David wakes around 6:30, showers, fixes breakfast, and takes off for work. A former drug addict, he is the first to admit that he is one of the lucky ones.

When David was using drugs, he would neglect washing for days, and never brush his teeth. Addicts, he told me, would blame Methadone (a medication used to block cravings) for losing their teeth, but, he had added, addicts don’t care about themselves.

“Unless I had drugs,” he revealed, “I had no motivation to do anything.”

David, from Glasgow, grew up on a housing estate in the north of the city, and started taking drugs when he was 14.

“From where I came from,” he explained, “it was quite a traditional journey into drugs, with cannabis, with things like solvents, stuff like that.”

‘Traditional’ makes it sound like some sort of perverse, Scottish, adolescent rite of passage. But these are youngsters, predominantly, from sprawling council estates, where poverty is rife and grinding struggle a soul-destroying aspect of everyday existence.

So-called ‘schemes’, senses of a real and tangible future, and with that, hope, are almost non-existent. To have aspirations, David informed me, was not the norm. The escape into drugs is killing people in increasingly high numbers.

Figures released on July 16 revealed that the drug related death (DRD) rate in Scotland was by far the highest in Europe, even outnumbernig the USA.

In 2018, Scotland lost 1187 lives to drugs, a shocking 27 per cent increase on 2017. This is the highest since records began in 1994. This equates to 218 deaths per million – in the USA that same year, 217 deaths per million were drug related fatalities. The rate of DRDs in Scotland was also triple that of England and Wales.

In a recent paper, academics Ian McPhee, Barry Sheridan and Steve O’Rawe Of the University of the West of Scotland identified socially inadequate conditions, poverty, and deprivation as a major contributory factor in drug related deaths in Scotland. That is not to say that DRDs in Scotland do not come from other socio-economic situations, of course, but it is predominantly poor people from poor neighbourhoods who are losing their lives.

Another factor outlined by the authors is the fact that governments seem determined to use the full force of the criminal code to punish drug users, instead of treating drug misuse as a health problem.

“The fact that they (drug addicts) have got criminal records stigmatises them and allows the stigma to become discrimination,” Dr McPhee told InsideOver. “Every drug user with a criminal record is discriminated against because every time they apply for a job, every time they go for housing, or access to education, or even if they try to get access to benefits, the punishment continues as long as we continue to criminalise them”

The research paper does note that the Scottish government has introduced several policy measures to try and alleviate the rapid rise in drug related deaths, but the numbers have continued to increase year upon year. Between 2006 and 2016, DRDs in Scotland doubled. This climbed to 934 in 2017, an increase of 8 per cent, and then leapt by 27 per cent in 2018 to 1187.

“Most recently, the impact of austerity, and massive reductions in funding,” Dr McPhee continued, “meant that most of the third or independent sector who provided drugs services were dismantled and not funded. Drug services became highly centralised, meaning that drug users had to travel from great distances, in some cases, to attend. Sometimes, the treatment wasn’t available or wasn’t suitable. So there is a whole series of complexities that have an impact, largely on the poor.”

The criminalisation of drugs users, the neglect of the poorest quarters of society, and austerity measures have combined to create an explosive cocktail of factors impacting largely on the poorest members of society..

“If they keep cutting,” Chris Bermingham, Service Manager with Addaction in Kilmarnock, a small town just south of Glasgow, told me: “You can’t help the people who are going to die.”

In response to these worrying statistics, The Scottish Government have now assembled a task force of experts to look at new and innovative ways of addressing issues around drug taking.

But the devolved government, of course, can only do so much in terms of altering legislation around drugs policy. For now, it is a reserved issue and can only be changed by the United Kingdom’s Parliament at Westminster.

It is sobering to think that in the fifth richest nation on Earth, the poorest and most vulnerable members of society are paying a high price for what many would see as the inadequacies of the political system. A system, apparently, unwilling to address poverty and inequality and all of the disastrous trains of consequences for real and tangible life chances.

“We have to change this situation,” Ian McPhee said unequivocally. “We can’t change it by using the systems we have in place. I think we have to embrace what other countries in the EU are doing, particularly Portugal. Portugal not only decriminalised all drugs, they also dismantled the systems that discriminated against drug users. They created access to welfare benefits, they created access to employment, and they asked the police to do other things other than lock up these people and give them criminal records. Scotland has a model that they can embrace if they are bold enough. I am not sure that, at the moment, that is the case unfortunately.”

