How Pharma Sabotaged the Drug Enforcement Company and Brought on A whole lot of Hundreds of Deaths
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Story at-a-glance –
- The Manchester, New Hampshire, fireplace division responds to extra requires drug overdoses than fires nowadays. In 2015, 33,091 People died from an opioid-related overdose; 15,281 had been by prescription
- In a current episode of 60 Minutes, DEA whistleblower Joe Rannazzisi lays the blame for the opioid disaster squarely on the shoulders of the drug trade — particularly the drug distributors — and Congress
- Somewhat than taking proactive steps to curtail the opioid epidemic, trade lobbyists and Congress made it nearly not possible for DEA to take motion in opposition to the highest offenders and promoters of the epidemic by enacting the Making certain Affected person Entry and Efficient Drug Enforcement Act of 2016
- President Trump has reconfirmed his intention to declare opioid dependancy a nationwide emergency, thereby securing much-needed funds and coverage initiatives to handle the burgeoning epidemic
- As of February 1, 2018, CVS Pharmacy will restrict opioid prescriptions to a seven-day provide for sure well being circumstances. By doing so, CVS turns into the primary pharmacy chain to limit medical doctors’ potential to overprescribe the medication
By Dr. Mercola
Opioid-related statistics reveal the U.S. has an unlimited drawback on its fingers. People use 80 p.c of all of the opioids offered worldwide.1 In Alabama, which has the best opioid prescription price within the U.S., 143 prescriptions are written for each 100 individuals.2 A results of this over-prescription development is skyrocketing deaths from overdoses.Three,four
As lately reported by CNN, the Manchester, New Hampshire, fireplace division responds to extra requires drug overdoses than fires nowadays.5 In 2015, 52,404 People died from drug overdoses; 33,091 of them concerned an opioid and almost one-third of them, 15,281, had been by prescription.6,7,Eight
The next graph by the Nationwide Institute on Drug Abuse exhibits the progressive incline in overdose deaths associated to opioid ache relievers between 2002 and 2015.9 This doesn’t embrace deaths from heroin dependancy, which we now know is a standard facet impact of getting hooked on these highly effective prescription narcotics. In all, we’re taking a look at simply over 202,600 deaths on this 13-year time-frame alone.10
In the meantime, kidney illness, listed because the ninth main reason behind demise on the Heart for Illness Management and Prevention’s (CDC) prime 10 listing, killed 48,146.11 The CDC doesn’t embrace drug overdoses on this listing, however when you did, drug overdoses (63 p.c of that are opioids), would change kidney illness because the ninth main reason behind demise as of 2015. As if that wasn’t dangerous sufficient, current statistics reveal that in People below the age of 50, opioids are actually the LEADING reason behind demise.
In a sadly ironic twist, analysis reveals many different nations battle with a dire lack of ache reduction for end-stage, terminal sufferers. As reported by The Atlantic:12 “Some 45 p.c of the 56.2 million individuals who died in 2015 skilled severe struggling, the authors discovered. That included 2.5 million kids. Greater than 80 p.c of the individuals had been from growing areas, and the overwhelming majority had no entry to palliative care and ache reduction.”
Drug Enforcement Company Whistleblower Speaks Out
In a current episode of 60 Minutes,13 whistleblower Joe Rannazzisi lays the blame for the opioid disaster squarely on the shoulders of the drug trade — particularly the drug distributors — and Congress.14
It was well-known that drug distributors had been sending terribly giant shipments of opioids — a whole bunch of tens of millions of drugs — to pharmacies throughout the U.S., and that folks had been dying from their misuse; but, somewhat than taking steps to cease the bloodbath, trade lobbyists and Congress made it nearly not possible for brokers on the U.S. Drug Enforcement Company (DEA) to take any motion in any respect.
