by tyler | Mar 20, 2024 | CNN, health
Just as spring is a time for rebirth, the Persian New Year is a time to celebrate new life. Nowruz is celebrated on the spring equinox, which Tuesday, March 19.
This celebration of spring is filled with symbolism around rebirth and renewal, because spring is a time when life is coming back after a long, cold winter, said Yasmin Khan, the London-based human rights campaigner turned author of “The Saffron Tales: Recipes from the Persian Kitchen,” “Zaitoun: Recipes and Stories from the Palestinian Kitchen,” and “Ripe Figs: Recipes and Stories from the Eastern Mediterranean.”
These three cookbooks from Khan inspire and provide a window into the cultures and stories of people from the Middle East through food.
The conversation has been edited and condensed for clarity.
CNN: What are some of Persian New Year’s traditions and rituals?
Yasmin Khan: On the last Tuesday before the New Year, there is a tradition to make small bonfires in your garden. Traditionally people jump over the bonfires, and it’s supposed to be a symbol of purification, challenges of the year gone by, and energetically cleansing you and preparing you for the year ahead.
A key tradition is to set up an altar in your house called a Haft-seen, which means seven S’s in Farsi. You place seven things on your altar that begin with the letter S in Farsi, which are symbols or qualities you’d like to invite in for the year ahead. You can have apples for good health, candles for light, eggs for fertility, wheatgrass for rebirth and renewal, vinegar for wisdom, and a gold coin for abundance and prosperity. Each person chooses items that have meaning for them.
The festival lasts two weeks. At the end of the festival, you take the wheatgrass you’ve been growing on your altar and you take it down to some running water somewhere. You tie knots in the wheatgrass then throw it into the running water. It would float off along with all your hopes and dreams for the year ahead.
CNN: What food is important for the holiday?
Khan: Like all cultural celebrations, food is a really integral part. Because it’s a festival celebrating spring, we eat lots of green and fresh herbs. For example, there’s this dish called Kuku Sabzi (see recipe below), which is a gorgeous herb and spinach frittata that we always eat on the first day of the year in our house. The frittata is fragrant and aromatic and is served with flatbreads, sliced tomatoes and pickles.
The first meal of the Persian New Year is always fish served with herb-flecked rice filled with dill, parsley and chives in it. The two-week festival is a time of celebration with people you know … traditionally you go to people’s houses and eat lots of delicious sweets and pastries.
CNN: What are some easy ways people can join in the celebrations?
Khan: Cooking is probably the easiest and most fun way to celebrate the new year. I really recommend that people give some Persian recipes a go. As well as being delicious, they’re healthy and vibrant with all the herbs that are packed in them.
In the weeks before the new year, we do a big deep spring cleaning called “shaking down the house” in Farsi. It’s really lovely to have a focus and have something that is about bringing in new life, renewal and rebirth during this difficult time.
And no one regrets a spring clean, so I think that’s also a really great idea. I think this is a beautiful kind of nonreligious festival that everyone can join into and that we can all relate to. It’s a time where we really try and let go of any difficulties that we’ve had in the past year and try to start the new year with a clean slate.
This Iranian frittata is a sensational deep green color and tastes like spring on a plate, bursting with fresh herby flavor. It is incredibly quick to throw together, will keep for a few days in the fridge, and can be enjoyed hot or cold.
Serve as an appetizer or as part of a mezze spread, wrapped up in a flatbread with some slices of tomato and a few salty and sour fermented cucumber pickles, or add some crumbled feta and lightly toasted walnuts for a more substantial main.
Makes 4 servings as a main or 8 servings as a starter
Prep time: 15 minutes | Total time: 35 minutes
Ingredients
7 ounces|200 grams spinach
1 3/4 ounces|50 grams fresh parsley
1 3/4 ounces|50 grams fresh dill
2 2/3 ounces|75 grams fresh cilantro
5 medium eggs
1/2 teaspoon turmeric
2 tablespoons all-purpose flour
1 teaspoon sea salt
1 teaspoon freshly ground black pepper
1 teaspoon dried fenugreek leaf
2 teaspoons sunflower oil
2 garlic cloves, crushed
Instructions
1. Wash spinach, parsley, dill and cilantro, then dry well on paper towels or in a salad spinner. Squeeze out as much moisture as possible; if the greens are wet when they are cooked, they will make the kuku go spongy. Chop finely or blitz in a food processor, in a couple of batches.
2. Heat broiler to high. Crack eggs into a large mixing bowl. Add turmeric, flour, salt, pepper and fenugreek leaf. Stir in the chopped spinach and herbs.
3. Heat oil in a large ovenproof skillet. Add garlic and gently fry over low heat to soften, about 2 minutes.
4. Make sure garlic is evenly distributed around the skillet, then pour in the egg mixture. Cook over low heat until kuku is almost cooked through, 5-8 minutes. Finish off in hot broiler.
