Judge rejects Purdue Pharma's $4.5B opioid settlement(axios.com)
axios.com
Judge rejects Purdue Pharma's $4.5B opioid settlement
https://www.axios.com/purdue-pharma-opioids-settlement-ruling-5d56f27b-eebe-4d6e-a1ac-7915d45f8795.html
92 comments
> Steve Miller, chair of the Purdue board of directors, said in an emailed statement that the ruling "will delay, and perhaps end, the ability of creditors, communities, and individuals to receive billions in value to abate the opioid crisis."
> "These funds are needed now more than ever as overdose rates hit record-highs, and we are confident that we can successfully appeal this decision and deliver desperately needed funds to the communities and individuals suffering in the midst of this crisis," Miller added.
I mean, if that's what you're concerned about, you can just do that now, without a court decision. You can just spend money on opiod addiction relief. You fucking muppet.
> "These funds are needed now more than ever as overdose rates hit record-highs, and we are confident that we can successfully appeal this decision and deliver desperately needed funds to the communities and individuals suffering in the midst of this crisis," Miller added.
I mean, if that's what you're concerned about, you can just do that now, without a court decision. You can just spend money on opiod addiction relief. You fucking muppet.
Should you be free to use whatever drug you want?
Do doctors hold any responsibility over getting you addicted by drugs they prescribe? (Aren't doctors the experts?)
Now that marijuana is legal, should you sue the legal stores if you get addicted?
Do doctors hold any responsibility over getting you addicted by drugs they prescribe? (Aren't doctors the experts?)
Now that marijuana is legal, should you sue the legal stores if you get addicted?
> Do doctors hold any responsibility over getting you addicted by drugs they prescribe? (Aren't doctors the experts?
In this case doctors wrongly prescribed ( when it wasn't necessary or in too high doses) a drug for personal profit. They're guilty, and so is the company that paid them to do that and kept bullshit marketing reassuring doctors and patients everything is ok.
In this case doctors wrongly prescribed ( when it wasn't necessary or in too high doses) a drug for personal profit. They're guilty, and so is the company that paid them to do that and kept bullshit marketing reassuring doctors and patients everything is ok.
I keep hearing this, but there is no mechanism I am aware of for a doctor to see a cent related to prescription of outpatient medication. What’s the purported mechanism by which docs were making money on this?
Purdue would give them kickbacks, vacations, etc. as part of their marketing outreach. It's not like the doctors made commission on every pill
If you keep hearing this, maybe take a look at all the despicable bullshit that Purdue have been caught in. If you like the video format, you can start with John Oliver's "Opiods" episodes.
> Should you be free to use whatever drug you want?
Your body, your choice? There are many ways to answer this, and no matter how it is answered there will always be a group of people who disagree. This is why as a society we have a framework for making those decisions which sometimes gets it right and sometimes gets it wrong.
If we legalized all drugs and let people do what they want, do we stop a 10 year old from taking meth, after all it their choice. I think it would be absurd to have 0 restrictions, but that would go against the concept of being able to make free choices.
> Do doctors hold any responsibility over getting you addicted by drugs they prescribe? (Aren't doctors the experts?)
If they prescribed them outside of the boundaries of their professional framework, then yes.
> Now that marijuana is legal, should you sue the legal stores if you get addicted?
You buying marijuana intentionally is a little different from being under the mindset that a licensed medical professional (and health system) is acting within your best interest. Part of this problem also is Purdue mislead people on the addictiveness of their product.
However in saying the above, there is a lot more to this than just supplying a drug. They broke other laws such as the anti kickback.
Your body, your choice? There are many ways to answer this, and no matter how it is answered there will always be a group of people who disagree. This is why as a society we have a framework for making those decisions which sometimes gets it right and sometimes gets it wrong.
If we legalized all drugs and let people do what they want, do we stop a 10 year old from taking meth, after all it their choice. I think it would be absurd to have 0 restrictions, but that would go against the concept of being able to make free choices.
> Do doctors hold any responsibility over getting you addicted by drugs they prescribe? (Aren't doctors the experts?)
If they prescribed them outside of the boundaries of their professional framework, then yes.
> Now that marijuana is legal, should you sue the legal stores if you get addicted?
You buying marijuana intentionally is a little different from being under the mindset that a licensed medical professional (and health system) is acting within your best interest. Part of this problem also is Purdue mislead people on the addictiveness of their product.
However in saying the above, there is a lot more to this than just supplying a drug. They broke other laws such as the anti kickback.
I want every drug to be on the shelf at the store, but depending on what it is you may have to show your ID to prove you are at the age of majority or emancipated. A pharmacist may still exist to answer questions but nobody is filling pill bottles. Every bottle has the factory safety seal. Scan the label with your phone to locally validate what risks are specific to you without the use of a cloud.
In some ways I agree. I believe while there are still huge issues with the manufacturing, cultivation etc of drugs, that there are still a multitude of issues which we need to deal with first. That's why I am an advocate of decriminalization, so we sort those issues first.
I have had first hand experience of dealing with immediate family members and friends who have been addicted to legal drugs like alcohol, and illegal drugs like meth. The impact that addiction can have on others who are not addicts is quite disturbing and I have had a mild experience to say the least. I have even struggled with my own addictions.
