6 ms·

It's facile and wrong to think of Oxycontin as an unmitigated evil in society. What about all the people who were diagnosed with terminal cancer and were suffer

It's facile and wrong to think of Oxycontin as an unmitigated evil in society. What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain? It doesn't matter if you will get a crippling addiction if you're going to be dead in 8 months anyway. From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day and gave meaningful pain relief even for the worst pain. The drug may well have made bearable the last months of millions of people.

bombela 6y ago
Yes. But do you need to market that to anybody with a headache?
GordonS 6y ago
> From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day There are other opioids with extended release formulas, including morphine - they are nothing new. One of the major problems with OxyContin was that they lied about how long the effects lasted. From memory, they claimed up to 12 hours, and insisted you shouldn't take it more than twice a day. This turned out to be BS, with patients reporting it lasted for 6-8 hours max - just the same as other extended-release opioid formulations.
- AndrewUnmuted 6y ago
  That wasn't a lie. Tolerance is an issue with any narcotic medicine - from amphetamines to opiates. Many patients, whether they take Oxycontin or Vyvanse, will eventually complain that their tolerance will make that claim untrue. It doesn't mean the chemical isn't in their system.
  - GordonS 6y ago
    Tolerance is a separate issue than the one I brought up. The issue of lying about the length of action is not related to tolerance - even patients new to OxyContin complained. I was prescribed OxyContin myself for a while, and know very well that it only works around 6 hours for me, just the same as other ER opioids.
    - AndrewUnmuted 6y ago
      Thanks for this follow-up, I did more research and came across this information [0] on Wikipedia. I am not aware of how anyone would be able to give a guarantee on duration of action. I'm not a doctor, so this could simply be naivety, but how could they possibly make the claim about how long the medicine would work, when all they know is how long the drug takes on average to be ingested and secreted from the patient's system? In my personal experience, I have never been able to feel the effects of opioid medicines as long as the prescribing doctor said to space out doses. Though I have never been prescribed OxyContin or anything that powerful, I fail to see how requiring companies to "guess at" things like this is anything beyond a way to scapegoat a company post-approval when the FDA finds it convenient. [0] https://en.wikipedia.org/wiki/Oxycodone#Duration_of_action https://en.wikipedia.org/wiki/Oxycodone#Duration_of_action
- Balgair 6y ago
  Aside: To Kill a Mockingbird famously had the character of Mrs. Henry Lafayette Dubose, a virulently racist morphine addict. Despite Mrs. Dubose's hatred of Atticus, he calls her the bravest person he ever knew. This is due to her resolve to break her addiction before her death, likely a horrifically painful experience due to her terminal cancer. In a book chock full of memorable people and events, these scenes still speak across the decades as the US struggles with the damnable effects of the Sacklers' unmitigated avarice. The book remains a must read to this day. https://en.wikipedia.org/wiki/List_of_To_Kill_a_Mockingbird_characters#Mrs._Henry_Lafayette_Dubose https://en.wikipedia.org/wiki/List_of_To_Kill_a_Mockingbird_...
ves 6y ago
OxyContin isn’t an unmitigated evil, but the Sacklers are quite a bit closer.
aikah 6y ago
> It's facile and wrong to think of Oxycontin as an unmitigated evil in society. What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain? It doesn't matter if you will get a crippling addiction if you're going to be dead in 8 months anyway. From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day and gave meaningful pain relief even for the worst pain. The drug may well have made bearable the last months of millions of people. Problem is that it was pushed on people who didn't suffer from terminal disease but milder chronic pain, only to make more money, not for the sake of their health. Yes it was effective but it turned people in hardcore addicts who then turned to nastier drugs when they couldn't get their fix. It killed a lot of people and destroyed a lot of families.
- AndrewUnmuted 6y ago
  So, in this scenario, you have a pill and a doctor. You have an inanimate object that cannot defend itself against being prescribed to a person unnecessarily... and you have a doctor, who prescribes drugs to patients. You are choosing to blame the inanimate object, when it is clearly the doctor who has acted unscrupulously.
  - deleted 6y ago
    [deleted]
  - tlrobinson 6y ago
    You’re conveniently ignoring the people who produced and promoted (including apparently paying doctors to prescribe) the inanimate object.
    - AndrewUnmuted 6y ago
      Precisely - I ignored it out of convenience. OxyContin could grow on trees for all I care - it doesn't matter who made it, and that property doesn't do anything to strengthen or diminish my argument. To make the argument you're making, you would have to prove that it doesn't need to exist and was fraudulently made and promoted to deceive, not to help. The problem is that the thing exists, it has a necessary purpose for existing, and by existing it makes the world better for millions of people.
hhs 6y ago
Don’t think the author would disagree with you on the point that it gave pain relief. It was approved by the FDA. But the author does raise questions on the steps taken to achieve this: “The Sacklers have long maintained that they and their company are blameless when it comes to the opioid crisis because OxyContin was fully approved by the Food and Drug Administration. But some of the more shocking passages in the prosecution memo involve previously unreported details about the F.D.A. official in charge of issuing that approval, Dr. Curtis Wright. Prosecutors discovered significant impropriety in the way that Wright shepherded the OxyContin application through the F.D.A., describing his relationship with the company as conspicuously “informal in nature.” Not long after Wright approved the drug for sale, he stepped down from his position. A year later, he took a job at Purdue. According to the prosecution memo, his first-year compensation package was at least three hundred and seventy-nine thousand dollars—roughly three times his previous salary. (Wright declined to comment.)”