Rannazzisi ought to know. He led the DEA’s Workplace of Diversion Management, which particularly regulates and investigates the drug trade. Based on Rannazzisi, “That is an trade that is uncontrolled. What they wish to do is do what they wish to do, and never fear about what the regulation is. And if they do not comply with the regulation in drug provide, individuals die.” As reported by CBS Information:15
“His best ire is reserved for the distributors — a few of them multibillion greenback, Fortune 500 firms. They’re the middlemen that ship the ache drugs from producers, like Purdue Pharma and Johnson & Johnson to drug shops all around the nation. Rannazzisi accuses the distributors of fueling the opioid epidemic by turning a blind eye to ache drugs being diverted to illicit use.”
Drug Distributors Acted With Full Information
The three largest drug distributors — Cardinal Well being, McKesson and AmerisourceBergen — management as a lot as 90 p.c of the opioid distribution within the U.S., and in keeping with Rannazzisi, they had been most definitely conscious of the truth that the suspiciously giant orders they stuffed had been killing tens of hundreds of individuals every year. The drug makers facilitated these killings as effectively, by falsely testifying to their security and low danger of dependancy when used for ache.
This lie allowed a whole bunch of hundreds of People to grow to be addicted and tens of hundreds die over the previous 20 years. As dependancy rose, so did “tablet mills” — so-called ache clinics that did little greater than distribute narcotics. In Rannazzisi’s phrases, the fast rise in opioid abuse “made the entire crack epidemic appear like nothing.” The primary distinction was that opioids had been distributed by medical professionals somewhat than road gangs.
Rannazzisi was in command of prosecuting medical doctors and pharmacists caught pandering the medication to addicts, but as quickly as one was taken off the road, one other would take his or her place. It did nothing to quench the epidemic. So, he determined to “transfer up the meals chain” and go after the distributors who, by regulation, are required to report and cease suspicious orders. Unusually giant or excessively frequent orders each match the invoice of a suspicious order, and such orders had been being routinely stuffed with out ever being reported to the DEA.
Jim Geldhof, who labored on the DEA for 40 years, attests to the truth that distributors shipped hundreds of suspicious orders. One of many extra apparent examples embrace a pharmacy in Kermit, West Virginia, which ordered 9 million hydrocodone drugs over the course of two years. With a inhabitants of simply 392 individuals, nobody of their proper thoughts might probably mistake this for something however a drug distribution ring.
Between 2007 and 2012, greater than 12 million drugs had been additionally shipped to McDowell County in West Virginia, a county with a inhabitants of 28,00zero — sufficient for almost 86 drugs per capita per yr.16 Based on Geldhof, the DEA saved searching for “a good-faith effort” by drug distributors “to do the best factor,” however there was none. “Greed all the time trumped compliance,” he says. DEA efforts to enhance compliance additionally got here to naught. “They only flat out ignored us,” Geldhof says.
Chump Change Fines Levied
In 2008, the DEA levied a $13.2 million effective in opposition to McKesson for the filling of a whole bunch of suspicious orders totaling tens of millions of drugs. Cardinal Well being was additionally fined $34 million that very same yr. Such fines did nothing to stem the tide, nonetheless. Earlier this yr McKesson once more agreed to pay a $150 million settlement for a similar violation — the biggest effective ever levied in opposition to a drug distributor.
The settlement additionally prevents McKesson from promoting managed substances from distribution facilities in Colorado, Ohio, Michigan and Florida “for a number of years,” and imposes “new and enhanced compliance obligations on McKesson’s distribution system,” in keeping with the U.S. Division of Justice.17 Nonetheless, when you think about the large earnings made by these firms — in 2008, Cardinal Well being was reporting $Three.four billion in annual income — even fines within the tens of tens of millions quantity to chump change.
Drug Distributors Took Purpose at DEA
In all, distributors have been slapped with fines in extra of $341 million over the previous seven years,18 with little impact. Quite the opposite, distributors began complaining to Congress saying the DEA was “treating them like a international drug cartel.” In 2011, Cardinal Well being took purpose at Rannazzisi personally. 4 years later, after having his authority tremendously lowered, he resigned. As reported by CBS:
“The businesses’ attorneys went over his head and referred to as his bosses on the Justice Division, who referred to as in Rannazzisi to have him clarify his ways. ‘And it infuriated me that I used to be over there, attempting to clarify what my motives had been or why I used to be going after these companies?
