Drug companies misrepresented the research around addiction; they aggressively sold the medication to doctors and patients; they continued these sales even when they had data showing large amounts of misuse in a region.
People seem to think there can only be one point of failure, one organisation or person to blame. The opioid crisis is complex and many things failed. You're right that doctors should not have prescribed as many opioids, but that doesn't absolve the makers or the insurance companies.
Some doctors are blamed for over-prescribing, which is why some doctors were jailed and some doctors struck off.
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.
Pharmaceutical companies promoted deregulation to permit advertising directly to doctors and creating quid-pro-quo situations. Pharmaceutical companies campaigned heavily for 'pain management' strategies that used 'safe' opioids. Pharmaceutical companies withhold negative trial results, generating false science. https://onlinelibrary.wiley.com/doi/pdf/10.1111/jep.12147
These 'safe' slow-release formulations allowed Pharma to generate new IP and new revenue sources. It was never about healthcare or patient comfort, it was about money. And those addicted to opioids are paying the price.
...Except doctors are very busy people who often rely necessarily on drugmaker-published literature to update their knowledge on those products and ailments. They don't generally have the ability to conduct their own research. Therefore, your assertion that all doctors 'knew' that these drugs were addictive is simply untrue.
Now, there is definitely a spectrum of responsibility/guilt that could be applied to all parties here. In some ways, the buck even stops with the patient: it's their decision what to put in their mouth and swallow, and no one was holding a gun to their head and forcing them to take the meds they were prescribed. But that of course is a very skewed view on the subject of addiction.
The crux of the issue is how society decides to assign blame. Collectively, we seem have a hard time dumping more responsibility on patients. Plenty of doctors have been fined, lost licenses, and gone to prison. Heck, my own childhood physician lost his license. But we also understand that many doctors who made mistakes deserve some leniency because they were tasked with helping people in pain.
But the drug companies...it's hard to imagine that they deserve even a shred of clemency. Their only job was to produce a product and represent it truthfully. Their failure mode was knowing, made them vast sums, and destroyed many lives.
> And remember - we did have a long experiment with legally prescribed opioids, and their widespread availability contributed to the current addiction crisis.
People couldn't just go to a store; trusted family advisors were overprescribing due to intentionally misleading advertising. The addiction crisis is what happens when insurance no longer covers the pills.
Any doctor who believed in addiction-proof opiates wasn't worth their salt to begin with. Opiates are opiates.
Any consumer who took opiates and got addicted has exactly one person to blame - themselves for being uninformed.
I love recreational drugs, and I've had back problems that required more than NSAID's alone, but I've never taken opiates, and I never will until I'm ready to die, because I know just how awesome they are.
Blaming the manufacturer for opiate deaths is like blaming manufacturers for firearm deaths, rather than the shooters.
People are looking for anyone to blame. Drug reps. Doctors. Pharmaceutical firms.
Now we've entered the "politicians/the media is to blame" stage.
When something goes wrong in this spectacular a fashion, you can bet people will try to lay blame wherever they can. But probably the truth is that this was on all of us. Doctors for prescribing without disseminating incredibly pertinent information, Parmas for creating "medicinal" opioids in the first place, politicians for not admitting the need for stronger regulation earlier, media for not covering the story better earlier, the people for being in denial about the obvious signs of addiction in their friends and loved ones. I mean the list probably goes on and on.
Society refusing to draw a link between the homelessness/addition crisis in the States and the pharmaceutical companies becoming drug dealers/pushers of opioids that flooded the country is honestly shocking.
Hundreds of thousands or millions of Americans became opioid addicts because they were prescribed unnecessary pills by their own doctors, and became hooked (the risks of opioids have been known for what, thousands of years?). We have barely given the pharma industry a slap on the wrist for the harm they've caused and the direct link between the two crises is never drawn in the public sphere.
Why should the companies that pushed opioids be allowed to push anything else? All those doctors who knew they were overperscribing opioids to addicts knew what they were doing, and they would do it with any other drug too.
Yeah, much of the 'opioid crisis' is entirely manufactured by how we've dealt with things. If doctors had recognized opioids as habit-forming and planned ahead of time to wean patients off of them with a long period of gradual tapering down in dosage (so if it takes 6 months or more, so what?) before quitting. Instead, they decided 'addiction' was a moral failing and simply stopping giving anyone prescriptions no matter how legitimate the need.
One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). Overdoses primarily happen with people mixing medications, trying to use unfamiliar medications recreationally (nothing can save a stupid person who wants to get high but can't be bothered to figure out what the right dose for that is for their body mass), or, most often now, having to get things from a black market where the supply is unknown potency or contents.
Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow. And they've been driving policy since the 80s, costing countless lives and monumental amounts of resources. Just to make sure no one has an easier time of life than they had.
> I think the question to ask is what created the opioid problem in the first place - I tend to think it's lack of regulation in the pharma space.
The opioid addiction crisis is a complex issue, and the data defies reduction to any particular cause.[0] It's become popular to blame the issue on the pharma industry, but to do so is an oversimplification large enough to call a mischaracterization, and focusing primarily on that area will not solve the problem.
