5 ms·

I'm certainly willing to hate the Sacklers, but it should be remembered that they didn't work alone. Nor did Purdue. The FDA approved their drugs. The doctors p

I'm certainly willing to hate the Sacklers, but it should be remembered that they didn't work alone. Nor did Purdue. The FDA approved their drugs. The doctors prescribed them and the pharmacists filled these scripts. What they did was entirely legal. They filled out the forms. Got the government approval and worked within the system. It strikes me as a bit unfair for society to turn around, designate them as a scape goat and then ask them to pay for the sins of everyone.

chuckee 5y ago
That's because the maker of a drug is expected to know more about it than doctors. And when that maker conceals information about it with the deliberate aim of causing overprescription, we are justified in blaming them far more than the doctors they fooled. Purdue Pharma knew about “significant” abuse of OxyContin in the first years after the drug’s introduction in 1996 and concealed that information. - https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy...
- bryan0 5y ago
  > When the Food and Drug Administration approved OxyContin in late 1995, the agency permitted Purdue Pharma to make a unique claim for it — that its long-acting formulation was “believed to reduce” its appeal to drug abusers compared with shorter-acting painkillers like Percocet and Vicodin. It seems like both the FDA and Purdue thought / hoped it would be less addictive, but this was not to be the case. And after it became clear from real-world data that this was not true, the FDA still didn't do anything about it? > a Canadian physician, Dr. Brian Goldman, wrote that the findings turned thinking about the supposed safety of long-acting opioids like OxyContin on its head by showing that drug abusers “coveted” such drugs. “This should ring alarm bells,” Dr. Goldman, who was then a paid speaker for Purdue Pharma, wrote in the editorial. Why wouldn't the FDA act on this alarm? Why would we rely on a pharmaceutical company to police its own drug when there is a clearly a massive conflict of interest? Isn't this what the FDA is for?
jessaustin 5y ago
If the last twenty years have taught us anything, it is that unimaginable amounts of unconscionable evil may be done "legally". That is certainly not the criterion to which thinking people should limit our judgment. We subjects don't decide our laws and regulations. [0] Instead, those are written by lawyers and lobbyists in the employ of reptiles like the Sacklers. They make the rules by which they play, so when we're told to "hate the game, not the players", well, they get that hate too. [0] https://scholar.princeton.edu/sites/default/files/mgilens/files/gilens_and_page_2014_-testing_theories_of_american_politics.doc.pdf https://scholar.princeton.edu/sites/default/files/mgilens/fi...
qeternity 5y ago
100% this. It’s like the Wall Street 2008 hate. Fuck the Sacklers, for sure. But they were nothing without all of the “pain clinics” that were shoving pills down addicts throats.
- CryptoBanker 5y ago
  The Sacklers heavily incentivized those clinics to do that
naasking 5y ago
> The FDA approved their drugs. The doctors prescribed them and the pharmacists filled these scripts. What they did was entirely legal. I think everyone who wants a good background on this issue should read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ Purdue misrepresented many facts in their aggressive marketing.
HappySweeney 5y ago
The Sacklers knew what they were doing was evil, which is why all the hate. Also, why ask for lifetime immunity if it was all legit?
javajosh 5y ago
They got the majority of benefit from the sin, and so deserve the majority of the punishment. Anyway the culpability of others isn't an argument to go easy on the Sacklers, but rather an argument to go after the others, too.
JohnWhigham 5y ago
It strikes me as a bit unfair for society to turn around, designate them as a scape goat and then ask them to pay for the sins of everyone They knew the addictive nature of Oxycontin and that tolerance builds up fast, yet they still told sales reps to pressure doctors to always prescribe subsequent amounts be taken at 12 hours intervals (and not at 8 hour intervals to account for the tolerance buildup). That's fucking egregious. The entire family deserves to be put up against the wall.
Gunax 5y ago
The media has lied about opiods. Most people who take opiods do not get addicted. And most people who are addicted did not start with a legitimate prescription--they started using it as an illicit drug.
- rcurry 5y ago
  What was really strange about the whole Opiod Crisis thing was this weird narrative that was being pushed for a while with all sorts of people claiming that Ibuprofen was just as good as Hydrocodone. I’ve gotten pretty badly messed up a few times, whether a bad landing skydiving or some guy ripping my knee up in jiu jitsu, and I’m sorry but no - Ibuprofen is nowhere near as good for pain relief as opioids are.
- s5300 5y ago
  A significant amount of addictions came from those who were overprescribed and instructed to take, by their doctors (who were instructed and given bogus studies by the Pharma reps) after surgeries, which led to chemical dependence and addiction. Perhaps you could like, read before you post incorrect statements, or so that your attempts at trolling won't be so easily shot down.
  - rcurry 5y ago
    One of the things I enjoy about HN is the fact that we try to steer away from personal attacks. It’s one of the last places on the net where I enjoy taking part in conversations, because even people who disagree completely with me make an effort to keep their arguments civil. Please help us keep it that way.
  - Gunax 5y ago
