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Inside an L.A. OxyContin ring that pushed more than 1M pills
- revelation 10y agoSo you can't buy effective decongestant or other medicine that isn't spiked with caffeine or painkillers because you might try and turn it into a meager amount of a controlled substance, or more likely burn yourself in the process. But nobody is monitoring when a doctor prescribes tons of opioids. Prescribing something seems like a privilege granted by the state, so clearly it should be the DEA monitoring this, but apparently this article is more keen to blame the salespeople at the manufacturer?!
- gkop 10y agoThe newspaper has other evidence the manufacturer is sketchy as hell: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
- refurb 10y agoI find the 12-hour vs. 8-hour argument to be very weak. Of course the manufacturer was pushing for 12-hour. You will be fined by the FDA for pushing any use of your drug that is not approved by the FDA. You can get approval for 12-hour dosing, then just start saying "nahh... let's change it to 8 hour". That article found some data and twisted it into a conspiracy.
- nxzero 10y agoPer the FDA, at least in 1995, you're correct, OxyContin was only allowed to be prescribed in 12 hours doses, not 4-6, per the FDA. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm338566.htm http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/u...
- deleted 10y ago[deleted]
- DanBC 10y agoYes, the manufacturer was sketchy as hell. The prescribing doctor and clinic were quickly identified, by worried pharmacists and by the sketchy manufacturers. This was during the time the "war on drugs" was pretty full on, and the risks of opiate prescribing were well known. How did the various systems fail? We see this across a range of different industries. People sort of report some concerns, but they often don't do it properly. Sometimes that means mildly defective product is shipped. Other times it means many people are harmed. There was a submission several years ago about an accountant who somehow got wrapped up in massive amounts of fraud. He said that many people along the way could have stopped him, and he didn't make much effort to perpetuate the fraud. He would just ask people to fill out that bit of paper, or to wait a few days before sending some other bit of paper, and they all just thought "he's okay, I'll do him this favour". Individually they were little favours. Collectively, it was pretty big. (I'm trying to fidn the link now)
- 55555 10y agoI'm pretty interested in that accounting link. Please update if you find it.
- stordoff 10y agoDoes anyone know why the manufacturer was pushing q12h dosing so strongly? As an opiate user, I don't want large, infrequent doses - I want small, but frequent, doses to maintain a consistent level of pain relief without side-effects (e.g. euphoria, nausea) Fortunately my current codeine prescription ("take 15-30mg as directed as required") gives me a fairly wide latitude - most days I don't need it at all, but on a bad day can take 15mg every three hours or so.
- xkcd-sucks 10y agoA less frequent dosing schedule is an 'improvement' over formulations which are available as generics. This justifies the patent/ increased cost of using the oxycontin or whatever's replaced it
- khuey 10y agoThe big selling point of 12 hour dosing is you don't wake up in the middle of the night in pain.
- stordoff 10y agoFair point. I use tamazepam for my sleep issues (generally they are for reasons other than pain) so hadn't really thought about that.
- jonknee 10y agoWell the big selling point for the manufacturer is that it's patented and has no generic equivalent. It's no matter if the new feature doesn't really work.
- sukilot 10y agoThe claim is that the large does are time-release. But your point re variable need is still relevant.
- ars 10y agoThe q12h dosing is patented. The regular dosing is generic. That's all. OxyContin would not exist if not for q12h dosing.
- knowaveragejoe 10y ago> But nobody is monitoring when a doctor prescribes tons of opioids. Prescribing something seems like a privilege granted by the state, so clearly it should be the DEA monitoring this, but apparently this article is more keen to blame the salespeople at the manufacturer?! That's exactly what the article describes, though. I feel like you didn't read it. They detail, at length, a system for keeping track of doctors and pharmacies who over-prescribe and over-order Oxycontin.
- Girlang 10y agoOf course he didn't read it! This is YCombinator News after all. Just echo the "right opinion" and collect the delicious karma points.
- FireBeyond 10y agoAnd then proceed to do nearly nothing with that information other than in one or two of the most egregious instances "reducing supply" and "instructing sales people that they shouldn't promote Oxy". It's almost like they did the bare minimum, enough to have some plausible deniability, but not enough to actually be responsible. Oh, and then only after they knew the doctors were out of business (read "already arrested, charged, sent to trial") did they belatedly say "oh hey, you might want to look at them". When it would do nothing to harm profit, but so no-one could say "you did nothing".
