8 ms·

Anti-addiction drug maker found a captive market in the criminal justice system

96 points by Geekette 9y ago

thatcat 9y ago
Judges are essentially prescribing medication without an MD for behavioral modification. Who will be liable when a patient/defendant experiences a complicated reaction as a result? You would think judges would be aware of their exposure to the legal risks of their actions, so maybe they have insurance.
- sleepychu 9y ago
  Don't judges have immunity from legal retaliation to their actions as judges?
  - jhall1468 9y ago
    Only monetary damages. But they have effective immunity from prosecution because it's (as far as I know) never happened that a prosecutor has pressed charges against a judge for his ruling, outside of corruption.
    - gozur88 9y ago
      The system couldn't work if judges could be prosecuted for their rulings, unless you're counting bribes, which they already get prosecuted for.
  - webnrrd2k 9y ago
    Almost. It takes a lot to go after a judge. The big case that comes to mind is the Cash for Kids Scandal, where Honest Services Fraud was one of the charges used. https://en.wikipedia.org/wiki/Kids_for_cash_scandal https://en.wikipedia.org/wiki/Kids_for_cash_scandal I didn't know there was even such a thing as honest service fraud until recently. It appears to have a lot of problems as a charge, but it certainly feels like it should be used a lot more to simply prevent some of the Machiavellian screw-jobs modern business (and politics) inflict on people. I know, I'm getting a little "ranty", but doesn't the term "honest service fraud" seem to fit so many of the problems caused by big organizations today?
  - avs733 9y ago
    I may be being overly pedantic, but I believe there is a little submeaning in your post. I believe judges have immunity from retaliation within the judicial system. As far as I am aware, state medical boards are non-judicial and do have the authority to issue fines for such things as practicing medicine without a license.
- vkou 9y ago
  > Who will be liable when a patient/defendant experiences a complicated reaction as a result? The defendant. The same person who is liable when corrections bunks them with a prison rapist, or a psychopath who ends up building a guitar out of their vocal chords. The justice system is a deep pit that we toss people into, without any care for what happens after. If we made anyone in on the side of the prosecution accountable for the consequences, the entire system would grind to a halt.
notadoc 9y ago
Sounds like a nice gravy train for the company.
zkms 9y ago
"Drug courts" don't help addicted people (nor the people around them) -- they're mostly a way for the criminal legal system to whitewash itself and pretend that it cares about drug users in a "medical" way (and not just by slamming them in the clink), and there's a decent article about this: https://psmag.com/news/how-america-overdosed-on-drug-courts https://psmag.com/news/how-america-overdosed-on-drug-courts Besides the inherent issue of non medically-trained people coercively prescribing medication for behavioural modification, there's the fact that drug court judges tend to disfavour opioid maintenance therapy and value abstinence from drug use over everything else; which severely increases the risk of fatal overdoses and other bad outcomes. Abstinence-only treatment does not work well for opioid addiction (http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...), and coercive abstinence-only treatment doesn't work well either. Drug rehab in US is a fucked up industry where degradation, isolation, and humiliation are commonplace and are seen as best practice, and this is the case because, well, their "patients" are literally captive -- it's either that or literal jail.
- Zigurd 9y ago
  This system also invites and funds quack medicine, like "treatment" for non-addictive drug use and non-addicts, while real addicts find a shortage of treatment resources.
  - gozur88 9y ago
    This. A non-alcoholic friend of mine got popped for drunk driving, and part of his sentence was counseling for alcoholism. At one point they asked him if he'd ever done cocaine, he foolishly answered yes, and they sent him to a similar program for coke. On the other hand, since he had to pay the cost it's not like anybody who needed treatment got shorted as a result.
    - OvidNaso 9y ago
      It also educates him about addiction which helps disseminate correct information back to the public (hopefully).
tcj_phx 9y ago
Naltrexone - the active ingredient in this $1000 reformulation of a generic drug - can also be injected as pellets under the skin for the same time-release effect. It's been a while since I ran across this option. Here's a random site about this therapy: http://www.naltrexpellet.com/ http://www.naltrexpellet.com/ The active ingredient costs <$2, so Vivitrol is 90% price gouging. Edit: IMHO, Naltrexone is a good prescription drug that actually helps people physiologically. People's pain receptors get overloaded; naltrexone helps to reset them. Naltrexone helps with alcoholism, and apparently with meth amphetamine [1] too. [1] http://newsroom.ucla.edu/releases/ucla-researchers-identify-a-potentially-effective-treatment-for-methamphetamine-addiction http://newsroom.ucla.edu/releases/ucla-researchers-identify-... With that said, Naltrexone doesn't address the fundamental emotional problems that underlie most cases of addiction. So it doesn't do them a whole lot of good to force them to take it, without also helping them find stability, the lack of which probably led them to self-medicate in the first place.
