How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin
bloomberg.com
bloomberg.com
10.8 Billion Dollars (not million, billion with a 'b'), of which 4.6 Billion, close to half of it, went to the Government as tax payments...
And yet the article seems to imply fault of some sort that various Sacklers moved millions (millions with an 'm') -- an order of magnitude less money of their post-tax-paid-for money, when 4.6 Billion, close to half of it, went to the Government as tax payments.
I mean, with respect to the people that paid for the opioids, the Government doesn't give that tax money they collected, that $4.6 Billion back to the opioid purchasers, does it?
Also, why is it that federal investigators seem to have no problems finding all sorts of ways that big corporate entities misspend millions of dollars -- but simultaneously overlook government misspending in the billions of dollars?
I for one (and I realize my opinion is in the minority!), think the opioid addicts should get their $4.6 Billion dollars directly back from the Government -- and in cash -- not in political promises, treatment programs, hammers, or government cheese...
You know, like give them all a "hey, you were an opioid addict and here's the money we took from you (as Sackler tax money!) back as an opiod stimulus package, an opioid stimulus check!" <g>
And yes, I realize my opinions are politically incorrect. <g>
Because of the...money? There is/was plenty for everyone.
https://lowninstitute.org/industry-payments-to-doctors-opioi...
Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it.
But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.
Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school.
They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming.
Just some anecdata tho.
Well, if I had to make an educated guess, they really did cross their fingers and nobody seems to be investigating/enforcing otherwise and they're getting away with it - because I'm telling you, first hand... it's happening, quite frequently, at least on the West Coast.
If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.
Holding doctors responsible for their actions only starts making sense once we are talking about doctors who keep prescribing this long after the risks have become known, which I am sure has happened too. But it's not the root problem.
Pill mill doctors are a different story and they are prosecuted for it.
https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback...
And while some jail time happened - for some of the distributors - the sentences were relatively light.
https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec...
Purdue kept a database of doctors willing to prescribe their products "for pain relief" and have now switched sides to push a drug that treats opioid addiction under a new marketing campaign and a new industry front.
https://www.genesisrecovery.com/who-caused-the-opioid-crisis...
My parents are retired Dutch GPs who also ran a small pharmacy[0], so I know a little about how this works, at least in the Netherlands (I admit that this is a pretty big caveat, because (aside from the obvious biases that this introduces) the opioid crisis doesn't exist here - it seems to be a US-only thing. On the other hand, that only gives me more reason to suspect that the problem is systemic, not something to be blamed on individual doctors).
Every year doctors (or any other medical professional as well) have to attend a mandatory amount of lessons to update their knowledge of recent developments in their medical field. In my parents case this also was true for pharmaceutical knowledge. This is where they learn about new medications and their usage. So yeah, they do in fact learn which drug is supposedly safe to prescribe under which circumstances. But you know what is required for all of that to work? An authoritative source of trustworthy information on drug use.
Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases.
Sure, there might have been some stories going around that this drug might not be quite as safe as claimed, but keep in mind that at any given moment hundreds of quack medicine scaremongering stories are making the rounds. When given a choice between believing those, or the official body that is supposed to verify which drugs are safe or not, doctors will usually pick the latter, and in most cases rightly so.
[0] in the Netherlands this is relatively common in small countryside villages that are too small to sustain a pharmacist, who typically needs at least 5000 clients to be sustainable
The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement.
Oxycontin wasn’t approved for chronic non-cancer pain, because it’s a poor choice for that, but that’s where the recurring revenue is and somehow accounted for most of its usage.
Short-term post-operative pain and cancer pain just isn’t that big of a market.
Yes, but pharmaceutical companies cannot market the drug for non-approved uses or discuss off-label use when promoting or selling the drug. That is illegal.
That illegal activity is exactly what the courts determined Purdue did - bribery, fraudulent marketing, and more. The issue is that Purdue broke the law (and that their sentences for breaking the law were way too light).