I think drugs like marijuana is ok, but a drug like meth oh no that's just not good at all. Even alcohol I question a lot, even a quick google search suggest 40% of murders are committed in the USA while under its influence.
Also there are questions about how drugs can be legally sold, I read an article the other day that San Francisco was stopping tax hikes on marijuana stores because of the rise of the illegal marijuana trade. When governments get involved the outcomes are not always as expected. Would legalizing and taxing cocaine for example really stop the mass murders and gang violence in South and Central Americas.
Decriminalize, treat the people with addiction rather than locking them up for possession, educate, etc. That's my thinking.
I have had first hand experience of dealing with immediate family members and friends who have been addicted to legal drugs like alcohol, and illegal drugs like meth. The impact that addiction can have on others who are not addicts is quite disturbing and I have had a mild experience to say the least. I have even struggled with my own addictions.
I think drugs like marijuana is ok, but a drug like meth oh no that's just not good at all. Even alcohol I question a lot, even a quick google search suggest 40% of murders are committed in the USA while under its influence.
Also there are questions about how drugs can be legally sold, I read an article the other day that San Francisco was stopping tax hikes on marijuana stores because of the rise of the illegal marijuana trade. When governments get involved the outcomes are not always as expected. Would legalizing and taxing cocaine for example really stop the mass murders and gang violence in South and Central Americas.
Decriminalize, treat the people with addiction rather than locking them up for possession, educate, etc. That's my thinking.
I can see where you are coming from and it makes sense to me. I personally am not a fan of decriminalization as it keeps the control and power of drugs in the hands of the pharmaceutical and medical industries. They can still abuse that power. I personally would prefer to move that power and the potential abuse to the individual at their own legal discretion.
I believe an alternate solution to somewhat mitigate the risks you mention would be an insurance system whether private or public funded that incentivizes good health. Not just good health in the sense of getting off of and staying off of opiates, but also things like sugar, alcohol, starchy processed foods, etc... People that prove they are making progress towards being and staying healthy get lower insurance rates, lower federal income taxes and probably some other realistic benefits. But again, I can see where you are coming from. I have lost people I care about to drugs and alcohol and I empathize for others that have also lost people they care about. It is a vicious cycle that seems to be never ending. I hope that some day we start doing different things to try to break those cycles.
I believe an alternate solution to somewhat mitigate the risks you mention would be an insurance system whether private or public funded that incentivizes good health. Not just good health in the sense of getting off of and staying off of opiates, but also things like sugar, alcohol, starchy processed foods, etc... People that prove they are making progress towards being and staying healthy get lower insurance rates, lower federal income taxes and probably some other realistic benefits. But again, I can see where you are coming from. I have lost people I care about to drugs and alcohol and I empathize for others that have also lost people they care about. It is a vicious cycle that seems to be never ending. I hope that some day we start doing different things to try to break those cycles.
Hmm. There are five drug classes for controlled substances and oxycontin was always a class 2 narcotic which carries the second highest risk of being abused. I don't think most doctors/pharmacist really bought into the idea there was zero chance of abuse. I think in the beginning Richard Sackler the best intentions (by Creating a successful drug and racking in a bunch of money and there is no crime in that)but ended getting in way over his head leading to Purdue spiral out of control. I don't believe he created the opiod pandemic but he certainly played a role in it. But as Al Pacinos character says in scarface, "You need people like me so you can point your fckn’ fingers and say, “That’s the bad guy.” And that guy happened to he Richard Sackler
"I don't think most doctors/pharmacist really bought into the idea there was zero chance of abuse."
APPENDIX TO WILLIAM S. BURROUGHS Naked Lunch : Burroughs quote in The British Journal of Addiction, Vol 53, No.2
"LETTER FROM A MASTER ADDICT TO DANGEROUS DRUGS (August 3rd, 1956. Venice (p. 189, Paladin 1992 ed.):"
"I have Taken morphine for acute pain. Any opiate that effectively relieves pain to an equal degree relieves withdrawal symptoms. The conclusion is obvious: Any opiate that relieves pain is habit forming, and the more effectively it relieves pain the more habit forming it is. ..."
William Burroughs.
There is no argument about this and there hasn't been any for about at least a century or more. This is medicine/pharmacy 101 stuff.
All those who thought/think otherwise are fools and should not be anywhere near such decision-making processes. Those qualified in pharmacy or medicine and involved in the pushing and peddling of oxycontin had to know EXACTLY what they were doing - that's to say the serious damage they were doing to patients' health not to mention the deaths - the 65-year old Burroughs quote being the scientific orodoxy in hundreds of medical and pharmacopeia texts.
Burroughs, an opiate addict for 15 years, is one of the most articulate drug users to have written on the matter of opiate addiction and the fact that his descriptions of the addictiveness of opioids has been widely published for decades in the popular press meant that not just the professions knew the details intimately but also that everyone did.
Nothing that Purdue or the Shacklers can say or do can absolve them from their responsibility for the deaths of over 800,000 people - a truly staggering number.
