Drug addiction

It costs HOW MUCH?

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The mind boggles. War is expensive to conduct. Once wars finish, the cost of looking after veterans is massive. In 2000, the Department of Veteran Affairs (VA) in America spent $43.6bn to look after returned servicemen and women. In 2020 it is expected to exceed $212bn (c. 5x), the equivalent of what the Chinese currently spends on its military.  Digging deeper into the data reveals that the cost of the aftermath of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) on veteran treatment keeps growing in a straight line.

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Total obligations for OIF/OEF/OND patients has grown 19-fold in the last 14 years to over $7bn. Total veterans from those campaigns now totals 965,000 and is expected to hit 1.1mn by 2020. Cost per veteran patient over the 2006-2020 period will virtually treble.

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Expenditure on prosthetic devices (e.g. limbs, hearing aids) has near as makes no difference quadrupled in that period.

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Spending on pharmaceutical products is up 1.9x since 2006.

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Drugs such as Oxycontin which contain opioids have found their way to creating problems in the US armed forces. 15% of Army troops admitted to taking illicit drugs (cocaine, heroin, marijuana) and opioids back in 2008.

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Spending on programs to prevent substance abuse is up 1.8x since 2006.

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The VA notes key clinical metric trends from Quarter Four of 2012 to Quarter Four of 2017 show:

• 67% reduction in Veterans receiving opioid and benzodiazepine together;
• 44% reduction in Veterans on long-term opioid therapy (> to 90 days);
• 38% reduction in Veterans receiving opioids;• 56% reduction in Veterans receiving > 100 Morphine Equivalent Daily Dose;
• 51% increase in Veterans on long-term opioid therapy with a Urine Drug Screen
(UDS) completed within last year to help guide treatment decisions.

Spending on mental health programs is up almost 4x since 2006. The VA plans to promote the development of skills in VA providers to diagnose and assess PTSD
by developing a computer-based training using simulated virtual patient
technology that will allow clinicians to practice and receive customizable feedback
on giving CAPS-5 to a lifelike virtual patient.

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The 2019 VA Budget requests $8.6 billion for Veterans’ mental health services, an increase of 5.8% above the 2018 current estimate. It also includes $190 million for suicide
prevention outreach. VA recognizes that Veterans are at an increased risk for suicide and
implemented a national suicide prevention strategy to address this crisis. Veteran suicide in the US is at a 22/day clip.

The price of freedom. All said and told the US over the last 20 years will have spent the equivalent of $2.476 trillion with a “T” on veterans. That is the equivalent of one entire year of UK GDP.

Smart technologies are an absolute must for the VA. The cost of veteran health is the equivalent of 29% of what the US spends on defence, up from 14.8% two decades ago. Asking for yearly increases is a band aid solution.

Musk charged with securities violations

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Tesla CEO Elon Musk has been accused by the SEC of violating Section 10(b) of the Securities Exchange Act of 1934 (“Exchange Act”) [15 U.S.C. § 78j(b)] and Rule 10b-5 [17 C.F.R. § 240.10b-5]. The SEC claimed,

“Musk’s false and misleading public statements and omissions caused significant confusion and disruption in the market for Tesla’s stock and resulting harm to investors…Musk knew or was reckless in not knowing that each of these statements was false and/or misleading because he did not have an adequate basis in fact for his assertions. When he made these statements, Musk knew that he had never discussed a going-private transaction at $420 per share with any potential funding source, had done nothing to investigate whether it would be possible for all current investors to remain with Tesla as a private company via a “special purpose fund,” and had not confirmed support of Tesla’s investors for a potential going private transaction. He also knew that he had not satisfied numerous additional contingencies, the resolution of which was highly uncertain, when he unequivocally declared, ‘Only reason why this is not certain is that it’s contingent on a shareholder vote.’ Musk’s public statements and omissions created the misleading impression that taking Tesla private was subject only to Musk choosing to do so and a shareholder vote.”

The eccentric and maverick CEO responded,

This unjustified action by the SEC leaves me deeply saddened and disappointed. I have always taken action in the best interests of truth, transparency and investors. Integrity is the most important value in my life and the facts will show I never compromised this in any way.”