    Yes, there are thousands of people who got addicted without any history of co-morbidity of addiction. But as a portion of people who were prescribed, they are small. Remember we are talking about a drug that had 245 million prescriptions in the US in 2014. Also, 30% of Americans are living with chronic pain. [2] If anything, we may be under-prescribing these drugs. 1. The narrative is that some poor guy took pain meds for a legitimate reason then ended up addicted. While this does occur, it's actually not very common. > Among people who are prescribed opioids, addiction is relatively uncommon. The percentage of patients who become addicted after taking opioids for chronic pain is measured in the single digits; studies show an incidence from less than 1 percent to 8 percent. Most of the estimates are skewed toward the low end of this range, when those at risk (due to a history of substance abuse or, to a lesser but meaningful extent, a concurrent mental illness) are removed from the sample. 2. Most addicts had a history of drug abuse. > People who abuse pills are rarely new to drugs. The federal government’s 2014 National Survey on Drug Use and Health, for example, revealed that more than three-fourths of misusers had used non-prescribed benzodiazepines, such as Valium or Xanax, or inhalants. A study of Oxycontin users in treatment found that they “were not naive individuals with accidental addictions who were introduced to painkillers by their physicians as reported by the media … [Instead they had] extensive drug use histories.” It's hard to bring this up without straying into classism or victim blaming. The reality is that most people without comorbidities and abuse history are quite safe, and these are drugs we need. [1] https://www.theatlantic.com/ideas/archive/2019/08/what-america-got-wrong-about-opioid-crisis/595090/ https://www.theatlantic.com/ideas/archive/2019/08/what-ameri... [2] https://www.nejm.org/doi/full/10.1056/NEJMra1507771 https://www.nejm.org/doi/full/10.1056/NEJMra1507771 My claims are actually backed by published research (cited within the Atlantic article if you want to check)... Maybe you could like read before you get shot down.
samizdis 5y ago
I see your point, but there have certainly been accusations that the Sacklers directed operations and while knowing risks associated with drug doses. An NYT article from 2019 [1] Sacklers Directed Efforts to Mislead Public About OxyContin, Court Filing Claims lays out the accusations. (I'll try to find the subsequent ruling and add to this.) From that article, albeit citing the prosecutor's case, "... internal Purdue communications are cited by the attorney general of Massachusetts in a new court filing against the company, released on Tuesday. They represent the first evidence that appears to tie the Sacklers to specific decisions made by the company about the marketing of OxyContin. The aggressive promotion of the drug helped ignite the opioid epidemic. The filing contends that Mr. Sackler, a son of a Purdue Pharma founder, urged that sales representatives advise doctors to prescribe the highest dosage of the powerful opioid painkiller because it was the most profitable." [1] https://www.nytimes.com/2019/01/15/health/sacklers-purdue-oxycontin-opioids.html https://www.nytimes.com/2019/01/15/health/sacklers-purdue-ox... Edit to add: Actually, there's a pretty good (and seemingly neutral) history of the Massachusetts case on Wikipedia, with background info and related cases: https://en.wikipedia.org/wiki/Massachusetts_v._Purdue https://en.wikipedia.org/wiki/Massachusetts_v._Purdue
- bryan0 5y ago
  Why would we rely on a pharmaceutical company's marketing department to give us unbiased data on the safety of a drug? This is what studies and the FDA are for. If we're letting marketing departments dictate drug doseage then something is severely broken in the system.
kuraudo 5y ago
Legality has nothing to do with justice; I'm all for bringing everyone you just described to justice. Laws are made by the rich, not the just.
mullingitover 5y ago
Don't forget the DEA, who are chartered with keeping tabs on doctors who overprescribe. There's also the factor of systemic issues that drove doctors to overprescribe: Pain Management Questionnaires[1]: > ...pain management is the only clinical measurement among eight components of Hospital Value-Based Purchasing, and many physicians see their patient satisfaction scores in patient surveys drop as a result of changes in their prescribing practices. These scores affect compensation and promotion. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880256/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880256/
bryan0 5y ago
Because people want to blame someone, so why not blame the people that got filthy rich off it. Meanwhile it's the FDA's responsibility to make sure that drugs are safe. The FDA thought oxycontin wouldnt be as addictive as it was, and apparently neither did Purdue. But then when the data rolled in that it was actually highly addictive (A Purdue doctor said alarmed bells should be raised[0] after a study in Canada), the FDA didn't do anything about it. People expect a drug company to say their own drug is too dangerous when the FDA says it is fine? Is that a good system for drug safety in our country? [0]: https://www.cmaj.ca/content/cmaj/159/2/149.full.pdf https://www.cmaj.ca/content/cmaj/159/2/149.full.pdf
coding123 5y ago
While I don't want blame OFF the Sacklers, there's an enormous point there. If society is willing to JUST blame the Sacklers, we're pretty much fucked.
- LanceH 5y ago
  We already saw this play out with the mortgage crises. It was all the banks. It wasn't the Congress pushing banks to get homes to everyone. (requiring things like a job disproportionately impacts my district!) Nevermind the tremendous number of ways Congress could have intervened. It wasn't the fault of the borrowers. No, they are all noble people just struggling to get by on pennies. They weren't buying houses on credit and paying by flipping them on the run-up. Deep down, a lot of people knew they couldn't afford the house, but chose to do it anyway. We saw this play out with cigarettes. The execs get dragged before congress and their performance was certainly ludicrous, but somehow the blame is entirely on them. The result is cigarettes are taxed more. They kill, but are taxed more. So the outrage was used to assign blame so the states could pull in more money. Same thing here as far as I can see. Everyone has enjoyed their cut of the pharma pie, and when blame goes out the state which has been regulating this entire market heavily from top to bottom is blaming someone else and then absolving liability in exchange for money. We really need to stop looking for single points of blame for these things. If it's at the point where we say, "look at the last 20 years how obviously reckless this behavior was" it's well beyond the fault of the person exhibiting that behavior.