There are lots of FDA-approved drugs that are highly inappropriate for most patients. One of the reasons we tolerate the professional status of physicians is because of their purported expertise in prescribing these drugs safely. If they don't know the function and habit-forming potential of opioids, one might well question that expertise. They aren't regulated in any sense by FDA, and they can't blame FDA for their ignorance.
The drug being talked about was given a new time-release formulation which was described as less addictive.
The drug company spent a lot of time and money distorting the image around addictiveness.
Here's a list of things Purdue did: https://www.feinberg.northwestern.edu/sites/ipham/conference...
Given that the same opioids are approved in the US and Netherlands, with the same warnings and information, why do you think the outcomes are so different between countries?
People need to realize that medical school isn't some all-knowing institution where everything knowable about human physiology is imparted unto students.
Is it an opioid? Then it is probably addictive for some people.
I know that there is some experimentation involving kappa opioid receptors, trying to essentially neutralize any euphoria or uplift with the k-receptor's dysphoria "bummer," but until that has been ironed out, they're habit-forming for many. Not all, but many.
In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.
I am merely pointing out that the idea that medical doctors being unaware of a basic correlation between opioids and addiction, one which has progressed from one medicine to another over the decades, seems ... disingenuous? Preciously naive? Remember, I am replying to "If the companies are lying about safety, how are the doctors supposed to know?"
Here, I think the doctors are supposed to know in the case of opioids because this is an ongoing historical trend. A random new class of medicine? No, they will probably trust the safety sheet, as well they should. The umpteenth opioid? I would be viewing with a gimlet eye anything saying "Nah, no addictive potential."
You would probably not do this because you have a historical association with pesticides turning out to be rather broader in impact than was originally let on. You understand that history.
I only suggest that this historical wariness sounds completely reasonable for opioids, whereas a brand new drug class has no history associated with it.
Does your understanding of the companies history outweigh your experience of the formats history?
And I would still not add that pesticide to my drinking water. So I will ask ... would you?
It's a dumb hypothetical though, as my point has repeatedly been that doctors have far too many areas to be concerned about to selectively decide that this one pain killer needs more investigation before I prescribe it regularly.
And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...
Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.
My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data?
The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more.
Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.
This is my point - the claims were BS. A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims, as did patient evidence right in front of their very eyes.
I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Purdue committed fraud, but they never made claims that were so outrageous that they would be prima facie false. (If that had been the case, Oxycontin would never have been approved in the first place). The problem wasn't that the claims were outrageously impossible; it's that the claims were wrong, and Purdue either falsified or misrepresented clinical data in order to convince doctors that Oxycontin was safer than it actually was.
> Patient evidence right in front of their eyes
Encouraging people to rely overly on anecdotal observations is incredibly dangerous, especially when most doctors who prescribe opioids don't prescribe them in such numbers that these issues would be readily visible to them in the first place.
Yes, there were a small number of doctors who did aggressively overprescribe and misprescribe Oxycontin. That was the result of a direct and explicit campaign by Purdue to identify and enable those doctors. Some of those doctors were prosecuted and/or did lose their licenses, but those doctors still only amounted to a small part of the opioid crisis.
> I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Most doctors weren't seeing massive discrepancies. We know the discrepancies exist now because there were lawsuits and prosecutions which revealed the specific fraudulent behavior that Purdue and others were engaged in. But without the benefit of hindsight, these issues simply weren't reasonably visible to a typical doctor - they were only visible at large scale to Purdue, who went out of their way to mislead everyone else about it.
Furthermore, opioids shouldn't even be used as first line after wisdom teeth removal - across Europe you'd be sent home and told to take paracetamol or ibuprofen, because those medications generally work very well for inflammation-type pain.
Now they are "shocked" to find out they people they've been accepting money from were leading them astray -- not that they knew where that money was ever coming from.
That doesn't take away from the fact that the manufacturers led a campaign to deliberately mislead people for years about the addictiveness and efficacy of opioid medication to treat pain.
Because doctors are human beings and in particular they’re people who are motivated by the desire to alleviate suffering. When faced with patients who repeatedly return to their office, complaining of severe pain, what can they do?