- knowaveragejoe 10y agoOh, I totally agree. That's the real shocker in the article, that they had the information necessary to stop a lot of this years ago. I was just pointing out that the above's comment seems to have missed the point.
- nojvek 10y agoThey were making billions. Why make so much noise when the machine is shittin money. Let the DEA handle that. Probably the same when Morgan Stanley and the big banks were financing the wars. Let the money flow, make no noise.
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- code_duck 10y agoPseudoephedrine being made into homemade amphetamines is a different channel than opiates obtained via doctor and pharmacy. You can also get amphetamines that way, as Adderall or Vyvanse. Like opiates, amphetamines net over $10 billion a year and a significant portion are diverted for non-medical use.
- brbsix 10y agoPeople are absolutely monitoring when a doctor prescribes tons of opiods. The State of California runs a PDMP (prescription drug monitoring program) known as CURES (Controlled Substance Utilization Review and Evaluation System) [0]. It's a database that records detailed information on all Schedule II, III, and IV prescriptions dispensed in California. Though they don't always check, it's accessible to all doctors and pharmacists. Patients can and do get flags on their accounts, (though as I mentioned, doctors and pharmacists will sometimes ignore them). The DEA is very much in the loop. Anecdotally, they seem to be more concerned with doctors (visiting offices to review records) than individual patients. [0]: https://oag.ca.gov/cures/faqs https://oag.ca.gov/cures/faqs
- mv 10y agoCURES works but at the cost of completely negating any type of privacy protection on medical records. Pretty much anyone (prescriber, dispenser, law enforcement) can pull up CURES reports knowing a persons last name and birthdate. What is the point of HIPAA and medical privacy if anyone can log in and see what scheduled drugs you're taking? From the drugs you take I can pretty much derive your medical history. I consider this a much larger problem than the 'war on drugs'.
- brbsix 10y agoAbsolutely, though I'd argue that this is simply one consequence of the war on drugs rather than separate larger issue. The war on drugs is a masterful play. It's a free pass for law enforcement to circumvent your rights, to search your vehicle (via warrant dog), to enter your home (via anonymous tip), to review your doctor's records, to surveil your activities, to seize your cars, cash or real estate without due process. It's the master key for an authoritatian police state and the selective targeting of undesirables.
- peteretep 10y ago> you can't buy effective > decongestant Science has a solution: http://blogs.scientificamerican.com/observations/better-living-through-chemistry-making-sudafed-from-meth/ http://blogs.scientificamerican.com/observations/better-livi...
- tptacek 10y agoMaybe your decongestant needs are abnormal, but you certainly can buy effective decongestants. Pseudoephedrine isn't outlawed; its purchase is simply rate limited. If you weren't already aware: you can simply walk up to the pharmacy counter and ask for it.
- PhasmaFelis 10y agoIt's also not terribly difficult to get a legitimate prescription for it, if you have chronic needs.
- marcoperaza 10y agoThis is pretty disgusting. The lack of accountability is especially troubling. For a long time, I believed that we're better off legalizing all drugs and making them available to anyone who wants to buy them. But I've had a change of heart recently. People simply aren't in control of themselves when they're addicted to these substances. The crooked doctors, the pain clinics, and all the complicit organizations in the supply chain profit, while millions of people lose their human agency to a chemical that alters their mind and transforms them into irrational drug addicts. It is very difficult for them to recover, and very easy to relapse. It is a human tragedy of enormous proportions. It tears apart families, ruins childhoods, and creates poverty. And at its worst, it takes lives. We have to take care of our people.