The original settlement was a fucking farce of the first order. Why the Shacklers weren't stripped of everything they own then locked up and the key thrown away simply amazes me. What's wrong with US justice that it can fail so terribly? Here, justice is nothing other than a joke - a joke run and told by the accused.
Moreover, what went wrong with the medical profession and the regulators? Why was the FDA AWOL on this matter for decades - a matter with very well known and long-honed parameters?
After all, the matter of narcotics and addiction is the subject of international treaties. We all know the issues and yet it still happened.
The Purdue, Sacklers and oxycontin matter is one of the greatest failures of public health of all time: a tragedy of unprecedented proportions - and as far as I can determine, no one - except the dead - have paid any penalty whatsoever.
APPENDIX TO WILLIAM S. BURROUGHS Naked Lunch : Burroughs quote in The British Journal of Addiction, Vol 53, No.2
"LETTER FROM A MASTER ADDICT TO DANGEROUS DRUGS (August 3rd, 1956. Venice (p. 189, Paladin 1992 ed.):"
"I have Taken morphine for acute pain. Any opiate that effectively relieves pain to an equal degree relieves withdrawal symptoms. The conclusion is obvious: Any opiate that relieves pain is habit forming, and the more effectively it relieves pain the more habit forming it is. ..."
William Burroughs.
There is no argument about this and there hasn't been any for about at least a century or more. This is medicine/pharmacy 101 stuff.
All those who thought/think otherwise are fools and should not be anywhere near such decision-making processes. Those qualified in pharmacy or medicine and involved in the pushing and peddling of oxycontin had to know EXACTLY what they were doing - that's to say the serious damage they were doing to patients' health not to mention the deaths - the 65-year old Burroughs quote being the scientific orodoxy in hundreds of medical and pharmacopeia texts.
Burroughs, an opiate addict for 15 years, is one of the most articulate drug users to have written on the matter of opiate addiction and the fact that his descriptions of the addictiveness of opioids has been widely published for decades in the popular press meant that not just the professions knew the details intimately but also that everyone did.
Nothing that Purdue or the Shacklers can say or do can absolve them from their responsibility for the deaths of over 800,000 people - a truly staggering number.
The original settlement was a fucking farce of the first order. Why the Shacklers weren't stripped of everything they own then locked up and the key thrown away simply amazes me. What's wrong with US justice that it can fail so terribly? Here, justice is nothing other than a joke - a joke run and told by the accused.
Moreover, what went wrong with the medical profession and the regulators? Why was the FDA AWOL on this matter for decades - a matter with very well known and long-honed parameters?
After all, the matter of narcotics and addiction is the subject of international treaties. We all know the issues and yet it still happened.
The Purdue, Sacklers and oxycontin matter is one of the greatest failures of public health of all time: a tragedy of unprecedented proportions - and as far as I can determine, no one - except the dead - have paid any penalty whatsoever.
Dupe from a few hours ago:
https://news.ycombinator.com/item?id=29586740
Good.
For those that haven't watched them yet, there are 3 John Oliver segments on the subject that will back up the "Good." statement:
Opioids https://www.youtube.com/watch?v=5pdPrQFjo2o
Opioids II https://www.youtube.com/watch?v=-qCKR6wy94U
Opioids III (this one focuses 100% on the Sacklers) https://www.youtube.com/watch?v=uaCaIhfETsM
For those that haven't watched them yet, there are 3 John Oliver segments on the subject that will back up the "Good." statement:
Opioids https://www.youtube.com/watch?v=5pdPrQFjo2o
Opioids II https://www.youtube.com/watch?v=-qCKR6wy94U
Opioids III (this one focuses 100% on the Sacklers) https://www.youtube.com/watch?v=uaCaIhfETsM
The Pharmacist on Netflix also worth a watch
https://www.netflix.com/ie/title/81002576
https://www.netflix.com/ie/title/81002576
Just watched part 3 and I've gotta say, I love the website stuff. "You gotta buy the .com"
Can anyone explain why opioids are still being sold and prescribed?
The problem was never that they don't work the problem was that they're addictive.
So since they do work this means it remains appropriate to prescribe them, it just isn't appropriate to give them to everybody to pop one every day before work and say it's "non-addictive".
Drugs that work but have a terrible reputation are almost always still available. For example Thalidomide works, but it causes birth defects. Well, if you're a 45 year old man and the doctor can fix what's wrong with you using Thalidomide, what do you care about birth defects? You get a lecture about why child-bearing age women must under no circumstances take this drug, and then you're issued a prescription.
If you were a young woman, and there was no other option, you'd get an even sterner lecture, explaining that you absolutely must not become pregnant while taking this drug, that the best way to not become pregnant is to not have sex, but that if you're going to have sex you absolutely must prevent pregnancy, and if you get pregnant you must immediately stop using Thalidomide and come see a doctor... and then you're issued a prescription.
The main exception is drugs that had powerful societal bias (often driven by racism or sexism) against them, which might get outlawed even though if doctors were allowed to they'd probably sometimes prescribe them. In the UK these are "Schedule 1" drugs and it requires a specific government license to even test what they do.
So since they do work this means it remains appropriate to prescribe them, it just isn't appropriate to give them to everybody to pop one every day before work and say it's "non-addictive".