It is common knowledge to corporates that the exchange is the first port of call for all public releases to be openly documented for consistency and equal access. It is irrelevant whether a social media feed might be deemed as “in the spirit” of open disclosure to Musk’s personal opinions. The SEC rules are the rules. There aren’t soft interpretations. A listing requirement is to follow the rules of fair disclosure. Whether Musk was or wasn’t aware is irrelevant – as the CEO of a $50bn company he should know better or at least sought the advice from those that do.

In any event if he was true to the spirit of good corporate governance he would have the good sense to realise his position as CEO has become untenable. How the board can have confidence in him is beyond CM? The multiple senior resignations give an insight but for all of Musk’s instellar cosmic brilliance as a salesman, unfortunately laws are there to provide safety for investors. The shares are offered 13% lower in the aftermarket.

A court will ultimately decide his fate but the $420 a share with secured funding unraveled so quickly as to question his judgement.

Investors, even the die hard believers, don’t need a CEO already under the pump to be distracted anymore than he already is. It is a shame because he is undoubtedly a brilliant mind. Unfortunately that would seemingly make him feel he’s somewhat untouchable leading him to make knee jerk decisions such is what he’s been charged over.

Is Musk losing it?

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Is Tesla CEO Elon Musk losing it? More senior resignations from accounting and HR this week  reveal more cracks in the automaker. He emailed a journalist, calling him a “mother f*cker”. He went further to say he hoped the cave rescuer he called a “”pedo” sued him because a UK man who is single and spent so much time in Thailand must be a child rapist.

He rattled off he had “secured” funding of $420/share to go private and then all of a sudden he didn’t, prompting the SEC to investigate. He was then on radio with comedian Joe Rogan toking what is reportedly a mixture of tobacco and marijuana. Are these the actions of a man running a $50bn market cap company?

Clearly his board can’t control him.  With the shares collapsing and bond prices falling, refinancing will become problematic. Chief  Accounting Officer Dave Morton quit the company after revealing his concerns about the various obstacles Tesla faces.

Tesla’s Chief People Officer, Gabrielle Toledano, took leave in August and said she wouldn’t be returning to Tesla.

Musk has been a genius and visionary to get Tesla where it is today. Yet he is a direct victim of his own hubris. Sleeping under boxes with Tesla bankrupt written on them to living on the factory roof to rattling off about production hell while accusing families of drivers dead due to over reliance in a system he aggressively promoted.Tesla was technically asking for suppliers to refund a portion of the monies they were paid since 2016 to the EV maker so it could post a profit which is borderline accounting manipulation in an attempt to give the impression of an ongoing concern.

He also complained at the lack of support in the media despite being called out on this nonsense.

Musk’s compensation is also linked to a $650bn market cap, which is effectively saying to the market that his company will be worth more than Daimler, BMW, VW, GM, Ford, Toyota, Nissan, Honda, Renault, Fiat-Chrysler, Ferrari and Porsche combined. Just read that last sentence again. Do investors honestly believe that Tesla which consistently misses and is going up against companies that have been in the game for decades, seen brutal cycles, invest multiples more in technology and forgotten more than they remembered will somehow all become slaves to a company which has no technological advantages whatsoever?

The Tesla story is on the ropes. Expect more mega-releases on new products to try to keep the dream alive and the disciples faithful. I guess ‘Lucy in the sky with diamonds’ worked for The Beatles…

Cheikmate

Australian Wallabies coach Michael Cheika is clearly massively under pressure. Sporting the second worst win/loss record of any Australian rugby coach he hit out at journalists questioning whether it is time to pack it in by suggesting they take mental disorder suppressing “pills” for exposing his dreadful stats. His team was walloped by New Zealand 40-12. The All Blacks retain the Bledisloe Cup for the 16th straight year.

Cheika talked of “passion” for the job but a great coach is one that extracts the best from the players by making them believe in themselves and achieve well beyond what they think they can. Australia need a Brian Clough type coach rather than the thuggish style of Cheika. Basic discipline is lacking in the Aussie team and that stems from the top. A coach that was confident in his ability to attain quality results wouldn’t resort to cheap shots. He’d merely let the scoreboard do the talking. Instead he shows the pressure is too much for him.  This press conference (especially from 5:30) confirms he is not right for the role. Time to replace him.

