Anti-addiction drug maker found a captive market in the criminal justice system
propublica.org
propublica.org
Besides the inherent issue of non medically-trained people coercively prescribing medication for behavioural modification, there's the fact that drug court judges tend to disfavour opioid maintenance therapy and value abstinence from drug use over everything else; which severely increases the risk of fatal overdoses and other bad outcomes. Abstinence-only treatment does not work well for opioid addiction (http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...), and coercive abstinence-only treatment doesn't work well either.
Drug rehab in US is a fucked up industry where degradation, isolation, and humiliation are commonplace and are seen as best practice, and this is the case because, well, their "patients" are literally captive -- it's either that or literal jail.
I suffer from Chronic pain and have been prescribed Buprenorphine in the past (Butrans, which don't have the same counter-measures as Subutex), unfortunately they are no longer adequate for me (the patches get pretty big in higher doses).
On the other hand, since he had to pay the cost it's not like anybody who needed treatment got shorted as a result.
"If our process hasn't worked for you, you didn't want it to work enough" is unfalsifiable and can be used to defend any sort of quackery. Indeed, there's no way to generate a counterexample -- of someone who had "willingness to change" but for whom the drug court didn't work -- because the defender of the drug court can always claim that they "didn't want to change enough".
Pseudoscience of this sort has no role in anything as fraught and complex as drug use/addiction.
Notably, it is routinely used to defend 12-step programs. The standard set of slogans includes the phrase "it works if you work it" (which I've more recently seen applied to cognitive-behavioral therapy).
It replaces a bigger problem with a smaller problem.
Can better be done? Yes.
We could research this stuff and then listen to the research. Use the methods with the best general outcome for the patient, based on medical proceedings. And perhaps use these things with iffy outcomes - AA, for example - as add-ons or options for patients to choose from, with a medical doctor's blessing.
It's been a while since I ran across this option. Here's a random site about this therapy:
The active ingredient costs <$2, so Vivitrol is 90% price gouging.
Edit: IMHO, Naltrexone is a good prescription drug that actually helps people physiologically. People's pain receptors get overloaded; naltrexone helps to reset them. Naltrexone helps with alcoholism, and apparently with meth amphetamine [1] too.
[1] http://newsroom.ucla.edu/releases/ucla-researchers-identify-...
With that said, Naltrexone doesn't address the fundamental emotional problems that underlie most cases of addiction. So it doesn't do them a whole lot of good to force them to take it, without also helping them find stability, the lack of which probably led them to self-medicate in the first place.
My bigger concern is with naltrexone itself: If individuals on this need any dental/medical procedure, or have an accident, anaesthesia is very atypical. On-scene EMS won't be able to provide pain management beyond an ibuprofen.
Something like non-opioids that aren't typically used (ketamine, nitrous oxide, other volatile anaesthetics) or sufficiently high doses of short-acting opioids (fentanyl derivative) to overcome the naltrexone blockade (which would need active anaesthesiologist .management)
A drug addict seems more likely to suffer from his addiction than to suffer from an accident. I am basing this on the assumption that naltrexone will only delay pain treatment by a day at most. If it has people in agonizing pain until it wears off things are different.
Could just as easily be exposure and genetic predisposition, there's plenty of "stable" addicts.
So you're saying that the only cost associated with bringing a new drug to market is the cost of the ingredients?
Not if it's generic, it doesn't. The cost of R&D has to be paid off during the patent period. Also, to call it "repackaged" is disingenuous. The delivery method is what's being charged for.
Are you saying that's not the correct price in a competitive market? After accounting for all costs, of course.
Maybe you should read those people as saying "this market is lacking in competition to make prices reasonable".
10000% of costs is, quite simply, asking for someone to put a shiv in your kidney.
The only way to achieve such margins is by literally suppressing all competition with armed force, with an unquenchable, non-substitutable demand. In the case of pharmaceuticals, the feds provide that force.
Normally, the balance point is the fair point. By making it cheaper, you get people who don't need it still buying it, leaving no supply for others that do need it. At the same time, making it more expensive leaves people who need it not being able to get it.
This reasoning is why we say the market price and fair price coincide. This breaks down when demand is inelastic. (It also breaks down when income inequality gets to be huge). Specifically, when there are no people that want something but don't need it, the argument breaks down. In this situation, the market price is called price gouging.
There are some cases where responding to the market makes sense. I.e. when there is a flood incoming, make flashlights and batteries a bit more expensive to discourage hoarding and encourage more supply. Don't charge the market price mark-up of 10x though.
