Americans Popping Nearly Twice as Many Painkillers Than in 1997

People in the United States are living in a world of pain and they are popping pills at an alarming rate to cope with it.

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.

Oxycodone, the chemical used in OxyContin, is responsible for most of the increase. Oxycodone use jumped nearly six-fold between 1997 and 2005. The drug gained notoriety as "hillbilly heroin," often bought and sold illegally in Appalachia. But its highest rates of sale now occur in places such as suburban St. Louis, Columbus, Ohio, and Fort Lauderdale, Fla.

The world of pain extends beyond big cities and involves more than oxycodone.

In Appalachia, retail sales of hydrocodone — sold mostly as Vicodin — are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee.

Suburbs are not immune to the explosion.

While retail sales of codeine have fallen by one-quarter since 1997, some of the highest rates of sales are in communities around Kansas City, Mo., and Nashville, Tenn., and on New York's Long Island.

The DEA figures analyzed by the AP include nationwide sales and distribution of drugs by hospitals, retail pharmacies, doctors and teaching institutions. Federal investigators study the same data trying to identify illegal prescription patterns.

An AP investigation found these reasons for the increase:

—The population is getting older. As age increases, so does the need for pain medications. In 2000, there were 35 million people older than 65. By 2020, the Census Bureau estimates the number of elderly in the U.S. will reach 54 million.

—Drugmakers have embarked on unprecedented marketing campaigns. Spending on drug marketing has gone from $11 billion in 1997 to nearly $30 billion in 2005, congressional investigators found. Profit margins among the leading companies routinely have been three and four times higher than in other Fortune 500 industries.

—A major change in pain management philosophy is now in its third decade. Doctors who once advised patients that pain is part of the healing process began reversing course in the early 1980s; most now see pain management as an important ingredient in overcoming illness.

Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va., survived two helicopter crashes and Gulf War Syndrome over 20 years in the Marine Corps. He remains disabled from his service-related injuries and takes the equivalent of nine painkillers containing oxycodone every day.

"It's made a difference," he said. "I still have bad days, but it's under control."

Such stories should hearten longtime advocates of wider painkiller use, such as Russell Portenoy, head of New York's Beth Israel pain management department. But they have not.

"I'm concerned and many people are concerned," he said, "that the pendulum is swinging too far back."

Consider:

—More people are abusing prescription painkillers because the medications are more available. The vast majority of people with prescriptions use the drugs safely. But the number of emergency room visits from painkiller abuse has increased more than 160 percent since 1995, according to the government.

—Spooked by high-profile arrests and prosecutions by state and federal authorities, many pain-management specialists now say they offer guidance and support to patients but will not write prescriptions, even for the sickest people. The increase in painkiller retail sales continues to rise, but only barely. There was a 150 percent increase in volume in 2001. Four years later, the year-to-year increase was barely 2 percent.

—People who desperately need strong painkillers are forced to drive a long way — often to a different state — to find doctors willing to prescribe high doses of medicine. Siobhan Reynolds, the widow of a New Mexico patient who needed large amounts of painkillers for a connective tissue disorder, said she routinely drove her late husband to see an accommodating doctor in Oklahoma.

Perhaps no place illustrates the trends and consequences for the world of pain better than Myrtle Beach, a sprawling community of strip malls, hotels and bars perched along a 60-mile strip of sand on the Atlantic Ocean. The metro area, which includes three counties, is home to 350,000 people but sees more than 14 million tourists annually, drawn to its warm water, golf courses and shopping.

During the eight-year period reflected in government figures, oxycodone distribution increased 800 percent in the area of Myrtle Beach, partly due to a campaign by Purdue Pharmaceuticals of Stamford, Conn. The privately held company has pleaded guilty to lying to patients, physicians and federal regulators about the addictive nature of the drug.

Use of other drugs soared in the area, too: Hydrocodone use increased 217 percent; morphine distribution went up 180 percent; even meperidine, most commonly sold as Demerol, jumped 20 percent.

It is no small wonder that federal authorities suspected the area was home to a notorious "pill mill," or a clinic that dispenses prescription medication without verifying that it's needed.