There are no miracle painkillers. We have anti-inflammatories for minor aches and pains. We have opioids for severe, temporary pain (such as recovery from surgery and end-of-life care). We do not have a painkiller suitable for chronic pain.
Purdue pharma offered doctors a way out. The institutional structure of healthcare, into which doctors and pharma companies fit, permits diffusion of responsibility [1]. Doctors escape blame because the determination of the safety and efficacy of medication is outside their area of responsibility.
[1] https://en.wikipedia.org/wiki/Diffusion_of_responsibility
2. Physicians are responsible for writing prescriptions, pharmacists dispense them, and patients self-administer in most cases. The opioid epidemic was caused by failures at each of these levels, not just when writing the rx.
3. Physicians are routinely prosecuted, lose their licenses, and go to jail for this: https://www.deadiversion.usdoj.gov/crim_admin_actions/index....
Your lack of information on the topic is not the same as a systemic problem. Please do a bit more due diligence before making claims like this.
It's why you'll walk into a medical plaza lobby that looks like a 4-star hotel, with fountains and art on the wall, and why the doctor will write you a prescription for an absurd dose of narcotics after surgery. After you've been cut open, it's normal to be in some pain for a while, but if the doctor drugs you into such a daze that you feel nothing, you'll rate him or her more highly. Even if 9/10 people end up being fine and stop taking the drug when they're supposed to, 1/10 people have a new addition.
This is bizarre the end-result of the privatization of our medical system. We're just one step away from rating doctors with stars like Uber, where they offer you drugs instead of a free water bottle when you walk in.
In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.
The tendency I observed when competency was questioned was to not punish in any way that had strong ramifications. They might badmouth them, but the desire to strip of their license or award large punitive damages isn't there because they are worried about it happening to them, real or imagined.
I'm sure there's some complicated technical way around it, but it's not a willy-nilly rx system, at least in CA.
In general, the rule of thumb is if you need opiates, more that a simple vicodin or tramadol, we refer you to a pain management specialist.
[1] https://floridadailypost.com/florida-pill-mills-gateway-opio...
https://www.nytimes.com/2020/06/09/business/media/cops-cance...
Imagine if this scenario played out in China.
1. nobody ever hears nor finds out anything because it's all kept within the party.
2. they are publically shamed and they are sent to a re-education camp never to be seen or heard again.
my 2 cents...
China would have zero tolerance due to their opium history that was imposed by the west. This is even more insidious however as the country’s institutions were mislead and this family made billions on the back of their countrymen’s misery.
The political structure in the west encourage these kinds of crimes. If you can exploit millions to make billions then you can settle in the event of criminal persecution, hire a pr firm to take care of public optics, and donate generously to parties in power to ensure that the pesky prosecutor/attorney-general is sufficiently motivated not to attempt to make an example out of you.
In this case it doesn't look like they even bothered hiring a PR firm (or they're doing a piss poor job), and they seem to be getting off "fine".
They'll take a plea, say "aww gee sorry", and ride off into the sunset with billions. It's the American way.
Because it didn't happen, people will just impose their own preconceptions on it.
The simple reality is that the Chinese would absolutely not accept this resolution and in fact would consider the actions of the Sacklers to be completely unforgivable, which brings the American reaction into stark contrast.
https://slatestarcodex.com/2019/09/16/against-against-pseudo...
The music suggests the drug is horrible, but of the five patient cases: two are doing well on the drug and require it to function normally, one did well but died of a (not determined to be related) heart attack, one got off the drug with some difficulty, and one died after falling asleep while driving.
Opioids are a miracle drug for people living with chronic pain. More people die every year from alcohol - which has absolutely zero therapeutic benefit.
Part of the problem in the US is that doctors were reaching for opioids as first or second line drugs, when they should be further down the line.
But we don't have a justice system. We have a legal system, and a financial system.
Give me a break, legal system never changes itself.
From Ghandi, Bolshevik revolution, Solidarity, French revolution to MLK.
