Health & Fitness

The featured 2019 BBC documentary, “Addicted: America’s Opioid Crisis,” explores the depth of the nation’s addiction to opioid painkillers and the role played by Purdue Pharma and other makers of the drug.

As noted in the film, opioids kill more people than any other drug on the market, and it’s the only type of drug that can condemn a person to a life of addiction after a single week of use.

According to the BBC, “1 in 8 American children live with a parent who suffers from a substance abuse disorder,” and “every 15 minutes, a baby in America is born suffering from opioid withdrawal.” Middle school-aged children interviewed also say they have easy access to drugs, should they want them.

Many now blame the drug companies that make these drugs and have falsely promoted them as safe and nonaddictive for patients of all kinds, including children.

That includes one of the former addicts followed in the film, who says he thinks the drug companies need to be held responsible for their role in creating this epidemic, and made to help pay for the solution.

Purdue Pharma Pleads Guilty and Folds

One of the most prominent drug companies involved in the creation of this opioid addiction crisis is Purdue Pharma, the maker of OxyContin. At the end of October 2020, Purdue Pharma agreed to plead guilty to three federal criminal charges relating to its role in the opioid crisis, including violating a federal anti-kickback law, conspiracy to defraud the U.S. government and violating the Food, Drug and Cosmetic Act.^1,2

To settle the charges, Purdue is supposed to pay $8.3 billion in fines, forfeiture of past profits and civil liability payments,³ but because it doesn’t have the cash, the company will instead be dissolved and its assets used to erect a “public benefit company” that both makes opioids and pays for addiction treatment.

Legal Painkillers Now the Gateway Drug to Heroin

While marijuana was long known as the gateway drug to other illicit drug use, that distinction now belongs to prescription opioids. According to data⁴ from the National Institute on Drug Abuse, prescription opioid use is a significant risk factor for subsequent heroin use.

The incidence of heroin use is 19 times higher among those who have used opioids nonmedically than among those who have no history of opioid use, and 86% of young, urban injection drug users report using opioid pain relievers nonmedically before starting heroin. Overall, nearly 80% of heroin users now report using prescription opioids prior to heroin.

Similarly, data⁵ from the University of Michigan shows just under 1 in 3 people (31.8%) who misused opioids during their high school years ended up using heroin by age 35.

When it comes to children and teens, a major source of opioids are dentists, who wrote a staggering 18.1 million prescriptions for opioids in 2017.⁶ Opioids are frequently prescribed when extracting wisdom teeth, even though there’s no evidence to support this strategy.

This is especially true if you see a biological dentist who knows what they are doing. Earlier this year I had a periapical abscess and had to have the tooth extracted. I saw one of the best dentists in Florida, Dr. Carl Litano, just south of Tampa. He used platelet rich plasma (PRP) at the extraction site and I had zero pain and no swelling without any medication. Afterward, no one could tell I had an extraction the previous day.

Children are also recklessly prescribed addictive opioids for minor surgical procedures. For example, insurance claims data from 2016 and 2017 reveal 60% of children between the ages of 1 and 18 with private insurance filled one or more opioid prescriptions after surgical tonsil removal.^7,8

Meanwhile, research⁹ shows opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter drugs such as acetaminophen, ibuprofen and naproxen.

An Epidemic Caused by Greed

As noted in the film, this is an epidemic caused by greed within the medical system. Purdue Pharma was exceptionally skilled at marketing its product, cleverly disguising its advertisements as educational material. (The same can clearly be said about many other drug companies and their wares today.)

There can be no doubt that false advertising played a central role in the opioid epidemic,¹⁰ and for doctors, it highlights the importance of staying on top of published research rather than relying on drug company sales reps for their education.

The fraud has its roots in a short letter to the editor^11,12 published in The New England Journal of Medicine in 1980. The letter — which was simply commenting on a cursory examination of patient files in a Boston hospital — stated that narcotic addiction in patients with no history of addiction was very rare.

Purdue built its marketing of OxyContin on this letter, for years falsely claiming that opioid addiction affects less than 1% of patients treated with the drugs. According to Purdue’s marketing material, featured in the film, “the most serious risk with opioids is respiratory depression.”

