Inside an L.A. OxyContin ring that pushed more than 1M pills

You think that by banning opiates no one will get opiates? The methadone clinic two blocks from my apartment, and the people who panhandle around it and the subway station, and the needles I walk past when I cut through the tennis court, do not show the government's laws are solving the problem. As a physician you may see the emotional side, but logically I would love to hear your solutions to the problem.

A more relevant metric would be number of overdoses per number of total doses, no?

If there are 50x more prescription opiate users than heroin users and 10x more prescription overdoses than heroin ones that still implies heroin is more dangerous.

http://www.latimes.com/projects/oxycontin-part1/

It seems patents, drug marketing and insurance reimbursement are the cause of this epidemic.

Most likely because the statistics aren't available.

> Moral arguments apart, they are simply not in the business of reporting their patients to law enforcement, nor they ever should.

Why should they be allowed to be in business at all when their product is so destructive?

When someone dies of an opioid overdose how do you know which opioid they overdosed on? How do you know they were using oxycontin or oxycodone?

In this spreadsheet, the most granular category is Opoid Pain Relievers: https://www.drugabuse.gov/sites/default/files/overdose_data1...

Oxycontin's market share seems to be around 20%: http://www.jefferies.com/CMSFiles/Jefferies.com/files/Confer...

I don't think drug companies are held to account on whether doctors prescribe illegally...however they do get criticized/prosecuted for how they market their drugs: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__ffn_s...

Federal law, namely 21 CFR 1301.74(a) disagrees with you. And they're not reporting patients, they're reporting doctors that that are humongous outliers for prescribing certain painkillers.

That article found some data and twisted it into a conspiracy.

The prescribing doctor and clinic were quickly identified, by worried pharmacists and by the sketchy manufacturers.

This was during the time the "war on drugs" was pretty full on, and the risks of opiate prescribing were well known.

How did the various systems fail?

We see this across a range of different industries. People sort of report some concerns, but they often don't do it properly.

Sometimes that means mildly defective product is shipped. Other times it means many people are harmed.

There was a submission several years ago about an accountant who somehow got wrapped up in massive amounts of fraud. He said that many people along the way could have stopped him, and he didn't make much effort to perpetuate the fraud. He would just ask people to fill out that bit of paper, or to wait a few days before sending some other bit of paper, and they all just thought "he's okay, I'll do him this favour". Individually they were little favours. Collectively, it was pretty big.

(I'm trying to fidn the link now)

Fortunately my current codeine prescription ("take 15-30mg as directed as required") gives me a fairly wide latitude - most days I don't need it at all, but on a bad day can take 15mg every three hours or so.

It's almost like they did the bare minimum, enough to have some plausible deniability, but not enough to actually be responsible. Oh, and then only after they knew the doctors were out of business (read "already arrested, charged, sent to trial") did they belatedly say "oh hey, you might want to look at them".

When it would do nothing to harm profit, but so no-one could say "you did nothing".

A system for keeping track of them and then largely ignoring them. Purdue had all the information they needed, and they mostly sat on it and dragged their feet. That's arguably worse than if they had been completely blind.

What is the point of HIPAA and medical privacy if anyone can log in and see what scheduled drugs you're taking? From the drugs you take I can pretty much derive your medical history. I consider this a much larger problem than the 'war on drugs'.

The margins on legal good are a whole lot less than illegal ones. You'd be putting most dealers out of business overnight by legalizing.

The tax money from legal drugs can be put into prevention and rehabilitation. We can measure the effectiveness of prevention strategies just like my current government measures their anti smoking and alcoholism prevention strategies.

Tax dollars made by my regional government from selling cigarettes went into a program here for a free long term supply of nicotine patches. This policy combined with other anti smoking initiatives have worked we now have the lowest rates of smoking in the country. Nicotine cessation therapy is proven to work. I don't understand why heroin or meth is not treated the same even when there is data that methadone does not work as well for treatment http://www.theglobeandmail.com/news/british-columbia/vancouv...

The truly evil dealers, the violent street gangs who prey off the mentally ill and homeless addicts are impossible to bust because of how they have set up their operations to avoid prosecution by employing the desperate junkies to hold and sell small amounts of product 24hrs a day, while low level gangsters, who handle no evidence, run street security. The police if they arrest these addicts simply go to court for minor possession and are released the next morning. The low level gangsters are routinely arrested for violence while debt collecting or running off other gangsters and a replacement is there the next day. Sometimes they get them on conspiracy charges but it doesn't matter, they're hardened criminals who consider prison a cost of doing business and again somebody else replaces them and their operations change to adapt to a police crackdown status. Police have been fighting these gangs as long as I have been alive but the availability of narcotics remains steady. They have changed their policy to management of the drug war now, propping up one semi cooperative gang by turning a blind eye to their activities in exchange for intel on rival gangs, as to prevent a more violent and unstable gang they can't control from taking over and turning the streets into a warzone.

But the majority of people serving sentences for drug crimes are there for selling drugs.

http://www.rollingstone.com/culture/lists/top-10-marijuana-m...

"About 40,000 inmates of state and federal prison have a current conviction involving marijuana, and about half of them are in for marijuana offenses alone; most of these were involved in distribution. Less than one percent are in for possession alone."

Remember that distribution of weed, while it sounds relatively harmless, is very often controlled by violent gangs. It's like getting Al Capone for evading taxes. The best solution is to legalize weed and put it in the hands of legal businesses.

Also:

http://fivethirtyeight.com/datalab/releasing-drug-offenders-...

There he shows that releasing all prisoners who are in jail with drug offenses as the most serious charge would only reduce the prison population by about 14%. This is counting both distribution AND simple possession. Not insignificant, but not the headline figure of 50% that you often hear.

The drug war has been a total disaster. It's thrown much of Latin America into chaos, with their governments unable to contend with the sophistication and brutality of drug cartels that rake in billions from the most lucrative drug market in the world, the United States. It's also a massive source of revenue for the criminal gangs that plague our cities within our country.

The laughable propaganda from the government has also totally undermined important anti-drug messages. The ridiculous claims about the dangers of weed, for example. The reefer madness stuff. The DEA's insistence on keeping weed Schedule I. It's actually given rise to an equally ridiculous myth: that weed is totally harmless. But more importantly, it's undermined the message against harder drugs. If the government is lying about weed and shrooms, then people will think they're lying about other drugs as well.

If we don't win the cultural battle against drug use being acceptable, then all is lost. You're right that no amount of law enforcement can change that in a liberal democracy. But assuming that battle can be won, this is what I think needs to happen on the legal and military end:

I say legalize weed and other drugs with lower abuse potential; this will immediately destroy the largest segment of the illegal drug market. For hard drugs, stop imprisoning people for possession. Withhold the first arrest for simple possession from the public record, so it doesn't show up on background checks and destroy people's ability to get a job. This will create the public support for what must come next: come down like an iron fist on the weakened organized crime groups that have lost their largest source of revenue. Exploit internal strife caused by dwindling revenues, turn some people into informants, and then put away the rest for a very long time.

The second biggest drug market is cocaine. Almost all of it comes from Colombia. Once the current peace process falls through or fails to stick, the US needs to help Colombia finish off the FARC completely. Unconditional surrender should be the only acceptable outcome. A complete commitment to ending mass coca production in Colombia should then be a condition of their friendly standing with the United States.