15 ms·

The lucrative business of America’s opioid crisis

263 points by dpflan 9y ago

Donnaj 9y ago
TRY HAVING YOU MORE THAN FOUR DISEASES ARE BEING A VETERAN THAT IS IN CONTINUOUS PAIN. BETTER YET WHY DONT U TRY GETTING A CONCIOUS.
quantumofmalice 9y ago
> The industry of addiction treatment is haphazardly regulated, poorly understood and expanding at a rapid clip, bringing in $35 billion a year. Why not focus on the root company and family actually getting rich off selling the damned opioids (Purdue Pharma and the Sacklers, respectively)? I don't understand how this company and family haven't been sued into the ground yet.
- minikites 9y ago
  Few people actually have the resources to pursue legal remedies and given the demographics of those affected by opioid addiction, I'm completely unsurprised.
  - danmaz74 9y ago
    Isn't this a perfect situation to use class action?
    - macintux 9y ago
      I'm not sure how you'd identify participants. Medical privacy rules would prevent you from taking the typical "this consumer product causes warts so we'll find everyone on record of having bought one" approach.
      - moduspol 9y ago
        Have you or a loved one been diagnosed with mesothelioma? Received a vaginal mesh implant? Taken the drug Risperdal? They've been able to do it before.
        macintux 9y ago
        I guess as someone who doesn't own a TV I've not been exposed to much of that, but I do wonder whether the success rate of such an initiative would be lower among opioid addicts. "Please step forward, admit to the world you're addicted, and in 10-15 years you might get a coupon for free drugs." Also, what are we really looking for? Do addicts really know whether they were overprescribed? Is being addicted sufficient cause for a lawsuit? Anyway, I'm not saying it's unsolvable, but I can imagine some tougher hurdles than the class action suits I've been privy to.
- malchow 9y ago
  The family are all Democrats. That isn't the sole reason, but if you compare the "shadowy financier" tone of many stories about right-of-center families to the stories about opioids, you'll see that the "shadowiness" component of the reporting suddenly disappears.
  - brohoolio 9y ago
    It's not all democrats. Rep. Tom Marino, the main force behind the bill limited the DEA's ability to fight against these companies is a republican. Also Trumps nominee to become the next drug czar. https://www.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/ https://www.washingtonpost.com/graphics/2017/investigations/...
  - QAPereo 9y ago
    Please explain this... https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain https://www.newyorker.com/magazine/2017/10/30/the-family-tha...
  - quantumofmalice 9y ago
    What bothers me is that this can be interpreted as a "New York thing", to quote Lorne Michaels, and I don't like going down that road.
    - happyrock 9y ago
      What do you mean? EDIT: I googled it, I see where you're going with that...
  - fzeroracer 9y ago
    This seems objectively false after even a brief cursory search and I'm curious as to why you think it has anything to do with this topic.
    - dahdum 9y ago
      It's false, but fair to say the family is involved in both political parties. They seem to lean more towards the Democrat side, but that's to be expected given Obama's two terms. The reason it matters is that political clout and general goodwill helps shield them from legislative action and judicial inquiry.
- creaghpatr 9y ago
  Much has been written on the Sackler family this year, including the article below, but rest assured they are embedded deep in politics and popular culture behind the scenes. Not so easy to simply sue them out of business. https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain https://www.newyorker.com/magazine/2017/10/30/the-family-tha...
NOSHSHNACKERS 9y ago
if we tried to stop them they would just send a gunboat up the river
sidcool 9y ago
I cannot understand why the Government is not acting against the pharmas profiting from this crisis. And why people are not revolting. There is a clear nexus between pharmas and doctors. Something should be done.
- MechEStudent 9y ago
  The 0.1% unilaterally owns the government. Better than half of all laws are made for them. Where do you think the 0.1% stands on the opioid crisis? It doesn't touch them. It is a poverty-problem, not theirs.
  - shams93 9y ago
    They're making money off their big pharma stock holdings do for the 0.1 this addiction crisis is no crisis at all it's an opiate Bonanza
  - nol13 9y ago
    Citation? Addiction doesn't care about the size of your bitcoin wallet. But yes all things considered better to be a rich addict than a poor one.
- creaghpatr 9y ago
  To be fair, the government did launch "what federal officials Thursday called the “largest ever health care fraud enforcement action” by the Medicare Fraud Strike Force, 412 individuals, including 115 doctors, nurses and other licensed medical professionals, were arrested in a nationwide operation that involved more than 1,000 law enforcement agents in at least 30 states." this past July. Not a shabby start. https://www.washingtonpost.com/news/business/wp/2017/07/13/doj-announces-charges-against-400-people-for-1-3-billion-in-health-care-fraud/?utm_term=.9be94be043e9 https://www.washingtonpost.com/news/business/wp/2017/07/13/d...
- wu-ikkyu 9y ago
  >I cannot understand why the Government is not acting against the pharmas profiting from this crisis. $$$ > And why people are not revolting. Drugs are an effective and subtle form of chemical warfare. They keep the people docile and apathetic.
MechEStudent 9y ago
Paywalled.
jijji 9y ago
Heroin is a Schedule I (in the US) which means no medical benefit, and its a 20 year felony for distributing it. There is also the Federal Analogue Act, 21 U.S.C. § 813, which is supposed to group similar drugs in the same category. So, how do these companies get away with selling analogs of heroin? Shouldn't the people who work there and make money off these opioid drugs be arrested? Why haven't they?
- sandworm101 9y ago
  Because what they sell isnt on the schedual and does have medical use. Hate opiods addiction and overprescription, but dont forget that these things have a place.
  - DanielBMarkham 9y ago
    Absolutely yes. We don't want to go back to a world without drugs for chronic and severe pain. For all the hoopla around the addiction problem, we must never forget there are real people who need these things. With some of the treatment options, as I understand it, it's even possible to be an addict and a functioning member of society. I start worrying in public discussions when people ascribe too much good or evil to inanimate objects. Drugs are tools, like a lot of other things. They can do great good or evil. It's how we use them that makes the difference. Education will get us a lot further in helping folks than prohibition ever will.
    - macintux 9y ago
