drugs: the back story

 

so where is this discussion in the MSM?

guess what? Psychodelics have side effects

 I have watched cynically how various psychodelics have been pushed as miracle drugs for depression etc. in the lay press, and alas even in some so called medical journals.

Those pushing them come from well funded institutes that start with the idea that they work, and then they experiment with patients who often are desparate (where placebo effect would be high) or who already have used similar drugs and are eager to do so again and cure themselves (again high placebo effect).

I wonder who is pushing these institutes and funding their studies?

I am cynical, because a lot of these drugs led to mental illness when they were used in the 1960s, 

and even the use of them in ceremonies by Native Americans was usually in a ceremony, where only the patient took the drug, complete with community and religious aspects: 

the Native American church took it regularly, but one wonders if this was done traditionally as a regular practice, instead of a single ceremony. 

The dosage also is something not discussed. Mother Drexel once took peyote in a ceremony to understand those she worked with, and she claims the experience was similar to the deep prayer after communion. She did not hallucinate, but many taking it said they did hallucinate.

And is there brain damage? LSD leaves a hole in the brain on PET scans, meaning permenant damage. Any studies here? I don't know because I haven't done the research and of course I distrust the research because the experments were done to prove they work, not from a neutral point of view.

These drugs, if used correctly, could be letting one go into one's deep psyche. Similar to self hypnosis, meditation and other ways to get peace via rituals.

(one could say the same thing about vision quests, with fasting and prayer to get a vision. Not something one does all the time).

But even with TM types of meditation, the dirty little secret about these things is that a certain number of people freak out or get psychotic breaks: 

Well, anyway, the goofiness of Prince Harry might be because he took these drugs, says an article in the UKMail.

where an expert admits there can be problems.Even with a great therapist and a perfect situation, Dr Johnson said a person using these drugs is still vulnerable to having their view warped.

He said he has heard of cases where patients were effectively brainwashed using psychedelic therapy. 

But the expert added that for many people, '[They] can come to terms withpersonal issues with others... [and] feel that they have gained closure.'

Dr Johnson has seen many positive cases in clinical trials, though. Sometimes, a person will finally understand a loved one, and even break estrangement to reconnect.

the psychiatric equivalent of Russian Roulette

and one wonders if taking placebo with a sympathetic psychiatrist would work just as well.

latest opioid from China can be bought on line

 

 synthetic opioids such as Nitazene, which is stronger than Fentanyl, have been seen in Europe and in the USA for a couple of years, but now seem to be spreading in the USA.

CDC report on it's use in Tennesee notes 

During 2019–2021, a total of 52 nitazene-involved fatal drug overdoses were identified using TN SUDORS data, including no cases in 2019, 10 in 2020, and 42 in 2021

the average person was a middle aged white male, but the article notes that many overdose deaths from this new synthetic opioid are probably missed since the specific test is not done in many areas.

So where is this coming from? Anyone? Anyone?

well, a simple google shows you where you can buy it (you don't even have to go to the dark web to find it)

Place of Origin:ChinaBrand Name:HuiduoCertification:SGSModel Number:Lab Research Chemical

 who brags you can buy it from them instead of buying it on the street where you can't be sure of the quality of the drug.

The substance is one of the latest products of our specialists. Its formula was improved and researched and now it is ready to be sold online. To provide our customers with the opportunity to test the substance our online vendor offers to purchase online a sample of this legal powder at a reasonable price and free delivery. For the smaller research chemicals suppliers which are intended to resell the substance we can consider the wholesale terms of collaboration in order to promote the substance at the research chemicals market and among the clients. You can also figure out a lot of other already well known designer chemicals for sale at our web-site. The substance can bring a lot of pleasant emotions. The lasting of this legal powder is extremely long and it causes absolutely no comedown. You can enjoy the mild euporia from the substance or it can help you to stimulate your organism to work longer. But there will be no consequences the day after. The process of research chemical online purchase here is simple. You need to fill in the electronic order from at the page of item you have chosen, then pay for the package and then wait. The delivery of product will not take long.