5. Let kuku cool slightly, then cut into triangular slices to serve.
Makes 4 servings
Ingredients
Marinade
2 garlic cloves, minced
1/2 cup dark soy sauce
Juice of 1 medium lemon
3 tablespoons extra-virgin olive oil
Pinch of cayenne pepper (optional)
4 salmon fillets
Mixed herb rice
1 3/4 cups white basmati rice
Sea salt
Pinch of saffron strands
Pinch of granulated sugar
2 tablespoons freshly boiled water
1 small bunch fresh parsley, finely chopped
1 small bunch fresh coriander, finely chopped
2 tablespoons fresh dill, finely chopped
2 tablespoons bunch fresh chives, finely chopped
1 garlic clove, crushed
Sunflower oil
2 tablespoons unsalted butter, divided
Instructions
1. To make the marinade, combine garlic, soy sauce, lemon juice, olive oil and cayenne pepper, if using, in a deep bowl. Add salmon, turn to coat well, cover with plastic wrap and let marinate in the fridge for at least 30 minutes.
2. Rinse and parboil rice and prepare the saffron liquid. Place saffron in a pestle and mortar with sugar and grind until you have a fine powder. Add just-boiled water and let steep for 10 minutes.
3. Very carefully, fold rice, chopped herbs, garlic clove and 1 tablespoon oil together, being careful not to break the rice grains.
4. Preheat oven to 400°F/Gas 6. Place an 8”-wide nonstick saucepan with snug-fitting lid over a medium heat. Melt 1 tablespoon butter with 2 tablespoons oil. Add 1 tablespoon saffron liquid and season with a pinch of salt. Once the fat is hot, sprinkle a thin layer of rice over the bottom and firmly press down to line the base of the pan. Using a large spoon, gently layer the rest of the rice on top, building it up into a pyramid shape. Using the handle of a wooden spoon, make 4 holes in the rice. Dot remaining 1 tablespoon butter into holes and then pour over the rest of the saffron liquid.
5. Place a clean tea towel or 4 paper towels on top of the pan and fit the lid on tightly. Tuck in the edges of the tea towel, or trim paper towels to fit, so they won’t catch the flame. Cook over medium heat for 5 minutes, then reduce heat to very low and cook 15 minutes more. Take rice off heat and let sit. Do not be tempted to sneak a peek while it is cooking as this will disturb the steaming process. When rice has been cooking for 10 minutes, place salmon on a baking tray and bake skin side up until cooked to your liking, 10-15 minutes.
6. Once rice has cooked, fill sink with 2” cold water and place saucepan – with lid still tightly on – in the water. This will produce a rush of steam that should loosen the base of the rice. Remove lid, place a large plate on top of pan and quickly turn rice over. Present the herbed rice with the fish and serve immediately.
This recipes are adapted from Yasmin Khan’s book “The Saffron Tales: Recipes from the Persian Kitchen.”
by tyler | Mar 12, 2024 | CNN, health
It’s almost time for clocks to “spring forward” one hour and lose one hour of sleep.
On the second Sunday of March, at 2 a.m., clocks in most of the United States and many other countries move forward one hour and stay there for nearly eight months in what is called Daylight Saving Time. On the first Sunday of November, at 2 a.m., clocks fall back an hour to standard time.
The current March to November system that the US follows began in 2007, but the concept of “saving daylight” is much older. Daylight Saving Time has its roots in train schedules, but it was put into practice in Europe and the United States to save fuel and power during World War I, according to the US Department of Transportation’s Bureau of Transportation Statistics.
Pro tip: It’s Daylight Saving Time, with singular use of “saving,” not “savings.”
The US kept Daylight Saving Time permanent during most of World War II. The idea was put in place to conserve fuel and keep things standard. As the war came to a close in 1945, Gallup asked respondents how we should tell time. Only 17% wanted to keep what was then called “war time” all year.
During the energy crisis of the 1970s, we tried permanent Daylight Saving Time again in the winter of 1973-1974. The idea again was to conserve fuel. It was a popular move at the time when President Richard Nixon signed the law in January 1974. But by the end of the month, Florida’s governor had called for the law’s repeal after eight schoolchildren were hit by cars in the dark. Schools across the country delayed start times until the sun came up.
By summer, public approval had plummeted, and in early October Congress voted to switch back to standard time.
In the US, states are not required by law to “fall back” or “spring forward.” Hawaii, most of Arizona and some territories in the Pacific and Caribbean do not observe Daylight Saving Time. The twice-yearly switcheroo is irritating enough to lawmakers of all political stripes that the US Senate passed legislation in March 2022 to make Daylight Saving Time permanent. The bill passed by unanimous consent.
House lawmakers failed to vote on the bill in 2022. On March 2, 2023, a dozen senators forming a bipartisan group reintroduced the legislation that would end clock switching in favor of permanent Daylight Saving Time. Companion legislation to the Sunshine Protection Act was introduced by Rep. Vern Buchanan, a Republican from Florida, in the House.
Studies over the last 25 years have shown the one-hour change disrupts body rhythms tuned to Earth’s rotation, adding fuel to the debate over whether having Daylight Saving Time in any form is a good idea.
The issue is that for every argument there is a counterargument. There are studies, for example, that show we have more car accidents when people lose an extra hour of sleep. There are also studies that show robberies decline when there is an extra hour of sunlight at the end of the day. We also know that people suffer more heart attacks at the start of Daylight Saving Time. But what about our mental health? People seem to be happier when there is an extra hour of daylight.
Of course, there’s the economy, which pays for all that outdoor fun in the sun. Although saving energy was often put out as a reason to have Daylight Saving Time, the energy saved isn’t much — if anything at all.
Instead, the lobbying effort for Daylight Saving Time came mostly from different sectors of the economy. In the mid-20th century, lobby groups for the recreational sports industry (think driving ranges) wanted more customers to come out after a day at the office. It’s easier to do so when there is more light at the end of the day.
