instruction:
Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
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The decision by Cleveland County District Judge Thad Balkman in Norman, Oklahoma, came in the first case to go to trial out of 2,700 nationally by states, counties and cities seeking to hold drug companies responsible for the deadly epidemic. Balkman reduced the amount he had awarded in August by $107 million after agreeing with New Brunswick, New Jersey-based J&J that he had made a math error. J&J said it will appeal, and that the award and finding of liability were “neither supported by the facts nor the law.”  A spokesman for Oklahoma Attorney General Mike Hunter said that office is reviewing the decision and will formally respond within the next few days. Opioids were involved in almost 400,000 overdose deaths from 1999 to 2017, according to the U.S. Centers for Disease Control and Prevention. Following a non-jury trial, Balkman ruled in August that Oklahoma had proven that J&J engaged in misleading marketing about the benefits of painkillers, and that their addictive risks caused a public nuisance in the form of the opioid crisis. Hunter had sought to have J&J pay $17 billion to help fund addiction treatment and other services to repair damage from the opioid epidemic over the next 30 years. Balkman, however, awarded only enough money for one year of programs, saying Oklahoma failed to support its claims regarding the need to abate the epidemic in future years. Following the August ruling, Oklahoma asked Balkman for permission to return to his courtroom annually to prove those costs, but Balkman on Friday maintained his prior ruling. J&J, meanwhile, argued that it deserved a $355 million credit, reflecting pre-trial settlements by the drugmakers Purdue Pharma LP and Teva Pharmaceutical Industries Ltd.  Balkman concluded on Friday that state law did not allow such credits. Last month, J&J and four other companies proposed a $48 billion settlement framework to resolve all of the opioid cases they face, with J&J paying $4 billion. Lawyers for the local governments have opposed the proposal. If approved, the settlement would let J&J resolve some of the thousands of product liability lawsuits it faces. The company also faces litigation over whether its baby powder causes cancer, a claim it denies.
answer:
Oklahoma judge reduces Johnson & Johnson opioid payout to $465 million.


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With an alcohol by volume figure of 43 percent, the 2-ounce sachets are about as intoxicating as a typical 16-ounce beer, but consumers say that’s just one of their virtues. Kouame claimed they give him a jolt of energy other drinks can’t match — just what he needs to face a long day of hectic traffic, run-ins with police and testy fare negotiations. “It inspires me. It gives me a bit of courage to confront the challenges of life,” he said. From now on, however, Ivory Coast’s government wants Kouame to get his courage elsewhere. Last month, officials announced a ban on alcohol sachets, citing their health risks and the need to combat alcoholism, especially among youth. The measure is one of more than a half-dozen bans or partial bans on alcohol sachets in effect in sub-Saharan Africa, according to the World Health Organization. Other countries with bans include Zambia, Kenya, Tanzania, Rwanda, Burundi, Congo and South Sudan, said Jean-Marie Vianny Maurice Yameogo, the WHO’s Ivory Coast representative. Tracking the sales of alcohol sachets, many containing spirits distilled from palm wine, is difficult because they are often produced outside regulated markets. The sachets are typically mass-produced in West Africa, with colorful packaging. The drink “Amour Profond,” or “Deep Love,” shows a man standing behind a bare-shouldered woman, whispering into her ear. The sachets are not necessarily more potent than other drinks available. Palm wine-based traditional drinks such as koutoukou, which are similarly cheap, can have alcohol by volume rates of more than 50 percent. But sachets are more likely to contain toxic chemicals such as methanol, or wood alcohol, Yameogo said. And the packaging often boasts of health and other benefits that Yameogo said have no basis in science. Some are said to provide cures for maladies such as hemorrhoids, while others are reputed to function as appetite-suppressants or aphrodisiacs. Moreover, the small sachets are easy to hide, making them especially tempting for schoolchildren, according to the Ivorian government and the WHO. “It’s something that’s accessible to everyone. You can buy a sachet, put it in your pocket and just walk around like that,” said Patrick Gbodou, president of School Anti-Drug, an Ivorian organization that campaigns against drinking and drug use by students. The official drinking age in Ivory Coast is 21, but it is rarely enforced, and teenage drinking is common. Vendors are worried they will take a huge hit if the ban on sachets is enforced, as many drinkers go for sachets and nothing else. “The government needs to have pity on us,” said Adjo Abega, the owner of a bar in Abidjan’s Port-Bouet district. Drinkers generally acknowledge the health risks posed by alcohol sachets, but some criticized the government for cracking down on their favorite vice while permitting other health hazards such as cigarettes. Desire N’Guessan, an unemployed 26-year-old, began drinking sachets when he was a teenager. He said he relies on them to ward off illness and for motivation to keep looking for work. “When you are not able to overcome your timidity, it can be difficult to operate in your neighborhood,” N’Guessan said. If the government makes good on the ban, he warned, Ivorian children could turn to drugs. He also predicted marches and protests. But Kouame, the taxi driver, was less worried. In the absence of alcohol sachets, he said he would switch up his morning routine by drinking glasses of palm wine instead, adding: “Man can adapt to anything.”
answer:
Ivory Coast is latest to crack down on alcohol sachets.


