Editorial Note: The death of Philip Seymour Hoffman featured heavily in early news bulletins this week. It seems highly likely that Hoffman’s death originated from a prescription drug problem. As it happens Johanna Ryan from RxISK’s Community Board had been liaising with the parents of Steve Rummler and others concerned about the licensing of yet another opiate pain-killer – Zohydro. The combination has produced this post.
What would Steve say about Zohydro?
Steve Rummler’s story comes to us by way of his parents, Judy and Bill Rummler. Their son was one of over 16,000 Americans to die from an overdose of opioid painkillers in 2011. Overdoses have now surpassed auto accidents as the leading cause of accidental death in the U.S. Sixty percent involve pharmaceuticals, rather than illegal drugs – and three-fourths of those are due to opioids.
Many who die are like Steve Rummler. They have chronic pain and become addicted to the pills prescribed by their doctors. In the past twenty years, sales of synthetic opioids like Vicoden, OxyContin and Fentanyl have more than quadrupled, thanks to aggressive efforts to promote these drugs as safe and effective tools for long-term pain management. Industry-sponsored educational programs led doctors to believe that addiction is a problem only among those who “abuse” these pills to get high – patients with real pain conditions are supposedly immune. The result has been an epidemic of opioid addiction among chronic pain patients as well as a rising number of recreational users, many in their teens.
The Steve Rummler Hope Foundation is campaigning to put a stop to this epidemic, and make safe humane treatment available for addiction and chronic pain. That’s a tall order – but there’s one step we can take right now to help.
In October, the FDA approved yet another powerful opioid narcotic for the U.S. market: Zohydro ER, to be sold by Zogenix and manufactured by Alkermes Inc. of Ireland. It’s a long-acting pill containing a higher dose of pure hydrocodone than previous drugs. And to make matters worse, it does not even contain tamper-proof features to prevent it from being crushed and snorted or injected. This is like pouring gasoline on a fire.
The Rummler foundation and the Fed-UP Coalition are petitioning the FDA to withdraw its approval for Zohydro. You can sign the Zohydro petition on Change.org by clicking here.
You can learn about the bigger picture from the Rummlers’ foundation, or from ARPO – Advocates for Prescription Opioid Reform, a U.S./Canadian group. Health care professionals should check out Physicians for Responsible Opioid Prescribing (PROP). And if you have a story of your own to tell about prescription opioids, get in touch with us at RxISK.org to tell your story and to report any difficulties.
Stephen Robert Rummler – May 28, 1968 – July 1, 2011
Steve Rummler was born in 1968 in Evanston, Illinois. e was a happy, fun-loving child who grew up surrounded by the love of family and friends. He loved his fiancée Lexi Reed Holtum, her beautiful daughter Isabella, his parents Judy and Bill Rummler, his brother Jeff, his sister-in-law Kim, his nephew Zack, his nieces Chloe and Sophie, and his large extended family. He was loved in return and had a wide circle of friends.
Steve graduated from Edina High School in Edina, Minnesota in 1986. He loved sports and was an all-conference soccer player. A bright, creative student, Steve took Advanced Placement courses and was very musically-gifted. In fact, music became his passion. After his graduation, he decided to put off college to follow his dream.
The GooneyBirds
Steve became part of a band called The GooneyBirds. He was a drummer, vocalist and sometimes a guitarist or keyboardist. He wrote many of the songs which the band performed. From 1986 until the mid-1990’s, the band played regularly at the Cabooze in Minneapolis and performed throughout the country. They released a CD and were often heard on the radio.
The GooneyBirds earned enough money from their music to support themselves for many years, but eventually some of the band members got married and settled down. At this time, Steve decided to complete his education at the University of Minnesota. He excelled in his studies of Economics and received his B.S. degree in 1996. He then went to work as a financial advisor in Minneapolis and in 2009 was named by Mpls St. Paul Magazine as a FIVE STAR: Best in Client Satisfaction Wealth Manager.
A lifeline
In December 1996 Steve suffered a life-changing injury to his back. Although never diagnosed as a condition that could be successfully treated, he was told he had a “spinal contusion” which caused him to continually have electric-shock-like symptoms going up and down his spine. This was the chronic pain he dealt with for the remainder of his life.
Steve’s condition caused him to seek help from many medical professionals. The constant pain and the lack of a treatable diagnosis led Steve to become depressed. He was prescribed anti-depressants which helped, but did not eliminate his symptoms. Eventually, in about 2005, he was prescribed narcotic painkillers which provided the first real relief from his symptoms, he said. At the same time he was taking clonazepam, a benzodiazepine.
