CVS has over 700 Florida locations and will not say the amount of doctors they notified with the official letter telling them prescriptions will no longer be filled at their stores. One doctor claims CVS has pegged him a criminal and he has fired back with legal action. Many are praising CVS for taking this measure since Florida has reached an all time high with abuse of prescription drugs and is seeing epidemic proportions of abuse and overdoses.

In 2010, 90 percent of all Oxycodone was purchased from doctors in Florida. CVS spokesman, Mike DeAngelis said that while CVS regrets any inconveniences they have caused their customers, they do treat the distribution of controlled substances with the most serious care and awareness. CVS maintains that they are unwavering in their compliance and prevention efforts to keep drug abuse controlled and these substances free from the wrong hands. Law enforcement officials have targeted local drug rings in the state by monitoring doctors who supply prescriptions at pain clinics to be sold on the streets. Last July, lawmakers enforced legislation that increased penalties on doctors and later banned most from dispensing painkillers in their offices.

It is uncertain what impact this decision from CVS will have as they are the first to take such action in the fight against prescription painkiller abuse, publicly.

OxyContin is one of the best-selling brand-name narcotic painkillers in the world, amassing Purdue Pharma billions of dollars in annual revenue.

In fact, this is one instance where big Pharma isn’t about to get away with misrepresentation of a drug’s addictive potential. Cutting to the latest development first, the state of Kentucky, home of the thoroughbred racers, among other notable attractions, is suing Purdue Pharma in a billion-dollar lawsuit. For more detailed information on the Kentucky lawsuit, see Jim Edwards’ story in BNET (http://www.bnet.com/blog/drug-business/how-purdue-used-misleading-charts-to-hide-oxycontins-addictive-power/9870).

The state’s lawsuit, now pending, alleges that Purdue actively suppressed data about OxyContin’s addictive potential and knowingly remained silent as the drug known as "hillbilly heroin" became one of the most widely abused and deadly prescription drug in the country.

Kentucky’s suit says that an estimated 80,000 Kentuckians have become hooked on Oxy, along with millions of other Americans. A recently released study showing that drug-related fatalities have outnumbered traffic deaths for the first time since such statistics have been collected will no doubt add some strength to Kentucky’s arguments.

Not only is Kentucky suing for reimbursement for Medicaid payments for patients who were prescribed Oxy, it also demands restitution for all the harm that the drug has caused in the state. In this, the lawsuit is unique. The fine Kentucky seeks from Purdue Pharma would cover rehab and healthcare for addicts, as well as education, prevention and "excessive prescription costs."

The timeline and detail on how this landmark lawsuit came about is simply a matter of connecting the dots.

OxyContin’s Addictive Potential Misrepresented in Charts

When Purdue Pharma was involved in safety hearings over the drug, it presented charts showing that OxyContin stays in the bloodstream at least 24 hours. Such a representation, if it were true, would mean that the physical and psychological impact of withdrawal would be significantly reduced.

But that was not the case, according to Kentucky prosecutors who allege that the chart was deliberately manipulated by Purdue and was factually wrong. What the charts showed was data using a logarithmic or log scale, rather than a linear scale. See the BNET story referenced above for a more complete understanding of the misrepresented charges.

Sales reps used the log chart to convince doctors that OxyContin wasn’t addictive because it didn’t have a sharp user comedown. Doctors did not know that the chart was in log scale and not linear scale, and thus were duped into believing OxyContin was less addictive than other pain relievers.

In many reports surfacing after the publicity over OxyContin and Purdue’s marketing of the drug, numerous doctors claimed that Oxy’s effects peak quickly in the bloodstream, leaving the system after just a few hours. This, in turn, triggers severe withdrawal symptoms and cravings.

The Federal Drug Administration (FDA) had ordered Purdue to remove the misleading chart from all of its promotional materials as far back as 1996. Yet the company continued to include it on the drug’s official labeling – where it remains today.

Long History of Misrepresentation of OxyContin’s Addictive Danger

The FDA had also, back in 1995, explicitly banned Purdue from claiming that the extended-release form of OxyContin was less addictive or less susceptible to abuse than any other pain medication on the market. Yet Purdue continued to market OxyContin to doctors as a less-addictive form of opiate pain medications, using altered charts and referring to OxyContin as having "fewer ‘peaks and valleys’ than with immediate release oxycodone."

In 2007, three Purdue executives – the former CEO, R&D chief, and chief legal counsel — were held personally liable for, as a U.S. attorney told USA Today, unleashing "a highly abusable, addictive and potentially dangerous drug on an unsuspecting an unknowing public."

