US opioid deaths rising amid coronavirus lockdowns, state health officials say

Opioid deaths are spiking in places across the U.S. as states remain locked down during the ongoing battle against the coronavirus, state and county health officials reported this month.

While national data isn’t available for most of 2020, several individual states are reporting an increase in opioid overdose deaths amid the coronavirus pandemic.

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Health officials and experts have cited increased isolation and job loss due to statewide shutdowns as possible factors for the surge in drug-related deaths.

“The pandemic has really increased risk factors for substance abuse disorder,” Rebecca Shultz, director of community health at the Onondaga County Health Department, told Syracuse.com.

Opioid deaths in Onondaga County, N.Y., jumped to 86 in the first six months of 2020, according to the county health department. This number was nearly double the reported 44 fatalities in the first half of 2019, the outlet reported, citing the county medical examiner’s office.

Oregon saw a 70% increase in opioid overdose deaths in April and May 2020 compared to the same time last year, the Oregon Health Authority said.

While the department called the rise an “alarming spike,” it also said it was “premature to say how much of the spike in overdose deaths is attributable to the COVID-19 pandemic.”

“However, the realization that we will be dealing with COVID-19 for some time, and other stressors related to jobs, school, and social isolation, may increase feelings of anxiety and depression, and that can lead to a harmful level of alcohol or other drug use,” said Tom Jeanne, deputy state health officer and deputy state epidemiologist.

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In Maine, which saw 258 overdose deaths from January through June, there was a 27% increase over the second half of 2019. Officials cited increased isolation as a partial factor for the rise.

“It is clear from the data that the increase in deaths from the opioid epidemic can be partially attributed to the increased isolation of living through the pandemic,” Attorney General Aaron Frey said in a report on the state’s drug deaths for the second quarter.

California Attorney General Xavier Becerra told FOX40 Sacramento that “in some of our counties, there are more deaths from overdoses than there are from COVID-19.”

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Becerra said that in San Diego there was a 50% increase in overdose deaths in July and August compared to the months leading to the pandemic. He said “the effects of these plagues are exacerbating” due to the pandemic.

Meanwhile, preliminary overdose death counts were up in Connecticut more than 19% through the end of July, compared with the same period last year. They were up 9% in Washington through the end of August, 28% in Colorado, and 30% in Kentucky during that same time.

After a one-year drop in 2018, U.S. opioid overdose deaths increased again in

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New guidelines address rise in opioid use during pregnancy

Opioid use in pregnancy has prompted new guidance from the American Academy of Pediatrics, aimed at improving care for women and newborns affected by their mothers’ drug use.

The number of affected women and infants has increased in recent years but they often don’t get effective treatment, and the pandemic may be worsening that problem, said Dr. Stephen Patrick, lead author of the academy report released Monday.

“While we have been talking about the opioid crisis for years, pregnant women and their newborns seldom make it to the top of the heap. Infants are receiving variable care and not getting connected to services,” said Patrick, a Vanderbilt University pediatrician.


The academy’s report says pregnant women should have access to opioid medication to treat opioid misuse. Two opioids, buprenorphine and methadone, are effective treatments but pregnant women often face stigma in using them and doctors who prescribe them are scarce.

The academy says hospitals should written protocols for assessing and treating opioid-affected newborns. Many don’t and practices vary widely.

Breastfeeding and other practices that promote bonding should be encouraged, and parent education and referral to services for affected newborns should be provided, the academy says. Its recommendations echo guidance from other medical groups and the U.S. government.

“This is a substantial public health problem that is still lacking solutions,” Patrick said.

According to the federal Centers for Disease Control and Prevention, 7% of U.S. women reported in 2019 that they had used prescription opioids during pregnancy. One in 5 of those women reported misusing the drugs while pregnant.

Some infants born to these women develop symptoms of opioid withdrawal, including tremors, fussiness and diarrhea.

By some U.S. estimates, nearly 80 affected infants are diagnosed every day on and the numbers have tripled in recent years.

Patrick has done research suggesting that these infants may be at risk for developmental delays, but says it’s possible those findings reflect use of alcohol or other drugs during pregnancy, poor prenatal care or stress.