And after I went again to the workplace, and I sat down with my workers, I principally mentioned, ‘You realize, I simply obtained questioned on why we’re doing … what we’re doing … [N]ow that is conflict. We’re going after these individuals and we’re not going to cease’ …
Rannazzisi says the drug trade used [industry] cash and affect to strain prime legal professionals on the DEA to take a softer strategy. Former DEA lawyer Jonathan Novak mentioned it divided the litigation workplace. He mentioned in 2013, he observed a sea change in the best way prosecutions of huge distributors had been dealt with.
Circumstances his supervisors as soon as would have simply accredited, now weren’t ok … Novak prosecuted instances dropped at him by Joe Rannazzisi’s investigators. He mentioned his caseload began to decelerate dramatically … [Jonathan Novak said:] ‘These had been instances the place the proof was crystal clear that there was wrongdoing occurring.’ He mentioned his bosses began to lavatory down the system, demanding ever extra proof.”
A number of Dozen DEA Officers Have Taken Drug Business Jobs
Based on Novak, one of many major causes for the slowdown in instances was the exodus of DEA legal professionals that took high-paying jobs working for the drug trade. Not less than 56 former DEA and Division of Justice officers have been employed by the drug trade since 2000.19 As soon as on the trade’s facet, they lobbied in opposition to the DEA, arguing the company’s instances had been weak and did not stand an opportunity in courtroom — regardless that they’d constantly gained most of their instances up to now.
In different phrases, these attorneys levied their insider information of potential weak factors in opposition to their former employer to guard the trade — all whereas prescription charges, dependancy charges and opioid-related overdoses saved growing. However the trade wasn’t glad with slowing the DEA right down to a crawl. They wished the company off its again completely. So, lobbyists began engaged on Congress to enact laws that will successfully remove the DEA’s powers of enforcement.
DEA Stripped of Its Enforcement Powers
Simply such a regulation was handed in April 2016. The Making certain Affected person Entry and Efficient Drug Enforcement Act severely restricts the DEA’s potential to trace and cost pharmacies and wholesalers who’re increasing the opioid epidemic.
As famous by Rannazzisi, when you actually wished to hurt the U.S. with medication, “the one factor I might consider that will instantly hurt is to take the authority away from the investigative company that’s attempting to implement the Managed Substances Act and the rules applied below the act. And that is what this invoice did.”
On account of this laws, the DEA not has the ability to freeze suspicious distribution of prescription narcotics. The regulation additionally successfully prevents individuals on the prime of the chain from being held accountable. Total, the DEA’s potential to go after wholesale distributors peddling narcotics to tablet mills is now almost nonexistent. As famous by Novak, the Justice Division has been rendered “toothless; I do not understand how they cease this now.”
The primary sponsor of the regulation — and a staunch advocate for the drug trade on the whole — was Rep. Tom Marino, R-Pa., a former county and federal prosecutor nominated by President Trump to grow to be the subsequent drug czar. Fortuitously, this explicit fox was not entrusted with the hen home. In mid-October, Marino withdrew his title from consideration.20
Marino No Longer within the Working for Drug Czar
Marino’s choice got here proper on the heels of this joint investigation by 60 Minutes and The Washington Put up — which recognized Marino as a key participant in getting the invoice handed21 — and President Trump’s announcement that his administration would look into the allegations in opposition to Marino.22 As famous by Charlie Brown, president of Shoppers for Dental Selection and the World Alliance for Mercury-Free Dentistry, in a personal e-mail to me:
“Now the actual battle begins. Extra essential than the destiny some Congressman from rural Pennsylvania who works secretly in opposition to his personal constituents is that this dangerous regulation, which Congress created therefore solely Congress can repeal. should come off DEA’s energy to behave in opposition to heroin drug kingpins within the company suites carrying their three-piece fits and lab coats — and the native distributors whose names finish in M.D. and DDS and MHA (Masters in Hospital Administration).