I think that the reason for the popularity of this misconception is that it throws a bone to almost anyone's ideological predispositions. It blames both "big business capitalism" and "the out-of-touch elite", it avoids laying blame on doctors, or on homeless urban addicts, or on poor rural addicts, or on the suburban middle class, or on a culture that fosters both urban homelessness and rural poverty, and it's a simple explanation that has intuitive appeal.
And I know people who have been effected by big pharma. Anecdotal evidence doesn't fly in the face of a journalistic documentary. There's tons of docs on the crisis and the blame is squarely on big pharma.
I mean big pharma creates mistrust time after time. Look up Bayer selling HIV infected blood products in Africa after removing it from the North American market.
Opiates were marketed as sleeping aid for babies.
Synthetic opiates, such as tramadol were marketed not to be addictive that turned out to be a lie.
Many medications were taken of the market due to side effects, and often the pharmaceutical company knew and downplayed the side effects.
Anti-depressants were also supposed to be safe and non addicting, but withdrawals are actually insane.
I have been nearly crippled by an antibiotic and again side effects are downplayed, and FDA is updating the label year after year adding more and more side effects and not recommending the medication as first line treatment anymore.
You should blame the makers of OxyContin for publishing misleading information and pushing it on people who don't need it and creating a big health crisis that way. The people who really need it are suffering from it. Blame the company and not the people who have to deal with the tens of thousands of opioid deaths.
You might be right, but it's not an either or situation.
Some sales reps that told doctors Oxy was NOT or LESS addictive and knew that was untrue so they did lie.
Ironically the exact same thing happened a century earlier with Bayer and Heroin, history does indeed repeat itself.
The thieves that burgled drugs from pharma are also responsible obviously.
As far as the fast down votes, chances are everyone knows someone who has been hurt from the opiod crisis. It is a very painful subject for people. Playing the devils advocate is going to get a swift response that just the way it is.
My personal experience with the opiod crisis is typical, I had a friend who got hurt, started taking oxy, got hooked, his doctor cut him off, he spent a ton of money buying pills off the street, when the cost got too high he switched to heroin, when he decided to get help he went to a doctor for methadone, they did a blood test, because of the fentinyl he tested positive for abusing methadone and was refused. Three months later he was gone.
I feel the entire system failed him, ofcourse he was not without blame, everyone played a part in his death, including me for giving him money.
Purdue mislead doctors, and the public, in several different ways.
They said that their medication was unlikely to lead to addiction if used to treat pain. They said their medication was less likely to lead to addiction than other opioids. They knew some doctors were prescribing vast quantities of opioids - far more than even Purdue recommended as treatment for pain. They used a variety of marketing to doctors and to members of the public, and some of that was designed to evade regulation of marketing. They used stealth marketing methods such as employing physicians to speak at conferences without disclosure. They interfered with the creation of treatment guidance. They used front groups. They targeted vulnerable and wealthy populations. They concealed what they knew about the addictiveness of their product. They concealed what they knew about the efficacy of their product (people may tolerate an addictive medication if it increases function. Purdue knew their meds didn't increase function for many patients.)
There's a huge list of absolutely scumbag behaviour from that company, and we need to recognise their part in driving death and misery to millions of Americans.
They haven't been demonized for making opioids. They've been rightly criticized for deceptively marketing them to patients and doctors as safe and non-addictive[1]. They've been rightly criticized for allegedly bribing doctors to overprescribe opioids to patients who don't need them[2]. They've been rightly criticized for failing to properly monitor and control the supply of opioids.[3]
Some pharmaceutical manufacturers have made billions of dollars from oxycodone, hydrocodone and other synthetic opioid drugs. They used bad science, deception and outright criminality to flood the United States with powerful narcotics, sparking an epidemic of addiction. Nobody forced them to do it. Nobody asked them to do it. They should bear the consequences of their actions.
I hear what you're saying, but it feels like you should be placing your blame on the sacklers too - if they hadn't pushed opioids on people who didn't need them, fueling the crisis, then there would not have been this backlash you describe.
Like, we shouldn't be mad at opioids, we should be mad at drug pushing profiteers.
The Sacklers engaged in unethical behavior to get people hooked on something that made them money. Easy opioid prescriptions created thousands of (mostly) functional addicts who were getting their fix in a high-quality control form via their doctor on a monthly basis. That's bad but that's not an opioid "crisis". You don't get a crisis because of a few evil billionaires. More things have to go wrong. What really turned the opioid problem into a crisis is when the feds cracked down. The doctors had to cut the junkies off or lose their licenses. The junkies predictably switched to the street for their supply with predictably tragic results.
The Sacklers may have done unethical, arguably evil, things to make a buck but there's plenty of blame that should be cast in the direction of other parties here.
People seem to think there can only be one point of failure, one organisation or person to blame. The opioid crisis is complex and many things failed. You're right that doctors should not have prescribed as many opioids, but that doesn't absolve the makers or the insurance companies.
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