“Getting into treatment may be getting even harder” because of the pandemic, he said. “There’s so much going on in the world that that issues involving opioid use are flying under the radar.”

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Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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Is Walmart a villain or victim of America’s deadly opioid crisis?

As the opioid crisis ravaged communities across the United States two years ago, the U.S. Attorney for the Eastern District of Texas at the time, Joe Brown, set about fixing blame on Walmart, alleging its pharmacies were filling prescriptions from “pill mill” doctors facilitating drug misuse and abuse by overprescribing narcotics.

The Department of Justice has also had a long-running civil investigation into Walmart’s pharmacies. The Bentonville, Arkansas, retail behemoth is now preemptively suing the Department of Justice, asking a federal district court to untangle the contradictory laws that have left Walmart open to investigation. The “DOJ is threatening to sue Walmart for not going even further in second-guessing doctors,” Walmart said in a press release, while “state health regulators are threatening Walmart and our pharmacists for going too far and interfering in the doctor-patient relationship.”

Walmart has been tightening its policies on filling opioid prescriptions, according to its “opioid stewardship initiative” – not just questioning particular scripts, but refusing to fill any prescription for controlled substances from doctors about whom the company had doubts. In part to appease federal regulators, Walmart applied various restrictions on controlled substances. But soon state authorities accused the company of violating state regulations – even of committing crimes – by blocking prescriptions or even just filling smaller quantities of drugs than doctors had specified. The company also received pushback from medical groups that accused Walmart of trampling on doctors’ prescribing prerogatives.

Walmart’s damned-if-you-fill-the-script, damned-if-you-don’t bind reflects the problems faced by large chain pharmacies, which also include CVS and Walgreens. They are among the chief targets in opioid-related lawsuits that may be some of the most complicated and expensive litigation in American history – the so-called National Prescription Opiate Litigation. The companies didn’t get there on their own: Contradictory regulations, demands, and threats from Washington and the states have combined to create a tangle trapping the pharmacies, leaving them exposed to plaintiffs’ lawyers in a massive “multi-district litigation” playing out in an Ohio court.

The nationwide tobacco litigation of the 1990s was complex enough, involving the states and a handful of cigarette manufacturers. By contrast, plaintiffs in the National Prescription Opiate Litigation – counties, boroughs, parishes, cities, townships, municipalities, and villages – number in the thousands. They are looking for just about everyone in the opioid business – manufacturers, distributors, and retailers – to pay for the opioid misuse that has been so costly to society. Plaintiffs’ lawyers are seeking damages well into the billions.

The court case consolidated in 2017 was supposed to get rolling in November, but has recently been postponed to the spring out of concerns COVID-19 would spread through a crowded courthouse.

The “multi-district litigation” follows efforts by federal prosecutors who have tried to build both criminal and civil cases against pharmacies, including Walmart, for not acting soon enough in blocking all prescriptions written by doctors pharmacists had questions about.

Pharmacies, though, are a curious place to assign blame for the opioid epidemic. They don’t make the drugs: Controlled substances are

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Walmart sues US government in dispute linked to opioid crisis

Retail giant Walmart filed suit Thursday against the US Justice Department over what it said was an unfair attempt to hold it legally responsible for certain sales of opioid drugs.

The lawsuit is the latest legal battle linked to the opioid crisis in the United States, where widespread abuse has led to government efforts to address the problem and hold drugmakers accountable.

In its lawsuit brought before a federal court in Texas, the US retailer says its pharmacists and pharmacies were being put “in an untenable position” by the government.

The suit, which also names the US Drug Enforcement Administration (DEA), says Walmart was acting preemptively to head off a separate civil suit that the Justice Department has been preparing to file against it.

Walmart said the government’s rules were unclear and that pharmacists could not be expected to know when a prescription written by a licensed doctor should not be filled.

“Walmart and its pharmacists should not be held responsible for the government’s failures to address the opioid crisis,” the suit says.

With the help of aggressive marketing from pharmaceutical companies, particularly through doctors, prescriptions for highly addictive opiate painkillers that had previously been reserved for serious cases skyrocketed in the late 1990s.

