The Sackler Family – A Secretive Billion Dollar Opioid Empire - https://www.youtube.com/watch?v=zGcKURD_osM
However, food for thought on that same subject is the over prescribing of amoxicillin and other similar class of drugs for viruses. The doctor is operating a business and his/her clients want a solution to their problem, so they write a script as they want to keep their customer happy and it “can’t be too bad”.
There’s a case to be made that a certain amount of immediate gratification expected on the part of the consumer is a large contributing factor to overprescribing in general.
However, in this case, Purdue was very much in the wrong and should not have been encouraging over prescription of a highly addictive drug.
Lo and behold, people are addicted to OxyContin, some start looking for more immediate-relase formulations of opioids because they don't feel right even on 80mg Oxy tablets, and hundreds of thousands who otherwise would have been alive with chronic pain are now dead of overdose. Meanwhile, research is showing that opioids are not very good for chronic pain and other approaches, usually multimodal approaches, are better, including NSAIDs, gaba-ergic drugs like gabapentin and pregabalin, ketamine, physical therapy, psychological retraining, meditation, acupuncture, etc.
That was/is the position of the IOM though. Was Purdue involved with convincing the IOM to adopt that position?
Legally selling the drug is orthogonal from morally/ethically dealing with the consequences of the drug, including regulating how it is sold, how it is marketed, how it deals with its own consequences.
There are a lot of different drugs. You can't lump them all together!
Actually some of us do. Just open the floodgates when it comes to what you're able to have access to.
Spending money enforcing prohibition feels less helpful than spending that same money on treatment of underlying issues or addressing other social problems that lead to drug use in the first place. Rather than criminalize the use behavior, which doesn't do anything to save lives in any real way, try to fix the actual problem rather than just sweep it under the rug of the criminal justice system.
1. Overprescription, in the US, there were 240 million opioid prescriptions in the US in 2015, enough for one for every adult in the general population.[1]
2. Poor mental health treatment, "in the United States, 18.7% of all patients with mental health conditions receive 51.4% of the total opioid prescriptions distributed each year, meaning that having a mental health disorder was associated with a two-fold greater use of prescription opioids"[1]
3. Greater availability + lower cost and higher purity of opioids sold by criminal orsg. Mexican criminal orgs have been pushing much greater amounts of opioids in the last ten years, probably due to profits from marijuana being undercut. Prescription drug OD deaths have actually decreased as people switch from controlled substances to heroin/other opiates.[2]
4. Lack of access to effective treatment procedures. The US is woefully inadequate in this regard. "n the United States and Canada, rehabilitation programmes are still mainly abstinence based (Annan et al., 2017[75]). More specifically, in the United States only 8-9% of all substance treatment facilities between 2006 and 2016 had MAT programmes certified by SAMHSA...This happens despite evidence showing that opioid users who are treated only with psychological support are at twice greater overdose death risk than those who receive opioid agonist pharmacotherapy (Pierce et al., 2016[77])"
5. Stigmatization causing addicts not to seek treatment. "Research indicates that stigma contributes to individuals poor mental and physical health, non‐completion of substance use treatment, delayed recovery and reintegration processes, and increased involvement in risky behaviour (e.g. needle sharing)"
OxyContin is a controlled substance, so it's not actually legal. Here is an excerpt from an OECD publication on the opioid crisis on a specific case of decriminalization of opioids:
In 2001, Portugal decriminalised the possession and consumption of all narcotics and psychotropic substances for personal use, intended as the quantity required for an average individual consumption during a period of ten days. Exceeding this quantity, criminal procedures apply. Portugal’s decriminalisation reform has been particularly influential, since by introducing a de jure decriminalisation (changes in the law instead of changes in the daily practice), it has been a pioneer of the explicit decriminalisation of all drugs. Some of the main benefits of decriminalisation mentioned by Portuguese authorities can be summarised as follows:
Changes in the mind-set of the general population, contributing to consider drug use disorders as a medical condition rather than a criminal offence.
Creation of supplementary entrance doors to the public health system, particularly, through the Commissions for the Dissuasion of Drug Dependence.
Coherence enhancement between the health and judicial systems, markedly, to provide and expand access to public health interventions.