      > With some of the treatment options, as I understand it, it's even possible to be an addict and a functioning member of society. Absolutely. Unfortunately it's often very hard to get good treatment options. A close friend of mine has to travel 45 minutes each way, each day, to get to a clinic where she pays $20 each day. ...and she's fortunate that she was able to get a spot there after spending months buying suboxone from other addicts because she couldn't get a doctor to prescribe it because doctors are constrained on how many prescriptions they can write. When you're poor and have no reliable transportation, that's a brutal way to live. Falling into addiction is easy, and often you never truly escape.
pmc1 9y ago
> Millions of people have fallen victim to drugs, painkiller abuse, alcoholism, the rise of meth and the revival of heroin. Through all this carnage somehow the left still fights for the legalization of the gateway drug marijuana. Of course not all weed users move towards harder drugs, but it opens the door to more lethal drugs once susceptible individuals become accustomed to the highs. I have personally seen friends from college smoke weed for a couple of years and then move to coke for the better highs. Less drugs, not more would be a good step EDIT: Its extremely well documented that marijuana usage leads to increased vulnerability for addiction to other substances. One of many research links: https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-gateway-drug https://www.drugabuse.gov/publications/research-reports/mari...
- ElatedOwl 9y ago
  I only started using cannabis because I got accustomed to the highs from coffee /s
  - DaiPlusPlus 9y ago
    Slightly off topic, but I do sometimes experience a pleasant and relaxing, but short-lived (5-15 minute) “high” from caffeine comparable to a mild Adderrall high without the motivation drive. People I’ve spoken to about this have generally been dismissive of it as placebo or saying it is atypical - am I alone in experiencing this?
    - trophycase 9y ago
      Caffeine is a stimulant. I personally feel motivational effects for hours from a single cup.
- wavefunction 9y ago
  Marijuana is not a gateway drug. It also offers a safer, less addictive alternative to opiates for some pain management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569620/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569620/ Your opinion is archaic and not supported by facts. It is the distilled ignorance of decades of drug war propaganda propped up by some anecdotes with dubious conclusions.
SnowingXIV 9y ago
It does not take much, I had injury that resulted in a prescription and once it's no longer hitting just the pain receptors (I don't really understand how this all works or claim to) and you feel the "calming" effect you can pretty quickly see why it can become so addictive and scary. Even being educated, happy, well-off, and aware you can fall to these type of addictions, I can't imagine how hard it must be for many others.
- MichaelMoser123 9y ago
  i am a foreigner trying to understand this issue: why don't they just stop prescribing opium based pain killers to the general public and limit them to cancer patients - like they do in the rest of the world, wouldn't that scale down the crisis? How did the problem get this large? Even Imperial China went to war when Britain started pushing Opium to the public, why wasn't this whole thing stopped much earlier?
  - rand_r 9y ago
    Opium-based pain killers are the most reliable way to ease pain without causing organ damage in the near term. Drugs like Advil and Tylenol cause organ damage even at small doses and are thus unusable for extreme pain. Opiates are used the world over for pain relief, not just for cancer patients. If we had a way to ease pain with something non-addictive that didn’t cause immediate organ damage that would be great.
    - MichaelMoser123 9y ago
      But only in the US there is overprescription and a crisis. Why?
    - zoul 9y ago
      The key difference is the easy availability in the US. It seems to me that the GPs are eager to prescribe you some opiates, whereas here in the Czech Republic they would have to go through quite a lot red tape to do that. Which, given the potential harm, seems like a good idea. (Even though we do have some problems with opiates not being used often enough. But compared to the US situation that’s a great problem to have.)
Nicholas7900 9y ago
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doggydogs94 9y ago
I am sure these problems with opiate addiction centers will be solved by going to a single payer system.
unabst 9y ago
Capitalism is sinister like this. It doesn't intentionally do it, because capitalism isn't a person, but when everything is monetized by our creative entrepreneurs, it grows; our problems being no exception. Once someone makes money, they want more of it. Capitalism demands more of it. And we stretch every line of the law, even cross it, just to get more from where that came from. Unfortunately one person suppressing their unethical behavior is inconsequential. If an opportunity exists, eventually someone will use it.
- mjfl 9y ago
  It's not capitalism, it's people. People do this. Stop absolving them with college-freshman-level ideological appeals.
  - baq 9y ago
    People play the game and the rules are capitalism, sort of. You can and should blame both.
    - unabst 9y ago
      Exactly. People shoot guns. But guns being available is half the problem. Capitalism has it's unique characteristics when paired with people.
- cpursley 9y ago
  I'm not so sure Capitalism is the correct term for this (it's the most misused "'ism"). If there was a free market for drugs (legalization), I suspect we would not be in a crisis.
  - dahdum 9y ago
    "If there was a free market for drugs (legalization), I suspect we would not be in a crisis." If not in direct crisis we'd always be on the knife's edge of one.
amasad 9y ago
The first story of the series about how a short-selling investor was able to uncover a potential murder case against a rehab company and profit from it is an interesting anecdote on how the same market incentives that we tend to blame so much on can also be a force for good. https://www.nytimes.com/interactive/2017/12/27/business/drug-addiction-rehab.html https://www.nytimes.com/interactive/2017/12/27/business/drug...
hesdeadjim 9y ago
I have a lot of friends in the treatment business and some of the stories I’ve heard of unethical providers are absolutely shocking. Ignoring the urine testing schemes, in the worse areas people will sometimes pay clients to relapse after they leave a program so that they can reenroll and they can bill insurance all over again. Google AdWords for treatment became such a problem that Google stopped allowing them because unethical centers were basically killing people. Don’t even get me started on the altnernative “treatments” out there. In a town near me there is a place that will give you amino acid injections and claim that’s all one needs to get clean. It’s obscene that this happens and unfortunately as a consumer it can be hard to separate the good from the bad if you are desperate for help.
- cptskippy 9y ago