Product Details:

Place of Origin:	China
Brand Name:	Huiduo
Certification:	SGS
Model Number:	Lab Research Chemical

Payment & Shipping Terms:

Minimum Order Quantity:	10g
Price:	300$
Packaging Details:	By standard sea worthy package
Delivery Time:	Within 7 days after payment
Payment Terms:	Western Union, MoneyGram, T/T, D/P, D/A, L/C
Supply Ability:	100mt/month

two years ago the FDA noted that you could buy it illegally on certain websites (and didn't have to use the Dark web to find it).

wikipedia notes: 

While several substances in this class have found applications in research, they have never been used in clinical medicine due to their profound risk of respiratory depression and death,.

But hey, the US government is right up there stopping this legal drug use: 

.the FDA has proposed to make them illegal as of last December...

this video is from last year and includes a lot of pharmacology information 

 

Pain pills and trauma care

People rarely die of prescription opioid medications they are prescribed. 
Well, duh. Sounds about right.

even those on high doses for chronic pain don't get "addicted": They might need to be withdrawn slowly from the medicine, but the psychological problems of addiction are not there (i.e. they take it to get rid of the pain not to get high).

The opioid crisis got bad after I left practicing medicine and moved here, but I know of two deaths in people who stole narcotic medications from cancer patients and died of an overdose. One was a known druggie, but another was a 13 year old girl at a party who was told to "drink this" and did. She was unpopular so obeyed the girl who gave it to her (probably as a joke). The source of the narcotic was the girl's grandmother, who kept liquid morphine for break through pain in her purse. Sigh.

but the dirty little secret is that the little old ladies often sell or borrow pain pills from each other because... arthritis pain.

A lot of older people just use a single mild opioid tablet at bedtime so they can sleep.


Yes, NSAIDs are just as good: indeed, for a lot of pain they are better, because they relieve inflammation: but in the elderly they have the risk of bleeding ulcer and kidney damage, so may kill more people than prescription opioids. So which are safer? It's hard to do a "clean" study, since the abuse cases and suicides confuse the statistics LINK

as for the suggestion to use Paracetamol (Tylenol), sorry: it just doesn't work as well, and it only lasts for 4 hours so you have to take a lot of pills to stay comfortable and again they do not relieve inflammation (which causes pain).

Drug abuse is a societal problem.

But of course, if you acknowledge it is Chinese fake percocet/ oxycontin /Fentanyl being smuggled in via Mexican drug cartels, you might have people actually saying yes build that wall to keep out drugs.

and my question: Where are the churches here? Isn't this a moral weakness to use drugs to get high? And how many take drugs because they were in despair, and no one was there to comfort them?

Ah, but PC churches have different priorities: Too busy worshipping Pachamama and changing Wikipedia pages for their enemies I guess...
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The Good news: from StrategyPage: Freeze dried plasma will save lives.

you give it to people suffering from blood loss. Plasma has been used since World War II (one of my professors was in charge of the blood bank using this to treat D Day casualties) but the new version is portable and doesn't require refrigeration.

The bad news: The French have been using it since 1994, and the US military has been using the French version since 2010 but is still trying to get the paperwork done to make it for the USA.

Article on the history of treatment of shock with plasma and blood transfusions and with IV fluid. LINK

A black physician, Dr. Charles Drew, developed the logistics of providing blood to the injured used in World War II.

His pioneering research and systematic developments in the use and preservation of blood plasma during World War II not only saved thousands of lives, but innovated the nation’s blood banking process and standardized procedures for long-term blood preservation and storage techniques adapted by the American Red Cross.

The Strategypage article notes other lifesaving methods devised for the military and now used in civilian life, such as hemecon and woundstat, used to stop bleeding and the abdominal belt to stop internal bleeding from the aorta.

not mentioned: Don't forget the helicopters.

The opening scene of MASH shows the helicopters bringing in the wounded, but in the last 30 years, helicopter transfer for civilians is becoming more common: Indeed, when possible they will land at your car accident site or near by (e.g. in parking lots) to take you to the Emergency room in some isolated rural communities.


the bad news: Consumer reports laments often they are used when alternative transport is available, leaving the person with a huge bill. But the problem is that when you call the ambulance, you don't often know how serious is the injury, or if the patient might die at the less equipped local hospital, or deteriorate during the long ambulance ride (when I worked in Northern Minnesota, it was 6 hours to Minneapolis and three hours to Fargo by ambulance... and in rural Pennsylvania a trip that is ten miles by map might take an hour and 30 miles by the mountain roads).

This article about a central Pennsylvania auto accident discusses how people are rescued and transported by medivac helicopter. 

