[mcguire]

Purdue aggressively marketed OxyContin as having a very small rate of addiction to doctors who weren't pain specialists and thus had little experience with controlled medications, while providing a dosing regime that was almost designed to cause addiction. (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)

"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)

"The Family That Built an Empire of Pain" (https://www.newyorker.com/magazine/2017/10/30/the-family-tha...)

[com2kid]

> . (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)

The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.

Thankfully most doctors will willingly prescribe a small after lunch short acting dose.

There is a large delta between the average response curve and an individual's response curve!

[darawk]

> The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.

Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.

> There is a large delta between the average response curve and an individual's response curve!

True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.

There are a lot of sources of variability, but variation does not actually make it very difficult to detect improper opioid prescribing behavior. Just like the variation in people's weights would not tell you much about the strength of asphalt roads. These things are not measured in the same scale.

The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.

[com2kid]

> Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.

True, my point more was that false advertising about "duration of extended release action" is a problem across multiple types of prescription drugs.

> True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.

The marketing material doesn't care. "All day", "24 hour", "12 hour" are the phrases that get used.

Meanwhile reality is that every person who takes a drug is different and doctors need to be aware of this and just ask the patient how well things are working out.

> The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.

Yeah it got out of hand, but I'd imagine that this wasn't happening from day 1.

Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.

[darawk]

> Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.

This has changed over time. At first it was the pharmaceutical route, largely due to the shift in medical norms to prescribe opioids for chronic, not just acute, pain. Prescribing them for chronic pain is a near guaranteed recipe for addiction. However, I think things have changed in the past decade or so, with people largely moving straight to fentanyl and/or other illicit opioids. I don't think the pipeline is largely pharmaceutical in nature anymore.

[thegrimmest]

Blindly listening to a company trying to sell you something has never been a good idea. Doctors doing just that despite the clear, obvious, conflict of interest is their failure, not Purdue's.

Thinking that an individual or organization with a vested interest will not bullshit you at every turn is absurdly naive. This is why third-party testing, accreditation, certification, and audits are a thing.

> doctors who weren't pain specialists

Then they should have insisted on third party, board approved, usage guidelines; especially when it became obvious that OxyContin is highly addictive. It doesn't take that long. Doctors have not however been held responsible for their abject failure towards their patients, and continue to prescribe a month's worth of Oxy for minor issues. This will continue until doctors start losing their licenses.

[mcguire]

Everyone in every industry that I know about relies on true information from their suppliers, from software to produce. They're the ones who know about the products, after all. In fact, pharmaceuticals are the one industry most likely to treat suppliers at adversaries, with FDA regulations continually attacked as too stringent.

Purdue was actively lying about their drugs.

"Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”50(p99) The company cited studies by Porter and Jick,51 who found iatrogenic addiction in only 4 of 11 882 patients using opioids and by Perry and Heidrich,52 who found no addiction among 10 000 burn patients treated with opioids. Both of these studies, although shedding some light on the risk of addiction for acute pain, do not help establish the risk of iatrogenic addiction when opioids are used daily for a prolonged time in treating chronic pain. There are a number of studies, however, that demonstrate that in the treatment of chronic non–cancer-related pain with opioids, there is a high incidence of prescription drug abuse. Prescription drug abuse in a substantial minority of chronic-pain patients has been demonstrated in studies by Fishbain et al. (3%–18% of patients),53 Hoffman et al. (23%),54 Kouyanou et al. (12%),55 Chabal et al. (34%),56 Katz et al. (43%),57 Reid et al. (24%–31%),58 and Michna et al. (45%).59 A recent literature review showed that the prevalence of addiction in patients with long-term opioid treatment for chronic non–cancer-related pain varied from 0% to 50%, depending on the criteria used and the subpopulation studied.60"

"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)

"Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.

"When many doctors began prescribing OxyContin at shorter intervals in the late 1990s, Purdue executives mobilized hundreds of sales reps to “refocus” physicians on 12-hour dosing. Anything shorter “needs to be nipped in the bud. NOW!!” one manager wrote to her staff."

"‘You want a description of hell?’ OxyContin’s 12-hour problem" (https://www.latimes.com/projects/oxycontin-part1/)

From what I've seen (women sent home days after a c-section with Ibuprofen as the only pain medication; all of the doctors near me displaying signs saying they will not treat chronic pain), pain medication may well be under-prescribed at this point.