- deleted 9y ago
  [deleted]
- refurb 9y ago
  Vivitrol is 90% price gouging So you're saying that the only cost associated with bringing a new drug to market is the cost of the ingredients?
  - 55555 9y ago
    No, he didn't say that at all. He strongly implied that the other costs involved don't add up to 90% of the list price. Ofcourse bribing judges costs money too.
    - aisofteng 9y ago
      What evidence is there of judges being bribed here? That's a hell of an accusation.
  - ploxiln 9y ago
    He left another 9.8% for the other costs
CodeWriter23 9y ago
The most insidious effect this has, with drugs like Suboxone or Subutex, the courts are basically mandating prolonged opioid use by the defendants, all on some Doctor's opinion that this is better. They should also seek the opinions of addicts who have sought or been forced into this treatment regime. Though I have not experienced it myself, the general consensus from the people whom I have spoken to who have, is that withdrawal from these drugs is much more severe than Heroin. If the point is to help the addict through the withdrawal process so they can get clean, it seems rapid detox protocols would be more expedient. But of course, as we all here on HN know, the real money is in a monthly subscription, not a one-time payment. And that's what Drug Replacement Therapy (or as pharma PR prefers, "Medically Assisted Treatment") is. It's switching to a dope man who wears a lab coat and uses a prescription pad instead of balloons. And a huge payola scheme for pharma and practitioners.
- refurb 9y ago
  So what you're saying is there is no benefit to person from switching from impure, potentially fatal street drugs to a pharmaceutically pure drug, free of charge that lets them live a relatively normal life? I take it your a proponent of drug abstinence rather than harm reduction?
  - undersuit 9y ago
    I wonder why the street drugs are impure? I wonder why you can't get pharmaceutically pure heroin? I wonder why you think that opioid recovery is free of charge, is that just near you? I think what GP was trying to say was that trying to treat people in opioid recovery programs with opioids that can be abused in the same way as dirty street drugs is ineffectual and their use isn't being proscribed for recovery as much as it's being proscribed because it's profitable to someone. I agree with them. I don't think I interact with many opioid dependent people, but I've heard good anecdotes about Kratom, Marijuana, and Narcotics Anonymous for recovery. Two vilified plants and an organization that rejects outside help(or how ever the local chapter interprets their traditions) versus a potential goldmine of profits and feel-goods, I think I know which way the government is going to enforce their minimal efforts at drug rehabilitation.
empath75 9y ago
There's two parts of addiction, and chemical dependency is only a small part of it, imo. This might resolve that problem, but it doesn't do anything about people who just like to be high all the time. There are lots of people who have addictions to drugs or just activities that don't have any chemical dependency associated with them at all. Psychology's discovery of the relationship of neurotransmitters to behavior was a huge breakthrough, but trying to treat every problem with drugs is like trying to fix a broken Office install by replacing RAM. Sometimes the problem is software, not hardware.
tp3z4u 9y ago
I take Low Dose Naltrexone for chronic fatigue. It was an instant fix. A return to an almost forgotten normal. I do get crazy vivid dreams that I remember well and they can be a little disturbing but it is a small price to pay for my life back. I buy the 50mg pills from overseas and dose it down to 4.5mg. It's the only thing that worked for me after years of trying practically everything else. It is super cheap. I think the world would benefit from more people knowing about it.
- _acme 9y ago
  Is there any evidence of it working for this application other than your anecdotal experience?
girvo 9y ago
I despise vivitrol. Two people I knew back when I was an addict used it to try and get clean, they're both dead due to trying to "break through" as it does nothing for your cravings, or the reasons you started using in the first place. Buprenorphine was much more effective for myself, and I broke my six year heroin addiction using it, legally from my government for a nominal cost of a few dollars per day. America seems hung up on abstinence and "cold turkey" as if it's the be-all end-all of treating addiction. Just use willpower, right? Vivitrol seems "perfect" in that environment, as it should stop you chemically from using, but the thing is that people don't want to be junkies, they want to live their lives and be happy, without the noose around their neck that is addiction. But if you don't deal with why they started using, how can you expect someone to heal?