CM has made the argument multiple times – if money was taken away from the game all current All Blacks would still play proudly for their country. For the Aussies it is likely only a handful that might feel the same. Cheika is not building a team steeped in history, but making excuses for his dreadful deficiencies. He may accuse journalists of being clueless by stating they’ve never coached before, but should he possess an enviable success ratio the press wouldn’t ask for reasons why the Wallabies were road kill.

Cheikmate- time to go gracefully. The fans aren’t buying it.

Monkey Dust

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Monkey Dust is the latest drug to hit the streets in the UK turning users into zombies. Monkey Dust is the street name for Methylenedioxy-α-pyrrolidinohexiophenone or MDPHP. It is a synthetic drug made from bath salts which contain MDPHP. The off-white powder can be swallowed, injected or snorted, and can cost as little as two pounds. Effects of the drug can last several days and only requires doses as little as 3 milligrams to get a hit.

The drug makes users feel empowered, super human, paranoid and subject to eating their own flesh or throwing themselves in front of cars or off buildings. Users give off a sweat smell close to prawns and vinegar and feel no pain. Monkey Dust is also addictive.

Staffordshire Police said it had 950 reports in three months or roughly 10 a day. Ambulance crews reveal a lot of call outs are to revive users from heart attacks or strokes. For drug companies these addictions can be big business.

Across the pond, the total number of U.S. overdose deaths involving heroin from 2002 to 2015 show a 6.2-fold increase in the total number of deaths over the period. Automobiles killed around 32,000 people last year or a little over 2x that of heroin overdoses. When adding non-methadone opioids (illicit fentanyl) overdose that number surged to 20,000, a 33% YoY jump on 2014 and 5.9x 2002.

According to the National Institute on Drug Abuse (NIDA), “Suicide rates in the military were traditionally lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008. Substance use is involved in many of these suicides. The 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides from fiscal year (FY) 2005 to FY 2009 involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them.”

As opioid overdoses rise, companies such as Adapt Pharma have seen sharp rises in the sales of products like Narcan (Naloxone) which basically revives victims from the dead. Narcan publicizes its price that is even insured meaning one can overdose and revive with a $10 co-payment.

“94% of insured lives in the US have coverage for NARCAN® Nasal Spray*. According to IMS Health, nearly three quarters (74%) of prescriptions for NARCAN® Nasal Spray have a co-pay of $10 or less**. For those paying cash, ADAPT Pharma has partnered with retail pharmacies to reduce out of pocket costs (Retail is $62.50/dose)…To expand community access, NARCAN® Nasal Spray is available to all qualified group purchasers for $37.50 per 4mg dose ($75 per carton of 2 doses). This pricing is available for all Qualified Group Purchasers, such as first responders (EMS, Fire Department, Police), community organizations and Departments of Health, regardless of size. This pricing represents a 40% discount off the Wholesale Acquisition Cost (WAC) of $125 per carton.”

Price hikes have been a feature of naloxene. As of January 2015, Amphastar’s version of naloxone was up to $41 a dose, according to Fierce Pharma, a pharmaceutical industry news website. That follows a price increase from $17 to $33 a dose back in October 2014, according to data provided by Truven Health Analytics. So not only is volume spiking, so is price. Walgreens has expanded the availability of prescription-free naloxone to 33 states.

West Virginia health officials are responding to opioid overdoses by distributing more than 8,000 kits with Naloxone that can get people breathing again if administered in time. Money for the kits comes from a $1 million federal grant to West Virginia, which has had the nation’s highest rate of overdose deaths at 41.5/100,000 people.

Local emergency medical services agencies in West Virginia administered 4,186 doses of Naloxone in 2016, up from 3,351 the year before and 2,165 two years ago and that data doesn’t include uses by hospital emergency departments, urgent care centers, first responders and family members.

There is a conundrum for narcotics suppliers as such synthetic drugs cause new markets enabling bigger highs from cheaper DIY ingredients. On the flip side, pharma companies stand to cash in  from our ability to poison ourselves with designer drugs. Monkey magic from monkey dust.

Child Abuse – the shocking stats

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Child abuse is reaching shocking proportions globally. The stats you are about to read show just how widespread the problem has become.The National Institute of Health reports that approximately 80 % of those who attempted suicide had a history of child abuse. About 30% of abused and neglected children will later abuse their own childrencontinuing the horrible negative spiral.

