Hacker News Reader

Comment by revelation | Hacker News Reader

So you can't buy effective decongestant or other medicine that isn't spiked with caffeine or painkillers because you might try and turn it into a meager amount of a controlled substance, or more likely burn yourself in the process.

But nobody is monitoring when a doctor prescribes tons of opioids. Prescribing something seems like a privilege granted by the state, so clearly it should be the DEA monitoring this, but apparently this article is more keen to blame the salespeople at the manufacturer?!

View on HN

> But nobody is monitoring when a doctor prescribes tons of opioids. Prescribing something seems like a privilege granted by the state, so clearly it should be the DEA monitoring this, but apparently this article is more keen to blame the salespeople at the manufacturer?!

That's exactly what the article describes, though. I feel like you didn't read it. They detail, at length, a system for keeping track of doctors and pharmacies who over-prescribe and over-order Oxycontin.

And then proceed to do nearly nothing with that information other than in one or two of the most egregious instances "reducing supply" and "instructing sales people that they shouldn't promote Oxy".

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".

Oh, I totally agree. That's the real shocker in the article, that they had the information necessary to stop a lot of this years ago. I was just pointing out that the above's comment seems to have missed the point.

They were making billions. Why make so much noise when the machine is shittin money. Let the DEA handle that.

Probably the same when Morgan Stanley and the big banks were financing the wars. Let the money flow, make no noise.

> That's exactly what the article describes, though. I feel like you didn't read it. They detail, at length, a system for keeping track of doctors and pharmacies who over-prescribe and over-order Oxycontin.

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.

The newspaper has other evidence the manufacturer is sketchy as hell: http://www.latimes.com/projects/oxycontin-part1/

I find the 12-hour vs. 8-hour argument to be very weak. Of course the manufacturer was pushing for 12-hour. You will be fined by the FDA for pushing any use of your drug that is not approved by the FDA. You can get approval for 12-hour dosing, then just start saying "nahh... let's change it to 8 hour".

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

Per the FDA, at least in 1995, you're correct, OxyContin was only allowed to be prescribed in 12 hours doses, not 4-6, per the FDA.

http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/u...

Yes, the manufacturer was sketchy as hell.

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)

I'm pretty interested in that accounting link. Please update if you find it.

I really think it's this one: http://www.npr.org/2012/05/01/151764534/psychology-of-fraud-...

But I'm struggling to find the HN submission for it.

Thank you, that was very interesting.

Does anyone know why the manufacturer was pushing q12h dosing so strongly? As an opiate user, I don't want large, infrequent doses - I want small, but frequent, doses to maintain a consistent level of pain relief without side-effects (e.g. euphoria, nausea)

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.

A less frequent dosing schedule is an 'improvement' over formulations which are available as generics. This justifies the patent/ increased cost of using the oxycontin or whatever's replaced it

The big selling point of 12 hour dosing is you don't wake up in the middle of the night in pain.

Fair point. I use tamazepam for my sleep issues (generally they are for reasons other than pain) so hadn't really thought about that.

Well the big selling point for the manufacturer is that it's patented and has no generic equivalent. It's no matter if the new feature doesn't really work.

The claim is that the large does are time-release. But your point re variable need is still relevant.

The q12h dosing is patented.

The regular dosing is generic.

That's all.

OxyContin would not exist if not for q12h dosing.

Pseudoephedrine being made into homemade amphetamines is a different channel than opiates obtained via doctor and pharmacy. You can also get amphetamines that way, as Adderall or Vyvanse. Like opiates, amphetamines net over $10 billion a year and a significant portion are diverted for non-medical use.

Maybe your decongestant needs are abnormal, but you certainly can buy effective decongestants. Pseudoephedrine isn't outlawed; its purchase is simply rate limited. If you weren't already aware: you can simply walk up to the pharmacy counter and ask for it.

It's also not terribly difficult to get a legitimate prescription for it, if you have chronic needs.

People are absolutely monitoring when a doctor prescribes tons of opiods. The State of California runs a PDMP (prescription drug monitoring program) known as CURES (Controlled Substance Utilization Review and Evaluation System) [0]. It's a database that records detailed information on all Schedule II, III, and IV prescriptions dispensed in California. Though they don't always check, it's accessible to all doctors and pharmacists. Patients can and do get flags on their accounts, (though as I mentioned, doctors and pharmacists will sometimes ignore them). The DEA is very much in the loop. Anecdotally, they seem to be more concerned with doctors (visiting offices to review records) than individual patients.

[0]: https://oag.ca.gov/cures/faqs

CURES works but at the cost of completely negating any type of privacy protection on medical records. Pretty much anyone (prescriber, dispenser, law enforcement) can pull up CURES reports knowing a persons last name and birthdate.

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'.

Absolutely, though I'd argue that this is simply one consequence of the war on drugs rather than separate larger issue.

The war on drugs is a masterful play. It's a free pass for law enforcement to circumvent your rights, to search your vehicle (via warrant dog), to enter your home (via anonymous tip), to review your doctor's records, to surveil your activities, to seize your cars, cash or real estate without due process. It's the master key for an authoritatian police state and the selective targeting of undesirables.

    > you can't buy effective
    > decongestant

Science has a solution:

http://blogs.scientificamerican.com/observations/better-livi...

Reply on news.ycombinator.com