96 points by Geekette 9y ago

Judges are essentially prescribing medication without an MD for behavioral modification. Who will be liable when a patient/defendant experiences a complicated reaction as a result? You would think judges would be aware of their exposure to the legal risks of their actions, so maybe they have insurance.

sleepychu 9y ago
Don't judges have immunity from legal retaliation to their actions as judges?
- jhall1468 9y ago
  Only monetary damages. But they have effective immunity from prosecution because it's (as far as I know) never happened that a prosecutor has pressed charges against a judge for his ruling, outside of corruption.
  - gozur88 9y ago
    The system couldn't work if judges could be prosecuted for their rulings, unless you're counting bribes, which they already get prosecuted for.
- webnrrd2k 9y ago
  Almost. It takes a lot to go after a judge. The big case that comes to mind is the Cash for Kids Scandal, where Honest Services Fraud was one of the charges used. https://en.wikipedia.org/wiki/Kids_for_cash_scandal https://en.wikipedia.org/wiki/Kids_for_cash_scandal I didn't know there was even such a thing as honest service fraud until recently. It appears to have a lot of problems as a charge, but it certainly feels like it should be used a lot more to simply prevent some of the Machiavellian screw-jobs modern business (and politics) inflict on people. I know, I'm getting a little "ranty", but doesn't the term "honest service fraud" seem to fit so many of the problems caused by big organizations today?
- avs733 9y ago
  I may be being overly pedantic, but I believe there is a little submeaning in your post. I believe judges have immunity from retaliation within the judicial system. As far as I am aware, state medical boards are non-judicial and do have the authority to issue fines for such things as practicing medicine without a license.
vkou 9y ago
> Who will be liable when a patient/defendant experiences a complicated reaction as a result? The defendant. The same person who is liable when corrections bunks them with a prison rapist, or a psychopath who ends up building a guitar out of their vocal chords. The justice system is a deep pit that we toss people into, without any care for what happens after. If we made anyone in on the side of the prosecution accountable for the consequences, the entire system would grind to a halt.

notadoc 9y ago

Sounds like a nice gravy train for the company.

zkms 9y ago

"Drug courts" don't help addicted people (nor the people around them) -- they're mostly a way for the criminal legal system to whitewash itself and pretend that it cares about drug users in a "medical" way (and not just by slamming them in the clink), and there's a decent article about this: https://psmag.com/news/how-america-overdosed-on-drug-courts https://psmag.com/news/how-america-overdosed-on-drug-courts Besides the inherent issue of non medically-trained people coercively prescribing medication for behavioural modification, there's the fact that drug court judges tend to disfavour opioid maintenance therapy and value abstinence from drug use over everything else; which severely increases the risk of fatal overdoses and other bad outcomes. Abstinence-only treatment does not work well for opioid addiction (http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...), and coercive abstinence-only treatment doesn't work well either. Drug rehab in US is a fucked up industry where degradation, isolation, and humiliation are commonplace and are seen as best practice, and this is the case because, well, their "patients" are literally captive -- it's either that or literal jail.

Zigurd 9y ago
This system also invites and funds quack medicine, like "treatment" for non-addictive drug use and non-addicts, while real addicts find a shortage of treatment resources.
- gozur88 9y ago
  This. A non-alcoholic friend of mine got popped for drunk driving, and part of his sentence was counseling for alcoholism. At one point they asked him if he'd ever done cocaine, he foolishly answered yes, and they sent him to a similar program for coke. On the other hand, since he had to pay the cost it's not like anybody who needed treatment got shorted as a result.
  - OvidNaso 9y ago
    It also educates him about addiction which helps disseminate correct information back to the public (hopefully).

tcj_phx 9y ago

Naltrexone - the active ingredient in this $1000 reformulation of a generic drug - can also be injected as pellets under the skin for the same time-release effect. It's been a while since I ran across this option. Here's a random site about this therapy: http://www.naltrexpellet.com/ http://www.naltrexpellet.com/ The active ingredient costs <$2, so Vivitrol is 90% price gouging. Edit: IMHO, Naltrexone is a good prescription drug that actually helps people physiologically. People's pain receptors get overloaded; naltrexone helps to reset them. Naltrexone helps with alcoholism, and apparently with meth amphetamine [1] too. [1] http://newsroom.ucla.edu/releases/ucla-researchers-identify-a-potentially-effective-treatment-for-methamphetamine-addiction http://newsroom.ucla.edu/releases/ucla-researchers-identify-... With that said, Naltrexone doesn't address the fundamental emotional problems that underlie most cases of addiction. So it doesn't do them a whole lot of good to force them to take it, without also helping them find stability, the lack of which probably led them to self-medicate in the first place.