In reality, opioids have a very high rate of addiction and have not been proven effective for long-term use.¹³ A number of court cases in recent years have demonstrated how Purdue systematically misled doctors about OxyContin’s addictiveness to drive up sales.

As noted by David Powell, a senior economist at Rand, to produce the most lethal drug epidemic America has ever seen “you need a huge rise in opioid access, in a way that misuse is easy, but you also need demand to misuse the product.”¹⁴

According to the documentary, Purdue made more than $1 billion a year from its sales of OxyContin. OxyContin’s success also quickly led to other drug companies mimicking Purdue’s tactics. Other companies being called to account include Allergan, Cephalon, Endo International, Egalet Corporation, Insys Therapeutics, Johnson & Johnson, Janssen Pharmaceuticals, Mallinckrodt plc and Teva Pharmaceutical Industries.

In the final analysis, it’s clear that unconscionably deceitful marketing tactics have resulted in the death of hundreds of thousands of Americans; 46,802 Americans died from opioid overdoses in 2018 alone.¹⁵ As of June 2017, opioids became the leading cause of death among Americans under the age of 50.¹⁶

That said, the BBC also rightfully points out that we need stronger regulations and more effective checks and balances to prevent this kind of situation from happening again in the future. Merely making drug companies pay is not enough. 

Purdue Lured in, Then Abandoned Doctors

Steven May, a former Purdue sales rep, also highlights yet another scandal. The company came up with a plan to help doctors to better document their treatment of pain. Sales reps were taught how to instruct doctors to use these tools.

When those same doctors eventually got in trouble for overprescribing opioids, using Purdue’s tools, the company walked away and offered no support. Many doctors lost their medical licenses. Some ended up doing jail sentences and some committed suicide. “And they were doing exactly what [Purdue] taught us to teach them to do,” May says.

No Remorse

Adding insult to injury, when it became clear that people were dying in droves from opioid overdoses, Purdue launched an extensive damage-control operation that included the suggestion that those dying from opioids were already addicts, and that this wouldn’t happen to patients who were not already addicted to drugs. It was basically just a variation on the original lie.

According to lawsuits filed against Purdue, the company knew as early as the 1990s that OxyContin was one of the most abused drugs in the country, yet they did nothing to change their marketing and sales strategies.

That the Sacklers, the owners of Purdue, had no remorse and didn’t care about the societal effects that overprescription of their drug was having is illustrated in a 2001 email exchange between then-Purdue president Richard Sackler and an acquaintance.

In the documentary, Connecticut Attorney General William Tong reads this exchange, which begins with the unnamed acquaintance stating: “[Drug] abusers die, well that is the choice they made. I doubt a single one didn’t know the risks,” to which Sackler replied, “Abusers aren’t victims; they are the victimizers.”

“It’s hard to stomach that someone would write that about people who are suffering, people who are in real distress and people who have died,” Tong says, “and that is the kind of thing that powered this company during a period and led to deceptive, fraudulent, misleading product development and marketing … [They] made money off people’s misery and I think that is what these emails show.”

Unemployment and Poverty Fuel Addiction

Many of the opioid and heroin abusers featured in “Addicted” live on the streets. Desperation and despair are evident in all. Several investigations seeking to gain insight into the causes fueling the opioid epidemic have been conducted in recent years.

Among them is a 2019 study¹⁷ in the Medical Care Research Review journal, which looked at the effects of state-level economic conditions — unemployment rates, median house prices, median household income, insurance coverage and average hours of weekly work — on drug overdose deaths between 1999 and 2014. According to the authors:¹⁸

“Drug overdose deaths significantly declined with higher house prices … by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were … only significant among males, non-Hispanic Whites, and individuals younger 45 years …

Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.”

Similarly, an investigation published in the International Journal of Drug Policy¹⁹ in 2017 connected economic recessions and unemployment with rises in illegal drug use among adults. Seventeen of the 28 studies included in the review found that the psychological distress associated with economic recessions and unemployment was a significant factor:²⁰

“The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important.”

