Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Supreme Court blocks controversial Purdue Pharma opioid settlement

washingtonpost.com

Post reply on HN
Print view View original

431–440 of 691 posts

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#431

Post by sailingparrot »

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…

Sure, OxyContin is better than Fentanyl, and banning Oxy can push people to way more dangerous opioids. But before painting Purdue as a hero of the people, let’s remember that million of people were pushed to opioids through Oxy when they shouldn’t have in the first place. Purdue played a big part in creating the epidemic in the first place. People that are now pushed to harder drugs because of an addiction they got into for the sake of Purdue making more dough.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#432

Post by Spivak »

lesuorac wrote: post #370
wmf wrote: post #343

Earlier quoted context omitted.

They could be imprisoned.

Really unclear how knowingly creating a scenario where people die of overdosing for profit isn't criminal.

Because car manufacturers exist, and this isn't theoretical or a jab at cars themselves. We are 100% certain that people will die while using cars, and by cars. Vehicular manslaughter even has a high bar for real punishment precisely because driving a car has an inherent risk of killing others and that risk is legal to take on.

Knowing that some people using your product will die, and even that selling more of your product increases the deaths is something we're okay with. It's true of guns, red meat, skateboards, alcohol, lawn mowers, and industrial equipment — all sold for profit.

I very much dislike cases like this because while yes, opioids were overprescribed and Purdue sales people did go out and sell often times not in legal ways, doctors still prescribed them and we knew that people dying was necessarily an outcome. So while the crime they actually committed was about kickbacks, not doing the DEAs job enough for them, and lying with statistics they get blamed for the actual deaths which is silly. I take stimulants that double my risk of heart attack and are also known to be addictive, neither outcome is the maker's fault if those happen. It's the tobacco settlement all over again where when bad thing happens the proximate deepest pockets get blamed. I couldn't care less about the government taking money from rich people because reasons, have at it, but I think they're the scapegoat.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#433

Post by relaxing »

rayiner wrote: post #408
relaxing wrote: post #358

Earlier quoted context omitted.

[flagged]

I'm trying to convey how legal conservatives think, as someone who is one. I am, on many policy issues, quite liberal. I think rich people should pay more taxes, people should drive EVs, etc. But ultimately I care more about the rules--especially the rules about who makes decisions and where power is allocated--than I do about what people or outcomes. I'd rather see 3C of global warming than administrative agencies o…

[flagged]

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#434

Post by kidme5 »

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…

username "addicted" eh?

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#435

Post by shawndrost »

doctorpangloss wrote: post #420
shawndrost wrote: post #414

Earlier quoted context omitted.

Thank you for the reply! I am honestly not informed about this stuff and not asking to covertly push an agenda. Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely? Are there certain formulations that have been or should be removed from the market? How do we reinstate the taboo on prescribing them? For EG: I got a vasectomy recently and was told to expect a day or two of pain. I w…

> I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. Is this really what the question was about? Reflections on a personal experience? Those are perfectly valid concerns. Nobody is stopping you from asking any of the professionals you interacted with about addiction, if you are worried, go and ask!

No, my question is about how people judge our opioid status quo: a medical system that prescribes addictive opioids for routine and low-grade pain.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#436

Post by darawk »

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…

> Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?

This is a nice idea, but most Oxycontin is not prescribed by someone's doctor (it is prescribed by a doctor, but it is power-law distributed, most of it is sold by dealers). There are a small number of doctors in the country at any given time that prescribe almost all of the supply. This is not something you can readily fix with responsibility at the doctor level. It may seem like you can, because you could just prosecute "those doctors", but the problem is that the incentives are too concentrated.

That isn't to absolve these individuals of responsibility. They are responsible, and we should prosecute them legally. The problem is that we already do and always have. We should keep doing it, but I don't expect it to fix anything.

EDIT: To be clear I'm not necessarily for or against this settlement. There was a time that we might have stopped the opioid crisis at the corporate or pharmaceutical level, but that time has long since past. We could criminalize all opioids tomorrow and it would make almost no difference. Most opioid addicts use fentanyl now, and most fentanyl is produced/sold illegally. Heroin, for instance, has been Schedule I forever - the only thing that reduced its popularity was a cheaper substitute in fentanyl.

If we are going to bother prosecuting or civilly charging Purdue or its principals, it would have to be for purely punitive reasons. Corporate behavior unfortunately does not matter anymore.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#437

Post by jjk166 »

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

Taboos are not simply undesirable things, they are rules which carry severe penalties if you break them. The difference is that rather than going through the effort of getting society on the same page and agreeing what is okay and what isn't, you instead leave ambiguity that harms the well meaning and benefits the malicious. If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule. If you aren't willing to ban something by law, then it ought to be permissible.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#438

Post by mcguire »

yostrovs wrote: post #300
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 understand there's fraud and bribes and such, but it seems to me that in the end it is doctors and the medical system, with a bit of help from government regulators, that decide prescriptions, dosages, limitations and such. Purdue could have been making pure poison, but they don't prescribe anything.

Is it fraud if the pharmaceutical company falsely claims that the addiction rate is very low? If the company aggressively pushes a dose regimen that is almost designed to produce addiction?

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#439

Post by thegrimmest »

mcguire wrote: post #429
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…

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 rath…

Blindly listening to a company trying to sell you something has never been a good idea. Doctors doing just that despite the clear, obvious, conflict of interest is their failure, not Purdue's.

Thinking that an individual or organization with a vested interest will not bullshit you at every turn is absurdly naive. This is why third-party testing, accreditation, certification, and audits are a thing.

> doctors who weren't pain specialists

Then they should have insisted on third party, board approved, usage guidelines; especially when it became obvious that OxyContin is highly addictive. It doesn't take that long. Doctors have not however been held responsible for their abject failure towards their patients, and continue to prescribe a month's worth of Oxy for minor issues. This will continue until doctors start losing their licenses.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#440

Post by doctorpangloss »

shawndrost wrote: post #435
doctorpangloss wrote: post #420

Earlier quoted context omitted.

> I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. Is this really what the question was about? Reflections on a personal experience? Those are perfectly valid concerns. Nobody is stopping you from asking any of the professionals you interacted with about addiction, if you are worried, go and ask!

No, my question is about how people judge our opioid status quo: a medical system that prescribes addictive opioids for routine and low-grade pain.

I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!

If you want a poll, this court case was a poll. A majority of victims who had ample time to participate in litigation agreed to the settlement terms. They told you that addiction is bad, the new Purdue would help, and that money from its owners was sufficient justice. That some agitator basically played the Yogg-Sauron of this meta, the Supreme Court, and cast 5 fireballs against his opponent versus 4 fireballs on himself, isn't super material to the seeming success of the hard political work of this bankruptcy judge.

Post reply on HN