Change only occurs due to mass civil dissonance or armed revolutions.
Never because you talk in a court and all people in power agreed you make sense.
What I was getting at is that protesting is not a very reliable way to effect change either. The "other side" of any protest is also trying to change the narrative and can often just wait out the protests. Look at how the various Occupy movements eventually dissolved after a few months because they weren't getting anywhere. Even the "main" camp (if one can talk about such a thing with Occupy) was eventually cleared by the police and didn't bother reforming somewhere else anymore. The gilets jaunes in France are currently experiencing the same problem.
I'd be quite interested in a way to reliably bring about societal change in a reasonable amount of time and in a morally defensible way, but I have not found any yet. Since philosophers have been debating this since the days of the ancient Greeks I'm a bit doubtful that this is the time when we'll finally figure it out.
Proper protests etc. are direct action by the people against capital. There are still disadvantages, but they can be drowned out by simple numbers.
Its easy to start. Just pick up some textbooks.
Seriously, all of those who goofed off in home ec and math complaining years later that they don't know how to cook or balance a checkbook.
The immediate resources were often subpar I will admit but don't say you weren't taught.
Sounds like it was worded wrong (depending what you mean by "protests"). "fight your battles in the courts" is generally a statement about non-violence, meant to suggest metaphorical fighting in courts instead of actual violence.
And yes, I have heard that PR companies exist to clean up reputations, but it should be possible to at least make it clear what happened.
I think I read somewhere that a hedge fund had decided not to take an allocation from the Sacklers. That's exactly the kind of thing reputation is supposed to do. It's a blunt instrument, but people deciding to partially ostracize those who have done wrong is how things should work.
They were billionaires yesterday and they’re going to be billionaires tomorrow. Their reputation is going to be fine because we live in a society that absolutely worships money and those who have it. People with that kind of money can pay to scrub the internet.
I'm sorry but this is so naive.
Maybe true if you've got a bit of money and a little bit of notoriety, but I don't think that it would be possible to dissociate the Sacklers' name from the opioid crisis anytime soon.
Attention is short. I wouldn't rule it out; pr goes a long way. Spend a couple million on a completely unrelated but well regarded cause of charity and folks who don't have skin in the opioid-game won't associate them for the bad they did (but for their most recent memories).
What will keep the association alive for a while will be documentaries and those who watch them, but lets be real: that's not the public.
I think this is too big to be easily cleaned up.
The Sacklers have been donating huge sums to put their name on things for a long time.
Never argued against that, and I don't disagree with that at all. But if someone cares to do even the bare minimum of research, it's easy to come up with the Sacklers. What I am arguing against is that the Sacklers will somehow be able to use their wealth to scrub Google et al of their association with OxyContin.
> It’s not like they absolutely have to donate using the Sackler name.
For folks like them, though, then what's the point? After a certain level of Midas-like wealth, the only point is societal standing and legacy. The Sacklers don't seem like the type of folks who are going to get inner joy by donating anonymously.
Aye, there's the rub.
No, but I don’t see how that deters them from misbehaving. How many billionaire oil or pharma magnates just wish they had a little more respectability? You think they care at all what people think about them? If they did, they wouldn’t have done what made them their blood money in the first place.
The Sacklers enabled the deaths of hundreds of thousands of people, and yet which did they choose to protect: their money or their reputation?
You should make people aware of it when they invite you to events or places with their name on it. I've seen people call out Jeff Dean for inviting people to some Sackler named event; he seemed pretty horrified as well he should be.
It will talk about how the heir has become an active philanthropist, dedicating his/her life to “making things right”. It will list their accomplishments since the family was exposed. It will end with an open ended question about “the sins of our fathers.” It will really make you think.
They will spend their life slowly giving away half their fortune, one gala at a time. They will start a foundation. It will have a name not too dissimilar from a pharmaceutical brand name—meaningless but vaguely positive (too bad Altria is taken). They will max out that foundation’s board with Big Names in that world—just so long as their name isn’t Sackler.