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There is no discussion of the cost of N-acetylcysteine although it is on the World Health Organization’s list of essential medicines, is available over-the-counter and is not very expensive. An online search reveals prices ranging from about $6 for 100 capsules containing 600 mg to around $12 for 50 high-dose capsules containing 700 mg. The intent of the pilot study was to determine the effect of N-acetylcysteine on PTSD symptoms, cravings and substance use. All three endpoints are described in the news release albeit in relative terms. We are told that the 8-week trial randomized 35 veterans with PTSD and substance use disorder. Some received N-acetylcysteine and others a placebo, but all of the participants received cognitive behavioral therapy (CBT). The release reported that “Veterans in the NAC-treated group showed a 46% reduction in PTSD symptoms, compared with a 25% reduction in the placebo group on the Clinical-Administered PTSD Scale (CAPS), which assesses trauma history and symptom severity. The threshold CAPS score for diagnosis of PTSD is 50.” The release quotes the lead author: “As a group, the NAC-treated veterans were below diagnostic level for PTSD at the end of treatment.” This establishes that the benefit was clinically meaningful. But we prefer to see absolute rather than relative numbers as used here. For example, the actual before and after scores on the PTSD scale would have better illustrated how large the benefit was. The release explains that the drug used “does not cause side effects at the doses used in the study, but it degrades quickly when stored, is contraindicated in patients with asthma, and can cause nausea at higher doses and so should always be obtained and administered under a physician’s supervision.” However, the published study notes a higher incidence of adverse events in the N-acetylcysteine treated group that in those treated with placebo (66.7% vs. 47.1%). N-acetylcysteine can cause “nausea, vomiting, and diarrhea or constipation. Rarely, it can cause rashes, fever, headache, drowsiness, low blood pressure, and liver problems,” according to WebMD. This news release does not exaggerate the benefits found in the study, and added helpful caveats about the limitations of the study, its applicability to the general population and its small size. We’d have preferred to see some specific language cautioning about the short duration of the study (just 8 weeks) and the fact that the results might not hold up over time. There is no obvious disease-mongering here. However, when the release notes that 7-8 percent of Americans have experienced PTSD at some point in their lives it could have been noted that the PTSD experienced by military veterans — leaving them ‘difficult-to-treat’ — is in a different category than what civilians might experience. The release clearly states the funding sources and it would be very unlikely that these researchers would have a financial interest in the product under study since it is off-patent and generically available without a prescription. The news release mentions other treatments for PTSD (such as SSRI antidepressants) even though we don’t learn how effective those treatments are compared to N-acetylcysteine. The lead researcher very helpfully mentions that the drug should not be used without cognitive behavioral therapy or other forms of psychological counseling. The news release places the results of the study in a positive light noting, “Currently, there are no well-explored pharmacological treatments for patients with co-occurring PTSD/SUD. Although selective serotonin reuptake inhibitors have been approved by the FDA for treatment of PTSD, pharmacological treatments for co-occurring PTSD/SUD have yielded suboptimal results.” While SSRI’s have been the most studied to date, other drugs that have been studied in preliminary trials could have been mentioned, including prozosin, prazosin, guanfacine, atomoxetine, topiramate, memantine, acamprosate, and ketamine. A 2014 article in Addictive Behaviors journal describes some of these: “Pharmacological treatment of comorbid PTSD and substance use disorder: recent progress.” (Addictive behaviors 39.2 (2014): 428-433.) We learn it is sold over-the-counter and available everywhere. The release claims novelty with these statements: “This trial is the first to use NAC as a pharmacotherapy for PTSD and a broad range of SUDs” and “NAC treatment with CBT would be a novel approach to treat co-occurring PTSD and SUD.” This does appear to be the first such clinical trial of the supplement to address this combination of disorders. There is no use of unjustifiable language. In fact, we were pleased to see the consistent use of “substance use disorder” or SUD to describe the inappropriate use of illegal and legal drugs. Our recent post on ways to put people first when talking about addiction shows how careful terminology improves accuracy and reduces stigma.
answer:

A potential pharmaceutical intervention for co-occurring PTSD and substance use disorder