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First, did anybody notice that the hundreds of thousands of deaths attributed to the opioid epidemic included heroin? Seems like shitty reporting to me.
There's two sides of this. What Purdue did is truly awful and they deserve to be punished.
The other half of it, is that oxycontin works. I know somebody who has chronic pain due to a car accident, they have tons of metal in their body and the surgery never healed quite right. The result is they are never, ever, pain-free. On a good day they are at 3/10, bad day 8/10 on the 0 to 10 pain scale.
Oxycontin was one of the few drugs that brought them anywhere close to being pain-free. On oxycontin their pain was actually managed to the point that it didn't impact their everyday life. For my friend, oxycontin was truly a wonderful life restoring drug.
In fighting the opioid epidemic, my friend was a bystander casualty. In the fight to stop opioid abuse, prescribing oxycontin even for people who genuinely benefit from it became a regulatory and insurance minefield. It's like in the effort to stop abuse, the entire world forgot that some people actually need the stuff. Prescribing it became a problem for my friends pain doctor, as the amount of pushback from government and insurance for every prescription became totally untenable.
My friend now takes multiple short acting pain pills a day, and gets significantly less relief and lower quality of life despite being on a very similar daily morphine equivalent dosage.
So for whoever reads this, please don't forget that while there are awful people at drug companies and insurance companies and the like, and pushing prescriptions of unneeded addictive medications should result in a lot of jail time, there are patients involved in this fight. Patients who can benefit from this drug, and whose needs are being totally forgotten.
This is because of two main things, AFAIK.
The number of heroin and other opiate addicts that got that way because of prescription opioids. This is a period of time where a significant majority of opiate/opioid addicts started on legally prescribed pills, were kept on them too long and weren't properly tapered off. Many then sought street versions of the drugs to avoid withdrawals and fell further into addiction.
Adulteration of other drugs. It has long been common to adulterate drugs by adding cheaper but stronger drugs and filler to the mix so that most users know something is happening but remain unaware they paid more for a mix of dubious efficacy. Incomplete mixing, higher tolerance to the advertised drug than the additive one, or are in some way compounding in the mixed drugs cause many more overdose deaths than those of known and consistent effects.
And when both aspects combine, it can prove to be a particularly deadly combo.
Okay so you're really telling me that the inner city addict who steals his brother's watch and pawns it for drug money, back in 1992, that was all because he used to be functioning member of society but then got a prescription? Come on man. Heroin has been around a lot longer than any sort of Perdue malfeasance, as have the criminals supplying it to junkies.
I will perhaps give you that it's possible a large number of new heroin users started with prescription pills, for some period during the height of the crisis. But it is beyond ridiculous to ascribe every opioid death to Purdue.
And as for combining drugs, yes that is the risk you take when you buy illicit substances off the street. That is a thing that has been going on long before Purdue, continues today, and will continue into the future even after they rebrand or reorganize or whatever they call it. None of that has anything to do with Purdue.
My point is, the US of course has a drug problem and lots of people die from it. But if you are going to talk about the harm a company creates, you should focus on the deaths actually related to that harm, not out of a broad general category.
For example, if you say 'People need to slow down in work zones! 500 highway workers died on the job last year!' But if the reality is only 100 of those died from being hit by vehicles, the other 400 died from equipment malfunction, chemical exposure, and bad workplace safety practices, your statistic is irrelevant and disingenuous, just like this article.
And how do you propose the people crunching the numbers separate these cases? Most addicts will lie about how they became addicted, choosing whatever story they feel paints them in a positive light. Most families of deceased addicts will stick to the same story, either because they believe it or because they too want to paint their dearly departed as a victim rather than irresponsible. Practically speaking, there is no way to get an accurate split between who was addicted to prescription drugs first and who wasn't.
If you don't have good statistics, then you don't include them right next to talking about the prescription drug epidemic sending the impression (If not precisely stating) that your number is directly caused by prescription drugs.
Journalistic integrity is important.
I agree, but exactly zero large media organizations agree as well. Journalistic integrity is bad for business. That said, when a huge corporation is profiting by turning people into addicts and killing them, I have no sympathy. Let the FDA and DEA worry about which opioid deaths are whose fault while the courts lay each and every one at Purdue's feet. The odds that they deserve it due to some other as-yet undiscovered shenanigans that they're likely to get away with are as close to 100% as makes no difference.
I agree on journalistic integrity. But isn't it important to uphold that standard, even if others don't?
They may deserve it, but it's by knowing those details that we determine if they do or not.
Because otherwise your position basically becomes 'If company did thing x and as a result is bad, it's okay to blame them for thing y and thing z, which they probably had nothing to do with, but we've already determined they are bad and therefore they deserve any blame we throw at them justified or not'.
The problem with that is it sets up witch hunts. You are bad, therefore we can blame you for anything we want, and that blame justifies your being treated as bad.
That is why the Constitution mandates due process. And we should uphold that same standard, in our minds and in our positions and in our debates.
That would be a very fair assessment if the entire system weren't rigged for the benefit of corporations and the very wealthy. Mitt Romney said thay "corporations are people too" so I'd like to see them get death sentences as well.
Much like racism, the solution isn't to rig it in the other direction, the solution is to unrig it.
There should absolutely be a corporate death penalty. Perhaps the same process should be used for anything too big to fail. Nationalize the company, All existing shareholders and equity owners get wiped out. Then either wind down operations or appoint an interim administrator and interim directors, then issue a new stock offering the proceeds of which first pay back any taxpayer expenses or bailouts, then pay back creditors, then used as capital for the company.
That's what should have happened to all the banks that got bailed out. Wipe out anybody who held the stock, fire management, then issue new stock for purchase, the proceeds of which pay back the bailout.