Steve later wrote about the painkillers: “At first they were a lifeline. Now they are a noose around my neck.”
A noose
When Steve first became an addict is unknown, but by 2009 it was clear that he was getting prescriptions for narcotic painkillers from more than one source. His primary-care physician then insisted that he get help, so Steve chose to go the Pain Rehabilitation Center at the Mayo Clinic in Rochester, Minnesota in January 2010. There he learned techniques for dealing with his pain, was weaned off of the painkillers, and sent home with instructions for tapering off of the clonazepam. The doctors at the Mayo Clinic also recommended that he go to the Hazelden Addiction Treatment Center in Center City, Minnesota. He was encouraged to go by his family and his therapist, but Steve believed that he could handle his addiction without further treatment.
Steve’s situation seemed hopeful after this, especially since he had re-connected with Lexi, his high school and college sweetheart and the love of his life. They became engaged in August 2010, and planned to marry.
Eventually Steve became unable to manage his pain with the techniques he had learned at the Mayo Clinic. He sought out a doctor who would prescribe narcotic painkillers and benzodiazepines in the quantities Steve felt he needed. Lexi realized that these amounts were excessive and that Steve was addicted to the painkillers. She made the difficult decision to tell him that he needed to stop taking the pills and/or go for chemical dependency treatment by April 15, 2011 … or she would have to leave him. He agreed to go to Hazelden.
Addicted
Steve went to Hazelden on April 15th and completed 28 days of treatment. Toward the end of his stay, Hazelden tried unsuccessfully to get Steve’s insurance company to approve some additional days of treatment. In spite of this, Steve seemed to be in good spirits when he first returned home.
While Steve was at Hazelden, the doctor who had been prescribing Steve’s narcotic painkillers and diazepam (Valium) was under investigation by the Minnesota Board of Medical Practice. On May 14, 2011, the Board took disciplinary action against this doctor’s license for “unprofessional and unethical conduct” and for “prescribing a drug for other than medically accepted purposes.” The doctor surrendered his medical license and the Board agreed to “close its files in this matter.”
Steve relapsed shortly after returning home from Hazelden. By this time, the disease of addiction had “hijacked” his brain. He was sure that the only way he could handle his pain was to treat it with narcotic painkillers. When his supply of these ran out in late June, Steve said that he was going to detox on his own before going to get additional help for his addiction. His fiancée and family were following the advice of Al Anon to “Let Go, Let God” and “Detach with Love” in hopes that Steve would hit bottom and seek help. This was not to be.
His pain must have seemed unbearable and he became desperate. In his desperation he sought out illegal drugs. These killed him on July 1, 2011. Steve’s friends, fiancée and family know that Steve had never, until the night of his death, taken a narcotic drug that had not been prescribed for him. A terrible tragedy.
Not forgotten
Steve was a loving, kind, sensitive and generous young man who took care of others at the expense of himself. He suffered with chronic pain for 15 years. He tried hard to get well and did not want to die. But Steve did die, of a drug overdose, and his death certificate shows that the “immediate” cause of his death was “mixed drug toxicity (opiates and benzodiazepines)”. The real cause of his death, however, was the disease of addiction.
After his death we established The Steve Rummler Memorial Foundation with the goal of helping others who suffer from chronic pain and the disease of addiction.