I know the area.

Boalsburg is 30 minute drive to state StateCollege and another one hour or more drive to Altoona and in this case, the helicopter landed in a nearby parking lot.

the maps insist it is only a 45 minute drive to drive the 49 miles, but that is not true: that assumes the car accident happened near the interstate highway, that there is perfect weather, and that you can break the speed limit... 
And the dirty little secret is that it is hard to care for a critical patient in a noisy moving ambulance or in a fixed wing transport...

(I have no experience in the helicopters but these medevacs are well equipped, with experienced personnel, so things are less primitive than when I used to make ambulance runs in ambulances or in the fixed wing Cessna owned by the local undertaker that we used to borrow in the 1980s to transport people 150 miles to Rapid City from the Reservation).

My son in law is a Medevac pilot, Keep him in your prayers. 

----------------------------------------

In World War I, those suffering mental problem from combat were said to be suffering from "Shell shock".

And the SP article cited above notes that yes, post traumatic stress syndrome is more common in those who had mild brain concussions from IED explosions.

While largely the result of being exposed to a lot of combat, it was, by the late 1990s, realized that head trauma, usually from being too close to a lot of explosions, played a part as well. Work on PTSD continues, especially now that more methods have been developed, including medicines...

more HERE. 

however PTSD also occurs in civilians who had traumatic experiences. WEBMD discusses diagnosis and treatment.

Joe Kenda (of Homicide Hunter) discusses:

Kenda knows he suffers from post-traumatic stress disorder similar to what military veterans experience, and the show is a way for him to release some of the pent-up stress that still eats away at him to this day.

“It doesn’t go away,” says Kenda, who worked his way up to commander of the Major Crimes Unit. “You can’t un-see those things, you can’t not think about them, and you can’t forget them, even though you want to...

There are certain events that will trigger a memory, and it’s startling. Imagine having a nightmare while you’re awake. That’s what it can be sometimes.”

Sigh. Been there, done that. We docs see a lot of horrors too, cases of suffering we couldn't stop, or abuse cases or accidents, or of treatment that didn't work,  and you keep busy so just put the memory in a box and carry on. But after retirement, the memories pop back suddenly, and all I can do it give the problem to the Lord...

sigh.

(cross posted from my regular blog.)

CDC in the news

CDC: most violent deaths are... suicides.

by white males, young or old, or AmerIndian/Innuits.

homicides are more likely among Black non Hispanic teenage males.

Less than 1 percent are death by law enforcement.

----------------------------------

CDC reports one third of those with Lupus (SLE) take opioids for pain, and the experts are not happy about it.

Quick: What's wrong with this statement.

The widespread and long-term use of prescription opioids among this cohort of patients with SLE was striking given lack of evidence regarding safety and efficacy of opioids for treating chronic pain associated with rheumatic disease (1,7).

translation: we don't have scientific studies that opioids work for this type of pain (just ignore the experience of thousands of physicians who find it's the only thing that keeps their patients comfortable enough to function)

Particularly concerning is that some of the less appreciated medical risks associated with long-term opioid use, such as myocardial infarction, immunosuppression, and osteoporosis (8), are potentially compounded in persons with SLE, whose baseline risks for these comorbidities are elevated because of the underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies.

translation: opioid use is associated with these things, but hey, the disease of the patient cause them too.

Further, recent preliminary data suggest that opioids are associated with increased mortality in lupus.¶

so is it from the opioids, or because we give opioids to the patients whose lupus is worse?

The study about increased mortality is, of course, a "metanalysis" meaning it took a bunch of studies and averaged the results.

so what does this mean?

A qualitative review was performed because the number of articles pertaining to specific adverse effects of opioids was typically small, and the diversity of adverse effects across systems precluded a quantitative analysis.

hmm.. in other words, not a lot of data out there so the analysis might not be accurate.

Through a variety of mechanisms, opioids cause adverse events in several organ systems. Evidence shows that chronic opioid therapy is associated with constipation, sleep-disordered breathing, fractures, hypothalamic-pituitary-adrenal dysregulation, and overdose.

True. Constipation in cancer patients on opioids is a big problem no one wants to talk about. You get respiratory depression, and I've seen this in the elderly, who are doing well on their opioid dosage until they pneumonia... a Overdoses might be accidental or deliberate (not just suicide but from taking extra dosese because you hurt and take a second or third dose before the first dose starts to work).