  I had a similar experience though the treatment providers were actually trying to work in the patient's best interest. I had a family member who was in and out of treatment for a disorder and discharge was largely dictated by the insurance company against the recommendation of everyone else involved. Without saying as much, the treatment providers strongly implied a quick relapse and return to the facility would ultimately be the best thing because it would reset the clock with insurance.
shawnee_ 9y ago
The "lucrative" aspect of many of these businesses results because they register themselves as 501c3 orgs; yet they clearly operate for-profit enterprises, with active solicitation at jails and courtrooms. This is AKA the body broker model. There was a discussion about it on HN not too long ago: https://news.ycombinator.com/item?id=15024185 https://news.ycombinator.com/item?id=15024185 Report body brokers: https://www.irs.gov/pub/irs-pdf/f13909.pdf https://www.irs.gov/pub/irs-pdf/f13909.pdf
Donnaj 9y ago
Really? And what do you base your unintelligent rumbling on?
Donnaj 9y ago
Evidently you don't know Jack about SLE LUPUS, DISCOID LUOUS, FIBROMYALGIA, TMJ IN BOTH JAWS, IMFLAMATORY ARTHRITIS, OSTEOARTHRITIS, CHRONIC SEVERE INSOMNIA, FULL BODY RESTLESS LEG SYNDROME, SCOLIOSIS, PINCHED NERVE BEHIN THE SPINE, SPINALSTENOSIS, AND HACKERS FOR ALMOST THREE YEARS. ARE DO YOU? ENLIGHTEN ME.
Donnaj 9y ago
I feel nothing that your capable of imagining in your wildest nightmare.
Donnaj 9y ago
Your sinister.
CalChris 9y ago
Marijuana should be legal. That it is a schedule 1 narcotic and that we put people in prison for decades and even life is immoral. https://www.dea.gov/druginfo/ds.shtml https://www.dea.gov/druginfo/ds.shtml http://www.motherjones.com/politics/2015/07/life-sentence-marijuana-pot-prison-commuted/ http://www.motherjones.com/politics/2015/07/life-sentence-ma...
- nkrisc 9y ago
  Interesting how legal opioids are fueling a national 'crisis' while illegal marijuana, though widely used, is not.
  - trhway 9y ago
    Hard to find a person/family devastated by marijuana use. At least devastated beyond what alcohol does.
    - cr1895 9y ago
      It’s not hard to find lives devastated by the illegality of it.
      - trhway 9y ago
        It is devastation by police and/or by trafficking mafia, not by marijuana itself.
  - soundwave106 9y ago
    I personally think the combination of the (legal, or at least government approved) prescription opioid crisis, combined with the relatively successful decriminalization at various levels of cannabis in several states, has really changed the tone of conversation on pharmaceutical compounds, recreational or otherwise. Old paradigms (particularly ones that are not 100% based on factual / scientific analysis, as drug law tended to be) die hard, and it will take some time to change laws as a result. But the moral panic over "illegal drugs" is way less these days than it was in, say, the 1980s.
DaBallsOnDisGuy 9y ago
It's nice to see an exceptional paper like NYTimes bring this issue to light. I look forward to seeing more ground breaking reporting from them.
Feniks 9y ago
I find it endlessly hilarious that nobody in the US is asking WHY Why are people taking drugs? The country needs to do some serious soul searching. Won't happen though.
- neandrake 9y ago
  I've been reading Dreamland by Sam Quinones, which goes into detail and background of the past ~50 years or so about how we got into this situation. A large part of the WHY you're referring to I'll summarize as 1. Pain being identified as a vital sign and hospitals/institutions new-found focus on tracking and treating pain 2. Deceptive pharmaceutical marketing that painkillers are a be-all solution to pain and also non-addictive (Purdue/Sackler seem to be worst offenders here) This lead to doctors prescribing opioid painkillers to many of middle-class americans who would likely have otherwise not come in contact with drug addiction. The book so far has been a really good read and also goes into detail around how heroin started spreading through the rust belt as well (feeding on the existing prescription addiction). I highly recommend it (about 65% through it right now).
  - deleted 9y ago
    [deleted]
  - Feniks 9y ago
    Maybe one day instead of prescribing sleeping pills GPs in the US will try to find out why someone has trouble sleeping. It will even save money.
tcj_phx 9y ago
Somewhat recently I visited a webpage that referenced Gabor Maté's work, In the Realm of Hungry Ghosts: Close Encounters with Addiction [0] - my local library had a copy. Dr. Maté spent decades working with the most hopeless of the residents of "the drug ghetto of Vancouver's Downtown Eastside". [0] https://www.google.com/search?tbm=bks&q=editions:4tpUFXvV_8sC https://www.google.com/search?tbm=bks&q=editions:4tpUFXvV_8s... Part I has some anecdotes from patients - virtually 100% of Dr. Maté's patients suffered from childhood trauma. Part II goes into the science of addiction. "'It may be said without hesitation that for man the most important stressors are emotional', wrote the pioneering Canadian stress researcher and physician Hans Selye." I went to the science library to look up the reference - Dr. Selye discussed how he came to appreciate the general syndrome of being sick, and claimed to have originated the term 'stress' into the medical lexicon. I have to wonder why good science gets ignored, while garbage science [1] persists for decades? [1] https://news.ycombinator.com/item?id=16020617 https://news.ycombinator.com/item?id=16020617 (my comment from yesterday about bad science) This theory of addiction basically matches my observations of my girlfriend's predicament. She had some childhood stress (won't get into here). After six months of my influence she was doing fine, then she got sucked into the mental health system. Her current drug treatment program costs $10,000/month, and is mostly a scam. They try real hard to be helpful, though - I think they want an 'A for Effort'. Helping people to feel safe is most important intervention of all [2]. [2] https://news.ycombinator.com/item?id=15024780 https://news.ycombinator.com/item?id=15024780 - my comment from 134 days ago about the importance of helping people feel safe, and how drug rehab helps people feel like failures. (minor edits) Edit2: Dr. Maté's book tells of how one of his patients described heroin as 'a hug in a needle'... "Chapter 14: Through a Needle, a Warm, Soft Hug" [3] [3] https://books.google.com/books?id=Oew75Hp8XP4C&printsec=frontcover&dq=editions:4tpUFXvV_8sC&hl=en&sa=X&ved=0ahUKEwiP9tupu63YAhUp6oMKHQidD7YQ6AEIJzAA#v=onepage&q=hug%20in%20a%20needle&f=false https://books.google.com/books?id=Oew75Hp8XP4C&printsec=fron... (pg 156)
emiraga 9y ago
And now you have false allegations mounted against Kratom for the purpose of banning it. People were using Kratom to get themself off the heavy drugs with minimal side-effects. But we can't let all that money go to waste, instead they want only publicly available addiction remedy to go to expensive treatments and expensive drugs.
DoreenMichele 9y ago
