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You’ve Never Seen the Opioid Crisis Like This Before: A Review of Empire of Pain
- protonfish 5y agoPharmaceutical companies are evil... who knew? The problem is a medical system that rewards bad actors. The systemic problems need to be fixed. And that won't happen so we can continue to pretend that "it's a few bad apples" and nobody else's fault.
- reddog 5y ago>Pharmaceutical companies are evil I've lost count how many institutions, governments and corporations have disappointed me over the last year. But Moderna and Pfizer are not among them.
- lurquer 5y ago> But Moderna and Pfizer are not among them. https://www.justice.gov/opa/pr/justice-department-announces-largest-health-care-fraud-settlement-its-history https://www.justice.gov/opa/pr/justice-department-announces-... I suppose if the company involved in the largest health care fraud in US history doesn’t disappoint you, little would. Or, maybe you’re just limiting it to the last year. Seems strange either way...
- iechoz6H 5y agoFor those who read the comments before the article, here's the punchline: read this book if you want to understand how profit in medicine corrupts medical professionals to the point that they can become perfectly willing to kill their patients, for the right price.
- blacktriangle 5y agoThen go lookup how much hospitals get per COVID case they record.
- kmonad 5y agoit is the punchline at the end of the article. i found it confusing though, and to be honest, lurid---the article deals with the Sackler family, their greed, lies and ambition.
- version_five 5y agoWhatever pharmaceutical companies have done, the drug war is what is directly responsible. Stigma, limiting options for treating addiction, and favoring extremely potent drugs are the big culprits here. Blaming a specific family or industry is a convenient cop out
- minikites 5y agoWhy not blame both? Pharmaceutical companies did in fact knowingly take actions to increase abuse potential because it made them more money.
- DennisP 5y agoAlso, the pharmaceutical companies have been lobbying against marijuana legalization. Even if the drug war were entirely at fault, the companies are partially responsible for the drug war. https://www.google.com/search?q=pharmaceutical+companies+lobby+marijuana https://www.google.com/search?q=pharmaceutical+companies+lob... This is specifically relevant because studies have shown lower opioid use in states with medical marijuana. For example: https://journals.lww.com/jaaos/Fulltext/2021/02150/State_Medical_Cannabis_Laws_Associated_With.11.aspx https://journals.lww.com/jaaos/Fulltext/2021/02150/State_Med...
- noasaservice 5y agoThe Sacklers have caused more pain in more people because of the "abuse". And the med establishment has only fed onto those fears. Now, everyone in med is 'deeply concerned' with abuse, that many people with legitimate pain are being denied access. The Sacklers lied about addictivity - seriously, how did the FDA allow a morphine derivative to say 'non-addicting'??? But it's also the whole medical establishment's fault in thinking that all pain should be extremely restricted.
- smolder 5y agoI'm assuming you're not some kind of shill, as it should be, and I do think your point has merit. At the same time I can't help myself from thinking this sort of deflective take has at least some roots in the PR efforts of "a specific family" and the industry. All it takes is a few convincing arguments to be made by real shills and taken up by others that "no, we shouldn't blame the Sacklers, because..." That's how PR does its work. That aside, I think it's clear their family got away with profiting off of wrongdoing, even after the fines. Profiting off of wrongdoing is much too common for big businesses. In some sense they can afford not to be held to account.
- CraigJPerry 5y agoThere’s a few Youtube channels doing a kind of street journalism recording the effects of the crisis in different cities. Some channels do interviews with the addicts when they’re sober. It’s hard to see what the “best” way forward is but i think its not that difficult to identify some things we do today that aren’t helping at all. https://m.youtube.com/channel/UCOuf_kStlWnhuauw4ce8l-w/videos https://m.youtube.com/channel/UCOuf_kStlWnhuauw4ce8l-w/video... https://m.youtube.com/channel/UCyWpRDBBb84ogtALVskwciw https://m.youtube.com/channel/UCyWpRDBBb84ogtALVskwciw
- olivermarks 5y agoI think the north star regarding addiction are people like https://twitter.com/Twolfrecovery https://twitter.com/Twolfrecovery who was addicted and is now sober and campaigning hard to stop the San Francisco/California co dependent state enabling of addiction with safe consumption sites, free needles and paraphenalia and no questions asked hotel rooms to live and die in. The Sacklers products are now illegally mass produced, most of the bay area fentanyl is run by Honduran drug dealers who are allowed to operate openly due to relaxation of California laws and a'restorative justice' SF DA. Add in stealing up to $950 a day with no legal consequence and we have a massive problem. The solution is to surely cut off the drugs at source. The Sacklers are wealthy scum but they have enabled a vast underworld of deeply evil people and our politicians are just not addressing this.
