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The Family Making Billions from the Opioid Crisis
- refurb 9y agoI love how the article switches between OxyContin and opioids throughout the article, particularly when talking about deaths. It's a clever way to include drugs like heroin, fentanyl, etc in the numbers to inflate them and make the story more gripping. Of course it's silly to hold OxyContin's manufacturer responsible for all opioid deaths.
- deleted 9y ago[deleted]
- QAPereo 9y agoHow many people on heroin or fentanyl started on Rx Oxy?
- refurb 9y agoGood question! I don't know and I assume others don't as well. But we need a scapegoat right? Purdue will suffice.
- iaw 9y agoIn the article they note that epidemic opioid addiction was correlated with OxyContin prescription volume in a region. This article isn't about Purdue, it's about the Sackler's that influence Purdue, MundiPhrama, and a number of other global pharmaceutical companies to increase their wealth while also "braiding their name" into high society.
- refurb 9y agoThere was a resurgence of heroin use back in the 1970's in the US. So it's clear it can happen even without a legal opioid driving it. So why are we so quick to claim causation when there is only correlation? I know, because it sells newspapers!
- iaw 9y agoThat was attributed to returning veterans from Vietnam being hooked on opiates and creating a massive market, also the baby boomer generation coming off of "free love" didn't help the problem. It's generally understood for both that epidemic and the current how the problem arose, in part this understanding was achieved through interviews with addicts. Going back to the original morphine epidemic in the 19th/20th century it parallels closely the current Purdue/OxyContin epidemic lending further evidence to the driver being OxyContin. Do you really think that OxyContin is not a driver and only correlated? If so, what is driving the ever-increasing opiate usage?
- QAPereo 9y agoGood question! I don't know and I assume others don't as well. Unsafe assumption. Why not go the self-education route before taking the "angry preacher" role so seriously?
- refurb 9y agoNot angry in the least! Just surprised how quick people are to believe something without data. I guess it's just human trait to simply problems into "that person is at fault" rather than appreciate the multiple factors that resulted in a complex problem.
- QAPereo 9y agoAgain, you’re making assumptions, and offering only rhetoric. Why?
- rdtsc 9y agoOver-prescription of OxyContin is considered a major reason many heroin and fentanyl users became addicted. If street price of OxyContin would be lower they'd still be using that.
- vasilipupkin 9y agoThe company and the family is responsible for dramatically increasing number of opioid prescriptions based on fraudulent marketing and made up evidence. A lot of people, who, as a result, got addicted to Oxy, at some point ended up switching to heroin because it's cheaper. So, the manufacturer is not responsible for all opioid deaths, but is responsible for a significant percentage of those deaths.
- sillysaurus3 9y agoFor more on this, see https://youtu.be/5pdPrQFjo2o?t=164 https://youtu.be/5pdPrQFjo2o?t=164 "How many people here moved from prescription drugs to heroin?" Everybody raised their hands.
- loeg 9y ago> A lot of people, who, as a result, got addicted to Oxy, at some point ended up switching to heroin because it's cheaper. Counter-point: no, they largely did not. There is a huge population using prescription opiates and a tiny tiny population using heroin. Check out https://grokinfullness.blogspot.com/2017/09/debunking-standard-narrative-on-opioid.html https://grokinfullness.blogspot.com/2017/09/debunking-standa... for a lot more detail. > There is no convincing evidence that prior prescription opioid use caused subsequent heroin use. ... This is much like the argument, popular among drug warriors, that marijuana is a gateway drug because most users of hard drugs start with marijuana. There are simply so many current and past prescription opioid users that most heroin users will probably have had past experience with these drugs, but that says nothing at all about a causal link. Indeed, the vast majority of prescription opioid users never go on to use heroin, so the causal link is dubious. > In 2015, 85 million people used prescription opioids legally, and there were ~200 million legal prescriptions. By contrast, there were half a million heroin users. But there were comparable numbers of deaths in both categories (~13,000 from prescription opioids and 12,000 heroin deaths, or 18,500 heroin deaths if you add the "heroin" and "synthetic opioids" together to capture the fact that some dealers have been mixing fentanyl in with heroin). Some relevant numbers in my piece here, once again from the CDC's website. Deaths per legal opioid user are in the 0.015% range; deaths per heroin user are probably somewhere in the 1% to 3.5% range. > In other words, the prescription opioid deaths are a very small risk applied to a very large population. The heroin-related deaths are an extremely high risk applied to a relatively small population. These are very different issues with very different underlying social causes.