But the movie industry didn’t like Daylight Saving Time. You’re less likely to go to a movie when it’s bright outside. Despite the myth, farmers didn’t like it either because it made it difficult to get their food to the market in the morning.
The bottom line: It’s not clear whether having that extra hour of sunlight at the end of the day versus the beginning is helpful. It just depends on who you are and what you want. And it doesn’t look like Daylight Saving Time in the US is going away anytime soon.
by tyler | Mar 11, 2024 | CNN, health
It’s almost time for clocks to “spring forward” one hour and lose one hour of sleep.
On the second Sunday of March, at 2 a.m., clocks in most of the United States and many other countries move forward one hour and stay there for nearly eight months in what is called Daylight Saving Time. On the first Sunday of November, at 2 a.m., clocks fall back an hour to standard time.
The current March to November system that the US follows began in 2007, but the concept of “saving daylight” is much older. Daylight Saving Time has its roots in train schedules, but it was put into practice in Europe and the United States to save fuel and power during World War I, according to the US Department of Transportation’s Bureau of Transportation Statistics.
Pro tip: It’s Daylight Saving Time, with singular use of “saving,” not “savings.”
The US kept Daylight Saving Time permanent during most of World War II. The idea was put in place to conserve fuel and keep things standard. As the war came to a close in 1945, Gallup asked respondents how we should tell time. Only 17% wanted to keep what was then called “war time” all year.
During the energy crisis of the 1970s, we tried permanent Daylight Saving Time again in the winter of 1973-1974. The idea again was to conserve fuel. It was a popular move at the time when President Richard Nixon signed the law in January 1974. But by the end of the month, Florida’s governor had called for the law’s repeal after eight schoolchildren were hit by cars in the dark. Schools across the country delayed start times until the sun came up.
By summer, public approval had plummeted, and in early October Congress voted to switch back to standard time.
In the US, states are not required by law to “fall back” or “spring forward.” Hawaii, most of Arizona and some territories in the Pacific and Caribbean do not observe Daylight Saving Time. The twice-yearly switcheroo is irritating enough to lawmakers of all political stripes that the US Senate passed legislation in March 2022 to make Daylight Saving Time permanent. The bill passed by unanimous consent.
House lawmakers failed to vote on the bill in 2022. On March 2, 2023, a dozen senators forming a bipartisan group reintroduced the legislation that would end clock switching in favor of permanent Daylight Saving Time. Companion legislation to the Sunshine Protection Act was introduced by Rep. Vern Buchanan, a Republican from Florida, in the House.
Studies over the last 25 years have shown the one-hour change disrupts body rhythms tuned to Earth’s rotation, adding fuel to the debate over whether having Daylight Saving Time in any form is a good idea.
The issue is that for every argument there is a counterargument. There are studies, for example, that show we have more car accidents when people lose an extra hour of sleep. There are also studies that show robberies decline when there is an extra hour of sunlight at the end of the day. We also know that people suffer more heart attacks at the start of Daylight Saving Time. But what about our mental health? People seem to be happier when there is an extra hour of daylight.
Of course, there’s the economy, which pays for all that outdoor fun in the sun. Although saving energy was often put out as a reason to have Daylight Saving Time, the energy saved isn’t much — if anything at all.
Instead, the lobbying effort for Daylight Saving Time came mostly from different sectors of the economy. In the mid-20th century, lobby groups for the recreational sports industry (think driving ranges) wanted more customers to come out after a day at the office. It’s easier to do so when there is more light at the end of the day.
But the movie industry didn’t like Daylight Saving Time. You’re less likely to go to a movie when it’s bright outside. Despite the myth, farmers didn’t like it either because it made it difficult to get their food to the market in the morning.
The bottom line: It’s not clear whether having that extra hour of sunlight at the end of the day versus the beginning is helpful. It just depends on who you are and what you want. And it doesn’t look like Daylight Saving Time in the US is going away anytime soon.
by tyler | Mar 8, 2024 | CNN, health
It’s almost time for clocks to “spring forward” one hour and lose one hour of sleep.
On the second Sunday of March, at 2 a.m., clocks in most of the United States and many other countries move forward one hour and stay there for nearly eight months in what is called Daylight Saving Time. On the first Sunday of November, at 2 a.m., clocks fall back an hour to standard time.
The current March to November system that the US follows began in 2007, but the concept of “saving daylight” is much older. Daylight Saving Time has its roots in train schedules, but it was put into practice in Europe and the United States to save fuel and power during World War I, according to the US Department of Transportation’s Bureau of Transportation Statistics.
Pro tip: It’s Daylight Saving Time, with singular use of “saving,” not “savings.”
The US kept Daylight Saving Time permanent during most of World War II. The idea was put in place to conserve fuel and keep things standard. As the war came to a close in 1945, Gallup asked respondents how we should tell time. Only 17% wanted to keep what was then called “war time” all year.
During the energy crisis of the 1970s, we tried permanent Daylight Saving Time again in the winter of 1973-1974. The idea again was to conserve fuel. It was a popular move at the time when President Richard Nixon signed the law in January 1974. But by the end of the month, Florida’s governor had called for the law’s repeal after eight schoolchildren were hit by cars in the dark. Schools across the country delayed start times until the sun came up.
