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阿片類藥物危機(jī)升級(jí),藥片效力變得更強(qiáng)

阿片類藥物危機(jī)升級(jí),藥片效力變得更強(qiáng)

Geoff MUlvihill, Riin Aljas, 美聯(lián)社 2019-08-01
研究發(fā)現(xiàn),大多數(shù)海洛因新增吸食者的吸毒之路都始于服用開(kāi)給他們或別人的處方藥。

2012年,美國(guó)阿片類藥物危機(jī)造成的死亡人數(shù)不斷升級(jí),當(dāng)年制藥公司的強(qiáng)效成癮性止疼藥的出貨量足夠讓全美國(guó)的每一個(gè)人(包括孩子)吃上20天。

在一些縣——主要集中在阿巴拉契亞,當(dāng)?shù)氐闹固鬯帀虺?00多天。

在針對(duì)該行業(yè)的訴訟中公布了一些關(guān)于藥物供應(yīng)的數(shù)據(jù),美聯(lián)社對(duì)上述數(shù)據(jù)的分析發(fā)現(xiàn),直到這十年之初,阿片類藥物的藥片數(shù)量盡管開(kāi)始下降,藥效總量卻仍然在上升。

原因是:醫(yī)生開(kāi)的藥方藥效更強(qiáng),制藥業(yè)供應(yīng)的藥片藥效也更強(qiáng)。

“這表明,增加的不僅僅是藥片的供應(yīng)量。阿片類藥物的實(shí)際處方量和消耗量都上升了。”斯坦福大學(xué)的教授安娜·蘭姆克說(shuō),她是阿片類藥物研究專家,在訴訟中為原告擔(dān)任有償專家證人。

“我們知道,即便是因?yàn)樘弁窗凑仗幏胶戏ǚ冒⑵愃幬?,藥物劑量越高,服用時(shí)間越長(zhǎng),就越容易上癮?!?/p>

美聯(lián)社發(fā)現(xiàn),從2006年到2012年,運(yùn)往藥店、醫(yī)療機(jī)構(gòu)和醫(yī)院的阿片類藥物總劑量增加了55%。在此期間,藥片的數(shù)量也顯著增加,但增幅略低,約為44%。(藥物劑量是通過(guò)一種叫做嗎啡毫克當(dāng)量的標(biāo)準(zhǔn)來(lái)計(jì)算的。)

2006年和2007年,接收阿片類藥物最多的縣都分布在美國(guó)東部,到2012年,它們都在阿巴拉契亞地區(qū)。數(shù)量也急劇上升。

例如,2006年,田納西州漢布倫縣的人均阿片類藥物使用量居全國(guó)之首——大約相當(dāng)于當(dāng)?shù)厝咳丝?0天的常規(guī)處方用量。到2012年,弗吉尼亞州諾頓縣排名第一,數(shù)量相當(dāng)于134天的處方用量,令人咂舌。

在計(jì)算用藥天數(shù)時(shí),美聯(lián)社使用50嗎啡毫克當(dāng)量作為每日劑量。這是美國(guó)疾病控制和預(yù)防中心(Centers for Disease Control and Prevention)設(shè)定的使用上限,醫(yī)生需謹(jǐn)慎使用。

這些數(shù)據(jù)來(lái)自于美國(guó)聯(lián)邦緝毒署(Drug Enforcement Administration)從制藥公司收集的信息,這些信息主要包括受控物質(zhì)是如何流通到藥店、醫(yī)生和醫(yī)院的。這是2000多個(gè)州、地方和部族政府就阿片類藥物危機(jī)起訴該行業(yè)的關(guān)鍵內(nèi)容。

俄亥俄州凱霍加縣和薩米特縣是最先提起聯(lián)邦訴訟的,計(jì)劃于10月開(kāi)庭。

7月中旬,一名法官同意公布2006年至2012年的數(shù)據(jù)。在此期間,美國(guó)阿片類藥物服用過(guò)量導(dǎo)致的死亡人數(shù)從每年18000人增加到23000多人。此后,這個(gè)數(shù)字已經(jīng)翻了一番,阿片類藥物已經(jīng)超過(guò)了汽車事故,成為該國(guó)意外死亡的頭號(hào)原因。

在這十年的大部分時(shí)間里,海洛因和芬太尼等更強(qiáng)的毒品推動(dòng)了危機(jī)的增長(zhǎng)。研究發(fā)現(xiàn),大多數(shù)海洛因新增吸食者的吸毒之路都始于服用開(kāi)給他們或別人的處方藥。

原告在訴訟中聲稱,制藥商夸大了阿片類藥物的好處,淡化了它們的成癮性,勸說(shuō)醫(yī)生增加劑量,向更多的病人提供此類藥物。

阿片類藥物危機(jī)的起源在很大程度上可以追溯到20世紀(jì)90年代中期,當(dāng)時(shí)普渡制藥公司(Purdue Pharma)推出了奧施康定(OxyContin)。在此之前,阿片類藥物一般只用于外科手術(shù)或極度疼痛的癌癥患者。

政府部門在訴訟中還稱,這些公司違反了美國(guó)緝毒署的政策,因?yàn)榧词顾麄冋J(rèn)為某些訂單“可疑”——因?yàn)檫h(yuǎn)遠(yuǎn)大于正常用量,卻仍然正常發(fā)貨。