Scotland faces an emergency situation in relation to the stark statistics around the level of drug related deaths it is now experiencing.

But isn’t there a huge incentive to prevent this rapidly escalating death rate getting even worse? With each tragedy, of course, there is a grieving family, while potentially untapped talent is being allowed to slip away.

As David has shown, things can be turned around. His parting words to me as we finished the interview were:

“Life is great.”

In the meantime, it seems likely that if we continue to demonise and criminalise drug users, fail to properly address poverty and hopelessness, and do not put cash into potentially life saving services, the 2019 statistics are once again destined to make grim reading.

L'articolo Scotland’s Killing Fields: Drugs Related Deaths Shock The Nation proviene da InsideOver.

Hacking at the roots with a shovel, yanking out the severed bush – it’s exhausting work in the equatorial heat. The labourers can expect little respite though, with orders from up high to hasten their efforts. Clearing plantations near the Ecuadorian border, these “eradicators” are leading the fight on Colombia’s cocaine production crisis. The South American nation grows and exports more of the notorious drug than anyone else, something new president Iván Duque is determined to change. But with one-time narco-farmers struggling to scratch out a living on the right side of the law, there are fears that Colombia’s cocaine cultivation boom won’t be tailing off anytime soon. 

Nearly 2000 tons of the drug was produced on Colombian soil in 2017, figures from the UN Office on Drugs and Crime (UNODC) show, accounting for a staggering 70% of global output. And while that number dipped slightly in 2018, levels remain close to the record high. Once it’s produced, packed and paid for, traffickers feed the illicit haul into global circulation. Much makes its way west across the Pacific to Australia and New Zealand – but the biggest consumer is the United States to the north, which is facing a spiralling opioid crisis. 

Colombia’s drug boom has come at an unlikely juncture in the state’s turbulent history.  After a half century of civil war, 2016 saw a landmark peace deal between the Bogotá government and FARC, Colombia’s notorious rebel group. Deeply involved in the cocaine trade, many had hoped the guerrillas’ disarmament would help break production chains. Instead, a violent new generation of narco-gangs have moved into former rebel territory, ensuring the industry’s continuation.

Many blame a lack of foresight in the peace accords. They hoped to address the structural causes of the war, bringing disenfranchised drug farmers into the national economy with the promise of subsidies for those willing to go straight. Some 124,000 volunteered to uproot their coca crops in exchange for cash – but the system soon backfired. Financial incentives pushed those not already growing the drug to do so, as payments were promised only to those in the cocaine industry who committed to reduce their cultivation. UNODC observers also noted an uptick in production from pre-existing coca farmers for the same reason.

Those who did shift to a legal crop have fared poorly. Subsidies have been slow to reach these ‘alternative development’ farmers, with perhaps as many as half yet to receive their promised payout. Investment in local services has been equally sluggish, stymieing any hope of commercial viability. To profit in the trade of avocados, for instance, remote farmsteads need proper roads to convey their bulky harvest to market. But the infrastructure of Colombia’s poverty stricken rural hinterland is crumbling at best – addressing this is a prerequisite for progress, experts believe.

“In the municipalities with the highest coca presence, poverty reaches 93 percent of the rural population,” said Isabel Pereira of Dejusticia, a think-tank. “Rural development, the formalisation of rural property, and the guarantees to live in the countryside with decent conditions, are effective [strategies] for the elimination of coca,” she added.

President Duque seems wedded to a more direct approach, however. “If we want to achieve a lasting peace in Colombia, coca crops have to be absolutely defeated,” he told a conference in London recently. To this end, his administration is pushing to reintroduce aerial crop spraying. Airborne herbicide campaigns were widespread in Colombia in the 1990s, and helped restrict coca cultivation to one-third of its current size. But it was linked to a spike in cancer rates and the accidental destruction of legal crops, and was banned by a constitutional court in 2015. Undeterred, Duque is fighting the ruling – a move some say is unwise.

“Fumigation [in Colombia] achieved short-term reductions in coca cultivation in specific areas,” says Adam Isacson of the Washington Office on Latin America group (WOLA). “In the medium and long term, though, crops recovered as growers adjusted. They did so through replanting, growing more plants to minimize lost harvests, cutting back plants to save them immediately after spraying, and other strategies,” he added. 

President Duque is under pressure to get results however, least not from his American counterpart. Desperate to reduce the flow of cocaine into the US, the Trump administration – which supports aerial spraying – has threatened to decertify Colombia as a reliable partner in the war against drugs, which would lump Duque with Venezuela’s rogue leader Nicolás Maduro.