- beisner 9y agoThere absolutely are grounds to hold the manufacturer accountable. As the article mentions, the company marketed OxyContin as a medication supposed to be used for all kinds of ailments, almost casually. Purdue Pharmaceuticals advertised to doctors, and directly contributed to the overprescription of opioids, knowing full well the addiction potential. There are absolutely legitimate uses for OxyContin - I myself was prescribed it for a week or so after a particularly invasive knee surgery - but many many cases of pain management should have been dealt with using much tamer and less addictive treatments. In search of profits, the company influenced decisions at all parts of the prescription process that have directly led to the deaths of tens of thousands. They should be held accountable for that.
- iaw 9y agoDo you have ties to Purdue or the pharama industries? You seem super defensive about this/not open to discussion and your submission history seems to be pharma related.
- dyeje 9y agoWhat do you mean by switching? All of the drugs you listed are opioids. It's not clever, it's a fact.
- refurb 9y agoIt's called reading with a critical eye. They talk about OxyContin, then talk about the hundreds of thousands of opioid deaths. If you're not paying attention, you'd think OxyContin caused all of them.
- astura 9y agoOxyContin was certainly a catalyst to this entire epidemic.
- kasey_junk 9y agoCertainly? I think the point the parent was trying to make is that the evidence damning Oxy is not nearly as compelling as people claim & the way this article is worded lends credence to his claim. I’m no expert on this & have seen enough oxy abuse to be skeptical but saying it’s a certainty seems unfounded in the face of the argument.
- mcguire 9y ago"In May 2007 the company pleaded guilty to misleading the public about Oxycontin's risk of addiction and agreed to pay $600 million in one of the largest pharmaceutical settlements in U.S. history. Its president, top lawyer and former chief medical officer pleaded guilty as individuals to misbranding charges, a criminal violation and agreed to pay a total of $34.5 million in fines. Those executives are: Michael Friedman, the company’s president, who agreed to pay $19 million in fines; Howard R. Udell, its top lawyer, who agreed to pay $8 million; and Dr. Paul D. Goldenheim, its former medical director, who agreed to pay $7.5 million. "In addition three top executives were charged with a felony and sentenced to 400 hours of community service in drug treatment programs." https://en.wikipedia.org/wiki/Purdue_Pharma?wprov=sfla1 https://en.wikipedia.org/wiki/Purdue_Pharma?wprov=sfla1 I wouldn't really consider them a scapegoat. "As shown in Figure 1A, the selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later (P<0.001). Simultaneously, selection of hydrocodone and other oxycodone agents increased slightly, whereas for other opioids, including high-potency fentanyl and hydromorphone, selection rose markedly, from 20.1% to 32.3% (P=0.005). Of all opioids used to “get high in the past 30 days at least once” (Figure 1B), OxyContin fell from 47.4% of respondents to 30.0% (P<0.001), whereas heroin use nearly doubled." http://www.nejm.org/doi/full/10.1056/NEJMc1204141 http://www.nejm.org/doi/full/10.1056/NEJMc1204141 The abuse-resistant version had some unhappy consequences. "Available data indicate that the nonmedical use of prescription opioids is a strong risk factor for heroin use. Yet, although the majority of current heroin users report having used prescription opioids nonmedically before they initiated heroin use, heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate." http://www.nejm.org/doi/full/10.1056/NEJMra1508490#conclusions http://www.nejm.org/doi/full/10.1056/NEJMra1508490#conclusio... Of course, the issue here is not that oxycontin is a gateway drug, but that prescription opioids are being abused, and Purdue and oxycontin are undoubtedly at the forefront of that.