I just don't see this issue the way others do. "Capitalism" or profit motive certainly is interacting problematically with the issue. But profiteers are not, per se, why we have an opiod epidemic to begin with. The roots of that look pretty complicated. One of the roots is hopelessness. We need to pass universal basic healthcare and solve the affordable housing crisis to make headway on that. Another is, frankly, the success of modern medicine. You can live for decades these days with debilitating conditions that would have just killed you decades ago. And this often means living with a lot of pain. Figuring out how to not just improve lifespan but also quality of life is the answer to that. And it is no small ask. It is quite the tall order.
- microcolonel 9y ago
  > We need to pass universal basic healthcare and solve the affordable housing crisis to make headway on that. Just like them, you jump to your own conclusions.
  - DoreenMichele 9y ago
    Just like them, Them? To whom are you comparing me? you jump to your own conclusions. I am not jumping to anything. I have spent a lot of years studying and contemplating certain problem spaces.
    - microcolonel 9y ago
      > Them? To whom are you comparing me? Well... > I just don't see this issue the way others do. Maybe the others you're referring to. You still jumped to the conclusion, you provided no reasoning to support the (not widely accepted) ideas that single-payer health insurance and subsidized housing will make people less desperate in a way which affects opioid addiction dramatically.
      - DoreenMichele 9y ago
        I comment on this fairly often, so I saw no reason to do a long write up and lots of reasons not to. If you are curious as to my thinking on the matter, you can just ask rather than taking swipes at me.
esaym 9y ago
> Then, the new insurance laws in 2008 and 2010 transformed what had largely been a government-funded and charitable-minded field into an enticing for-profit business. That's freaking discussing and yet another reason I refuse to pay for insurance. I'll take the fines.
nwah1 9y ago
This one is interesting because it deals with a young short seller, Chris Drose, that caused a lot of share price decline in a stock I once held, likewise by writing an article for SeekingAlpha. https://www.nytimes.com/interactive/2017/12/27/business/drug-addiction-rehab.html https://www.nytimes.com/interactive/2017/12/27/business/drug... This is the other stock he did that to, but his article was retracted... of course, only after the stock tanked huge, and continued to tank more afterwards. He must have made a fortune. https://seekingalpha.com/news/3189718-bearish-sa-article-questions-chromadexs-value-cites-connection-stock-promoter-shares-slump-42 https://seekingalpha.com/news/3189718-bearish-sa-article-que... I am amazed by how effective that is, and how he was able to get away with that.
- highd 9y ago
  Investors that investigate companies, identify hidden problems and report on them to the public help enable more accurate price discovery. This wouldn't happen at all if they couldn't trade against it. For instance, I recall a story where a hedge fund sent PIs to determine that a factory reported running was actually closed down. They can't just trade against that info - it also has to be made public for them to realize gains. I can't imagine how you'd consider activity like this "getting away with it", when the alternative is companies performing unscrupulous acts in secret.
  - nwah1 9y ago
    I wasn't criticizing the act of short selling itself. I was criticizing the concept of an individual writing what amounts to a hit piece that was later retracted, and yet profiting off it despite the fact. Or, in the first case, alleging that a company led to the death of an individual, when later the charge of murder was dropped. It piqued my interest that in both cases, the meat of his allegations are at least highly ambiguous. As someone whose job is not nearly as difficult as working with opioid addicts, it would be difficult to condemn such people without damning evidence. That a person having respiratory issues might not be thought of as requiring hospitalization to me seems like something that could happen without negligence on the part of a rehab facility. And the idea that rehab facilities are inherently motivated by greed when compared to cheaper outpatient programs based around prescriptions seems to infer malice when the obvious conclusion is that some people really believe that approach is superior. This claim is the type of thing that a competitor might believe but nobody else should.
cletus 9y ago
Puritanical drug policy in response to the anti-war and hippie movements on the 1960s has a lot to answer for and is a huge contributing factor to this current crisis. - Under Nixon, the Controlled Substances Act of 1970 inexplicably made cannabis a Schedule 1 drug. Cocaine, by comparison, is Schedule 2. - Cannabis became harder to get and more expensive than both cocaine and opiate based drugs. - In 2016, a bill sailed through Congress and was signed into law by Obama with little discussion or concern. It was the result of pharma lobbyists. The bill made it nigh-on-impossible for the DEA to investigate and penalize drug companies of suspicious shipments of drugs [1]. An example of this is shipping NINE MILLION hydrocodone pills over a two year period to a single pharmacy in Kermit, WV with a population of 392 [2]. - A large number of people get onto heroin after becoming addicted to prescription opiates [3], which seem to be dispensed far more frequently in the US than in other developed nations [4]. - Not only does cannabis seem to reduce the rate of opiate addiction, it seems like it might help treat opiate addiction too [5]. I choose to be an optimist here. I see Trumpism as a desperate last gasp for a declining but increasingly militant religious conservative minority in the United States. As much as these short-term policy decisions hurt, I look forward to the day when Puritan ideals will no longer blindly dictate policy with no basis in fact whatsoever. [1] http://www.latimes.com/local/california/la-me-pharma-bill-20160728-snap-story.html http://www.latimes.com/local/california/la-me-pharma-bill-20... [2] https://qz.com/866771/drug-wholesalers-shipped-9-million-opioid-painkillers-over-two-years-to-a-single-west-virginia-pharmacy/ https://qz.com/866771/drug-wholesalers-shipped-9-million-opi... [3] https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use https://www.drugabuse.gov/publications/research-reports/rela... [4] https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html https://www.cnbc.com/2016/04/27/americans-consume-almost-all... [5] http://edition.cnn.com/2017/05/17/health/addiction-cannabis-harm-reduction/index.html http://edition.cnn.com/2017/05/17/health/addiction-cannabis-...
WalterBright 9y ago
The thrust of this is that opiod manufacturers should be sanctioned, charged with crimes, etc. But don't we do that already with cocaine, meth, heroin, etc.? Why should going after the suppliers work for opiods when it failed for every other drug?
FuckPaywalls 9y ago
Has paywall, please remove from HNN

