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American Resistance To Empire

Colorado Going After the Source of the “Opioid Epidemic”…The Drug Makers and Sales Reps (Pushers)

Colorado Sues Oxycontin Maker Who Patented a New Drug to Get People off Oxycontin…

BY CHRIS CENTENO

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This week the State of Colorado launched a lawsuit aimed at the maker of Oxycontin, Purdue Pharma. I’ve blogged a few times about just how insane the late 1990s through 2000s were during the narcotic-prescribing free-for-all that began with Oxycontin. I still remember the pushy sales rep from Purdue Pharma. I also recall that once the prohibition on physicians freely prescribing high-dose narcotics for pain was broken, the floodgates opened, and this caused the opioid crisis. Let me explain.

Colorado’s Lawsuit

The Colorado attorney general’s office in its lawsuit stated that Purdue Pharma “downplayed the risk of addiction associated with opioids,” “exaggerated the benefits,” and “advised health care professionals that they were violating their Hippocratic Oath and failing their patients unless they treated pain symptoms with opioids.”

The most bizarre thing for me as a practicing doctor during this time and getting hit up frequently by the Purdue Pharma sales rep is that reading this statement this morning was déjà vu. Meaning, this is exactly what Purdue’s sales rep did. Let me explain.

What Is Oxycontin?

Oxycontin was an evil stroke of marketing genius. Why? Rather than creating a new narcotic drug and having to go through new clinical trials, Purdue simply took an existing drug (oxycodone, or the stuff that makes up a Percocet) and jammed loads of it into a pill with new delayed-release binder. Hence, getting it approved by the FDA was simply demonstrating what the binder and narcotic did to patients, as the base drug was presumed to be effective.

The problem with Oxycontin is that it can pack as many as 16 Percocet pills worth of oxycodone into a single pill. This made it a perfect drug for diversion by addicts as a handful of Oxy tablets was more powerful than any heroin hit. In short, you couldn’t design a better drug for abuse.

Downplaying the Risk of Addiction

It’s been said that the entire opioid crisis began with one sentence: “Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” This was allowed by the FDA to be on the package insert and marketing materials for Oxycontin. The problem? It was never true.

I remember my Purdue sales rep telling the doctors in my office this very statement. The delayed absorption of this stuff is what made it safe and “addiction proof.” The problem? We had seen many patients who were clearly addicted to it.

How could Purdue create the perception that Oxycontin was safe despite what doctors knew to be true? First, while it marketed to pain doctors, most of us knew that what Purdue was selling was not true. Hence, in an evil stroke of marketing genius, Purdue began focusing on getting opioid-prescribing naive family physicians comfortable with prescribing this stuff. In fact, in 2001 alone, Purdue spent 200 million on marketing! By 2003, because of this primary-care marketing focus, more than half of all prescribers of Oxycontin were family doctors rather than more-experienced pain management physicians.

So how did Purdue craft its message that dramatically underestimated the risk of addiction? The number we were told by our rep was that Oxycontin only had a 1% chance of creating an addict. To get this manufactured number, Purdue cited studies where narcotics were only used for acute pain and not chronic pain (the area where Purdue was pushing Oxycontin). In 2007, Purdue and its executives pled guilty to misleading doctors.

Purdue Opened the Floodgates

One of the reasons I’m happy to see this Colorado AG lawsuit is that in a very real way, Purdue opened the floodgates. By convincing a generation of family doctors that it was their moral obligation to treat chronic pain with opioids, they lit the bonfire that became the opioid crisis. In addition, the sales reps also pushed a philosophy to increase the dose of Oxycontin until the patient was out of pain. Hence, what began as 10mg of Oxycontin (the equivalent of two Percocets) soon escalated to 20mg, 40mg, and, finally, 80mg.

In addition, the financial success and blockbuster drug status of Oxycontin inspired many copycat narcotic drug plays, which was like throwing gasoline on the bonfire of the opioid crisis. As an example, we soon saw the fentanyl lollipop (Actiq). This little diabolical drug concoction made Oxycontin look like M&M’s. I watched as more than half of our patients who had chronic pain and who were given Actiq for post radiofrequency procedural pain couldn’t ever get off of the narcotic-laced candy.

