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There is a difference between marketing and actual use. Its a synthetic opioid, which means it has all the variability of opioids. Any decent doctor should know

There is a difference between marketing and actual use. Its a synthetic opioid, which means it has all the variability of opioids. Any decent doctor should know this, and the guides, if they were any good will indicate it. For example codamol is now not prescribed in a hospital setting for under 5s, after one child died because they had large amounts of the enzyme required to processes it all at once. This caused respiratory arrest. the BNF has prices: https://www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/47-analgesics/472-opioid-analgesics/oxycodone-hydrochloride/modified-release/oxycontin https://www.evidence.nhs.uk/formulary/bnf/current/4-central-... and some basic advice: https://www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/47-analgesics/472-opioid-analgesics/oxycodone-hydrochloride https://www.evidence.nhs.uk/formulary/bnf/current/4-central-... also a big fat warning saying its a fucking opiate. If a doctor is surprised that a synthetic slow release diamorphene derivative has variable outcomes, is deeply upsetting. Its their fucking job to monitor the outcome of drugs. Its pretty much half of being a doctor. One of the many advantages of the NHS is the chances of getting hooked on painkillers if miniscule, mainly because drugs are prescribed for the purpose of helping you, not because you've seen an advert, or you want to make a bit more money.

ludamad 11y ago
What about their push for higher, instead of more frequent, doses?
- KaiserPro 11y ago
  But that's standard opiate management. Long term usage leads to resistance which must be managed. Its a well understood pathway.
- deleted 11y ago
  [deleted]
deleted 11y ago
[deleted]
OliverJones 11y ago
Sure, it's an opioid. That's not the point. The point is that it's made from an inexpensive generic opioid feedstock: oxycodone. The supposed value-add isn't the painkiller, it's the timed-release agent. Unless these reporters are simply lying, there's evidence of great variability in the effectiveness of that timed-release agent. But the company's market position depends on the 12-hour dose. If the drug's needed every six hours, the only difference between it and the cheap stuff is price. In that case, most doctors won't prescribe and most payers won't reimburse the expensive stuff. So, a doctor can ask a patient, "are you willing to take a pill every six hours?" If the patient agrees, the prescription can be very inexpensive and effective. And, wide swings in blood concentration are controllable, which helps avoid both grogginess and withdrawal struggles. A friend who develops instruments for anesthesiologists has told me that a well-controlled minimal effective dose of pain med works, and manages risk very well. Peoples' rates of clearing these compounds vary a lot, and the timed-release compound doesn't appear to reduce that variability, contrary to the what the marketer is implicitly claiming. If the treatment is for acute short-term pain (post-op, etc) a six-hour regime isn't a big burden, and the reduced risk of addiction justifies some inconvenience. If the treatment is for chronic pain, a wise patient and doctor might start by trying the more frequent doses, and move to "time-release" doses if the first treatment doesn't work. Patients and doctors tune their meds all the time. Why not start trying for minimal effective dose, and move to a more addiction-prone regime if the first one desn't work? But that would foul up the business of Oxycontin's marketer. A weekly Narcotics Anonymous meeting just moved out of the hall of a church I serve to a bigger hall, because they're gaining members fast. That's not good.
- MichaelGG 11y ago
  Isn't NA mandated by courts? Even for pot sometimes? A growing group could easily just mean a change in law enforcement or sentencing.
  - themartorana 11y ago
    Which is a terrible intrusion upon people voluntarily there for actual support and help.
dlitz 11y ago
> Any decent doctor should know this It sounds like they did, at first, and the manufacturer (ostensibly the experts on this particular drug) pushed back hard.
- rdancer 11y ago
  More like "nagged" than "pushed". The responsibilities of a salesman vs. doctor are clearly delineated. The salesman sells. The doctor must not outsource his decision making to the salesman. What people underappreciate is that salespeople provide a vital role. Their job is to aid buyers in choosing what to do with their money. If doctors were susceptible to fraud of other underhanded sales tactics, that'd be alarming — they're the smart ones, are they not? But it's not that. They're not being duped. They succumb to corruption, or actively seek it.
blazespin 11y ago
This last bit is very true. Same thing in canada. Doctor shopping is very hard because there is no benefit to the Doctor, only risk.
- deleted 11y ago
  [deleted]
ars 11y ago
> One of the many advantages of the NHS is the chances of getting hooked on painkillers if miniscule You have got to be kidding. The UK might be behind the US, but the trendlines are pointing up, not down. The UK working hard to close the gap. "Miniscule" please.
- KaiserPro 11y ago
  You'll need data to back that up. So long as opiates are used for acute pain, not long term chronic pain, the chances of addiction are pretty low. It does happen, with about 30K people addicted in the UK total. The reason why its much harder is that unless you have lots of money you'll have to persuade your GP that there is a medical reason for continuing. This is much harder in the UK where patients are patients, not customers that must be pleased.

