11 ms·

Well, let's take Oxy. That drug, at recommended doses, was supposed to provide 24 hours of pain relief but frequently did not do so in practice. This lead peop

Well, let's take Oxy. That drug, at recommended doses, was supposed to provide 24 hours of pain relief but frequently did not do so in practice. This lead people to increase doses, and down that road lies addiction. Purdue knew this and lied to the medical community. Unless doctors ran their own studies they couldn't know that Purdue's dosage recommendations were pure garbage.

aianus 9y ago
You'd think their patients would tell them that it wasn't lasting 24h, no?
- makomk 9y ago
  Their patients did tell them that it wasn't lasting long enough, and then Purdue leaned heavily on doctors to just increase the size of the doses rather than decrease the interval between then.
- hwillis 9y ago
  They did, Purdue instructed the doctors do prescribe higher doses if it wore off too soon. They actively discouraged prescribing more than one dose a day. This dramatically increases the addiction potential. I have to say, the doctors have some plausible deniability. When the drug company tells you how to prescribe, there are good reasons to listen. Pharmokinetics is heinously complex and unpredictable. Unfortunately in this case the drug manufacturer outright lied.
  - aanm1988 9y ago
    The problem I have with this is that Opiates have been known to be highly addictive for how long? I do feel like doctors should have questioned the notion that these drugs were completely safe.
    - penagwin 9y ago
      (This reply only concerns the US AFAIK). But who else do we trust? These drugs have the government's approval (FDA) as being safe, and a very large cooperation who makes the drug says it's safe. Did I mention the FDA approved it? What's the alternative here? I know my family doctor can't just run his own studies with drugs, he'd never have the resources for that.
      - lr4444lr 9y ago
        He doesn't have to run his own studies. When patient after patient starts suffering from withdrawal symptoms, and he reads common journals and talks to his peer doctors and other medical professionals about it (let alone the mainstream media reporting), given his training and intelligence, he'd have to be a fool, lazy, or outright unethical not to question the prescribing practices recommended by the manufacturer. There's an ethical responsibility here.
        penagwin 9y ago
        I'm wondering how often people who become addicted - after prescribed use - tell their doctor (Serious question, I don't have any clue as to what the answer is). Mine specifically seems to be smart enough to avoid opiates if possible, however when I had my wisdom teeth removed (few months ago) they prescribed a bottle of Norco - enough for maybe two weeks or more. I only took them for less then 3 days - even that was longer then needed (not that I knew this, you don't know how painful the results of the surgery are until you stop the painkiller, which could cause incredible pain you are in pain (physically). Let's say the doctor doesn't have many client complaints, reads journals and memos that promote opiates (this is called advertising, something J&J spent 3x more money on then research), it seems like there should be an independent organization that researches, tests (or validates studies), and validates the results and usage instructions. Oh wait that's the FDA job. I want to emphasize my criticism of the FDA's current performance of what I believe their job is: to make sure that the drugs sold do what they say they do, don't cause serious side effects unless they are clearly listed, have dosages that do as they are supposed to (without purposely causing addiction).
    - 9y ago
learc83 9y ago
Doctors initially started recommending patients take it more frequently, but the drug maker new it's only real benefit was the 12 hour pain relief. So they mounted a campaign to convince doctors to increase dosages instead. This was apparently the more harmful of the 2 options. Here's an article on the subject: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
- zzalpha 9y ago
  Ah, right, I'd forgotten that little nugget (and I read that article... Stupid long term memory).
wand3r 9y ago
Anecdotally Oxy has been in short supply for nearly a decade. Purdue was sued in 2006 iirc and OCs were scarce within a couple years of that. If we accept your point; which I do; why the fuck didnt the doctors catch on for 10 years w/ similar generics.
patrickg_zill 9y ago
Purdue made at least $5 Billion USD in profit from OxyContin, as an aside.
IAmGraydon 9y ago
With all due respect, dosing schedule and biological half life have little to do with the addictive potential of oxycodone. Put simply, it lights up the brain's reward center like a Christmas tree. If you dig, you can find studies that show that oxycodone causes a far greater dopamine release in the nucleus accumbens than even IV heroin. This has been known for a long time. The people who developed oxycodone knew what they were doing - engineering the most addictive opiate on the market. Purdue really needs to be held accountable for what they've done and the lives they've ruined and/or ended. The blame for the opioid epidemic falls squarely on them, in my opinion.
- SmellTheGlove 9y ago