263 points by dpflan 9y ago

TRY HAVING YOU MORE THAN FOUR DISEASES ARE BEING A VETERAN THAT IS IN CONTINUOUS PAIN. BETTER YET WHY DONT U TRY GETTING A CONCIOUS.

quantumofmalice 9y ago

> The industry of addiction treatment is haphazardly regulated, poorly understood and expanding at a rapid clip, bringing in $35 billion a year. Why not focus on the root company and family actually getting rich off selling the damned opioids (Purdue Pharma and the Sacklers, respectively)? I don't understand how this company and family haven't been sued into the ground yet.

minikites 9y ago
Few people actually have the resources to pursue legal remedies and given the demographics of those affected by opioid addiction, I'm completely unsurprised.
- danmaz74 9y ago
  Isn't this a perfect situation to use class action?
  - macintux 9y ago
    I'm not sure how you'd identify participants. Medical privacy rules would prevent you from taking the typical "this consumer product causes warts so we'll find everyone on record of having bought one" approach.
    - moduspol 9y ago
      Have you or a loved one been diagnosed with mesothelioma? Received a vaginal mesh implant? Taken the drug Risperdal? They've been able to do it before.
      - macintux 9y ago
        I guess as someone who doesn't own a TV I've not been exposed to much of that, but I do wonder whether the success rate of such an initiative would be lower among opioid addicts. "Please step forward, admit to the world you're addicted, and in 10-15 years you might get a coupon for free drugs." Also, what are we really looking for? Do addicts really know whether they were overprescribed? Is being addicted sufficient cause for a lawsuit? Anyway, I'm not saying it's unsolvable, but I can imagine some tougher hurdles than the class action suits I've been privy to.
malchow 9y ago
The family are all Democrats. That isn't the sole reason, but if you compare the "shadowy financier" tone of many stories about right-of-center families to the stories about opioids, you'll see that the "shadowiness" component of the reporting suddenly disappears.
- brohoolio 9y ago
  It's not all democrats. Rep. Tom Marino, the main force behind the bill limited the DEA's ability to fight against these companies is a republican. Also Trumps nominee to become the next drug czar. https://www.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/ https://www.washingtonpost.com/graphics/2017/investigations/...
- QAPereo 9y ago
  Please explain this... https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain https://www.newyorker.com/magazine/2017/10/30/the-family-tha...
- quantumofmalice 9y ago
  What bothers me is that this can be interpreted as a "New York thing", to quote Lorne Michaels, and I don't like going down that road.
  - happyrock 9y ago
    What do you mean? EDIT: I googled it, I see where you're going with that...
- fzeroracer 9y ago
  This seems objectively false after even a brief cursory search and I'm curious as to why you think it has anything to do with this topic.
  - dahdum 9y ago
    It's false, but fair to say the family is involved in both political parties. They seem to lean more towards the Democrat side, but that's to be expected given Obama's two terms. The reason it matters is that political clout and general goodwill helps shield them from legislative action and judicial inquiry.
creaghpatr 9y ago
Much has been written on the Sackler family this year, including the article below, but rest assured they are embedded deep in politics and popular culture behind the scenes. Not so easy to simply sue them out of business. https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain https://www.newyorker.com/magazine/2017/10/30/the-family-tha...

NOSHSHNACKERS 9y ago

if we tried to stop them they would just send a gunboat up the river

sidcool 9y ago

I cannot understand why the Government is not acting against the pharmas profiting from this crisis. And why people are not revolting. There is a clear nexus between pharmas and doctors. Something should be done.

MechEStudent 9y ago
The 0.1% unilaterally owns the government. Better than half of all laws are made for them. Where do you think the 0.1% stands on the opioid crisis? It doesn't touch them. It is a poverty-problem, not theirs.
- shams93 9y ago
  They're making money off their big pharma stock holdings do for the 0.1 this addiction crisis is no crisis at all it's an opiate Bonanza
- nol13 9y ago
  Citation? Addiction doesn't care about the size of your bitcoin wallet. But yes all things considered better to be a rich addict than a poor one.
creaghpatr 9y ago
To be fair, the government did launch "what federal officials Thursday called the “largest ever health care fraud enforcement action” by the Medicare Fraud Strike Force, 412 individuals, including 115 doctors, nurses and other licensed medical professionals, were arrested in a nationwide operation that involved more than 1,000 law enforcement agents in at least 30 states." this past July. Not a shabby start. https://www.washingtonpost.com/news/business/wp/2017/07/13/doj-announces-charges-against-400-people-for-1-3-billion-in-health-care-fraud/?utm_term=.9be94be043e9 https://www.washingtonpost.com/news/business/wp/2017/07/13/d...
wu-ikkyu 9y ago
>I cannot understand why the Government is not acting against the pharmas profiting from this crisis. $$$ > And why people are not revolting. Drugs are an effective and subtle form of chemical warfare. They keep the people docile and apathetic.