- fineIllregister 5y agoI respect that person's perspective, but more failed drug war is the completely wrong answer. It has solved nothing and has exacerbated many of the complaints mentioned on the twitter feed. Comparing pill mills and online sales of drugs to safe injection sites is a bad take. The staff at the safe injection site make no additional money for getting more people addicted. Being under professional supervision all but eliminates the risk of overdose. The real answer is prevention: strengthening communities, increasing opportunity, and mitigating hopeless situtations for everyone, so they don't get ensnared in addiction in the first place. For those who are already addicted, harm reduction while exploring paths to recovery is the most effective way to help people.
- noasaservice 5y agoAnd these people are the ones who also have singlehandedly made legitimate access to opiates for things like surgery and after-care. Now, any opiates being prescribed have to go through stupid levels of approvals including the actual doctor/surgeon, the insurance company, the hospital (if the doc is there), and the pharmacist. At least cannabis works to dull the pain. But I've considered finding a local (illicit) drug dealer for getting proper pain pills and paying the appropriate markup. But that's what I think of this whole situation.
- quickthrowman 5y ago> But I've considered finding a local (illicit) drug dealer for getting proper pain pills and paying the appropriate markup. But that's what I think of this whole situation. If you enjoy being alive, I wouldn’t recommend it.. there’s a lot of fake pills with fentanyl in them Edit: Apparently people think my comment isn’t correct? Well, here’s some links that support my claim: https://www.dea.gov/sites/default/files/2018-07/BUL-167-17%20Fake%20Rx%20in%20Indiana%20-%20UNCLASS.PDF https://www.dea.gov/sites/default/files/2018-07/BUL-167-17%2... https://www.justice.gov/usao-id/pr/acting-us-attorney-addresses-increasing-danger-counterfeit-prescription-opioids-0 https://www.justice.gov/usao-id/pr/acting-us-attorney-addres... https://www.justice.gov/usao-de/pr/claymont-man-sentenced-over-10-years-federal-prison-selling-fake-oxycodone-pills https://www.justice.gov/usao-de/pr/claymont-man-sentenced-ov... https://coloradosun.com/2021/04/26/fentanyl-death-conviction/ https://coloradosun.com/2021/04/26/fentanyl-death-conviction... https://www.santacruzhealth.org/Portals/7/Pdfs/Alerts/Fentanyl%20Patient%20Bulletin%205.3.16.pdf https://www.santacruzhealth.org/Portals/7/Pdfs/Alerts/Fentan... https://www.insidenova.com/headlines/dea-pills-laced-with-fentanyl-tied-to-increase-in-overdose-deaths-in-d-c-area/article_4aa19bb2-e0d9-11eb-b6e6-df8588f08336.html https://www.insidenova.com/headlines/dea-pills-laced-with-fe... I could post more, or you could Google “fake oxy fentanyl” and see the thousands of results yourself
- fighterpilot 5y agoNo idea why this is being downvoted. It is totally accurate. 50,000 people died from synthetic opioids in the US last year, and fentanyl in illicit pain pills are common. Stick to cannabis if the medical system is failing to give you a legitimate prescription.
- yarcob 5y agoCan you really blame people for being sceptical of the vaccines when you read stories like this everyday? As a lay person, how do I know that the vaccine really is as safe as everyone says? I mean, if you told people in 1995 that you won't take the pills that the doctor prescribed because they just want to get you addicted, people would have looked at you funny. How do we know it's different this time?
- MisterBastahrd 5y agoYes? The opioid is not the problem. It's the way it was marketed and prescribed. Nobody is getting addicted to vaccinations.
- thechao 5y agoThis is a great concept for a near-future sci-fi short story, though.
- zepto 5y agoThat’s not the issue. The issue is that it’s legitimate to distrust medicine as a whole because there are numerous good examples of it being untrustworthy at every level from public health officials, drug manufacturers, down to individual physicians. I don’t think it’s good sensemaking to be generically anti-vax, but I think the lack of trust in medicine is a systemic problem and not one that can so easily be blamed on the people who don’t trust it.