- joemag 9y agoAren’t the doctors to blame for this as well? It always surprised me how quickly and easily they prescribe serious painkillers. A few years ago I had a tooth pulled, and the doctor gave me prescription painkiller. In the end, I ended up using regular ibuprofen, and that was more than enough. I wonder how much of this comes pharmaceutical sales reps pressuring the doctors to use their medicine. That whole system seems broken and unethical to me.
- mavhc 9y agoCapitalist medicine is to blame, when you can vote with your money you can pick the doctor who does what you want, not what's best for you.
- walshemj 9y agoAh not so its the same in France everyone demands a second opinion I recall a BBC program where a French doctor admired the NHS's strictness in that regard.
- refurb 9y agoWhat? Even in single payer systems you can choose your doctor!
- maccard 9y agoNot always. I recently moved, and was forced to change doctor (NHS in the UK). My new GP surgery is farther away from my new apartment than my old surgery was, I’m far less happy with the doctors there, and it’s far more oversubscribed than my previous GP was.
- golergka 9y agoIf people are idiots, why deny them the possibility to realize their potential?
- mavhc 9y ago
- iaw 9y agoVery good write-up from Esquire, I'm thoroughly impressed with the article. That said, my visceral emotional response is strongly negative especially when reading the following paragraph: >In May, a dozen lawmakers in Congress, inspired by the L.A. Times investigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.
- wozniacki 9y agoIn the Massachusetts episode of Parts Unknown, Bourdain talks to a general physician who explains how patients who were administered OxyContin for routine procedures & injuries quickly developed a habit for the drug and when they couldn't find it post-treatment moved to illegal variants like Heroin and now Fentanyl.[1][2] Bourdain travels to Franklin County to explore the heroin epidemic that’s spreading throughout this and other New England towns.[1] Dr. Ruth Potee of Greenfield, Massachusetts talks about how they were taught in their residency that their ER / Hospital performance was tied to their pain scores and the generous administration of pain medication to patients.[1][2] Purdue Pharmaceuticals promotion from 1996 can also be seen. [1] Video - Parts Unknown - Massachusetts https://archive.org/details/AnthonyBourdainPartsUnknownMassachusetts https://archive.org/details/AnthonyBourdainPartsUnknownMassa... 22:16 Purdue Pharmaceuticals Promotion from 1996 25:10 Dr. Ruth Potee of Greenfield, Massachusetts [2] Transcript - Parts Unknown - Massachusetts -- CNN http://transcripts.cnn.com/TRANSCRIPTS/1502/20/abpu.01.html http://transcripts.cnn.com/TRANSCRIPTS/1502/20/abpu.01.html Edit: Another link to the same Parts Unknown - Massachusetts video http://www.dailymotion.com/video/x58d4ci http://www.dailymotion.com/video/x58d4ci
- yourapostasy 9y ago> ER / Hospital performance was tied to their pain scores and the generous administration of pain medication to patients... Trace back how these performance metrics were chosen, look in history if there was any advocacy or studies funded by Sackler-controlled/-influenced parties to tilt the selection of performance measurements towards subjective pain "scoring". It would be interesting to find out if Arthur's insight of nebulous broad applications was generalized to pushing for these kinds of metrics. After reading how Epipen configured a de facto monopoly, I've wondered where else this kind of corporate behavior shows up within our economic landscape. None of it breaks any laws, but I have to wonder if anyone involved regrets the consequences engendered.
- brucelidl 9y ago"Behind every great fortune there is a crime." —Balzac (apocryphal)
- pdog 9y agoThe full quote isn't apocryphal. It's from a character in Balzac's Le Père Goriot. Roughly translated: "The secret of great unexplained fortunes is a forgotten crime, because it has been properly executed." The quote isn't really applicable in this case. Everyone reading the article knows how the Sackler family made their money.
- brucelidl 9y agoEveryone reading the article knows the source of the fortune. The millions of people who have interacted with Sackler supported cultural institutions likely had zero idea of where the money came from, myself included.
- pdog 9y agoThis also raises an important question. Do these museums have a responsibility to disclose the source of the Sackler family's wealth?
- sumedh 9y agoIs Warren Buffett's fortune a crime as well?