By summer, public approval had plummeted, and in early October Congress voted to switch back to standard time.
In the US, states are not required by law to “fall back” or “spring forward.” Hawaii, most of Arizona and some territories in the Pacific and Caribbean do not observe Daylight Saving Time. The twice-yearly switcheroo is irritating enough to lawmakers of all political stripes that the US Senate passed legislation in March 2022 to make Daylight Saving Time permanent. The bill passed by unanimous consent.
House lawmakers failed to vote on the bill in 2022. On March 2, 2023, a dozen senators forming a bipartisan group reintroduced the legislation that would end clock switching in favor of permanent Daylight Saving Time. Companion legislation to the Sunshine Protection Act was introduced by Rep. Vern Buchanan, a Republican from Florida, in the House.
Studies over the last 25 years have shown the one-hour change disrupts body rhythms tuned to Earth’s rotation, adding fuel to the debate over whether having Daylight Saving Time in any form is a good idea.
The issue is that for every argument there is a counterargument. There are studies, for example, that show we have more car accidents when people lose an extra hour of sleep. There are also studies that show robberies decline when there is an extra hour of sunlight at the end of the day. We also know that people suffer more heart attacks at the start of Daylight Saving Time. But what about our mental health? People seem to be happier when there is an extra hour of daylight.
Of course, there’s the economy, which pays for all that outdoor fun in the sun. Although saving energy was often put out as a reason to have Daylight Saving Time, the energy saved isn’t much — if anything at all.
Instead, the lobbying effort for Daylight Saving Time came mostly from different sectors of the economy. In the mid-20th century, lobby groups for the recreational sports industry (think driving ranges) wanted more customers to come out after a day at the office. It’s easier to do so when there is more light at the end of the day.
But the movie industry didn’t like Daylight Saving Time. You’re less likely to go to a movie when it’s bright outside. Despite the myth, farmers didn’t like it either because it made it difficult to get their food to the market in the morning.
The bottom line: It’s not clear whether having that extra hour of sunlight at the end of the day versus the beginning is helpful. It just depends on who you are and what you want. And it doesn’t look like Daylight Saving Time in the US is going away anytime soon.
by tyler | Feb 14, 2024 | CNN, health
Here’s a look at the opioid crisis.
Experts say the United States is in the throes of an opioid epidemic. An estimated 8.9 million Americans aged 12 and older misused opioids in 2022, including 8.5 million prescription pain reliever abusers and 1 million heroin users.
Opioids are drugs formulated to replicate the pain-reducing properties of opium. Prescription painkillers like morphine, oxycodone and hydrocodone are opioids. Illegal drugs like heroin and illicitly made fentanyl are also opioids. The word “opioid” is derived from the word “opium.”
Overdose deaths have been on the rise for years in the United States, but surged amid the Covid-19 pandemic: Annual deaths were nearly 50% higher in 2021 than in 2019, CDC data shows. Data on overdose deaths.
Prescription opioid volumes peaked in 2011, with the equivalent of 240 billion milligrams of morphine prescribed, according to the market research firm, IQVIA Institute for Human Data Science.
Alabama, Arkansas, Louisiana and Tennessee had the highest opioid dispensing rates in 2020.
Opioids such as morphine and codeine are naturally derived from opium poppy plants more commonly grown in Asia, Central America and South America. Heroin is an illegal drug synthesized from morphine.
Hydrocodone and oxycodone are semi-synthetic opioids, manufactured in labs with natural and synthetic ingredients.
Fentanyl is a fully synthetic opioid, originally developed as a powerful anesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illnesses like cancer. The drug is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been a driving factor in the number of overdose deaths in recent years.
Methadone is another fully synthetic opioid. It is commonly dispensed to recovering heroin addicts to relieve the symptoms of withdrawal.
Opioids bind to receptors in the brain and spinal cord, disrupting pain signals. They also activate the reward areas of the brain by releasing the hormone dopamine, creating a feeling of euphoria or a “high.”
Opioid use disorder is the clinical term for opioid addiction or abuse.
People who become dependent on opioids may experience withdrawal symptoms when they stop using the medication. Dependence is often coupled with tolerance, meaning that users need to take increasingly larger doses for the same effect.
A drug called naloxone, available as an injection or a nasal spray, is used as a treatment for overdoses. It blocks or reverses the effects of opioids and is often carried by first responders.
Regulation and Funding
The 21st Century Cures Act, passed in 2016, allocated $1 billion over two years in opioid crisis grants to states, providing funding for expanded treatment and prevention programs. In April 2017, Health and Human Services Secretary Tom Price announced the distribution of the first round of $485 million in grants to all 50 states and US territories.
In August 2017, Attorney General Jeff Sessions announced the launch of an Opioid Fraud and Abuse Detection Unit within the Department of Justice. The unit’s mission is to prosecute individuals who commit opioid-related health care fraud. The DOJ is also appointing US attorneys who will specialize in opioid health care fraud cases as part of a three-year pilot program in 12 jurisdictions nationwide.
On October 24, 2018, President Donald Trump signed opioid legislation into law. The SUPPORT for Patients and Communities Act includes provisions aimed at promoting research to find new drugs for pain management that will not be addictive. It also expands access to treatment for substance use disorders for Medicaid patients.
State legislatures have also introduced measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense.