Adding Insult to Injury

There’s a scene in HBO’s Breast Men that describes what just happened this week with the Sackler family and Purdue Pharma. The movie follows two plastic surgeons who developed silicone breast implants through the high times and then the low times of women reporting illness. At the end of the movie, one of the doctors has now created a new practice removing the silicone implants and inserting saline ones. A woman who is having a consultation to have her implants removed asks, “So let me get this straight, you charged me a bunch of money to put these in, they made me sick, and now you want to charge more to take them out?” The doctor says, “Yep, that’s about it,” and the woman says, “Where do I sign up?”

In a hat tip to that scene from Breast Men, this week the Sackler family, who owns Purdue Pharma and who made billions from Oxycontin, made news by patenting a new drug to wean patients off Oxycontin! Turns out their new drug is a form of buprenorphine, a drug commonly used to switch addicts from narcotics, like Oxycontin, to a slightly less (but still addictive) narcotic. This “treatment” in my experience just switches the addiction from one drug to another. You just can’t make this stuff up.

The upshot? A big thank you to the State of Colorado! I was there when Purdue began the opioid crisis, which has now either ruined or claimed the lives of millions worldwide. They deserve whatever it is they get!

If you have ten minutes and really want to dive into the genesis of the opioid epidemic and how it relates to Oxycontin, read this great review published by Van Zee in the American Journal of Public Health.

NATO To Takeover and Rebuild Old Albanian/Soviet Airbase

Albania’s graveyard of MiGs to become NATO air base

Second life

Long the graveyard of its once mighty air force, Albania’s base at Kucova is set to become a NATO station – to the delight of its former airmen longing to hear the engines roar again.

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Remnants of the past

Albania retired its 224 Soviet- and Chinese-made MiGs in 2005, and since 2009 NATO neighbours Italy and Greece monitor its airspace. That led to economic decline in and around Kucova, which was called “Stalin City” during the era of Communist rule.

“The base is the first footprint of NATO in the Western Balkans as it will transform Kucova into the first NATO air base for the region,” Defence Minister Olta Xhacka said.

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Cost to rebuild

NATO will spend over 50 million euros ($58 million) on the first stage of work to turn Kucova into a support base for supplies, logistics, training and drills, Xhacka said.

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Earning a transformation

Albania feels it has earned such a transformation at the base for helping maintain stability in the Balkans and contributing to NATO peacekeeping missions around the world.

“The region as a whole has entered into an irreversible Euro-Atlantic integration process,” Xhacka added.

In pic: A Mi-4 helicopter is pictured in Kucova Air Base in Kucova, Albania.

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Bringing hope

News of a NATO base has stirred hopes in Kucova.

Civilians see the base project as an economic boost for an area plagued by emigration and unemployment. The last generation of trained pilots, now in their early fifties, are keen to hear the rumble of engines again, while younger people on the site mull quitting due to their low wages.

Sheep graze in the bushes between the taxiing lanes and the runway. Some 88 MiGs squat on their flat tires near three underground hangars, while birds sing around them.

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Stashing dynamite

Stashing dynamite

The runway, conceived by Soviet planners who stored dynamite under the airfield to blow it up should it fall into enemy hands and built by political prisoners in the 1950s, has good weather conditions all year round.

“A NATO base there will boost the country’s defence capacities, and foreign investors will have more confidence in Albania. It will also be good for employment in the area,” said 68-year-old retired air force commander Klement Alikaj.

Afghanistan’s Rogue General Raziq Killed In Terror Attack

Are Kabul Blasts War Within Afghan Govt, Or Taliban Reply To Abdul Raziq’s Invitation?

Did the Divided Afghan Govt Just Blow-Up In Kandahar?–Or Is It Open War w/Pakistan’s ISI?

