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Supreme Court blocks controversial Purdue Pharma opioid settlement
491–500 of 691 posts
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#492Interestingly the same kinds of tactics used to push opiates on the general public are still being used to push amphetamine analogs - but the death rate from amphetamine addiction/overdose is much much lower (>1000X lower) than that from opiate addiction/overdose so it doesn't really hit the headlines, and arguably is not as much of a concern. From a libertarian point of view, mood- and mind-altering substance use sh…
Difference is the death rate from prescription ADHD meds is zero, and they’re not addictive like opiates. I’m open to discussing the underlying problems that push people to take ADHD meds. Like the insane work life required to just maintain the same standard of lives as our parents generation, or modern devices eating our attention spans. But limiting access to ADHD drugs is just going to affect the most vulnerable a…
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Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#493Earlier quoted context omitted.
> "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed." > We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them! This is conflating two things. It is not criminal to move money offshore, and nothing suggested any money laundering occurred, be…
> And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction. Renouncing your citizenship because you owe the US government money is generally not seen as a valid reason by the US government to renounce your citizenship.
That’s not the reason you would say in your renunciation ceremony
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#494Earlier quoted context omitted.
> 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…
I am not a lawyer. I am from a legal family (three generations) and I understand jurisprudence
> you instead leave ambiguity that harms the well meaning and benefits the malicious.
Two points
1. Law advantages those with access, and often benefits the malicious and harms the good. Case in point: Drug law. Another is IP law
2. Law is not objective. The words that form it are in black and white, but there are courts and judges because the application of the law is subjective. The boundary cases are numerous and important
More generally....
> 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.
Sotp, just stop! This is the idea that we must punish and scantion people into being good.
I think of things that are good (like treating drug addicts as ill, not criminal or imoral). I think not of "bans". They accomplish little.
Permissible, impermissible, these are blunt concepts that are not very useful. We can be, and should be, aspirational and collegial not judgemental and competitive
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#495Earlier quoted context omitted.
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…
As someone who deals with chronic pain, I watched this situation develop: people lost access to their “safer” opioid and switch to whichever one they can get. Or suicide; there were many suicides around this time. Thankfully opioids have never been an appropriate treatment for my pain so I didn’t have to deal with this, but I feel real empathy for the people who switched to street drugs at that time. OD is a risk but…
The black pill with chronic pain is it’s often better to off yourself depending on the condition. There’s no hope for some things like erythromelalgia.
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#496Earlier quoted context omitted.
> 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 distri…
The on-ramp from minor pain or surgery; to a massive, blindly-renewed, over-prescription of Oxy; to an opioid addiction that spirals into street drugs is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open. > a small number of doctors in the country at any given time that prescribe almost all of the supply…
> The on-ramp from minor pain or surgery to a massive, blindly-renewed, over-prescription of Oxy to an opioid addiction that spirals into street drugs
This is mostly not a thing. I have known hundreds of current and former opioid addicts. I don't think I know a single one that was "on-ramped" from Vicodin or Percocet in any truly meaningful sense. It is the case that people almost always use these first. But it is relatively rare to become an opioid addict as the result of a one-off, acute vicodin prescription, per se.
> is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
I hope that is true! It doesn't seem like that to me, but I admit to not having carefully studied the data. Casually, there are 1.6 million opioid addictions currently in the US [1]. There were ~50,000 overdose deaths in 2019. That is, 1/1600 opioid addicts died in 2019 alone. To a first approximation, 0 people overdose annually from vicodin/percocet and other short term acute pain treatments.
It would be fairly surprising to me if (much) more than 1/1000 strong opioid users (per year) dies from an overdose. If the numbers were substantially higher than this, the epidemic would burn itself out in the population rather quickly. We can infer from this that most active opioid addicts are users of strong opioids, which are basically never prescribed for acute use. Hence, the overwhelming majority of current addicts are users of strong, non-acute opioids.
