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There's something odd about this article. The opiod crisis is a crisis, and we should go about mitigating the consequences of having so many addicts (And stop c

There's something odd about this article. The opiod crisis is a crisis, and we should go about mitigating the consequences of having so many addicts (And stop creating new ones as much as possible.) I think it's because there are some hidden assumptions going on that the author just needs to come out and fess up to. One, that drug companies should look at shipments per town as being an indicator of problems. Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. You shut-off/slow-down the pill flow, you just create a bigger black market. Addiction is a natural result of using opiods to treat pain. It is not caused by too many pills. Three, that drug companies are the only people with agency here. Surely there are doctors, pharmacists, nurse-practitioners, ministers, social workers, and a slew of other people in these towns that are exposed to this problem every day. Many of them assist in the problem, either directly or through studied ignorance. This is a complex social problem with lots of players. Simplifying it to "evil drug companies" dumbs the problem down to the point of being intractable. I'm not sure this article educated anybody as much as it made them upset. I'm struggling to find something useful and positive to say about how it could be improved. I sure don't want drug companies using some kind of statistical process control to determine who can get pills or not. That's whack.

DanBC 9y ago
> Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. You shut-off/slow-down the pill flow, you just create a bigger black market. Addiction is a natural result of using opiods to treat pain. It is not caused by too many pills. When you make the medication you know how additictive it is. You have all the studies you published showing that it's mildly addictive. You have all the studies you didn't publish showing it's somewhat more addictive. You also know what safe dosing levels are, and what the target audience is, and how many pills you predict to sell per capita in a region. So when you see a small doctor's office ordering vast quantities you should be clued in that maybe they're not a good doctor, maybe they're a pill-mill. https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-fueled-pill-mills-in-rural-wv/article_14c8e1a5-19b1-579d-9ed5-770f09589a22.html https://www.wvgazettemail.com/news/cops_and_courts/drug-firm...
- DanielBMarkham 9y ago
  I follow the reasoning, it just strikes me as facile. Surely not every town with a statistically-outlying amount of opiod drug purchases is full of addicts. Some towns have hospitals that are not part of the town's population. Or clinics. Or pain centers. You're mixing up a bunch of stats and claiming a conspiracy. Yes, in general there's something amiss, no doubt. But in general people are married with 2.3 kids. Generalities don't public policy make. If we're all going to go banging on the drug companies, and I'm fine with that, by the way, then let's talk about lobbying, kickbacks for doctors, marketing, and so forth. They're doing actual direct things that may be making the problem worse. Failure to follow up on anomalies like this isn't one of them. What would you have them do? Create a report, investigate each problem? Will you deny pain drugs to people who need them because other people in their town are using a pill mill? There's no remedy here that makes any sense. What it feels to me like is an easy fishing expedition where you can put together some reports, make a few statements, bring in Big Pharma for a photo op. Maybe get some donations for the next election. It doesn't feel like any kind of process aimed at either discovering or dealing with causality. It's crap. Worse still, you play these stupid games, you end up having discussions like we did with the cigarette companies. Most people who smoke do not get cancer. That's a true stat -- they usually die from heart disease or other causes before they live that long. Stats are fun. You can do all kinds of things with them, just about anything. (Insert long discussion here about the problems encountered when stats are used) Sorry. I didn't mean to pick on you. Like I said, the article itself bugged me. We have a serious problem and we need to take serious action to help people. I think because it's such a serious problem, people tend to overreact in public discussion. A bit of hyperbole is fine. Personal attacks are not. Hopefully I didn't do that.
JKCalhoun 9y ago
> Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. I hope you're right and it's not the other way around. If you had told me a few years ago that drug companies were in on the take — that the drug companies had caused the opioid crisis, I would have told you to put your tin foil hat back on and stop watching 70's conspiracy films. But with the millions (billions?) of dollars we're talking about and pharma's questionable track record....
- drspacemonkey 9y ago
  >I hope you're right and it's not the other way around. Sadly, it is the other way around. Purdue spent millions of dollars advertising Oxycontin as a safe, less-addictive painkiller for chronic pain. Doctors were inundated with "FDA-approved" marketing info, telling them that this specific kind of heroin was an easy, twice-per-day way to deal with back problems, knee pain, arthritis, etc. It was so deceptive that three of their executives were found guilty of criminal charges, and the company was hit with a fine so high it was a record in the pharmaceutical industry. After people had been prescribed what is effectively heroin on a regular basis for months or years, they were addicted.
kbenson 9y ago
> Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. And epidemic takes two things, and infection vector, and a high spread rate. Supplying far too many pills, if that is indeed what they did, allows for a higher infection rate, and let's a problem become an epidemic. > You shut-off/slow-down the pill flow, you just create a bigger black market. Addiction is a natural result of using opiods to treat pain. It is not caused by too many pills. If it's already established, then yes, you create a large black market because the demand is already there. When looking at the problem from the beginning though, it's clear to me that restricted supply would lead to restricted growth to some degree. The question is what degree? If there were no pills to be shipped to these locations, and there never was, what would it look like now? What about 10% of the amount that was shipped? What if it was 1000% of the amount that actually shipped? Unless those scenarios would cause little or no difference in the current situation, it's clear that supply has considerable effect on how the problem develops and progresses. > Three, that drug companies are the only people with agency here. Surely there are doctors, pharmacists, nurse-practitioners, ministers, social workers, and a slew of other people in these towns that are exposed to this problem every day. Yes, but we talk about and deal with those people all the time. Doctors and pharmacists lose their licenses, people go to jail. But that's individual people, and their individual effect on the problem is necessarily small. There are relatively few drug companies, so if even one is acting negligently then we need to look very closely, and very hard, as their effect on the system and thus the problem is much greater. It's the same everywhere. Out of a clerk, policeman, judge, and politician, whose corruption has the ability to cause harm to the most people? The drug companies are at the top of this pyramid, so they deserve quite a bit of scrutiny.

