OxyContin billionaire has patented a drug to wean addicts from opioids
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Subutex is for patients that are not clinically stable, so they get daily doses from their treatment center and are watched as they take the medicine. You could argue that the providers should watch them until they have dissolved it, and thus this patent is over-engineering a solution, but that's not what you argued.
Suboxone is for patients that are clinically stable, compliant, and/or are unable to make frequent visits to their treatment center, so they are able to take-home their medication and take it as prescribed. These are patients that you as the healthcare provider are relatively certain wouldn't abuse it.
And yes, while buprenorphine isn't as abusable as most other medications, and is far more forgiving than methadone, it's not perfect, and there is still some liability for abuse, especially with subutex. So while I agree that this patent makes very little difference (again, check my longer comment), it's not all that bad of an idea, hence why Purdue likely patented it.
> the naltrexone does nothing compared to how strongly bupe itself binds to your receptors.
What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them. And secondly, it's very, VERY well known that naloxone/naltrexone have far more binding affinity to the mu-opioid receptor (the type that we think causes euphoria/analgesia) compared to any sort of opioid we have on the market (maybe not sufentanyl, but even that I'm fairly certain is weaker affinity). That's exactly why we can use Narcan effectively to combat opioid overdose.
I always get them mixed up, but it really isn't changing my point. And yes, no kidding, you brought up Suboxone as well as Subutex which is why I'm discussing it! I'd really prefer if you read my comments with a little more charity. Anyway, it doesn't appear as if you're listening to my point here, and that's okay :) Have a good day
Interestingly, although the treatment center I'm with offers both Methadone and Subutex/Suboxone I was never actually given the choice between the two, or informed of the pros and cons of either. I asked, and basically I was put on Methadone treatment because I happened to mention it in one of my admission interviews. No idea if this is policy driven due to pricing or something else?
Actually, I suspect it may just be a lack of training due to low funding levels, poor compensation for staff which leads to high turnover and lower quality. Thanks, NHS.
My personal belief is that we need a two-fold attack:
1) Harm reduction: provide people with less harmful emotional anesthetics (like Kratom)
2) Fix the underlying problem: provide people with better mental health care, better coping strategies, more community and more human connection.
Most people agree that #2 is needed, but #1 is controversial. I think that we should treat emotional injuries like physical injuries. When someone breaks their leg and they ask for painkillers, we don't tell them "sorry, but you know that painkillers aren't going to help you heal any faster."
Sometimes people need palliative treatments, but we're unwilling to provide these when it comes to psychological pain. As far as I can tell, this unwillingness is based entirely on an aphoristic assumption: "if you want to heal it, you have to feel it." Okay, great, but where's the science? Where's the research? Do you have to feel it completely to heal it, or can you take a drug that helps you feel it a bit less? What's the exact relationship between experiencing distress and healing that distress? We can't allow slogans to guide the treatment of psychological trauma.
It would discourage pushing over prescription, encourage more work into accurately identifying addictiveness (and presumably reducing it), and if all else fails would encourage them to develop cheap drugs to recover from addiction.
When you get back from the hospital they will come take your drugs.
Why? Nothing personal, just that unlike many of your rural brethren, you have insurance.
People deliberately created your guests and are profiting even now from your pain, should they be shut down?
But making manufacturers responsible for covering costs for recovery/withdrawal from drugs they sell would encourage them to work to make drugs less addictive (currently making an addictive drug is a perpetual money printing machine), and result in them coming up with better/faster/cheaper drugs to withdraw.
I mean if an individual stage did this of course they’d just bribe (I mean support) some senators to make such a rule unenforceable at a federal level.
Assuming that it is 'easy' to tell who is abusing drugs in itself sounds like a way to do a lot of harm.
Getting off suboxone itself is very difficult. It seems most users describe the withdrawal as harder than heroin because it lasts a much longer time. [1] [2]
I'm perfectly fine with the idea of replacement therapy. And in fact I actually think we should just provide pure morphine to users for free it would actually be pretty safe for long term use (and WAY cheaper).
Long term Suboxone replacement therapy also sounds like a great tool if it weren't for the marketing lies and profit. That's where my huge beef is.
Yet again making big profit by marketing the (at best not the whole truth, I think truth is closer to false and morally corrupt) idea that this is temporary. Maybe after they make a few billion and get people hooked on subs they will pivot to sell another expensive patented drug to 'wean off' suboxone and continue the profits. Of course there are examples of users being able to taper off. But there seems to be far more examples of users not being able to wean from Buprenorphine itself.
1: https://www.nytimes.com/2013/11/17/health/in-demand-in-clini... 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398454/
Of course Suboxone and methadone are so much safer to use than street heroin. And doctors will help those who want to, to taper. I just don't think that describes most sub/methadone users.
I don't think the issue is a lack of safer alternatives. It's whatever is driving the person to seek out the effects produced by those drugs in the first place.
The difference is, Suboxone is mandated in alternative sentencing programs by the judiciary of certain states. And in some states, with no consideration of whether the addict was addicted to opiates/opioids.