例如,奧施康定的制造商普度制藥公司的電子郵件顯示,2009年10月27日下午4點(diǎn)15分,一名員工在藥品分銷商卡地納健康公司(Cardinal Health)的一份訂單上打了個(gè)標(biāo)記,因?yàn)檫@張訂單的數(shù)量幾乎是該客戶往常12周訂單劑量的兩倍。該訂單價(jià)值近29.3萬(wàn)美元。

郵件顯示,該訂單于下午4點(diǎn)16分得到了批準(zhǔn)。

這封電子郵件是7月末公布的一批行業(yè)文件的一部分。這些文件還包括今年早些時(shí)候的一份證詞,美國(guó)最大的藥品經(jīng)銷商之一卡地納健康公司的一名高管在該證詞中說(shuō),該公司在分銷阿片類藥物時(shí)沒(méi)有義務(wù)對(duì)公眾負(fù)責(zé)。

卡地納健康公司的法律顧問(wèn)詹妮弗·諾里斯被一位律師問(wèn)及,該公司是否想“確保盡其所能地防止公眾受到傷害?”

她回答說(shuō):“我不知道卡地納健康公司在這方面對(duì)公眾負(fù)有責(zé)任。”

她接著說(shuō):“卡地納健康公司有義務(wù)根據(jù)法律、法規(guī)、規(guī)章和指南履行其職責(zé)?!?/p>

卡地納健康公司的一位發(fā)言人說(shuō),該回應(yīng)僅用于法律語(yǔ)境。(財(cái)富中文網(wǎng))

譯者:Agatha

In 2012, as the death toll from the nation’s opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply.

In some counties, mostly in Appalachia, it was well over 100 days.

An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip.

The reason: Doctors were prescribing—and the industry was supplying—stronger pills.

“It shows it wasn’t just the number of pills being shipped that increased. The actual amount of opioids being prescribed and consumed went up,” said Anna Lembke, a Stanford University professor who researches opioids and is serving as a paid expert witness for plaintiffs in the litigation.

“We know that the higher the dose of prescribed opioids, and the longer patients are on them, even for a legitimate pain condition, the more likely they are to get addicted.”

The AP found that the overall amount of opioid medication shipped to pharmacies, medical providers, and hospitals increased 55% from 2006 through 2012. The number of pills rose significantly over that period, too—but that increase was lower, about 44%. (The amount of medication was calculated using a standard measure of potency known as a morphine milligram equivalent, or MME.)

In 2006 and 2007, the counties at the very top of the list of those receiving the most opioids were scattered about the eastern half of the U.S. By 2012, they were all in the Appalachian region. And the numbers were up dramatically.

For instance, in 2006, Tennessee’s Hamblen County received the most opioid medication per person in the country—about 70 days’ worth of a typical prescription for every man, woman, and child. By 2012, the top county was Norton, Va., and the number of days’ worth of opioids was a staggering 134.

In calculating days of medication, the AP used 50 MMEs as a daily dosage. That is the upper limit beyond which the Centers for Disease Control and Prevention urges doctors to use caution.

The data comes from the federal Drug Enforcement Administration’s collection of information from pharmaceutical companies about how controlled substances were distributed down to pharmacies, doctors, and hospitals. It’s a key part of the case for some 2,000 state, local, and tribal governments suing the industry over the opioid crisis.

The first of the federal trials, involving claims from Ohio’s Cuyahoga and Summit counties, is scheduled to start in October.

In Mid-July, a judge agreed to make public the data covering 2006 through 2012. During that period, opioid overdose-related deaths in the U.S. increased from about 18,000 a year to more than 23,000. Since then, the number has doubled, and opioids have overtaken automobile accidents as the top cause of accidental death in the country.

Heroin and even stronger illicit drugs such as fentanyl drove the increase for most of this decade. Studies have found that most new heroin users started with prescription drugs that had been prescribed to them or to someone else.

Plaintiffs in the lawsuits claim drugmakers overstated the benefits of opioids and downplayed their addictiveness, persuading doctors to offer the drugs to more patients and in higher amounts.

The origins of the opioid crisis are largely traced to the mid-1990s, when Purdue Pharma introduced OxyContin. Up until then, opioids were generally reserved for surgery or cancer patients in extreme pain.

The government lawsuits also say the companies violated DEA policy by shipping orders even when they believed them to be “suspicious” because they were far larger than normal.

For example, an email chain from Purdue Pharma, the maker of OxyContin, showed an employee flagging an order at 4:15 p.m. on Oct. 27, 2009, from drug distributor Cardinal Health because it was nearly twice as big as the customer's usual 12-week order of a certain dosage. The order was worth close to $293,000.

It was approved at 4:16 p.m., the emails show.

The email was part of a new trove of industry documents made public in the end of July. They also include a transcript of a testy deposition earlier this year in which an executive at Cardinal Health—one of the nation’s largest drug distributors—said the company has no obligation to the public when it comes to the opioids it ships.

Cardinal Health counsel Jennifer Norris was asked by a lawyer whether the company wants to “ensure that it does what it can to prevent the public from harm?”

She answered: “I don’t know that Cardinal owes a duty to the public regarding that.”

She went on to say, “Cardinal Health has an obligation to perform its duties in accordance with the law, the statute, regulations, and guidance.”

A Cardinal spokeswoman said the comment was made only in a legal context.

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