Drugs that work but have a terrible reputation are almost always still available. For example Thalidomide works, but it causes birth defects. Well, if you're a 45 year old man and the doctor can fix what's wrong with you using Thalidomide, what do you care about birth defects? You get a lecture about why child-bearing age women must under no circumstances take this drug, and then you're issued a prescription.
If you were a young woman, and there was no other option, you'd get an even sterner lecture, explaining that you absolutely must not become pregnant while taking this drug, that the best way to not become pregnant is to not have sex, but that if you're going to have sex you absolutely must prevent pregnancy, and if you get pregnant you must immediately stop using Thalidomide and come see a doctor... and then you're issued a prescription.
The main exception is drugs that had powerful societal bias (often driven by racism or sexism) against them, which might get outlawed even though if doctors were allowed to they'd probably sometimes prescribe them. In the UK these are "Schedule 1" drugs and it requires a specific government license to even test what they do.
We learned the lesson that opioids are too addictive to be used to treat everyday pain back in the 1970's.
However, Purdue Pharma's claim to fame with opioids was that their time release formulation was not addictive, so unlike traditional opioids these could be safely used on a daily basis.
Obviously, this claim was fraudulent.
Opioids still have their place, for treating terminal cancer patients, for instance. Short term use after a catastrophic event is still warranted.
However, Purdue Pharma's claim to fame with opioids was that their time release formulation was not addictive, so unlike traditional opioids these could be safely used on a daily basis.
Obviously, this claim was fraudulent.
Opioids still have their place, for treating terminal cancer patients, for instance. Short term use after a catastrophic event is still warranted.
You touch on the core issue, but I would like to highlight it. At the core, the opioid issue is not really about opioids at all, it too is just a symptom of a far greater issue, corruption, rot, degeneration of the system. And of course that manifests itself in ways like this "opioid epidemic" that is really no different than what Pablo Escobar or El Chapo were doing; they just didn't have the connections and were not part of the identity group that makes up the ruling class, something they may have learned even no amount of money can buy you into … ignoring all their less than sophisticated antics for a moment.
The Sacklers are just purely evil people that were part of the system of evil people who are the ruling class. That's fundamentally why they got away with what objectively is mass murder and even essentially treason, because the ruling class they are a part of is no longer a group that has the USA or its people in its interests. The American people and America are clearly well beyond their circle of interests and priorities. We now have not just the "opioid epidemic" to prove that, but the total and complete hollowing out of the American economy and also the complete burying of America under masses of debt. Not just the American, but the whole Trans-Atlantic ruling class are objectively made up of abusive, predatory, parasitic, evil people. Their actions and words speak for themselves, no amount of postulation required.
The only other alternative is that they are utterly incompetent to such a degree that they are mentally ill with something like schizophrenia or some other psychosis.
But one must assume that since they were actively and zealously behind all that they now lay at the feet of regular people of their own counties and societies (colonialism, slavery, etc.) that they too now are actively behind this new plunder and enslavement to debt and erosion of currency and value. Why would they not be, they have only ever gotten away with it, barring a few revolutions here and there before they learned to control them.
The Sacklers are just purely evil people that were part of the system of evil people who are the ruling class. That's fundamentally why they got away with what objectively is mass murder and even essentially treason, because the ruling class they are a part of is no longer a group that has the USA or its people in its interests. The American people and America are clearly well beyond their circle of interests and priorities. We now have not just the "opioid epidemic" to prove that, but the total and complete hollowing out of the American economy and also the complete burying of America under masses of debt. Not just the American, but the whole Trans-Atlantic ruling class are objectively made up of abusive, predatory, parasitic, evil people. Their actions and words speak for themselves, no amount of postulation required.
The only other alternative is that they are utterly incompetent to such a degree that they are mentally ill with something like schizophrenia or some other psychosis.
But one must assume that since they were actively and zealously behind all that they now lay at the feet of regular people of their own counties and societies (colonialism, slavery, etc.) that they too now are actively behind this new plunder and enslavement to debt and erosion of currency and value. Why would they not be, they have only ever gotten away with it, barring a few revolutions here and there before they learned to control them.
I was given an opioid via IV to prep for surgery in my 20s and while that dosage was by design higher than standard Oxycontin prescriptions, people just use more OxyContin to achieve similar effect.
It’s very hard to describe the effect except to say it’s like a form of ecstasy (the feeling, not the drug) that is far more consuming and also more referable than I’d believe, had I not experienced it firsthand.
For years after that five minutes or so of being sky-high I could conjure up the physical sensation and I absolutely craved it.
The Purdues basically weaponized this chemical for profit, knowing full well the human consequences, and they should lose it all.
It’s very hard to describe the effect except to say it’s like a form of ecstasy (the feeling, not the drug) that is far more consuming and also more referable than I’d believe, had I not experienced it firsthand.
For years after that five minutes or so of being sky-high I could conjure up the physical sensation and I absolutely craved it.
The Purdues basically weaponized this chemical for profit, knowing full well the human consequences, and they should lose it all.