- candiodari 6y ago
  I don't get this reasoning. If what's implied is true, that's a failure of the FDA, not of Purdue Pharmaceuticals. Also despite being criminal investigators they refuse to state he did anything wrong. I assure you that that means they couldn't find a comma out of place. And if a single person can subvert an entire government department why bother having one at all ? Furthermore I don't entirely get blaming this on Oxycontin. It's not like it's predecessors were any less addictive ... Morfine is famous for being both heavily addictive and very successful (and is in fact not very different from Oxycontin), as are all the more famous psychoactive drugs (that are even heavily used on children, and do lead to addiction) like Oxazepam and Ritalin. There is the further compounding factor that when used as a "fix" for real problems (like a spine that needs surgery) any pain relief medication, regardless of what it is, will trigger extreme addiction symptoms ... For example, I've had the pleasure of having gall stones. Now let me assure you, I am not addicted to anything and morfine doesn't actually help much in that case, but when it makes the difference from being in constant pain so severe it takes away any and all focus (and sleep) to getting 2-3h of sleep before the pain resumes and sometimes even finishing 10 pages in a book before curling up in pain for the 20th time that day ... 2-3 days of that (needed for booking operating theatre) and you're ready to kill for it. I hate what morfine does to you, especially after finding out Diclovenac would have essentially stopped the pain for real (by relaxing the muscle that was tearing itself with billirubin crystals, it's not even technically pain relief), I mean I would have had severe leakage after eating anything with a bit of fat in it, but no pain. Let's hope I know associate opioids with the pain I felt back then. The last thing I ate before the first real pain hit was strawberries. I still (~5 years later) freeze when I see strawberries in the supermarket and feel terrified. I have to use a lot of willpower to go on. And yes, I've forced myself to eat some, it doesn't help. If you're in need of real medical help (but, say, misdiagnosed or unable to pay), this situation can last for years or decades. But of course real medical help requires days to months of attention from real experts, but pain relief any quack can easily do. You cannot take away severe pain relief and put nothing in it's place ... I mean what's the patient to do ? Kill themselves ? (Which, by the way, seems to have increased dramatically when the opioid crisis started getting fought, so clearly that's one answer that's actually used). And yes, Oxycontin (and Rilatin) takes away your ability to think deeply in a similar way to alcohol. But even a strong dose will not have more effect than mild drunkenness. One might wonder why (especially cheap) alcohol is kept available if you take offence at strong pain relief.
deleted 6y ago
[deleted]
spaetzleesser 6y ago
Oxycontin has its uses and benefits. No doubt. The problem is that the manufacturers thought that's not enough profit. So they expanded their target market and pushed it on people for whom it was a harmful choice. To do this they lied about the necessary doses perfectly knowing that this was a lie. It's the same playbook the tobacco industry used (still does?). Lie about known problems with your product while at the same going all out on sales.
ak217 6y ago
I think what's facile is to discuss the properties of the drug as though the drug itself is representative of the damage that Purdue/Sacklers have done. They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem. I am fully prepared to believe it helped a lot of people - I've had family members get oxy prescribed for serious pain - but their physician should not be getting paid to prescribe more of it.
- hilbert42 6y ago
  'They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem.' Exactly, not only has Purdue's irresponsible pushing up sales of OxyContin led to more people consuming the narcotic but also and more importantly—as we've seen from the opioid epidemic—it means that thousands of patients who are not terminally ill have already become seriously addicted to the drug when otherwise they likely would not have been had they had proper medical care/pain management. I mention terminally ill patents here both because others have done so and the fact that it's necessity to classify them separately from those who are not terminally ill because essentially both groups have very different opioid regimens to each other. For obvious reasons, concern about addiction in terminally ill patients is not as an acute a problem as it is for those who are not terminally ill whereas it is an extremely serious matter for the latter group. The issue of discriminating between pain relief for terminally ill patients and for others who are NOT terminally ill has long historical roots—a fact that many, especially the regulators, (FDA et al) including those within the medical profession who have either seemed to have forgotten the facts or who never learned them in the first instance. Excuse me for not having the exact details to hand, but when international treaties that were concerned with illicit narcotics and the illicit narcotic trade were being signed some 80 years ago, they included provisions that permitted the use of morphine for medical purposes but banned heroin (aka, diamorphine or diacetylmorphine) outright, as then it was considered too dangerous (and unmanageable) for said purpose. This was despite the fact, which was already well known at the time, that heroin is significantly better at suppressing very severe pain than is any increased amount of morphine. Thus, the inclusion of this clause in the treaty meant that heroin became illicit for any purpose. Nevertheless, one country refused to sign the treaty in its entirety. The United Kingdom became the stand-out exception in that whilst it still signed the treaty it had clauses that banned heroin per se struck out and or had them altered to allow heroin to be used in