Episode 20: Cut Off

Image: Garth, in a black tank top, black ball cap and headphones, interviews Jeff who has long black hair and is wearing a black t-shirt, jeans & a ball cap. Both are smoking. (Credit: 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?” 

A free transcript of this episode is available here. 


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. 

Works Cited

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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.

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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.

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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.

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“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.


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 me, Garth Mullins.  

Original score for today’s episode was written and performed by me, Sam Fenn, and James Ash. 

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