Drug firms poured 780M painkillers into WV amid rise of overdoses
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I'm in favor of maximum MD power. I think they should be allowed to prescribe everything from cocaine to bleach, or any other chemical compound, as suits the patient care, if they know what they're doing.
But they should also bear maximum accountability for what they prescribe, including abuse potential.
In this case it looks like they are incentives for pain pills to be issued on both sides -- money maker for pharma and time saver for doctors (a third side -- convenience and feel good for the patient).
It is not as useful to find so-called bad actors but instead we should evaluate the medical system as a whole and put in safeguards to do less harm. Patients have generally too much influence on doctors for their treatment (otherwise why would direct to consumer marketing exist?), that doctors are not educating patients enough on the risks of narcotics and that pharma has $$ incentive to push medicine. That things like physical therapy and lifestyle changes will better deal with root causes than drugs that only address the symptom (but feel better and are easier to swallow). It's a recipe for a disaster.
I was in a motorcycle accident a few years ago and broke over 10 bones. The worst part of my recovery was kicking my addiction to narcotics. I did not understand what I was getting into and I was never given a path to get off them (not in a coherent way, not until I called to say I was going through withdrawals). This should not be.
On the other hand, the pharmacies might know, but that could be worked around by a motivated pill-obtainer.
The pharma companies, however, definitely know that they sent 780 million painkillers to a state with only 1.8 million men, women, and children.
I am not saying it is their duty to do something about this, but maybe they have some high-level information that others do not.
I really don't see a way this could be fixed without giving every doctor in the US access to some huge database of every prescription of every person in the country -- which I would not be cool with, nor would anyone else, other than maybe law enforcement agencies.
I can't imagine many people that have real pain bad enough to need opioids are going to be selling them to other people.
For people that really need them to manage pain, they can literally be a live saver.
So if you can get enough pills to cover your own pain management (meaning you likely can't work anyway), and you know you can get and sell more pills by going to other doctors, why not?
He said after a while it became a game. User would get a script and come in totally strung out. My buddy would refuse to refill their meds. User would call doctor and yell and them. Doctor would call Pharmacy and yell at my friend, who would then have to tell the Doctor what was going on. Most of the time, he said the Doctors had no idea this person had 15 different scripts for pain killers.
For me, there's still too many loopholes to exploit in the process.
When I had back pain, the doctor handed me a prescription for 100 hydrocodone tablets. I took none; just some physical therapy and stretching gave me immense relief. Later, I was shocked to find out from a friend that the street value of these tablets was $5/each.
To expand: I had maybe 4 different doctors writing me RX for pain meds at the time and none of them were coordinating. I remember having far more drugs than I needed for the first few months -- I had prescriptions to spare. This is because I had several doctors treating me but again, none were coordinating.
> The unfettered shipments amount to 433 pain pills for every man, woman and child in West Virginia.
That is incredible. What a damning article.
I mean, what is supposed to be done about this? Cut off WV from painkillers? Have the DEA raid a bunch of pharmacies?
Given the kind of logical leaps the War on Drugs takes, why not? I'm sure that someone, somewhere, in WV is getting high on pills as we speak.
It doesn't take a whole lot of doublethink to want laws around marijuana relaxed while at the same time preferring to keep the FDA.
What takes doublethink is imagining that, once these powers are in place, they won't be used against one's preferred substances.
How many people are in prison for violating FDA rulings? I'm sure there are a few, but policing egregious behavior is probably a step that a reasonable society takes out onto that slippery slope of having rules about a thing.
The War on Drugs has involved arresting and imprisoning a lot of people, because a lot of people really want drugs. Once the soft enforcement mechanisms (reprimands, misdemeanors, fines of legitimate businesses) fail, then if you really want to suppress the act, you have to ramp up the level of force. The reason that fewer people are imprisoned under FDA rulings is, I would say, because the FDA is more lenient, and because the things it bans are far more niche and less desired. You can have effective, or you can have gentle, but you cannot have both.
I do believe that you can tell store fronts not to market literal gasoline as a restorative tonic without automatically escalating to violent raids. As far as I can tell, a rule against marketing gasoline as a restorative falls afoul of the standard you declare in your first sentence. People aren't very comfortable shrugging and not doing anything about perceived problems (illicit distribution of the restorative gasoline), but we'd be better off if we did that more often.