DanBC 9y ago

> Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. You shut-off/slow-down the pill flow, you just create a bigger black market. Addiction is a natural result of using opiods to treat pain. It is not caused by too many pills. When you make the medication you know how additictive it is. You have all the studies you published showing that it's mildly addictive. You have all the studies you didn't publish showing it's somewhat more addictive. You also know what safe dosing levels are, and what the target audience is, and how many pills you predict to sell per capita in a region. So when you see a small doctor's office ordering vast quantities you should be clued in that maybe they're not a good doctor, maybe they're a pill-mill. https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-fueled-pill-mills-in-rural-wv/article_14c8e1a5-19b1-579d-9ed5-770f09589a22.html https://www.wvgazettemail.com/news/cops_and_courts/drug-firm...

DanielBMarkham 9y ago
I follow the reasoning, it just strikes me as facile. Surely not every town with a statistically-outlying amount of opiod drug purchases is full of addicts. Some towns have hospitals that are not part of the town's population. Or clinics. Or pain centers. You're mixing up a bunch of stats and claiming a conspiracy. Yes, in general there's something amiss, no doubt. But in general people are married with 2.3 kids. Generalities don't public policy make. If we're all going to go banging on the drug companies, and I'm fine with that, by the way, then let's talk about lobbying, kickbacks for doctors, marketing, and so forth. They're doing actual direct things that may be making the problem worse. Failure to follow up on anomalies like this isn't one of them. What would you have them do? Create a report, investigate each problem? Will you deny pain drugs to people who need them because other people in their town are using a pill mill? There's no remedy here that makes any sense. What it feels to me like is an easy fishing expedition where you can put together some reports, make a few statements, bring in Big Pharma for a photo op. Maybe get some donations for the next election. It doesn't feel like any kind of process aimed at either discovering or dealing with causality. It's crap. Worse still, you play these stupid games, you end up having discussions like we did with the cigarette companies. Most people who smoke do not get cancer. That's a true stat -- they usually die from heart disease or other causes before they live that long. Stats are fun. You can do all kinds of things with them, just about anything. (Insert long discussion here about the problems encountered when stats are used) Sorry. I didn't mean to pick on you. Like I said, the article itself bugged me. We have a serious problem and we need to take serious action to help people. I think because it's such a serious problem, people tend to overreact in public discussion. A bit of hyperbole is fine. Personal attacks are not. Hopefully I didn't do that.

JKCalhoun 9y ago

> Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. I hope you're right and it's not the other way around. If you had told me a few years ago that drug companies were in on the take — that the drug companies had caused the opioid crisis, I would have told you to put your tin foil hat back on and stop watching 70's conspiracy films. But with the millions (billions?) of dollars we're talking about and pharma's questionable track record....

drspacemonkey 9y ago
>I hope you're right and it's not the other way around. Sadly, it is the other way around. Purdue spent millions of dollars advertising Oxycontin as a safe, less-addictive painkiller for chronic pain. Doctors were inundated with "FDA-approved" marketing info, telling them that this specific kind of heroin was an easy, twice-per-day way to deal with back problems, knee pain, arthritis, etc. It was so deceptive that three of their executives were found guilty of criminal charges, and the company was hit with a fine so high it was a record in the pharmaceutical industry. After people had been prescribed what is effectively heroin on a regular basis for months or years, they were addicted.

kbenson 9y ago

> Two, that by shipping drugs, drug companies are causing the epidemic. They may be profiting from it, they may support legislation to make it worse, but it doesn't take millions of pills to get hooked. This is a result of additiction, not a cause of it. And epidemic takes two things, and infection vector, and a high spread rate. Supplying far too many pills, if that is indeed what they did, allows for a higher infection rate, and let's a problem become an epidemic. > You shut-off/slow-down the pill flow, you just create a bigger black market. Addiction is a natural result of using opiods to treat pain. It is not caused by too many pills. If it's already established, then yes, you create a large black market because the demand is already there. When looking at the problem from the beginning though, it's clear to me that restricted supply would lead to restricted growth to some degree. The question is what degree? If there were no pills to be shipped to these locations, and there never was, what would it look like now? What about 10% of the amount that was shipped? What if it was 1000% of the amount that actually shipped? Unless those scenarios would cause little or no difference in the current situation, it's clear that supply has considerable effect on how the problem develops and progresses. > Three, that drug companies are the only people with agency here. Surely there are doctors, pharmacists, nurse-practitioners, ministers, social workers, and a slew of other people in these towns that are exposed to this problem every day. Yes, but we talk about and deal with those people all the time. Doctors and pharmacists lose their licenses, people go to jail. But that's individual people, and their individual effect on the problem is necessarily small. There are relatively few drug companies, so if even one is acting negligently then we need to look very closely, and very hard, as their effect on the system and thus the problem is much greater. It's the same everywhere. Out of a clerk, policeman, judge, and politician, whose corruption has the ability to cause harm to the most people? The drug companies are at the top of this pyramid, so they deserve quite a bit of scrutiny.