chuckee 5y ago

That's because the maker of a drug is expected to know more about it than doctors. And when that maker conceals information about it with the deliberate aim of causing overprescription, we are justified in blaming them far more than the doctors they fooled. Purdue Pharma knew about “significant” abuse of OxyContin in the first years after the drug’s introduction in 1996 and concealed that information. - https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy...

bryan0 5y ago
> When the Food and Drug Administration approved OxyContin in late 1995, the agency permitted Purdue Pharma to make a unique claim for it — that its long-acting formulation was “believed to reduce” its appeal to drug abusers compared with shorter-acting painkillers like Percocet and Vicodin. It seems like both the FDA and Purdue thought / hoped it would be less addictive, but this was not to be the case. And after it became clear from real-world data that this was not true, the FDA still didn't do anything about it? > a Canadian physician, Dr. Brian Goldman, wrote that the findings turned thinking about the supposed safety of long-acting opioids like OxyContin on its head by showing that drug abusers “coveted” such drugs. “This should ring alarm bells,” Dr. Goldman, who was then a paid speaker for Purdue Pharma, wrote in the editorial. Why wouldn't the FDA act on this alarm? Why would we rely on a pharmaceutical company to police its own drug when there is a clearly a massive conflict of interest? Isn't this what the FDA is for?

jessaustin 5y ago

If the last twenty years have taught us anything, it is that unimaginable amounts of unconscionable evil may be done "legally". That is certainly not the criterion to which thinking people should limit our judgment. We subjects don't decide our laws and regulations. [0] Instead, those are written by lawyers and lobbyists in the employ of reptiles like the Sacklers. They make the rules by which they play, so when we're told to "hate the game, not the players", well, they get that hate too. [0] https://scholar.princeton.edu/sites/default/files/mgilens/files/gilens_and_page_2014_-testing_theories_of_american_politics.doc.pdf https://scholar.princeton.edu/sites/default/files/mgilens/fi...

qeternity 5y ago

100% this. It’s like the Wall Street 2008 hate. Fuck the Sacklers, for sure. But they were nothing without all of the “pain clinics” that were shoving pills down addicts throats.