A marketing campaign to point out Congressional complicity in heroin should get to the grassroots; accountability should start. Congress will not be powerful on unlawful medication, passing legal guidelines that put a pathetic drug person in jail for all times; Congress is hard on medication by slicing off the availability and placing in jail the kingpins.”
Sen. Joe Manchin, D-W.Va., instructed The Washington Put up23 he was “horrified” by the revelations of the investigation, saying the true intent of Marino’s invoice was “camouflaged,” such that nobody understood the impact it could have on the opioid epidemic. “That invoice needs to be retracted, needs to be repealed,” Manchin mentioned. Sen. Claire McCaskill, D-Mo., has introduced she is going to in reality introduce laws to repeal it. Manchin has additionally steered Rannazzisi could be a superb candidate to move the DEA.
It is value noting the invoice was truly written by former director of DEA litigation and compliance observe, Linden Barber, one of many a number of dozen individuals who swapped sides to work on behalf of the drug trade. His deep understanding of the inner workings of the company’s enforcement methods is a part of what makes the regulation so efficient in its potential to hinder DEA motion in opposition to drug firms and distributors.
President Renews Vow to Deal with Opioid Epidemic
Drug firms, distributors, drugstore chains and drug producers additionally spent $102 million lobbying for the invoice, claiming the DEA was impeding sufferers’ potential to obtain “wanted remedy.” With statistics clearly telling a distinct story, it ought to have been simple to see by means of this ruse. Clearly, it was (and is) far too simple to get your fingers on these drugs. But the drug trade gained, and after they win, they usually accomplish that on the sufferers’ expense.
October 16, after the 60 Minutes interview aired, President Trump introduced his intention to declare opioid dependancy a nationwide emergency, thereby securing much-needed funds and coverage initiatives to handle the burgeoning epidemic.24,25 He had initially supported such a transfer again in August, and has defended accusations of foot dragging by saying it entails numerous time-consuming work.
CVS Takes Affirmative Motion
In associated information, CVS Pharmacy lately introduced it’s going to restrict opioid prescriptions to a seven-day provide for sure well being circumstances26 — almost one-third of the typical provide prescribed by U.S. medical doctors. As of 2015, the typical prescription for an opioid was 18 days’ value.27 By doing so, CVS turns into the primary pharmacy chain to limit medical doctors’ potential to overprescribe the medication. CVS pharmacists will even be required to:
- Talk about the dangers of dependancy with sufferers
- Instruct sufferers on safe storage and correct disposal
- Use immediate-release formulations earlier than dishing out extended-release variations, to decrease the affected person’s danger of constructing tolerance
The initiative is scheduled to roll out as of February 1, 2018. CVS can be increasing its drug disposal assortment program, including an extra 750 kiosks at pharmacies throughout the U.S., for a nationwide whole of 1,500, and is pledging an extra $2 million donation to medication-assisted therapy packages provided by group well being facilities. One other earlier noble motion they did was to refuse to promote cigarettes of their shops.
Regardless of Epidemic of Opioid-Associated Deaths, Medical doctors Are Nonetheless Being Paid to Enhance Opioid Gross sales
Clearly, to actually rein in the issue of overprescriptions and dependancy, medical doctors want to vary their prescription habits. Sufferers have to take larger duty for their very own well-being as effectively. Greater than 33,00zero People had been killed by opioids in 2015, and almost half of them concerned a prescription for the medication.
Understanding that these medication carry the intense danger of dependancy, abuse and overdose, they need to be prescribed sparingly and just for essentially the most extreme instances of ache, for which no different choices can be found. As an alternative, they’re typically prescribed broadly to deal with milder instances of persistent ache, similar to that from osteoarthritis or again ache, the latter of which has was a serious “gateway situation” that traps unsuspecting sufferers within the grip of dependancy.