According to the Centers for Disease Control and Prevention, more than 500,000 Americans have died of opioid overdoses — both prescription and non-prescription — since 1999.

Walmart accuses the DEA of seeking to pass blame for its failures.

It alleges the agency “authorized manufacturers to produce ever-increasing quantities of the drugs, and largely abandoned its most potent enforcement tools against bad actors.”

It also said that “nearly 70 percent of the doctors whose prescriptions” the government intends to challenge “maintain their DEA prescription privileges to this day.”

Walmart alleges the government has spent years and considerable amounts of money on a criminal investigation that has not produced an indictment and was now turning to a civil lawsuit instead.

It is calling on the court to state that the company and its pharmacists are not subject to the legal responsibility with which the government is seeking to brand it.

Other large companies, including drug distributors Cardinal Health and McKesson, have been targeted in lawsuits by local and state authorities that accuse them of turning a blind eye to millions of opioid prescriptions despite knowing their addictiveness.

A settlement was reached between three distributors and two Ohio counties in October 2019, raising the possibility of a larger settlement.

On Wednesday, the Justice Department announced that Purdue Pharma, manufacturer of the drug OxyContin, had agreed to plead guilty as part of a deal worth some $8.3 billion.

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As Purdue Pharma Agrees to Settle with the DOJ, Revisit Its Role in the Opioid Crisis | Opioids, Inc. | FRONTLINE | PBS

In the latest chapter of a complex legal battle over who is responsible for the nation’s opioid crisis, Purdue Pharma, the manufacturer of the notorious painkiller OxyContin, has arrived at an $8.3 billion settlement with the federal government, pending court approval.

Announced in an Oct. 21 Department of Justice press conference, the settlement, if approved, resolves the federal government’s civil and criminal probes into Purdue Pharma, which is currently in bankruptcy; an additional settlement resolves a federal civil case against Purdue Pharma’s owners, the Sackler family.

“It’s also important to note that this resolution does not prohibit future criminal or civil penalties against Purdue Pharma’s executives or employees,” Jeffrey A. Rosen, the U.S. deputy attorney general, said at the press conference.

Under the settlement, Purdue Pharma admits guilt on three felony charges involving conspiring to defraud the U.S. and break anti-kickback regulations in how it marketed opioids. The settlement involves a $3.5 billion criminal fine and a $2 billion criminal forfeiture, as well as a civil payment of $2.8 billion, though actual monetary payments could be substantially less, once the company’s value is factored in. Separately, the Sacklers themselves will make a $225 million payment to the U.S.

The settlement “will require that the company be dissolved and no longer exist in its present form,” Rosen said, with the Sacklers barred from any controlling or owning role moving forward. Instead, if the settlement is approved by bankruptcy court, the company’s assets would become “owned by a trust for the benefit of the American public,” Rosen said. The new company would still be able to manufacture opioid drugs but would also be required to produce large quantities of medicines to treat and respond to addiction and overdoses, and would need to offer the latter as donations or “at cost.”

“Purdue deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice in the agreed statement of facts,” Steve Miller, chairman of Purdue Pharma’s board, said in a statement.

In a separate statement, Sackler family members who served on the Purdue Pharma board said they had “acted ethically and lawfully” and that they “reached today’s agreement in order to facilitate a global resolution that directs substantial funding to communities in need, rather than to years of legal proceedings.”

The statement also said, “Regarding the plea agreement between the government and Purdue, no member of the Sackler family was involved in that conduct or served in a management role at Purdue during that time period.”

A number of states’ attorneys general spoke out against the terms of the proposed settlement as inadequate and vowed to continue to pursue cases against the company and the Sacklers, which the federal settlements do not resolve.

Purdue Pharma has long been accused of being a driver of America’s opioid crisis. FRONTLINE’s 2016 documentary Chasing Heroin investigated how that crisis came to be, examining allegations about Purdue Pharma’s role in the early years of what has been called the worst drug epidemic in U.S. history.