ludamad 11y ago

What about their push for higher, instead of more frequent, doses?

KaiserPro 11y ago
But that's standard opiate management. Long term usage leads to resistance which must be managed. Its a well understood pathway.
deleted 11y ago
[deleted]

deleted 11y ago

[deleted]

OliverJones 11y ago

Sure, it's an opioid. That's not the point. The point is that it's made from an inexpensive generic opioid feedstock: oxycodone. The supposed value-add isn't the painkiller, it's the timed-release agent. Unless these reporters are simply lying, there's evidence of great variability in the effectiveness of that timed-release agent. But the company's market position depends on the 12-hour dose. If the drug's needed every six hours, the only difference between it and the cheap stuff is price. In that case, most doctors won't prescribe and most payers won't reimburse the expensive stuff. So, a doctor can ask a patient, "are you willing to take a pill every six hours?" If the patient agrees, the prescription can be very inexpensive and effective. And, wide swings in blood concentration are controllable, which helps avoid both grogginess and withdrawal struggles. A friend who develops instruments for anesthesiologists has told me that a well-controlled minimal effective dose of pain med works, and manages risk very well. Peoples' rates of clearing these compounds vary a lot, and the timed-release compound doesn't appear to reduce that variability, contrary to the what the marketer is implicitly claiming. If the treatment is for acute short-term pain (post-op, etc) a six-hour regime isn't a big burden, and the reduced risk of addiction justifies some inconvenience. If the treatment is for chronic pain, a wise patient and doctor might start by trying the more frequent doses, and move to "time-release" doses if the first treatment doesn't work. Patients and doctors tune their meds all the time. Why not start trying for minimal effective dose, and move to a more addiction-prone regime if the first one desn't work? But that would foul up the business of Oxycontin's marketer. A weekly Narcotics Anonymous meeting just moved out of the hall of a church I serve to a bigger hall, because they're gaining members fast. That's not good.

MichaelGG 11y ago
Isn't NA mandated by courts? Even for pot sometimes? A growing group could easily just mean a change in law enforcement or sentencing.
- themartorana 11y ago
  Which is a terrible intrusion upon people voluntarily there for actual support and help.

dlitz 11y ago

> Any decent doctor should know this It sounds like they did, at first, and the manufacturer (ostensibly the experts on this particular drug) pushed back hard.

rdancer 11y ago
More like "nagged" than "pushed". The responsibilities of a salesman vs. doctor are clearly delineated. The salesman sells. The doctor must not outsource his decision making to the salesman. What people underappreciate is that salespeople provide a vital role. Their job is to aid buyers in choosing what to do with their money. If doctors were susceptible to fraud of other underhanded sales tactics, that'd be alarming — they're the smart ones, are they not? But it's not that. They're not being duped. They succumb to corruption, or actively seek it.

blazespin 11y ago

This last bit is very true. Same thing in canada. Doctor shopping is very hard because there is no benefit to the Doctor, only risk.

deleted 11y ago
[deleted]

ars 11y ago

> One of the many advantages of the NHS is the chances of getting hooked on painkillers if miniscule You have got to be kidding. The UK might be behind the US, but the trendlines are pointing up, not down. The UK working hard to close the gap. "Miniscule" please.

KaiserPro 11y ago
You'll need data to back that up. So long as opiates are used for acute pain, not long term chronic pain, the chances of addiction are pretty low. It does happen, with about 30K people addicted in the UK total. The reason why its much harder is that unless you have lots of money you'll have to persuade your GP that there is a medical reason for continuing. This is much harder in the UK where patients are patients, not customers that must be pleased.