Sadly, the present medical system closely discourages medical doctors from making much-needed modifications of their prescription habits. Affected person ache evaluation performs a major function in a health care provider’s high quality of care indicator, and nothing will remove ache as successfully as a narcotic. In different phrases, if sufferers report not getting ache reduction, a health care provider’s ranking will go down. On prime of that, and within the midst of this epidemic of opioid overdose deaths, drug firms are additionally nonetheless paying physicians to spice up opioid gross sales by writing extra prescriptions.
Based on a research printed within the American Journal of Public Well being,28 between August 2013 and December 2015, greater than 375,00zero nonresearch opioid-related funds had been made to greater than 68,00zero physicians, totaling in extra of $46 million. This quantities to 1 in 12 U.S. physicians amassing cash from drug firms producing prescription opioids.
The highest 1 p.c of physicians acquired almost 83 p.c of the funds, and the drug fentanyl, an artificial opioid that may be anyplace from 500 to 1,00zero p.c stronger than morphine, was related to the best funds. Lots of the states battling the best charges of overdose deaths, similar to Indiana, Ohio and New Jersey, had been additionally these exhibiting essentially the most opioid-related funds to physicians. This means there is a direct hyperlink between medical doctors’ kick-backs and affected person dependancy charges and deaths.
It is also value noting vital quantity of individuals get their first opioid prescription from their dentist.29 That is notably true for youngsters and younger adults.30 Half of all opioids are additionally prescribed to individuals with psychological well being issues.31
Nondrug Options for Ache Reduction
It is extraordinarily essential to be absolutely conscious of the addictive potential of opioid medication, and to significantly weigh your want for them. There are numerous different methods to handle ache. Under is an extended listing of recommendations. Clearly, there are occasions when ache is so extreme narcotic ache reliever could also be warranted. However even in these cases, the choices that comply with could mean you can not less than scale back the quantity you’re taking, or the frequency at which it is advisable take them.
In case you are in ache that’s tolerable, please attempt these choices first, earlier than resorting to prescription painkillers of any sort. When you want a ache reliever, contemplate an over-the-counter (OTC) choice. Analysis32 exhibits prescription-strength naproxen (Naprosyn, offered OTC in decrease dosages as Aleve) supplies the identical ache reduction as extra harmful narcotic painkillers. Nonetheless, whereas naproxen could also be a greater various to narcotic painkillers, it nonetheless comes with a really lengthy listing of potential negative effects,33 and the dangers enhance with frequency of use.
✓ Eradicate or radically scale back most grains and sugars out of your food plan
Avoiding grains and sugars will decrease your insulin and leptin ranges and reduce insulin and leptin resistance, which is likely one of the most essential explanation why inflammatory prostaglandins are produced. That’s the reason stopping sugar and sweets is so essential to controlling your ache and different varieties of persistent sicknesses.
✓ Take a high-quality, animal-based omega-Three fats
Omega-Three fat are precursors to mediators of irritation referred to as prostaglandins. (In reality, that’s how anti-inflammatory painkillers work, by manipulating prostaglandins.) Good sources embrace wild caught Alaskan salmon, sardines and anchovies, that are all excessive in wholesome omega-3s whereas being low in contaminants similar to mercury. As for dietary supplements, my favourite is krill oil, because it has a number of advantages superior to fish oil.
✓ Optimize your solar publicity and manufacturing of vitamin D
Optimize your vitamin D by getting common, applicable solar publicity, which is able to work by means of a wide range of totally different mechanisms to scale back your ache. Solar publicity additionally has anti-inflammatory and ache relieving results which can be unrelated to vitamin D manufacturing, and these advantages can’t be obtained from a vitamin D complement.
Pink, near-, mid- and far-infrared gentle remedy (photobiology) and/or infrared saunas might also be fairly useful because it promotes and speeds tissue therapeutic, even deep contained in the physique.