  It's scary good. I've had it prescribed to me twice - once when I had my wisdom teeth out (a fairly significant surgery, they were bony impacted) and again when I had a hernia repaired. Both were 5mg, 30 pills. I took 'em all. This was years ago, but I still remember to this day _exactly_ how good they made me feel. Scary stuff, I'll never fill a prescription for these again, I don't give a shit what I have going on.
  - msmm 9y ago
    When I had my wisdom tooth out I was told to take paracetamol. I didn't need to because pain was bearable and was gone next day.
refurb 9y ago
You know why Purdue "lied" to the medical community? Because they aren't allowed to say anything that isn't in their drug label. That's called "off label promotion".
- zzalpha 9y ago
  BS. Purdue actively lobbied doctors to not alter their dosage schedules when prescribing the drug to their patients. That has nothing to do with labelling or regulations.
  - refurb 9y ago
    I suggest you go and read FDA regulations about what drug companies can and can't say about their products.
    - zzalpha 9y ago
      I suggest you go do a little research about what Purdue did before commenting further. Other commenters have already provided links to the LA Times investigation. Read it. Purdue knew full well that 24 hour effectiveness was the factor that distinguished Oxy from other drugs on the market, despite the fact that their own studies showed the drug did not offer 24 hours of relief in many cases. Upon hearing that doctors were shortening the dosage schedules, they could have left well enough alone. Doctors prescribe off label all the time. There was no need for Purdue to step in. But that's exactly what they did. Purdue actively fought the doctors and lobbied to convince them to stick to the marketed dosage schedules because otherwise Oxy would have no perceived benefit in the marketplace over other opiods. There is documented evidence as reported by the LA Times that supports this. This has absolutely zero to do with regulation. The only way you could convince yourself of that is if you've already got a conclusion ("big government regulations bad!") and are you simply trying to find an explanation that fits it.
      - refurb 9y ago
        I've read the LA Times article. It's full of misleading information and sensationalism. I'm not saying Purdue acted like an angel, but their actions are twisted into a sinister plot. If Oxycontin didn't work with a 12 hour interval, why did the FDA approve it for that? Why is it in the label if it couldn't be supported by clinical trial data? Was the FDA asleep at this switch? “There is no Q8 dosing with OxyContin,” one sales manager told her reps, according to a memo cited in an FDA filing. She added that 8-hour dosing “needs to be nipped in the bud. NOW!!” Is a great example of creating the narrative the LA Times wants to spin. Take a look at the documents that are in the article. The reason for the Q12h dosing is: 1) insurance companies won't pay for it [since it's not in the label], 2) some pharmacies won't fill a script for anything but Q12h dosing [because it's not in the label], 3) FDA/DEA oversight [because it's not in the label], 4) minimize diversion and abuse. Those seem like real good reason to me!
kem 9y ago
Not to absolve Purdue's responsibility in this, but I do think this exposes the fraud that is the US healthcare system. First and foremost, it illustrates that drug regulation is basically a failure, and that the FDA and physicians cannot be trusted as sole authorities on drug safety. There needs to be more diversity of authority. You say "unless doctors ran their own studies" as if it is not the responsibility of physicians to be thinking critically about scientific information about drugs, in terms of who is providing the information and how to respond as scientists. Your statement basically assumes that doctors are not competent to evaluate and conduct scientific research. Why shouldn't doctors run their own studies? Maybe not each physician, by why don't they as a group? Why doesn't a large hospital run a trial? A conglomerate? It's not that difficult given the magnitude of the consequences involved and the frequency of prescription. It is the job of the medical community to be proactive participants in scientific process, especially when clinical consequences are on the line. That we've reached a point where we lay the responsibility of critical evaluation at the lap of the corporation says as much about the fault of the physicians and FDA as it does about the corporations. It's kind of like saying that an individual who knows a child is being abused but goes out of their way to transport the kid day after day to the abuser without reporting it bears no responsibility because they weren't abusing the child themselves. Anyone involved in the healthcare system knew that oxy was an addictive substance and there were rampant problems. The idea that someone with an MD shouldn't have a clue that increasing the dose would lead to greater problems is absurd--it's like claiming that a chemical engineer shouldn't understand that adding jet fuel to a fire wouldn't increase the blaze. Acting like physicians were innocent victims is a joke. The corporations and physicians were both complicit. Either that, or they were incompetent. It can't be neither. The FDA and physician groups need to be dethroned from their perches.

