Purdue Pharma files for bankruptcy with $10B plan to settle claims • Hacker News Board

Re: Purdue Pharma files for bankruptcy with $10B plan to settle claims

#191

Post by loeg » Tue, Sep 17, 2019, 3:37 AM UTC

Scoundreller wrote: post #160

loeg wrote: post #78

Earlier quoted context omitted.

Tl;dr: About 80% of heroin users started on prescription opioids. This sounds bad, but actually the conversion rate from opioid on-label use to abuse is pretty low and the conversion from pill abuse to heroin is even lower. * 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…

> * Rate of conversion from on-label opioid prescription to addiction And there we already have a problem. Off-label prescribing of opioids are a huge problem. They’re really not supposed to be used so frequently for chronic non-cancer pain, but they’re used all the time for it. And that’s a much bigger market than chronic cancer pain patients, because of life expectancy. Cancer will often kill you, your back pain wo…

Sorry, that wasn't really the idea I was trying to express at all. The two points are "using opioids as prescribed by Dr" => "using the same opioids in a way that was not prescribed."

I know off-label is specific industry jargon and it doesn't mean the way I tried to use it; sorry for the confusion.

Totally agree that chronic pain is a hard problem and tolerance effects make opioids a non-ideal long term solution. That said, I am neither a Doctor nor a researcher in the pharma industry so I don't have a lot of helpful suggestions for anything better than opioids today.

Re: Purdue Pharma files for bankruptcy with $10B plan to settle claims

#192

Post by loeg » Tue, Sep 17, 2019, 3:43 AM UTC

mnm1 wrote: post #132

loeg wrote: post #78

Earlier quoted context omitted.

Tl;dr: About 80% of heroin users started on prescription opioids. This sounds bad, but actually the conversion rate from opioid on-label use to abuse is pretty low and the conversion from pill abuse to heroin is even lower. * 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…

That magic wand is allowing doctors to prescribe safe opiates to addicts, providing safe places they can use, and providing support and means to quit. It's not magic. Many places around the world are doing it. Eliminate the black market and you eliminate those deaths. Our government and society are simply not interested in eliminating those deaths. Places like Portugal, Switzerland, Vancouver bc have been waving that…

Sure, that's one harm reduction technique that works as long as doctors (and Governments) are willing to prescribe the amount of opioids that addicts want. I touched on the same technique in an earlier, longer form version of the same comment (in response to a slightly different thread the other day):

https://news.ycombinator.com/item?id=20973171

Excerpt:

  Given we don't have a magic wand, what can we do? Obviously we can't stop fentanyl
  from entering our borders or being synthesized illicitly here. We can (and have)
  leaned on illicit fentanyl-producing countries like China and Mexico to make those
  businesses less lucrative. We can do harm reduction things for the vulnerable
  population — which is mostly heroin users. We could legalize heroin with a
  prescription for existing addicts?

  Harm reduction stuff: Provide free/cheap testing for fentanyl adulteration? Make
  naloxone available without prescription, on the shelf, for cheap or free, and
  encourage businesses and residents to keep some around, even if they aren't users and
  don't know any users? Maybe provide monitored, safe injection sites where addicts
  overdosing can be assisted immediately if needed but are not arrested or forced into
  any overbearing programs. Maybe even supply quality- and quantity-controlled heroin 
  to these addicts for use on-site to reduce likelihood of overdose and even allow
  people to taper off if they want to.

It's still nearly equally magical to wishing fentanyl away in that effecting such a policy is incredibly difficult politically (US, anyway).

Pick any level of government. This doesn't really have populist mandate even in Blue states and you can be damn sure Republican Governors are going to reject any "give drugs to addicts" proposal on their desk, if it even makes it through state legislatures. Meanwhile, Congress is stalled with a Democrat-controlled house and a Republican Senate that won't pass any laws. I don't see Trump taking ... positive executive action on this, either.

Maybe some harm reduction can be done at the municipal level, but that probably leaves some of the worst hit parts of the country (rural areas in Red states) without help.

Re: Purdue Pharma files for bankruptcy with $10B plan to settle claims

#193

Post by loeg » Tue, Sep 17, 2019, 3:52 AM UTC

youeseh wrote: post #88

loeg wrote: post #81

Earlier quoted context omitted.