- majormajor 5y agoDistrust is different than "downright reject" and lumping the two together, painting it as a picture of "reasonable distrust," is being extremely favorable to those who simply have stopped engaging. Nobody who disagrees with them (that Covid is real, that masks have value, that the vaccine is worth getting...) is trustworthy by definition. That's not "distrust," that's not something that can be addressed simply by "oh I talked to some more people and now I believe that this isn't a case of the system abusing us." Rejecting the vaccine because you don't even understand it's described mechanism and so you fall victim to nonsense claims about "viral shedding" or "gene editing" is not being skeptical, it's being gullible.
- phkahler 5y agoJust declare phentanyl a schedule 1 drug. There, fixed that for ya. OK not, but that is the required first step.
- quickthrowman 5y agoHow will that help? The fentanyl in street ‘heroin’ is manufactured in China (and maybe Mexico) and smuggled into the US, it isn’t fentanyl from Roche or Lilly being diverted to the black market.
- Gibbon1 5y agoYou could take a step towards hard reduction and reduce penalties for pure morphine. As in you get caught with a kilo of pure morphine go to jail for 6 months. Caught with a gram of fentanyl, 10 years in prison.
- quickthrowman 5y agoThe consequences for drug crimes do not matter to the people who sell them, the potential profits are too big. You can make hundreds of thousands of dollars a year selling cocaine or heroin to addicts. The consequences do not deter drug sales, the evidence being that drugs are widely available. The profit margins are too big. Fentanyl probably has a 95-99% net profit margin, that’s why people kill each other over drugs.
- Gibbon1 5y agoI just remember what happened when California decriminalized pot back in 1975. Didn't take long for ordinary pot dealers to stop selling hash. Also they stopped selling anything but buds. So based on that I'm pretty sure if you reduced penalties for high quality morphine and slammed people selling Fentanyl, dealers wouldn't touch Fentanyl.
- jimbob45 5y ago>Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence That describes Fentanyl very well. Compare that to... >Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse There are clear uses for Fentanyl. However, you could argue that we could phase out use of Fentanyl for any procedure in favor of other drugs and I wouldn't be opposed (which would shift it up to Schedule 1).
- jraby3 5y agoBy far the worst part of this is the Sackler family gets to keep the money. They were just given immunity from additional lawsuits: https://www.npr.org/2021/09/01/1031053251/sackler-family-immunity-purdue-pharma-oxcyontin-opioid-epidemic https://www.npr.org/2021/09/01/1031053251/sackler-family-imm...
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- thehappypm 5y ago"The deal grants "releases" from liability for harm caused by OxyContin and other opioids to the Sacklers, hundreds of their associates, as well as their remaining empire of companies and trusts. In return, they have agreed to pay roughly $4.3 billion, while also forfeiting ownership of Purdue Pharma." They pay $4.3B and lose their empire. More lawsuits would be for.. what purpose exactly? Put them behind bars? Who does that benefit exactly? Just some sort of vengeance?
- cryptoz 5y agoThey murdered untold thousands of people and ruined millions of lives. They are criminals and should be treated as such. Basic justice is not 'vengeance', it's simple justice. Also there is no deterrent for future criminals. There is no dissuading jail time; our society just says, hey can you ruin some lives and make some money? You'll get to stay rich and out of jail! It's not sustainable - future criminals will see the royal treatment that the Sacklers' got and be unworried about hurting more people while they get richer.
- Causality1 5y agoIf I tell someone a glass is full of water when it's actually strychnine, that's murder. If I convince a doctor a medicine isn't dangerous when it is, that's murder. The punishment for half a million murders should not be a line item in a checkbook. My vote's for scaphism.
- djoldman 5y agoDoes anyone have a link to a specific text or advertisement written and promoted by Purdue Pharma that is uncontrovertibly false? I'm curious.
- jfoutz 5y agoDoes this count as uncontrovertibly false? It was good enough for convictions. "OxyContin is a Schedule II prescription pain relief medication, classified as having the highest potential for abuse of legally available drugs. The Purdue Frederick Company, Inc., and the three executives have admitted that Purdue fraudulently marketed OxyContin by falsely claiming that OxyContin was less addictive, less subject to abuse, and less likely to cause withdrawal symptoms than other pain medications when there was no medical research to support these claims and without Food and Drug Administration approval of these claims." https://media.defense.gov/2007/May/10/2001711223/-1/-1/1/purdue_frederick_1.pdf https://media.defense.gov/2007/May/10/2001711223/-1/-1/1/pur... You'd probably have to look at the case for evidence, rather than the AG's statement for the actual text.