Their investment of half of the payout they kept will grow larger than the original started at, and they’ll never pay more than a nominal dime in taxes thanks to those sweet 501(c)3 write-offs.
Their reputation will be laundered, at least enough for their checkbooks invited back to the parties. And their kids? Home free.
In a few generation the hundreds of thousands of deaths on their hands will be forgotten, except by the families of the victims that were just the cost of doing business for them.
Frédéric Bastiat
Outside the pandemic, we see oil companies and other manufactures move their operations overseas to countries without power or understanding that the earth is being pillaged, or that the big company is there because they don't have modern labor laws or laws that protect their environment.
Hell, the amount of beer cans on the side of the road in my suburban neighborhood and surrounding parks areas indicates that there's a portion of the population that can't handle not drinking and driving.
I wonder if this is specific to America/capitalism, but I don't really have a frame of reference for other cultures that champion values like community over the individual, following the rules, etc.
This is another one of those situations where the crazies are driving the conversation, because they are much louder than their actual portion of the population. According to Gallup the portion of their panel who “never” wear a mask outside of their home is 10%, while those who “rarely” wear a mask is 2%.
The vast majority of the population wears masks “always” (50%), “very often” (27%), or at least “sometimes” (11%). The vast majority of us are complying with mask regulations; we’re just not making a lot of noise about it.
They repeated the stunt approximately yesterday but one of the organizers was arrested this time; he handcuffed himself to a chair but didn't consider that it was on wheels, so they just rolled him out of the building. https://www.npr.org/2020/08/25/906046911/ammon-bundy-is-arre...
The Bastiat quote is on point if your criticism of Purdue Pharma is that it profited from the medical licensing laws and drug prohibition laws that unfairly proscribes teenagers from buying madak cigarettes on the free market.
If the criticism is merely that they made money selling addictive drugs, this really isn't what the quote is about.
They did not make billions from selling yet another opioid of which there are dozens available cheaply. They made billions by subverting the medical system largely though completely legal means. Essentially they sold yet another synthetic street drug through Doctors rather than on street corners. And this worked because they jumped through the correct hoops and advertised in the correct manner.
If they went and produced 'Oxycotin gets you high and it is legal!' like a head shop the operation would have not reached multimillion dollar size before it got cracked down.
Jumping through the hoops is the part the system understands as important though.
Those two differences although irrelevant to end outcome being bad and condemnable are pretty damn big distinctions akin to claiming you "unleashed a savage wolf to attack unsuspecting children" when you sold out a pit bull puppy who was sourced from a dog fighting ring and the dog mauled a kid who yanked on his tail.
We’re in the midst of a series of lawsuits and criminal probes seeking to do exactly that. When public pressure rushes prosecutors, we get nonsense like Arizona getting rejected for original jurisdiction by SCOTUS.
We have due process. Not mob rule.
We have due process for the privileged. Tell all of the poor defendants who have been held in Rikers for over a year without a trial that they have due process.
Yet this reporter was able to assemble the trail from court documents.
For every person creating Byzantine structures there are several adept at untangling them.
> Tell all of the poor defendants who have been held in Rikers for over a year without a trial
Not arguing that they aren’t getting an advantage. Just that there is zero evidence so far that they’re going to get away with it.
Also, New York has abolished cash bail. If someone is in pre-trial detention, it’s because they were deemed to be a flight risk. Not because they couldn’t afford bail. (EDIT: Never mind, we rolled back most of the changes in April after a purported crime surge)
It's hard to make a case for something being prosecuted in good faith if there is never any attempt at using the tools that are otherwise so vastly abused in prosecuting the most meaningless "crimes".
But yeah, take all their money. The actions described in TFA obliterate the corporate veil. Frankly I don't know how they've avoided assassination attempts by the families of addicts.
Basically yeah.
The "war on drugs" was pathetically laughable for reasons like this.
