Drug firms poured 780M painkillers into WV amid rise of overdoses • Hacker News Board

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#41

Post by greeneggs » Mon, Dec 19, 2016, 3:14 PM UTC

dx034 wrote: post #24

Clubber wrote: post #9

Earlier quoted context omitted.

You can tell it was a tabloid style article by the headline: "Drug firms poured..." >Which is about 72 per year, per person. That doesn't sound unreasonable. I would guess the average prescription is 2-4 a day per person per year.

I'd be surprised if more than 5% (probably even less) of the population should be on heavy painkillers at any given time. I don't know statistics from other countries but we're talking about pills that are being used to treat severe pain, not just a headache.

In this article, they found that ~10% of surveyed Americans used prescription painkillers in the last 30 days, including ~6% on narcotic analgesics.

Trends in Prescription Drug Use Among Adults in the United States From 1999-2012 E. Kantor et al., JAMA 2015

http://jamanetwork.com/journals/jama/fullarticle/2467552

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#42

Post by misja111 » Mon, Dec 19, 2016, 3:17 PM UTC

Clubber wrote: post #9

snrplfth wrote: post #4

Earlier quoted context omitted.

Well, 433 over six years, 2007 through 2012. Which is about 72 per year, per person. I mean, what is supposed to be done about this? Cut off WV from painkillers? Have the DEA raid a bunch of pharmacies?

You can tell it was a tabloid style article by the headline: "Drug firms poured..." >Which is about 72 per year, per person. That doesn't sound unreasonable. I would guess the average prescription is 2-4 a day per person per year.

> That doesn't sound unreasonable.

According to the article, the 780 million pills were hydrocodone and oxycodone pills. Those are highly powerful and addictive opioids. 72 of those per inhabitant of WV per year seems insane to me.

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#43

Post by GordonS » Mon, Dec 19, 2016, 3:18 PM UTC

mhuffman wrote: post #14

imglorp wrote: post #5

Not that pharma is angelic here, but don't the doctors have the largest measure of blame for writing unnecessary scripts, failing to monitor for abuse, and failing to encourage alternate options? I'm in favor of maximum MD power. I think they should be allowed to prescribe everything from cocaine to bleach, or any other chemical compound, as suits the patient care, if they know what they're doing. But they should als…

Well, there is also information asymmetry at play here. Patients could have legit pain, and then go to multiple doctors, without the others finding out. Then they could sell those to other people, or use them all themselves. On the other hand, the pharmacies might know, but that could be worked around by a motivated pill-obtainer. The pharma companies, however, definitely know that they sent 780 million painkillers t…

> Patients could have legit pain, and then go to multiple doctors, without the others finding out. Then they could sell those to other people, or use them all themselves

I can't imagine many people that have real pain bad enough to need opioids are going to be selling them to other people.

For people that really need them to manage pain, they can literally be a live saver.

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#44

Post by kelvin0 » Mon, Dec 19, 2016, 3:18 PM UTC

commentzorro wrote: post #35

These are rational people making a decision for themselves if the pain relief is worth and side effects or other Iissues. Let the people of WV make up their own minds and let the market speak for itself.

'Mama' Rand would be so proud of you :-)

Seriously though, 'rational' people can also be misinformed by a large corporation and a system which does not necessarily incentivize getting people healthy, and only wish to make their shareholders happy. The 'market' will always try to optimize for profits even at the expense of everything else.

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#45

Post by GordonS » Mon, Dec 19, 2016, 3:21 PM UTC

VLM wrote: post #34

Clubber wrote: post #9

Earlier quoted context omitted.

You can tell it was a tabloid style article by the headline: "Drug firms poured..." >Which is about 72 per year, per person. That doesn't sound unreasonable. I would guess the average prescription is 2-4 a day per person per year.

Chronic pain can use a lot of pills per year. One every couple hours perhaps. I knew WV was a bit militaristic but some google results and some division imply 10% of the population are military veterans. Its almost believable given how many WV residents I met in the Army, generally extremely nice people BTW. So if no one in WV takes pain pills but military vets, then the vets get a whopping two pills per day and ever…

> One every couple hours perhaps

'Instant' release pills usually last for 4 hours. There are also 'extended' release formulations that generally last 5-7 hours (despite the longer claims of manufacturers).

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#46

Post by burkaman » Mon, Dec 19, 2016, 3:22 PM UTC

commentzorro wrote: post #35

These are rational people making a decision for themselves if the pain relief is worth and side effects or other Iissues. Let the people of WV make up their own minds and let the market speak for itself.

Why do you think these are rational people making rational decisions? Do you know what addiction is?

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#47

Post by snrplfth » Mon, Dec 19, 2016, 3:23 PM UTC

maxerickson wrote: post #36

snrplfth wrote: post #26

Earlier quoted context omitted.

Okay, but what I'm saying is that once the tools are in place to ban various substances for personal consumption, and make those bans stick through enforcement, then that's all the tools you need for a War on Drugs. I mean, at that point, it's just "ban this thing, and not that thing, because it's what I want." What takes doublethink is imagining that, once these powers are in place, they won't be used against one's…

In practice the War on Drugs has involved arresting and imprisoning a lot of people and the militarization of police. How many people are in prison for violating FDA rulings? I'm sure there are a few, but policing egregious behavior is probably a step that a reasonable society takes out onto that slippery slope of having rules about a thing.