- seaman1921 5y agoFunny this shows up when I am watching this : https://www.youtube.com/watch?v=AMJWeluZ3tI https://www.youtube.com/watch?v=AMJWeluZ3tI
- OJFord 5y agoIs there any good de-clickbaiting (/de-spammy-buzzfeed-esque-naming) extension? Stripping certain patterns (such as anything starting with 'You') out of headlines, or hiding matches?
- aomobile 5y agoNot a bad problem to solve .. how to identify clickbait
- dragontamer 5y agoBut how will you advertise your clickbait bot? * Clickbait writers hate this Firefox extension!
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- peter_l_downs 5y agoIt probably wouldn't be that hard to build one. I trained the world's dumbest clickbait classifier a few years ago if you want some ideas https://github.com/peterldowns/clickbait-classifier https://github.com/peterldowns/clickbait-classifier
- amartya916 5y agoThis is great! I liked the "know it when I see it" comment :).
- jerf 5y agoBe careful with that... that's the sort of thing that might be dangerous to run backwards... your program might produce clickbait so clickbaity that you can't help but try to click on it... but... oh no, there's no actual article there.... (hat tip https://slatestarcodex.com/2018/10/30/sort-by-controversial/ https://slatestarcodex.com/2018/10/30/sort-by-controversial/ )
- joegahona 5y ago
- yelling_cat 5y agoIt was interesting seeing this play out as a patient, as I had the same injury and surgery last year as I'd had during the height of the epidemic but was prescribed only 20% of the pain meds I'd received the first time. The second prescription was a lot more reasonable, to be honest, but I did have to fight with my insurance company as they wanted me to revisit the pharmacy every few days instead of giving me my full prescription at once. That was a little impracticable when I was on crutches.
- dcolkitt 5y ago> The second prescription was a lot more reasonable No it wasn't. Fewer than 1% of post-surgical patients given opioids develop any sort of abuse whatsoever.[1] Under treating pain is in no way medically responsible. It is true that there's a (very weak) association between high opioid prescription rates and society wide abuse. But that's entirely due to outright fraud and diversion. Just because some crooked doctor is fabricating prescriptions on dead patients to supply the mob with Oxycontin does not mean that legitimate patients shouldn't have their pain adequately managed. Narcotic analgesics are literally a medical miracle. The force of Neo-Puritanism are forcing millions to suffer needlessly. [1]https://www.bmj.com/content/360/bmj.j5790 https://www.bmj.com/content/360/bmj.j5790
- yelling_cat 5y agoTo clarify I meant "more reasonable" in terms of getting the number of painkillers I actually needed to comfortably heal from my surgery. I don't find them habit-forming, fortunately, and agree that the anti-narcotic backlash is making life miserable for chronic pain sufferers.
- teknopaul 5y agoSeems to me the USAs opium problem got a lot bigger while the military were present in Afghanistan, it will be interesting to see if the opium habit is some what curtailed by the swift exit.
- JumpCrisscross 5y ago> opium problem got a lot bigger while the military were present in Afghanistan Is there any credible evidence that Afghan opium made it to the U.S., much less to its pharmaceutical companies?
- nostrademons 5y agoI mean, basically every trend of the past 20 years got a lot better while the military were present in Afghanistan, by definition. Internet use and smartphone use exploded during the Afghanistan war, Netflix use got much higher, social division got much worse, and asset prices got much higher. I doubt many of those had much to do with the Afghan war (except possibly the last, with low interest rates to finance government war spending inflating asset prices).
- rufus_foreman 5y agoI'm confused lately by articles like this and the comments on them. Is the war on drugs OK now again? There should be more people in prison for selling drugs now instead of less? Or is it OK to sell addictive drugs but only if you don't get rich doing it? What's the new conventional wisdom?
- JumpCrisscross 5y ago> Is the war on drugs OK now again? There should be more people in prison for selling drugs now instead of less? You don’t see shades of grey between years in prison for marijuana possession and no jail time for causing a nationwide opioid epidemic?
- rufus_foreman 5y agoVery few people are going to prison for possession. At the federal level, virtually all of the people in prison for drug offenses are traffickers. That's been the war on drugs, busting small time traffickers to go after big time traffickers. Is that cool now again?
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- otabdeveloper4 5y ago> Is the war on drugs OK now again? It was always OK. > What's the new conventional wisdom? You're allowed to have your own opinion on issues. You don't have to follow the herd, trust me.
- simonswords82 5y agoI don't see the connection between the war on drugs and big pharma pushing drugs. I think you're looking for an angle on this topic that does not exist. The war on drugs and big pharma murdering people by selling addictive drugs are not related.