cases of very severe pain that were unable to be adequately controlled with any quantity of morphine. Typically, these were terminally ill patients with cancer. Whilst this enlightened and humane view put British doctors (or at least those ones who controlled policy and regulations) at odds with doctors in other countries, it meant that doctors throughout the UK could [continue] to use heroin in cases where pain was otherwise intractable (note: heroin had been in use before the treaties came into effect). Not only did UK doctors acknowledge that heroin was essential to their pain-relieving arsenal for terminally ill patients but also they went even further in that they continued to use a combination of both heroin and cocaine (and sometimes also in combination with other drugs) in a mixture that became known as Brompton cocktail (named after the UK hospital of the same name). This combination of drugs acted synergistically to not only relieve a cancer sufferer's severe pain but it also made the patient feel substantially better and more comfortable during his or her remaining days. That doctors in other counties did not adopt this approach is, in my opinion, heartless. Whilst concoctions such as Brompton cocktail are not as relevant these days for various reasons too involved to mention here, there's still a longstanding problem with pain management that's not necessarily directly connected with opioid addiction problems. It's as if these bastards have adopted the attitude that too much pain relief is not good for one even if it has nothing to do with increasing addiction. https://en.wikipedia.org/wiki/Brompton_cocktail https://en.wikipedia.org/wiki/Brompton_cocktail Comment on my various posts to this news article: If you read my other/earlier posts here, you'll notice that I'm not only vehemently opposed to the proposed leniency that's likely to be extended to the Sacklers but also you'll see that my anger almost surges to zealot-like proportions over what both they and Purdue have done. My reason for reacting to the extent that I have is that this Sackler/Purdue scandal is not just another instance of corporate corruption caused by the nefarious actions of bad and greedy players—rather; it goes much, much further than that. Those of us who actually understand the true extent of what has happened in this horrible saga know that the issues it crosses are those that are fundamental to underlying integrity of modern medicine. The matter is truly that significant and the fact that so many people do not really care about it is truly tragic. Like so many other things that have gone wrong these days, it almost seems that people have willingly parted with their long-held ethical values for good. The matter of opioid regulations was about as high as it got in international treaties. The fact that Sacklers and Purdue have completely undermined that 100-year understanding between nations is just staggering. Moreover, as I've shown, it is not only the medical profession that was convinced of the absolute necessity to tightly control the distribution of opiates. As we can see from the universal actions of governments around the world some 80 or so years ago, in that they were all of similar minds and convinced to the extent that they were prepared to enter into international treaties that bound both them and their citizens to this effect. In addition, each government then enacted strict local drug law legislation with draconian penalties to back said treaties. Essentially, that for the better part of a century, the regulated control and distribution of narcotic opioids and other drugs of addiction has not only been of prime concern to the medical profession worldwide but also to every government on the planet for the very reason that the unregulated distribution of these drugs would have a devastating negative affect on their citizens. Stated another way: that if the world's citizens were given unregulated and unfretted access to drugs of addiction then many of them would suffer irreparable harm and damage to themselves from having access to said drugs—is a notion upon which both the medical profession and governments almost universally agree—and they have so agreed to this notion for most of the 20th Century and they continue do so into the 21st Century. That long-winded statement is to emphasize the universality of this position. What you have to understand is that the Sacklers and Purdue have deliberately undermined that almost universal covenant on drugs of addiction and they have done so in the most despicable, reprehensible and nefarious way possible. The family/company combo of Sackler/Purdue, whose ethics are as equally bad as the large illegal drug cartel barons, acted outrageously and in an irresponsible manner by deliberately co-opting and undermining the ethics of many doctors by bribing them. Many of who have since acted in a greedy and disingenuous towards their patients, not to mention also having breached their Hippocratic Oath towards them. In summary, the Sacklers and Purdue along with their complicit doctors including the irresponsible FDA have completely undermined the very foundations of present day medical 'law', in essence they've torn away the ethical fabric from asunder, and in so doing they have effectively destroyed the universal consensus that's been built up over the past one hundred years or so between the medical profession, the regulators such as the FDA and those countries that signed the otherwise irrevocable drug treaties. The fact that Sacklers/Purdue can wield this much power is, in my view, terrifying.
akamaka 6y ago
> The drug may well have made bearable the last months of millions of people. If you think that is a fair trade-off, how many deaths would you consider acceptable to gain the pain relief benefit? As an exercise, try calculating an exact number and then comparing that to actual deaths from the opioid epidemic.
mensetmanusman 6y ago
This is analogous to point out that ‘guns don’t kill people, people do’ It is true, but there is a point at which giving it out like candy might change the stakes.
Reason077 6y ago
> "What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain?" I don't think anyone would disagree here. But they weren't just prescribing it to terminal cancer patients, were they? "With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients."