Despite Purdue having to pay close to $1 billion in plea agreements as a result of lawsuits that arose because the company deliberately concealed OxyContin’s abuse and addiction potential, the three convicted company executives never had to pay a penny in restitution. The executives were shielded from the monetary damages pursuant to indemnification agreements. As for Purdue, it had factored in the costs of the lawsuits as part of doing business.

However, there was one small ray of light. Despite trying to have a 12-year ban on doing business with the government overturned, none of the three convicted Purdue executives can ever work in the field again, and can never do business with Medicare and Medicaid again. Since almost every drug company accepts payments from the government, this permanent ban, in effect, ruins the careers (in the drug industry) of those three former Purdue executives. See BNET story "Feds Wage War on Pharma CEOs: Ban on OxyContin Execs Upheld" (http://www.bnet.com/blog/drug-business/how-purdue-used-misleading-charts-to-hide-oxycontins-addictive-power/9870).

What’s the Big Deal? Don’t Patients Deserve Legitimate Pain Relievers?

Clearly there is a demonstrated need for effective painkilling medications for patients with a legitimate medical condition. The scandal over OxyContin isn’t that it’s meant to deprive such patients from receiving relief from pain from medication prescribed by their doctors, but that the addictive potential was deliberately concealed both from doctors and patients.

Many narcotic analgesic pain relieving medications contain oxycodone, the key ingredient in OxyContin, although in much smaller amounts. In OxyContin, it’s a time-release formula that contains 40 to 160 milligrams of oxycodone. The fact that patients seeking relief from pain who have been prescribed OxyContin may become addicted to the drug is one part of the problem.

The other part of the problem is that the drug has quickly become the alternative drug of choice among users of heroin. By snorting, chewing, crushing, or shooting the pills, the drug’s time-release aspect is easily bypassed, leading to a quick high. But since the high quickly dissipates, this leaves the user wanting more of the drug, more often, which may lead to addiction.

Diversion, doctor shopping, borrowing pills prescribed to others, buying Oxy on the street – all have become common practice as users clamor for the drug to satisfy their addiction. Thus, the millions of Americans currently addicted to, or in danger of becoming addicted to, OxyContin.

Landmark Case Will be Closely Followed

One thing is clear in this sad litany of misrepresentation of OxyContin’s addictive potential and Purdue Pharma’s role in it: the Kentucky lawsuit will be closely followed and may be just the tip of the iceberg for many more such suits to be brought in the future by other states seeking restitution for damages done.

Will Purdue Pharma be hit with a substantial penalty in this latest lawsuit? Will the days of OxyContin on the street be numbered? Will the company be forced to change the formulation of the drug? Across the country, petitions have been and are being filed seeking to get rid of this scourge once and for all and to make pharmaceutical companies and any executives involved pay the price for their misdeeds and misrepresentations.

It will be very interesting to see how this all unfolds.

Benjamin hopes to bring together medical professionals, law enforcement, community advocates, educators, treatment experts and many others in efforts to battle this huge problem in America. Karen Kelly, president and CEO of Operation UNITE based in Kentucky, says Benjamin is at the forefront of response to this crisis. Benjamin is the 18th Surgeon General in the U.S. and provides the top scientific information that is available in efforts to improve the health of our nation.

The National Prevention Strategy acknowledges that good health doesn’t just come from receiving the best medical care but also from healthy lives at home, in the workplace, in safe outdoor places and with physical activity and healthy nutrition. Kelly adds that America’s youth are especially susceptible but that Benjamin is skilled at implementing strategies for prevention of drug abuse. Benjamin brings her expertise to the Spring Summit and her knowledge from overseeing the command of over 6,000 health officers serving in areas around the world. The goal of the Summit is to help name policies that are data-driven and find the solutions. Benjamin has various degrees and experience over the course of her work that includes 15 honorary doctorates.

The goal of the summit is to bring all of these top stakeholders together in an effort to prevent this epidemic from further escalating.

The Violence in Mexico

Mexican leaders report almost inconceivable numbers of casualties in the war against drugs. Officials report that close to 48,000 persons have been killed there in violence connected to drug activity just since 2006. In the first four months of 2011, 13,000 more people died drug-related deaths. The Mexican National Human Rights Committee says that as horrendous as those figures are, they do not include the greater than 5,000 citizens who have gone missing as a result of drug violence nor include the thousands of children who have become orphaned as a result of drug-inspired violence.