1861-1865 – During the Civil War, medics use morphine as a battlefield anesthetic. Many soldiers become dependent on the drug.
1898 – Heroin is first produced commercially by the Bayer Company. At the time, heroin is believed to be less habit-forming than morphine, so it is dispensed to individuals who are addicted to morphine.
1914 – Congress passes the Harrison Narcotics Act, which requires that doctors write prescriptions for narcotic drugs like opioids and cocaine. Importers, manufacturers and distributors of narcotics must register with the Treasury Department and pay taxes on products
1924 – The Anti-Heroin Act bans the production and sale of heroin in the United States.
1970 – The Controlled Substances Act becomes law. It creates groupings (or schedules) of drugs based on the potential for abuse. Heroin is a Schedule I drug while morphine, fentanyl, oxycodone (Percocet) and methadone are Schedule II. Hydrocodone (Vicodin) is originally a Schedule III medication. It is later recategorized as a Schedule II drug.
January 10, 1980 – A letter titled “Addiction Rare in Patients Treated with Narcotics” is published in the New England Journal of Medicine. It looks at incidences of painkiller addiction in a very specific population of hospitalized patients who were closely monitored. It becomes widely cited as proof that narcotics are a safe treatment for chronic pain.
1995 – OxyContin, a long-acting version of oxycodone that slowly releases the drug over 12 hours, is introduced and aggressively marketed as a safer pain pill by manufacturer, Purdue Pharma.
May 10, 2007 – Purdue Pharma pleads guilty for misleadingly advertising OxyContin as safer and less addictive than other opioids. The company and three executives are charged with “misleading and defrauding physicians and consumers.” Purdue and the executives agree to pay $634.5 million in criminal and civil fines.
2010 – FDA approves an “abuse-deterrent” formulation of OxyContin, to help curb abuse. However, people still find ways to abuse it.
May 20, 2015 – The DEA announces that it has arrested 280 people, including 22 doctors and pharmacists, after a 15-month sting operation centered on health care providers who dispense large amounts of opioids. The sting, dubbed Operation Pilluted, is the largest prescription drug bust in the history of the DEA.
March 18, 2016 – The CDC publishes guidelines for prescribing opioids for patients with chronic pain. Recommendations include prescribing over-the-counter pain relievers like acetaminophen and ibuprofen in lieu of opioids. Doctors are encouraged to promote exercise and behavioral treatments to help patients cope with pain.
March 29, 2017 – Trump signs an executive order calling for the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie is selected as the chairman of the group, with Trump’s son-in-law, Jared Kushner, as an adviser.
July 31, 2017 – After a delay, the White House panel examining the nation’s opioid epidemic releases its interim report, asking Trump to declare a national public health emergency to combat the ongoing crisis
September 22, 2017 – The pharmacy chain CVS announces that it will implement new restrictions on filling prescriptions for opioids, dispensing a limited seven-day supply to patients who are new to pain therapy.
November 1, 2017 – The opioid commission releases its final report. Its 56 recommendations include a proposal to establish nationwide drug courts that would place opioid addicts in treatment facilities rather than prison.
February 9, 2018 – A budget agreement signed by Trump authorizes $6 billion for opioid programs, with $3 billion allocated for 2018 and $3 billion allocated for 2019.
February 27, 2018 – Sessions announces a new opioid initiative: The Prescription Interdiction & Litigation (PIL) Task Force. The mission of the task force is to support local jurisdictions that have filed lawsuits against prescription drugmakers and distributors.
March 19, 2018 – The Trump administration outlines an initiative to stop opioid abuse. The three areas of concentration are law enforcement and interdiction; prevention and education via an ad campaign; and job-seeking assistance for individuals fighting addiction.
April 9, 2018 – The US surgeon general issues an advisory recommending that Americans carry the opioid overdose-reversing drug, naloxone. A surgeon general advisory is a rarely used tool to convey an urgent message. The last advisory issued by the surgeon general, more than a decade ago, focused on drinking during pregnancy.
May 1, 2018 – The Journal of the American Medical Association publishes a study that finds synthetic opioids like fentanyl caused about 46% of opioid deaths in 2016. That’s a three-fold increase compared with 2010, when synthetic opioids were involved in about 14% of opioid overdose deaths. It’s the first time that synthetic opioids surpassed prescription opioids and heroin as the primary cause of overdose fatalities.
May 30, 2018 – The journal Medical Care publishes a study that estimates the cost of medical care and substance abuse treatment for opioid addiction was $78.5 billion in 2013.
June 7, 2018 – The White House announces a new multimillion dollar public awareness advertising campaign to combat opioid addiction. The first four ads of the campaign are all based on true stories illustrating the extreme lengths young adults have gone to obtain the powerful drugs.
December 12, 2018 – According to the National Center for Health Statistics, fentanyl is now the most commonly used drug involved in drug overdoses. The rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016.
January 14, 2019 – The National Safety Council finds that, for the first time on record, the odds of dying from an opioid overdose in the United States are now greater than those of dying in a vehicle crash.
March 26, 2019 – Purdue Pharma agrees to pay a $270 million settlement to settle a historic lawsuit brought by the Oklahoma attorney general. The settlement will be used to fund addiction research and help cities and counties with the opioid crisis.
July 17, 2019 – The CDC releases preliminary data showing a 5.1% decline in drug overdoses during 2018. If the preliminary number is accurate, it would mark the first annual drop in overdose deaths in more than two decades.