aianus 9y ago

You'd think their patients would tell them that it wasn't lasting 24h, no?

makomk 9y ago
Their patients did tell them that it wasn't lasting long enough, and then Purdue leaned heavily on doctors to just increase the size of the doses rather than decrease the interval between then.
hwillis 9y ago
They did, Purdue instructed the doctors do prescribe higher doses if it wore off too soon. They actively discouraged prescribing more than one dose a day. This dramatically increases the addiction potential. I have to say, the doctors have some plausible deniability. When the drug company tells you how to prescribe, there are good reasons to listen. Pharmokinetics is heinously complex and unpredictable. Unfortunately in this case the drug manufacturer outright lied.
- aanm1988 9y ago
  The problem I have with this is that Opiates have been known to be highly addictive for how long? I do feel like doctors should have questioned the notion that these drugs were completely safe.
  - penagwin 9y ago
    (This reply only concerns the US AFAIK). But who else do we trust? These drugs have the government's approval (FDA) as being safe, and a very large cooperation who makes the drug says it's safe. Did I mention the FDA approved it? What's the alternative here? I know my family doctor can't just run his own studies with drugs, he'd never have the resources for that.
    - lr4444lr 9y ago
      He doesn't have to run his own studies. When patient after patient starts suffering from withdrawal symptoms, and he reads common journals and talks to his peer doctors and other medical professionals about it (let alone the mainstream media reporting), given his training and intelligence, he'd have to be a fool, lazy, or outright unethical not to question the prescribing practices recommended by the manufacturer. There's an ethical responsibility here.
      - penagwin 9y ago
        I'm wondering how often people who become addicted - after prescribed use - tell their doctor (Serious question, I don't have any clue as to what the answer is). Mine specifically seems to be smart enough to avoid opiates if possible, however when I had my wisdom teeth removed (few months ago) they prescribed a bottle of Norco - enough for maybe two weeks or more. I only took them for less then 3 days - even that was longer then needed (not that I knew this, you don't know how painful the results of the surgery are until you stop the painkiller, which could cause incredible pain you are in pain (physically). Let's say the doctor doesn't have many client complaints, reads journals and memos that promote opiates (this is called advertising, something J&J spent 3x more money on then research), it seems like there should be an independent organization that researches, tests (or validates studies), and validates the results and usage instructions. Oh wait that's the FDA job. I want to emphasize my criticism of the FDA's current performance of what I believe their job is: to make sure that the drugs sold do what they say they do, don't cause serious side effects unless they are clearly listed, have dosages that do as they are supposed to (without purposely causing addiction).
  - 9y ago

learc83 9y ago

Doctors initially started recommending patients take it more frequently, but the drug maker new it's only real benefit was the 12 hour pain relief. So they mounted a campaign to convince doctors to increase dosages instead. This was apparently the more harmful of the 2 options. Here's an article on the subject: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/

zzalpha 9y ago
Ah, right, I'd forgotten that little nugget (and I read that article... Stupid long term memory).

wand3r 9y ago

Anecdotally Oxy has been in short supply for nearly a decade. Purdue was sued in 2006 iirc and OCs were scarce within a couple years of that. If we accept your point; which I do; why the fuck didnt the doctors catch on for 10 years w/ similar generics.

patrickg_zill 9y ago

Purdue made at least $5 Billion USD in profit from OxyContin, as an aside.

IAmGraydon 9y ago

With all due respect, dosing schedule and biological half life have little to do with the addictive potential of oxycodone. Put simply, it lights up the brain's reward center like a Christmas tree. If you dig, you can find studies that show that oxycodone causes a far greater dopamine release in the nucleus accumbens than even IV heroin. This has been known for a long time. The people who developed oxycodone knew what they were doing - engineering the most addictive opiate on the market. Purdue really needs to be held accountable for what they've done and the lives they've ruined and/or ended. The blame for the opioid epidemic falls squarely on them, in my opinion.