“He has done nothing for us,” seethed a furious Donald Trump in April – words that’ll fill Colombia’s president with dread. His country is dependent on American development money, receiving some $10bn in aid between 2000 and 2015. If the White Houses suspends the cash flow, Duque’s cocaine crusade almost certainly falter. That means – in the short-term at least – evermore manual eradication. 

But for every crop cut from the ground, another ten might be planted. When their options are a flimsy promise of government investment or cold hard militant cash (often offered at the end of a rifle), it’s hard to blame the resurgent coca growing communities. Forgotten by far off federal powers and doomed to destitution, Colombia’s far-flung farmers are vulnerable to coercion – something no amount of aerial herbicide will change. If progress is really to be made, a softer touch is required. 

L'articolo Colombia’s Cocaine Crisis proviene da InsideOver.

Drug overdose is the leading cause of death for Americans under the age of 50, and sixty percent of those deaths are attributable to opioids. In America, the abuse of opioids has reached epidemic proportions.

Independent of the emotional toll addiction takes on family, friends and colleagues, it’s costly to the federal and state governments that have to deal with it. According to the United States Center for Disease Control (CDC) when you consider public healthcare, treatment facilities, law enforcement, criminal justice and jail expenses, drug abuse costs approximately $75 billion per year.

In the past twelve years, both the state and federal government have decided to hold drug companies and distributors accountable. Companies such as Cardinal Health, McKesson Corporation, Purdue Pharma and Janssen Pharmaceuticals (a subsidiary of Johnson & Johnson) are among this, but there are many more.

In some cases, these companies have been sued and reached sizable settlements with either the state or federal government, and sometimes both. But what is the settlement’s dollar impact to their bottom line? Did the $11.75 million dollar settlement from Costco Health in 2017 impact them significantly that year? In short, no. It was 0.59% of their $2 billion dollar net revenue.

Cardinal Health is an American multinational health care services company headquartered in the heart of America – Dublin, Ohio. It also happens to be the 14th highest revenue-generating company in the US. In 2017, Cardinal Health reached a settlement of $20 million dollars with the state of West Virginia for “not controlling the supply of opiates to the state.”

Between 2007 and 2012, in conjunction with other companies, Cardinal Health distributed an estimated 780 million hydrocodone and oxycodone pills to pharmacies in West Virginia. The West Virginia Charleston Gazette-Mail reported that this amounted to 433 pills per state resident.

Also in 2017, Cardinal Health reached a settlement with the U.S. Department of Justice that includes two separate fines: $34 million related to suspicious orders of controlled substances from its warehouse in Lakeland, Florida, and $10 million to resolve allegations from the US Attorney for the Southern District of New York that a company it acquired, Kinray Inc., didn’t report suspicious orders from pharmacies.

For the year 2017, Cardinal was hit with two settlements totalling around $64 million dollars. For that same year, they had earnings of $309 million on $32 billion in sales in the first quarter that ended Sept. 30, 2017. That accounts for about 21% of their earnings… for one quarter. Cardinal Health ended 2017 with $2 billion in cash.

After the settlements, Cardinal Health issued a statement denying the allegations. According to Columbus Business First, the company had settled because they wanted to help curb “the epidemic of prescription drug abuse.”

In 2017, deaths involving opioids in West Virginia were 49.6 deaths per 100,000 persons – three times the national rate of 14.6 deaths per 100,000 persons.

Headquartered in San Francisco, California, McKeeson Corporation distributes pharmaceuticals and provides health information technology, medical supplies, and care management tools. It’s one of the nation’s largest distributors of pharmaceuticals.

Like Cardinal Health in 2017, McKesson Corporation settled a lawsuit with the US government for violations of the Controlled Substances Act. The government claimed that they had failed to detect and report “suspicious orders” for controlled substances distributed to its independent and small chain pharmacy customers. Notably, these orders were unusual “in their frequency, size, or other patterns.”

The lawsuit covered the period from 2008 until 2013 – for its malfeasance, McKesson paid a $150 million dollar civil penalty. According to their annual report for 2017, McKesson Corporation had $49 billion dollars in revenue and $3.6 billion in net income. That $150 million dollar settlement represents 3.6% of their net income.

California has one of the lower death rates per 100,000. In 2017 it had dropped to 5.3, again versus the national average of 14.6 deaths per 100,000 attributed to opioids.