MechEStudent 9y ago

Paywalled.

jijji 9y ago

Heroin is a Schedule I (in the US) which means no medical benefit, and its a 20 year felony for distributing it. There is also the Federal Analogue Act, 21 U.S.C. § 813, which is supposed to group similar drugs in the same category. So, how do these companies get away with selling analogs of heroin? Shouldn't the people who work there and make money off these opioid drugs be arrested? Why haven't they?

sandworm101 9y ago
Because what they sell isnt on the schedual and does have medical use. Hate opiods addiction and overprescription, but dont forget that these things have a place.
- DanielBMarkham 9y ago
  Absolutely yes. We don't want to go back to a world without drugs for chronic and severe pain. For all the hoopla around the addiction problem, we must never forget there are real people who need these things. With some of the treatment options, as I understand it, it's even possible to be an addict and a functioning member of society. I start worrying in public discussions when people ascribe too much good or evil to inanimate objects. Drugs are tools, like a lot of other things. They can do great good or evil. It's how we use them that makes the difference. Education will get us a lot further in helping folks than prohibition ever will.
  - macintux 9y ago
    > With some of the treatment options, as I understand it, it's even possible to be an addict and a functioning member of society. Absolutely. Unfortunately it's often very hard to get good treatment options. A close friend of mine has to travel 45 minutes each way, each day, to get to a clinic where she pays $20 each day. ...and she's fortunate that she was able to get a spot there after spending months buying suboxone from other addicts because she couldn't get a doctor to prescribe it because doctors are constrained on how many prescriptions they can write. When you're poor and have no reliable transportation, that's a brutal way to live. Falling into addiction is easy, and often you never truly escape.

pmc1 9y ago

> Millions of people have fallen victim to drugs, painkiller abuse, alcoholism, the rise of meth and the revival of heroin. Through all this carnage somehow the left still fights for the legalization of the gateway drug marijuana. Of course not all weed users move towards harder drugs, but it opens the door to more lethal drugs once susceptible individuals become accustomed to the highs. I have personally seen friends from college smoke weed for a couple of years and then move to coke for the better highs. Less drugs, not more would be a good step EDIT: Its extremely well documented that marijuana usage leads to increased vulnerability for addiction to other substances. One of many research links: https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-gateway-drug https://www.drugabuse.gov/publications/research-reports/mari...

ElatedOwl 9y ago
I only started using cannabis because I got accustomed to the highs from coffee /s
- DaiPlusPlus 9y ago
  Slightly off topic, but I do sometimes experience a pleasant and relaxing, but short-lived (5-15 minute) “high” from caffeine comparable to a mild Adderrall high without the motivation drive. People I’ve spoken to about this have generally been dismissive of it as placebo or saying it is atypical - am I alone in experiencing this?
  - trophycase 9y ago
    Caffeine is a stimulant. I personally feel motivational effects for hours from a single cup.
wavefunction 9y ago
Marijuana is not a gateway drug. It also offers a safer, less addictive alternative to opiates for some pain management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569620/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569620/ Your opinion is archaic and not supported by facts. It is the distilled ignorance of decades of drug war propaganda propped up by some anecdotes with dubious conclusions.

SnowingXIV 9y ago

It does not take much, I had injury that resulted in a prescription and once it's no longer hitting just the pain receptors (I don't really understand how this all works or claim to) and you feel the "calming" effect you can pretty quickly see why it can become so addictive and scary. Even being educated, happy, well-off, and aware you can fall to these type of addictions, I can't imagine how hard it must be for many others.

MichaelMoser123 9y ago
i am a foreigner trying to understand this issue: why don't they just stop prescribing opium based pain killers to the general public and limit them to cancer patients - like they do in the rest of the world, wouldn't that scale down the crisis? How did the problem get this large? Even Imperial China went to war when Britain started pushing Opium to the public, why wasn't this whole thing stopped much earlier?
- rand_r 9y ago
  Opium-based pain killers are the most reliable way to ease pain without causing organ damage in the near term. Drugs like Advil and Tylenol cause organ damage even at small doses and are thus unusable for extreme pain. Opiates are used the world over for pain relief, not just for cancer patients. If we had a way to ease pain with something non-addictive that didn’t cause immediate organ damage that would be great.
  - MichaelMoser123 9y ago
    But only in the US there is overprescription and a crisis. Why?
  - zoul 9y ago
    The key difference is the easy availability in the US. It seems to me that the GPs are eager to prescribe you some opiates, whereas here in the Czech Republic they would have to go through quite a lot red tape to do that. Which, given the potential harm, seems like a good idea. (Even though we do have some problems with opiates not being used often enough. But compared to the US situation that’s a great problem to have.)

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doggydogs94 9y ago

I am sure these problems with opiate addiction centers will be solved by going to a single payer system.

unabst 9y ago

Capitalism is sinister like this. It doesn't intentionally do it, because capitalism isn't a person, but when everything is monetized by our creative entrepreneurs, it grows; our problems being no exception. Once someone makes money, they want more of it. Capitalism demands more of it. And we stretch every line of the law, even cross it, just to get more from where that came from. Unfortunately one person suppressing their unethical behavior is inconsequential. If an opportunity exists, eventually someone will use it.

mjfl 9y ago
It's not capitalism, it's people. People do this. Stop absolving them with college-freshman-level ideological appeals.
- baq 9y ago
  People play the game and the rules are capitalism, sort of. You can and should blame both.
  - unabst 9y ago
    Exactly. People shoot guns. But guns being available is half the problem. Capitalism has it's unique characteristics when paired with people.
cpursley 9y ago
I'm not so sure Capitalism is the correct term for this (it's the most misused "'ism"). If there was a free market for drugs (legalization), I suspect we would not be in a crisis.
- dahdum 9y ago
  "If there was a free market for drugs (legalization), I suspect we would not be in a crisis." If not in direct crisis we'd always be on the knife's edge of one.

amasad 9y ago

The first story of the series about how a short-selling investor was able to uncover a potential murder case against a rehab company and profit from it is an interesting anecdote on how the same market incentives that we tend to blame so much on can also be a force for good. https://www.nytimes.com/interactive/2017/12/27/business/drug-addiction-rehab.html https://www.nytimes.com/interactive/2017/12/27/business/drug...

hesdeadjim 9y ago

I have a lot of friends in the treatment business and some of the stories I’ve heard of unethical providers are absolutely shocking. Ignoring the urine testing schemes, in the worse areas people will sometimes pay clients to relapse after they leave a program so that they can reenroll and they can bill insurance all over again. Google AdWords for treatment became such a problem that Google stopped allowing them because unethical centers were basically killing people. Don’t even get me started on the altnernative “treatments” out there. In a town near me there is a place that will give you amino acid injections and claim that’s all one needs to get clean. It’s obscene that this happens and unfortunately as a consumer it can be hard to separate the good from the bad if you are desperate for help.

cptskippy 9y ago
I had a similar experience though the treatment providers were actually trying to work in the patient's best interest. I had a family member who was in and out of treatment for a disorder and discharge was largely dictated by the insurance company against the recommendation of everyone else involved. Without saying as much, the treatment providers strongly implied a quick relapse and return to the facility would ultimately be the best thing because it would reset the clock with insurance.

shawnee_ 9y ago

The "lucrative" aspect of many of these businesses results because they register themselves as 501c3 orgs; yet they clearly operate for-profit enterprises, with active solicitation at jails and courtrooms. This is AKA the body broker model. There was a discussion about it on HN not too long ago: https://news.ycombinator.com/item?id=15024185 https://news.ycombinator.com/item?id=15024185 Report body brokers: https://www.irs.gov/pub/irs-pdf/f13909.pdf https://www.irs.gov/pub/irs-pdf/f13909.pdf

Donnaj 9y ago

Really? And what do you base your unintelligent rumbling on?