bombela 6y ago

Yes. But do you need to market that to anybody with a headache?

GordonS 6y ago

> From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day There are other opioids with extended release formulas, including morphine - they are nothing new. One of the major problems with OxyContin was that they lied about how long the effects lasted. From memory, they claimed up to 12 hours, and insisted you shouldn't take it more than twice a day. This turned out to be BS, with patients reporting it lasted for 6-8 hours max - just the same as other extended-release opioid formulations.

AndrewUnmuted 6y ago
That wasn't a lie. Tolerance is an issue with any narcotic medicine - from amphetamines to opiates. Many patients, whether they take Oxycontin or Vyvanse, will eventually complain that their tolerance will make that claim untrue. It doesn't mean the chemical isn't in their system.
- GordonS 6y ago
  Tolerance is a separate issue than the one I brought up. The issue of lying about the length of action is not related to tolerance - even patients new to OxyContin complained. I was prescribed OxyContin myself for a while, and know very well that it only works around 6 hours for me, just the same as other ER opioids.
  - AndrewUnmuted 6y ago
    Thanks for this follow-up, I did more research and came across this information [0] on Wikipedia. I am not aware of how anyone would be able to give a guarantee on duration of action. I'm not a doctor, so this could simply be naivety, but how could they possibly make the claim about how long the medicine would work, when all they know is how long the drug takes on average to be ingested and secreted from the patient's system? In my personal experience, I have never been able to feel the effects of opioid medicines as long as the prescribing doctor said to space out doses. Though I have never been prescribed OxyContin or anything that powerful, I fail to see how requiring companies to "guess at" things like this is anything beyond a way to scapegoat a company post-approval when the FDA finds it convenient. [0] https://en.wikipedia.org/wiki/Oxycodone#Duration_of_action https://en.wikipedia.org/wiki/Oxycodone#Duration_of_action
Balgair 6y ago
Aside: To Kill a Mockingbird famously had the character of Mrs. Henry Lafayette Dubose, a virulently racist morphine addict. Despite Mrs. Dubose's hatred of Atticus, he calls her the bravest person he ever knew. This is due to her resolve to break her addiction before her death, likely a horrifically painful experience due to her terminal cancer. In a book chock full of memorable people and events, these scenes still speak across the decades as the US struggles with the damnable effects of the Sacklers' unmitigated avarice. The book remains a must read to this day. https://en.wikipedia.org/wiki/List_of_To_Kill_a_Mockingbird_characters#Mrs._Henry_Lafayette_Dubose https://en.wikipedia.org/wiki/List_of_To_Kill_a_Mockingbird_...