(I do understand that the example is ridiculous because there is no demand for a restorative gasoline tonic amongst competent adults, it's just that there is ample evidence that people want some assurances about safety. A less ridiculous example would be requiring people buying cocaine to go through some sort of educational material that made the risk of forming a habit clear, and regulating the manufacture of the cocaine that is eventually sold so that it is not adulterated)
If someone was convinced that gasoline would cure their hair loss, they couldn't get it through a pharmacy, but they could still get it from someone making no such promises. If someone was convinced that cocaine would cure their hair loss, they can't get it any way, any how - even just as something labelled "dangerous goods, do not consume". That's the prohibitive authority that leads to raids and cartel warfare. And that's the power that many people still support the FDA/DEA/government having, and which I am pointing out is the root of the problems with the drug war.
Surely there is middle ground. A drug can be regulated but not banned. The way a drug is prescribed could be regulated. This needs to happen with opiates. That doesn't mean they should be banned but the addiction potential is very serious for these drugs (and vastly underestimated when they first entered the market).
You can put whatever the hell you want in your non-FDA-approved snake oil supplement - but then you won't have the legitimacy of the medical establishment behind you. This legitimacy depends on your drug having verifiable, understood effects. You can't have it both ways.
My point is really that, if somebody's solution to the problem of people overdosing on drugs is to ban them or prohibit access, then they're defacto acquiescing to the tools that make the War on Drugs possible. People seem to expect drugs they don't like to just "go away", without any of the nasty raiding and shooting.
The milk salesman wasn't raided for selling whole milk. He was raided for selling unpasteurized milk... Across state lines.
Generally speaking, clearing the bar for FDA tolerance of nutritional supplements is quite easy. They don't care that your product works, only that you don't put actively dangerous things in it. It's caveat emptor for efficiency, but not for safety - which is a pretty reasonable place to draw the line.
The FDA approach to regulation goes after dealers and manufacturers - not their customers. So yes, we absolutely can end the War on Drugs, and keep the FDA's enforcement mechanisms.
I honestly have a lot more sympathy for an addict, or a bystander, whose life was destroyed by the state, then I do for his heroin dealer. I think most people opposing the War on Drugs on grounds other then ideological anarcho-capitalism share this assessment.
Well, sure, the current way it's being done. But you'd still have cartel warfare for selling territory, adulterated goods, and to effectively shut down distributors, you'd have to define smaller and smaller amounts of substance as qualifying for "dealing", as dealers learned what they could and couldn't get away with. Perhaps I should not have used the capital-letter "War on Drugs" to refer to this. But you would still have much of what you have now.
Now, would it be net improvement if enforcement of drug laws moved towards a dealers-and-manufacturers model? Sure, I think so. But my point is that there would still be no principle in place preventing that model from expanding again into a broader prohibition, involving new substances, posessions, uses, or what have you. It would be like saying "we'll have free speech, except if it's bad, or we don't like the person saying it, or some other reason that we might think up later." There's no sufficiently strong principle preventing prohibitions from continually increasing.
> I honestly have a lot more sympathy for an addict, or a bystander, whose life was destroyed by the state, then I do for his heroin dealer. I think most people opposing the War on Drugs on grounds other then ideological anarcho-capitalism share this assessment.
That's probably true. However, I don't think sympathy is an effective basis for judging whether things should be legal. And if observing that a government with an expansive power to ban things will probably use and aggrandize that power makes me an anarcho-capitalist (rather than, say, just a boring classical liberal) then so be it.
https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...
What percentage of the population 1) is taking any? 2) needs to be taking any? Not everyone has had accident/surgery/cancer/etc.
It'd be like saying "the per capita income of New York State is $185,688!" When that's actually the per capita income over six years.
"Drug firms poured..."
>Which is about 72 per year, per person.
That doesn't sound unreasonable. I would guess the average prescription is 2-4 a day per person per year.
Am I misunderstanding the figure? Instead of 2-4 a day per person, maybe you should calculate how many it is per person with a legitimate need for the drug.