The way I understand it is that time release opioids are in fact not addictive when used as directed by the manufacturer. However, they are also ineffective for most patients. As a result, doctors just up the dosage. This winds up being effective and addictive for many patients.
This is just what I have read, I have never been addicted to anything.
This is just what I have read, I have never been addicted to anything.
They are addictive. Purdue knew they were addictive.
2007
>ABINGDON, Va., May 10 — The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.
Also, in a rare move, three executives of Purdue Pharma, including its president and its top lawyer, pleaded guilty today as individuals to misbranding, a criminal violation. They agreed to pay a total of $34.5 million in fines.
https://www.nytimes.com/2007/05/10/business/11drug-web.html
2020
>Purdue admits it illegally and misleadingly marketed its opioids, including “to more than 100 health care providers whom the company had good reason to believe were diverting opioids” for misuse; illegally paid doctors to prescribe more opioids; and took part in other fraudulent and illegal practices. Purdue says it did all of this between 2007 and at least 2017 — after a separate guilty plea in 2007 forced the company to pay more than $600 million in fines.
https://www.vox.com/2020/10/21/21526868/purdue-pharma-oxycon...
2007
>ABINGDON, Va., May 10 — The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.
Also, in a rare move, three executives of Purdue Pharma, including its president and its top lawyer, pleaded guilty today as individuals to misbranding, a criminal violation. They agreed to pay a total of $34.5 million in fines.
https://www.nytimes.com/2007/05/10/business/11drug-web.html
2020
>Purdue admits it illegally and misleadingly marketed its opioids, including “to more than 100 health care providers whom the company had good reason to believe were diverting opioids” for misuse; illegally paid doctors to prescribe more opioids; and took part in other fraudulent and illegal practices. Purdue says it did all of this between 2007 and at least 2017 — after a separate guilty plea in 2007 forced the company to pay more than $600 million in fines.
https://www.vox.com/2020/10/21/21526868/purdue-pharma-oxycon...
Also humans vary in their ability/ desire to ween themselves off.
One of my acquaintances needed fentanyl lollipops to manage the incredible amount of pain he was in. Once the surgeries and other treatment were finished he got off opioids, in maybe a year or two.
One of my acquaintances needed fentanyl lollipops to manage the incredible amount of pain he was in. Once the surgeries and other treatment were finished he got off opioids, in maybe a year or two.
> You get a lecture
It's stronger than that, you get a three page consent form that you sign to say that, for instance, you won't get anyone pregnant.
It's stronger than that, you get a three page consent form that you sign to say that, for instance, you won't get anyone pregnant.
The idea that opioids are addictive is a myth. People taking them are treating “pain” that isn’t diagnosed in the medical system. For example, joblessness. It’s an easy scapegoat for politicians to let them avoid dealing with harder structural problems.
>The idea that opioids are addictive is a myth.
They have literal physical withdrawals. The body becomes dependent on them. What else would you call that?
They have literal physical withdrawals. The body becomes dependent on them. What else would you call that?
Withdrawal from opioids is overrated. It’s unpleasant, but that’s it. Unlike alcohol or benzodiazepine withdrawal, which can literally kill you, opioid withdrawal is like a bad cold.
So, yes there’s adaptations, but it’s way overrated compared to the media hype.
So, yes there’s adaptations, but it’s way overrated compared to the media hype.
I'm not following. I feel like you are trying to tell me the Sun isn't warm, and is in fact, cold. Opioids are most definitely addicting by any definition of the word.
As someone who had major surgery a few months ago I am glad they are for sale and prescribed. No I am not taking opioids now but in the few days after surgery they kept me mostly pain free.
Perdue deserves to be punished. Opioids are a public health crisis when abused. That doesn’t mean that they don’t have legitimate uses.
Perdue deserves to be punished. Opioids are a public health crisis when abused. That doesn’t mean that they don’t have legitimate uses.
>Can anyone explain why opioids are still being sold and prescribed?
If you take a look at the various alternatives for pain medication: https://en.wikipedia.org/wiki/Analgesic
... you'll see that every pain drug has tradeoffs and opioids are still often the "best" solution even though it has potential for abuse and addiction.
- acetaminophen/aspirin like Tylenol/Excedrin and ibuprofen like Advil are not addictive but they can only treat mild pain
- local anesthesia can eliminate sensation of severe pain but it only lasts a few hours and also causes localized numbness and paralysis. This means you're not functional. So hypothetically trying to use it for knee pain will mean the person can't even walk around.
The ineffectiveness of alternatives means doctors and patients will keep relying on opioids until science comes up with something better.
If you take a look at the various alternatives for pain medication: https://en.wikipedia.org/wiki/Analgesic
... you'll see that every pain drug has tradeoffs and opioids are still often the "best" solution even though it has potential for abuse and addiction.
- acetaminophen/aspirin like Tylenol/Excedrin and ibuprofen like Advil are not addictive but they can only treat mild pain
- local anesthesia can eliminate sensation of severe pain but it only lasts a few hours and also causes localized numbness and paralysis. This means you're not functional. So hypothetically trying to use it for knee pain will mean the person can't even walk around.
The ineffectiveness of alternatives means doctors and patients will keep relying on opioids until science comes up with something better.