However, significant gaps remain regarding the spectrum of potentially opioid-related adverse effects. Opioid-related adverse effects can cause significant declines in health-related quality of life and increased health care costs.

or maybe they increase the quality of life when taken. That part is not addressed.

------------------------------
remember all the hysteria about the Zika virus causing mental retardation among infants whose moms were exposed to it?

well the dirty little secret is that Rubella does this too:

but thanks to vaccine, (MMR means Measles Mumps Rubella) it has gone down world wide.

CDC report:

Progress toward rubella elimination has resulted in 168 (87%) of 194 countries protecting infants with RCV and 81 (42%) eliminating rubella transmission. Equity between countries using rubella-containing vaccine has increased as lower-income countries have introduced rubella-containing vaccine.

this paper notes the decrease in cases from 2000 to 2016 

In 2016, 22,361 rubella cases were reported to WHO, a 97% decrease from 670,894 cases reported in 2000, and a 76% decrease from 94,277 cases reported in 2012 

there is a big worry that the increase in refusing "measles" shots (actually MMR shots) will increase the rate of fetal rubella syndrome: 

but one might not see this until these unvaccinated kids grow up and get pregnant.

and in some poorer countries, only measles vaccine was given, not the MMR combination which is usually used in the USA.

Speed in wartime

Stimulants are frequently abused (one big problem here in the Philippines is use of Shabu, i.e. meth, by drivers and farmers to stay awake, but also leading to abuse and violence in some users, especially when used to get high).

StrategyPage has a long article on the use of drugs in the War, including new treatments for post traumatic stress, but also how soldiers cope in stressful combat situations using stimulents so people don't fall asleep in times of battle (and sometimes sleeping pills to counteract these pills to fall asleep).

This is not just by Americans: The ISIS type crazies like it too.

While Islamic terrorists found heroin, cocaine and prescription drugs useful, the most widely used Islamic terrorist chemical enhancer was that old World War II era standby amphetamines ("speed") pills. When shipments of Islamic terrorist weapons and ammo were seized there were often quantities of amphetamines as well guns, ammo and sometimes medical supplies.

this is nothing new: A recent book showed how the Nazis pushed this on not just soldiers in combat (which was also how the Yanks used it) but in civilians.

from the UKGuardian:

The book in question is The Total Rush – or, to use its superior English title, Blitzed – which reveals the astonishing and hitherto largely untold story of the Third Reich’s relationship with drugs, including cocaine, heroin, morphine and, above all, methamphetamines (aka crystal meth), and of their effect not only on Hitler’s final days – the Führer, by Ohler’s account, was an absolute junkie with ruined veins by the time he retreated to the last of his bunkers – but on the Wehrmacht’s successful invasion of France in 1940. Published in Germany last year, where it became a bestseller, it has since been translated into 18 language

of course, the traditional drug has always been alcohol.

my take? I agree with StrategyPage: It's the lesser of two evils,

Prolonged use of these drugs is not healthy. But neither is being drowsy during combat. It's better to get some sleep when you can, even if you have to take more medications to help make that happen. Troops exposed to prolonged combat find the stimulants lifesavers and consider them as essential as ammunition. Thus Islamic terrorists consider a weapons and ammo shipment incomplete if some Captagon was not included.

but I do wonder if the drug use in combat contributes to the high rate of suicide.

long discussion here (and note how traumatic brain injury also might be one reason for the high rate of psychiatric problems)

MARIJUANA IN PREGNANCY

fetal alcohol syndrome is a terrible problem, but now we see marijuana use in early pregnancy soaring, and it is worse because some women seem to be using it as a "treatment" for morning sickness in the first trimester, when fetal development is most sensitive to chemicals.

CDC report here.

It is important to include accurate information about the health risks of using marijuana for a mother and her baby. Some important ideas to convey include, marijuana use during pregnancy may increase your baby’s risk of developmental problems; the chemicals in any form of marijuana may be bad for your baby (this includes edible marijuana products such as cookies, brownies, or candies);
marijuana use during pregnancy may negatively impact your baby after birth (research shows marijuana use during pregnancy may make it hard for your child to pay attention, learn, or do well in school and these issues may only become noticeable as your child grows older); and if you’re using marijuana and are pregnant or planning to become pregnant, talk to your doctor.

