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Supreme Court blocks controversial Purdue Pharma opioid settlement

washingtonpost.com

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Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#421

Post by shawndrost »

feoren wrote: post #319
shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

Loaning money at 8% interest to informed parties is OK. Loaning money at 200% interest to vulnerable people is usury and should be illegal. Where in the middle is the right line to draw, legally? Does the intent of the lender matter? Does it matter if the lender is intentionally trying to keep people uninformed and vulnerable? These are hard questions, but that doesn't change the basic facts at the extreme ends of th…

I like this analogy. How does it apply to the status quo of opioids? What rate of interest is the present-day Purdue business charging? This year I was prescribed 30 days of opioids for post-vasectomy use and guided to expect low-grade pain for 1-2 days. Is this like 8% interest or 200%? Does anyone here feel like they know the answers to these questions?

It seems to me like the emergent answer I get is that the old Purdue was charging 200% interest and the new Purdue is charging 8%. But why does anyone think that? It seems like the core doom loop (dumb opioid scrips -> addiction -> fentanyl) is still in place, from what I can tell.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#422

Post by [deleted] »

darawk wrote: post #389
shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

[deleted]

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#423

Post by worik »

thegrimmest wrote: post #405
darawk wrote: post #389

Earlier quoted context omitted.

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

> That last thing was their crime Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game. Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding t…

> Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game.

No. There are many legal and bad things.

Laws are a boundary, that few of us need.

Laws are not a target

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#424

Post by thegrimmest »

worik wrote: post #423
thegrimmest wrote: post #405

Earlier quoted context omitted.

> That last thing was their crime Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game. Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding t…

> Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game. No. There are many legal and bad things. Laws are a boundary, that few of us need. Laws are not a target

I would argue that fiduciary responsibility mandates that corporate leaders do everything right up to the legal boundary in pursuit of their shareholders interests. In fact profitably violating regulations would also be the right thing to do in this case. Certainly most shareholders seem to appoint executives that do exactly that.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#425

Post by addicted »

janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

I’d argue it’s the opposite.

Look at what’s happened since Oxycontin was heavily regulated.

Opioid deaths in America have exploded by an order of magnitude.

There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S.

The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was).

But it’s quite clear that America had a parallel opioid crisis going on. By making OxyContin easily available, ie, a slow acting opioid (it had to be crushed to be fast acting) that was produced legitimately and had a legitimate supply chain so people were able to get exactly what they wanted, Purdue Pharma helped keep the number of opioid deaths under control.

IOW, the U.S. has had an addiction crisis that is independent of prescription drugs whose cause is not clear yet because everyone has thrown the blame on Oxy instead of researching it. This is the same kind of drug crisis that hit inner cities in the 20th century but has hit rural areas in the 21st century. By providing easy access to regulated and legitimate opioids the Sacklers may have marginally worsened the addiction crisis, but they minimized the number of deaths and severe negative impacts.

The moment Oxy and the other opioids were made less easy to get, the underlying drug crisis hadn’t gone anywhere, so instead the people suffering from the crisis had to get their opioids from illicit sources as opposed to the pharmacy, exposing them to all sorts of unregulated drugs that had all sorts of nonsense like Fenranyl mixed in, which causes the actual negative impacts of the drug crisis to explode.

The funny thing is that when the entire country was just absolutely united at making the Sacklers the big bad evil, the actual people working on the ground trying to help those who were facing this drug crisis were predicting this exact situation and were asking authorities to not clamp down on Oxy. But they were all ignored and so we have a situation where opioid OD deaths have gone from a consistent 10-15,000/year (a rate which preceded Oxy) to about 50,000/yr now.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#426

Post by shawndrost »

legitster wrote: post #297
shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

The settlement was not at all about Purdue operating as is. Purdue was going to be turned into a legal fund and treatment provider as part of the settlement agreement.

Under the bankruptcy settlement, Purdue will continue to sell opioids. The ownership will change (profits will be used to fund the causes you listed) but the operations will not. Right?

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#427

Post by api »

janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

Don't forget McKinsey:

https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#428

Post by api »

addicted wrote: post #425
janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

I’d argue it’s the opposite. Look at what’s happened since Oxycontin was heavily regulated. Opioid deaths in America have exploded by an order of magnitude. There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S. The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was). But it’s q…

Wasn't Oxycontin kind of the boot loader for the present opioid crisis in that it mainstreamed opioid use and got a huge number of people introduced to it?

Then it was taken away and things like illicit fentanyl filled the gap, but that came later.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#429

Post by mcguire »

thegrimmest wrote: post #405
darawk wrote: post #389

Earlier quoted context omitted.

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

> That last thing was their crime Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game. Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding t…

Purdue aggressively marketed OxyContin as having a very small rate of addiction to doctors who weren't pain specialists and thus had little experience with controlled medications, while providing a dosing regime that was almost designed to cause addiction. (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)

"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)

"The Family That Built an Empire of Pain" (https://www.newyorker.com/magazine/2017/10/30/the-family-tha...)

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#430

Post by shawndrost »

Mistletoe wrote: post #307
shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

I mean I have been prescribed opioids many times and I just take them as prescribed and they help the pain of the surgery or whatever. I don’t even take the whole bottle. What will replace the opioids if we don’t allow them to be prescribed?

I understand two answers to your question:

1. Nothing will replace the opioids, but we should make most routine use illegal anyway, because the usage you described causes addiction, abuse, and death in some cases, which overrules your QOL improvements.

2. Nothing could replace the opioids, so we should keep the status quo. The addiction, abuse, and death are a relatively minor downside to an important bundle of benefits. The Sacklers marketed them illegally, but we've course-corrected as best as possible, and the new status quo is uncomfortable but OK.

These are, I think, the first two buckets of people I listed. I understand them both. I think you're in the second camp. I'm in the first. But I think most commenters here are in neither camp???

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