[DickingAround]

I have a high level question; a lot of want to legalize drugs. Ending the war on drugs and all that. This is a drug that was legal and a lot of people got on it and now we're angry. Why? I don't like that people got hurt. I also recognize that bad drugs are bad. But I can't find a way out of "tell people drugs are bad and they have to make their own choices." Is the problem here the doctors told them the bad drugs were good drugs?

[brogrammernot]

OxyContin isn’t a bad drug, it’s a highly addictive drug and the company knew it was highly addictive & not only didn’t do enough due diligence to make sure prescribers didn’t over prescribe it but also intentionally encourage that behavior which has led to an epidemic.

However, food for thought on that same subject is the over prescribing of amoxicillin and other similar class of drugs for viruses. The doctor is operating a business and his/her clients want a solution to their problem, so they write a script as they want to keep their customer happy and it “can’t be too bad”.

There’s a case to be made that a certain amount of immediate gratification expected on the part of the consumer is a large contributing factor to overprescribing in general.

However, in this case, Purdue was very much in the wrong and should not have been encouraging over prescription of a highly addictive drug.

[projektfu]

Yeah. I think the underlying story is that doctors used to be more apprehensive about prescribing opioid painkillers, and when they did they prescribed lortabs or something like that for acute cases and they wouldn't put refills on or rewrite the scripts when asked. Then, along comes Purdue with a claim that OxyContin, because of its unique formulation, is a big addiction concern and is safe to prescribe for chronic pain. Then they (and a couple other manufacturers) basically conducted a successful campaign to convince doctors that undertreatment of chronic pain was widespread and they were basically letting their patients suffer, strongly suggesting that this may be considered malpractice in the future if they do not start prescribing more opioids. This campaign was very smart and even reached the doctors who refuse to take incentives from drug manufacturers. Essentially, in the way that Pfizer created a new category of concern in the mind of patients with Viagra, Purdue did the same in the mind of doctors with OxyContin.

Lo and behold, people are addicted to OxyContin, some start looking for more immediate-relase formulations of opioids because they don't feel right even on 80mg Oxy tablets, and hundreds of thousands who otherwise would have been alive with chronic pain are now dead of overdose. Meanwhile, research is showing that opioids are not very good for chronic pain and other approaches, usually multimodal approaches, are better, including NSAIDs, gaba-ergic drugs like gabapentin and pregabalin, ketamine, physical therapy, psychological retraining, meditation, acupuncture, etc.

[Alex3917]

> Then they (and a couple other manufacturers) basically conducted a successful campaign to convince doctors that undertreatment of chronic pain was widespread and they were basically letting their patients suffer, strongly suggesting that this may be considered malpractice in the future if they do not start prescribing more opioids.

That was/is the position of the IOM though. Was Purdue involved with convincing the IOM to adopt that position?

[projektfu]

Yes, when ideas become fashionable, they become the conventional wisdom.

[projektfu]

Oops, I meant is not a big addiction concern.

[usertrjx]

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

[diag]

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.

[brogrammernot]

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.

[binarymax]

Much of the legality argument for drugs stems from not punishing the user. Nobody is really interested in protecting the dealer. Manufacturing, selling, and marketing highly addictive substances at the cost of society isn't where people are interested in relaxing laws. Purdue (and others) have been operating as legal cartels. Shutting them down is a net benefit to society.

[14]

From my understanding, this company lied about the effects of the drug. That is the problem. If they would have said "hey we have a great drug that completely dopes a patient up and works like magic to block pain, BUT only give it for one or two days OR ELSE they will become addicted" then we would not be here now debating this. Instead what they told doctors was that the drug was safe at the recommended prescription levels which was not true.

[WorldMaker]

A direct comparison is to the tobacco industry. Tobacco sales still remain legal in most of the country, but for multiple reasons there's been huge restrictions on how and where and to whom (no marketing to minors/kids) tobacco companies can market. Tobacco products have to be marked with big addiction warnings, and very visible reminders of side effects. Tobacco products also generally have taxes collected specifically to directly finance anti-addiction resources in many states.

Legally selling the drug is orthogonal from morally/ethically dealing with the consequences of the drug, including regulating how it is sold, how it is marketed, how it deals with its own consequences.