Growing Violence in the United States

The violence is paying almost no regard to the U.S. – Mexican border. The billions of dollars in profits that drug cartels realize annually are largely made selling drugs on U.S. soil. The U.S. Justice Department has reported that drug cartels were present in 230 U.S. towns and cities in 2008, but today that number is closer to 1,000 cities. Gangs on the streets of border cities like Los Angeles, Dallas and others are often connected to drug cartels in Mexico. In one infamous recent case, a 14 year old known as ‘El Ponchis’ (the Cloak) was found guilty of acting as a cartel assassin who tortured and beheaded his victims. The boy is serving a three year prison sentence in a Mexican prison for his crimes.

The Love of Money

U.S. officials are wondering just how long the violence in Mexico can go on. After all, at some point the harm is destroying not only their own country but even their own families. At the center of the murderous violence is the struggle among cartels for control over smuggling channels from Mexico into the U.S. Greed is behind it all. Cocaine grown south of our border costs around $2,000/kilo to produce but sells for anywhere from $34,000 to $120,000/kilo on the streets of American cities. It is estimated that the combined annual income of traffickers in Mexico and Colombia runs close to $40 million. With no ideology but the love of money, as long as U.S. buyers will buy, the violence is unlikely to cease.

The Mexican government seems to be losing the battle for control of its long border with the United States. Instead, the border is falling into the control of bloodthirsty cartels with no apparent regard for human life. Those cartels are attempting to push their control northward essentially moving the border. As they do, more and more American law enforcement agents and innocent civilians are paying a heavy price. Until Americans decide to stop consuming, the killing is likely to continue.

Why did Vinny choose to leave the Jersey Shore house? In his own words, Vinny tells us as he opens up about dealing with anxiety and stress in a video broadcast on vinny.halfofus.com.

• Vinny started having anxiety and panic attacks at a young age, especially in high school. That’s when he really started having bad panic attacks. "They came out of nowhere. There’s nothing really to pinpoint it, when it happens. It can be all in your subconscious."
• How anxiety mounts up. "When my anxiety starts to interfere with my job, my school, things that I do in my everyday life, then it starts to become a problem. One of your resources is to actually remove yourself from the situation at hand.
• Why he left Jersey Shore. "I was on the Jersey Shore and it’s a terrible environment for me to be involved in when I’m anxious because there’s drinking involved, there’s fighting involved, lack of sleep, lack of privacy and it’s just not a good place for me. So, in order for me to get better, I had to go home and recharge my batteries."
• "We’re in a pretty crazy environment when we film. I feel bad for my roommates, for any inconvenience that I caused them. They really didn’t have that many resources to help me when I was filming the show.
• Advice for dealing with anxiety or stress. "The advice that I have for someone dealing with anxiety or stress is to definitely get help, just to say something to somebody, whether it’s your sister, your brother, a friend, your mother, a therapist. It doesn’t have to be that extreme. You have to just speak up so, in case the problem ever does become manifest and gets worse, you have already laid down the foundation and people already are aware. You’re on their radar that something’s not right.
• What about a friend who may be dealing with anxiety? "I would definitely recommend help for your friend. Maybe the person dealing with anxiety doesn’t want to go to a professional, or is embarrassed to see a therapist or to open up about it. I would be a support system for that friend that’s going through anxiety. Be there for them, but also help them. Maybe go through their insurance book with them and look up therapists or say, ‘You know what, I hear that there’s school counselors around that can help you.’ Because a lot of times, the anxious person or the depressed person has no drive or motivation themselves, so the best advice I can give for someone that’s a bystander is to do the work for the anxious person, just so the anxious person just has to walk through the door."
• Go to vinny.halfofus.com for phone numbers you can call, people that can give advice. "It doesn’t have to be so extreme. No one has to be on a ledge in order to seek help. Just ask a professional or someone around you. Just speaking up is the hardest part."

Anxiety Disorders are Common

You may feel like you’re alone in this situation, but the facts are otherwise. Anxiety disorders are the most common mental illness in the United States. They frequently co-occur with depressive disorders, substance abuse, or eating disorders.

Approximately 5 to 10 percent of the U.S. population has one or more phobias. Research shows that people with phobias, particularly social phobias, may also exhibit problems with substance abuse. Many individuals with social phobias become so anxious that they also experience panic attacks as well.

Between 2 and 3 percent of Americans, approximately 6 to 9 million, have obsessive-compulsive disorder, also called OCD.

Panic disorder typically develops in the late teens or early adulthood. But not everyone who experiences panic attacks will later develop panic disorder. Many individuals have a single panic attack and never have another one.