There are people who still have legitimate need for pain medication
But what are the the criteria to decide legitimacy of those needs? Pain is a symptom. It is your body signaling a problem. Indeed, sometimes, there are no solution to those problems but I doubt that all those who got prescribed opioids and got addicted didn't have an underlying solvable problem.
If you are obese because you eat too much and your knees hurt, the solution is not an opioid. The whole discourse about pain being a condition that must be addressed is nefarious. Except in some pretty rare case (like terminal illness), pain is a symptom for which the healthcare organizations must find the root cause of and treat properly. Using expedient like opioids is a recipe for failure and a problem of that only the medical community can address. Serious introspection for those in charge of healthcare system in the US (and many other countries) is necessary.
Also, serious failures of the FDA for labeling opioids as not addictive and putting the breaks on fixing it for years.
If you are obese because you eat too much and your knees hurt, the solution is not an opioid. The whole discourse about pain being a condition that must be addressed is nefarious. Except in some pretty rare case (like terminal illness), pain is a symptom for which the healthcare organizations must find the root cause of and treat properly. Using expedient like opioids is a recipe for failure and a problem of that only the medical community can address. Serious introspection for those in charge of healthcare system in the US (and many other countries) is necessary.
Also, serious failures of the FDA for labeling opioids as not addictive and putting the breaks on fixing it for years.
> I doubt that all those who got prescribed opioids and got addicted didn't have an underlying solvable problem.
The US health care system is set up to cause exactly these kinds of issues. If you're in pain because of a bad hip, if you're uninsured, it may be much cheaper to just buy pain killers in stead of getting surgery. Once you get used to the pills, the pain is even worse if you stop taking them and might get withdrawals.
Opioids are indispensable in cancer treatment and after many surgeries. In some cases they can be used to combat chronic pain or leading up to surgery. But you're right, they shouldn't be a replacement.
If the US wants to fix this epidemic, just decreasing sales of opioids won't be enough, they'll have to provide the alternative. If people can't get affordable health care, they'll get affordable pain killers.
The US health care system is set up to cause exactly these kinds of issues. If you're in pain because of a bad hip, if you're uninsured, it may be much cheaper to just buy pain killers in stead of getting surgery. Once you get used to the pills, the pain is even worse if you stop taking them and might get withdrawals.
Opioids are indispensable in cancer treatment and after many surgeries. In some cases they can be used to combat chronic pain or leading up to surgery. But you're right, they shouldn't be a replacement.
If the US wants to fix this epidemic, just decreasing sales of opioids won't be enough, they'll have to provide the alternative. If people can't get affordable health care, they'll get affordable pain killers.
You seem to have made up the example of obese knees with no prior knowledge of what actually causes opioid prescription as evidence that it “might” not have good foundations. You realize that’s backwards right? Throwing out a made up example with no idea if it’s representative is just distracting. This entire post would be better reduced to “what are the most common reasons for legitimate opioid prescription”
That wouldn’t let the poster signal that he’s better than others.
There are lots of illnesses that cause pain for which we have no fix, just palliative care. Not everybody is a fat guy with sore knees.
Opioids are also prescribed for short term healing from major surgery, of which there is no root cause beyond having major surgery or other painful injury.
One of my family members gets terrible debilitating migraines. When they get it, the whole day gets lost, vomiting, dehydration, maybe a trip to urgent care.
An opioid based tablet they are prescribed for migraine cuts this to about 2 hours. The tablet is issued only by the clinic itself or in a major hospital pharmacy and you can't buy it in regular pharmacies.
The problem in US is lack of controls and perverse profit incentives in the American healthcare business.
An opioid based tablet they are prescribed for migraine cuts this to about 2 hours. The tablet is issued only by the clinic itself or in a major hospital pharmacy and you can't buy it in regular pharmacies.
The problem in US is lack of controls and perverse profit incentives in the American healthcare business.
Because they work. When I had a relatively mild hip fracture (greater throcanter broken clean off) they enabled me to walk and sleep. I went off them as quickly as I could and switched to paracetamol only, but the first week would have been hell without them. Sure I could have survived on week of pain but one week of opiates has no risk of addiction.
Hi, I prescribe opiates often as a cancer doc. Opiates act on the central nervous system and decrease the perception of pain but don't address the pain itself. They are quite useful in the short term as bridging therapy (a few days to weeks) analgesia while you work as hard and as quickly as possible to address the physical cause of pain.
On the same token, there are great alternatives too. For musculoskeletal pain, a combination of 1000mg Tylenol and 800mg Ibuprofen all at once has efficacy close to that of low dose opiates. This regimen however carries increased kidney and liver injury.
There are also less addictive opiates such as tramadol (rate of addiction 1 in 100,000).
But again, all of the above is simply to mask the pain. The most important aspect is quick and vigorous pain source control.
On the same token, there are great alternatives too. For musculoskeletal pain, a combination of 1000mg Tylenol and 800mg Ibuprofen all at once has efficacy close to that of low dose opiates. This regimen however carries increased kidney and liver injury.
There are also less addictive opiates such as tramadol (rate of addiction 1 in 100,000).