The U.S. attorney for South Carolina secured a 58-count indictment in June 2002 against seven physicians and one employee of the Comprehensive Care and Pain Management Center, a nondescript storefront on Myrtle Beach's main drag.

Tipped off by local pharmacists concerned about an increase in the volume of painkiller prescriptions, the federal investigation created a furor in the medical profession. The owner, D. Michael Woodward, was sentenced to 15 years in the case and has relinquished his license.

A second physician, Deborah Bordeaux, had worked at the clinic less than two months before quitting in disgust. Bordeaux, now serving a two-year prison term, was threatened with a 100-year sentence if she did not help the prosecution.

Officials with the Justice Department and the DEA would not discuss what some activists say is a "war on doctors."

Reynolds, the widow who drove her late husband hundreds of miles for his pills, became an activist after the Myrtle Beach indictments. She contributed money to appeal some of the criminal convictions in South Carolina and started the Pain Relief Network, an advocacy organization for people living in pain. She believes the doctors sent to prison were railroaded.

"It was a witch hunt," she said.

Bordeaux's husband, Edworth Swaim, agrees. A retired U.S. Postal Service employee, Swaim believes his wife was sentenced to two years because she would not turn on her former colleagues. Even though Bordeaux had worked at the clinic less than two months and eventually sued over what she alleged was rampant Medicare fraud, he said she did not stand a chance of avoiding prison.

"She wasn't guilty of anything, so she wasn't going to plead to anything," Swaim said. "She was absolutely railroaded, made an example of. I can't tell you how angry I am."

Myrtle Beach physicians are not convinced that the "Myrtle Beach Eight," as they became known, were innocent.

A Myrtle Beach internist who also works in addiction medicine, Brian Adler, said physicians were flooded with patients seeking pain medicine after the clinic was shut down.

The community has a slightly higher-than-average number of older people and relatively high numbers of people between 21 and 64 who describe themselves as disabled.

"There's a significant problem with narcotics in this area," Adler said. After the pain management clinic closed, "all those folks were like rats, scurrying from a burning building, trying to get their fix."

Other physicians were concerned about patients with legitimate needs for painkillers. The federal bust raised the stakes.

When radio commentator Rush Limbaugh settled a federal case charging him with illegally obtaining painkillers, he did not get prison time. Neither did NFL star Brett Favre, who publicly acknowledged an addiction to Vicodin that he obtained legally.

To pain management specialists, they were being blamed for everyone's addiction.

The DEA cites 108 prosecutions of physicians during the past four years; 83 pleaded guilty or no contest, while 16 others were convicted by juries. Eight cases are pending, and one physician is being sought as a fugitive.

In congressional testimony, the agency's deputy assistant administrator, Joseph T. Rannazzisi, estimated that fewer than 1 percent of the nation's physicians — under 9,000 — illegally provide prescription drugs to patients. He told lawmakers it is far more common for people to illegally obtain prescription drugs from friends and family members.

"It is not merely illegal but could feed or lead to an addiction and place that loved one in a life-threatening situation," Rannazzisi said.

It is impossible to reliably measure painkiller abuse.

A 2004 government study estimated between 2 million and 3 million doses of codeine, hydrocodone and oxycodone are stolen annually from pharmacies, distributors and drug manufacturers. The AP's analysis only included retail sales and did not include estimates of diverted pharmaceuticals.

John Charles, director of medical affairs at the Grand Strand Regional Medical Center in Myrtle Beach, practices pain management. A few years ago, Charles said, he took a drastic step to reduce his potential legal risks: He stopped prescribing painkillers.

The decision gave him peace of mind, but he does not expect there to be less of a need for painkillers or physicians who prescribe them.

"People with cancer are surviving longer, elderly people are living longer," Charles said. "So, physicians are walking a fairly fine line. We're walking a narrow path. And I think we'll continue to see it for a while."

