阿片类药物危机升级，药片效力变得更强

2012年，美国阿片类药物危机造成的死亡人数不断升级，当年制药公司的强效成瘾性止疼药的出货量足够让全美国的每一个人（包括孩子）吃上20天。

在一些县——主要集中在阿巴拉契亚，当地的止疼药够吃100多天。

在针对该行业的诉讼中公布了一些关于药物供应的数据，美联社对上述数据的分析发现，直到这十年之初，阿片类药物的药片数量尽管开始下降，药效总量却仍然在上升。

原因是：医生开的药方药效更强，制药业供应的药片药效也更强。

“这表明，增加的不仅仅是药片的供应量。阿片类药物的实际处方量和消耗量都上升了。”斯坦福大学的教授安娜·兰姆克说，她是阿片类药物研究专家，在诉讼中为原告担任有偿专家证人。

“我们知道，即便是因为疼痛按照处方合法服用阿片类药物，药物剂量越高，服用时间越长，就越容易上瘾。”

美联社发现，从2006年到2012年，运往药店、医疗机构和医院的阿片类药物总剂量增加了55%。在此期间，药片的数量也显著增加，但增幅略低，约为44%。（药物剂量是通过一种叫做吗啡毫克当量的标准来计算的。）

2006年和2007年，接收阿片类药物最多的县都分布在美国东部，到2012年，它们都在阿巴拉契亚地区。数量也急剧上升。

例如，2006年，田纳西州汉布伦县的人均阿片类药物使用量居全国之首——大约相当于当地全部人口70天的常规处方用量。到2012年，弗吉尼亚州诺顿县排名第一，数量相当于134天的处方用量，令人咂舌。

在计算用药天数时，美联社使用50吗啡毫克当量作为每日剂量。这是美国疾病控制和预防中心（Centers for Disease Control and Prevention）设定的使用上限，医生需谨慎使用。

这些数据来自于美国联邦缉毒署（Drug Enforcement Administration）从制药公司收集的信息，这些信息主要包括受控物质是如何流通到药店、医生和医院的。这是2000多个州、地方和部族政府就阿片类药物危机起诉该行业的关键内容。

俄亥俄州凯霍加县和萨米特县是最先提起联邦诉讼的，计划于10月开庭。

7月中旬，一名法官同意公布2006年至2012年的数据。在此期间，美国阿片类药物服用过量导致的死亡人数从每年18000人增加到23000多人。此后，这个数字已经翻了一番，阿片类药物已经超过了汽车事故，成为该国意外死亡的头号原因。

在这十年的大部分时间里，海洛因和芬太尼等更强的毒品推动了危机的增长。研究发现，大多数海洛因新增吸食者的吸毒之路都始于服用开给他们或别人的处方药。

原告在诉讼中声称，制药商夸大了阿片类药物的好处，淡化了它们的成瘾性，劝说医生增加剂量，向更多的病人提供此类药物。

阿片类药物危机的起源在很大程度上可以追溯到20世纪90年代中期，当时普渡制药公司（Purdue Pharma）推出了奥施康定（OxyContin）。在此之前，阿片类药物一般只用于外科手术或极度疼痛的癌症患者。

政府部门在诉讼中还称，这些公司违反了美国缉毒署的政策，因为即使他们认为某些订单“可疑”——因为远远大于正常用量，却仍然正常发货。

例如，奥施康定的制造商普度制药公司的电子邮件显示，2009年10月27日下午4点15分，一名员工在药品分销商卡地纳健康公司（Cardinal Health）的一份订单上打了个标记，因为这张订单的数量几乎是该客户往常12周订单剂量的两倍。该订单价值近29.3万美元。

邮件显示，该订单于下午4点16分得到了批准。

这封电子邮件是7月末公布的一批行业文件的一部分。这些文件还包括今年早些时候的一份证词，美国最大的药品经销商之一卡地纳健康公司的一名高管在该证词中说，该公司在分销阿片类药物时没有义务对公众负责。

卡地纳健康公司的法律顾问詹妮弗·诺里斯被一位律师问及，该公司是否想“确保尽其所能地防止公众受到伤害？”

她回答说：“我不知道卡地纳健康公司在这方面对公众负有责任。”

她接着说：“卡地纳健康公司有义务根据法律、法规、规章和指南履行其职责。”

卡地纳健康公司的一位发言人说，该回应仅用于法律语境。（财富中文网）

译者：Agatha

In 2012, as the death toll from the nation’s opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply.