- lostgame 10y agoOh ok so the real thing to do is shove them in jail - that helps them recover and totally helps their families and stuff. :/
- marcoperaza 10y agoPutting addicts in jail is certainly not the answer. Harsh enforcement against drug users is one of the biggest failings of the War on Drugs. So is the ban on "soft" drugs like weed and hallucinogens, which don't have the same abuse potential. But the majority of people serving sentences for drug crimes are there for selling drugs. http://www.rollingstone.com/culture/lists/top-10-marijuana-myths-and-facts-20120822/myth-prisons-are-full-of-people-in-for-marijuana-possession-19691231 http://www.rollingstone.com/culture/lists/top-10-marijuana-m... "About 40,000 inmates of state and federal prison have a current conviction involving marijuana, and about half of them are in for marijuana offenses alone; most of these were involved in distribution. Less than one percent are in for possession alone." Remember that distribution of weed, while it sounds relatively harmless, is very often controlled by violent gangs. It's like getting Al Capone for evading taxes. The best solution is to legalize weed and put it in the hands of legal businesses. Also: http://fivethirtyeight.com/datalab/releasing-drug-offenders-wont-end-mass-incarceration/ http://fivethirtyeight.com/datalab/releasing-drug-offenders-... There he shows that releasing all prisoners who are in jail with drug offenses as the most serious charge would only reduce the prison population by about 14%. This is counting both distribution AND simple possession. Not insignificant, but not the headline figure of 50% that you often hear.
- discardorama 10y agoFTA: > More than 194,000 people have died since 1999 from overdoses involving opioid painkillers, including OxyContin. Wow, that's about 12,000 per year. :(
- twilightfog 10y agoStatements like that immediately make me suspect the integrity of the article. Instead of reporting the actual figures of Oxycontin related overdoses, they bundle it with ALL overdoses over a year (which obviously would be a large enough number). Why didn't they mention the % of overdoses directly related to Oxy ? My assumption is that it would be significantly smaller number which didn't serve the article's purpose. Personally, I don't think its the Pharma's job to track if the pills are illegally prescribed. Just like its not an ISP's job to track if the internet is getting used for illegal downloads. They are absolutely right to assert that they "at all times complied with the law." and any conduct "did not interfere with legitimate patients getting medication". Moral arguments apart, they are simply not in the business of reporting their patients to law enforcement, nor they ever should.
- grkvlt 10y agoYes, I'd be willing to bet that the vast majority of that headline OD number are heroin plus alcohol or benzos deaths. It's actually pretty hard to overdose on just Oxy pills...
- grkvlt 10y agoAfter the downvotes, I decided to check out the numbers, and looks like I'd lose the bet. According to the CDC [0] the ratio is almost 2:1 for Opioid analgesics versus Heroin. What's interesting is that this is very different to the statistics for the UK [1] and Europe. [0] http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoni... [1] http://webarchive.nationalarchives.gov.uk/20160105160709/http://www.ons.gov.uk/ons/dcp171778_414574.pdf http://webarchive.nationalarchives.gov.uk/20160105160709/htt...
- prklmn 10y agoThis is peanuts compared what was going on in Florida several years ago http://www.bloomberg.com/news/articles/2012-06-06/american-pain-the-largest-u-dot-s-dot-pill-mills-rise-and-fall http://www.bloomberg.com/news/articles/2012-06-06/american-p... > Over 20M pills prescribed, wreaking havoc far beyond just Florida. Many of the people that were taking these pills have resorted to heroine now that Florida has enacted better oversight
- oxide 10y agoThat's because once you've gotten deep enough into the hole of opiate dependence, your perspective on heroin shifts drastically. Suddenly that little green pill that barely gets you off anymore looks a lot less appealing for $1/mg. Especially once you discover how cheap and widely available heroin truly is. A $10 purchase of heroin gets you exponentially more bang for your buck. It's not a long journey, especially once you've walked half way. You can't regulate or price someone out of an addiction.
- MichaelGG 10y agoThese people should be seen as heroes. They are fighting a corrupt, anti-liberty system. Laws that require official permission (papers please!) to buy and use medication. You can get anything you want, from meth to morphine, if you can afford enough medical consultants, or are deemed worthy. If not, or if some medical-related person deems you an addict, enjoy your pain. Run PSAs, perhaps require a waiver before sale. But people are in pain (both mentally and physically) and opiates are by far the most effective treatment. (Sure, they don't work for everyone, etc. etc.) This abstinence mindset is as harmful as it is in sex education.
- panic 10y agoWhy do we allow people to make a profit selling habit-forming drugs? The system that protects Purdue's profits also creates this horrible incentive.