(http://www.foxnews.com/)

National Debt as a Percent of GDP

(http://zfacts.com/)

U.S. holding passports hostage until parents pay child support

WASHINGTON - New passport requirements that have complicated travel this summer also have uncovered untold numbers of child-support scofflaws and forced them to pay millions.

The price of a passport: $311,491 in back support payments for a U.S. businessman now living in China; $46,000 for a musician seeking to perform overseas; and $45,849 for a man planning a Dominican Republic vacation.

The State Department denies passports to non-custodial parents who owe more than $2,500 in child support. Once the parents make good on their debts, they can reapply for passports.

Now that millions of additional travelers need passports to fly back from Mexico, Canada, the Caribbean and South America, collections under the Passport Denial Program are on pace to about double this year, federal officials say.

In one case last year, a man got his parents to pay his overdue child support: $50,498 to the state of Illinois.

"For us, it's been amazing to see how people who owe back child support seem to be able to come up with good chunks of money when it involves needing their passport," said Adolfo Capestany of Washington state's Division of Child Support.

(http://www.azcentral.com)

Arizona - Ruling says hospitals can require full payment from patients

PHOENIX - A state appellate court on Tuesday ruled in a case with bottom-line impact for health-care consumers, deciding that all hospital patients aren't entitled to discounts given to many group insurance plans.

A dissenting Court of Appeals judge said the ruling ignores that some standard rates charged by hospitals could be "unconscionable."

Seven patients and their insurance company, Medical Savings Insurance Co., had appealed a Maricopa County Superior Court judge's ruling in favor of Phoenix-based Banner Health, a major Arizona hospital company.

The case revolved around the widespread practice in the American health-care industry for hospitals and other providers to give sharp price discounts to group plans that agree to steer patients to those providers.

Banner had rebuffed partial payments offered by Medical Savings on behalf of the patients as reasonable amounts for the care provided. Banner then sued to recover after the patients refused to pay Banner's full bills for their care.

All the patients or family members had signed admission papers agreeing to pay their hospital bills. Some of those agreements specifically referred to rates which Banner had filed with state regulators.

While Banner argued that it appropriately billed the patients, Medical Insurance contended that it and the patients were responsible only for reasonable charges.

Banner charged the patient 400 percent of its costs, sought full payment from only 2 percent of its customers and usually received 34 percent of its billed charges from patients who received similar care, Medical Insurance argued.

However, the majority of a three-judge panel noted that Banner had no agreement with Medical Insurance to provide rate discounts to its insured and that the patients' promises to pay were the only agreements between Banner and the patients regarding Banner's charges.

Hospitals are free to accept reduced payments to satisfy a bill but an unwillingness to do so for all patients isn't illegal or make the hospital's full rates unreasonable, Judge John C. Gemmill wrote for the panel's majority.

Judge Donn Kessler dissented from part of the ruling, saying the case should have included an evaluation of whether the full rates Banner filed with the state amounted to "unconscionable contract terms."

Banner's 576 pages of "single-space impenetrable filed rates" effectively make it impossible for consumers to price-shop in advance for their hospital care, Kessler said.

Judge Patricia A. Orozco joined Gemmill in the majority.

(http://www.azcentral.com)

Success Story Reg. "Chinese product scares prompt US fear"

By Laura Smith-Spark BBC News, Washington

Success story

A lesson may lie in the approach taken by the fireworks industry, which has focused on education and stringent product testing within China.

Firework safety has improved with closer monitoring in China

In the late 1980s and early 1990s, standards for Chinese-made fireworks were so low that as many as 75% failed US safety tests.

To tackle the problem, US importers were encouraged to pay for a testing operation set up in China - the American Fireworks Standards Laboratory (AFSL) - to monitor production straight from the assembly line.

At least three-quarters of US fireworks importers are signed up to the scheme and the lab has about 50 technicians in China.

Since 1994, injury rates among US consumers have dropped by more than two-thirds and sales of fireworks have increased greatly. About 99% of the fireworks used in the US come from China.

John Rogers, executive director of the AFSL, said: "It's had a very positive impact for the American public, for the government that regulates fireworks and obviously for the companies."