True, but I added a little more nuance here: https://news.ycombinator.com/item?id=20981382

Those conversion rates are not low.

They're not zero, but single digit percent times single digit percent is generally considered a small percent. The math works out to 0.32-0.72% total, taking either the low end of both ranges or the high end of both. I think anyone should agree that in an absolute mathematical sense, 0.3-0.7% is a "low percent."

In this specific context? Sure, it's subjective and reasonable people can disagree.

Re: Purdue Pharma files for bankruptcy with $10B plan to settle claims

#194

Post by rosybox » Tue, Sep 17, 2019, 4:26 AM UTC

TheOtherHobbes wrote: post #107

darawk wrote: post #99

Earlier quoted context omitted.

Ok, but he was rich. And he got "touched". Therefore the rich are not untouchable, which was the original point under discussion. Just like the Sackler family does not appear to be immune from prosecution and confiscation of their property.

We don't know that he got touched. We have a press story with some unlikely events that strongly suggests he got touched. There's a between-the-wars novel by English author Evelyn Waugh called Decline and Fall. The main character gets involved in all kinds of unspeakable crimes, more out of naivety than inherent criminality, and at the end is "disappeared" out of jail and given a new identity. Waugh was an Establishm…

> But if you're in a position to bribe prison guards and authorities to cover up murder-by-fake-suicide, I suspect it's not significantly harder or more expensive to bribe prison guards and authorities to cover up an escape.

> It's debatable if it would more expedient to remove the evidence permanently or have it moved to another location where some of its skills might continue to be useful. But I would be surprised if option 2 wasn't at least a possibility.

To think any of this is plausible given the context requires an unwell mind.

Re: Purdue Pharma files for bankruptcy with $10B plan to settle claims

#195

Post by mnm1 » Tue, Sep 17, 2019, 11:54 AM UTC

loeg wrote: post #192

mnm1 wrote: post #132

Earlier quoted context omitted.

That magic wand is allowing doctors to prescribe safe opiates to addicts, providing safe places they can use, and providing support and means to quit. It's not magic. Many places around the world are doing it. Eliminate the black market and you eliminate those deaths. Our government and society are simply not interested in eliminating those deaths. Places like Portugal, Switzerland, Vancouver bc have been waving that…

Sure, that's one harm reduction technique that works as long as doctors (and Governments) are willing to prescribe the amount of opioids that addicts want. I touched on the same technique in an earlier, longer form version of the same comment (in response to a slightly different thread the other day): https://news.ycombinator.com/item?id=20973171 Excerpt: Given we don't have a magic wand, what can we do? Obviously we…

Yeah we're going to continue to kill hundreds of thousands more people before this will even start to be discussed by politicians because our politicians are incredibly stupid and closed minded. But maybe if enough people die, things will change, possibly through voter referendums. I never thought legal marijuana would be a thing, yet it is (federal laws notwithstanding). Once people in states with referendums get tired of their friends and family dying by the thousands, maybe they'll act. Current politicians sure won't. But these primitive morons will eventually die themselves, hopefully sooner rather than later, and hopefully their replacements will be slightly less idiotic, more pragmatic, or perhaps even compassionate. Stranger things have happened. That's why we must continue to advocate for the only solution that has been proven to work despite the challenge of getting it implemented. One day we will look upon the drug war and its perpetrators the way we look at Nazis now. Or our children or grandchildren will. That I'm certain of. How far down the line, no one knows.

Re: Purdue Pharma files for bankruptcy with $10B plan to settle claims

#196

Post by brogrammernot » Tue, Sep 17, 2019, 3:47 PM UTC

diag wrote: post #184

usertrjx wrote: post #181

Earlier quoted context omitted.

can you explain the issue with Amoxicillin and viral use? Is it that amox does nothing for viral infections, and was prescribed anyways?

Bacterial co-infection is a risk with viral infections, the problem is that antibiotics have been prescribed as a first line script when it isn't indicated.

Yeah, that’s the point I was trying to make.

Lots of times Doctors are providing a service and the expectation is “I feel bad, give me some pills to help” when in reality many cases are rest & recover but as a client can you imagine paying your social media person $500 for them to say “doing nothing is the right move”? Not really, no.