Buprenorphine is good. And someone can’t get on it if they’re too addicted to opiates because as a partial agonist it can precipitate accelerated withdrawal, which acts as a protective mechanism, I imagine.
genuinely curious, what are these?
> the reduced risk of overdose isn't because of the drug
it is significantly harder to overdose on buprenorphine, especially in formulations that contain naloxone.
On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well...
Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.
A test to show you are addicted to opiates does not exist, and also your own experiences do not represent the experiences of every person that ever used drugs.
I'm happy to hear that your treatment is going well -- opioids can be incredibly hard to kick. On the other hand, you might be interested in some of the newer science of what drives addiction:
https://theoutline.com/post/2205/this-38-year-old-study-is-s...
The time-worn story of how every single addict starts out.
With opiates, the bigger danger is daily or consistent use over a period of time. The period depending on how often you take it and how you are using it and the strength of your dose.
Yet, if someone has an incident with alcohol (for example), they might be required to attend AA meetings even if they aren't a regular drinker. Same with other drugs.
This is true even if heroin withdrawal symptoms start after just a few days. Recreational use generally isn't daily use or two days in a row.
Oxycodone (present in oxycontin and percocet) is a full opioid agonist. Buprenorphine is a partial agonist and actually blocks most of subsequent opioid's effects.
The patent is still bullshit
During the bird flu scare, a bunch of countries said that they were ready to ignore the patents on Tamiflu and produce it on their own if they don't get shipments of it - Taiwan, India, Indonesia...
Cibil forfeiture would be seizing the assets of these drug cartels for their intentionally criminal behavior of bribing doctors and lying to regulators.
If this doesn't tell you all you need to know about regulatory capture and the FDA...
https://web.archive.org/web/20180908213017/https://www.washi...
This is such a scummy spin.
You can bet it’s a carefully chosen statistic.
For those who aren't familiar with Richard Sackler or the Sackler family. I highly recommend this piece:
https://www.newyorker.com/magazine/2017/10/30/the-family-tha...
“First they came for the big pharma capitalists that caused opioid epidemic, and I did not speak up because I was not a big pharma capitalist that caused the opioid epidemic.” Etc.
What if I work real hard and become one of those guys one day. I don’t wanna get executed.
“[…] the poor see themselves not as an exploited proletariat, but as temporarily embarrassed millionaires.”
— John Steinbeck
But as soon as the pain become remotely manageable I stopped it and just used NSAIDs.
Because it doesn't take a genius to look up online what you're taking and know the side effects (I'm counting addition as one)
To this day I keep the unused pills close just in case but I honestly never once tempted to use them for recreational purposes.
I guess my point is that it takes two to tango and let's not throw personal responsibility out of the window when talking about opioids.
or do you just have to downvote anyone who shares a first hand experience that happen to not fit into your narrative?
If you have the self-control the idea is having some in case you fall and break your arm or something(Obviously only for serious injuries).
In that context, "it doesn't take a genius" and "personal responsibility" are rather victim-blaming.
I had several kidney stones while I lived in Sweden, and they did give me opiates for it - but only at the hospital. I was prescribed Diclofenac (an NSAID) as a fast-acting suppository to take home, with instructions to take that and then go to the hospital if I had another stone.
The next time I woke up with cramps, I did as told, and the meds worked quickly to reduce the pain to manageable levels until I got to hospital.
Perhaps there are medical reasons to prescribe some patients a take-home opiate for this.. but I can't help but wonder if kick-back programs and so on are playing a role here for what treatment path doctors choose.
...and to prescribe so many that the GP commenter has enough left over to be used in future.
Unsure of how long the pain would last, this worked. I was able to sleep a few nights and work out the pain since I had a few things to do. I had an xray planned just in case, but it wound up being necessary.
I don't see the point of taking more pills than I have needed, so they are in the cabinet. I also don't see the point of breaking up a bubble package at the pharmacy. They are made to both keep costs down and ensure pill safety. No pill miscounts, for example. Bubble packs have shown to help slow down suicides as well (people have to work harder to get the pills out, giving them time to rethink things at the last minute). I don't have a history of asking for pain medicine.
The time before this was for gall bladder surgery some years ago. As soon as I didn't need the pills, I stopped taking them. This was in the US, so they were loose pills, but I*m not sure they numbered more. I did need one later when I returned to work as the first day was rough. I assume the prescription I received was standard procedure after the operation. Just because I didn't need that many doesn't mean that someone else didn't.
different people have individual relationships with opiates. Some have no trouble keeping recreational enjoyment occassional. Some are able to use them therapeutically then taper off. Others are more susceptible to problematic abuse, irrespective of whether they were prescribed or sourced elsewhere.
your anecdata is as much about good luck as a morally superior appreciation of responsibility.
Sackler joined Purdue Pharma in 1971, as assistant to the president.[8] He became head of R&D and head of marketing before becoming president in 1999, and co-chairman in 2003.[8] Sackler was in charge of the research department that developed OxyContin. As president, he approved the targeted marketing schemes to promote sales of OxyContin to doctors, pharmacists, nurses, academics, and others. Shelby Sherman, an ex-Purdue sales rep, has called these marketing schemes "graft".[2]
In 2015, Sackler was deposed by four lawyers in Louisville, Kentucky. The deposition concerned the development and marketing of OxyContin under the watch of him and his family, who were and are active board members of their private company, Purdue Pharma. The marketing and prescribing of OxyContin in Pike County, Kentucky, was of particular interest.