He admits that initially Chinese factories "weren't happy" about the AFSL's checks but, as Chinese-language guidelines were produced to help them meet US requirements, attitudes changed.

"What the manufacturers understand is that safer, better quality fireworks translates into bigger sales, so now they like what we do," he said.

"I think that every industry that imports products from China could very well benefit from this kind of a programme."

Of course, the majority of goods imported from China are perfectly safe - but until standards improve across the board, US consumers must rely on officials to sift out potential hazards before they cause harm.

(http://news.bbc.co.uk/)

Mattel Recalls Millions of Toys (as reported by Fox News, BBC, and CNN)

Reported by FOX News

Mattel Recalls Millions of Toys, Adds to Chinese-Made-Lead-Linked List

Toy-making giant Mattel Inc. (MAT) issued recalls Tuesday for about 9 million Chinese-made toys that contain magnets that can be swallowed by children or could have lead paint.

The recalls includes 7.3 million play sets, including Polly Pocket dolls and Batman action figures, and 253,000 die cast cars that contain lead paint. The action was announced on the company's Web site and at a news conference here by the Consumer Product Safety Commission.

Reported by BBC
Mattel recalls millions more toys

US toymaker Mattel has recalled more than 18 million toys worldwide, the second such recall in two weeks.

Chinese-made Sarge die-cast toys from the Pixar film Cars have been recalled because their paint contains lead.

It has also recalled toys containing small magnets that can come loose, including Polly Pocket, Batman Magna, Doggie Daycare and One Piece playsets.

Reported by CNN (under US)

BETHESDA, Maryland (CNN) -- Toymaker Mattel is voluntarily recalling 9 million of its toys in the United States including popular characters such as Batman, Barbie, Polly Pockets and a toy from Pixar's "Cars" movie because of hazards to children, the U.S. Consumer Product Safety Commission said Tuesday.

Mattel's Barbie and Tanner doll set is one of the products being recalled.

"The company has ordered that all products be pulled off retail shelves," said Nancy Nord, acting chairman of the commission.

Mattel is recalling 18.2 million magnetic toys globally and the majority of the toys are no longer available in stores.

Six slam-dunk time management tips

By Robert Half International

(CareerBuilder.com) -- The basketball court and the office may have more in common than you think. After all, one key to top performance in both arenas is time management. Keeping a careful eye on the clock can help your team sink buzzer-beating shots and allow you to work more effectively.

But properly managing your time isn't always easy, especially if last-minute projects or requests seem to constantly pop up. Even star players sometimes have trouble prioritizing competing demands. In fact, in a recent survey conducted by Robert Half International, executives cited time management as the greatest challenge they face today.

Whether you're a time-tested veteran or a promising rookie, the following tips will help you manage your time better:

Create a to-do list.

At the end of each day, invest some time in identifying and writing down the next day's tasks and rank them in terms of importance and urgency. Review your prioritized to-do list in the morning to get a good jump on the day.

Develop a system.

Tracking systems can help you stay on point. Options include project-management software programs, which electronically track activities and deadlines, and "tickler" files that remind you of pending items. And, of course, there's always a good old-fashioned planner, which you can use to write down each project on your plate, its status and the next steps you need to take. Choose whichever option you are most likely to stick with. By systematically monitoring your progress, you'll be less likely to procrastinate or overlook important dates and details.

Clean up.

How many times have you searched frantically for an important document only to find it days later, buried under outdated memos, take-out menus and sticky notes? Schedule time once a week to remove clutter from your office so you can work more efficiently. Go through documents and separate the critical from the unimportant. Once you've categorized an item, file it, forward it or trash it -- just don't leave it to collect dust on your desk.

Don't overextend yourself.

For instance, you can't write a detailed memo while simultaneously talking on the phone, filing paperwork and thinking about an upcoming brainstorming session. When working on a crucial assignment, give the issue at hand your undivided attention so you do it right the first time. Fight the urge to multitask, which often impedes real productivity by leading to oversights and errors.

Take a break from technology.

When you're trying to concentrate, is there anything more distracting than a vibrating cell phone or the pinging sound of an incoming e-mail or instant message? If possible, give yourself periodic breaks from technology. This will allow you to work free of interruption and get more done.

Help others.

There's no better way to build rapport, foster goodwill and gain allies than by volunteering to assist overworked and frazzled co-workers. By lending a hand when you can, you're likely to be offered one in return the next time you're swamped.

Developing stellar time-management skills takes practice and discipline, but your efforts will pay big dividends. By establishing good habits and making the most of each workday, you'll not only avoid mad scrambles, you'll also increase your chances of completing your projects well before the buzzer sounds.

(http://www.cnn.com/)

Battered jeans earn big bucks for Sri Lanka

by Mel GunasekeraSun Aug 12, 4:06 AM ET

The denims look tattered and frayed, but shoppers in Europe and the United States are prepared to pay good money for "distressed" jeans and Sri Lanka is cashing in.

In the industrial town of Avissawella east of the capital Colombo, it takes workers around 13 minutes to cut and sew basic five-pocket denims.

They then spend another four days torturing the pants by dying, bleaching, and sandpapering them to get a "distressed" look.

"Each garment is dyed or dipped around 16 and sometimes as many as 30 times to achieve the proper torn, tattered look," explains Indrajith Kumarasiri, chief executive of Sri Lanka's Brandix Denim.

"We earn more money by making denims look dirty and torn, the classic clean look doesn't bring us much," Kumarasiri told AFP during a visit to the 10-million dollar plant, which can make over three million pairs of jeans a year.

Basic denim jeans cost around six dollars to make, but the shabbier "premium" ones cost twice as much.

"In many ways, premium denims are replacing the little black dress as the wear-anywhere fashion staple," he said.

Overseas buyers such as Levis, Gap and Pierre Cardin are now regular buyers of premium jeans from Sri Lanka where they can be made for as little as 12 dollars a pair, and often sell for over 100 dollars.

Buyers have been gradually shifting production out of Europe to low-cost countries such as Sri Lanka, explains Ajith Dias, chairman of the Sri Lanka Joint Apparel Association Forum.

"Retaining the business and growing the order book is tough with India and China competing with us on price and quicker lead times," Dias said.

Sri Lanka's three-billion dollar garment industry accounts for more than half its annual seven billion dollars of export earnings, and it provides jobs for nearly one million people. Nearly all the garments are shipped to the United States and the European Union.

But Dias said casual wear, including jeans, are they key to Sri Lanka's success in the price-sensitive global apparel market, and now account for 16 percent of total garment export earnings.

"We have invested millions to install high-tech plants, develop a sound raw material base and design garments, to ensure we remain competitive, by doing everything from fabric to retail hangers," Dias said.

Brandix, Sri Lanka's biggest exporter with annual sales in excess of 320 million dollars, and MAS Holdings, are also expanding overseas.

In an attempt to get an advantage over the competition, Sri Lanka is trying to position itself as an ethical manufacturer in the hope of getting greater access to the US and European markets at lower duty rates.

"We have high labour standards. We don't employ child labour, we provide rural employment and we empower women. There are no anti-dumping cases against us on trading practices," said Suresh Mirchandani, chief executive of Favourite Garments.

While eco-friendly and ethically-made clothes are becoming increasingly fashionable, their manufacture provides challenges for Sri Lanka.

Big-name brands are now adding organic-cotton clothes to their collection. "The joke is that one day we'll have a shirt we can eat," said Prasanna Hettiarachchi, general manager of MAS Holdings.

He said Levis recently launched eco-jeans using organic cotton, natural dyes, a coconut shell button on the waist band and a price tag made of recycled paper printed with environmentally friendly soy ink. The price tag is a cool 250 dollars.

"We are also working on an eco garment," said Brandix Denim's Kumarasiri.

And when asked what made a perfect pair of jeans, he had a quick answer.

"Same as always. It comes down to how your behind looks when you wear them," grins Kumarasiri.

"No matter how good the wash, the detail or the label, if it doesn't look good on your behind, it won't sell."

(http://news.yahoo.com/)