✓ Medical hashish
Medical marijuana has an extended historical past as a pure analgesic and is now authorized in 29 states together with Washington, D.C. You’ll be able to study extra concerning the legal guidelines in your state on medicalmarijuana.procon.org.34
Kratom (Mitragyna speciosa) is one other plant treatment that has grow to be a well-liked opioid substitute.35 In August 2016, the U.S. Drug Enforcement Administration issued a discover saying it was planning to ban kratom, itemizing it as a Schedule 1 managed substance. Nonetheless, following large outrage from kratom customers who say opioids are their solely various, the company reversed its choice.36
Kratom is probably going safer than an opioid for somebody in severe and persistent ache. Nonetheless, it is essential to acknowledge that it’s a psychoactive substance and shouldn’t be used carelessly. There’s little or no analysis exhibiting tips on how to use it safely and successfully, and it could have a really totally different impact from one individual to the subsequent.
Additionally, whereas it could be helpful for weaning individuals off opioids, kratom is in itself addictive. So, whereas it seems to be a far safer various to opioids, it is nonetheless a strong and doubtlessly addictive substance. So please, do your individual analysis earlier than attempting it.
✓ Emotional Freedom Strategies (EFT)
EFT is a drug-free strategy for ache administration of all types. EFT borrows from the ideas of acupuncture in that it helps you steadiness out your refined vitality system. It helps resolve underlying, typically unconscious, and unfavourable feelings that could be exacerbating your bodily ache. By stimulating (tapping) well-established acupuncture factors together with your fingertips, you rebalance your vitality system, which tends to dissipate ache.
✓ Meditation and Mindfulness Coaching
Amongst volunteers who had by no means meditated earlier than, those that attended 4 20-minute courses to study a meditation method referred to as centered consideration (a type of mindfulness meditation) skilled vital ache reduction — a 40 p.c discount in ache depth and a 57 p.c discount in ache unpleasantness.37
Many research have confirmed that chiropractic administration is way safer and fewer costly than allopathic medical therapies, particularly when used for ache similar to low again ache.
Certified chiropractic, osteopathic and naturopathic physicians are dependable, as they’ve acquired in depth coaching within the administration of musculoskeletal problems throughout their course of graduate well being care coaching, which lasts between 4 and 6 years. These well being consultants have complete coaching in musculoskeletal administration.
Analysis has found a “clear and sturdy” impact of acupuncture in the therapy of again, neck and shoulder ache, and osteoarthritis and complications.
✓ Bodily remedy
Bodily remedy has been proven to be nearly as good as surgical procedure for painful circumstances similar to torn cartilage and arthritis.
✓ Basis Coaching
Basis coaching is an modern methodology developed by Dr. Eric Goodman to deal with his personal persistent low again ache. It is a wonderful various to painkillers and surgical procedure, because it truly addresses the reason for the issue.
✓ Therapeutic massage
A scientific assessment and meta-analysis printed within the journal Ache Medication included 60 high-quality and 7 low-quality research that seemed into the usage of therapeutic massage for varied varieties of ache, together with muscle and bone ache, complications, deep inside ache, fibromyalgia ache and spinal wire ache.38
The assessment revealed therapeutic massage remedy relieves ache higher than getting no therapy in any respect. When in comparison with different ache therapies like acupuncture and bodily remedy, therapeutic massage remedy nonetheless proved useful and had few facet results. Along with relieving ache, therapeutic massage remedy additionally improved anxiousness and health-related high quality of life.
Astaxanthin is one of the vital efficient fat-soluble antioxidants identified. It has very potent anti-inflammatory properties and in lots of instances works much more successfully than anti-inflammatory medication. Larger doses are usually required and it’s possible you’ll want Eight milligrams (mg) or extra per day to realize this profit.
This herb has potent anti-inflammatory exercise and provides ache reduction and stomach-settling properties. Contemporary ginger works effectively steeped in boiling water as a tea or grated into vegetable juice.
