Connect with us

International

OxyContin created the opioid crisis, but stigma and prohibition have fueled it

False narratives about drug addiction and policies that are not supported by research are deepening the overdose epidemic in the US.

Published

on

People around the world mourned loved ones on International Overdose Awareness Day on Aug. 31, 2021. NurPhoto/Getty Images

The highly contentious Purdue Pharma settlement announced Sept. 1, 2021, comes at a pivotal time for the U.S. overdose crisis: 2020 was the worst year on record, with over 93,000 Americans losing their lives to fatal drug overdose. The drug overdose epidemic, now more than two decades long, has claimed the lives of more than 840,000 people since 1999. Current estimates suggest that some 2.3 million people in the U.S. use heroin and 1.7 million people use pharmaceutical opioids without a prescription.

Since 2016, I’ve studied the overdose crisis with an eye to understanding its roots as well as its ramifications. As a sociologist, I came to this area of research in my own quest for meaning, as each year brought more funerals of former classmates and friends. What I found was an increasingly dangerous drug environment for people who use drugs, often exacerbated by policies not founded in research and by attitudes that harm those affected.

How prohibition fuels dangerous markets

Research shows that the illicit drug market adapts to both demand and drug enforcement efforts.

The first consequence of increased demand is that drugs become cheaper over time. For example, the price of heroin and cocaine have been falling for decades. Political economists explain that demand, coupled with globalization, increases efficiency and competition. The result is that there are more drugs on the illicit market, which in turn lowers prices.

Second, as a response to drug prohibition, drugs become more potent. A stronger product in a smaller package is easier to transport and harder to detect. The American overdose crisis has become a case study in the devastating interplay of demand and prohibition.

OxyContin was released in 1996 and mass-marketed as a revolutionary intervention in the medical treatment of pain. Purdue Pharma, its maker, knowingly downplayed its addictive potential. As an opioid and central nervous depressant, OxyContin has effects similar to those of morphine or heroin. Not surprisingly, studies show that prescription patterns of opioids from 1999 to 2008 were directly linked to a surge in overdose deaths.

Pill bottle and pills of OxyContin prescription-only pain medication
Oxycontin prescription-only pills were aggressively promoted to primary care physicians as a safe and effective pain control method for patients. Lawrence K. Ho/Los Angeles Times via Getty Images

As concern over opioid overdose grew, doctors’ prescribing practices came under scrutiny. In 2010, Purdue Pharma replaced the original OxyContin with an “abuse deterrent” formulation that was more difficult to crush and inhale. As a result, many people who were addicted to OxyContin turned to heroin, which was cheaper and easier to get. This spurred a surge in heroin-related fatal overdoses, which is often termed the second wave of the overdose crisis.

The growing market for heroin paved the way for the introduction of fentanyl into the illicit U.S. drug market. Fentanyl, a drug used in medical settings for severe pain, is 50 times more potent than heroin. From the standpoint of efficiency for shipping and trafficking, fentanyl is easier to transport and sell than heroin. Fentanyl’s entry into the illicit drug market, in particular in combination with heroin, led to a doubling and tripling of overdose deaths around 2012 to 2013.

Since then, fentanyl has contaminated the U.S. illicit drug supply: It is often found in not just heroin but cocaine, MDMA – commonly known as Ecstasy – methamphetamine and counterfeit prescription pills. The result is that most people do not know the potency or contents of what they are using.

As the overdose crisis evolves, communities of color in particular have experienced a surge in fatal overdoses – deaths that are often preventable. And most recently, COVID-19 supply chain disruptions led people to use whatever was available, causing a surge in overdoses from drug mixing.

Barriers to treatment

Too often, people who use drugs are bombarded with messages that are not supported by research and that deepen the harm.

Public health officials and community leaders urge people to seek treatment and highlight that recovery is within reach. Yet, roughly 70% of people who seek treatment are unable to access it. Barriers to treatment include health care costs, lack of available treatment options and social stigma. Research also demonstrates that some people are not ready for treatment or do not want to be sober.

Sobriety is touted as the ultimate goal for people who use drugs. Yet research shows that addiction is a recurring brain disease, and relapse is highly likely. Most people who use drugs do so in a sporadic way that features bouts of controlled and uncontrolled use as well as sobriety. It is also well documented that fear of arrest and shame encourages people to hide their drug use in ways that increase their risk of a fatal overdose. This is because when people use alone, there is no one there to call 911 or perform CPR should an overdose occur.