[GreaterFool]

> a lot of want to legalize drugs. Ending the war on drugs and all that

There are a lot of different drugs. You can't lump them all together!

[moate]

>>You can't lump them all together!

Actually some of us do. Just open the floodgates when it comes to what you're able to have access to.

Spending money enforcing prohibition feels less helpful than spending that same money on treatment of underlying issues or addressing other social problems that lead to drug use in the first place. Rather than criminalize the use behavior, which doesn't do anything to save lives in any real way, try to fix the actual problem rather than just sweep it under the rug of the criminal justice system.

[notfromhere]

Problem here is that doctors pushed highly addictive painkillers on anyone and anything, while Purdue did everything they could to increase sales and disguise the risks associated with opioids.

[calphalon]

Yes, and in some cases actively pushed them, as did the manufacturers.

[jcranberry]

The problem is complicated. Here are some abridged points from an OECD document linked below.

1. Overprescription, in the US, there were 240 million opioid prescriptions in the US in 2015, enough for one for every adult in the general population.[1]

2. Poor mental health treatment, "in the United States, 18.7% of all patients with mental health conditions receive 51.4% of the total opioid prescriptions distributed each year, meaning that having a mental health disorder was associated with a two-fold greater use of prescription opioids"[1]

3. Greater availability + lower cost and higher purity of opioids sold by criminal orsg. Mexican criminal orgs have been pushing much greater amounts of opioids in the last ten years, probably due to profits from marijuana being undercut. Prescription drug OD deaths have actually decreased as people switch from controlled substances to heroin/other opiates.[2]

4. Lack of access to effective treatment procedures. The US is woefully inadequate in this regard. "n the United States and Canada, rehabilitation programmes are still mainly abstinence based (Annan et al., 2017[75]). More specifically, in the United States only 8-9% of all substance treatment facilities between 2006 and 2016 had MAT programmes certified by SAMHSA...This happens despite evidence showing that opioid users who are treated only with psychological support are at twice greater overdose death risk than those who receive opioid agonist pharmacotherapy (Pierce et al., 2016[77])"

5. Stigmatization causing addicts not to seek treatment. "Research indicates that stigma contributes to individuals poor mental and physical health, non‐completion of substance use treatment, delayed recovery and reintegration processes, and increased involvement in risky behaviour (e.g. needle sharing)"

OxyContin is a controlled substance, so it's not actually legal. Here is an excerpt from an OECD publication on the opioid crisis on a specific case of decriminalization of opioids:

In 2001, Portugal decriminalised the possession and consumption of all narcotics and psychotropic substances for personal use, intended as the quantity required for an average individual consumption during a period of ten days. Exceeding this quantity, criminal procedures apply. Portugal’s decriminalisation reform has been particularly influential, since by introducing a de jure decriminalisation (changes in the law instead of changes in the daily practice), it has been a pioneer of the explicit decriminalisation of all drugs. Some of the main benefits of decriminalisation mentioned by Portuguese authorities can be summarised as follows:

Changes in the mind-set of the general population, contributing to consider drug use disorders as a medical condition rather than a criminal offence.

Creation of supplementary entrance doors to the public health system, particularly, through the Commissions for the Dissuasion of Drug Dependence.

Coherence enhancement between the health and judicial systems, markedly, to provide and expand access to public health interventions.

...

The decriminalisation of drugs is controversial in nature. However, empirical evidence shows that following decriminalization, Portugal has not witnessed major increases in drug use, but has experienced reductions in problematic use, drug-related harms (e.g. HIV-AIDS, hepatitis, overdose deaths) and criminal justice overcrowding (EMCDDA, 2018[223]; Hughes and Stevens, 2010[224]; Greenwald, 2009[225]). In addition, decriminalisation seems to have caused no harm through lower illicit drugs prices, which would lead to higher drug usage and dependence (Félix and Portugal, 2017[226]).[1]

I recommend checking out the sources I've linked, there's a lot of interesting information in them.

1. https://www.oecd-ilibrary.org/social-issues-migration-health...

2. https://www.overdosefreepa.pitt.edu/wp-content/uploads/2017/...