Another 2019 study²¹ published in Population Health reviewed the links between free trade and deaths from opioid use between 1999 and 2015, finding that “Job loss due to international trade is positively associated with opioid overdose mortality at the county level.” Overall, for each 1,000 people who lost their jobs due to international trade — commonly due to factory shutdowns — there was a 2.7% increase in opioid-related deaths.

Trauma Raises Addiction Risk

Abuse-related trauma is also linked to unemployment and financial stress, and that too can increase your risk of drug use and addiction. As noted in The Atlantic,²² when the coal mining industry in northeastern Pennsylvania collapsed, leaving many locals without job prospects, alcohol use increased, as did child abuse.

Many of these traumatized children, in turn, sought relief from the turmoil and ended up becoming addicted to opioids. All of this is particularly pertinent today, as many parts of the U.S. have been shut down for extended periods of time over fears of COVID-19.

Not being allowed to work, being forced to stay at home for weeks or months on end, maintaining an unnatural distance even to your loved ones and not being able to see people’s faces when out in public — all of these things can contribute to fear, anxiety and, ultimately, despair that fuels addiction. Indeed, reports²³ warn that substance abuse is on the rise as a result of pandemic measures, as is domestic violence.²⁴

Struggling With Opioid Addiction? Please Seek Help

It's vitally important to realize that opioids are extremely addictive drugs that are not meant for long-term use for nonfatal conditions. If you've been on an opioid for more than two months, or if you find yourself taking a higher dosage, or taking the drug more often, you may already be addicted. Resources where you can find help include the following. You can also learn more in “How to Wean Off Opioids.”

• Your workplace Employee Assistance Program
• The Substance Abuse Mental Health Service Administration²⁵ can be contacted 24 hours a day at 1-800-622-HELP

I also urge you to listen to my interview with Dr. Sarah Zielsdorf, which is being published in tomorrow’s newsletter. In it, she explains how low-dose naltrexone (LDN), used in microdoses, can help you help combat opioid addiction and aid in your recovery.²⁶

Using microdoses of 0.001 milligrams (1 microgram), long-term users of opioids who have developed a tolerance to the drug are able to, over time, lower their opioid dose and avoid withdrawal symptoms as the LDN makes the opioid more effective.

For opioid dependence, the typical starting dose is 1 microgram twice a day, which will allow them to lower their opioid dose by about 60%. When the opioid is taken for pain, the LDN must be taken four to six hours apart from the opioid in order to not displace the opioid’s effects.

Nondrug Pain Relief

Many types of pain can be treated entirely without drugs. Recommendations by Harvard Medical School^27,28 and the British National Health Service²⁹ include the following. You can find more detailed information about most of these techniques in “13 Mind-Body Techniques That Can Help Ease Pain and Depression.”

Gentle exercise	Physical therapy or occupational therapy
Hypnotherapy	Distracting yourself with an enjoyable activity
Maintaining a regular sleep schedule	Mind-body techniques such as controlled breathing, meditation, guided imagery and mindfulness practice that encourage relaxation. One of my personal favorites is the Emotional Freedom Techniques (EFT)
Yoga and tai chi	Practicing gratitude and positive thinking
Hot or cold packs	Biofeedback
Music therapy	Therapeutic massage

In “Billionaire Opioid Executive Stands to Make Millions More on Patent for Addiction Treatment,” I discuss several additional approaches — including helpful supplements and dietary changes — that can be used separately or in combination with the strategies listed above to control both acute and chronic pain.

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Loss of sense of smell, a condition known as anosmia, has emerged as a hallmark symptom of COVID-19. It’s estimated that 33.9% to 68% of COVID-19 patients¹ — and as high as 98%, according to one study² — experience some type of olfactory dysfunction, which is often regarded as more of an inconvenience than an actual health threat. In reality, however, you may not realize how important your sense of smell is until it’s gone.