Woman holding up phone with image of brother and son who died after taking fentanyl-laced drugs
Laurie Restivo’s brother, David Restivo, 47 (left on phone image), died from fentanyl-laced heroin, and her son, Jason Fisher Jr., 25 (right), died from fentanyl-laced cocaine. Reading Eagle/MediaNews Group via Getty Images

In terms of effective treatment, medically assisted treatments are considered the gold standard for opioid use disorder, yet they are still underutilized. Buprenorphine is an opioid with a “ceiling effect,” meaning it does not intoxicate like morphine or heroin but instead satiates an opioid craving. Buprenorphine assists people in transitioning away from uncontrolled use and mitigates physical cravings. People who are prescribed it are often able to work, attend therapy and regain enjoyment of day-to-day life.

Nonetheless, buprenorphine’s availability varies widely by state, and people of color are persistently underprescribed this lifesaving medication. Methadone has been used as a treatment for opioid use disorder since the 1950s, yet it is persistently hard to access long term. Researchers point to the ongoing role of stigma in the underuse of both of these medications.

Better paths forward

Public health officials, harm reduction activists and concerned citizens across the U.S. are working to secure safer injection sites where people can use drugs in the presence of medical staff. Such sites facilitate the prevention of fatal overdose by assuring an adequate and timely medical response and open a pathway for further health care and addiction-related treatment. In response to the pandemic’s strains on inpatient care facilities, take-home methadone availability was expanded in new ways – a change that some treatment experts hope will be permanent.

For people who use drugs, the potency and contents of their drugs are often unknown. Drug-checking programs allow people to inspect the contents of their drugs for fentanyl at home with a simple test strip. Such programs have recently gained traction with federal support. States also continue to expand access to naloxone, an overdose reversal nasal spray that is simple to administer. People who use drugs or have loved ones who use drugs are encouraged to receive training on how to administer naloxone and to carry the nasal spray on them.

Those who argue for a safer supply and decriminalization of drugs point to success abroad. Heroin-assisted treatment is shown to be effective in keeping people away from an unpredictable drug market, thus lowering the risk of overdose. Germany’s use of heroin-assisted treatment improved patients’ physical and mental health while dramatically reducing illicit drug use. In the early 2000s, Portugal decriminalized all drugs in response to consistently having the highest fatal overdose rates in Western Europe. With diversion of funds away from prohibition to education and treatment, Portugal saw a drop in overall drug use and now boasts among the lowest fatal overdose rates in Western Europe.

Americans are the world’s largest consumers of drugs and consistently have among the highest rates of opioid and cocaine dependence globally. In my own research, I’ve found that people often describe drug use as a battle between sobriety and death. But the heartbreaking surge in accidental, fatal overdose deaths tells a much more complex story. Ignoring the evidence will surely cost many more lives.

If you or someone you care about has a substance use disorder and wants help, you can call SAMHSA’s National Helpline: 1-800-662-HELP (4357). Immediate emotional support is available from the National Suicide Prevention Hotline 800-273-8255.

[Get our best science, health and technology stories. Sign up for The Conversation’s science newsletter.]

Emily B. Campbell ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.

Read More

Continue Reading

International

This country became first in the world to let in tourists passport-free

Singapore has been on a larger push to speed up the flow of tourists with digital immigration clearance.

Published

on

In the fall of 2023, the city-state of Singapore announced that it was working on end-to-end biometrics that would allow travelers passing through its Changi Airport to check into flights, drop off bags and even leave and exit the country without a passport.

The latter is the most technologically advanced step of them all because not all countries issue passports with the same biometrics while immigration laws leave fewer room for mistakes about who enters the country.

Related: A country just went visa-free for visitors with any passport

That said, Singapore is one step closer to instituting passport-free travel by testing it at its land border with Malaysia. The two countries have two border checkpoints, Woodlands and Tuas, and as of March 20 those entering in Singapore by car are able to show a QR code that they generate through the government’s MyICA app instead of the passport.

A photograph captures Singapore's Tuas land border with Malaysia.