- _acme 10y agoDo you have a way of treating severe pain (such as cancer pain or post-surgical pain) that is not habit-forming?
- panic 10y agoMaybe my comment wasn't clear; I think these drugs are fine, and I think drug-related patents are at least somewhat defensible as a way to fund R&D, but in this case they're really not working very well. There shouldn't be such a huge profit incentive to ruin people's lives like this.
- seibelj 10y agoI have yet to meet one single person who can logically explain to me why drugs should be 100% illegal. I've heard, "Would you want cocaine available at 7/11?" No, I don't want cocaine available at 7/11. But if you can already buy any drug on the street, a doctor should be able to prescribe medicinal heroin to an addict and get them into the system to monitor them for treatment, with the end goal of getting them off of drugs. Putting unknown chemicals of varying strength and quality into their vein is what kills addicts. They do not typically OD because they are suicidal, it's because they unknowingly bought an extra strong stamp and then die. I grew up in Massachusetts, and had a high school graduating class of around 300 people, and 6 people have died of overdoses in the last 10 years. One of the most popular girls in my class died a few months ago. I firmly believe that allowing her (and everyone else) to get her opioids prescribed would at the minimum keep her from overdosing, and let people who care know she has a problem. Dying on a toilet with a needle still in your arm is a terrible, useless way to die.
- deleted 10y ago[deleted]
- brady8 10y agoI'm a physician. Unfortunately, most of our overdoses in North America are from prescribed opiates. They are very addictive, and despite best efforts to control and monitor dosing and schedules, these opiates are often either purposefully overdosed (suicide attempts), diverted, or accidentally ingested. My worst memory in pediatrics was a 7 year old who was brain-dead after ingesting only one (!!!) tablet of her grandfather's high-strength Oxy prescription that she thought was Tylenol. Opiates are bad news, and physicians unfortunately were duped into prescribing way too much for the last ~15 years.
- seibelj 10y agoI don't follow your logic. A 7 year old swallows drain cleaner, so we should ban drain cleaner? A shame that happened, but irrelevant to the discussion. You think that by banning opiates no one will get opiates? The methadone clinic two blocks from my apartment, and the people who panhandle around it and the subway station, and the needles I walk past when I cut through the tennis court, do not show the government's laws are solving the problem. As a physician you may see the emotional side, but logically I would love to hear your solutions to the problem.
- feklar 10y agoThere's a heroin shooting gallery here staffed by nurses and it proves keeping narcotics illegal is a complete farce. Out front at any given time of the day is a row of dealers openly selling junk to the junkies. Once in a while a new group of dealers will try to violently jack this lucrative business by causing a massive street gang war where countless people end up shot in the crossfire. Should just sell and distribute the drugs legally.
- pacala 10y agoI hear this argument a lot in young liberal circles, can't wrap my head around it. In particular given how much well deserved flak the tobacco industry has gotten, industry also driven by addiction. Drugs are addictive, messing up people's rewards path and inducing self-destructive and asocial behavior. Priorities are: 1. Keep as many innocent people as possible away from drugs. 2. Help as many junkies recover as possible. 3. Fuck the dealers. Legalizing drugs seems to reduce the risk for dealers, now having their posh addiction-driven business at the mall, while increasing the availability of drugs for the untainted population and for the junkies. Are we really that concerned by dealer's quality of life that we willing to tradeoff the lives of our neighbors, friends or even family?
- aianus 10y ago> Legalizing drugs seems to reduce the risk for dealers, now having their posh addiction-driven business at the mall The margins on legal good are a whole lot less than illegal ones. You'd be putting most dealers out of business overnight by legalizing.
- titanomachy 10y agoI've heard this argument, and it makes sense -- medical morphine costs basically nothing compared to street heroin or oxycontin, so it seems like switching to legal supply of drugs could basically delete the profitability of the trade. Instead of a criminal gang making ~$75 from the sale of an oxy pill, some pharmacy makes $1-2 and society makes some taxes we can use to fund rehabilitation programs. Question, though -- why does legal pot cost the same as illegal pot used to in places like WA? It seems there is still a large amount of profit to be made from growing and selling pot, although I guess (pretty much by definition) that money is no longer going towards criminal enterprise. Is it just high taxes?