This doesn't mean there can't be some gateway effect (I do in fact think there is), but it does mean that "the problem" is mostly the presence of the strong opioids, not the Vicodin prescription for your wisdom teeth.
I'd be open to contrary data on the matter, though.
> The fact that medical boards allow these doctors to retain their licenses is the core of the issue
It is an issue, and we should absolutely try to improve it. It's just unlikely to materially dent the larger issue.
> I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
I can personally attest to this being false. It was really quite annoying - I had to find new doctors on a number of occasions as a result, and that was ~15 years ago. Things have gotten much, much tighter on the pharmaceutical side since then. Every doctor who wrote me something was in prison or dead (from suicide, in prison) within 2-3 years of the last time I saw them, and I didn't even turn them in.
It is true that at any given time the Oxycontin prescriptions are power-law distributed, with most of the scripts being written by a small number of doctors. But this is a little bit like looking at the profits in the high frequency trading industry, or the cartels in Mexico (not to morally equate these things). Yes, there are a small number of them and they seem to make a lot of excess profits, but that does not mean you can knock them off and change anything. Nature abhors a vacuum, as they say.
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#497Earlier quoted context omitted.
> But it’s quite clear that America had a parallel opioid crisis going on I don’t think that’s really the case. What happened here was that peddling oxy, created the excess demand that is now met by illicit sources that cause more deaths now that oxy is regulated. But what you’re missing in your understanding is that without oxy, demand wouldn’t exist in the first place. And that’s the harm everyone is talking about.…
You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients. I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers. Now, in addition to dealing with pain every day, I also have to “prove” that I’m not an opioid seeker if I end up in the ER for overwhelming pain. Because sayin…
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
> I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
To the GPs point, the cause of the regulation was the abuse of the sale. Many deaths were caused by aggressively selling oxy to folks who weren’t managing pain.
The fallout has resulted into harm with people that have a legitimate need for pain management.
Both can be true. The Sacklers are the culprits any way you slice it.
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#498Earlier quoted context omitted.
> I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that. As a reminder, Oxy was heavily marketed, (to doctors!) as a "not bad" opioid. As in, not as addictive, not as problematic, and something that can be prescribed more easily and with less worries. If a doctor comes up and tell you "don't worry about this one, it isn't addictive like the others", and you are in a t…
You didn't learn about the opium wars? I'm not talking about dare which was obvious bullshit, I'm talking of learning from history. There was no weed war, that a drug caused a couple wars lasting decades should at least raise an eyebrow of any thinking person.
I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society. It's not as if US high schoolers get a comprehensive education in world history except for a few select omissions. I agree with you that this is something they ought to be aware of but I think you've kinda stretched the causality here.
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#499Pound 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…
Are you one of the lawyers?
None of that would’ve happened if they didn’t start the flood of opiates to begin with. It wasn’t a marginally increased issue, they flooded the market with it. People with minor pain were getting massive bottles of OxyContin and selling or using it. This led to pill mills and crooked doctors. You had normal people getting hooked on high dosages. These are not the people who were using opioids before that. Pills made it seem safer. Most users don’t start with heroin, they start with pills because of exactly that. “A doctor prescribed it, must be okay.”
This is some insane logic to absolve them of responsibility. I say this as someone who also saw the problem firsthand. Was regulation handled badly? Sure but there’s no way you can say they didn’t start the problem.
Re: Supreme Court blocks controversial Purdue Pharma opioid settlement
#500Pound 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.
You're really underselling it if anything. Over a million Americans have died so far in the opioid epidemic. That more than any of their wars, including their civil war.
A good book to read regarding this topic is "Death in Mud Lick" by Eric Eyre who was a reporter for a local newspaper in WV during the early discovery phase of the epidemic.
The book details the methods used by the drug companies to pedal these drugs into small communities, the tragic victims, and lastly the refusal of drug suppliers to admit any wrong doing. There's also a slight dose (no pun intended) of WV AG's sheer incompetence on the matter due to donations and gifts by said drug suppliers.
Super depressing book, but great read nonetheless.