Individuals who suffer post-traumatic-stress disorder (PTSD) may have flashbacks that are so strong they feel as if they are reliving the traumatic event.

What to Watch for with Anxiety Disorders

While everyone feels anxious at some time or another, when anxiety takes over your life and begins interfering with it, as it did with Vinny of Jersey Shore, you need to be aware of the warning signs so that you can get help to do something about your anxiety.

Watch out for:

• Excessive worry with an inability to control it
• Intense episodes of fear or panic
• Recurring nightmares
• Avoidance of social situations
• Difficulty concentrating
• Repeated, unwanted thoughts (obsessions)
• Sleep disturbances
• Upsetting and intrusive memories of a traumatic event
• Physical symptoms, such as nausea, rapid heart rate, stomach pain, muscle tension, sweating, shaking, dizziness, numbness, or difficulty breathing

Questions to Ask Yourself

One way to test yourself to see if you are dealing with high anxiety is to ask yourself the following questions:

• Have you found yourself in situations where you felt more anxious than usual?
• Have you been feeling sad, tired, blue or depressed lately?
• Have you had difficulty managing stress in your daily life?
• Have you ever felt as though you should cut down on your use of alcohol or drugs, whether prescription or illegal)?
• Over the past couple of weeks, have you ever felt bad about yourself, like you’ve let somebody down or that you are a failure?
• Over the past couple of weeks, have you ever felt as if you had a hard time concentrating, or that your thoughts came out slow or jumbled up?
• Have you noticed recent changes in your mood, interests, sleep patterns, or eating habits?

If you answered yes to several of these questions, you may have one or more problems that you could use help dealing with.

For more information and help, check out the National Alliance on Mental Illness (NAMI) by calling 1-800-950-NAMI or go to their www.nami.org/.

There’s also the www.adaa.org/.

Bottom line: Don’t suffer with anxiety, depression, or any other mental health disorder that’s taking over your life. Speak up and ask for help. You can learn how to effectively manage these conditions so that you can go on living your life and be happier and more self-fulfilled.

Start by talking with someone you know and who cares about you. Let them know how you are feeling and ask for their assistance in finding some help for you. Don’t think about it as a big thing. Just do it. The road to recovery and feeling better about yourself and your life begins with taking this first step. And it’s a step that’s well worth taking.

As Vinny’s experience shows us, sometimes you just have to leave a stressful situation and concentrate on taking care of your emotional health. But you don’t do this alone. Get the help you need, whether it’s from a therapist that your family doctor recommends or through a school counselor or other referring professional. Just do it, and do it today.

About The Half of Us Campaign

Launched in 2006 by The Jed Foundation and mtvU, MTV’s college network, The Half of Us campaign seeks to raise awareness and reduce stigma around emotional health issues and to encourage individuals to seek help if they need it. The campaign tells stories of high-profile artists and celebrities, like Mary J. Blige, who came back from alcohol, drugs, depression and the brink of suicide, Billy Corgan, of Smashing Pumpkins, who overcame anxiety, depression, cutting, childhood abuse and contemplating suicide, Ron Artest, NBA Laker who got treatment to deal with his depression, and Pete Wentz, musician, who learned how to deal with anxiety, depression, and thoughts of suicide, along with those of college students across the country.

To learn more about The Half of Us campaign, go to www.halfofus.com.

FDA officials say shortages are due to overly strict DEA regulations while the DEA wonders if the shortage is because the FDA is making more of only expensive pills in order to create imbalances with supply and demand. The situation has made for disagreement among the two agencies which is rare and FDA Associate Director, Valerie Jensen says they have reached out to the DEA and explained the shortage issues.

The DEA believes the supply of drugs is plenty and Agent Gary Boggs maintains that quota issues are outside their area of responsibility. Drug manufacturers are responsible for the expected demand as far as allotted portions go and the DEA only sets up the manufacturing quotas in order to control supplies and prevent abuse. Multiple manufacturers are claiming their medicines are short in supply and the FDA has put certain pills on their official shortage lists.

Doctors say these shortages are widespread throughout numbers of states.

In 1999, the Veterans Affairs Department released a statement that said the main reason patients consult with their doctor is because of pain and they launched the campaign "Pain is the Fifth Vital Sign". You now often see the chart with the 1 to 10 scale asking you to rate your pain when you go into your doctor’s office. Hospitals are supposed to measure your pain using a similar method.

There have been various studies done at the VA that have not shown any advancement in pain management due to the above mentioned policy. OxyContin was introduced by the FDA in 1995 and prescriptions for it have skyrocketed from over 800,000 in 1997 to nearly 6.2 million back in 2002, according to the FDA’s statistics.