In a research of osteoarthritis sufferers, those that added 200 mg of curcumin a day to their therapy plan had lowered ache and elevated mobility. A previous research additionally discovered turmeric extract composed of curcuminoids blocked inflammatory pathways, successfully stopping the overproduction of a protein that triggers swelling and ache.39
Additionally identified as boswellin or “Indian frankincense,” this herb accommodates particular lively anti-inflammatory elements.
This enzyme, present in pineapples, is a pure anti-inflammatory. It may be taken in complement type however consuming recent pineapple, together with a few of the bromelain-rich stem, might also be useful.
✓ Cetyl Myristoleate (CMO)
This oil, present in fish and dairy butter, acts as a joint lubricant and anti-inflammatory. I’ve used this for myself to alleviate ganglion cysts and carpal tunnel syndrome. I used a topical preparation for this.
✓ Night Primrose, Black Currant and Borage Oils
These include the important fatty acid gamma-linolenic acid (GLA), which is notably helpful for treating arthritic ache.
✓ Cayenne Cream
Additionally referred to as capsaicin cream, this spice comes from dried scorching peppers. It alleviates ache by depleting the physique’s provide of substance P, a chemical part of nerve cells that transmits ache indicators to your mind.
✓ Strategies similar to cold and hot packs, aquatic remedy, yoga, varied mind-body methods and cognitive behavioral remedy40 may end in astonishing ache reduction with out medication.
Strolling barefoot on the earth might also present a sure measure of ache reduction by combating irritation.
✓ Thoughts-Physique Therapies
Strategies similar to cold and hot packs, aquatic remedy, yoga, varied mind-body methods and cognitive behavioral remedy41 may end in astonishing ache reduction with out medication.
✓ Low-Dose Naltrexone (LDN)
Naltrexone is an opiate antagonist, initially developed within the early 1960s for the therapy of opioid dependancy. When taken at very low doses (LDN, out there solely by prescription), it triggers endorphin manufacturing, which may increase your immune perform and ease ache.
- 1 Aplus.com April 19, 2016
- 2 NPR.com July 1, 2014
- Three Newsy.com December 18, 2016
- four CDC.gov December 16, 2016
- 5 CNN October 20, 2017
- 6 CDC Morbidity and Mortality Weekly Report December 30, 2016 / 65(50-51);1445–1452
- 7 CDC Prescription Opioid Overdose Knowledge
- Eight Washington Put up April 2, 2017
- 9, 10 Drugabuse.gov Overdose Loss of life Charges as of September 2017, Supporting Knowledge Doc (XLS)
- 11 CDC.gov Main Causes of Loss of life 2015
- 12 The Atlantic October 18, 2017
- 13, 15, 18 CBS Information October 15, 2017
- 14 The Guardian October 19, 2017
- 16 Sharon Herald December 24, 2016
- 17 Justice.gov January 17, 2017
- 19 Washington Put up October 15, 2017
- 20  Vox October 17, 2017
- 21 Washington Put up October 17, 2017
- 22, 23 Washington Put up October 16, 2017
- 24 CNN October 16, 2017
- 25 Washington Examiner October 22, 2017
- 26 NBC Information September 29, 2017
- 27 CDC.gov Morbidity and Mortality Weekly Report July 7, 2017; 66(26);697–704
- 28 American Journal of Public Well being August Eight, 2017
- 29 STAT Information October 17, 2017
- 30 AL.com April 15, 2017
- 31 Kaiser Well being Information June 26, 2017
- 32 WebMD October 20, 2015
- 33 Drugs.com Naproxen
- 34 medicalmarijuana.procon.org, Legal guidelines, Charges, and Possession Limits
- 35 Current Subjects in Medicinal Chemistry 2011;11(9):1165-75
- 36 Washington Put up October 12, 2016
- 37 J Neurosci. 2011 Apr 6;31(14):5540-Eight
- 38 Pain Medication Might 10, 2016
- 39 Arthritis & Rheumatism November 2006; 54(11): 3452–3464
- 40, 41 CNN Might 25, 2014