Making doctos scapegoats for drug cartel opiods.. And patients suffer

Inside Sources: Misdiagnosing the Opioid crisis.

Policymakers in Washington and in state capitals are misdiagnosing the opioid crisis as a doctor-patient problem. Their policies are coming between doctors and patients. They are preventing doctors from using their judgment and expertise to ease pain and suffering. They are making many patients suffer needlessly, with some turning in desperation to the black market.

yeah. Old ladies often sell or give each other their pain pills, not so their friends can get high, but so they can get pain relief. Ditto for tranquilizers. This doesn't bother me too much.

Then you have the stealing of grandma's medicines by druggies or by teenagers trying to get high. This can be a problem, especially if the one stealing the drug is the caregiver or friend who "helps" the old person (often they are not working and living off of grandma's pension, or stealing money from her).

This is low level crime, and hurts our patients.

But this is nothing new.

The real problem behind the "crisis" is the drug cartels. Again from the article.

On August 1, and September 5, two separate raids by combined federal and local narcotics police in New York City seized the largest haul of the powerful opioid fentanyl in New York history. This included 140 pounds of fentanyl (32 million lethal doses), 75 pounds of fentanyl mixed with heroin, and additional stores of heroin and cocaine.
New York City special narcotics prosecutor Bridget Brennan told reporters, “The sheer volume of fentanyl pouring into the city is shocking. It’s not only killing a record number of people in New York City but the city is used as a hub of regional distribution for a lethal substance that is taking thousands of lives throughout the Northeast.”

unfortunately, he then says: stop drug prohibition and the overdose problem will go away.

Nope. Because they will still go to illegal sources to get high. And Fentanyl is a much better "high" than marijuana. The dirty little secret is that marijuana is almost legal anywhere: it is rarely prosecuted (all those folks jailed for "marijuana possession" are often plea bargains for bigger crimes that might be hard to prove, maybe because the victim is afraid of being killed if they testify, and more often because the court system if overworked).

And of course, the societal problems from being high is huge, as we see in broken families, in car accidents, and in unemployment because who will hire such a person.


I have been saying this for quite some time: The "opioid crisis" is not from doctors prescribing opioids for pain, but from drug cartels smuggling in opioids, often fentanyl and analogs that are powerful and easy to overdose. And, like in the Philippines "Shabu" drug wars, a lot of it is from China.

That is why Duterte remains popular here, despite the  SJW complaining all the time and spreading their complaints all over the world. That is why the "huge" anti drug war anti Duterte demonstration that the MSM in the US lauded as showing people are starting to oppose his war last week only had 5000 demonstrators, even though you can hire people to demonstrate for ten dollars a day: because even the unemployed street people won't take your money. (and three times that many supporting Duterte, something that the MSM missed).

So where are the anti drug types in the USA?

A friend used to tell me about the huge amounts of cocaine etc. used by the elites in Washington back in the 1990's (a friend's daughter worked for the Justice Dept and was scandalized).

And of course, I worked on the Indian reservations, where alcohol was the drug of choice: Keep them drunk, and they won't be a problem. (which is why as the tribes get more sovereignty they often prohibit alcohol). Nowadays, of course, it is stronger drugs, but never mind.

Who was the black politician who blamed the CIA for the crack epidemic in the 1990's? Yup. Maxine Waters. She is still at her "Conspiracy theories" of course, but you know, most conspiracy theories arise from information that is not being reported, and then they exaggerate and/or twist the information, so easily get things wrong, but there is a core of truth underneath.

But who benefits from the drugging of America?

Place conspiracy theory here.

I know who "benefits" from Shabu trade here.

Politicians, and businessmen, and crooked cops, and crooked officials looking the other way when it is smuggled in (e.g. like the recent discovery of how a load was let thru customs at the airport).

Also, since Filipinos work all over the place, it is easy to find a drug mule to carry the stuff all over: So we have been a hub for distribution.

Who suffers? The poor who take it to get high, or to be able to work harder. And their families. And now, of course, a lot of the casualties are ordinary folks who were in the local distribution racket: When a tricycle driver makes 600 pesos ($12) a day, it is hard to support a family, so why not take that package and deliver it because you need the money for your family?

This is why many of the casualties of the drug war are "innocent": No, they are often in the wrong place at the wrong time when a raid is going on.