ves 6y ago

OxyContin isn’t an unmitigated evil, but the Sacklers are quite a bit closer.

aikah 6y ago

> It's facile and wrong to think of Oxycontin as an unmitigated evil in society. What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain? It doesn't matter if you will get a crippling addiction if you're going to be dead in 8 months anyway. From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day and gave meaningful pain relief even for the worst pain. The drug may well have made bearable the last months of millions of people. Problem is that it was pushed on people who didn't suffer from terminal disease but milder chronic pain, only to make more money, not for the sake of their health. Yes it was effective but it turned people in hardcore addicts who then turned to nastier drugs when they couldn't get their fix. It killed a lot of people and destroyed a lot of families.

AndrewUnmuted 6y ago
So, in this scenario, you have a pill and a doctor. You have an inanimate object that cannot defend itself against being prescribed to a person unnecessarily... and you have a doctor, who prescribes drugs to patients. You are choosing to blame the inanimate object, when it is clearly the doctor who has acted unscrupulously.
- deleted 6y ago
  [deleted]
- tlrobinson 6y ago
  You’re conveniently ignoring the people who produced and promoted (including apparently paying doctors to prescribe) the inanimate object.
  - AndrewUnmuted 6y ago
    Precisely - I ignored it out of convenience. OxyContin could grow on trees for all I care - it doesn't matter who made it, and that property doesn't do anything to strengthen or diminish my argument. To make the argument you're making, you would have to prove that it doesn't need to exist and was fraudulently made and promoted to deceive, not to help. The problem is that the thing exists, it has a necessary purpose for existing, and by existing it makes the world better for millions of people.

hhs 6y ago

Don’t think the author would disagree with you on the point that it gave pain relief. It was approved by the FDA. But the author does raise questions on the steps taken to achieve this: “The Sacklers have long maintained that they and their company are blameless when it comes to the opioid crisis because OxyContin was fully approved by the Food and Drug Administration. But some of the more shocking passages in the prosecution memo involve previously unreported details about the F.D.A. official in charge of issuing that approval, Dr. Curtis Wright. Prosecutors discovered significant impropriety in the way that Wright shepherded the OxyContin application through the F.D.A., describing his relationship with the company as conspicuously “informal in nature.” Not long after Wright approved the drug for sale, he stepped down from his position. A year later, he took a job at Purdue. According to the prosecution memo, his first-year compensation package was at least three hundred and seventy-nine thousand dollars—roughly three times his previous salary. (Wright declined to comment.)”