When you lose your sense of smell, you also lose your normal sense of taste. In the case of COVID-19, anosmia often occurs alongside dysgeusia, an altered or impaired sense of taste.³ In fact, the combination of anosmia/dysgeusia was a far better predictor of COVID-19 than other common symptoms like fever/chills or respiratory difficulty.⁴

“It’s mentally tough knowing the foods you used to love now simply taste like sewage. I no longer crave food or enjoy eating. It’s a chore,” Lucy Packman, a university student who developed COVID-19 along with anosmia in March 2020, told Medium.⁵

Beyond that, cutting off your sense of smell detaches you from the environment in ways that can be isolating — like an inability to smell your partner or your baby — or dangerous, such as missing the scent of something burning.

The silver lining in COVID-19 is that 89% of those with an altered sense of smell had complete resolution or improvement in severity after four weeks.⁶ For those whose smell impairment is ongoing, or caused by one of the many risk factors beyond COVID-19, smell training may be the key to regaining this invaluable asset.

What Causes Loss of Smell?

COVID-19 aside, there are many reasons why you may lose your sense of smell. The common cold is among the most common, along with other illnesses like influenza, sinus infections, hay fever and nonallergic rhinitis.⁷

Virtually anything that causes your nasal passageways to become obstructed, including tumors, nasal polyps or nasal deformity, can also interfere with your sense of smell, as can conditions that impair your olfactory pathways, which transmit messages between your nasal passages and brain.

A variety of neurological conditions, certain medications and even advancing age can also affect your sense of smell. As you age, especially beyond age 70, loss of nerve endings and less mucus production in your nose may diminish smell, in part because mucus plays a role in keeping odors in the nose longer, so they can be detected by the nerve endings there.⁸

It’s estimated that 62.5% of 80- to 97-year-olds have some type of olfactory impairment,⁹ while even about 12% of people over the age of 40 may have some trouble smelling, along with close to 25% of men in their 60s.¹⁰

One important side note: Those with vitamin D deficiency are more likely to have smell impairment, and researchers believe this deficiency may play a significant role in age-related smell and taste impairment.¹¹ This is especially relevant since vitamin D deficiency is also linked to COVID-19. The following health conditions can also cause a dulling or diminishment of the sense of smell:¹²

Alzheimer’s disease	Brain aneurysm	Brain surgery
Cancer	Chemical exposures to insecticides or solvents	Diabetes
Huntington’s disease	Kallmann’s syndrome	Klinefelter's syndrome
Korsakoff’s psychosis	Malnutrition	Multiple sclerosis
Multiple system atrophy (MSA)	Paget’s disease	Parkinson’s disease
Pick’s disease	Radiation therapy	Rhinoplasty
Schizophrenia	Sjorgren’s syndrome	Traumatic brain injury
Zinc deficiency

Lost Your Ability to Taste? It Could Be Anosmia

As mentioned, when you lose your sense of smell, your taste goes along with it. Ann-Sophie Barwich, a cognitive scientist and assistant professor in the department of history and philosophy of science and medicine at Indiana University Bloomington, explained in STAT:¹³

“Many people don’t immediately recognize they’ve lost their sense of smell, but instead report they’ve lost their sense of taste. Most of what you think of as the taste of your food and drink, however, is actually due to smelling. When you chew, aromatic molecules are released from your food. These molecules travel up to your nose via the pharynx, the opening at the back of the throat that connects the mouth with the nasal cavity.

Think about it for minute. Your tongue detects salty and sweet, bitter and sour, umami (savory) and, according to recent research, fatty. There are no taste buds for mint or strawberry or vanilla. These flavors are created via ‘mouth-smelling,’ a process known as retronasal olfaction. It acts as a second sense of smell.”

This is one reason why anosmia is far more than an inconvenience or minor annoyance. Not only can you no longer detect if you’ve eaten something spoiled, which would prompt you to quickly spit it out, you can no longer enjoy your favorite foods and the scents that go along with them.

