None of that would’ve happened if they didn’t start the flood of opiates to begin with. It wasn’t a marginally increased issue, they flooded the market with it. People with minor pain were getting massive bottles of OxyContin and selling or using it. This led to pill mills and crooked doctors. You had normal people getting hooked on high dosages. These are not the people who were using opioids before that. Pills made it seem safer. Most users don’t start with heroin, they start with pills because of exactly that. “A doctor prescribed it, must be okay.”
This is some insane logic to absolve them of responsibility. I say this as someone who also saw the problem firsthand. Was regulation handled badly? Sure but there’s no way you can say they didn’t start the problem.
This combination or larger dose followed by mild withdrawal then results in a higher likelihood to become addicted to opioids. So not only they marketed it heavily and got more people on opioids than necessary, they did it in a way that maximizes the likelihood of addiction.
"man you got nothin', you should get some oxy for that!"
I'd been living outside the US and this in my first few hours back on US soil. A few hours later my friend (working in criminal defense) explained how opiates accounted for roughly 1/3rd of his income (other sources: drunk driving and domestic abuse). They all followed the same trajectory: minor condition -> prescribed oxy -> illegally obtained oxy -> heroin when the money ran out.
This wasn't normal. It didn't happen anywhere else in the world at the time, or at least not where I was living.
I don’t think that’s really the case. What happened here was that peddling oxy, created the excess demand that is now met by illicit sources that cause more deaths now that oxy is regulated. But what you’re missing in your understanding is that without oxy, demand wouldn’t exist in the first place. And that’s the harm everyone is talking about.
You’re talking about the aftermath of the problem. Parent is talking about the root cause.
I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
Now, in addition to dealing with pain every day, I also have to “prove” that I’m not an opioid seeker if I end up in the ER for overwhelming pain. Because saying that you’re hurting is clearly a sign that you’re actually an addict trying to get a fix.
This might sound cold-hearted, but as someone who deals with chronic pain I’m fine with some street ODs in exchange for people who are in pain being cared for. Now we just torture patients by doing nothing.
Recreational drugs are a choice. My pain was not. Why we punished for others’ bad choices?
When a pain patient becomes an addict, their demand tends to be in excess of their prescription. I don't think anything you're saying is a reasonable response to the comment you're responding to.
I personally knew people getting more than a cancer patient should’ve been given for day to day chronic pain.
I’m sorry if you were personally affected by regulation but that doesn’t mean they didn’t cause the crisis.
> I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
To the GPs point, the cause of the regulation was the abuse of the sale. Many deaths were caused by aggressively selling oxy to folks who weren’t managing pain.
The fallout has resulted into harm with people that have a legitimate need for pain management.
Both can be true. The Sacklers are the culprits any way you slice it.
Purdue Pharma didn’t just manufacture a drug. They did a great deal of behind the scenes manipulating so even people who did not seek out severe pain medication were prescribed extremely high doses.
In terms of long term pain management opioids suck. People need increasing doses over time until the drugs side effects become toxic. Not such a problem in hospice or someone in an ambulance after a major accident, but handing them to people with chronic conditions guarantees a downward spiral. Perdue Pharma knew this, strait up lied about it, and even pleaded guilty to mislabeling OxyContin.
This... Dr were involved too!
> long term pain management opioids suck
Opioids suck. And the medical profession was complicit. For a class that is supposed to be professional and well informed most Dr's are, shockingly, not that bright.
The actions of individual Doctors acting on their own simply don’t explain trends.
Doctors and the FDA etc were straight up lied to. I don’t think it’s reasonable to hold Doctors accountable for when some pharmaceutical company commits fraud. That doesn’t mean every doctor was blameless, but individual Doctors have always behaved poorly it was true before the opioid epidemic and it’s still true today.
Oh please.
Doctors, did not believe the preponderance of evidence that ulcers were caused by bacteria. The reason, the person who discovered it was a vet.
They had to give the man a Nobel Prize to get Dr's to pry their heads out of their self aggrandizing asses and pay attention to reality.
Opioids were addictive. They never stoped being that. Dr's were fiscally motivated to prescribe. Nothing more nothing less.
You’re wildly incorrect, nobody involved was a vet.
Barry Marshall shared that Nobel and is a Doctor. https://en.wikipedia.org/wiki/Barry_Marshall
Robin Warren received his M.B.B.S. an undergraduate degree focused on medical research. https://en.wikipedia.org/wiki/Robin_Warren He worked at: “SA Pathology, (formerly the Institute of Medical and Veterinary Science (IMVS)), is an organisation providing diagnostic and clinical pathology services throughout South Australia for the public health sector.” https://en.wikipedia.org/wiki/SA_Pathology
So whatever source you read that misinformation from is not trustworthy.