Donnaj 9y ago

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Donnaj 9y ago

I feel nothing that your capable of imagining in your wildest nightmare.

Donnaj 9y ago

Your sinister.

CalChris 9y ago

Marijuana should be legal. That it is a schedule 1 narcotic and that we put people in prison for decades and even life is immoral. https://www.dea.gov/druginfo/ds.shtml https://www.dea.gov/druginfo/ds.shtml http://www.motherjones.com/politics/2015/07/life-sentence-marijuana-pot-prison-commuted/ http://www.motherjones.com/politics/2015/07/life-sentence-ma...

nkrisc 9y ago
Interesting how legal opioids are fueling a national 'crisis' while illegal marijuana, though widely used, is not.
- trhway 9y ago
  Hard to find a person/family devastated by marijuana use. At least devastated beyond what alcohol does.
  - cr1895 9y ago
    It’s not hard to find lives devastated by the illegality of it.
    - trhway 9y ago
      It is devastation by police and/or by trafficking mafia, not by marijuana itself.
- soundwave106 9y ago
  I personally think the combination of the (legal, or at least government approved) prescription opioid crisis, combined with the relatively successful decriminalization at various levels of cannabis in several states, has really changed the tone of conversation on pharmaceutical compounds, recreational or otherwise. Old paradigms (particularly ones that are not 100% based on factual / scientific analysis, as drug law tended to be) die hard, and it will take some time to change laws as a result. But the moral panic over "illegal drugs" is way less these days than it was in, say, the 1980s.

DaBallsOnDisGuy 9y ago

It's nice to see an exceptional paper like NYTimes bring this issue to light. I look forward to seeing more ground breaking reporting from them.

Feniks 9y ago

I find it endlessly hilarious that nobody in the US is asking WHY Why are people taking drugs? The country needs to do some serious soul searching. Won't happen though.

neandrake 9y ago
I've been reading Dreamland by Sam Quinones, which goes into detail and background of the past ~50 years or so about how we got into this situation. A large part of the WHY you're referring to I'll summarize as 1. Pain being identified as a vital sign and hospitals/institutions new-found focus on tracking and treating pain 2. Deceptive pharmaceutical marketing that painkillers are a be-all solution to pain and also non-addictive (Purdue/Sackler seem to be worst offenders here) This lead to doctors prescribing opioid painkillers to many of middle-class americans who would likely have otherwise not come in contact with drug addiction. The book so far has been a really good read and also goes into detail around how heroin started spreading through the rust belt as well (feeding on the existing prescription addiction). I highly recommend it (about 65% through it right now).
- deleted 9y ago
  [deleted]
- Feniks 9y ago
  Maybe one day instead of prescribing sleeping pills GPs in the US will try to find out why someone has trouble sleeping. It will even save money.

tcj_phx 9y ago

Somewhat recently I visited a webpage that referenced Gabor Maté's work, In the Realm of Hungry Ghosts: Close Encounters with Addiction [0] - my local library had a copy. Dr. Maté spent decades working with the most hopeless of the residents of "the drug ghetto of Vancouver's Downtown Eastside". [0] https://www.google.com/search?tbm=bks&q=editions:4tpUFXvV_8sC https://www.google.com/search?tbm=bks&q=editions:4tpUFXvV_8s... Part I has some anecdotes from patients - virtually 100% of Dr. Maté's patients suffered from childhood trauma. Part II goes into the science of addiction. "'It may be said without hesitation that for man the most important stressors are emotional', wrote the pioneering Canadian stress researcher and physician Hans Selye." I went to the science library to look up the reference - Dr. Selye discussed how he came to appreciate the general syndrome of being sick, and claimed to have originated the term 'stress' into the medical lexicon. I have to wonder why good science gets ignored, while garbage science [1] persists for decades? [1] https://news.ycombinator.com/item?id=16020617 https://news.ycombinator.com/item?id=16020617 (my comment from yesterday about bad science) This theory of addiction basically matches my observations of my girlfriend's predicament. She had some childhood stress (won't get into here). After six months of my influence she was doing fine, then she got sucked into the mental health system. Her current drug treatment program costs $10,000/month, and is mostly a scam. They try real hard to be helpful, though - I think they want an 'A for Effort'. Helping people to feel safe is most important intervention of all [2]. [2] https://news.ycombinator.com/item?id=15024780 https://news.ycombinator.com/item?id=15024780 - my comment from 134 days ago about the importance of helping people feel safe, and how drug rehab helps people feel like failures. (minor edits) Edit2: Dr. Maté's book tells of how one of his patients described heroin as 'a hug in a needle'... "Chapter 14: Through a Needle, a Warm, Soft Hug" [3] [3] https://books.google.com/books?id=Oew75Hp8XP4C&printsec=frontcover&dq=editions:4tpUFXvV_8sC&hl=en&sa=X&ved=0ahUKEwiP9tupu63YAhUp6oMKHQidD7YQ6AEIJzAA#v=onepage&q=hug%20in%20a%20needle&f=false https://books.google.com/books?id=Oew75Hp8XP4C&printsec=fron... (pg 156)

emiraga 9y ago

And now you have false allegations mounted against Kratom for the purpose of banning it. People were using Kratom to get themself off the heavy drugs with minimal side-effects. But we can't let all that money go to waste, instead they want only publicly available addiction remedy to go to expensive treatments and expensive drugs.