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- herodotus 9y agoIn my experience with local philanthropy, there are donors who have no interest in "naming opportunities" and those for whom it is all about the name. To me it says a lot about the character of the donor if they specifically want as little fuss as possible about the donation, and especially if they do not want something named after them. It is the cause they support, not their own egos. Personally, the more often I see a particular donor's name attached to a building, the less admiration I have for the person. So for me the ethical defects of the company are consistent with the desire for the family name to be emblazoned everywhere.
- craftyguy 9y agoSometimes buildings are named after folks just because they were awesome. Too bad it's not easy to distinguish between awesome people who had buildings named after them from the much less awesome people who essentially bought the naming rights to a building.
- username223 9y agoOne indicator is whether the person was still alive when the building was named. Naming stuff after yourself when you're still alive (https://chanzuckerberg.com https://chanzuckerberg.com) is a good way to cheapen it.
- lostlogin 9y agoNo, naming it after yourself cheapens it, dead or alive. Someone else has to do it.
- nsedlet 9y agoThe Sacklers have ingratiated themselves at the highest levels of society using a fortune that's at best built on a product of dubious value, and at worst obtained at the cost of the lives of tens of thousands of people. I think this piece points to a big problem: we worship money and those that accumulate it, and often ignore the question of how much societal value was created in exchange for it. The least we can collectively do is not confer status and prestige upon those who make money in a destructive way. I love the line of inquiry in this piece because it puts pressure on the high-society keepers-of-culture whose admiration the Sacklers likely most crave. FYI you can also see an interview with the author on Democracy Now: https://www.democracynow.org/2017/10/19/who_profits_from_the_opioid_crisis https://www.democracynow.org/2017/10/19/who_profits_from_the... (disclaimer: I am friends with the author)
- deleted 9y ago[deleted]
- Findeton 9y agoThank the government for granting them monopoly rights.
- throwaway2048 9y agoI can hate both the player and the game, thanks. Especially a game that the players have a hand in rigging in their favour as hard as they can.
- joering2 9y agoI definitely don't wanna play devils advocate for these scumbags, but can't you apply your logic to basically any product? I mean, Coca-Cola. Its at best product of dubious value, and at worst produced for the need for sugar by tens of thousands of people.
- fmihaila 9y agoIt's not clear that Coca Cola is just "any product". I think the "at worst" part of your characterization of it is actually right on. It can be argued that the damage inflicted on society by excessive sugar consumption, of which Coca Cola is a most prominent promoter and beneficiary, is much larger than that caused by opioids (which is already huge).
- stefanwlb 9y agoAh Mr Sacklers, I have been waiting for you. It is time to pay back for your crimes, and you will not leave until the very last cent has been repaid. Indeed what you have sown, you will surely reap.
- cwyers 9y agoI'm reminded of that line from Chinatown. "Why are you doing it? How much better can you eat? What can you buy that you can't already afford?" Is there really no point of diminishing returns, where you can tell yourself you've made enough money?
- wyager 9y agoIf you can’t usefully spend arbitrarily large amounts of money, it’s a creativity problem. Sure, if your only interests are eating and watching TV then a billion dollars isn’t going to do much for you. The easy way to productively spend $X billion is to invest it in space/physics/medical research or development. If you need to blow a few hundred billion, you could launch an asteroid mining venture with a reasonable chance of turning that money into a few trillion and making space development vastly more affordable for the rest of humanity.
- trendia 9y agoThat reminds me of an old joke: Q: How do you make $1 million in aerospace? A: Start with $1 billion
- cwyers 9y agoI mean, the most effective contribution they could make to society is to stop lobbying Congress so effectively to protect their sales of Oxy, but sure, let's talk about how those profits could be rolled over into speculative investments in aerospace. EDIT: And of course, the response to that line in the movie is "The future, Mr. Gittes."