> Opioids where addictive
Hindsight bias here. We don’t want medical professionals to discard new information in favor of older treatments. There’s no way doctors can on their own replicate the medical research linking Ulcers with a bacterial infection and independently judge oxycodone’s effectiveness, and a dozen other drugs etc. Extended-release (ER) oxycodone was literally a new drug and described as not having the same issues associated with other Opioids on labeling approved by the FDA.
The crazy thing is how effective this all was. Medical schools were teaching students to hand out more opioids.
The doctors, all college educated, some of our most studied and intelligent citizens, they knew about the history of opiates and im not talking about the dare campaign. I knew before the epidemic even got into force when I tossed the opiates I was prescribed in the trashcan.
The oxy marketing was just the wink and the nod everybody needed to convince themselves to parrot with a straight face, but they didn't actually really believe it.
The Opium Wars were a cynical prototype for the modern war on drugs, which was initiated with similar designs and outcomes.
I don’t think you know the full history of how Purdue operated. They did two things: downplay how addictive oxy was & aggressively push oxy through doctors by providing kickbacks.
Chronic pain patients were actually a much smaller portion of the eventual victims. In a lot of cases, normal people would be prescribed oxy after minor procedures and they would get hooked on it and become permanent addicts. Once hooked, doctors would continue prescribing it for far longer and create a perpetual dependency. If the true effects of oxy were made public (which were known by Purdue pharma and Sackler family), oxy would’ve been prescribed with a lot more caution. And prescription of oxy for minor pain would’ve been non existent since a lot of safer alternatives existed.
I’m sorry you have a chronic condition, but not everyone who got hooked onto oxy had chronic conditions, and nor were they junkies.
Always the drug dealers fault.
I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that. What the doc said was just what they needed to hear to lie to themselves, but this is taught in every highschool.
I am not sure high schools are teaching people to be distrustful of their doctor’s advice. I think what’s being taught is about the dangers of illicit drugs, not those with a medical expert’s stamp of approval.
People have learned you can't trust the doc anymore than a quik-lube mecanico.
If you want to get rocked on opiates have at it, it's your body, just don't pretend you don't know they're addictive. It's ok to be an addict if you're honest to yourself about what's happening. Might even make sense if the pain is chronically awful.
As a reminder, Oxy was heavily marketed, (to doctors!) as a "not bad" opioid. As in, not as addictive, not as problematic, and something that can be prescribed more easily and with less worries.
If a doctor comes up and tell you "don't worry about this one, it isn't addictive like the others", and you are in a ton of pain at the time, you are going to thank modern medicine for its new miracle pain drug and accept the prescription.
> but this is taught in every highschool.
And as another reminder, most schools, until recently, just taught that "drugs are bad" and kind of left it at that. They exaggerated some of the down sides, and didn't mention any of the positive experiences.
IMHO South Park actually did the world's best anti pot ad -
"Well, Stan, the truth is marijuana probably isn't gonna make you kill people, and it most likely isn't gonna fund terrorism, but… well, son, pot makes you feel fine with being bored. And it's when you're bored that you should be learning some new skill or discovering some new science or being creative. If you smoke pot you may grow up to find out that you aren't good at anything."
-
And IMHO messages like that are more useful than what kids are being told.
There is also the social contract side of things - Since around 1950s, if people worked hard they things in return from society: A stable job, a house, the opportunity to raise a family. That social contract is shot to shit, and so it should be no surprise that more and more people are choosing to drop out of society via drugs/games/apathy.
Just learning about all the countries the British messed up would take at least another 5 or 6 years on top of whatever schooling is already done.
If you wanted to add everything America has done, well, people wouldn't be graduating high school until they are in their 30s.
We did learn about the Anglo-Zulu War and the East India Company, but a decision has to be made on what list of British atrocities to include in a history curriculum.
For that matter, I think China was only mentioned in passing throughout my entire education. WW1 was also only mentioned very briefly (maybe a couple weeks? Archduke is shot, shit goes down) and then we spent a fair bit of time on WW2, but less than we spent on Ancient Egypt honestly. (I think we spent an entire 2 or 3 months on Ancient Egypt).
We spent a fair amount of time on the Reformation and Renaissance, ancient Greece and Rome, and US history was mostly a ~bullshit~ censored history of the founding of the US. The Washington State history classes went into some history of the local tribes, but failed to mention any of the fun details about how Seattle was founded (prostitution, drinking, Seattle literally poisoning the wells of nearby towns to force them to join Seattle to get access to clean water)
College was better, mostly US history and World History, still nothing about the far east though.