If nothing else this would make investors take a much more active interest in the malfeasance of the companies they invest in.
That's a grrat solution. Sadly, that means it won't ever be implemented.
In some ways we as a society are afraid of change. A solution like I propose would require a serious rethink of major capital investors. Even if it was only limited to companies needing a bailout, it would make investors sit up and take notice on what their holdings are actually doing.
I think it should also be done in extreme cases where the company flagrantly violated the law. Forget the usual million dollar fine for a company that spends more on office supplies. Forget the billion-dollar fine that takes a hit on the financials. Wipe the owners out.
I think Purdue might be a good case for that. The company clearly and blatantly violated every legal and ethical standard and destroyed lives as a result.
You're right but it's more than just fear of change. The people who abuse the status quo and therefore have the most to lose if such a chanhe is implemented also own all the major media outlets. They would unleash a storm of disinformation and propaganda that would blackball any measure even remotely reminiscent of this for three venerations the very moment it was seriously proposed by a politician. Not to mention a smear campaign against said politician, possibly including fabricating evidence of criminal activity.
Quite true, many entrenched interests want no accountability. Look at the 'regulation' of big banks after 2008--- a lot of nothing. Nobody went to jail. Taxpayers bailed out the system, investors made whole or nearly whole. What should have been a 'party's over' moment became a 'back to business as usual' moment.
Those pain scales are subjective junk that motivated the opioid epidemic from when special interests pushed that "5th vital sign" bullshit.
This story covers how
Historically, physicians have regarded pain as "an inevitable part of life", "not usually an emergency like low blood pressure or an erratic heartbeat", and definitely not a vital sign.
Then in 1995, the American Pain Society started a campaign referring to pain as the '5th vital sign', which caught on with medical bureaucracies and the pharmaceutical industry.
I don't think I've ever read a more heartless and unempathetic reply in my whole life.
Your post, and the linked article, boiled down, basically all say that doctors should ignore pain and patients who are in pain should just suck it up and not think about it.
I'm very glad that medical science doesn't treat patients in such a cold and uncaring manner. By this logic, there's no reason to bother with anesthetic during or after surgery, because 'pain is part of life'. There's no reason to do joint replacements, because 'pain is part of life' and if the person can't walk more than 10' without pain too fucking bad for them.
Perhaps someday there will be an objective way to measure pain- some scanner that can read the signals going up the spinal cord or can read activations of nerve endings. But until then, this is what we've got.
I encourage you to take a serious look in the mirror and think about what kind of person you want to be. Because right now you're someone that looks at a fellow human who is suffering and says 'too bad, we shouldn't lift a finger to help them'.
Seems you want to repeat history.
The fact is there is no objective measurement of pain & the dangerous addictiveness of those drugs has already caused an epidemic of deaths. Some doctors take their oath to first do no harm very seriously. As unpleasant as pain is, it doesn't cause death.
Modern society's excessive preoccupation with pain relief has caused a crisis, and no lawsuit or monetary relief can undo all those needless deaths. Perhaps you should take a look in the mirror & learn some goddamn sense.
At least they'll live.
But what is the point of living if there's no quality of life?
This is the difference between treating a patient as a person and ignoring the person but treating the disease as a broken machine.
Almost any medical treatment has potential or real side effects, possibly including death. Sometimes those side effects happen, and the risk is weighed against the benefit.
Pain relief is no different. You're acting like an opioid pill is a death sentence. The fact is under proper medical care and supervision they can be quite safe.
The UNsafe things, the people who get addicted and die, are people who were NOT treated properly to begin with- given high dose extended release opioids (creating dependence), then cut off cold turkey. Proper protocol for that is a wean-off protocol where the dose is reduced slowly over time so the body adjusts without huge withdrawal. If the person turns to street drugs and ODs you're right money can't bring them back. But the problem is the prescriber that did an unsafe protocol, and the company that paid them to do it.
Blaming the pill for effects caused by medical mistreatment is stupid.
What is the point if you don't?
The doctor has a valid moral claim not to promote deadly addictions.
They can, and the doctor is the most qualified person to make that assessment.
I'm criticizing your undervaluation of the dangers & poor acknowledgement of the cultural causes of the opioid epidemic such as misguided thinking about pain promoted by the pain scales, influence & regulatory capture by pain associations & pharmaceutical industries of medical policymakers to pressure physicians, campaigns popularizing myths. Competent doctors then & to this day found it all ridiculous & mostly disregard the pain scales: they rely on patient history & background, knowledge of their medical conditions, patient conversation.
Some pain is untreatable, and there is something to the idea that focus amplifies pain, moderation & acceptance lessen it.
That's not how it works or the physician was incompetent.
That's why Perdue was in so much trouble. They got doctors to write tons of oxy prescriptions, including doctors who were NOT pain doctors and thus didn't fully understand proper opioid treatment. So the person would go in for whatever minor thing, they'd walk out with a big oxy prescription, no ramp up or ramp down just take these for two months and then stop. And of course a lot of them got addicted.
Sure. And that's exactly what a responsible pain management doctor does. They see their patient on a monthly basis, it's not just a 'here's a self-renewing script have fun'. I think if you had more experience / visibility into responsible pain management practices you might have a different view.
And that is my point exactly. I am NOT arguing that a patient should walk in and say 'omg doc i'm 10/10 it hurts so bad please give my oxycontin 25mg extended release 2 per day 6 month supply here I wrote it out can you sign this prescription?'
I'm NOT saying that a doctor should take a patient who they don't believe is in pain and blindly prescribe dangerous dosages of opioid pain relief.
I AM saying that a doctor SHOULD NOT say 'you broke your arm and have 47 stitches, you say you're in pain, but on my scan it looks like the arm is healing so too bad try not to think about it'.