- appleflaxen 9y agoCan you elaborate on your point? In your example, it seems like you are saying "there is more happiness in mining asteroids than in being able to live very comfortably, indefinitely, without having to work to support yourself". Except for a very narrow portion of humanity, this seems implausible. Would mining asteroids really bring fulfillment to a person who has experienced ennui when climbing a mountain, scuba diving the barrier reef, yachting the Mediterranean, or designing their own home? Failure of imagination, sure, but I think you're going to be disappointed if you think that a billion is going to be deeply fulfilling relative to 20 million.
- misterHN 9y agoWhy don't we just rip their bodies apart? Why don't we rip their arms and legs off?
- andreasgonewild 9y agoI was on Oxy for about a month after smashing one of my vertibraes into pieces in a climbing accident, I was prescribed more than three times as much. I walked through hell to get out of that crap; nothing else I've encountered even comes close, including heroine and cocaine. There are several natural, less addictive and less harmful methods for treating chronic pain; cannabis, mushrooms and meditation among others. Pharma is all about creating return customers; profits, at any cost; the people involved in creating this mess have some serious karma to deal with in the near future.
- mabub24 9y agoPerdue Pharma, the producer of Oxy, is basically making half of its customers into drug addicts by lying about "12-hours" of "effective" pain relief. The LA Times ran an investigation into Perdue Pharma's claim[1] and the article is incredibly disturbing. This is the killer quote: > "More than half of long-term OxyContin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times." Perdue Pharma has been lying about the 12-hour pain relief effect for decades. They wanted to dominate the 12-hour pain relief market. Whenever a doctor prescribed for a smaller interval of time, Perdue screamed bloody murder and sought to "refocus" doctors at all cost on the "12-hour rule" to ensure the drug stays in the 12-hour market share. To "refocus" doctors, Perdue Pharma tells doctors to prescribe stronger doses, rather than more frequent ones, and this leads to serious problems with reliance. [1]: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
- andreasgonewild 9y agoFrom my perspective, OxyContin is obviously designed to be as addictive as possible; and they have been lying all along. These people are not fully functioning humans, they will do whatever it takes to generate more profits. I promised myself to never touch their artificial crap again; if it doesn't grow on the ground, I'm not interested.
- frozenport 9y ago
- deleted 9y ago[deleted]
- Animats 9y ago... Medical Advertising Hall of Fame... This is a real thing.[1] They really give out awards for medical advertising. Typical writeup: "Ambien dominated the insomnia market like few products ever have. Our goal was to introduce a new way of thinking about sleep, and to introduce Rozerem as a new option for the treatment of insomnia. In order to take down Goliath, Rozerem needed to spend BIG. $200 million in broadcast media spend big. With millions of eyeballs being driven to the website we had to ensure that we provided a seamless, immersive brand experience with absolutely no tradeoffs."[2] It's am award program for scumbags. [1] https://www.mahf.com https://www.mahf.com [2] https://www.mahf.com/digital-pioneer-award-winners/ https://www.mahf.com/digital-pioneer-award-winners/
- EvanAnderson 9y agoIck! This reinforces my belief that direct-to-consumer advertising of prescription drugs should be illegal.
- lostlogin 9y agoIt is nearly everywhere. New Zealand, USA and Brazil allow it.
- neilk 9y agoIt's interesting how HN has near-universal disdain for people covertly making billions off an addictive product. But much of our industry is explicitly, openly trying to create addictive experiences.
- tclancy 9y agoThis smells of whataboutism and whatever the ethics of making addictive software, it's killed far fewer people so far.
- GigabyteCoin 9y ago>it's killed far fewer people so far. Sitting curled up in a chair for hours straight staring into a phone is killing you a lot quicker than you might think.
- neilk 9y agoI'm not equating the harms, or attempting to distract from this serious issue. But, if we feel clear outrage about another industry, we should consider applying the same standards to our own. Most everyone who works in opioid marketing probably thinks they are a good person too.
- dang 9y ago> we The fallacy in your comment isn't that you're wrong about addictions, it's that you're assuming two population samples are the same: 'HN users who complain about drug addiction' and 'HN users who create addictive technology'. Those are two different values of 'we'. (I worry about being in the latter group. HN is pretty addictive.)
- toephu2 9y agoWow, and this has been known for years...and yet OxyContin is still legal in the U.S. and being sold every day.