Who doesn't think like that? If demand is high, it's the perfect excuse to exploit people. Why would anyone try to rationalize a reasonable exchange, when they can rip desperate people off?
Especially when you can remove the clause containing the words "free market" without changing the meaning of the comment. "It is shocking how many people will ignore the fact that health care and pharma in the U.S. are nothing like the toy models taught in econ 101, but pretend that they are in order to defend rent seeking."
Ofcourse bribing judges costs money too.
If you are referring to R&D, that is typically a sunk cost for existing drug companies and is typically not figured into the price.
The defendant. The same person who is liable when corrections bunks them with a prison rapist, or a psychopath who ends up building a guitar out of their vocal chords.
The justice system is a deep pit that we toss people into, without any care for what happens after. If we made anyone in on the side of the prosecution accountable for the consequences, the entire system would grind to a halt.
https://en.wikipedia.org/wiki/Kids_for_cash_scandal
I didn't know there was even such a thing as honest service fraud until recently. It appears to have a lot of problems as a charge, but it certainly feels like it should be used a lot more to simply prevent some of the Machiavellian screw-jobs modern business (and politics) inflict on people. I know, I'm getting a little "ranty", but doesn't the term "honest service fraud" seem to fit so many of the problems caused by big organizations today?
Psychology's discovery of the relationship of neurotransmitters to behavior was a huge breakthrough, but trying to treat every problem with drugs is like trying to fix a broken Office install by replacing RAM. Sometimes the problem is software, not hardware.
They should also seek the opinions of addicts who have sought or been forced into this treatment regime. Though I have not experienced it myself, the general consensus from the people whom I have spoken to who have, is that withdrawal from these drugs is much more severe than Heroin.
If the point is to help the addict through the withdrawal process so they can get clean, it seems rapid detox protocols would be more expedient. But of course, as we all here on HN know, the real money is in a monthly subscription, not a one-time payment.
And that's what Drug Replacement Therapy (or as pharma PR prefers, "Medically Assisted Treatment") is. It's switching to a dope man who wears a lab coat and uses a prescription pad instead of balloons. And a huge payola scheme for pharma and practitioners.
I take it your a proponent of drug abstinence rather than harm reduction?
I think what GP was trying to say was that trying to treat people in opioid recovery programs with opioids that can be abused in the same way as dirty street drugs is ineffectual and their use isn't being proscribed for recovery as much as it's being proscribed because it's profitable to someone.
I agree with them. I don't think I interact with many opioid dependent people, but I've heard good anecdotes about Kratom, Marijuana, and Narcotics Anonymous for recovery. Two vilified plants and an organization that rejects outside help(or how ever the local chapter interprets their traditions) versus a potential goldmine of profits and feel-goods, I think I know which way the government is going to enforce their minimal efforts at drug rehabilitation.
Anecdotally, Suboxone saved my life. And I've got a number of dead friends to prove it (some of which had gone through NA multiple times, and two had the damnable Vivitrol injections). So I'm a bit biased here, but I find your comment quite naive, albeit typical for those who have an opinion on this life without having had much interaction with it, much less lived it.
I've seen the local success rate for AA, and I imagine that the NA programs are worse, but they are better than the alternatives we, the United States, present them.
I would ask, are you on long term therapy presently? Or was it a short term assist through withdrawal?
We've got plenty of studies showing how a few Oxy sends every day people to the streets looking for heroin. The studies haven't caught up for Subs yet. I know I'm projecting, but I'm pretty sure when the studies come, they will tell the same story. Why am I so confident in that? This story has repeated itself since Heroin was introduced as DRT for Morphine addiction. Then Methadone for Heroin. It's a vicious cycle across generations of the cure is worse than the problem.
PS working the 12 Steps would likely help you with that self-righteous condescension issue that has survived your chemical addiction.
Some countries even give it to addicts instead of buprenorphine/methadone.
In general though, I'm ok with real harm reduction programs like needle exchanges, free condoms, and safe using zones. I'm not present in this life to stop anyone from using, far from it. But state mandated opiate use, that quite simply is a Chemical Holocaust.
Buprenorphine was much more effective for myself, and I broke my six year heroin addiction using it, legally from my government for a nominal cost of a few dollars per day.
America seems hung up on abstinence and "cold turkey" as if it's the be-all end-all of treating addiction. Just use willpower, right? Vivitrol seems "perfect" in that environment, as it should stop you chemically from using, but the thing is that people don't want to be junkies, they want to live their lives and be happy, without the noose around their neck that is addiction. But if you don't deal with why they started using, how can you expect someone to heal?