But again, all of the above is simply to mask the pain. The most important aspect is quick and vigorous pain source control.
Opioids took me from suicide level pain to just tolerable pain over 6 months after I had a half golf ball sized hole scooped out of the base of my tongue due to cancer. It was a bad week when I stopped but it's doable. Opioids have a place.
Fentanyl is used in epidurals, for one.
It's used in all sorts of surgical procedures. I've had it a few times, used as a relatively minor painkiller under those circumstances. Which sounds crazy considering how much news is about how strong it is. But it works well in those controlled circumstances
Fentanyl that you get in an OR and the "fentanyl" on the streets are actually two different chemicals.
The street drug "fentanyl" is actually carfentanil, which is about 100 times more potent that fentanyl (or about 5000 times more potent than heroin). It is favored by criminals because when it's highly concentrated, you can fit ~the same amount of doses in a suitcase that with heroin would take a 20ft container. That suitcase, when bought from a legitimate Chinese pharmaceutical manufacturer, will also cost very little. Then if you can smuggle it into the states, you can run a billion-dollar drug empire from it, and never have to smuggle in anything again.
This is why all supply-side measures against opiates are never going to work again. There are already enough of them in the hands of criminals in the US to cover the demand for decades, if not centuries. It's also why "fentanyl" on the street is so deadly. When the active ingredient is so potent and arrives concentrated, if the dilution process is even a little uneven, a single dose can easily be accidentally a 100 times more potent than you expect it to be.
Even if you use other drugs, never use street fentanyl for any reason.
The street drug "fentanyl" is actually carfentanil, which is about 100 times more potent that fentanyl (or about 5000 times more potent than heroin). It is favored by criminals because when it's highly concentrated, you can fit ~the same amount of doses in a suitcase that with heroin would take a 20ft container. That suitcase, when bought from a legitimate Chinese pharmaceutical manufacturer, will also cost very little. Then if you can smuggle it into the states, you can run a billion-dollar drug empire from it, and never have to smuggle in anything again.
This is why all supply-side measures against opiates are never going to work again. There are already enough of them in the hands of criminals in the US to cover the demand for decades, if not centuries. It's also why "fentanyl" on the street is so deadly. When the active ingredient is so potent and arrives concentrated, if the dilution process is even a little uneven, a single dose can easily be accidentally a 100 times more potent than you expect it to be.
Even if you use other drugs, never use street fentanyl for any reason.
You would have been given micrograms of Fentanyl. Certainly not a milligram, and certainly not 2mg, which will probably kill you. For comparison, you require more than 10 times as much Heroin to do that.
This illustrates it pretty well; a lethal dose of Heroin (left) and Fentanyl (right): https://www.statnews.com/wp-content/uploads/2016/09/Heroin-F...
This is why it's been in the news and why you've read about how strong and dangerous it is. Usage in a medical setting is much safer because they have a known purity and precise dispensing and dosage schemes; something you won't find and can't achieve on the street.
This illustrates it pretty well; a lethal dose of Heroin (left) and Fentanyl (right): https://www.statnews.com/wp-content/uploads/2016/09/Heroin-F...
This is why it's been in the news and why you've read about how strong and dangerous it is. Usage in a medical setting is much safer because they have a known purity and precise dispensing and dosage schemes; something you won't find and can't achieve on the street.
Because they're extremely effective in treating extreme pain. In some cases, this is necessary because pain limits recovery. Use of them needs to be managed extremely well though and when that doesn't happen it's easy to get addicted.
They are very very important for late stage cancer patients.
Because they can be safe and effective for treating some conditions if used cautiously.
Not every opiate has the issues OxyContin does.
Not every opiate has the issues OxyContin does.
OxyContin is not significantly more (or less) addictive or dangerous than other opiates. The problem with it is that it has been marketed by Purdue as 'safe', and that it is over-prescribed. I recommend the book Pharma by Gerald Posner, which goes into this in excruciating detail - but well worth a read.
In its original formulation, the extended release oxycontin could be easily crushed without losing much potency. Other opiates have long had measures to combat this; fentanyl, for example, is frequently prescribed in patch form; extended-release morphine turns to an unusable gel if you crush it.
Purdue's sales practices are important, yes, but the impact all this has had on pain patients is severe; attitudes like "why is fentanyl legal" and the comment that started this thread are hurting people with real medical needs.
Purdue's sales practices are important, yes, but the impact all this has had on pain patients is severe; attitudes like "why is fentanyl legal" and the comment that started this thread are hurting people with real medical needs.
A large portion of the population is addicted and the street alternatives have a habit of killing poeple.
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Doctors prescribe drug -> pharmacy dispenses drug -> pharmacy orders from manufacturer. All I hear about is pharmacies and manufacturers getting sued, but why not doctors? Why do they seem to get off the hook when they are the main cause. Sure, Perdue marketed it to doctors (and I don't even see a way that pharmacies were responsible at all), but "I was manipulated by marketing" isn't a convincing defense from an expert.
I think doctors were directly lied to that those drugs are non-addictive.
This may have been a valid argument some decades ago.
Greedy doctors killed my aunt by selling her all the drugs she asked for. This is commonplace in the US.