Let me try to clarify: if you have rules prohibiting the creation and sale of substances solely for personal consumption by competent, consenting adults, then you have the primary tool needed to conduct a War on Drugs. I think that it is a mistaken notion to imagine creating this power, and saying "don't worry, we'll only ban dangerous things, and not harmless things, because we'll know better." I think that is definitely not the case. Yes, many people want a different mix of things banned and permitted. But people should not fool themselves into thinking that is what they will get, because a power like that is pretty much always used for more things than its creators intend. We cannot simultaneously prohibit things, and not enforce that prohibition through, ultimately, threats of imprisonment. If the maximum penalty for a drug charge is a ticket, then the prohibition on drugs will simply not be effective.

The War on Drugs has involved arresting and imprisoning a lot of people, because a lot of people really want drugs. Once the soft enforcement mechanisms (reprimands, misdemeanors, fines of legitimate businesses) fail, then if you really want to suppress the act, you have to ramp up the level of force. The reason that fewer people are imprisoned under FDA rulings is, I would say, because the FDA is more lenient, and because the things it bans are far more niche and less desired. You can have effective, or you can have gentle, but you cannot have both.

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#48

Post by jsjohnst » Mon, Dec 19, 2016, 3:29 PM UTC

dx034 wrote: post #24

Clubber wrote: post #9

Earlier quoted context omitted.

You can tell it was a tabloid style article by the headline: "Drug firms poured..." >Which is about 72 per year, per person. That doesn't sound unreasonable. I would guess the average prescription is 2-4 a day per person per year.

I'd be surprised if more than 5% (probably even less) of the population should be on heavy painkillers at any given time. I don't know statistics from other countries but we're talking about pills that are being used to treat severe pain, not just a headache.

2x Opiod pain pills a day every day for an entire year is a very serious amount of pain if legitimate.

If a state were to legitimately have 10% of its population that badly hurting, there should be a huge governmental investigation into what factor is causing that much crippling pain.

Of course we know it's not legitimate though.

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#49

Post by Clubber » Mon, Dec 19, 2016, 3:31 PM UTC

VLM wrote: post #34

Clubber wrote: post #9

Earlier quoted context omitted.

You can tell it was a tabloid style article by the headline: "Drug firms poured..." >Which is about 72 per year, per person. That doesn't sound unreasonable. I would guess the average prescription is 2-4 a day per person per year.

Chronic pain can use a lot of pills per year. One every couple hours perhaps. I knew WV was a bit militaristic but some google results and some division imply 10% of the population are military veterans. Its almost believable given how many WV residents I met in the Army, generally extremely nice people BTW. So if no one in WV takes pain pills but military vets, then the vets get a whopping two pills per day and ever…

It's a shame that this journalist, trying to make a name for themselves, feels it's perfectly OK to manipulate the numbers so that it sounds like it's worse than it is. When people read this dramatic account, who don't bother examining the numbers get it in their heads that "something must be done!" it's the people who are in chronic pain that suffer.

Also, since this is coal country, I assume black lung plays a big part in the need for these scripts.

As an aside, I have a family member who had a horrific injury who is on a pain killer script. This person isn't allowed to take an extra pill on days when the pain is worse than normal because the DEA is cracking down so hard on this, her doctor is afraid to subscribe over the government imposed "limit." Pretty sad. Her doctor even suggested she go to a pain clinic because he is concerned about getting heat for total subscriptions.

Didn't we learn anything from the immensely stupid and still ongoing drug war? Fk this journalist.

Re: Drug firms poured 780M painkillers into WV amid rise of overdoses

#50

Post by vkou » Mon, Dec 19, 2016, 3:39 PM UTC

snrplfth wrote: post #29

vkou wrote: post #22

Earlier quoted context omitted.

There are plenty of snake oil manufacturers who manage to operate within the boundaries of the law. Those don't get raided. The milk salesman wasn't raided for selling whole milk. He was raided for selling unpasteurized milk... Across state lines. Generally speaking, clearing the bar for FDA tolerance of nutritional supplements is quite easy. They don't care that your product works, only that you don't put actively d…

I understand that, yes. But what I am saying is that, even with a "safety" criterion, the War on Drugs is completely prosecutable. Heck, alcohol is dangerous as hell, as evidenced by the number of deaths it precipitates. There is nearly always a safety criterion that can be thought up for "products for personal consumption" (as opposed to, say, environmental pollutants) You can have prohibition of "unsafe substances"…

If personal possession and consumption stopped being a crime, that would effectively end the War on Drugs overnight. That kind of drug policy would make the current state of affairs unrecognizable. (Yes, I am well aware of how in the current legal framework, anyone can be accused of being a dealer.)

The FDA approach to regulation goes after dealers and manufacturers - not their customers. So yes, we absolutely can end the War on Drugs, and keep the FDA's enforcement mechanisms.

I honestly have a lot more sympathy for an addict, or a bystander, whose life was destroyed by the state, then I do for his heroin dealer. I think most people opposing the War on Drugs on grounds other then ideological anarcho-capitalism share this assessment.