Odor-evoked memories also come along with powerful emotions and are known to activate the “neurolobiological substrates of emotional processing,” according to neuroscientist Rachel S. Herz, an adjunct assistant professor of psychiatry and human behavior at Brown University.¹⁴

Research published in Learning and Memory even suggests that odors may modulate the dynamics of memory consolidation,¹⁵ and, by boosting mood, lowering stress and reducing inflammation, it’s likely that the powerful emotions elicited by positive odor-evoked memories can influence psychological and physiological health.¹⁶

Without your sense of smell, however, you miss out on experiencing those powerful, odor-evoked memories. “Two of the great joys in people’s lives are the sensations of smell and taste,” says Dr. R. Peter Manes, an ear, nose and throat specialist at Yale Medicine. “When these senses are altered or absent, people lose that pleasure and can feel isolated from those around them who are not afflicted.”¹⁷

Losing Your Sense of Smell Is Linked to Serious Health Risks

In a study of 3,005 community-dwelling adults, those who had a dysfunctional sense of smell were more likely to die in the next five years than those with a good sense of smell. Olfactory function was deemed to be one of the strongest predictors of five-year mortality, and researchers suggested it may “serve as a bellwether for slowed cellular regeneration or as a marker of cumulative toxic environmental exposures.”¹⁸

Another study of adults aged 71 to 82 also found those with “poor olfaction had a 46% higher cumulative risk for death after 10 years” compared to those with a good sense of smell, and poor olfaction was associated with a higher risk of death from neurodegenerative and cardiovascular diseases.¹⁹

An inability to identify odors is also an early symptom of neurological disorders, including Alzheimer’s disease and Parkinson’s disease.²⁰ Beyond the physical risks, losing your sense of smell can cause psychological distress. People with smell and taste disorders often report a negative emotional impact, including feelings of isolation and problems with relationships and day-to-day functioning.²¹

Among COVID-19 patients, smell and taste loss were associated with depressed mood and anxiety, while fever, cough and shortness of breath were not, even though the latter may be harbingers of more dire COVID‐19 outcomes,²² highlighting the power that these senses have over your emotional well-being. In a Harvard Health Blog post detailing his own experience with loss of smell and taste, Leo Newhouse, LICSW noted:²³

“Our senses — smell, vision, hearing, taste, and touch — are bridges that connect us to the world we live in, to life itself. Knock out two of the five bridges, and 40% of our sensory input is gone. Senses add richness and texture to everyday life; they are intricately tied in with our emotions.”

Retraining Your Nose How to Smell

Treating anosmia involves identifying its underlying cause and addressing it at the foundational level. Loss of smell due to a cold or influenza, for instance, should resolve along with the viral infection. In some cases, however, the cause of the olfactory dysfunction is unknown, making treatment difficult.

AbScent, an organization providing support to those affected by anosmia and other smell disorders, has developed the Sense of Smell Project in collaboration with patients with smell disorders and scientists.²⁴ They’ve developed a smell training app for members of the project, and also a simple smell training protocol designed to help those who have lost their sense of smell for two weeks or more to regain the sense.

The training is based on the protocol first described by professor Thomas Hummel of the Universitätsklinikum Carl Gustav Carus in Dresden, Germany.²⁵ He published research in 2009 showing that olfactory training involving exposure to four intense odors (rose, eucalyptus, lemon and clove) twice daily for 12 weeks led to an increase in olfactory function.²⁶

To try it, all you need is four different fragrances, such as those Hummel used — rose, lemon, clove and eucalyptus essential oils. Essential oils are ideal for scent training due to their highly concentrated scents. Once you’ve gathered your fragrances, actively sniff each scent for about 20 seconds a couple of times a day, such as immediately after waking up and before going to bed. AbScent explains:²⁷

“Open a jar and hold it close to your nose. Take some gentle sniffs for 20 seconds. During this time, concentrate on what you are doing. Keep your mind on lemon for instance, or one of the other smell training smells. Try to block out any intrusive thoughts. Be as attentive as you can and try to recall what your experience of lemon was. Close the jar after 20 seconds and take a few breaths. Then go on to the next jar.”

Smell Training May Strengthen Neural Pathways

The basis for smell training is that using a neural pathway, such as that used by your olfactory nerve cells, reinforces and strengthens it.