August 26, 2019 – Oklahoma wins its case against Johnson & Johnson in the first major opioid lawsuit trial to be held in the United States. Cleveland County District Judge Thad Balkman orders Johnson & Johnson to pay $572 million for its role in the state’s opioid crisis. The penalty is later reduced to $465 million, due to a mathematical error made when calculating the judgment. In November 2021, the Oklahoma Supreme Court reverses the decision.
September 15, 2019 – Purdue files for bankruptcy as part of a $10 billion agreement to settle opioid lawsuits. According to a statement from the chair of Purdue’s board of directors, the money will be allocated to communities nationwide struggling to address the crisis.
September 30, 2019 – The FDA and DEA announce that they sent warnings to four online networks, operating a total of 10 websites, which the agencies said are illegally marketing unapproved and misbranded versions of opioid medicines, including tramadol.
February 25, 2020 – Mallinckrodt, a large opioid manufacturer, reaches a settlement agreement in principle worth $1.6 billion. Mallinckrodt says the proposed deal will resolve all opioid-related claims against the company and its subsidiaries if it moves forward. Plaintiffs would receive payments over an eight-year period to cover the costs of opioid-addition treatments and other needs.
October 21, 2020 – The Justice Department announces that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty to three federal criminal charges for its role in creating the nation’s opioid crisis. They agree to pay more than $8 billion and close down the company. The money will go to opioid treatment and abatement programs. The Justice Department also reached a separate $225 million civil settlement with the former owners of Purdue Pharma, the Sackler family. In November 2020, Purdue Pharma board chairman Steve Miller formally pleads guilty on behalf of the company.
March 15, 2021 – According to court documents, Purdue files a restructuring plan to dissolve itself and establish a new company dedicated to programs designed to combat the opioid crisis. As part of the proposed plan, the Sackler family agrees to pay an additional $4.2 billion over the next nine years to resolve various civil claims.
September 1, 2021 – In federal bankruptcy court, Judge Robert Drain rules that Purdue Pharma will be dissolved. The settlement agreement resolves all civil litigation against the Sackler family members, Purdue Pharma and other related parties and entities, and awards them broad legal protection against future civil litigation. The Sacklers will relinquish control of family foundations with over $175 million in assets to the trustees of a National Opioid Abatement Trust. On December 16, 2021, a federal judge overturns the settlement.
February 25, 2022 – Johnson & Johnson and the three largest US drug distributors – McKesson Corp, Cardinal Health Inc and AmerisourceBergen Corp – finalize a $26 billion nationwide opioid settlement.
March 3, 2022 – The Sackler families reaches a settlement with a group of states the first week of March, according to court filings. The settlement, ordered through court-ordered mediation that began in January, requires the Sacklers to pay out as much as $6 billion to states, individual claimants and opioid crisis abatement, if approved by a federal bankruptcy court judge.
November 2, 2022 – CVS and Walgreens agree to pay a combined $10 billion, over 10 and 15 years, to settle lawsuits brought by states and local governments alleging the retailers mishandled prescriptions of opioid painkillers.
November 15, 2022 – Walmart agrees to the framework of a $3.1 billion settlement, which resolves allegations from multiple states’ attorneys general that the company failed to regulate opioid prescriptions contributing to the nationwide opioid crisis.
August 10, 2023 – The US Supreme Court blocks Purdue Pharma from going forward with bankruptcy proceedings.
February 1, 2024 – New York Attorney General Letitia James announces that for the first time, an advertising company that worked on Purdue Pharma’s OxyContin account has settled a lawsuit accusing it of falsely marketing opioids as safe. Publicis, a French marketing company, has agreed to pay $350 million within the next two months and will not take on any more opioid clients.
by tyler | Feb 13, 2024 | CNN, health
Here’s a look at the opioid crisis.
Experts say the United States is in the throes of an opioid epidemic. An estimated 8.9 million Americans aged 12 and older misused opioids in 2022, including 8.5 million prescription pain reliever abusers and 1 million heroin users.
Opioids are drugs formulated to replicate the pain-reducing properties of opium. Prescription painkillers like morphine, oxycodone and hydrocodone are opioids. Illegal drugs like heroin and illicitly made fentanyl are also opioids. The word “opioid” is derived from the word “opium.”
Overdose deaths have been on the rise for years in the United States, but surged amid the Covid-19 pandemic: Annual deaths were nearly 50% higher in 2021 than in 2019, CDC data shows. Data on overdose deaths.
Prescription opioid volumes peaked in 2011, with the equivalent of 240 billion milligrams of morphine prescribed, according to the market research firm, IQVIA Institute for Human Data Science.
Alabama, Arkansas, Louisiana and Tennessee had the highest opioid dispensing rates in 2020.
Opioids such as morphine and codeine are naturally derived from opium poppy plants more commonly grown in Asia, Central America and South America. Heroin is an illegal drug synthesized from morphine.
Hydrocodone and oxycodone are semi-synthetic opioids, manufactured in labs with natural and synthetic ingredients.
Fentanyl is a fully synthetic opioid, originally developed as a powerful anesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illnesses like cancer. The drug is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been a driving factor in the number of overdose deaths in recent years.
Methadone is another fully synthetic opioid. It is commonly dispensed to recovering heroin addicts to relieve the symptoms of withdrawal.