- sanguy 9y agoSad. Hope the family gets what's due -- being burnt alive would be a good start.
- deleted 9y ago[deleted]
- thr0waway187 9y agoThe thinly-veiled anti-Semitism of this article is abhorrent. Going after a family like this is shameful, the real people to blame are those taking drugs with solid medical uses and abusing them. Ever try to recover from surgery w/o painkillers? Pray you never do, you'll be thanking the Sacklers.
- throwaway0255 9y agoIt should simply be illegal to advertise prescription medications. "Ask your doctor about Klonopin today" "Ask your doctor about coronary artery bypass grafting today" One of these sounds completely ridiculous, and the other sounds commonplace. They should both sound ridiculous, because they're both equally completely ridiculous. The idea that the patient should be influencing the treatment decisions of medical professionals based on things they saw on television is just absurd. It should be illegal. Doctors are all complicit in it, that should be considered medical malpractice, but doctors are put in an impossible position on this stuff and I understand why they do it. Healthcare in general is just such a goddamn mess. There are so many completely obvious ways to improve it, but it's impossible to implement any of them, and in the meantime people just keep losing their loved ones early to all the inefficiencies and waste and stupidity. And all the politicians just want to get their stamp on it to show their constituency how caring and benevolent they are, but they're politicians so all they're actually capable of doing is fucking everything up. So they all just keep grandstanding and fucking everything up and it just gets worse and worse every year.
- valuearb 9y agoThe idea that the patient should be influencing their own treatment decisions is absurd?
- maskedSlacker 9y agoThe idea that the patient should be influencing treatment BASED ON WHAT THEY SAW ON TV is absurd. It's like you didn't even read what you responded to. What is this, reddit?
- valuearb 9y agoHow do you think people get informed? Do you really think that advertising isn't useful to informing people? Do you really think as many patients would find out about viable treatments for their conditions if you ban advertising? Advertising isn't hypnosis. People know not to take claims at face value and if they don't, US medical ads are full of disclaimers and warnings. And once you see an ad for a treatment, you have many opportunities to research it, including by discussing it with your doctor. Do you really think doctors alone should decide your treatment? My mother in law had terminal brain cancer. She could not eat due nausea from her chemotherapy. I accompanied her on a visit to her doctor. We told him the anti-nausea prescription wasn't working, and I asked why he didn't prescribe her medicinal marijuana. He angrily rejected it as a viable treatment and huffily said he'd change her prescription to a different anti-nausea medication. Shortly later she went on the last trip of her life, to Arizona for some sun and relaxation, but her nausea was so bad that she threw up in the airport and had to return home, where she died in bed a few months later, a 60 lb bundle of bones from barely eating for months on end. If you want to be protected from "advertising", change the channel. I don't, so stop trying to "protect" me by restricting my right to listen to other viewpoints.
- chmaynard 9y agoIn America, we worship people that create great fortunes. We idolize them and consider them geniuses. The source of their wealth is not important, even if it is obviously illegal or immoral. The only consideration is whether they built a successful business and managed to retain most of their money. This is the dark side of capitalism and the profit motive.
- tehlike 9y agoThis is why the US is so ahead in entrepreneurship. It also can be seen in individuals: Bill Gates was claimed to be ruthless at early times, but now he's known for his philanthropy.
- gesman 9y agoFree Splunk app that shows how to detect anomalies in drug prescriptions including anomalies in narcotics prescriptions and fraudulent providers (doctors): https://splunkbase.splunk.com/app/3693/ https://splunkbase.splunk.com/app/3693/ Comes with 2014 medicare dataset. All supporting data can be downloaded from data.cms.gov Story: https://www.splunk.com/blog/2017/09/28/building-a-60-billion-data-model-to-stop-us-healthcare-fraud-with-splunk-and-machine-learning.html https://www.splunk.com/blog/2017/09/28/building-a-60-billion...
- chiefalchemist 9y agoRegardless of how it started, I'm confused as to why/how this crisis has been allowed to persist and grow for so long. No checks? No balance? Zero to epidemic and nothing to prevent it?