"A major thrust of the sales campaign was that OxyContin should be prescribed not merely for the kind of severe short-term pain associated with surgery or cancer but also for less acute, longer-lasting pain: arthritis, back pain, sports injuries, fibromyalgia. The number of conditions that OxyContin could treat seemed almost unlimited. According to internal documents, Purdue officials discovered that many doctors wrongly assumed that oxycodone was less potent than morphine—a misconception that the company exploited."
AND
"But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.
Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal."\
AND
"Richard Sackler worked tirelessly to make OxyContin a blockbuster, telling colleagues how devoted he was to the drug’s success. The F.D.A. approved OxyContin in 1995, for use in treating moderate to severe pain. Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. But the F.D.A., in an unusual step, approved a package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism “is believed to reduce the abuse liability.” David Kessler, who ran the F.D.A. at the time, told me that he was “not involved in the approval.” The F.D.A. examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterward. Within two years, he had taken a job at Purdue."
>Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.
This really reads to me rather badly. Twice as powerful isn't necessarily bad. Rather, if it was less abusable (as they claim) and equally addictive, that would represent and improvement over morphine. The issue might then lie in overzealous prescription/usage.
------
ncbi.nlm.nih.gov/pmc/articles/PMC3550270/
> Oxycodone demonstrated high abuse liability on the basis of its high likability scores and a relative lack of negative subjective effects.
I found this conclusion pretty interesting, though I just skimmed this article.
'less abusable' - using the term as you did e.g. route of administration is a gross Purdue marketing lie.
Original formula oxycontin pills were insanely abusable. crushed up into ultra-fine powder very easily - like one of those sugar necklace candies. snortable and shootable. way easier to abuse than morphine which isn't super available in the US as a take home script.
also to the 'powerful,' the doses prescribed were insane compared to the baseline of what was regularly prescribed before Purdue's marketing. E.g. 5mg oxycodone + acetaminophen compared to Oxy's going commonly up to 80MG in a single pill (30's were pretty standard on the street). I think they even have a 160mg but I have never actually seen in real life. That's INSANE like 240 morphine equivalent or something and likely taken at least 2x a day.
This insane strength goes hand in hand with overzealous script writing.
All of this was caused by Purdue's tactics.
The 'OC' s (they are stamped this way) were on the market for a LONG time after Purdue was very aware of the criminal damage they were doing and the DEA and others were pushing for pill reformulation. They took forever to change to 'OP' which were less abusable at least not easily crushed and they gel up if trying to shoot (addicts will always find a way). Knowing how evil this company and family are I wouldn't be surprised if they waited a while to launch the new pill format for patent reasons but I don't know this
The cycle of 'less abusive' opiate marketing has been going on for a hundred years. They are all abusable and addictive. Even maintenance opiates like buprenorphine you would be dependent on and users will still combine for instance methadone and other pills to get high.
As much as the pharma industry and medical practitioners were irresponsible in their contribution to opioid addiction, there is a dimension to this problem that does still does not get enough attention: that people may really be in pain. Over the past couple decades economic conditions have stagnated at best and for many declined causing a lot of people chronic stress, depression, and anxiety. The food industry has raised generations of people on abysmal nutrition causing a rash of chronic health conditions, many of them inflammatory in nature. Whole cities have gone into decline and precarity because their core industries have laid off workers in droves and left. ... and so forth. The backdrop of the "opioid epidemic" has been a population that had arguably been already been declining in physical and mental health for decades. It is not too much of a stretch to suppose people are actually in more pain. This does not mean that the right thing to do is to allow the pharma industry to push pills on people, but if the underlying issues that cause this pain are not addressed people in pain are just going to move on to more alcohol and street drugs.
>It is not too much of a stretch to suppose people are actually in more pain. This does not mean that the right thing to do is to allow the pharma industry to push pills on people, but if the underlying issues that cause this pain are not addressed people in pain are just going to move on to more alcohol and street drugs.
Then by all means, let the sweeping political change commence, deconsolidation of the economy occur, unwind a few decades of M&A's, and let's get to fixing the social problems.
Throwing drugs at the issue won't make it go away, I'm stuck on one. I know where that road leads if you don't take due care in management and listening to the impact of your behavior on those around you. The fact is, these drugs may be good for some people, and I welcome them to use them, but due care needs to be exercised in not using them unwisely.
Also cultural issues like weakening of family ties, death of community around the church etc. Increasing alienation from the “coastal elites” and the culture that is broadcast on mass media. Fall in sense of belonging to the country.
The left tends to ignore these and focus solely on the material aspects.