As a percentage of the population, that still seems really high, but WV is taking 0.2 pills/person/day not 2-4 pills/person/day
I knew WV was a bit militaristic but some google results and some division imply 10% of the population are military veterans. Its almost believable given how many WV residents I met in the Army, generally extremely nice people BTW. So if no one in WV takes pain pills but military vets, then the vets get a whopping two pills per day and everybody else gets precisely zip nada nothing.
Yeah sure most vets are not taking pain pills. But the guy with no working knees or limbs blown off in an IED, he's probably taking more than two per day, the casualties from one IED explosion could make up for a whole retired company or even battalion of people not ever taking pills. And of course the general population has its own segments of people who have permanent physical problems, or temporary, or are painfully slowly dying of cancer, etc.
Here's another interesting depressing bottom up analysis. Lets say a third of people die of cancer after a year of horrific pain taking ten pills per day and they die on average at age 50 (think of all those heavy smokers and heavy drinkers with annihilated livers, plus the numbers are simpler and to one sig fig don't matter anyway). So if it takes 3650 pain pills per cancer death and a third of the population dies of cancer, that means the average dead took 1000 or so pain pills in the year before they died, and unless we suddenly become immortal that divided by 50 year lifetime means the average person is taking 20 pills per year over the course of their life, even if they never take a pill in their lives until the last year of life before a cancer death and 2/3 of them never take a single pill in their entire lives if they die in car accidents or whatever not from cancer. Now of course not every terminal cancer diagnosis takes an entire year to die and not all medical interventions including cancer in remission take zero pills and not everyone with terminal cancer takes ten pills per day, but none of these assumptions are more than an order of magnitude off on average.
Not really the season for depressing analysis like this, but math is math and the general public is utterly innumerate, so its relevant to the discussion...
I would suspect from this bottom up analysis that dozens of pills per person-year is not too far off from other states numbers and by playing games with careful selection of subgroups you can manufacture all sorts of crazy "surprisingly high" numbers that are anything but.
Also, since this is coal country, I assume black lung plays a big part in the need for these scripts.
As an aside, I have a family member who had a horrific injury who is on a pain killer script. This person isn't allowed to take an extra pill on days when the pain is worse than normal because the DEA is cracking down so hard on this, her doctor is afraid to subscribe over the government imposed "limit." Pretty sad. Her doctor even suggested she go to a pain clinic because he is concerned about getting heat for total subscriptions.
Didn't we learn anything from the immensely stupid and still ongoing drug war? Fk this journalist.
'Instant' release pills usually last for 4 hours. There are also 'extended' release formulations that generally last 5-7 hours (despite the longer claims of manufacturers).
If a state were to legitimately have 10% of its population that badly hurting, there should be a huge governmental investigation into what factor is causing that much crippling pain.
Of course we know it's not legitimate though.
Trends in Prescription Drug Use Among Adults in the United States From 1999-2012 E. Kantor et al., JAMA 2015
According to the article, the 780 million pills were hydrocodone and oxycodone pills. Those are highly powerful and addictive opioids. 72 of those per inhabitant of WV per year seems insane to me.
15*20/100 = 3.
They are applying a number of a subset of the population to the entire population. It's very misleading.
Edit: This journalist is also citing per year statistics, so take my math and multiply by 365, so that would be, "the US population smokes up to 1,095 cigarettes per person per year." The larger number implies that it is much worse. To add a little spice, I could say, "The US population smokes 1,095 cigarettes per year for every man, woman and child," which is exactly the same data set, but it's now implying that children are 1/3 of the people who smoke. Also most people don't envision a 17 year old as a child, so it further implies that young children (say 5-12) smoke.
The saddest part of this whole story is that this is what we can expect from serious journalism in this day and age. Gotta have their clicks!
Also, as an aside, take into account that there are 5+ million car accidents a year. I would guess that is or at least is one of the leading causes of chronic pain in the US.
Seriously though, 'rational' people can also be misinformed by a large corporation and a system which does not necessarily incentivize getting people healthy, and only wish to make their shareholders happy. The 'market' will always try to optimize for profits even at the expense of everything else.