Here is who is now able to enter Singapore passport-free

The latter will be available to citizens of Singapore, permanent residents and tourists who have already entered the country once with their current passport. The government app pulls data from one's passport and shows the border officer the conditions of one's entry clearance already recorded in the system.

More Travel:

While not truly passport-free since tourists still need to link a valid passport to an online system, the move is the first step in Singapore's larger push to get rid of physical passports.

"The QR code initiative allows travellers to enjoy a faster and more convenient experience, with estimated time savings of around 20 seconds for cars with four travellers, to approximately one minute for cars with 10 travellers," Singapore's Immigration and Checkpoints Authority wrote in a press release announcing the new feature. "Overall waiting time can be reduced by more than 30% if most car travellers use QR code for clearance."

More countries are looking at passport-free travel but it will take years to implement

The land crossings between Singapore and Malaysia can get very busy — government numbers show that a new post-pandemic record of 495,000 people crossed Woodlands and Tuas on the weekend of March 8 (the day before Singapore's holiday weekend.)

Even once Singapore implements fully digital clearance at all of its crossings, the change will in no way affect immigration rules since it's only a way of transferring the status afforded by one's nationality into a digital system (those who need a visa to enter Singapore will still need to apply for one at a consulate before the trip.) More countries are in the process of moving toward similar systems but due to the varying availability of necessary technology and the types of passports issued by different countries, the prospect of agent-free crossings is still many years away.

In the U.S., Chicago's O'Hare International Airport was chosen to take part in a pilot program in which low-risk travelers with TSA PreCheck can check into their flight and pass security on domestic flights without showing ID. The UK has also been testing similar digital crossings for British and EU citizens but no similar push for international travelers is currently being planned in the U.S.

Read More

Continue Reading

Government

Analysts issue unexpected crude oil price forecast after surge

Here’s what a key investment firm says about the commodity.

Published

on

Oil is an asset defined by volatility.

U.S. crude prices stood above $60 a barrel in January 2020, just as the covid pandemic began. Three months later, prices briefly went negative, as the pandemic crushed demand.

By June 2022 the price rebounded all the way to $120, as fiscal and monetary stimulus boosted the economy. The price fell back to $80 in September 2022. Since then, it has bounced between about $65 and $90.

Over the past two months, the price has climbed 15% to $82 as of March 20.

Oil prices often trade in a roller-coaster fashion.

Bullish factors for oil prices

The move stems partly from indications that economic growth this year will be stronger than analysts expected.

Related: The Fed rate decision won't surprise markets. What happens next might

Vanguard has just raised its estimate for 2024 U.S. GDP growth to 2% from 0.5%.

Meanwhile, China’s factory output and retail sales exceeded forecasts in January and February. That could boost oil demand in the country, the world's No. 1 oil importer.

Also, drone strokes from Ukraine have knocked out some of Russia’s oil refinery capacity. Ukraine has hit at least nine major refineries this year, erasing an estimated 11% of Russia’s production capacity, according to Bloomberg.

“Russia is a gas station with an army, and we intend on destroying that gas station,” Francisco Serra-Martins, chief executive of drone manufacturer Terminal Autonomy, told the news service. Gasoline, of course, is one of the products made at refineries.

Speaking of gas, the recent surge of oil prices has sent it higher as well. The average national price for regular gas totaled $3.52 per gallon Wednesday, up 7% from a month ago, according to the American Automobile Association. And we’re nearing the peak driving season.

Another bullish factor for oil: Iraq said Monday that it’s cutting oil exports by 130,000 barrels per day in coming months. Iraq produced much more oil in January and February than its OPEC (Organization of Petroleum Exporting Countries) target.

Citigroup’s oil-price forecast

Yet, not everyone is bullish on oil going forward. Citigroup analysts see prices falling through next year, Dow Jones’s Oil Price Information Service (OPIS) reports.

More Economic Analysis:

The analysts note that supply is at risk in Israel, Iran, Iraq, Libya, and Venezuela. But Saudi Arabia, the UAE, Kuwait, and Russia could easily make up any shortfall.

Moreover, output should also rise this year and next in the U.S., Canada, Brazil, and Guyana, the analysts said. Meanwhile, global demand growth will decelerate, amid increased electric vehicle use and economic weakness.

Regarding refineries, the analysts see strong gains in capacity and capacity upgrades this year.