CryptoBanker 5y ago
The Sacklers heavily incentivized those clinics to do that

naasking 5y ago

> The FDA approved their drugs. The doctors prescribed them and the pharmacists filled these scripts. What they did was entirely legal. I think everyone who wants a good background on this issue should read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ Purdue misrepresented many facts in their aggressive marketing.

HappySweeney 5y ago

The Sacklers knew what they were doing was evil, which is why all the hate. Also, why ask for lifetime immunity if it was all legit?

javajosh 5y ago

They got the majority of benefit from the sin, and so deserve the majority of the punishment. Anyway the culpability of others isn't an argument to go easy on the Sacklers, but rather an argument to go after the others, too.

JohnWhigham 5y ago

It strikes me as a bit unfair for society to turn around, designate them as a scape goat and then ask them to pay for the sins of everyone They knew the addictive nature of Oxycontin and that tolerance builds up fast, yet they still told sales reps to pressure doctors to always prescribe subsequent amounts be taken at 12 hours intervals (and not at 8 hour intervals to account for the tolerance buildup). That's fucking egregious. The entire family deserves to be put up against the wall.

Gunax 5y ago

The media has lied about opiods. Most people who take opiods do not get addicted. And most people who are addicted did not start with a legitimate prescription--they started using it as an illicit drug.

rcurry 5y ago
What was really strange about the whole Opiod Crisis thing was this weird narrative that was being pushed for a while with all sorts of people claiming that Ibuprofen was just as good as Hydrocodone. I’ve gotten pretty badly messed up a few times, whether a bad landing skydiving or some guy ripping my knee up in jiu jitsu, and I’m sorry but no - Ibuprofen is nowhere near as good for pain relief as opioids are.
s5300 5y ago
A significant amount of addictions came from those who were overprescribed and instructed to take, by their doctors (who were instructed and given bogus studies by the Pharma reps) after surgeries, which led to chemical dependence and addiction. Perhaps you could like, read before you post incorrect statements, or so that your attempts at trolling won't be so easily shot down.
- rcurry 5y ago
  One of the things I enjoy about HN is the fact that we try to steer away from personal attacks. It’s one of the last places on the net where I enjoy taking part in conversations, because even people who disagree completely with me make an effort to keep their arguments civil. Please help us keep it that way.
- Gunax 5y ago
  Yes, there are thousands of people who got addicted without any history of co-morbidity of addiction. But as a portion of people who were prescribed, they are small. Remember we are talking about a drug that had 245 million prescriptions in the US in 2014. Also, 30% of Americans are living with chronic pain. [2] If anything, we may be under-prescribing these drugs. 1. The narrative is that some poor guy took pain meds for a legitimate reason then ended up addicted. While this does occur, it's actually not very common. > Among people who are prescribed opioids, addiction is relatively uncommon. The percentage of patients who become addicted after taking opioids for chronic pain is measured in the single digits; studies show an incidence from less than 1 percent to 8 percent. Most of the estimates are skewed toward the low end of this range, when those at risk (due to a history of substance abuse or, to a lesser but meaningful extent, a concurrent mental illness) are removed from the sample. 2. Most addicts had a history of drug abuse. > People who abuse pills are rarely new to drugs. The federal government’s 2014 National Survey on Drug Use and Health, for example, revealed that more than three-fourths of misusers had used non-prescribed benzodiazepines, such as Valium or Xanax, or inhalants. A study of Oxycontin users in treatment found that they “were not naive individuals with accidental addictions who were introduced to painkillers by their physicians as reported by the media … [Instead they had] extensive drug use histories.” It's hard to bring this up without straying into classism or victim blaming. The reality is that most people without comorbidities and abuse history are quite safe, and these are drugs we need. [1] https://www.theatlantic.com/ideas/archive/2019/08/what-america-got-wrong-about-opioid-crisis/595090/ https://www.theatlantic.com/ideas/archive/2019/08/what-ameri... [2] https://www.nejm.org/doi/full/10.1056/NEJMra1507771 https://www.nejm.org/doi/full/10.1056/NEJMra1507771 My claims are actually backed by published research (cited within the Atlantic article if you want to check)... Maybe you could like read before you get shot down.