...
The decriminalisation of drugs is controversial in nature. However, empirical evidence shows that following decriminalization, Portugal has not witnessed major increases in drug use, but has experienced reductions in problematic use, drug-related harms (e.g. HIV-AIDS, hepatitis, overdose deaths) and criminal justice overcrowding (EMCDDA, 2018[223]; Hughes and Stevens, 2010[224]; Greenwald, 2009[225]). In addition, decriminalisation seems to have caused no harm through lower illicit drugs prices, which would lead to higher drug usage and dependence (Félix and Portugal, 2017[226]).
[1]I recommend checking out the sources I've linked, there's a lot of interesting information in them.
1. https://www.oecd-ilibrary.org/social-issues-migration-health...
2. https://www.overdosefreepa.pitt.edu/wp-content/uploads/2017/...
Sounds like this arm of the company will end up controlled by a government trust. The best outcome would probably be the government running the operation at break even, lowering costs, and heavily regulating how much product it could give to hospitals.
(Under capitalism) many costs of having PtLds are externalized.
But I get it. Someone dies and it’s the drug dealers fault, and punishing them will make everyone feel better. Except it doesn’t do anything about the actual problem (opioid addiction).
It feels to me like the elation here is because the Sacklers are rich and people really don’t like that, rather than any sort of victory in combating opiate addiction.
[1] https://www.dea.gov/press-releases/2019/05/13/pill-mill-doct...
The problem is that the prescribing guidelines, which were written by the pharmaceutical companies themselves, described a regimen that would get pretty much anyone physically addicted to their product.
So you had doctors acting in good faith, prescribing medications only when indicated and following their manufacturer's prescribing guidelines, inadvertently creating new addicts where the manufacturer's literature said there would be none.
Not only that, but we spent several decades treating chronic pain patients with opioids, such that they are completely dependent on that class of drugs to manage their condition. Only very recently have prescribing guidelines adjusted to reflect the reality that opioids are not a good treatment for chronic pain. When those pain patients are driven off of their opioid prescriptions, even if their doctor is well-meaning, some of them turn to heroin/fentanyl to manage their pain.
I can't recall the story exactly but there was a doctor who spoke out against a popular medication. He found that it increased a chance of a heart attack I believe by over 50%. They released a small study in a journal and his existence became a living hell. Eventually, the knowledge became main stream.
I for example had a serious reaction to cipro, left me with chronic pain. This reaction is starting to become common knowledge, yet I have found a single doctor willing to put down possible side effects of cipro in my chart. People have been reporting these side effects to FDA for 15+ years, it is affecting many people but symptoms take up to 12 months to surface and doctors don't want to accept it. I have talked to number of people diagnosed with fibromyalgia for example that later realized they took cipro for UTI right before symptoms began. Plus, the FDA has been making the label more severe almost every year. The European organization EMA suggested doctors use these medication only in life threatening infections.
what kind of chronic pain do you have?
i've had persistent joint issues that started shortly after a round of levaquin, a very similar drug.
Popping/clicking joints, and not intense pain just dull/achy. These drugs are known to cause peripheral nephropathy and tendinitis. I actually just read an interesting blog about a guy that is insanely fit, recently was given levaquin with prednisone, and continued to lift. Then, tendon in his arm snapped. He is documenting very well how his body is deteriorating and what new symptoms he is experiencing week to week. I think it would be worth posting on HN, I will send you a link when I find it.
Edit: It appears any flouroquinolone can cause these symptoms, this includes levaquin, cipro, avelox. Also, symptoms can develop after a single pill or 150 pills. It is insanely odd. Taking it with a steroid significantly increases chances of having a very negative reaction.
Excess payments to ownership (especially if you think the company is about to face a huge liability) is a classic example of one of the justifications for a judge to do just that: make the owners personally liable rather than just the company.
Don’t store your gold next to a nuclear reactor and all.
https://www.statnews.com/2019/09/09/purdue-pharma-data-downp...
As far as I know, generic manufacturers of off-patent drugs usually aren't sued.
On the one side, they don't actively promote/market their products to prescribers or patients, but I'd still think they share some blame by manufacturing it.