Before the case could go to trial and thus before the deposition could become a matter of public record, Purdue settled for $24 million, admitting no liability, sealing the deposition, and requiring the Kentucky prosecutors to destroy, or return to Purdue, millions of pages of internal documents obtained from the company during discovery. The medical news website STAT then sued to unseal Richard Sackler's deposition. A state judge ruled in its favor. Purdue appealed, and, as of October 26, 2017, that appeal remains outstanding. The deposition cannot be made public unless the appeal is decided in favor of STAT again.[9]
Sackler has donated to both Republican and Democratic politicians, though chiefly to Republicans.[3] His charitable foundation, the Richard and Beth Sackler Foundation, has donated to anti-Muslim organizations, as well as to organizations that have promoted the falsehood that millions of undocumented immigrants voted in the 2016 presidential election.[3]
Sackler is a member of the board of advisors of the Koch Institute for Integrative Cancer Research.[7]
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Even when they were developing opioids, they knew that that long term care was ineffective and that the risks outweigh the benefits for long term care. This guy does not care. Politicians are on the take so they don't care. As long as companies can patent and profit off of prescription drugs, this problem will continue. It's that simple, yet no one in government has the guts to take these people on. For starters, someone get that damn transcript because I'm sure it has plenty of information to blow the lid off of this.
Repeat customers are created by doing long term harm while providing short term relief, expecting corporations to actually solve problems or have a conscience is beyond silly.
Our current methods of providing buprenorphine are via sublingual (under your tongue, Subutex) or orally (Suboxone, which is actually buprenorphine plus naloxone). It's a wafer that immediately dissolves when taken delivering the drug orally.
Now, these methods of administration are pretty good. Subutex will dissolve relatively quickly and you've got good pain management in recovering addicts. However, patients will sometimes take these out of their mouth quickly before the healthcare provider notices, so that they can inject it later (which can definitely provide the euphoria associated with opioids).
Suboxone gets around that somewhat, by combining the buprenorphine with naloxone, an opioid antagonist. This works because if the provider wants to give the patient a longer term supply, the user can't abuse it by dissolving the med and injecting it. Why? Because the opioid antagonist that is built in only works when injected, causing severe withdrawal. The issue with this, however, is that opioid addicts are smart. They burn off the naloxone and then inject.
So this drug patent offers an alternative: give wafers of buprenorphine at addiction centers that dissolve immediately in front of the healthcare provider. This avoids the hiding issue of subutex, and provides the same route of administration which is the benefit of subutex over suboxone.
Now, at the end of the day, does any of this matter? Not really. Subutex is still hard to get covered by insurance, so most providers stick with Suboxone (or generics, as I think that's available now) anyways. Do you think that this new medication will make it into practice? We don't even have phase 1 trial data on the drug, just a patent.
If you're really outraged over a drug being patented, though, then the discussion becomes far more complicated. Smarter individuals than myself argue that on HN all the time.
Jack Donaghy: Imagine that your favorite corn chip manufacturer also owned the number one diarrhea medication.
Liz Lemon: That'd be great, 'cause then they could put a little sample of the medicine in each bag.
Jack Donaghy: Keep thinking.
Liz Lemon: [beat] Except then they might be tempted to make the corn chips give you...
Jack Donaghy: Vertical integration.This is just gonna be their new wave of "milder" Oxy, that people get hooked on first. Sure, we're sold that its for helping things now... But give it a few years and this will be just another prescription opiate slung by street dealers. "Oh its safer!"
Methadone is addictive too. And so is this filth.
Huh? Oxycodone is extremely addictive, just like every other opioid. This has been well known since always.
[1] https://www.nytimes.com/2007/05/10/business/11drug-web.html
Really, this patent is nothing to do with the drugs involved - even the idea of adding Naloxone isn't new, this is available as Suboxone, nor is the idea of sub-lingual administration. As far as I can tell what is being patented is administration in a gelatin-film matrix that dissolves very quickly, preventing diversion and resale on the street.
Remember that these drugs are not just handed out as a month's supply of pills like you would get antibiotics. Instead, they are 'supervised delivery' where the user must take the pill in front of a pharmacist. The fear is that if the pill takes 5m to dissolve, then it could be spit out and sold on once the pharmacy or treatment center has been left, so dissolving in seconds prevents this. Personally, I'm not convinced this is a problem except perhaps in prisons (see above) but then I'm also not convinced the idea is patentable...
Man makes a drug to help people in pain. Turns out this comes with some nasty side effects. Feeling guilty, he works on a way to help undo what he made.
Not that I believe this was the case, but this is a damned-if-you-do-damned-if-you-don't situation.
... couldn't they at least give them good names? (e.g. Chimera & Bellerophon from MI:2).
Plenty of blame to go around.
People always say "what about those who have pain at the 8, 9 or 10 end of the scale?" Well, the US could probably cut prescribing by 80% and leave those people still on the meds.