Kentucky (2007).” n.d. Accessed October 5, 2020. https://www.documentcloud.org/documents/6595442-PurdueKentuckyCallNotes.html.

• Richert, Lucas. 2009. “Pills, Policy Making and Perceptions: Inside the FDA During The.” Canadian Review of American Studies 39 (1). https://doi.org/10.1353/crv.0.0031.

• “State of Tennessee v Purdue Pharma, L.P.” 2018. Tennessee State Government. May 15, 2018. https://www.tn.gov/content/dam/tn/attorneygeneral/documents/foi/purdue/purduecomplaint-5-15-2018.pdf.

• Sun, Eric, and Jena Anupam. 2017. “Distribution of Prescription Opioid Use Among Privately Insured Adults Without Cancer: United States, 2001 to 2013.”  Ann Intern Med  167 (9). https://doi.org/10.7326/m17-1408.

• Tierney, John. 2007. “Trafficker or Healer? And Who’s the Victim?” The New York Times, March 27, 2007. https://www.nytimes.com/2007/03/27/science/27tier.html?ex=1177560000&en=5b5b33d313ff8f11&ei=5070.

• “Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse.” n.d. U.S. Food And Drug Administration. Accessed October 5, 2020. https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-opioid-misuse-and-abuse.

• Tompkins, D. Andrew, J. Greg Hobelmann, and Peggy Compton. 2017. “Providing Chronic Pain Management in the ‘Fifth Vital Sign’ Era: Historical and Treatment Perspectives on a Modern-Day Medical Dilemma.” Drug and Alcohol Dependence 173: S11–21. https://doi.org/10.1016/j.drugalcdep.2016.12.002.

• United States General Accounting Office. 2003. “OxyContin Abuse and Diversion and Efforts to Address the Problem.” December 2003. https://www.gao.gov/assets/250/240884.pdf.

• “U.S. Opioid Prescribing Rate Maps.” n.d. Centres for Disease Control and Prevention. Accessed October 5, 2020. https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html.

• 2010. “The New Face of Heroin Addiction.”  ABC News . http://abcnews.go.com/2020/video/face-heroin-addiction-12009941.

Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations. 

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters. 

Special thanks this month to: Maria Higginbotham, Owen Williamson, Maria Hudspith and Buck Doyle. Thanks also to Dr. Stefan Kertesz who has been answering annoying questions from our team for months now. Dr. Kertesz has asked us to let you know that he “represents his own views and not those of any of his employers.” 

Our editorial board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Al Fowler, and Laura Shaver. Rest in Peace Dave Murray and Chereece Keewatin.

Today's episode was conceptualized, written, and produced by, Alex de Boer, Alex Kim, Lisa Hale, Ryan McNeil, Sam Fenn, and Garth Mullins.  

Original score for today's episode was written and performed by Garth Mullins, Sam Fenn, and James Ash.