Contact: judy@
Barbara says
It is difficult for me to talk about these pain meds without shivering. First, let me say that I have always been sensitive to Rx medications of all kinds. I also come from a family where pain meds were accepted because my father suffered chronic pain . No one likes to endure pain. However, my physical constitution could not tolerate the pain meds Drs. prescribed to me and the list included Vicoden, Kadian, Talwain, Oxycotin, Soma, …when I encountered pain from migraines, and surgery for a torn rotator cuff a few years back. The headaches were chronic and thought to be ‘occipital neuralgia’ according to the neurologist. I could not function daily on the course of treatment with pain meds. Sometimes my eyes would roll back in my head and I’d just momentarily collapse. Luckily this never happened while I was driving. My blood pressure became so low it was regarded as an unsafe level to exercise at a local gym. I developed a slightly leaking heart valve during this course of treatment. I experienced much “fantastical” non-reality thinking. I knew something was wrong, but I did not know what. I stopped taking the medication after the syncope events resulted in numerous ER visits. I was being tested with Cat Scans, MRIs, Heart Caths, and many other expensive procedures because of what I now believe were side effects I was experiencing from multi medications that I was sensitive to. I am lucky to be here without having experienced addiction that lead to death, or without more physical damage than I currently have. My headaches diminished after stopping the Rx prescribed to treat them. I still have chronic pain from some arthritic conditions but I no longer am on the pain med merry-go-round that could have resulted in death, or unending invasive tests and procedures to determine what was wrong with me. Side effects are experienced differently by everyone. When patients complain of strange symptoms, why is it that doctors don’t look at the pharmaceuticals the patient is taking, but opts to perform expensive, and sometimes invasively dangerous, procedures/tests to “look for the cause” ?? Well, there’s probably more money to be made that way would be my guess. I used to be naïve about how the health care system works, but no more. I feel that I was abused by the health care system in more ways than one. I could write a book as I have had hideous experiences with psych meds also. One thing I know is that the problem currently experienced could have been brought to the public’s attention if the Medical Boards wanted to highlight it years ago. I submitted numerous complaints about my care because I was fearful for public safety. I thought surely, someone needs to know what is happening. That was about 10 years ago. Even sent them copies of pharmacy records. The bottom line is, doctors stick together like glue and it’s called a “regional standard of care.” Hey, that’s just the way they roll in these parts, yeah? Well, as they say, good luck with that. I’ll never go back to any of them. I’m better now. Off Rx meds for 8 years and have a new hobby. I’m no longer just more fat for the wheels of the corporate greed machine called “health care” in the US. It was quite an education! With the opiate abuse or as it is called “hillbilly heroin” so prominent in Appalachia districts, and thanks to Insurance Laws, now, everyone can get an “education” except that it comes with a death certificate instead of a diploma usually. I’m very lucky.
Dr. David Healy says
John Hempton of Bronte Capital posted the following on his blog two days ago and has given permission to add here
Get your opiates for free: Capitalism meets the zombie apocalypse
Posted: 02 Feb 2014 11:02 PM PST
I think I have found a new low in the pharmaceutical industry: giving away a month’s free supply of potentially lethal high-grade opioids.
This ambitious marketing strategy allows more than enough time and supply to create addicts.
The company is Galena Biopharma and their product, under the marketing name of Abstral is sublingual Fentanyl.
Fentanyl according to Wikipedia is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. In other words you get really high, really fast and it doesn’t last long. Also according to Wikipedia it is “one of a small number of drugs that may be especially harmful, and in some cases fatal, with just one dose”.
Fentanyl has a legitimate use – for intense “breakthrough” pain spasms for someone already being treated around the clock with a heavy opiod like morphine. The legitimate user is probably a terminal cancer patient with bursts of pain so intense that morphine just doesn’t cut it. In that case the seriously addicting properties of the drug are not particularly relevant and the benefit of use is indisputable.
Outside that it is hard to think of a good use for this drug.
The drug has killed plenty of people including a few notable rock-n-rollers. Read Wikipedia for the gory details.
Galena’s hot new product is a sublingual version of an old drug. The marketing (on their website) argues this drug is really fast. To quote: “Patients preferred Abstral for speed”.
However to give it that extra marketing pizazz they are giving it away. Here is the pitch – which I believe as a matter of policy should be criminalized.* [I note that tobacco companies are not allowed to give free samples of cigarettes – and it is curious that same does not apply here.]
See Bronte Capital BlogSpot for the picture
The advert has an irony of its own. It shows a new-age style woman completely blissed out (with a smiling kind) and the slogan “time better spent”.
We have US corporations doing hippy alternative lifestyle drug marketing for drugs that are especially effective in turning you into a zombie. Capitalism meets the zombie apocalypse.
It is as if Tim Leary was reincarnated as a cynical capitalist going for the mega dollars.
Dr. David Healy says
This post gave rise to a lot of informed comment – pointing out that the woman in the advert was almost certainly a cancer victim and mentioning some of the gimmicks companies use to sell new branded drugs in the face of generic competition and that JH might have been over-reading the degree of evil.
But it seems likely as Steve Rummler’s case shows JH was not guilty of over-reading the evil but perhaps missed how banal it can be. There will always be a case for pain relief in cancer and related diseases and the free supply for a month or discounted coupons trick are ones that many companies marketing non-addicting drugs use, but as the story of the last 20 years have shown the real market for all these drugs is never the hard-core of patients who need them but the vast penumbra who don’t and who are positively harmed – like Steve Rummler.