What if Donald Trump is elected president again? That “would likely be bearish for oil and gas," as Trump's policies could boost trade tension, crimping demand, they said.

The analysts made predictions for European oil prices, the world’s benchmark, which sat Wednesday at $86.

They forecast a 9% slide in the second quarter to $78, then a decline to $74 in the third quarter and $70 in the fourth quarter.

Next year should see a descent to $65 in the first quarter, $60 in the second and third, and finally $55 in the fourth, Citi said. That would leave the price 36% below current levels.

U.S. crude prices will trade $4 below European prices from the second quarter this year until the end of 2025, the analysts maintain.

Related: Veteran fund manager picks favorite stocks for 2024

Read More

Continue Reading

International

Disney remote jobs: the most magical WFH careers on earth?

Disney employs hundreds of thousands of employees at its theme parks and elsewhere, but the entertainment giant also offers opportunities for remote w…

Published

on

The Walt Disney Co. (DIS)  is a major entertainment and media company that operates amusement parks, produces movies and television shows, airs news and sports programs, and sells Mickey Mouse and Star Wars merchandise at its retail stores across the U.S.

While most of the jobs at the multinational entertainment conglomerate require working with people — such as at its theme parks, film-production facilities, cruise ships, or corporate offices — there are also opportunities for remote work at Disney. And while remote typically means working from home, with Disney, it could also mean working in a non-corporate office and being able to move from one location to another and conduct business outside normal working hours.

Related: Target remote jobs: What type of work and how much does it pay?

What remote jobs are available at Disney?

Many companies, including Disney, have called employees to return to the office for work in the wake of the COVID-19 pandemic, and the bulk of the company’s positions are forward-facing, meaning they involve meeting with clients and customers on a regular basis. 

Still, there are some jobs at the “most magical company on earth” that are listed as remote and don’t require frequent in-person interaction with people, including opportunities in data entry and sales.

While thousands work in forward-facing positions, such as greeting customers at Disney’s theme parks around the world, there are some positions with the Walt Disney Co. that allow work to be done remotely.

Orlando Sentinel/Getty Images

On Disney’s career website, there are limited positions available where the work is completely remote. One listing, for example, is for a “graphics interface coordinator covering sporting events.” This role involves working on nights, weekends, and holidays — times when corporate offices tend to be closed — and it may make sense for the company to hire people who can work from home or to travel and work in a location separate from the game venue.

Some of the senior roles that are shown on the website involve managers who can oversee remote teams, whether that be in sales or data. Sometimes, a supervisor overseeing staff who work outside corporate offices may be responsible for hiring freelancers who work remotely.

On the employment website Indeed, there are limited positions listed. A job listing for a manager in enterprise underwriting for a federal credit union indicates weekend duty, working outside of an 8 a.m. to 5 p.m. schedule, and being able to work in different locations. The listed annual salary range of $84,960 to $132,000, though, is well above the national annual average of around $50,000.

Internationally, Disney offers remote work in India, largely in the field of software development for its India-based streaming platform, Disney+ Hotstar.

The company also offers some hybrid schemes, which involve a mixture of in-office and remote work. For a mid-level animator position based in San Francisco, the role would involve being in the office and working from home occasionally.

How much do remote jobs at Disney pay?

Pay for remote jobs at Disney varies significantly based on location. A salary for a freelance artist in New York City, for example, may be higher than for the same job in Orlando, Florida. 

Disney lists actual salary ranges in some of its job postings. For example, the yearly pay for a California-based compensation manager who works with clients is $129,000 to $165,000.

In an online search for “remote jobs at Disney,” results range from $30 to $39 an hour, for data entry, or $28.50 to $38 an hour for social media customer support.

How can I apply for remote jobs at Disney?

You can look for remote jobs on Disney's career site, and type “remote” in the search field. Listings may also appear on career-data websites, including Indeed and Glassdoor.

How many employees does Disney have?

In 2023, Disney employed about 225,000 people globally, of which around 77% were full-time, 16% part-time, and 7% seasonal. The majority of the workers, around 167,000, were in the U.S.

Disney says that a significant number of its employees, including many of those who work at its theme parks, along with most writers, directors, actors, and production personnel, belong to unions. It’s not immediately known how many remote workers at the company, if any, are union members. 

Read More

Continue Reading

Trending