Hacker News Reader

Comment by twilightfog | Hacker News Reader

Statements like that immediately make me suspect the integrity of the article. Instead of reporting the actual figures of Oxycontin related overdoses, they bundle it with ALL overdoses over a year (which obviously would be a large enough number). Why didn't they mention the % of overdoses directly related to Oxy ? My assumption is that it would be significantly smaller number which didn't serve the article's purpose. Personally, I don't think its the Pharma's job to track if the pills are illegally prescribed. Just like its not an ISP's job to track if the internet is getting used for illegal downloads. They are absolutely right to assert that they "at all times complied with the law." and any conduct "did not interfere with legitimate patients getting medication". Moral arguments apart, they are simply not in the business of reporting their patients to law enforcement, nor they ever should.

View on HN

Are there official numbers that break it down by drug? I didn't see it on the CDC: http://www.cdc.gov/drugoverdose/data/overdose.html

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...

Personally, I don't think its the Pharma's job to track if the pills are illegally prescribed.

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.

> Why didn't they mention the % of overdoses directly related to Oxy ? My assumption is that it would be significantly smaller number which didn't serve the article's purpose.

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?

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

I don't think it's that simple.

If you're going to start doing heroin--which you shouldn't--oxy is a much safer form than street level heroin where you have no idea what you're getting.

Phillip Seymour Hoffman ODed and died because he didn't know what he was getting. Heroin is actually pretty safe, but it destroys your soul and you never really "cure" the addiction. Even still, I'd rather have oxy out there than tar heroin from Mexican drug cartels. And I'd rather spend government resources on something else.

There is nothing particular about heroin that puts one's soul at hazard compared to other opiates. I started my descent into opiate addiction with nice prescription drugs like oxycodone, but all to soon I found myself using heroin because it was cheaper, stronger, and more available.

Phillip Seymour Hoffman ODed and died because he didn't know what he was getting.

Is this true?

I've read what happens often is that when heroin addicts relapse they often don't account for the dropped tolerance while they were sober and they start back at the same levels as when they were using and because of that OD. I'm pretty sure I saw that this was what happened with Hoffman.

One reason for overdose is that dealers increase the potency of their product by cutting it with Fentanyl, and other synthetic opioids.

These opiates, while easy to produce in a lab, are active in very small amounts (at the microgram level.)

As a result, if a batch of heroin isn't fully mixed, you end up with "hot spots" in some doses, where the fentanyl content is high enough to kill you.

This is how one of the first young women I met at university died. We grew apart, and one day she stopped responding to my text messages. A few days later I found out via Facebook.

Sometimes a really pure batch appears, and the users' old dosage of impure/cut stuff is way too much. Quality control &consistent product isn't really high on importers' list of priorities.

> oxy is a much safer form than street level heroin where you have no idea what you're getting.

Just for clarity many people are getting oxycontin from the street, which leaves them open to counterfeit product. At $60 to $80 per 80 mg tablet there's considerable pressure to create counterfeits.

that's only because of misguided regulation and formula changes, you can't get a crushable 80mg oxycodone anymore through legit channels.

shockingly, changing the formula did nothing to quell the demand for abusable oxycontin formulations, leaving the market wide open to anyone willing to press their own chinese powder. chinese powder doesn't strictly mean oxycodone powder, either.

the counterfeits are often filled with cheaper, more easily acquired, more potent fentanyl analogues. fentanyl and it's analogues are active in microgram dosages. that's why heroin addicts are dropping like flies coast to coast, even heroin is being cut with the cheaper, exponentially more potent fentanyl.

More than twice as many people are killed by automobiles every year.

And it would certainly be even higher if we didn't regulate the hell out of automobiles and driving to make them safer and prevent fatalities.

> Why didn't they mention the % of overdoses directly related to Oxy ?

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?

Oxycontin was simply a massive dose of oxycodone, enough to kill an opiate-naive individual, wrapped in what might has well have been a candy shell.

Technically a time-release mechanism, it was easily defeated by anyone with a razor blade or a wet paper towel.

They aren't different drugs, and I'm sure Purdue has a finger in the oxycodone pie other than simply brand-name Oxycontin.

A little bit of old-fashioned police work would easily reveal what prescriptions a person was prescribed, a search of their personal property would reveal paraphenilia related to their drug use. Empty oxycontin bottles would indicated an oxycontin overdose. An empty syringe would indicate heroin abuse. Spent patches would indicate fentanyl abuse. etc

It's worse than that. When a serious drug user ODs and the tox screen comes back with opioids, cocaine, and barbituates, how could you possibly assign a particular drug to the death?

Perhaps the problem with breaking out the data involves not being able to read the manufacturers label on the side of the pill during an autopsy, and the unfortunate sudden unavailability of the lone reliable eyewitness.

Yes, I'd be willing to bet that the vast majority of that headline OD number are heroin plus alcohol or benzos deaths. It's actually pretty hard to overdose on just Oxy pills...

After the downvotes, I decided to check out the numbers, and looks like I'd lose the bet. According to the CDC [0] the ratio is almost 2:1 for Opioid analgesics versus Heroin. What's interesting is that this is very different to the statistics for the UK [1] and Europe.

[0] http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoni... [1] http://webarchive.nationalarchives.gov.uk/20160105160709/htt...

Even still, it's rather difficult to accidentally fatally overdose on just prescription opioids. The majority of prescription opioid-related deaths involve a mixture with some other depressant -- typically, as you say, alcohol or benzos.

Heroin is a different story, since there's no telling how potent a particular batch will be until you do some -- if it winds up being significantly stronger than what you're used to, it can be easy to do way too much. You also have various adulterants to take into account, including fentanyl which is often added with "worthless" adulterants as a cheap way to keep the qualitative potency of the effects up while significantly cutting the product. The thing about heroin is that you really don't know what you're getting -- this is a very different story when you're getting pills, unless you're happening upon counterfeits.

Other big problem is people going to rehab/getting clean, then relapsing after a while. Tolerance is much lower, but out of habit they are likely to do a dose similar to before.

This would be equally as possible with oxycotin.

It would be less likely with either if addicts didn't have to hide the addiction for fear of authorities

In another world street-drug users might have cheap and easily available chromatography or reagent tests.

Sure, but the reagent tests are really just qualitative, there's no good way of telling that the heroin I just bought from the nice man on the street corner is twice as pure as last weeks. I suppose there may be some tests that can tell if there is fentanyl present, which might help...?

Reply on news.ycombinator.com