I'm Barry Meier and for two decades I've chronicled for The New York Times how opioid abuse has ravaged America. Ask me anything.

Where I live, opioid prescriptions are extremely limited in duration and reasons for use. People who have used them for chronic pain have been cut off, told to find a green space for meditation or friends to talk to or line up with recreational users and get on the methadone train every day. The result in my area has been that heroin and fentanyl use has sky rocketed and so have OD’s.
How is this better? I’m not being funny. I just don’t understand how cutting off legit users has helped.

I am extremely sympathetic to your situation. There are patients who do well long term on opioids, particularly if dosages are not too high.

The problem, as I see it, is that opioid makers lobbied so hard to prevent any kind of reasonable control over these drugs that lawmakers eventually reacted by passing extremely stringent regulations in response.

Hopefully, doctors will provide patients with the treatments they need and will benefit them.

What was the story 20 years ago that brought you to this subject? How was it covered in the first 5 years vs these last five?

As often happens for reporters, I was sitting in the newsroom in late 2000 when an editor approached me and said he had gotten a tip from a druggist that a new drug called OxyContin was becoming a hot street drug. At the time, I didn't know anything about opioids, pain treatment, drug addiction, Purdue Pharma or the Sacklers. But I picked up the phone and started making calls. Soon, I realized the tipster was right.

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The companies that make them, the companies that distribute them and the companies that dispense them to patients.

As a chronic pain patient access to pain drugs is a big deal for me. Now with all this addiction news it is getting harder for me to acquire the drugs i need to function daily. I also worry about the dosages I'm given and if i am being made to take too many of these drugs.

Who is deciding which drugs patients receive and how much i should take? The prescriptions i am given do not match the recommended dosages for people of my size and symptoms

Why is this not a simple decision made by my medical practitioner?

How deep are the relationships between congress and the medical organizations responsible for advising public policy?

Why didn't our doctors speak up about this before now?

Doctors could and should have spoken up about this long ago.

But if you can believe it, the American Medical Association, the professions' lobbying organization, long opposed the idea of requiring doctors to undergo brief mandatory training as a condition of being able to prescribe the most addicting drugs to their patients.

Purdue shoulders a lot of blame for the opioid epidemic, but they regularly state that they only produced a small percentage of opioids on the market, from memory like 3 or 7 percent. Is that truthful or is it disingenuous?

That is truth but it is also convenient Purdue to downplay its role.

The company once accounted for a far larger share of the market and, experts believe that its promotion of OxyContin, which the Purdue acknowledged was criminal, laid the seeds for the disaster that followed.

First of all, thanks for joining the conversation.

We are about to start and I'll try to answer your questions as best as I can.

The opioid epidemic raises complex and difficult issues and the right answers are often not the easy ones.

Barry

What are your thoughts on the safe injection sites? I know it's worked in some European countries and I'm not apposed to it, but since you have been covering it for such a long time, I'd like to hear what your feelings are on this topic.

I have not really looked at this issue closely. But after watching this disaster unfold for two decades, I believe that any steps that reduce deaths should be considered. I know that some hospitals and treatment facilities have devices where drug users can screen pills they buy on the street for the presence of deadly fentanyl.

Thank you for doing this!

With the crisis continually spreading deeper into American culture and politics, it just seems like there isn’t a workable solution

is there any end in sight or anything a bystander (that cares about their fellow humans) can do to help?

.

My fear, and I hope I'm wrong, is that this crisis will be with us for a long time. It was allowed to fester for twenty years and without adequate prevention and treatments policies it may be here for twenty more.

How much of this is people without actual "real" pain, given opioids without any real due diligence by doctors, and then hooked.

As opposed to people with genuine pain, correctly given medication, then not managed off it.

Because the latter is a public healthcare issue, the former seems like criminal negligence?

it is a mixed bag. for many years, people abusing opioids was conning doctors into writing them prescriptions or going to docs who wrote scripts for cash.

but opioids also pose a variety of risks, including addiction, to patients taking them as prescribed by doctors.

What steps do you think that local public health departments can take to help combat opioid abuse on the local level?

Helping to make sure that the highest quality of addiction treatment services are available. This involves not only using drugs like buprenorphine but long-term counseling as well.

Given the massive financial and legal resources of such companies, what course of action can be taken against them? Should this come from elected officials, public action, or another avenue? And how realistic is it that these companies will be held accountable beyond a simple slap on the wrist like there have been in the past?

I hope that the massive combined opioid litigation now unfolding in an Ohio court has two outcomes: (1) that the truth about this industry knew and did comes out and (2) and that any funds awarded go for high-quality addiction treatment and not to lawyers or operators of treatment mills.

What are your thoughts on kratom?

sorry, really have not looked at it.

How much blame to you place on the American Pain Society's "Pain as the 5th Vital Sign" campaign for contributing to the opioid epidemic? Do you think this campaign, which began at approximately the same time that Purdue began cramming Oxycontin down doctor's prescription pads, had just as much impact at the drug itself?

this disaster was brought about by a number of forces, some well-meaning and some otherwise.

doctors were eager for an easy answer for patients in pain, a problem that can often be complex and multi-faceted.

What percentage of opioid overdose deaths started with the user being prescribed the opiod by a doctor vs recreational?

Good question and one for which, I believe, that there isn't really clear data.

In thinking about legal opioid use, though, it's important to consider that these drugs can have very significant side effects for patients that do not involve overdose, including emotional dependency, social withdrawal and reduced energy and drive.

Their long term use at high doses can also make patients, more responsive to pain.

What are your thoughts on marijuana use in comparison to opioids, or as a way to help people ween themselves off of opioids?

Medicinally, there appears some evidence that marijuana is useful to deal with pain. But I am unaware of information that suggest it can be used to wean people off opioids

So this is really a piece about Purdue Pharma, rather than opioids. That’s all fine and good, but the title should be clarified.

My question is this: do you think corporations have any duty to disclose the potential for addiction when developing drugs which, by their very nature, are addictive? In short, why is Purdue pharma responsible for telling people that OxyContin is addictive, when to any doctor or scientist, it’s common knowledge? Should the onus not be placed on the physician to ensure safe prescription practices?

Every drug company is responsible for telling doctors and patients about the addictive potential of an opioid and most doctors are aware of the risks these drugs pose.

Purdue Pharma admitted lying to patients and doctors by claiming that OxyContin, because it was a time-release drug, was less addicting that other opioids. It made billions doing so.

Doctors do have a responsibility. But companies have a responsibility not to lie to them.

If you had to present ideas for a solution to congress, what are the bullet points? Is there anything being done successfully at the state level...that other states should copy?

well funded addiction treatment.

stringent regulations on how opioids are marketed and promoted.

increased doctor education on their use and misuse.

With opioids killing so many people and affecting so many more why does it not get more press or talking points in politics versus something like home grown terrorism and gun violence that affect such a small amount of people in the country?

Do you see any change in this likely?

Unfortunately, every politician likes to talk about doing something about the opioid crisis. Few of them do anything

Our hour is up.

Thanks so much for your questions and for taking part in this discussion.

Signing off,

Barry Meier