In some counties, mostly in Appalachia, it was well over 100 days.

An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip.

The reason: Doctors were prescribing—and the industry was supplying—stronger pills.

“It shows it wasn’t just the number of pills being shipped that increased. The actual amount of opioids being prescribed and consumed went up,” said Anna Lembke, a Stanford University professor who researches opioids and is serving as a paid expert witness for plaintiffs in the litigation.

“We know that the higher the dose of prescribed opioids, and the longer patients are on them, even for a legitimate pain condition, the more likely they are to get addicted.”

The AP found that the overall amount of opioid medication shipped to pharmacies, medical providers, and hospitals increased 55% from 2006 through 2012. The number of pills rose significantly over that period, too—but that increase was lower, about 44%. (The amount of medication was calculated using a standard measure of potency known as a morphine milligram equivalent, or MME.)

In 2006 and 2007, the counties at the very top of the list of those receiving the most opioids were scattered about the eastern half of the U.S. By 2012, they were all in the Appalachian region. And the numbers were up dramatically.

For instance, in 2006, Tennessee’s Hamblen County received the most opioid medication per person in the country—about 70 days’ worth of a typical prescription for every man, woman, and child. By 2012, the top county was Norton, Va., and the number of days’ worth of opioids was a staggering 134.

In calculating days of medication, the AP used 50 MMEs as a daily dosage. That is the upper limit beyond which the Centers for Disease Control and Prevention urges doctors to use caution.

The data comes from the federal Drug Enforcement Administration’s collection of information from pharmaceutical companies about how controlled substances were distributed down to pharmacies, doctors, and hospitals. It’s a key part of the case for some 2,000 state, local, and tribal governments suing the industry over the opioid crisis.

The first of the federal trials, involving claims from Ohio’s Cuyahoga and Summit counties, is scheduled to start in October.

In Mid-July, a judge agreed to make public the data covering 2006 through 2012. During that period, opioid overdose-related deaths in the U.S. increased from about 18,000 a year to more than 23,000. Since then, the number has doubled, and opioids have overtaken automobile accidents as the top cause of accidental death in the country.

Heroin and even stronger illicit drugs such as fentanyl drove the increase for most of this decade. Studies have found that most new heroin users started with prescription drugs that had been prescribed to them or to someone else.

Plaintiffs in the lawsuits claim drugmakers overstated the benefits of opioids and downplayed their addictiveness, persuading doctors to offer the drugs to more patients and in higher amounts.

The origins of the opioid crisis are largely traced to the mid-1990s, when Purdue Pharma introduced OxyContin. Up until then, opioids were generally reserved for surgery or cancer patients in extreme pain.

The government lawsuits also say the companies violated DEA policy by shipping orders even when they believed them to be “suspicious” because they were far larger than normal.

For example, an email chain from Purdue Pharma, the maker of OxyContin, showed an employee flagging an order at 4:15 p.m. on Oct. 27, 2009, from drug distributor Cardinal Health because it was nearly twice as big as the customer's usual 12-week order of a certain dosage. The order was worth close to $293,000.

It was approved at 4:16 p.m., the emails show.

The email was part of a new trove of industry documents made public in the end of July. They also include a transcript of a testy deposition earlier this year in which an executive at Cardinal Health—one of the nation’s largest drug distributors—said the company has no obligation to the public when it comes to the opioids it ships.

Cardinal Health counsel Jennifer Norris was asked by a lawyer whether the company wants to “ensure that it does what it can to prevent the public from harm?”

She answered: “I don’t know that Cardinal owes a duty to the public regarding that.”

She went on to say, “Cardinal Health has an obligation to perform its duties in accordance with the law, the statute, regulations, and guidance.”

A Cardinal spokeswoman said the comment was made only in a legal context.