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Opioid use increases risk of death in older adults after outpatient surgery, study says

Oct. 21 (UPI) — Older adults who used opioid pain medications before minor surgery were up to 68% more likely to die within 90 days of the procedure compared with those who never used the drugs, an analysis published Wednesday by JAMA Surgery found.

Even among people older than 65 who had low levels of opioid use as long as eight months before surgery, about 55 people per 10,000 in the general population died within 90 days of having a procedure, the data showed.

Older adults who had not used opioid pain drugs prior to surgery died at a rate of just over 40 per 10,000 in the general population within 90 days of having a minor procedure, the researchers said.

“People who have preoperative exposure to opioids have a higher risk of mortality after outpatient surgery,” study co-author Dr. Katherine Santosa told UPI.

“Although our analysis cannot discern the underlying causes for this, our findings highlight the need to screen for opioid-related risk prior to surgery,” said Santosa, a surgeon at Michigan Medicine.

Opioids were the leading cause of drug overdose deaths in the United States in the first half of 2019, according to data released recently by the U.S. Centers for Disease Control and Prevention.

Much of the country has been in the grips of an “epidemic” of illegal opioid use and overdose deaths over the past 40 years, causing more than 1 million deaths, based on agency estimates.

At least some of this increase in use has been attributed to over-prescription for pain treatment, the CDC has said.

For this study, Santosa and her colleagues reviewed data on more than 99,000 Medicare beneficiaries — age 65 and older — who had outpatient surgical procedures between 2009 and 2015.

Outpatient procedures do not entail an overnight hospital stay, and patients are admitted, have surgery and are discharged the same day.

Patients included in the analysis had procedures ranging from varicose vein removal and hemorrhoid removal to trans-urethral prostate surgery, thyroid removal, carpal tunnel release, umbilical hernia repair and inguinal hernia repair, the researchers said.

Among outpatient surgery patients included in the study, 0.48% died within 90 days of having their procedure, the data showed.

However, those with “high” levels of opioid use — for 10 months or more and within one month — before surgery were 68% more likely to die within 90 days of their procedure, the researchers said.

In addition, those with low or medium use before surgery were 30% more likely to die, the data showed.
“Many Americans currently use opioids prior to surgery for a variety of conditions,” Santosa said.

“In this context, it is important to understand the potential impact of opioids on recovery, and create care pathways to decrease the risk of adverse effects [while undergoing surgery],” she said.

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Purdue Pharma Pleads Guilty To Criminal Charges Over Opioid Sales

US drugmaker Purdue Pharma pleaded guilty to three criminal charges over its intense drive to push sales of the prescription opioid OxyContin, which stoked a nationwide addiction crisis, the Justice Department announced Wednesday.

Purdue also agreed to $8.3 billion in fines, damages and forfeitures to settle the criminal case against it, the department said.

In a separate agreement, the billionaire Sackler family, which built Purdue to a pharmaceutical giant on the back of lucrative sales of OxyContin, agreed to pay $225 million to resolve civil liability charges filed by the Justice Department.

“Purdue, through greed and violation of the law, prioritized money over the health and well-being of patients,” said FBI assistant director Steven D’Antuono.

Purdue, which filed for bankruptcy protection last year, pleaded guilty to one count of fraud and two counts of violating kickback laws over its marketing and sales of OxyContin and two other hydrocodone-based treatments, which involved encouraging distributors and doctors to aggressively push the highly addictive drugs to consumers.

Headquarters of Purdue Pharma LP, the maker of the painkiller OxyContin, in Stamford, Connecticut Headquarters of Purdue Pharma LP, the maker of the painkiller OxyContin, in Stamford, Connecticut Photo: AFP / TIMOTHY A. CLARY

Even after paying $600 million for falsely marketing the painkiller as “less addictive,” the Justice Department said, Purdue ratched up its sales drive and developed new addictive applications which it marketed through a network of 100,000 prescribing doctors and nurse practitioners.

Among them were thousands of hyper-prescribers that Purdue “knew or should have known were prescribing opioids for uses many of which were not for a medically accepted indication, were unsafe, ineffective, and medically unnecessary,” or which were resold on the black market, the charges said.