Greedy doctors killed my aunt by selling her all the drugs she asked for. This is commonplace in the US.
I agree - goes on still, all day everyday all across the USA. Easiest thing for a doctor to do to not have to deal with a problem patient (i.e. a drug seeker - not saying your aunt was one of them), is give them what they want, and send them on their way.
Doctors should be held accountable - every script they write, is tracked - it would not be hard to find the doctors that are outside the range of normal.
Insurance companies should also be held accountable - they pay for a big portion of these oversubscribed opioids, they know who is writing those scripts, they know when a duration or quantity is out of the normal bounds, and yet they still keep enabling it.
But doctors do not get a cut of the prescriptions they write, not legally anyway, so don't think its greedy doctors - more like doctors who have to see upto 32 patients a day, in 15 min increments, and don't have time to argue with persistent drug seekers, so the close their eyes and pretend they don't know what is going on - and move on to the next 15 min appointment.
Doctors should be held accountable - every script they write, is tracked - it would not be hard to find the doctors that are outside the range of normal.
Insurance companies should also be held accountable - they pay for a big portion of these oversubscribed opioids, they know who is writing those scripts, they know when a duration or quantity is out of the normal bounds, and yet they still keep enabling it.
But doctors do not get a cut of the prescriptions they write, not legally anyway, so don't think its greedy doctors - more like doctors who have to see upto 32 patients a day, in 15 min increments, and don't have time to argue with persistent drug seekers, so the close their eyes and pretend they don't know what is going on - and move on to the next 15 min appointment.
It is greedy doctors; they would prefer to keep the patient and keep collecting payments for their visits than to call them out on their addiction, or god forbid actually treat them for it.
so they they are greedy for collecting payments for visits to keep writing prescriptions, but if they spend their time treating them during the visit, they are not greedy? How does that work? do you think somehow they get paid extra for writing prescriptions during a visit, vs spending their time during the visit coming up with alternatives? If you think that, you are wrong.
Do you know what a drug rep is?
Why do they take 32 15 min appointments a day instead of 16 x 30 mins? It's not rocket science.
because that is what the insurance companies will pay for - they CAN take 30 minutes, but the only get paid for 15 in many cases.
Sorry that happened to your aunt.
Doctors aren’t reimbursed for prescribing medications directly (except chemotherapy infusions). Was the physician selling the medication directly? That’s not commonplace.
Clinicians may financially benefit from not refusing their patients requests and thus losing the patient to another doctor that will acquiesce. But that’s a tricky topic to untangle.
Doctors aren’t reimbursed for prescribing medications directly (except chemotherapy infusions). Was the physician selling the medication directly? That’s not commonplace.
Clinicians may financially benefit from not refusing their patients requests and thus losing the patient to another doctor that will acquiesce. But that’s a tricky topic to untangle.
This is the part that I don't get. There must have been hundreds of papers on oxycodone done by Perdue, and other people. You would think that lying just couldn't get you to where you need to be for this, at least not without it being obvious that you were doing it. Like, I can see making up data for one paper, or getting a few legit publications via statistical outliers, but I don't see how you manufacture a whole industry level consensus.
There are some laws that make it harder to sue doctors for malpractice, maybe this combined with the fact that they could get a bigger payout from the drug manufacturers.
Also, the producers pay he doctors and provide different insentives to make them prescribe their drugs.
Encourage, not make. And that makes all the difference. If you take the money, you take the responsibility with it.
So, giving the money is not part of the problem? The responsibility of one of the sides does not relieve the other one from it.
Oh, but they are:
https://www.wrshlaw.com/blog/medical-malpractice/medical-mal...
The heart of the issue is that it's a legally approved drug. That's where the debate moves into questions like: To what extent can a doctor prescribe a drug before it can be perceived as medical malpractice?
Since the 2010s, states and federal government in the U.S. have started to enact countermeasures against the Opioid Crisis. This includes cracking down on pharmacists and doctors who over-prescribe:
https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_...
Reading into the above, you'll notice that the story is far more complex. It's a "wicked" problem with many in's and out's. On the surface level, fixing this seems easy, until you start digging into this and you see complex interests, countless stakeholders, political tensions, power structures, dependencies on other policy issues, etc. add to the complexity.
https://www.wrshlaw.com/blog/medical-malpractice/medical-mal...
The heart of the issue is that it's a legally approved drug. That's where the debate moves into questions like: To what extent can a doctor prescribe a drug before it can be perceived as medical malpractice?
Since the 2010s, states and federal government in the U.S. have started to enact countermeasures against the Opioid Crisis. This includes cracking down on pharmacists and doctors who over-prescribe:
https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_...
Reading into the above, you'll notice that the story is far more complex. It's a "wicked" problem with many in's and out's. On the surface level, fixing this seems easy, until you start digging into this and you see complex interests, countless stakeholders, political tensions, power structures, dependencies on other policy issues, etc. add to the complexity.
The Feds and forty-three states had already approved a settlement that that only required the family return a fraction of their ill-gotten gains, and stripped the victims of their right to seek redress in the courts.
If ever there was a case that called for piercing the corporate veil and clawing back all of the ill-gotten earnings, this would be it.