According to cell biologist Nancy Rawson, associate director at the Monell Center in Philadelphia, in an interview with AbScent founder Chris Kelly, “… Not only is smell training helping the olfactory receptor cells, but it also is helping to create pathways in the brain that will be better able to receive, interpret and remember the information that it is getting.”²⁸

Research trials suggest smell training is beneficial in many cases,²⁹ and, when used in people with a normal sense of smell, can enhance the sense to the level of a high-performing group of wine professionals. This suggests “the olfactory system is highly responsive to training,” according to researchers in the journal Chemical Senses.³⁰

In another study involving 10 anosmic patients and 14 healthy controls, a 12-week smell training session significantly increased the sensitivity to detect odors in the anosmic group, and modifications in the functional connections of networks used to process chemosensory input were also noted.³¹

Another study in adults aged 50 to 84 found significant improvement in olfactory function after olfactory training (OT), along with improved verbal function and well-being, and decreased depressive symptoms, with researchers concluding, “OT may constitute an inexpensive, simple way to improve quality of life in older people.”³²

Even if you feel it’s too soon to try retraining your sense of smell, it’s important to give the training a try. AbScent notes that “the earlier you begin, the greater the benefit to you in the long run.”³³

Considering there’s no risk involved to giving it a try, and the process takes only a few minutes a day using scents that are easily accessible, there’s every reason to give scent training a try if you’re experiencing any level of anosmia.

Also, as noted, since vitamin D deficiency is associated with smell and taste impairment, be sure to get your vitamin D levels tested and optimized. An overall healthy lifestyle will also support healthy olfaction, and exercising even one time a week — long enough to break a sweat — may reduce your risk of losing your sense of smell as you age.³⁴

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A computational model of a human lung cell has been used to understand how SARS-CoV-2 draws on human host cell metabolism to reproduce. This study helps understand how the virus uses the host to survive, and enable drug predictions for treating the virus to be made.

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A new study shows that among patients who have obesity and who tested positive for COVID-19, a past history of bariatric surgery was significantly associated with a lower risk of hospital and intensive care unit admission.

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None of the mutations currently documented in the SARS-CoV-2 virus appear to increase its transmissibility in humans, according to a new study.

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Analysis of recordings from infants' homes reveals that certain types of vocal interactions between adults and infants are associated with a larger infant vocabulary.

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Analysis of survey results has revealed that in women, obesity is linked to various social and economic factors. In addition, this study is the first in Japan to illuminate the connection between abuse during childhood and obesity in adulthood. These results highlight the importance of taking these factors into account when implementing policies to tackle obesity.

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The quantum sensing abilities of nanodiamonds can be used to improve the sensitivity of paper-based diagnostic tests, potentially allowing for earlier detection of diseases such as HIV, according to a new study.

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Among the new findings, the research team found that chronic oxidative stress during spaceflight contributed to the telomere elongation they observed. They also found that astronauts had shorter telomeres after spaceflight than they did before.

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New research has identified and described a cellular process that, despite what textbooks say, has remained elusive to scientists until now -- precisely how the copying of genetic material that, once started, is properly turned off.

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Demystifying traditional Chinese medicine for conservationists could be the key to better protecting endangered species like pangolins, tigers and rhino, according to researchers. Efforts to shift entrenched values and beliefs about Chinese medicine are not achieving conservation gains in the short term.

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Researchers have compiled the world's most comprehensive list of known plant species. It contains 1,315,562 names of vascular plants, thus extending the number by some 70,000 - equivalent to about 20%. The researchers have also succeeded in clarifying 181,000 hitherto unclear species names.

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Scientists have developed a new gene therapy approach that offers promise for one day treating an eye disease that leads to a progressive loss of vision and affects thousands of people across the globe. The study also has implications for a much wider suite of neurological disorders associated with aging.

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The health harms associated with prolonged sitting can be offset by exceeding weekly recommended physical activity levels, says the World Health Organization (WHO) in new global guidelines on physical activity and sedentary behavior.

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Being born early (before 37 weeks' gestation) is associated with a higher risk of hospital admission throughout childhood than being born at full term (40 weeks' gestation), finds a new study.

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Researchers have created the world's first bioactive plant-based nanocellulose hydrogel to support organoid growth for biomedical applications. This includes cancer development and treatment.

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