deleted 9y ago
[deleted]
refurb 9y ago
Vivitrol is 90% price gouging So you're saying that the only cost associated with bringing a new drug to market is the cost of the ingredients?
- 55555 9y ago
  No, he didn't say that at all. He strongly implied that the other costs involved don't add up to 90% of the list price. Ofcourse bribing judges costs money too.
  - aisofteng 9y ago
    What evidence is there of judges being bribed here? That's a hell of an accusation.
- ploxiln 9y ago
  He left another 9.8% for the other costs

CodeWriter23 9y ago

The most insidious effect this has, with drugs like Suboxone or Subutex, the courts are basically mandating prolonged opioid use by the defendants, all on some Doctor's opinion that this is better. They should also seek the opinions of addicts who have sought or been forced into this treatment regime. Though I have not experienced it myself, the general consensus from the people whom I have spoken to who have, is that withdrawal from these drugs is much more severe than Heroin. If the point is to help the addict through the withdrawal process so they can get clean, it seems rapid detox protocols would be more expedient. But of course, as we all here on HN know, the real money is in a monthly subscription, not a one-time payment. And that's what Drug Replacement Therapy (or as pharma PR prefers, "Medically Assisted Treatment") is. It's switching to a dope man who wears a lab coat and uses a prescription pad instead of balloons. And a huge payola scheme for pharma and practitioners.

refurb 9y ago
So what you're saying is there is no benefit to person from switching from impure, potentially fatal street drugs to a pharmaceutically pure drug, free of charge that lets them live a relatively normal life? I take it your a proponent of drug abstinence rather than harm reduction?
- undersuit 9y ago
  I wonder why the street drugs are impure? I wonder why you can't get pharmaceutically pure heroin? I wonder why you think that opioid recovery is free of charge, is that just near you? I think what GP was trying to say was that trying to treat people in opioid recovery programs with opioids that can be abused in the same way as dirty street drugs is ineffectual and their use isn't being proscribed for recovery as much as it's being proscribed because it's profitable to someone. I agree with them. I don't think I interact with many opioid dependent people, but I've heard good anecdotes about Kratom, Marijuana, and Narcotics Anonymous for recovery. Two vilified plants and an organization that rejects outside help(or how ever the local chapter interprets their traditions) versus a potential goldmine of profits and feel-goods, I think I know which way the government is going to enforce their minimal efforts at drug rehabilitation.

empath75 9y ago

There's two parts of addiction, and chemical dependency is only a small part of it, imo. This might resolve that problem, but it doesn't do anything about people who just like to be high all the time. There are lots of people who have addictions to drugs or just activities that don't have any chemical dependency associated with them at all. Psychology's discovery of the relationship of neurotransmitters to behavior was a huge breakthrough, but trying to treat every problem with drugs is like trying to fix a broken Office install by replacing RAM. Sometimes the problem is software, not hardware.

tp3z4u 9y ago

I take Low Dose Naltrexone for chronic fatigue. It was an instant fix. A return to an almost forgotten normal. I do get crazy vivid dreams that I remember well and they can be a little disturbing but it is a small price to pay for my life back. I buy the 50mg pills from overseas and dose it down to 4.5mg. It's the only thing that worked for me after years of trying practically everything else. It is super cheap. I think the world would benefit from more people knowing about it.

_acme 9y ago
Is there any evidence of it working for this application other than your anecdotal experience?

girvo 9y ago

I despise vivitrol. Two people I knew back when I was an addict used it to try and get clean, they're both dead due to trying to "break through" as it does nothing for your cravings, or the reasons you started using in the first place. Buprenorphine was much more effective for myself, and I broke my six year heroin addiction using it, legally from my government for a nominal cost of a few dollars per day. America seems hung up on abstinence and "cold turkey" as if it's the be-all end-all of treating addiction. Just use willpower, right? Vivitrol seems "perfect" in that environment, as it should stop you chemically from using, but the thing is that people don't want to be junkies, they want to live their lives and be happy, without the noose around their neck that is addiction. But if you don't deal with why they started using, how can you expect someone to heal?