[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.