Kandahar Chief Goes Forward w/His Taliban “Safe Zone”

UAE/Afghan Investigators Claim Quetta Taliban Ordered “The Hit” On UAE Officials In Kandahar

Top Afghan General Abdul Raziq killed in Kandahar attack

 

Powerful Kandahar police general killed, along with intelligence chief, in shooting claimed by Taliban.

Abdul Raziq was one of the most powerful figures in the Afghan security aparatus [Muhammad Sadiq/EPA]
Abdul Raziq was one of the most powerful figures in the Afghan security aparatus [Muhammad Sadiq/EPA]

The top security leadership of Afghanistan’s Kandahar has been assassinated in a brazen gun attack claimed by the Taliban, leaving a power vacuum in the crucial province ahead of Saturday’s elections.

General Abdul Raziq, one of Afghanistan’s most powerful security officials, was killed along with Kandahar’s intelligence chief, Abdul Mohmin, when a bodyguard opened fire after a meeting in the southern province, officials said.

Deputy provincial governor Agha Lala Dastageri said Kandahar Governor Zalmai Wesa also died of his wounds after being taken to a local hospital, although security officials in the capital maintained Wesa was wounded but survived.

Citing US military officials, TOLOnews reported that Wesa survived the attack after undergoing surgery, adding that he is in stable condition.

General Scott Miller, the top US commander in Afghanistan who had been at the meeting with Raziq only moments earlier, was also uninjured in the attack.

In their claim of responsibility, the Taliban said they had targeted both Miller and Raziq, who had a fearsome reputation as a ruthless opponent of the armed group.

The killing of Raziq is a major blow to the Afghan government ahead of parliamentary elections on October 20, which the Taliban have vowed to disrupt.

Al Jazeera’s Hashem Ahelbarra, reporting from Kabul, said two US official were also wounded in the attack.

“There was a meeting between the US top commander in Afghanistan Scot Miller and top government representatives in Kandahar. After that meeting, there was gunfire inside the governor’s compound.

“In that gunfire, the intelligence chief, and the top police commander were killed. Two Americans were injured,” Ahelbarra reported.

Taliban claim

The Taliban have managed to infiltrate the most secure government meetings on multiple occasions this year, striking at the heart of its command.

“The brutal police chief of Kandahar has been killed along several other officials,” a Taliban statement said.

Raziq was criticised by human rights groups but highly respected by US officers who saw him as one of Afghanistan’s most effective leaders, largely responsible for keeping Kandahar province under control.

A flamboyant commander, he had survived several attempts on his life over many years and narrowly escaped an attack last year in which five diplomats from the United Arab Emirates were killed in Kandahar.

NATO spokesperson Colonel Knut Peters said Miller, who took command of US and forces and the NATO-led Resolute Support mission in Afghanistan last month, was uninjured but he confirmed that two Americans were wounded in the crossfire.

In Final Column, Jamal Khashoggi Laments Dearth of Free Press in Arab World

In Final Column, Jamal Khashoggi Laments Dearth of Free Press in Arab World


The Washington Post published a column by the Saudi dissident Jamal Khashoggi on Wednesday, more that two weeks after he disappeared.  Middle East Monitor, via Reuters

By Jacey Fortin 

 

The dissident Saudi journalist Jamal Khashoggi disappeared after he walked into the Saudi Consulate in Istanbul just over two weeks ago, and evidence increasingly suggests he was brutally murdered.

But on Wednesday night, a new piece of his work — submitted by his assistant after he disappeared — was published by The Washington Post, for which Mr. Khashoggi worked as a columnist.

In just over 700 words, his column lamented the dearth of a free press in the Arab world, which he said “is facing its own version of an Iron Curtain, imposed not by external actors, but through domestic forces vying for power.” He sought to promote the free exchange of ideas and information under the headline, “What the Arab world needs most is free expression.

Mr. Khashoggi’s editor, Karen Attiah, wrote a preface to the column. She said she received the file from Mr. Khashoggi’s translator and assistant a day after he was reported to be missing.

“The Post held off publishing it because we hoped Jamal would come back to us so that he and I could edit it together,” Ms. Attiah wrote. “Now I have to accept: That is not going to happen. This is the last piece of his I will edit for The Post.”