candiodari 6y ago
I don't get this reasoning. If what's implied is true, that's a failure of the FDA, not of Purdue Pharmaceuticals. Also despite being criminal investigators they refuse to state he did anything wrong. I assure you that that means they couldn't find a comma out of place. And if a single person can subvert an entire government department why bother having one at all ? Furthermore I don't entirely get blaming this on Oxycontin. It's not like it's predecessors were any less addictive ... Morfine is famous for being both heavily addictive and very successful (and is in fact not very different from Oxycontin), as are all the more famous psychoactive drugs (that are even heavily used on children, and do lead to addiction) like Oxazepam and Ritalin. There is the further compounding factor that when used as a "fix" for real problems (like a spine that needs surgery) any pain relief medication, regardless of what it is, will trigger extreme addiction symptoms ... For example, I've had the pleasure of having gall stones. Now let me assure you, I am not addicted to anything and morfine doesn't actually help much in that case, but when it makes the difference from being in constant pain so severe it takes away any and all focus (and sleep) to getting 2-3h of sleep before the pain resumes and sometimes even finishing 10 pages in a book before curling up in pain for the 20th time that day ... 2-3 days of that (needed for booking operating theatre) and you're ready to kill for it. I hate what morfine does to you, especially after finding out Diclovenac would have essentially stopped the pain for real (by relaxing the muscle that was tearing itself with billirubin crystals, it's not even technically pain relief), I mean I would have had severe leakage after eating anything with a bit of fat in it, but no pain. Let's hope I know associate opioids with the pain I felt back then. The last thing I ate before the first real pain hit was strawberries. I still (~5 years later) freeze when I see strawberries in the supermarket and feel terrified. I have to use a lot of willpower to go on. And yes, I've forced myself to eat some, it doesn't help. If you're in need of real medical help (but, say, misdiagnosed or unable to pay), this situation can last for years or decades. But of course real medical help requires days to months of attention from real experts, but pain relief any quack can easily do. You cannot take away severe pain relief and put nothing in it's place ... I mean what's the patient to do ? Kill themselves ? (Which, by the way, seems to have increased dramatically when the opioid crisis started getting fought, so clearly that's one answer that's actually used). And yes, Oxycontin (and Rilatin) takes away your ability to think deeply in a similar way to alcohol. But even a strong dose will not have more effect than mild drunkenness. One might wonder why (especially cheap) alcohol is kept available if you take offence at strong pain relief.

deleted 6y ago

[deleted]

spaetzleesser 6y ago

Oxycontin has its uses and benefits. No doubt. The problem is that the manufacturers thought that's not enough profit. So they expanded their target market and pushed it on people for whom it was a harmful choice. To do this they lied about the necessary doses perfectly knowing that this was a lie. It's the same playbook the tobacco industry used (still does?). Lie about known problems with your product while at the same going all out on sales.

ak217 6y ago

I think what's facile is to discuss the properties of the drug as though the drug itself is representative of the damage that Purdue/Sacklers have done. They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem. I am fully prepared to believe it helped a lot of people - I've had family members get oxy prescribed for serious pain - but their physician should not be getting paid to prescribe more of it.