To encourage them Purdue had a program dubbed “Evolve to Excellence” which offered financial and other incentives, particularly offering doctors lucrative speaking gigs, which amounted to kickbacks for pumping out more prescriptions of the company’s drugs.

Its activities, combined with those of other prescription opioid producers and distributors, fed an epidemic of addiction. Millions of Americans became dependent on the painkillers while the drugmakers reaped billions of dollars in profits.

According to the Centers for Disease Control and Prevention, more than 500,000 Americans have died of opioid overdoses — both prescription and non-prescription — since 1999.

In a statement, Steven Miller, Purdue’s chairman since 2018, said the company “deeply regrets and accepts responsibility for the misconduct detailed by the Department of Justice.”

Deputy US Attorney General Jeffrey Rosen(C) announces that Purdue Pharma has agreed to plead guilty to criminal charges over its sales of the addictive prescription opioid OxyContin, which fed a national addiction epidemic Deputy US Attorney General Jeffrey Rosen(C) announces that Purdue Pharma has agreed to plead guilty to criminal charges over its sales of the addictive prescription opioid OxyContin, which fed a national addiction epidemic Photo: POOL / YURI GRIPAS

“Purdue today is a very different company. We have made significant changes to our leadership, operations, governance, and oversight,” he added.

Purdue also faces billions of dollars in claims from state and local authorities around the country, and in September 2019 filed for bankruptcy to fend off more legal claims against it.

Because of the bankruptcy and competing claims from litigants and creditors, the Justice Department admitted it might not

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Worsening opioid crisis overshadowed in presidential race

COLUMBUS, Ohio (AP) — Like millions of Americans, Diane Urban watched the first presidential debate last month at home with her family. When it was over, she turned off the television and climbed into the bed her 25-year-old son Jordan used to sleep in.

It was where she found Jordan’s lifeless body after he overdosed on the opioid fentanyl one morning in April 2019.

After watching President Donald Trump target the son of former Vice President Joe Biden for his history of substance abuse, Urban was reminded again of the shame her son lived with during his own battle with addiction.

“I just think that Trump doesn’t understand addiction,” said Urban, 53, a Republican from Delphos, Ohio, who voted for the president in 2016.


The exchange over Hunter Biden’s struggle with addiction was brief, and neither candidate was asked a follow-up question about their plan to tackle the nation’s drug addiction and overdose crisis.

Though Biden’s campaign has a policy paper on addiction, the issue has barely registered in this year’s presidential campaign, overshadowed by the human and economic toll of the coronavirus outbreak and the Trump administration’s response to the pandemic. Yet drug addiction continues its grim march across the U.S., having contributed to the deaths of more than 470,000 Americans over the past two decades.

And it’s only getting worse.

After a one-year drop in 2018, U.S. opioid overdose deaths increased again in 2019, topping 50,000 for the first time, according to provisional data from the U.S. Centers for Disease Control and Prevention. That accounted for the majority of the 71,000 fatal overdoses from all drugs. While national data isn’t available for most of 2020, The Associated Press surveyed individual states that are reporting overdoses and found more drug-related deaths amid the coronavirus pandemic.

Ohio, a battleground state in the presidential contest, is on track to have one of its deadliest years of opioid drug overdoses. More residents died of overdoses in May than in any month in at least 14 years, according to preliminary mortality statistics from the state health department.

As Trump nears the end of his first term, some supporters, including Urban, feel left behind by his administration’s drug policies.

During Trump’s first two years in office, 48 of the 59 Ohio counties with reliable data saw their overdose death rates get worse, according to an analysis of CDC data by The Associated Press. The data was compared to overdose death rates in 2015 and 2016, the last two years of the Obama administration.

What that looks like on the ground is mothers donating to GoFundMe accounts and Facebook campaigns so other mothers can bury their children who’ve overdosed. Some parents even reserve a casket while their child is still alive so they are prepared for what they believe is inevitable.

Others become legal guardians of their grandchildren. Among them are Brenda Stewart, 62, and her husband, who adopted their grandchildren a decade ago as their son struggled with addiction. That led Stewart to start

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