The column came amid reports of audio recordings suggesting that Mr. Khashoggi was met by his killers shortly after he walked into the consulate in Turkey on Oct. 2, and that his fingers were severed and he was beheaded.

Saudi officials have denied harming Mr. Khashoggi, but they have not provided evidence that he left the Saudi Consulate, or offered a credible account of what happened to him.

President Trump appeared to take Saudi officials’ claims at face value, disregarding Turkish assertions that senior figures in the royal court had ordered his killing. The president told reporters on Wednesday that the United States had asked for copies of any audio or video evidence of Mr. Khashoggi’s killing that Turkish authorities may possess — “if it exists.”

In his column on Wednesday, Mr. Khashoggi wrote that government clampdowns on the press in the Arab world were sometimes met with little resistance.

“These actions no longer carry the consequence of a backlash from the international community,” he said. “Instead, these actions may trigger condemnation quickly followed by silence.”

In Saudi Arabia, Mr. Khashoggi once served as an adviser to and unofficial spokesman for the royal family. But after Crown Prince Mohammed bin Salman barred him from writing in the kingdom, he traveled to the United States. He reinvented himself as a prominent critic of the Saudi government — and of Crown Prince Mohammed in particular — and became a resident of Virginia.

On Oct. 2, he entered the Saudi Consulate in Istanbul to pick up a document he needed to get married. His fiancée was waiting outside. But Mr. Khashoggi never came out.

His column on Wednesday was reminiscent of ones he had written before, which often condemned human rights abuses in Saudi Arabia. He wrote that he had been reading a Freedom House report on political rights and civil liberties around the world, and it ranked most countries in the Arab world as “not free.”

“As a result, Arabs living in these countries are either uninformed or misinformed,” Mr. Khashoggi wrote. “They are unable to adequately address, much less publicly discuss, matters that affect the region and their day-to-day lives.”

He wrote about the hopes that had been shattered across the Middle East after Arab Spring uprisings in 2011 failed in several countries. And he wrote about governments’ efforts to imprison dissidents, block internet communication and censor the media.

He suggested the formation of a transnational media outlet — like Radio Free Europe, which was created by the United States government during the Cold War — that could be a platform for Arab writers, reporters and thinkers.

“We need to provide a platform for Arab voices,” Mr. Khashoggi wrote.

“We suffer from poverty, mismanagement and poor education. Through the creation of an independent international forum, isolated from the influence of nationalist governments spreading hate through propaganda, ordinary people in the Arab world would be able to address the structural problems their societies face.”

In her note, Ms. Attiah wrote that Mr. Khashoggi’s column “perfectly captures his commitment and passion for freedom in the Arab world. A freedom he apparently gave his life for.”

Matt Stevens contributed reporting.

Pentagon/CIA Continue To Double-Cross Every Ally In Syria, Except For the Kurds

Truckloads of US weapons continue to arm PKK terrorists in Syria–September 21, 2018

US continues to arm PKK/PYD terrorists in Syria

Russia accuses US of allowing ISIS Sanctuary to grow east of Euphrates

Kurdish leader says Syria gov’t will meet Daesh’s fate if they attack eastern Euphrates

 

US Sends 500 Trucks Of Arms To PKK/YPG Militants In Northern Syria In One Week

The US administration has supplied militants of the Kurdistan Workers’ Party (PKK)’s Syrian affiliate, the YPG, with a sum of 500 truckloads of weapons in Syria’s Manbij in the past week alone, despite a deal between Ankara and Washington for the withdrawal of the group from the town.

The Manbij roadmap between Turkey and the US was agreed upon in June this year on the withdrawal of YPG/PKK from the town of Manbij to stabilize the region, which is in the Northeast of the Aleppo province in Northern Syria, the Turkish Yeni Safak paper reported.

The US forces in Syria’s Manbij have provided the YPG/PKK group with new construction equipment, allowing the militants to continue digging up trenches and build embankments around the town center.