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- morpheos137 5y agoPeople in physical or psychological pain deserve access to effective treatments. Outside of overdose, which is very rare if used as perscribed opioids are benign to the body compared to nicotine or alcohol. Where the problem comes from is they work so good people want more and they develop addiction and society restricts access due to moral stigma. Pharamceutical opioids perscribed by a doctor or methadone or buprenorphine maintenance is far better than using street drugs and yet access is difficult to get unless you already are into using street drugs. I find it curious how the same NPR set that hates pharmaceutical opioids supports abortion, euthansia and physical sex changing. Seems really inconsistent. During the heyday of open access to opioids in 19th century overdose was rare. Thomas de Quincy, who wrote "Confessions of an Opium Eater" functioned for I think about 20 years on the drug. Then he quit voluntarily. It is prohibition and restriction of access that is the problem. That said some habitual opioid users may be lazy and self centered. Not unlike some marijuana users or alcoholics or people in general.
- WarOnPrivacy 5y agoPSA: The much larger crisis is the much larger number of folks who are no longer able to get effective pain relief, thanks to opioid hysteria. Thank you. That is all.
- pope_meat 5y agoThe crackdown 10 years ago drove a bunch of people from Vicodin/Percocet to heroin. Bravo with your moral panic, turned a bad situation in to a nightmare. (This second part is a comment in general, not a direct reply to the parent comment)
- yarcob 5y agoPSA: People in other countries seem to be doing just fine with NSAIDs for pain relief. If pain can only be managed with opioids, you should get them in a hospital under supervision, since they are too dangerous for home use.
- cadr 5y agoAre they, though? Do you know many people with chronic pain?
- at_a_remove 5y agoC'mon. Anyone in the last fifty years believing that this time they have made opiods non-addictive? I mean, let me know if those people truly exist because I have one bridge to sell to quite a lot of them.
- linuxftw 5y agoIt's okay, we can count of the FDA to protect us in the future. Trust the science.
- kmonad 5y ago> But more importantly, read this book if you want to understand how profit in medicine corrupts medical professionals to the point that they can become perfectly willing to kill their patients, for the right price This last sentence seems disjoint from the bulk of the article, which singles out the family's guilt, how they dodged and lied to the FDA etc. Who are those murderous medical professionals, or does this refer to the MDs of the family?
- aazaa 5y ago> So, take it from me, a historian of opioids: if you want to learn how one family and their company caused arguably the biggest ongoing public health crisis in the US, but you only have the time to read one book on the subject, it should be Empire of Pain: The Secret History of the Sackler Dynasty. To say that Perdue Pharma caused the crisis seems too strong. The crisis was caused by people making bad decisions against a background of economic and social disintegration.
- scrubs 5y agoAmerican here: here's the deal: regulation slows things down and consumes resources both for the regulator and the regulatee. The deal is: either corp X is accountable, responsible for the control they exhibit or want, or in the vacuum for lack of, a regulator does it for you. Neither happens. Why? Institutional weakness. The top dog of shirking responsibilities is the US Congress. Whether it's outsourcing wars to the executive branch, 1990s deregulation, or failure to make any serious updates/changes to any of the big issues ongoing since the 1980s: - immigration - current account deficit - debt - guns - tax avoidance by corps (I've been in Apple's Cupertino headquarters. How in the hell is it based in Ireland for tax purposes?) corporations run wild. How in heck did the Sackler's not follow FDA guidelines and release a drug without criminal/civil consequences? Why is it that if you/I commit financial fraud we're nailed to the wall, but when Wells Fargo's employees do so there's no criminal consequences? Recall, they opened credit cards in customer's names due to internal compensation and incentives. Banks launder money and are not shutout of the US banking system? In other cases, banks report suspicious transfers and the Treasury doesn't follow-up. How are corps enabled to continue to hide behind off-shore shells? How can the Sackler's divest and separate dollars as law suites work up the court appeals process, and still keep it? The issue is not that corps are evil, or that capitalism is bad. The issue is that since 1980 the pendulum has swung too far in corp's favor, while regulators have failed to respond in kind. We need to bring it back center. Good god: if I was a share holder at JPMorgan and saw the money they spent on internal lawyers to defend themselves against the 2008 financial company I'd be pissed. Meanwhile people running for the Senate or the House run the same lame game during elections: - I am an outsider (b/c Washington's rep is crap) - I will make changes once in - But almost all House bills die in the Senate so net nothing happens. So the whole of Congress is always lost in the fog of the perpetual future.