Pushing pain as the fifth sign when checking patients’ vitals began in the 90s by the American Pain Society and other corporate members such as Purdue, which makes OxyContin, and Abbott, Vicodin’s maker.

Our country now has a huge epidemic of opioid drug addictions and prescription drug overdose fatalities. Physicians are concerned with managing pain effectively while working towards decreasing the number of patients who become addicted to these painkillers.

Online Pharmacies Are a Source

A commentary published in the December issue of the Annals of Internal Medicine highlights the role played by Internet pharmacies and goes on to suggest strategies which could be employed to eliminate them as a source of illicit prescription drugs. All agree that the flow of prescription drugs over the Internet needs to be more strongly regulated.

Physician Prescriptions Are Rarely Required

The University of Southern California (USC) released findings from a study which showed that from 2000-2007, states which experienced the greatest increase in use of high speed Internet also experienced an increase in treatment center admissions for prescription drug addiction.

Columbia University studies reveal that a full 85 percent of Internet Websites which sell prescription medications never require any form of physician prescription in order to purchase them. A few online pharmacies ask buyers to complete a questionnaire, but do not require a physician prescription. The rare pharmacy which does require a prescription often allows buyers to fax those prescriptions, leaving a huge potential for fraud.

No Way to Block Sales to Children

There is no current method for blocking the sale of prescription medications via the Internet to children. Addiction specialists warn that this is especially dangerous since most addictive lifestyles begin with substance abuse during adolescence.

Recent surveys, which suggest that roughly 10 percent of those abusing prescription drugs obtain them via the Internet, are probably woefully low estimates according to the commentary’s authors. Such a figure fails to account for the majority of abusers who purchase the drugs online and doesn’t even touch the street suppliers who make purchases online. The seriousness of the situation has moved some to take action.

Federal Regulations and Warnings Still Falling Short

The FDA has sent out letters of warning to Internet pharmacies and the service providers attached to them. These letters are backed up by the 2008 Ryan Haight Online Pharmacy Consumer Protection Act which makes it illegal for controlled medications to be delivered when the prescribing physician never saw the patient face to face. The efforts do not enjoy the support of search engines which continue to run advertising for online pharmacies.

What More Can Be Done?

Putting a stop to prescription drug abuse is becoming the number one drug abuse concern in the United States. Federal law enforcement agencies and research institutions are doing what they can to stem the flow of prescription drugs through illicit online pharmacies. Physicians need to become more alert to the problem and should inquire about online pharmacy drug use as a part of routine health history intake procedures. Establishing a national electronic record of all patient prescriptions could also help to limit access to these addictive medications.

Most of our U.S. emergency rooms are witnessing an increasingly large number of fatal overdoses due to prescription opioids like Vicodin and OxyContin. These outnumber overdoses of cocaine and heroin combined, according to a recent blog post. Thomas Frieden, CDC Director, says we have an epidemic of opioid overdoses in the U.S. Last year alone we averaged nearly 40 deaths a day, which totaled 15,000 deaths from prescription overdoses.

Frieden believes the majority of blame should lie with the few U.S. physicians that prescribe these types of painkillers too loosely, either from greed or out of a lack of knowledge. One CDC report found that 3 percent of doctors were responsible for over 60 percent of opioid prescriptions in California alone related to workers’ compensation beneficiaries. 48 states have already passed legislation to set up prescription drug management programs with the only two hold outs: Missouri and New Hampshire. Already in Oklahoma when an opioid has been prescribed, it is entered in the system within minutes under the recipient’s name.

The scientists met at the Stritch School of Medicine to talk about the negative side effects that the consumption of alcohol can produce on how our genes function and how all of these changes are passed down from generation to generation through our cells. These specific modifications do not include changes in our DNA patterns but rather are recognized as epigenetic changes which are caused by the consumption of alcohol.

The scientists’ discussion focused on these epigenetic changes and specifically the two key events that manifest in our genes known as DNA methylation and DNA histone deacetylation. The Director of Loyola’s Alcohol Research Program, Dr. Elizabeth J. Kovacs, says epigenetic is one of many new frontiers in the research of alcohol consumption. Kovacs points out that nearly 50 faculty members at Loyola are involved in this type of research and the group includes faculty members, postdoctoral fellows, students and technicians who are eager to explore these new findings.

The conference was sponsored by several alcohol research interest groups, including Loyola’s own Alcohol Research Program and their Dept. of Surgery and also the National Institute on Alcohol Abuse and Alcoholism and the society for Leukocyte Biology.