As the US troops continue military and logistic transportation from Northern Iraq into Northeastern Syria, despite a deal between Ankara and Washington on the withdrawal of the terror group from the city, local sources told Anadolu Agency that the US also sent aid to YPG/PKK in the region.

Trucks, carrying four construction vehicles, were transported to Manbij. The US soldiers escorted the transfer of the construction machinery, which included 3 bulldozers and one excavator.

The YPG/PKK uses bulldozers and excavators to dig up trenches and embankments in the area.

PKK/KCK formed embankments at various depths in front of trenches to make up a series of lines stretching nearly 30 kilometers (18.06 miles).The trenches can be clearly seen in satellite photos taken by Anadolu Agency.

The YPG/PKK also built tunnels linking trenches to use during possible combat.

FARS

Russia accuses US of allowing ISIS Sanctuary to grow east of Euphrates

Russia accuses US inaction of allowing ISIS to grow east of Euphrates

Terrorists have managed to establish complete control over a 20-kilometer territory on the Euphrates’ east bank in Syria due to the inaction of pro-American groups, chief of the Russian Center for Reconciliation of the Opposing Parties Vladimir Savchenko said on Monday.

“As a result of inaction of pro-American groups, terrorists have managed to establish complete control over a 20-kilometer strip on the Euphrates’ east bank between the settlements of Hajin and al-Susa,” he said.

According to Savchenko, despite the United States’ statement on the defeat of Islamic State (a terrorist group outlawed in Russia) terrorists, militants still enjoy control over some of Syria’s territories and the US-led coalition and pro-American Kurdish groups of the Syrian Democratic Forces continue to simulate fighting against militants in the south of the Deir ez-Zor governorate.

Thus, in his words, as many as 130 families (700 people) were taken to Hajin during the attack at a refugee camp near al-Bahrah on October 13.

The Russian reconciliation center continues to report ceasefire violations by militants in the Idlib de-escalation zone. “Thus, during the day, shelling attacks were reported in the settlements of Rashah, Akch Baer (thrice), Ain al-Naur, Jubb al-Zarur and Ikko in the Latakia governorate,” Savchenko said.

Officers of the Russian reconciliation center continue humanitarian assistance to the Syrian population.

Throughout the day, officers of the center conducted a humanitarian operation in the settlement of Bir Ajam in the al-Quneitra governorate.

A total of 1.3 tonnes of food products were distributed among civilians. Twenty-five wheelchairs, 50 blankets and 50 towels were handed over to the administration of a hospital in the city of Hamish in the Rif Dimashq governorate.

Trump Helping Saudis Squirm Out of “Intentional” Killing of Khashoggi In “Botched Interrogation”

Saudi Arabia will reportedly admit to killing Jamal Khashoggi

Saudi Arabia is prepared to admit that journalist Jamal Khashoggi was killed during an interrogation that went wrong, according to reports on Monday.

The kingdom is readying a report that will say Khashoggi’s death happened during an interrogation before being removed from Turkey, CNN reported.

The report will conclude that the operation was carried out “without clearance” and that those involved will be held responsible, the network said, but cautioned that it could still change.

The Wall Street Journal also reported that Khashoggi was killed during a botched interrogation.

Separately, the New York Times reported that Saudi Arabian officials were developing a scenario that would shield Saudi Crown Prince Mohammed Bin Salman from any involvement.

It said that version would accuse a friend of the prince for carrying out the killing.

Khashoggi, who wrote for the Washington Post, was living in self-imposed exile in the United States over the past year because he feared being arrested for writing critical articles about the Saudi ruling family.

The news comes after President Trump said he talked to Saudi King Salman and he “flatly denied” knowing anything about the disappearance of Khashoggi, who went missing from the Saudi consulate in Istanbul on Oct. 2.

After speaking to the king, Trump suggested that “rogue killers” may have been involved in Khashoggi’s disappearance.

“He didn’t really know. Maybe – I don’t want to get into his mind – but it sounded to me like maybe these could have been rogue killers – who knows?” the president said.