It's not that I don't acknowledge the addiction problem, it's that I fear in our quest for addicts we will forget the real good these drugs did. There are a lot of people in pain.
Here are some alternative facts not often discussed:
most opioid abusers were never prescribed the drug
most people prescribed opioids never become addicted
Many people who get opiates do not live long enough to become addicts. Think of terminal cancer patients.
Also, mind that there is the inverse problem in some countries. Doctors are afraid to prescribe opiates and pharmacies to distribute because of the risks of prosecution. Russia is a notorious example that lets cancer patients die without access to opiates.
Yeah that's obviously horrible. But I don't know anyone in the US who is advocating taking away pain management meds for terminal, cancer, etc patients that are suffering greatly.
17 comments
[ 4.1 ms ] story [ 47.8 ms ] threadThe views on pain and how to manage it differ widely.
Pain is a good signal... Tells you to take a rest and recover properly.
No you don't. If you want to criticize something, do it, but don't make stuff up to make your point.
> Pain is a good signal... Tells you to take a rest and recover properly.
A small amount is good. An excessive amount can cause lifelong PTSD.
AND
"But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.
Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal."\
AND
"Richard Sackler worked tirelessly to make OxyContin a blockbuster, telling colleagues how devoted he was to the drug’s success. The F.D.A. approved OxyContin in 1995, for use in treating moderate to severe pain. Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. But the F.D.A., in an unusual step, approved a package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism “is believed to reduce the abuse liability.” David Kessler, who ran the F.D.A. at the time, told me that he was “not involved in the approval.” The F.D.A. examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterward. Within two years, he had taken a job at Purdue."
This really reads to me rather badly. Twice as powerful isn't necessarily bad. Rather, if it was less abusable (as they claim) and equally addictive, that would represent and improvement over morphine. The issue might then lie in overzealous prescription/usage.
------
ncbi.nlm.nih.gov/pmc/articles/PMC3550270/
> Oxycodone demonstrated high abuse liability on the basis of its high likability scores and a relative lack of negative subjective effects.
I found this conclusion pretty interesting, though I just skimmed this article.
Original formula oxycontin pills were insanely abusable. crushed up into ultra-fine powder very easily - like one of those sugar necklace candies. snortable and shootable. way easier to abuse than morphine which isn't super available in the US as a take home script.
also to the 'powerful,' the doses prescribed were insane compared to the baseline of what was regularly prescribed before Purdue's marketing. E.g. 5mg oxycodone + acetaminophen compared to Oxy's going commonly up to 80MG in a single pill (30's were pretty standard on the street). I think they even have a 160mg but I have never actually seen in real life. That's INSANE like 240 morphine equivalent or something and likely taken at least 2x a day.
This insane strength goes hand in hand with overzealous script writing.
All of this was caused by Purdue's tactics.
The 'OC' s (they are stamped this way) were on the market for a LONG time after Purdue was very aware of the criminal damage they were doing and the DEA and others were pushing for pill reformulation. They took forever to change to 'OP' which were less abusable at least not easily crushed and they gel up if trying to shoot (addicts will always find a way). Knowing how evil this company and family are I wouldn't be surprised if they waited a while to launch the new pill format for patent reasons but I don't know this
The cycle of 'less abusive' opiate marketing has been going on for a hundred years. They are all abusable and addictive. Even maintenance opiates like buprenorphine you would be dependent on and users will still combine for instance methadone and other pills to get high.
If you want to criticize something, do it, but don't exact semantic correctness or else no debate will ever more forward.
https://news.ycombinator.com/newsguidelines.html
Then by all means, let the sweeping political change commence, deconsolidation of the economy occur, unwind a few decades of M&A's, and let's get to fixing the social problems.
Throwing drugs at the issue won't make it go away, I'm stuck on one. I know where that road leads if you don't take due care in management and listening to the impact of your behavior on those around you. The fact is, these drugs may be good for some people, and I welcome them to use them, but due care needs to be exercised in not using them unwisely.
The left tends to ignore these and focus solely on the material aspects.
https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
Here are some alternative facts not often discussed:
on the second, some studies put the rate of addiction from a prescription at 8-12%, a full 4-6% transition to heroin [1]
Sure 50% of everyone who gets an opiate script doesn't end up sooting heroin. but it's a damn high scary number.
And the main point is Purdue directly lied in their marketing about the abuse and dependence %.
[1] https://www.drugabuse.gov/drug-topics/opioids/opioid-overdos...
Also, mind that there is the inverse problem in some countries. Doctors are afraid to prescribe opiates and pharmacies to distribute because of the risks of prosecution. Russia is a notorious example that lets cancer patients die without access to opiates.