The banality lies in the fact that the company people and those commenting on JH’s blog post miss the bigger picture and bring the zeal of getting pain relief to the terminally ill to the marketing of dangerous opiates to people with minor complaints. “Turning” doctors is all too easily done.
Barbara says
Oh, by the way, I still have chronic pain; I’ve learned to cope with it through art therapy, and natural alternatives, like melatonin and/or valerian herb to help sleep. My diet is healthier and I neither drink alcohol or smoke. My enjoyment of art/sketching diverts my attention away from chronic pain (arthritic conditions/fibromyalgia/PTSD) and allows me to feel better. The one thing I have learned from experience with pain, is that “the more your focus on pain; the greater the pain is.” I have had no training in art therapy and taught myself this coping strategy. If I had not, well, I don’t like the thought of just being another statistic. I don’t think we need more addictive pain meds. I think we need more inquiry into natural methods that one’s body may find more adaptive to living with and managing chronic pain as opposed to total eradication of feeling that can lead to death. This epidemic of pain medication abuse that seems too often to lead to heroin or death needs to HALT. It has consequences for ALL of society. I remember pills in the past that were widely prescribed and then taken off the frequent flyer market. “Diet Pills” in the past caused so many problems for whole families because of mood swings, addictive behaviors. Pills–any pills–used unwisely have consequences for children in homes where the Rx “abuse” occurs-often in more ways than one. Doctors who prescribe without forethought or suggesting alternative methods of alleviating pain to their patients, in my opinion, are guilty of abuse. They are abusing the privilege of trust and dignity of their profession. Shame on them.
Johanna says
Actually the drug cos are not even giving it away – they’re getting paid. Here’s how it works:
Abstral retails for a cool $2,495 a month or more. You think I’m kidding?
http://www.goodrx.com/abstral
My insurance company does NOT want to pay. You’d hope they’d control costs by making sure only “appropriate” patients get this drug (mainly folks with terminal cancer). And to be fair, some insurance cos take the time to screen ethically. But most will just slap an extremely high co-payment on the patient, from $100 to as much as $500. It’s pure financial “screening” which may put the drug beyond the reach of those who need it, while the well-to-do will get the stuff even if it kills them.
So, if my insurance demands a copay of $300, Galena will step up & make my first few scripts “free” to me – then collect $2,200 from the insurance company! (Or a bit less, maybe, if they’ve negotiated a lower rate.) Of course, if this “compassionate” discount goes away after the first few scripts, what am I going to do, quit? Oh, I don’t think so. (When I worked on the railroad in the 70’s the dealers who hung around the yard used the same trick – minus the insurance angle of course…)
Here’s another thing: If Fentanyl costs that much at the pharmacy window, how much do you think it fetches on the black market? And how big is the temptation for a broke disabled person (drowning in medical debt and facing foreclosure, maybe) to sell their script? Fentanyl is one of the scariest pharmaceutical drugs now being sold on the street, from Duragesic patches to heroin cut with Fentanyl, which has killed 22 people in Pennsylvania in the past few weeks with similar outbreaks in other areas.
A small (but not that small!) number of doctors funnel these drugs onto the street knowingly and consciously; a larger number end up doing so inadvertently. But drug companies in the past decade or so have made millions, maybe billions, with the added luxury of not having to know where the money is coming from. Or, well, not exactly …
wellcallmecrazy says
My story is almost a mirror image of Barbara’s with one big difference…..I still take 30mg of morphine 4 times a day everyday. I have been searching for years for a non opiate and/or all natural alternative without success…..yet. My pain management doctor told me the FDA just approved a new medical device that is very similar to transcranial magnetic stimulation that we both hope might be the alternative answer I have been searching for. Now all we have to do is find out where you get the darned thing. I have tried so very many different medications and treatments in an effort to live an opiate free life with a tolerable pain level always to end up back on the emergency room merry go round within six or seven months. I even tried a 21 day inpatient lidocaine infusion treatment which left me with a tolerable level of pain for four months,,,,,but then it wasn’t tolerable anymore and I felt like my only choices were suicide or the emergency room. So here I am walking along the worlds most dangerous tightrope….suicide and intolerable pain on one side, addiction and all its associated trappings on the other, and hell underneath. I see a psychologist specializing in dealing with pain, I meditate and practice mindfulness everyday, I have a spiritual practice, I work with a nutritionist to optimize my diet to reduce inflammation, I practice yoga, and I still live on morphine everyday. All I want is to find a way to function daily without morphine and have a pain level that is tolerable. As of now, I’m still searching and praying that I can stay on top of that tightrope one more day.