SmellTheGlove 9y ago
It's scary good. I've had it prescribed to me twice - once when I had my wisdom teeth out (a fairly significant surgery, they were bony impacted) and again when I had a hernia repaired. Both were 5mg, 30 pills. I took 'em all. This was years ago, but I still remember to this day _exactly_ how good they made me feel. Scary stuff, I'll never fill a prescription for these again, I don't give a shit what I have going on.
- msmm 9y ago
  When I had my wisdom tooth out I was told to take paracetamol. I didn't need to because pain was bearable and was gone next day.

refurb 9y ago

You know why Purdue "lied" to the medical community? Because they aren't allowed to say anything that isn't in their drug label. That's called "off label promotion".

zzalpha 9y ago
BS. Purdue actively lobbied doctors to not alter their dosage schedules when prescribing the drug to their patients. That has nothing to do with labelling or regulations.
- refurb 9y ago
  I suggest you go and read FDA regulations about what drug companies can and can't say about their products.
  - zzalpha 9y ago
    I suggest you go do a little research about what Purdue did before commenting further. Other commenters have already provided links to the LA Times investigation. Read it. Purdue knew full well that 24 hour effectiveness was the factor that distinguished Oxy from other drugs on the market, despite the fact that their own studies showed the drug did not offer 24 hours of relief in many cases. Upon hearing that doctors were shortening the dosage schedules, they could have left well enough alone. Doctors prescribe off label all the time. There was no need for Purdue to step in. But that's exactly what they did. Purdue actively fought the doctors and lobbied to convince them to stick to the marketed dosage schedules because otherwise Oxy would have no perceived benefit in the marketplace over other opiods. There is documented evidence as reported by the LA Times that supports this. This has absolutely zero to do with regulation. The only way you could convince yourself of that is if you've already got a conclusion ("big government regulations bad!") and are you simply trying to find an explanation that fits it.
    - refurb 9y ago
      I've read the LA Times article. It's full of misleading information and sensationalism. I'm not saying Purdue acted like an angel, but their actions are twisted into a sinister plot. If Oxycontin didn't work with a 12 hour interval, why did the FDA approve it for that? Why is it in the label if it couldn't be supported by clinical trial data? Was the FDA asleep at this switch? “There is no Q8 dosing with OxyContin,” one sales manager told her reps, according to a memo cited in an FDA filing. She added that 8-hour dosing “needs to be nipped in the bud. NOW!!” Is a great example of creating the narrative the LA Times wants to spin. Take a look at the documents that are in the article. The reason for the Q12h dosing is: 1) insurance companies won't pay for it [since it's not in the label], 2) some pharmacies won't fill a script for anything but Q12h dosing [because it's not in the label], 3) FDA/DEA oversight [because it's not in the label], 4) minimize diversion and abuse. Those seem like real good reason to me!

kem 9y ago

Not to absolve Purdue's responsibility in this, but I do think this exposes the fraud that is the US healthcare system. First and foremost, it illustrates that drug regulation is basically a failure, and that the FDA and physicians cannot be trusted as sole authorities on drug safety. There needs to be more diversity of authority. You say "unless doctors ran their own studies" as if it is not the responsibility of physicians to be thinking critically about scientific information about drugs, in terms of who is providing the information and how to respond as scientists. Your statement basically assumes that doctors are not competent to evaluate and conduct scientific research. Why shouldn't doctors run their own studies? Maybe not each physician, by why don't they as a group? Why doesn't a large hospital run a trial? A conglomerate? It's not that difficult given the magnitude of the consequences involved and the frequency of prescription. It is the job of the medical community to be proactive participants in scientific process, especially when clinical consequences are on the line. That we've reached a point where we lay the responsibility of critical evaluation at the lap of the corporation says as much about the fault of the physicians and FDA as it does about the corporations. It's kind of like saying that an individual who knows a child is being abused but goes out of their way to transport the kid day after day to the abuser without reporting it bears no responsibility because they weren't abusing the child themselves. Anyone involved in the healthcare system knew that oxy was an addictive substance and there were rampant problems. The idea that someone with an MD shouldn't have a clue that increasing the dose would lead to greater problems is absurd--it's like claiming that a chemical engineer shouldn't understand that adding jet fuel to a fire wouldn't increase the blaze. Acting like physicians were innocent victims is a joke. The corporations and physicians were both complicit. Either that, or they were incompetent. It can't be neither. The FDA and physician groups need to be dethroned from their perches.