hilbert42 6y ago
'They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem.' Exactly, not only has Purdue's irresponsible pushing up sales of OxyContin led to more people consuming the narcotic but also and more importantly—as we've seen from the opioid epidemic—it means that thousands of patients who are not terminally ill have already become seriously addicted to the drug when otherwise they likely would not have been had they had proper medical care/pain management. I mention terminally ill patents here both because others have done so and the fact that it's necessity to classify them separately from those who are not terminally ill because essentially both groups have very different opioid regimens to each other. For obvious reasons, concern about addiction in terminally ill patients is not as an acute a problem as it is for those who are not terminally ill whereas it is an extremely serious matter for the latter group. The issue of discriminating between pain relief for terminally ill patients and for others who are NOT terminally ill has long historical roots—a fact that many, especially the regulators, (FDA et al) including those within the medical profession who have either seemed to have forgotten the facts or who never learned them in the first instance. Excuse me for not having the exact details to hand, but when international treaties that were concerned with illicit narcotics and the illicit narcotic trade were being signed some 80 years ago, they included provisions that permitted the use of morphine for medical purposes but banned heroin (aka, diamorphine or diacetylmorphine) outright, as then it was considered too dangerous (and unmanageable) for said purpose. This was despite the fact, which was already well known at the time, that heroin is significantly better at suppressing very severe pain than is any increased amount of morphine. Thus, the inclusion of this clause in the treaty meant that heroin became illicit for any purpose. Nevertheless, one country refused to sign the treaty in its entirety. The United Kingdom became the stand-out exception in that whilst it still signed the treaty it had clauses that banned heroin per se struck out and or had them altered to allow heroin to be used in cases of very severe pain that were unable to be adequately controlled with any quantity of morphine. Typically, these were terminally ill patients with cancer. Whilst this enlightened and humane view put British doctors (or at least those ones who controlled policy and regulations) at odds with doctors in other countries, it meant that doctors throughout the UK could [continue] to use heroin in cases where pain was otherwise intractable (note: heroin had been in use before the treaties came into effect). Not only did UK doctors acknowledge that heroin was essential to their pain-relieving arsenal for terminally ill patients but also they went even further in that they continued to use a combination of both heroin and cocaine (and sometimes also in combination with other drugs) in a mixture that became known as Brompton cocktail (named after the UK hospital of the same name). This combination of drugs acted synergistically to not only relieve a cancer sufferer's severe pain but it also made the patient feel substantially better and more comfortable during his or her remaining days. That doctors in other counties did not adopt this approach is, in my opinion, heartless. Whilst concoctions such as Brompton cocktail are not as relevant these days for various reasons too involved to mention here, there's still a longstanding problem with pain management that's not necessarily directly connected with opioid addiction problems. It's as if these bastards have adopted the attitude that too much pain relief is not good for one even if it has nothing to do with increasing addiction. https://en.wikipedia.org/wiki/Brompton_cocktail https://en.wikipedia.org/wiki/Brompton_cocktail Comment on my various posts to this news article: If you read my other/earlier posts here, you'll notice that I'm not only vehemently opposed to the proposed leniency that's likely to be extended to the Sacklers but also you'll see that my anger almost surges to zealot-like proportions over what both they and Purdue have done. My reason for reacting to the extent that I have is that this Sackler/Purdue scandal is not just another instance of corporate corruption caused by the nefarious actions of bad and greedy players—rather; it goes much, much further than that. Those of us who actually understand the true extent of what has happened in this horrible saga know that the issues it crosses are those that are fundamental to underlying integrity of modern medicine. The matter is truly that significant and the fact that so many people do not really care about it is truly tragic. Like so many other things that have gone wrong these days, it almost seems that people have willingly parted with their long-held ethical values for good. The matter of opioid regulations was about as high as it got in international treaties. The fact that Sacklers and Purdue have completely undermined that 100-year understanding between nations is just staggering. Moreover, as I've shown, it is not only the medical profession that was convinced of the absolute necessity to tightly control the distribution of opiates. As we can see from the universal actions of governments around the world some 80 or so years ago, in that they were all of similar minds and convinced to the extent that they were prepared to enter into international treaties that bound both them and their citizens to this effect. In addition, each government then enacted strict local drug law legislation with draconian penalties to back said treaties. Essentially, that for the better part of a century, the regulated control and distribution of narcotic opioids and other drugs of addiction has not only been of prime concern to the medical profession worldwide but also to every government on the planet for the very reason that the unregulated distribution of these drugs would have a devastating negative affect on their citizens. Stated another way: that if the world's citizens were given unregulated and unfretted access to drugs of addiction then many of them would suffer irreparable harm and damage to themselves from having access to said drugs—is a notion upon which both the medical profession and governments almost universally agree—and they have so agreed to this notion for most of the 20th Century and they continue do so into the 21st Century. That long-winded statement is to emphasize the universality of this position. What you have to understand is that the Sacklers and Purdue have deliberately undermined that almost universal covenant on drugs of addiction and they have done so in the most despicable, reprehensible and nefarious way possible. The family/company combo of Sackler/Purdue, whose ethics are as equally bad as the large illegal drug cartel barons, acted outrageously and in an irresponsible manner by deliberately co-opting and undermining the ethics of many doctors by bribing them. Many of who have since acted in a greedy and disingenuous towards their patients, not to mention also having breached their Hippocratic Oath towards them. In summary, the Sacklers and Purdue along with their complicit doctors including the irresponsible FDA have completely undermined the very foundations of present day medical 'law', in essence they've torn away the ethical fabric from asunder, and in so doing they have effectively destroyed the universal consensus that's been built up over the past one hundred years or so between the medical profession, the regulators such as the FDA and those countries that signed the otherwise irrevocable drug treaties. The fact that Sacklers/Purdue can wield this much power is, in my view, terrifying.

akamaka 6y ago

> The drug may well have made bearable the last months of millions of people. If you think that is a fair trade-off, how many deaths would you consider acceptable to gain the pain relief benefit? As an exercise, try calculating an exact number and then comparing that to actual deaths from the opioid epidemic.

mensetmanusman 6y ago

This is analogous to point out that ‘guns don’t kill people, people do’ It is true, but there is a point at which giving it out like candy might change the stakes.

Reason077 6y ago

> "What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain?" I don't think anyone would disagree here. But they weren't just prescribing it to terminal cancer patients, were they? "With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients."