Saturday, April 25, 2015

Slow Saturday Special: Boston Globe Street Drugs

You are better off having a beer:

"Researchers use black-market drug website to gauge public health" by Felice J. Freyer Globe Staff  April 18, 2015

On Friday, someone in New Bedford paid a dealer $2 for a 5-milligram hydrocodone pill, a price deemed “cheap” in the busy black market for prescription opioids. That same day in Winchendon, a person spent $5 on a 30-milligram Adderall, rated “not bad” for the popular stimulant.

The sales are illegal. But that didn’t stop buyers and sellers from reporting the transactions on , a five-year-old website that offers a glimpse into the shadowy world of illicit drug sales at a time when an epidemic of opioid abuse rampages through the Northeast.

Related: Narcan Carries Its Own Addiction

Anyone can visit StreetRx to learn about drug prices, and anyone can post information and rate the deals. Hundreds of people around the country contribute reports every day — voluntarily and anonymously.

Researchers are using StreetRx data to gauge the effectiveness of public policy, track changes in the market, and learn more about the people who obtain drugs this way, in the hope of helping them and deterring others. Law enforcement officials check the prices to inform officers buying undercover.

Although it peers into the black market, StreetRx is far removed from the street: It bears a respectable dot-com address and an academic pedigree.

And to the unending surprise of its creators, the website is booming.

“Of all the crowd-sourcing projects I’ve been involved with, this is the most successful,” said John S. Brownstein of Boston Children’s Hospital, a cofounder of the site. “It’s not been promoted. It’s a completely grass-roots data entry.” 

NSA had to have scooped it all up then.

StreetRx is one of several projects by Epidemico , an informatics company established in 2007 by disease-trackers and data scientists from Children’s, Harvard Medical School, and the Massachusetts Institute of Technology.

The website, which includes links to resources such as treatment programs and drug-disposal sites, receives 2,500 unique visitors each day and logs 4,000 to 5,000 drug-price reports per month.

“It’s an innovative approach to try to harness the information age to advance public health,” said Dr. Caleb Alexander, codirector of the Johns Hopkins Center for Drug Safety and Effectiveness, who is not involved with StreetRx but has used its data in his research.

For example, when the maker of OxyContin changed the formulation so it would be harder to crush for snorting or injection, StreetRx showed that the price of the new OxyContin dropped.

“It really shows the value of these abuse-deterrent formulations. People definitely don’t like them as well,” said Dr. Richard C. Dart, director of the Rocky Mountain Poison and Drug Center in Denver, who helped found StreetRx. On Friday, StreetRx presented data to pharmaceutical companies and federal regulators that compared three types of drug formulations intended to deter abuse, showing which is most effective.

The website is primarily focused on prescription drugs because they come in precise dosages whose prices can be easily compared. Heroin sales are sometimes reported on StreetRx, but quantities and potency can be inexact, making price comparisons difficult.

To use StreetRx, people fill out an online form with the name of the drug, the formulation (such as pill or tablet), price per unit, dose, date, and location of the sale, and source of the price information — whether personal experience or word of mouth.

Anyone can click on others’ purchases to rate the price as “cheap,” “not bad,” “reasonable,” “pricey,” or “overpriced.” People who use the site do not identify themselves, and StreetRx says it has no way of tracing them.

The website also cannot verify the accuracy of any individual post. But an Epidemico study found that, overall, the prices jibe with what is seen in law enforcement surveys and on websites that sell illegal drugs.

StreetRx started with conversations between Dart and the three cofounders of Epidemico, Nabarun Dasgupta, Clark Freifeld, and Brownstein. Dart heads the RADARS System (Researched Abuse, Diversion, and Addiction-related Surveillance), which tracks drug abuse, misuse, and diversion for pharmaceutical companies.

Dart wanted data that were up-to-date and included more drugs, to supplement what RADARS was learning from surveys of law enforcement officials. He was familiar with Epidemico’s work at the forefront of a growing trend to mine online sources for public health purposes.

Epidemico launched StreetRx in 2010. It is part of the RADARS System, which is funded by pharmaceutical companies. The companies pay a yearly subscription fee to track illegal use of their drugs, as a way to meet federal regulations requiring drug makers to ensure that their products’ benefits outweigh the risks. Subscribers are barred by contract from access to the raw data or any role in the website’s design or related research.

StreetRx got off to a slow start. It took more than a year for the site to attract significant numbers. Now, it is slowly expanding into seven other countries.

Why do people post drug prices on StreetRx? “Who knows?” said the site’s project manager, Chris Menone. The people reporting on StreetRx are probably a small subset of those buying drugs on the black market, he said, and there’s no way to know how representative they are. “We can’t know anything about them. We have no demographic information. That’s a challenge; it’s also a necessity,” he said.

Recently, StreetRx started posing questions to users, an experiment to study the link between health behavior and prices, said Dasgupta, the Epidemico cofounder. Today, at the bottom of the form used to enter price information, they are asked, “When did you last see a doctor?”

Those who have seen a clinician recently are more likely to be people who sought treatment for pain, who may have fallen into substance misuse after being prescribed opioid painkillers, health experts believe.

StreetRx’s growing trove of data has caught the attention of public health researchers hungry for information about an otherwise inaccessible population.

Alexander, of Johns Hopkins, traced the connection between drugs sold at pharmacies and those sold on the street.

In an as-yet unpublished study, Alexander and colleagues looked at the prices of 10 drugs that can lead to addiction or abuse. They compared the out-of-pocket costs for the drugs bought in pharmacies with their street prices as listed on StreetRx.

In areas where costs were low in the pharmacies, costs were lower on the street as well. Pharmacy prices also tended to be lower in areas where pharmacies were selling higher volumes of the 10 drugs.

“Our findings add to growing evidence that a key driver of the epidemic [of opioid abuse] is the incredible volume of opioids dispensed in the United States,” Alexander said.

Other researchers see great potential in StreetRx to inform public policy. Dara Lee Luca, a visiting assistant professor at Harvard’s John F. Kennedy School of Government, plans to study how street prices of opioids and heroin changed after Florida abruptly shut down pain clinics that were overprescribing.

And Margie Skeer, assistant professor of public health and community medicine at Tufts University School of Medicine, is seeking funding to open discussion forums on StreetRx. Skeer would pose questions to drug users, such as how they first got involved with drugs — information that could inform prevention efforts.


Related: More Money For Meningitis Murder Fund

No one tracked those?

"N.H. parents charged after passing out while bathing son" by Rebecca Fiore Globe Correspondent  April 17, 2015

Two people in Manchester, N.H., were arrested Thursday on charges of child endangerment after allegedly overdosing on heroin while giving their 3-year-old son a bath in December, officials said.

Eric Carter, 21, and Stephanie McCassin, 24, were arrested after the state Department of Child and Family Services issued a warrant alleging they put their son at risk, Manchester police said in a statement. Each was charged with endangering the welfare of a child.

On Dec. 4, officers responded to a call from the child’s grandmother, Mary Macdonald, who was in the home at the time. When police arrived at the Bethel Court home, the boy had been removed unharmed from the bathtub by his grandmother while the parents remained on the bathroom floor.

Macdonald told police that Carter, who is her son, and McCassin live with their child but that she is the primary caretaker for the boy because of her son’s past drug problems. Macdonald told police the adults were passed out while the child remained in the bathtub unaware of the situation.

Carter and McCassin were brought to Elliot Hospital in Manchester and treated for apparent heroin overdoses, police said.

They were released on $1,000 personal recognizance. Carter will appear in the Ninth Circuit Court in Milford, N.H., on May 22, while McCassin is scheduled to appear on Tuesday.


Going to get a jump on the NDU:

"Group’s lawsuits aim to boost public health" by Felice J. Freyer Globe Staff  April 12, 2015

There’s an intriguing twist to the suits filed in Middlesex Superior Court last month. They are the product of a new Boston group that seeks to promote public health through the courts. And these lawyers are working on several fronts, not just tobacco.

The suits were filed by the Center for Public Health Litigation , a small endeavor started last year by the Public Health Advocacy Institute , a nonprofit research group based at the Northeastern University School of Law.

The center’s purpose, says its founder, law professor Richard A. Daynard, “is to bring litigation that will begin to address public health problems that can’t be effectively addressed other ways.” He is not aware of any other group taking this approach.

In its first suit in early March, the center accused Star Markets and Stop & Shop of allowing children to buy lottery tickets.

The lottery case, Daynard said, is an example of how “litigation can be the best way to tackle a public health issue if regulation has not done its job.”

State law prohibits lottery sales to people younger than 18 because early exposure to lotteries might lead to problem gambling later in life. But neither the grocery stores nor the Lottery Commission took action when shown that a 14-year-old could easily buy tickets from an unattended machine near the front of the store, Daynard said.

I tell you what, kiddo. Head on down to the casinos that are coming. How's that for a mixed me$$age.

Future cases might focus on tanning salons and food marketers.

That will close them down.

So far, tobacco-related suits remain the highest-profile example of effective public health litigation.

“There is no question that litigation has been a major strategy that has led to substantial improvements in public health, especially with respect to tobacco,” said Dr. Michael B. Siegel, professor of community health sciences at the Boston University School of Public Health.

Litigation can unearth information that changes public opinion and policy.

Is that why they don't want to reopen 9/11? Or JFK's killing, for that matter.

Lawsuits have revealed that tobacco companies knew nicotine was addictive and manipulated its levels to maximize addiction, all the while publicly denying that tobacco harmed health.

And profits.

The damage to the industry’s reputation “has led to reduced consumption,” Siegel said. “When a company is viewed negatively, its products are viewed negatively.”

Dr. Michael C. Fiore, director of the University of Wisconsin Center for Tobacco Research & Intervention, said a leading cause of declining tobacco use over the past half-century has been changes in public perceptions and social norms — driven in large part by litigation.

“We have now moved to a recognition that tobacco use is incredibly harmful, it’s highly addictive, and if used as directed kills half the people who use it,” Fiore said.

 And it is LEGAL! Meanwhile, medical marijuana stalls for those suffering.

The $246 billion Master Settlement Agreement in 1998, which required tobacco companies to repay states for the cost of caring for people sickened by tobacco, also had the effect of raising the price of cigarettes, making them less attractive to teenagers.

That agreement prevented any further legal action by states but did not bar individuals from suing tobacco companies.

Still, few such suits have been filed, said Mike Moore, the former Mississippi attorney general who led the litigation that resulted in the Master Settlement Agreement. Lawyers are reluctant to take such cases “because they’re so expensive to try, and the results have been minimal,” said Moore, who serves on the boards of two major antitobacco organizations. Tobacco companies usually win, and when they lose, they appeal, he said.

But Northeastern’s Daynard said prospects for success against tobacco companies are brighter in Massachusetts than anywhere else, and Moore agreed.

Recent Supreme Judicial Court rulings have wiped out two of the most common tobacco industry defenses. In 2006, the high court ruled that manufacturers could not escape responsibility by blaming smokers for taking up the habit. And in 2013, it ruled that cigarettes met the legal definition of a “defective and unreasonably dangerous” product because they could have been made safer.

Moore cites another reason Massachusetts is a hospitable venue for antitobacco suits: The state’s “robust” tobacco prevention and education programs have probably produced a jury pool well-versed in tobacco’s harms.

Even so, the lawsuits last month are the first such cases filed in Massachusetts since the 2013 ruling, Daynard said. He founded the Center for Public Health Litigation out of frustration about the lack of action despite that case’s dramatic success: It resulted in a $35 million award — with interest, $79 million — against Lorillard Tobacco Co. to the family of Marie Evans. A lifelong smoker who died of lung cancer, Evans was introduced to cigarettes as a child when free samples were handed out at her Roxbury housing project.

Daynard was one of the lawyers involved with the Evans case, and he donated part of his earnings to establish the Center for Public Health Litigation last year. The center hired two lawyers to take on cases that other attorneys shunned.

They ran advertisements seeking people injured by tobacco or related to someone who died from tobacco-related illness and received dozens of calls. One of the plaintiffs in last week’s suits, Patricia W. Greene, replied to a newspaper ad.

Greene is a Newton real estate agent diagnosed with lung cancer in 2013. She smoked from age 13, when she was given free Marlboros, until age 30 and became ill 25 years after quitting. Her case seeks damages from Philip Morris USA, maker of Marlboros, and Star Markets Company Inc. of West Bridgewater, a cigarette distributor.

The other suit was filed on behalf of the family of James Flavin Jr., a former executive of Filene’s and Staples. He died in 2012 at age 69 after smoking Newport cigarettes for more than 40 years.

Flavin, who lived in Belmont, started smoking in his teens and consumed two to three packs a day, his brother, Paul K. Flavin, said in an interview....

“He was a wonderful guy, a superb family man,” Paul Flavin said. “His entire life revolved around his four daughters and 14 grandchildren.”

And that pack of cigs in his pocket.


I think I'll pass on the smoke, pills, needle, or what have you. Sorry. Doing this is enough of an addiction.