We did an excellent segment on the US Revolution in College, including the funding source behind the revolutionary war, that was very interesting.
Edit: Sex ed was pretty comprehensive, and we ended the quarter by watching Rocky Horror Picture Show, so that was fun. (The Nerd and Goth kids formed a voting block for what movie to watch. :D) I am still surprised they talked about so much about forms of contraceptives that almost no one uses (spermicidal gels and foams), but at least they properly demonstrated how to use a condom, so that was good.
For "don't smoke" the health teacher had lots of pictures of tumors.
Alcohol wasn't really talked about, but honestly in the 90s we didn't know a much about how unhealthy it is as we do now. (Doctors knew it was bad, but just in the last few years research has come out showing that the safe amount of drinking is none)
Here's the thing about what they teach you about drugs in high school: lots of it is bullshit. I don't know if it's still a thing but when I was in school there was a lot of pearl clutching about weed being a Gateway Drug. For a lot of people who smoked weed and didn't progress towards any harder drugs, weed was a prime example of how drug education was a sham. No one went crazy, none of the weed horror stories came true, everyone enjoyed the concert and woke up the next morning feeling better than if they'd been drinking alcohol the night before.
My story is not unique. It is so common it could be a troupe. The doctors saved my life in one way, then discharged me into a hell of addiction that it took 9 months of serious determined effort to overcome.
Then, some uninformed keyboard warrior like yourself comes along and blames people in my situation? Maybe you should have read a little less Opioid Wars and a little more Current Events. You clearly know nothing about this problem.
But you win the victim totempole height contest I guess.
The medical practice (until a few years ago) was profoundly and intentionally misinformed about the addictiveness of Oxycodone and Oxycontin. You brought up a question about why people didn't learn from the Opioid Wars, but your flippant question could just as easily be applied to the MDs who wrote the prescriptions.
Medical doctors are smart; they MUST know about the Opioid Wars and the horror the opium wrecked on Chinese society for centuries. Why would they prescribe such a dangerously addictive compound to injured and vulnerable people having the worst day of their lives?
Instead, you blame patients with little choice (or capacity to evaluate choices) in a terrible situation. And, if you talked to any addicts, you'd sure find that the top of the "victim totempole" is actually really crowded with people who got there the exact same way. That is no coincidence.
The fact of the matter is that Purdue intentionally misinformed everyone - doctors, patients, caregivers, and family. They used marketing, propaganda, bribes, recognition, and myriad other tools to convince everyone that their product was different. Doctors, knowing full well about the Opium Wars, wholeheartedly believed the propaganda. I wasn't the first patient to be discharged from the hospital with a multi-month supply of opioids. This was a common practice.
The worst part is for someone who claims to be around addicts, you think I am somehow unique in my story. My story is so mundanely typical that it should be nauseating. Medical treatment is, by far, the most common way addicts start with opioids. 75% of all heroin users whose addictions started in the 2000s reported that it began with prescriptions from their doctors.
https://nida.nih.gov/publications/research-reports/prescript...
I genuinely suggest you spend some time talking to the addicts around you rather than judging them. You'd quickly come to regret the flippancy of your statement and probably have some empathy for their situation. These were regular people with jobs, families, lives, hopes, and dreams. In a crisis, they entrusted medical doctors to make the best medical decision for them, and the price they paid was their future.
Thankfully opioids have never been an appropriate treatment for my pain so I didn’t have to deal with this, but I feel real empathy for the people who switched to street drugs at that time. OD is a risk but considering how consuming pain is many would probably rather be dead than experience that anyway. This is not hyperbole, on pain forums people talk about assisted suicide all the time.
We failed pain patients across the board.
It took 6 or 7 years for us even start to find therapies that work. To this day doctors have just shoveled handfuls of Gabapentin and muscle relaxers down our throats or sent us for very invasive and painful nerve blocks which both have a high complication rate and need to be repeated as frequently as every three months.
Or told us to get more exercise. I’ve always loved that one! I’ve been improving my fitness for three years, but advancement is very slow because if I go too fast it can trigger pain and be a huge setback.
Fuck the Sacklers, but fuck whoever decided that pain patients don’t deserve opioids at a rate of 100x. As is always our policy with the disabled in America, our suffering doesn’t matter anywhere near as much as the political moralization that gets people in office
Ok, I’ll get off my soapbox. This topic makes me so angry.
logically: this argument isn't sound at all. looking at what happened since Oxycontin was regulated is not a proper counterfactual. you would have to look at a universe in which it was never introduced to begin with
Then it was taken away and things like illicit fentanyl filled the gap, but that came later.