Nah. Opioids are an essential medication. The problem is not that OxyContin exists, it's the creation of irregular demand for it through the actions that Purdue Pharma are having to settle for.
The lawsuit is alleging systematic fraud and requests an order for the Sacklers to return any transferred assets; and to restrain them from disposing of any property. https://ag.ny.gov/sites/default/files/oag_opioid_lawsuit.pdf
Interesting that these decisions are so political. States with republican majority and AGs agreed to settlement, the states with democratic majority did not. Only four AG's favoring the settlement are democrats.
I'm pretty sure that was obvious to many people. But it was probably especially obvious to the people lying about it to make billions of dollars.
The news in that piece is that NY discovered the transfers at all. The transfers themselves are a decade old. The payments to the Sacklers from Purdue are from 2008-2016 but the lawsuits only date to 2018. All of this is in the article if you read it.
I.e., no self-payments after lawsuits became material threat.
Dont get me started on testorone or ADHD medication hypocrisy.
Shouldn't they look at the fund the company had on the "day that the lawsuit started".
Where ever they funneled the money, I am sure they are just look at the bank statement.
Also not all US based litigants are part of the settlement that is being worked out. There are also individuals who are being personally sued that aren't part of this as well.
Their fortune is safe.
Even within traditional US Bankruptcy codes, there could instead be a Chapter 7 liquidation bankruptcy. In which the company is simply (or not so simply) liquidated and all assets used to pay creditors. Purdue pharma isn't a public company. I'm not sure how to look up it's net worth.
The Sacklers will of course prefer whichever will lose them the least money.
That's before we start talking about the ways in which a company's owners can indeed legally be liable for the company's fraudulent or criminal behavior, and long before we start talking about the guillotines.
https://www.drugabuse.gov/related-topics/trends-statistics/o... Fig 3-5 & descriptions.
* Rate of conversion from on-label opioid prescription to addiction ("opioid use disorder") is lowish; this metastudy[1] claims 8-12% on average, but the 95% CI is anywhere from 3-17% and I'm not sure what they're measuring the percentage of (i.e., long-term prescriptions might both be more represented in the data and have higher conversion rates) — I doubt 8-12% of people who get 3 days of vicodin for their wisdom teeth extraction develop an opiate use disorder. They also point out that some studies showed misuse rates below 1% and "significant variability remains in this literature." We should expect these rates to fall as tighter prescription quantities from the last several years impact "leftover" pill rates.
* The rate of conversion from prescription opioid addiction to heroin is low; 4-6% per the government.[2]
* Overall opioid-involved overdose annual deaths in the US rose from 8000 in 1999 to 47600 in 2017; of those, the prescription-involved number rose by 13600 deaths (+300%), from 3400. Conversely, the non-prescription-involved deaths rose from by 26000 deaths (+465%), from 4600.[3](Figs 3-4) 26000/39600 = ~66%. (The population has also grown about 17% over that period, but that doesn't change the calculus too much.)
* Therefore: the overall growth pattern in opioid deaths in the last two decades is largely accounted for by heroin and other non-Rx use, which are a tiny population with a very high (and rising) death rate. The rising death rate is mostly due to the surge in black market sale of fentanyl as "heroin."[3] (esp. figures 4-5 and associated text) (Perhaps as a result of DEA and other restriction on the supply of the relatively safer, but less dense, heroin, and restriction on supply of the vastly safer prescription opioids.)
* Notably, the number of non-fentanyl-involved prescription opioid-involved deaths has actually been in decline since 2011![3] (fig. 4.), despite a rising population. Let me echo that since it's really important: prescription opioid-involved overdose, ex fentanyl, both in number and per capita rate, HAS BEEN IN DECLINE SINCE 2011! Why doesn't any news story on opioids in the US headline with that? The primary reason the overall prescription opiate-involved death rate hasn't tracked that decline is rising co-(ab)use with illicit fentanyl, and its relatively higher death rate.
If we could wave a magic wand and wipe (illicit) fentanyl off the earth, our annual opioid death rate would fall by something like half.
[1]: https://www.ncbi.nlm.nih.gov/pubmed/25785523
[2]: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdos...
[3]: https://www.drugabuse.gov/related-topics/trends-statistics/o...