We examine the US, UK, Australia and an outlier Japan, where child abuse cases have soared 111-fold in the last 30 years. Over 4,000,000 child abuse cases were reported in the US in 2015. Abused children show much higher tendencies for risky behaviours in later life. CM wrote about the shocking outcome of the independent report on child grooming gangs in Rotherham showing that the police and government were complicit for decades. We also wrote about abuse affecting safety at US schools, including mass shootings.

Warning – the data make for quite heavy reading. 

JAPAN

In 2016, CM wrote a piece on the breakdown in the nuclear family in Japan. The Ministry of Health, Labor & Welfare (MHLW) denoted that cases handled for child abuse in 2016 hit a record 122,578 cases, 111x the level of 1989. Part of the problem here would be due to a lack of reporting back then. However the growth in the last decade is still extreme. The MHLW denote over the last decade:

  • Physical related violence fell from 41.2% to 26% (despite doubling in absolute terms).
  • Neglect fell 38.5% to 21.1% (despite an 80% increase in absolute terms)
  • Sexual abuse fell from 3.2% to 1.3% (despite a 50% increase in absolute terms)
  • Psychological abuse jumped from 17.2% to 51.5% (a 10-fold absolute increase)

In the last decade filings of child abuse with the police have surged from 7% of all cases to 45%. Reporting to family or relatives has declined but neighbours remain the second largest factor in reporting abuse.

By prefecture, child abuse per 1000 children looks as follows as at 2016. The national average stands at 7.3 children per 1,000.

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AUSTRALIA

While the rate of growth is high, Australia’s Institute of Family Studies has reported in its June 2017 statistics that in 2015/16 a total of 355,935 notifications of child abuse were made vs 252,962 made in 2011/12. Total substantiations grew from 48,420 to 60,989 respectively.

The rate of notifications has risen from 33.8 per 1,000 children in 2011-12 to 42.0 per 1,000 in 2015-16 (AIHW, 2011, 2017).

  • Physical abuse accounted for 18.3%
  • Neglect  accounted for 24.9%
  • Sexual abuse accounted for 12.2%
  • Psychological abuse accounted for 44.5%
  • 51% of victims were female.

In Queensland, South Australia and the Northern Territory neglect was the most common type of substantiated maltreatment. Victoria had the largest proportion of emotional abuse substantiations (64.5%) compared to other states and territories, whereas South Australia had the smallest proportion of emotional abuse cases (25.2%).

While there were some gender differences for all abuse and neglect types, girls were significantly more likely to be the subject of substantiation cases of sexual abuse (15.8%) compared to boys (8.5%). The proportion of substantiated cases of harm/risk of harm from child maltreatment related to sexual abuse ranged from 3.4% in the Northern Territory to 16.6% in New South Wales and Western Australia.

Infants (children aged less than 1 year) were most likely to be the subject of a substantiation (16.1 per 1,000 infants), followed by children aged 1-4 years (9.0 per 1,000 children aged 1-4). Children aged 15-17 years were the least likely to be the subjects of a substantiation (3.9 per 1,000 children aged 15-17).

Australian children from remote and very remote areas were most likely to be the subject of a substantiation (16.2 per 1000 and 23.5 per 1000 respectively) compared with children in major cities (6.2 per 1000). Children in lower socio-economic areas were more likely to be the subject of a substantiation than children in higher socio-economic areas, with 6.9% of substantiations occurring in the highest socio-economic areas compared with 35.7% in the lowest socio-economic areas. 

This contradicts the trend in Japan were relatively poorer (tend to be remote) areas seem less prone to incidents of child abuse.

Perhaps the disturbing sign in Australia is the incidence of out of home care (OOHC) which continues to swell in numbers. Between the years 2014-15 and 2015-16 there was a 10.8% increase in children (from 11,581 to 12,829 children) admitted to OOHC. In 2015-16 there were 3,035 more children admitted to OOHC than were discharged.  In 2015-16, the median age of admission to OOHC was 6 years, with 46% of children admitted to OOHC aged under 5. In comparison, the median age of discharge from OOHC was 9 years and 32% were aged 15-17, compared with 8% admitted to OOHC.

Most children who were in OOHC on 30 June 2016 were residing in home-based care (94%). Of these children, 39% were in foster care, 49% were in relative/kinship care, 5% in third-party parental care and 1% were in some other type of home-based care.