You seem to just skip over that point in a bit of a blasé fashion, as if OxyContin's slow release formulation is somehow a defense of the Sacklers' behavior, when the exact opposite is true.
That is, a primary argument is that Purdue pushed OxyContin because they argued it was safer due to its slow release formula. Except they knew full well that "slow release" was pretty much bullshit because people were getting addicted by simply crushing the pills.
Purdue sales people deliberately pushed Oxy with the false promise of additional safety even though they knew this wasn't true.
The synthetic opioid demand in the US was a result of a chain of events including the purposeful stimulation of demand by marketing directly to Drs, lying about abuse potential, lying about withdrawal and addiction potential, and not introducing mediating controls when evidence of abuse and sales not meeting market demographics was clearly evident. Like they imported millions of pills to small towns with over selling pharmacies. Drs would up dosage to adjust to tolerance. But anyway it’s fentanyl that is killing people. I’d argue just let people use opium and regulate that sale.
Edit: changed and to an. Chinese precursor to imported precursor bc I honestly don’t know how many different countries are sources of a precursor. Added part about importing to small towns and upping dosage.
This is the largest and most deadly episode of addictiveness since the tobacco companies were marketing cigarettes as healthy. If this were a fire, you’d be arguing:
“Look, America has always had fires. Sure Purdue started fires in all 50 states that spread into the forest, but they were small when Purdue started them. Now, there is a blaze that has spread uncontrolled across the Continental US. So, obviously there were other parallel organizations starting fires.”
No. That doesn’t follow. Purdue stared the fires. They added tinder with marketing misinformation, then they inhibited any attempt at controlling it with active disinformation campaigns to confuse doctors and regulators about the root cause. Now, it’s a wild uncontrolled inferno, but they started the first fires.
But be careful about confusing cause & effect. The cause of the Afghani farmers growing opium was the insatiable demand for opium that was developed through legal means. Then, when countries like the US started to restrict access to opiates, addicts and patients alike started to seek alternatives to the scarce prescriptions.
More to the point, why didn't patients use something else? Because there is nothing. Purdue's misinformation actively discouraged the discovery of new non-addictive compounds for decades. No one was looking, and the R&D pipeline ran dry.
By the time enough doctors sounded enough alarms to cause a change in the late 2010s, research in non-addictive pain management solutions was decades behind. No one engaged in it because there was no need for it. Now that we realize it was all a lie and these drugs have killed millions, there are no alternatives. Very few potential compounds are even in Phase 2 clinical trials right now, let alone the half dozen that would be needed in Phase 3 to ensure we have a single alternate choice for pain management in the next five years.
So, the outlook looks bleak. Today, in 2024, we don't have good ways to manage pain that is non-addictive, and certainly no good way to reach the millions who are hopelessly addicted to opioids for pain management. But, very little of this is the patient's fault - and a lot of this is directly related to the monumental efforts of Purdue to misinform for profit.
Truly a stupendous point.
Look at what’s happened since Oxycontin was heavily regulated.
Opioid deaths in America have exploded by an order of magnitude.
There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S.
The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was).
But it’s quite clear that America had a parallel opioid crisis going on. By making OxyContin easily available, ie, a slow acting opioid (it had to be crushed to be fast acting) that was produced legitimately and had a legitimate supply chain so people were able to get exactly what they wanted, Purdue Pharma helped keep the number of opioid deaths under control.
IOW, the U.S. has had an addiction crisis that is independent of prescription drugs whose cause is not clear yet because everyone has thrown the blame on Oxy instead of researching it. This is the same kind of drug crisis that hit inner cities in the 20th century but has hit rural areas in the 21st century. By providing easy access to regulated and legitimate opioids the Sacklers may have marginally worsened the addiction crisis, but they minimized the number of deaths and severe negative impacts.
The moment Oxy and the other opioids were made less easy to get, the underlying drug crisis hadn’t gone anywhere, so instead the people suffering from the crisis had to get their opioids from illicit sources as opposed to the pharmacy, exposing them to all sorts of unregulated drugs that had all sorts of nonsense like Fenranyl mixed in, which causes the actual negative impacts of the drug crisis to explode.
The funny thing is that when the entire country was just absolutely united at making the Sacklers the big bad evil, the actual people working on the ground trying to help those who were facing this drug crisis were predicting this exact situation and were asking authorities to not clamp down on Oxy. But they were all ignored and so we have a situation where opioid OD deaths have gone from a consistent 10-15,000/year (a rate which preceded Oxy) to about 50,000/yr now.