But the rich are the ones behind the problem, the rich who don't care about the casualties of taking drugs, they are still at large, and using the SJW types to try to take Duterte down before he finds enough evidence to put them away.

The Catholic bishops are busy condemning Duterte's drug war, but they don't seem to see the casualties of drug use here.

Like the lady across the street who died of "a heart attack" at age 37 (shabu/meth induced of course).

Or the teenage girl killed by her druggie boyfriend whose body was dumped in the cemetery near Lolo's grave (she was breaking up with him).

or the elderly people killed in ordinary robberies/home invasions (three in our area in recent years).

Or the many bodies that are found tied up and with evidence of torture (by drug gangs, usually for being a snitch: these bodies were commonly reported found before the drug war started, so don't blame Duterte).

so where are the churches in all of this?

The Catholic bishops here of course condemn the poor pushers killed in Duterte's drug war, but how many bishops have condemned the politicians who take bribes and kickbacks from the drug lords?

Maybe in private, or maybe in vague terms without naming names.

Or are they too busy pushing the Green agenda and the Francis church's idea of "mercy" to bother to see the casualties of corruption?

The old Testament prophets wrote a lot of stuff condemning such corruption in business and government.

Ah but mercy!

Those who insist Jesus meek and mild would never condemn someone, well, could I remind you he broke up the sellers in the Temple. The naive left wing types that run the church hint this was anti capitalism, but anyone who lives with corruption figures they were over-pricing and gouging customers, and giving kickbacks to the priests.

The disease making a comeback with the Heroin epidemic and gangs

A two part series in the NYTimes.  One Two

this is what I posted on my main blog about part one of the story:



Syphilis is back, and the NYTimes blames gangs, drug s and "uneducated doctors".

yes, Syphilis is spread by IV drug use, and this is about the heroin injection epidemic.

And in Asia/Russia, IV drug use, not sex, is the major cause of HIV...

the article notes they are going back to the good old days of tracing contacts (a practice that was discouraged when HIV became a protected disease).

But if you read way down in the article, you find that syphilis is common in another group: men who have sex with men.

When I was in medical school, we learned syphilis was the "Great pretender" because it looked like so many other diseases.

and the underbelly of evil is here:

Usually such efforts lead to sagas of unrelenting grimness: mothers who prostitute daughters, and men who forcibly inject runaways with drugs to hook them, a practice known as guerrilla pimping.

Something to remember the next time you hear a libertarian insist that "sex workers" like to do their jobs.

In the good old days (until it was stopped because there were so few cases, in the 1970's)  everyone admitted to a hospital got a screening test for syphilis because often people didn't know that they had been exposed, especially women.

Sigh. In our prayers.

------------

part two discusses how public health officials investiage contacts of those diagnosed with the disease.


read the whole thing.

But every day, the disease intervention specialists keep reporting the same harsh story, a growing specter of broken young lives....

Th

And where, exactly, are all the clergymen in the Bible Belt state?

yes, they are there, trying to help.

Fentanyl updates

some of the overdoses are from a similar drug used to sedate large animals...

ordinary lab testing can't tell the difference between this and fenanyl and it is very similar in it's actions.

and guess where it is coming from?

Like fentanyl, carfentanil is dangerous not just to users but to anyone who comes into contact with it. Grains of it can be absorbed through the skin or inhaled. According to the DEA, most fentanyl analogues in the United States are being manufactured in China and transported through Mexico.

more HERE Carfentanil

China's drug page on Wikipedia.

a lot of it is supplying precursor chemicals to refine heroin in Burma etc.

But more recently it has gone into the manufacture and supply business.

more HERE. (International Business Times UK).

China has become the "chemical and pharmaceutical wholesaler and retailer of new psychoactive substances in the world," according to a new Europol report.
It warned that it is possible that criminal organisations will become even more active, given the large profits and low risk of production and distribution of these substances.

 The report, the EU Drug Markets Report 2016l....according to South China Morning Post, adds weight to previous reports that point to China and its expanding pharmaceutical industry as "playing an increasingly important role in the international drug trade."

Remember, in China, as in the Philippines, a small "gift" will get the regulators to look the other way.

And China, along with India, is one of the sources of "counterfeit" and cheap but inferior generic drugs.
--------------

The counterfeit/inferior drug problem, mainly from China and India, probably kills more people than heroin.