USA

The US is a whole other category. While the media screams about the mistreatment of children at the Mexican border how many of them know the extent of child abuse within their own country? The American Society of Positive Care of Children notes,

  • 4 million child mistreatment referral reports received in 2015 vs 3.6mn in 2014.
  • Child abuse reports involved 7.2 million children vs 6.2mn in 2014.
  • 207,000 children received foster care services.
  • The financial cost of child abuse and neglect in the US is estimated at $585 billion (equivalent to the GDP of Sweden or Taiwan)
  • 75.3% of victims are neglected.
  • 17.2% of victims are physically abused.
  • 8.4% of victims are sexually abused.
  • 6.9% of victims are psychologically mistreated.
  • Highest rate of child abuse in children under one (24.2% per 1,000).
  • Over one-quarter (27%) of victims are younger than 3 years.
  • Almost five children die every day from child abuse.
  • 80% of child fatalities involve at least one parent.
  • 74.8% of child fatalities are under the age of 3.
  • 72.9% of the child abuse victims die from neglect.
  • 43.9% of the child abuse victims die from physical abuse.
  • 49.4% of children who die from child abuse are under one year.
  • Almost 60,000 children are sexually abused.
  • More than 90% of juvenile sexual abuse victims know their perpetrator.
  • 14% of all men in prison and 36% of women in US prisons were abused as children, twice the frequency seen in the general population.
  • In 2016, more than 2,300 children were reported as victims to the National Human Trafficking Hotline.
  • Average age of entry by a child prostitute is 13 yo. Life expectancy after becoming a prostitute is only 7 years57% of prostitutes were sexually abused as children.

UK

Government figures show that 3,171 offences have been recorded in England and Wales across 80 platforms in England and Wales since a new anti-grooming law was introduced in 2017 which criminalizes sexual communication with a child. This amounts to almost 9 grooming offences on average per day. The police noted that

  • girls aged 12-15 were recorded in 62% of cases of grooming
  • under-11s were recorded in nearly 25% of cases.

Child abuse figures in the UK according to the NSPCC reveal

  • 1 in 20 children in the UK have been sexually abused
  • Over 8,000 contacts to the NSPCC’s helpline last year were concerns about sexual abuse
  • There are an estimated 137,000 women and girls affected by FGM in England and Wales
  • 1 in 14 children have experienced emotional abuse by a parent or guardian.
  • Over 19,000 children were identified as needing protection from emotional abuse in 2017.
  • 6.9% of children said they had experienced physical violence at the hands of a parent or guardian (3.7% said severe physical violence).
  • The NSPCC’s helpline responded to over 11,000 contacts about physical abuse in 2016/17
  • Over 6,000 children were identified as needing protection from physical abuse last year

The message is clear. The incidence of child abuse continues to rise to sickening levels. Perhaps the EU sums up its problem to an even more shocking degree:

“Few studies have been done on neglect, but analyses of worldwide research shows that prevalence is also high − 16.3% for physical neglect and 18.4% for emotional…They show a prevalence rate of 9.6% for sexual abuse (13.4% in girls and 5.7% in boys), 22.9% for physical and 29.1% for mental. Applying these figures to the population of children in Europe suggests that 18 million children suffer from sexual abuse, 44 million from physical abuse and 55 million from mental abuse.”

Maybe part of preventing neglect starts with the very basics:

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So when we see media reports wailing about injustices which are relatively tiny in the grand scheme of things, perhaps we can reflect on the real problems that are right in front of our noses. #LetsEndChildAbuse

Priorities, priorities…

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Maryland (MD) – 2018

  • High school graduation rate: 87.6% (12th highest)
  • Public school spending: $13,075 per pupil (19th highest)
  • 8th grade NAEP proficiency: 34.7% (math), 37.4% (reading) (11th highest).
  • Adults with at least a bachelor’s degree: 39.3% (3rd highest)
  • Adults 25-64 with incomes at or above national median: 61.6% (2nd highest)
  • Violent crime 4.72/1000 residents (national average 4.0/1000) (9th highest)
  • Crimes per square mile 57 (national average 31.9)
  • Baltimore, MD most dangerous city (out of biggest 50) in America.
  • Opioid death rate 29.7/100,000 (3rd highest) – national average 13.3/100,000

Good to see where things are ranked among the worst, Democrats wish to put the least focus and vice versa. Rather telling. Where is the focus on healthcare and climate change? Even more telling.