samizdis 5y ago

I see your point, but there have certainly been accusations that the Sacklers directed operations and while knowing risks associated with drug doses. An NYT article from 2019 [1] Sacklers Directed Efforts to Mislead Public About OxyContin, Court Filing Claims lays out the accusations. (I'll try to find the subsequent ruling and add to this.) From that article, albeit citing the prosecutor's case, "... internal Purdue communications are cited by the attorney general of Massachusetts in a new court filing against the company, released on Tuesday. They represent the first evidence that appears to tie the Sacklers to specific decisions made by the company about the marketing of OxyContin. The aggressive promotion of the drug helped ignite the opioid epidemic. The filing contends that Mr. Sackler, a son of a Purdue Pharma founder, urged that sales representatives advise doctors to prescribe the highest dosage of the powerful opioid painkiller because it was the most profitable." [1] https://www.nytimes.com/2019/01/15/health/sacklers-purdue-oxycontin-opioids.html https://www.nytimes.com/2019/01/15/health/sacklers-purdue-ox... Edit to add: Actually, there's a pretty good (and seemingly neutral) history of the Massachusetts case on Wikipedia, with background info and related cases: https://en.wikipedia.org/wiki/Massachusetts_v._Purdue https://en.wikipedia.org/wiki/Massachusetts_v._Purdue

bryan0 5y ago
Why would we rely on a pharmaceutical company's marketing department to give us unbiased data on the safety of a drug? This is what studies and the FDA are for. If we're letting marketing departments dictate drug doseage then something is severely broken in the system.

kuraudo 5y ago

Legality has nothing to do with justice; I'm all for bringing everyone you just described to justice. Laws are made by the rich, not the just.

mullingitover 5y ago

Don't forget the DEA, who are chartered with keeping tabs on doctors who overprescribe. There's also the factor of systemic issues that drove doctors to overprescribe: Pain Management Questionnaires[1]: > ...pain management is the only clinical measurement among eight components of Hospital Value-Based Purchasing, and many physicians see their patient satisfaction scores in patient surveys drop as a result of changes in their prescribing practices. These scores affect compensation and promotion. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880256/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880256/

bryan0 5y ago

Because people want to blame someone, so why not blame the people that got filthy rich off it. Meanwhile it's the FDA's responsibility to make sure that drugs are safe. The FDA thought oxycontin wouldnt be as addictive as it was, and apparently neither did Purdue. But then when the data rolled in that it was actually highly addictive (A Purdue doctor said alarmed bells should be raised[0] after a study in Canada), the FDA didn't do anything about it. People expect a drug company to say their own drug is too dangerous when the FDA says it is fine? Is that a good system for drug safety in our country? [0]: https://www.cmaj.ca/content/cmaj/159/2/149.full.pdf https://www.cmaj.ca/content/cmaj/159/2/149.full.pdf

coding123 5y ago

While I don't want blame OFF the Sacklers, there's an enormous point there. If society is willing to JUST blame the Sacklers, we're pretty much fucked.

LanceH 5y ago
We already saw this play out with the mortgage crises. It was all the banks. It wasn't the Congress pushing banks to get homes to everyone. (requiring things like a job disproportionately impacts my district!) Nevermind the tremendous number of ways Congress could have intervened. It wasn't the fault of the borrowers. No, they are all noble people just struggling to get by on pennies. They weren't buying houses on credit and paying by flipping them on the run-up. Deep down, a lot of people knew they couldn't afford the house, but chose to do it anyway. We saw this play out with cigarettes. The execs get dragged before congress and their performance was certainly ludicrous, but somehow the blame is entirely on them. The result is cigarettes are taxed more. They kill, but are taxed more. So the outrage was used to assign blame so the states could pull in more money. Same thing here as far as I can see. Everyone has enjoyed their cut of the pharma pie, and when blame goes out the state which has been regulating this entire market heavily from top to bottom is blaming someone else and then absolving liability in exchange for money. We really need to stop looking for single points of blame for these things. If it's at the point where we say, "look at the last 20 years how obviously reckless this behavior was" it's well beyond the fault of the person exhibiting that behavior.