Opioids bind to receptors in the brain and spinal cord, disrupting pain signals. They also activate the reward areas of the brain by releasing the hormone dopamine, creating a feeling of euphoria or a “high.”
Opioid use disorder is the clinical term for opioid addiction or abuse.
People who become dependent on opioids may experience withdrawal symptoms when they stop using the medication. Dependence is often coupled with tolerance, meaning that users need to take increasingly larger doses for the same effect.
A drug called naloxone, available as an injection or a nasal spray, is used as a treatment for overdoses. It blocks or reverses the effects of opioids and is often carried by first responders.
Regulation and Funding
The 21st Century Cures Act, passed in 2016, allocated $1 billion over two years in opioid crisis grants to states, providing funding for expanded treatment and prevention programs. In April 2017, Health and Human Services Secretary Tom Price announced the distribution of the first round of $485 million in grants to all 50 states and US territories.
In August 2017, Attorney General Jeff Sessions announced the launch of an Opioid Fraud and Abuse Detection Unit within the Department of Justice. The unit’s mission is to prosecute individuals who commit opioid-related health care fraud. The DOJ is also appointing US attorneys who will specialize in opioid health care fraud cases as part of a three-year pilot program in 12 jurisdictions nationwide.
On October 24, 2018, President Donald Trump signed opioid legislation into law. The SUPPORT for Patients and Communities Act includes provisions aimed at promoting research to find new drugs for pain management that will not be addictive. It also expands access to treatment for substance use disorders for Medicaid patients.
State legislatures have also introduced measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense.
1861-1865 – During the Civil War, medics use morphine as a battlefield anesthetic. Many soldiers become dependent on the drug.
1898 – Heroin is first produced commercially by the Bayer Company. At the time, heroin is believed to be less habit-forming than morphine, so it is dispensed to individuals who are addicted to morphine.
1914 – Congress passes the Harrison Narcotics Act, which requires that doctors write prescriptions for narcotic drugs like opioids and cocaine. Importers, manufacturers and distributors of narcotics must register with the Treasury Department and pay taxes on products
1924 – The Anti-Heroin Act bans the production and sale of heroin in the United States.
1970 – The Controlled Substances Act becomes law. It creates groupings (or schedules) of drugs based on the potential for abuse. Heroin is a Schedule I drug while morphine, fentanyl, oxycodone (Percocet) and methadone are Schedule II. Hydrocodone (Vicodin) is originally a Schedule III medication. It is later recategorized as a Schedule II drug.
January 10, 1980 – A letter titled “Addiction Rare in Patients Treated with Narcotics” is published in the New England Journal of Medicine. It looks at incidences of painkiller addiction in a very specific population of hospitalized patients who were closely monitored. It becomes widely cited as proof that narcotics are a safe treatment for chronic pain.
1995 – OxyContin, a long-acting version of oxycodone that slowly releases the drug over 12 hours, is introduced and aggressively marketed as a safer pain pill by manufacturer, Purdue Pharma.
May 10, 2007 – Purdue Pharma pleads guilty for misleadingly advertising OxyContin as safer and less addictive than other opioids. The company and three executives are charged with “misleading and defrauding physicians and consumers.” Purdue and the executives agree to pay $634.5 million in criminal and civil fines.
2010 – FDA approves an “abuse-deterrent” formulation of OxyContin, to help curb abuse. However, people still find ways to abuse it.
May 20, 2015 – The DEA announces that it has arrested 280 people, including 22 doctors and pharmacists, after a 15-month sting operation centered on health care providers who dispense large amounts of opioids. The sting, dubbed Operation Pilluted, is the largest prescription drug bust in the history of the DEA.
March 18, 2016 – The CDC publishes guidelines for prescribing opioids for patients with chronic pain. Recommendations include prescribing over-the-counter pain relievers like acetaminophen and ibuprofen in lieu of opioids. Doctors are encouraged to promote exercise and behavioral treatments to help patients cope with pain.
March 29, 2017 – Trump signs an executive order calling for the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie is selected as the chairman of the group, with Trump’s son-in-law, Jared Kushner, as an adviser.
July 31, 2017 – After a delay, the White House panel examining the nation’s opioid epidemic releases its interim report, asking Trump to declare a national public health emergency to combat the ongoing crisis
September 22, 2017 – The pharmacy chain CVS announces that it will implement new restrictions on filling prescriptions for opioids, dispensing a limited seven-day supply to patients who are new to pain therapy.
November 1, 2017 – The opioid commission releases its final report. Its 56 recommendations include a proposal to establish nationwide drug courts that would place opioid addicts in treatment facilities rather than prison.
February 9, 2018 – A budget agreement signed by Trump authorizes $6 billion for opioid programs, with $3 billion allocated for 2018 and $3 billion allocated for 2019.
February 27, 2018 – Sessions announces a new opioid initiative: The Prescription Interdiction & Litigation (PIL) Task Force. The mission of the task force is to support local jurisdictions that have filed lawsuits against prescription drugmakers and distributors.
March 19, 2018 – The Trump administration outlines an initiative to stop opioid abuse. The three areas of concentration are law enforcement and interdiction; prevention and education via an ad campaign; and job-seeking assistance for individuals fighting addiction.