More importantly, this is a part of the larger narrative that everything has been caused by overprescribed opioids. However, there's no correlation between increased prescriptions and increased illicit usage [0]. Rather, it seems there's been a large growth over time of illicit opioid use [1]. The only place this sort of thing has been effectively combated is in Portugal due to its decriminalization and attempts to make things safer. Politicians caused this with their stupid "war on drugs". They are now pointing and saying, "Look, the big bad Sacklers did it!" so their own failures are ignored. Stop scapegoating one family for a political and societal issue.
0: https://www.researchgate.net/publication/330922982_Today%27s...
1: https://www.sciencedaily.com/releases/2018/09/180920161028.h...
All that said, I generally favor your stance that ending prohibition would yield the greatest harm reduction.
Justice is inherently subjective. A "justice system" to you is a facist dictatorship as implemented because it inherently relies on all justice coming from the subjective opinions of a single person, you.
But doing only this is like beheading hydras: you cut one head off and nine new appear in its place. And with drugs, it's even worse than that - as users who previously were on medical quality clean stuff from legit pharmacies paid for by insurance, they are moving on to street stuff with all the side effects associated (criminal behavior to finance the addiction, contamination due to cutting agents, overdoses due to inconsistent dosing, gang fights, ...).
The opioid crisis must be tackled at the root level, and that is a lack of physical and mental healthcare combined with the lack of a social security network and appropriate governmental aid to regions devastated by 30 years worth of globalization, modernization and rabid capitalism - to continue with the hydra analogy, the US needs to burn off the necks and then kill the body of the beast.
Doctors prescribe opiates all over the world, including oxycontin. Nowhere else is it a problem as big as in the US. Before wanting to withdraw prescription rights and sue MDs on a personal basis, perhaps people could think about the american exception?
The US opiate problem is cultural and the responsibility is on both sides of the doctor-patient fence. The more people will be able and willing to sue MDs, the bigger the problem. Legal action on a personal basis is _so_ the wrong path. This is depressing.
[1] https://www.cbc.ca/news/canada/british-columbia/bc-overdose-...
What about Europe, Asia? They also have oxycontin. How about Germany, for example? How do they manage?
I've practiced both in Europe and in the US. I wouldn't go back to care for americans even for a million bucks. Healthcare culture in the US is incredibly toxic.
This is purely cultural. European patients and MDs are much less aggressive.
So in fact the difference is how MDs solve the immediate pain problem. In the US, they would try to suppress the pain (and legal threats with it). In Europe, they would try to make it bearable while keeping the patient functional, because they are not afraid of their patient.
Everyone benefits from a less tense relationship.
Canadian healthcare is great, and dissimilar to American, in that it's treated as a public good.
Canadian healthcare is not great, and similar to American, in that a lot of prescription decisions are made from a similar cultural perspective as in the US, ie drugs are handed out like candy.
But the US and NZ are the only two countries that allow DTC drug marketing. And Purdue in particular was monstrous (in size and as an evil creature) in their direct to healthcare provider marketing.
I would argue this a MUCH larger contributing factor than any cultural differences, and actually causing some 'cultural' differences.
Where else is a drug pusher allowed to legally access a database of all scripts written by which doctors in order to target the top 1% of script writers who make up a large % of the profit. Then pay HUGE commissions to pushy non-educated salespeople - armed with criminally false 'research' funded by shell 'non-profits' - to bribe doctors to write even more.
Not to mention Purdue actively incentivizing pill mill Doctors, actively reaching out to obvious criminal MDs to get them to sell more drugs!!!!
It's disgusting and they need to be held accountable for manslaughter. all ill-gotten gains should be reposed and used for treatment.
If this were any other drug dealer their cash/cars/etc would be seized immediately and the accused would have to prove the money was not ill-gotten to get it back.
Put the Sackler's on the treasury sanctions list just like we do with Cartel leaders. Maybe them museums will start chiseling their names off of the buildings.
In the long legal battle I do not think this money is going to be recoverable (at least most of it).
> So I wonder why controling this problem which casued so many loses of lifes
Did you not read $10billion in profit. People point to Mexico and the corruption the narcos bring to the Mexican state. It is the same in the US for this case. Just looked at who profited. Drs, lawyers, politicians, lobbists. Whilst the gravy train is running people are not asking questions at best and doing their best to stop them being asked.