DoreenMichele 9y ago

I just don't see this issue the way others do. "Capitalism" or profit motive certainly is interacting problematically with the issue. But profiteers are not, per se, why we have an opiod epidemic to begin with. The roots of that look pretty complicated. One of the roots is hopelessness. We need to pass universal basic healthcare and solve the affordable housing crisis to make headway on that. Another is, frankly, the success of modern medicine. You can live for decades these days with debilitating conditions that would have just killed you decades ago. And this often means living with a lot of pain. Figuring out how to not just improve lifespan but also quality of life is the answer to that. And it is no small ask. It is quite the tall order.

microcolonel 9y ago
> We need to pass universal basic healthcare and solve the affordable housing crisis to make headway on that. Just like them, you jump to your own conclusions.
- DoreenMichele 9y ago
  Just like them, Them? To whom are you comparing me? you jump to your own conclusions. I am not jumping to anything. I have spent a lot of years studying and contemplating certain problem spaces.
  - microcolonel 9y ago
    > Them? To whom are you comparing me? Well... > I just don't see this issue the way others do. Maybe the others you're referring to. You still jumped to the conclusion, you provided no reasoning to support the (not widely accepted) ideas that single-payer health insurance and subsidized housing will make people less desperate in a way which affects opioid addiction dramatically.
    - DoreenMichele 9y ago
      I comment on this fairly often, so I saw no reason to do a long write up and lots of reasons not to. If you are curious as to my thinking on the matter, you can just ask rather than taking swipes at me.

esaym 9y ago

> Then, the new insurance laws in 2008 and 2010 transformed what had largely been a government-funded and charitable-minded field into an enticing for-profit business. That's freaking discussing and yet another reason I refuse to pay for insurance. I'll take the fines.

nwah1 9y ago

This one is interesting because it deals with a young short seller, Chris Drose, that caused a lot of share price decline in a stock I once held, likewise by writing an article for SeekingAlpha. https://www.nytimes.com/interactive/2017/12/27/business/drug-addiction-rehab.html https://www.nytimes.com/interactive/2017/12/27/business/drug... This is the other stock he did that to, but his article was retracted... of course, only after the stock tanked huge, and continued to tank more afterwards. He must have made a fortune. https://seekingalpha.com/news/3189718-bearish-sa-article-questions-chromadexs-value-cites-connection-stock-promoter-shares-slump-42 https://seekingalpha.com/news/3189718-bearish-sa-article-que... I am amazed by how effective that is, and how he was able to get away with that.

highd 9y ago
Investors that investigate companies, identify hidden problems and report on them to the public help enable more accurate price discovery. This wouldn't happen at all if they couldn't trade against it. For instance, I recall a story where a hedge fund sent PIs to determine that a factory reported running was actually closed down. They can't just trade against that info - it also has to be made public for them to realize gains. I can't imagine how you'd consider activity like this "getting away with it", when the alternative is companies performing unscrupulous acts in secret.
- nwah1 9y ago
  I wasn't criticizing the act of short selling itself. I was criticizing the concept of an individual writing what amounts to a hit piece that was later retracted, and yet profiting off it despite the fact. Or, in the first case, alleging that a company led to the death of an individual, when later the charge of murder was dropped. It piqued my interest that in both cases, the meat of his allegations are at least highly ambiguous. As someone whose job is not nearly as difficult as working with opioid addicts, it would be difficult to condemn such people without damning evidence. That a person having respiratory issues might not be thought of as requiring hospitalization to me seems like something that could happen without negligence on the part of a rehab facility. And the idea that rehab facilities are inherently motivated by greed when compared to cheaper outpatient programs based around prescriptions seems to infer malice when the obvious conclusion is that some people really believe that approach is superior. This claim is the type of thing that a competitor might believe but nobody else should.

cletus 9y ago

Puritanical drug policy in response to the anti-war and hippie movements on the 1960s has a lot to answer for and is a huge contributing factor to this current crisis. - Under Nixon, the Controlled Substances Act of 1970 inexplicably made cannabis a Schedule 1 drug. Cocaine, by comparison, is Schedule 2. - Cannabis became harder to get and more expensive than both cocaine and opiate based drugs. - In 2016, a bill sailed through Congress and was signed into law by Obama with little discussion or concern. It was the result of pharma lobbyists. The bill made it nigh-on-impossible for the DEA to investigate and penalize drug companies of suspicious shipments of drugs [1]. An example of this is shipping NINE MILLION hydrocodone pills over a two year period to a single pharmacy in Kermit, WV with a population of 392 [2]. - A large number of people get onto heroin after becoming addicted to prescription opiates [3], which seem to be dispensed far more frequently in the US than in other developed nations [4]. - Not only does cannabis seem to reduce the rate of opiate addiction, it seems like it might help treat opiate addiction too [5]. I choose to be an optimist here. I see Trumpism as a desperate last gasp for a declining but increasingly militant religious conservative minority in the United States. As much as these short-term policy decisions hurt, I look forward to the day when Puritan ideals will no longer blindly dictate policy with no basis in fact whatsoever. [1] http://www.latimes.com/local/california/la-me-pharma-bill-20160728-snap-story.html http://www.latimes.com/local/california/la-me-pharma-bill-20... [2] https://qz.com/866771/drug-wholesalers-shipped-9-million-opioid-painkillers-over-two-years-to-a-single-west-virginia-pharmacy/ https://qz.com/866771/drug-wholesalers-shipped-9-million-opi... [3] https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use https://www.drugabuse.gov/publications/research-reports/rela... [4] https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html https://www.cnbc.com/2016/04/27/americans-consume-almost-all... [5] http://edition.cnn.com/2017/05/17/health/addiction-cannabis-harm-reduction/index.html http://edition.cnn.com/2017/05/17/health/addiction-cannabis-...

WalterBright 9y ago

The thrust of this is that opiod manufacturers should be sanctioned, charged with crimes, etc. But don't we do that already with cocaine, meth, heroin, etc.? Why should going after the suppliers work for opiods when it failed for every other drug?

FuckPaywalls 9y ago

Has paywall, please remove from HNN