April 9, 2018 – The US surgeon general issues an advisory recommending that Americans carry the opioid overdose-reversing drug, naloxone. A surgeon general advisory is a rarely used tool to convey an urgent message. The last advisory issued by the surgeon general, more than a decade ago, focused on drinking during pregnancy.
May 1, 2018 – The Journal of the American Medical Association publishes a study that finds synthetic opioids like fentanyl caused about 46% of opioid deaths in 2016. That’s a three-fold increase compared with 2010, when synthetic opioids were involved in about 14% of opioid overdose deaths. It’s the first time that synthetic opioids surpassed prescription opioids and heroin as the primary cause of overdose fatalities.
May 30, 2018 – The journal Medical Care publishes a study that estimates the cost of medical care and substance abuse treatment for opioid addiction was $78.5 billion in 2013.
June 7, 2018 – The White House announces a new multimillion dollar public awareness advertising campaign to combat opioid addiction. The first four ads of the campaign are all based on true stories illustrating the extreme lengths young adults have gone to obtain the powerful drugs.
December 12, 2018 – According to the National Center for Health Statistics, fentanyl is now the most commonly used drug involved in drug overdoses. The rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016.
January 14, 2019 – The National Safety Council finds that, for the first time on record, the odds of dying from an opioid overdose in the United States are now greater than those of dying in a vehicle crash.
March 26, 2019 – Purdue Pharma agrees to pay a $270 million settlement to settle a historic lawsuit brought by the Oklahoma attorney general. The settlement will be used to fund addiction research and help cities and counties with the opioid crisis.
July 17, 2019 – The CDC releases preliminary data showing a 5.1% decline in drug overdoses during 2018. If the preliminary number is accurate, it would mark the first annual drop in overdose deaths in more than two decades.
August 26, 2019 – Oklahoma wins its case against Johnson & Johnson in the first major opioid lawsuit trial to be held in the United States. Cleveland County District Judge Thad Balkman orders Johnson & Johnson to pay $572 million for its role in the state’s opioid crisis. The penalty is later reduced to $465 million, due to a mathematical error made when calculating the judgment. In November 2021, the Oklahoma Supreme Court reverses the decision.
September 15, 2019 – Purdue files for bankruptcy as part of a $10 billion agreement to settle opioid lawsuits. According to a statement from the chair of Purdue’s board of directors, the money will be allocated to communities nationwide struggling to address the crisis.
September 30, 2019 – The FDA and DEA announce that they sent warnings to four online networks, operating a total of 10 websites, which the agencies said are illegally marketing unapproved and misbranded versions of opioid medicines, including tramadol.
February 25, 2020 – Mallinckrodt, a large opioid manufacturer, reaches a settlement agreement in principle worth $1.6 billion. Mallinckrodt says the proposed deal will resolve all opioid-related claims against the company and its subsidiaries if it moves forward. Plaintiffs would receive payments over an eight-year period to cover the costs of opioid-addition treatments and other needs.
October 21, 2020 – The Justice Department announces that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty to three federal criminal charges for its role in creating the nation’s opioid crisis. They agree to pay more than $8 billion and close down the company. The money will go to opioid treatment and abatement programs. The Justice Department also reached a separate $225 million civil settlement with the former owners of Purdue Pharma, the Sackler family. In November 2020, Purdue Pharma board chairman Steve Miller formally pleads guilty on behalf of the company.
March 15, 2021 – According to court documents, Purdue files a restructuring plan to dissolve itself and establish a new company dedicated to programs designed to combat the opioid crisis. As part of the proposed plan, the Sackler family agrees to pay an additional $4.2 billion over the next nine years to resolve various civil claims.
September 1, 2021 – In federal bankruptcy court, Judge Robert Drain rules that Purdue Pharma will be dissolved. The settlement agreement resolves all civil litigation against the Sackler family members, Purdue Pharma and other related parties and entities, and awards them broad legal protection against future civil litigation. The Sacklers will relinquish control of family foundations with over $175 million in assets to the trustees of a National Opioid Abatement Trust. On December 16, 2021, a federal judge overturns the settlement.
February 25, 2022 – Johnson & Johnson and the three largest US drug distributors – McKesson Corp, Cardinal Health Inc and AmerisourceBergen Corp – finalize a $26 billion nationwide opioid settlement.
March 3, 2022 – The Sackler families reaches a settlement with a group of states the first week of March, according to court filings. The settlement, ordered through court-ordered mediation that began in January, requires the Sacklers to pay out as much as $6 billion to states, individual claimants and opioid crisis abatement, if approved by a federal bankruptcy court judge.
November 2, 2022 – CVS and Walgreens agree to pay a combined $10 billion, over 10 and 15 years, to settle lawsuits brought by states and local governments alleging the retailers mishandled prescriptions of opioid painkillers.
November 15, 2022 – Walmart agrees to the framework of a $3.1 billion settlement, which resolves allegations from multiple states’ attorneys general that the company failed to regulate opioid prescriptions contributing to the nationwide opioid crisis.
August 10, 2023 – The US Supreme Court blocks Purdue Pharma from going forward with bankruptcy proceedings.
February 1, 2024 – New York Attorney General Letitia James announces that for the first time, an advertising company that worked on Purdue Pharma’s OxyContin account has settled a lawsuit accusing it of falsely marketing opioids as safe. Publicis, a French marketing company, has agreed to pay $350 million within the next two months and will not take on any more opioid clients.