The corruption regarding oxycotin, ran from the top to the bottom of the system
Lots of shit falling apart here...
These are well-known forces that have acted this way for 150 years. Unfortunately, these systemic problems are not taught in school. Quite the opposite, they are treated more as minor aberrations that are fixed with a touch of social democratic intervention or regulation. And even that is considered an extremist position, extending to all kinds of subjects relevant to this community regarding how tech companies should be structured, labor organized, compensation structured (including healthcare), or even just having more coherent and explicit control over your personal data.
1. Open dev tools
2. Delete the overlay element (id = graphics-paywall-overlay)
3. Disable 'overflow: hidden' on body
document.getElementById("graphics-paywall-overlay").remove()
document.body.style.overflow = 'inherit'don't be lazy.
Somewhat coincidentally for the purposes of this conversation, it also inhibits chemical dependence (including opioids, which includes oxycontin and oxycodone). [1][2]
[1] https://www.sciencedirect.com/science/article/pii/S009130571...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089904/
This concludes the reply relevant section of my comment.
Sidenote (mostly me screaming into the void): due to excruciating constant chronic pain from a botched surgery, I took three oxycodone for 4 years (March 2015-August 2019) every single day. It enabled me to work and live a (greatly diminished) life. For all of the harm the crisis inflicted—and the Sacklers did great evil for great reward—there is really not another class of medication that would have kept me functioning.
Fortunately for me, I managed to get a very good job with great healthcare and I immediately used that to have a corrective surgery with the best surgery center in the country. This took me from about 65% functional (medicated) to about 85% functional, unmedicated. That last 15% is never coming back, and I have to live with the fact a doctor permanently damaged my body in an uncorrectable way.
But, over the course of my treatment, the backlash against opioids began to make it difficult for my pain management clinic to provide the treatment I needed even though I was completely compliant (and had the regular drug tests to prove it—so many cups of pee). I would be dead without opioids. I would have killed myself. There are many more like me who still suffer from unmanageable pain who either cannot get the medication they need. There are many people who are not here because of opioids as well so I completely understand the backlash, I just hope we don’t overcorrect.
The Sacklers harm cannot be undone, but their reward can be—expropriate it all (leave them an apartment with running water and a roof so that it’s technically legal).
Curious: how much did your pain affect your sleep? Did you need the pills to sleep too?
Also the US right now : "Some doctors are telling us the negative effect of THC are not that dangerous compared to the short term benefits on mental wellbeing. We sell that in dispensaries. This is a billion dollar industry. This is definitely a good choice, we don't need to listen to the people showing the danger of addiction. Let's praise the progressist that are responsible for that".
On the other hand THC is currently almost advertised as being "good for you" (see all the papers/studies around it), and a socially acceptable/fun thing to do. While I don't really see anyone posting on social media a picture of themselves crushing some oxy pills. Overall we can expect the number of people negatively impacted by a THC addiction to be significantly higher in the next few years than for opioids. Even if at the individual level, the effects are lower.
At the macro level this makes THC widespread use worrying - just like the opioids use is worrying. The really interesting thing is the difference in narrative. We know want to lock down one as much as possible, while we want to open the other as much as possible.
PR wise, it's incredible. The arguments used in this article against opioids (it was a great business making lots of money !), are exactly the argument used in favour of THC (it is going a great business making lots of [tax] money !).
The consequences make a huge difference. So a plan to make a million dollars selling sandwiches vs killing people on the street to rifle through their pockets should be treated very differently.
If THC has benefits in a narrow range of situation, doctors should absolutely be able to experiment with it. And the DEA classification should be reviewed under that light.
But there is a whooooole range of possible options that sit between "it's the worst substance ever. Anyone consuming it should be put in jail after 3 strikes. No one can even dream of making medical trials with it" and "Meh, it looks relatively harmless and fun, let's distribute that like candies with close to no control"