Perhaps the company most identified, and vilified, with this crisis is Purdue Pharma, the maker of OxyContin. Headquartered in Stamford, Connecticut, Purdue Pharma is a privately held company owned entirely by members of the Sackler family. As the company is not publicly traded, earnings for Purdue are speculative, but it’s reported that the companies earnings went from a few billion dollars in 2006 to about $37 billion in 2017.

The company is no stranger to setting large lawsuits for its product.

In 2007, Purdue settled a federal case for $600 million dollars, which remains one of the largest pharmaceutical settlements in U.S. history. The settlement included a $34 million dollar fine shared among the company’s president, top lawyer and chief medical officer for misbranding the potency and addictive nature of OxyContin. In addition to the $34 million dollar fine, the three heads were charged with a felony and given 400 hours of community service in drug treatment programs.

In March of 2019, Purdue Pharma settled a lawsuit with the state of Oklahoma for $270 Million dollars. The state claimed Purdue’s opioids contributed to the death of thousands of people. Since the company is private, there is no way to know what the gross or net revenue is for Purdue Pharma. However, using the estimated $37 billion dollars the company earned in 2017, the $270 million would represent 73% of that.

For years the Sackler family themselves lived a rather quiet life as they accumulated their wealth. Neither the family nor any individuals of the family had been personally involved in any lawsuits stemming from the opioid crisis. They only had public relation issues to deal with. Like in March of 2019, when the National Portrait Gallery and the Tate galleries in the UK announced they would no longer accept donations from the Sackler family. And then in the US, the American Museum of Natural History, the Guggenheim Museum and the Metropolitan Museum of Art all quickly followed by announcing they would no longer accept donations from the Sacklers.

At the same time that was happening, the Southern District of New York shattered the Sackler families personal immunity by filing suit against eight Sackler family members. Additionally, 36 states were in the process of suing Purdue Pharma with more than 1,600 lawsuits outstanding.

While the lawsuits work their way through the labyrinth that is the US justice system, the company has turned its attention to the global market. Their sister companies, Napp Pharmaceuticals and Mundipharma, sell their signature opioid products globally. Since Purdue Pharma consider themselves to be a “pioneer in developing medications for reducing pain” they’re also creating new drugs under different company names like Adlon Therapeutics and Imbrium that focus on pain management.

For the Sackler family and Purdue Pharma, the potential cost of settling these lawsuits is likely to be hundreds of millions, if not billions, of dollars, potentially involving settlements that are more than financially punitive. In the meantime, it’s business as usual.

Now these are just three companies – they’re hardly the only manufacturers and distributors of opioids.

To date, these lawsuits have settled with the companies “not accepting any responsibility.” That remains unlikely to change. Also unlikely to change is the lack of financial impact to these companies. In each of these cases, the dollar amounts settled impacted one year, while the companies had profited off the drugs for many years.

If you were to factor in all of the years for which they were settling the lawsuits, that number would be even smaller. For example, the $150 million dollar settlement McKesson Corporation paid represents 3.6% of their net income, for one year, yet the lawsuit covers six years. A closer look at their annual report includes their 2016 net income, which was $4.4 billion dollars. Combining their net revenue for those two years, then that $150 million settlement is cut in half and becomes 1.8% of their net income.

It’s a layered and complex issue that involves many hot button topics like healthcare, the pharmaceutical industry, addiction and, perhaps most of all, the marketing of these drugs.

Perhaps for the companies, the 130 people that die each day in America as a result of opioid related overdoses is just the cost of doing business. And the business is great.

What isn’t layered and complex about this is the fact that this crisis is impacting someone’s brother or sister or father or mother or son or daughter; and that’s not something that can be put on a balance sheet and calculated.

The opioid crisis in America shouldn’t be a zero sum game and it can’t just be about dollars and cents. It’s capitalism, so money matters, but it should be about dollars and sense.

L'articolo All Dollars, No Sense: The Opioid Crisis and the Bottom Line in America proviene da InsideOver.

To get into heroin, in the world of its consumers, to immerse in that abyss of drug addiction in Pakistan, a preliminary abandonment of certainties and a prior assimilation of certain concepts is necessary, it is necessary to unveil the cataloging that marks such weakness and despair, it is necessary to be devoid of every stigma and every accusation: only after having set aside all of this, one can understand the reality of those who left for the war, but who have a conscious awareness of being defeated.

L'articolo Pakistan, in the abyss of heroin proviene da InsideOver.