I guess I'm not sure what the point of the comparison is. If the death rate from opioid addiction were 1000x lower, I would happily bite the bullet and say Purdue did nothing wrong. Chronic pain is real and terrible - it would be great to have a solution where the downside risk is no worse than an Adderall dependency.
Problem here is that doctors pushed highly addictive painkillers on anyone and anything, while Purdue did everything they could to increase sales and disguise the risks associated with opioids.
Sure, OxyContin is better than Fentanyl, and banning Oxy can push people to way more dangerous opioids. But before painting Purdue as a hero of the people, let’s remember that million of people were pushed to opioids through Oxy when they shouldn’t have in the first place. Purdue played a big part in creating the epidemic in the first place. People that are now pushed to harder drugs because of an addiction they got into for the sake of Purdue making more dough.
"Apart from their addictive designs" is the key phrase here.
Purdue only created OxyContin for legitimate pain management but they knew full well the level of abuse because of their profits
I'd rather live in a society where the creators of these things take some responsibility for effects of whatever they've created, whether intentional or not
> "What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain?"
I don't think anyone would disagree here. But they weren't just prescribing it to terminal cancer patients, were they?
"With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients."
TL;DR: I think it is reasonable to blame Purdue for the reduced access to opioids we are now stuck with.
Purdue caused more addiction to occur, which in turn caused reduced access to the opioids that existed prior to the creation of Purdue's nuisance product.
Also, perverse incentives caused by the patent and licensing system motivated them to make OxyContin unnecessarily addictive in it's formulation and dosing schedule, in order to engage in patent "ever-greening" of an existing substance.
Oxycodone has been around for a long time, but was doesed and administered more safely in older products.
Purdue did some pretty perverse things to support their patent and regulatory rationale for OxyContin. To gain approval as a superior and patent-able alternative to the other extant gerneric hydrocodone and oxycodone products, it was claimed to require less frequent (but larger) doses. The result was that large numbers patients found that when taken as directed it provided superior pain relief, followed by a return of pain, in conjunction with hours of opioid withdrawals until the next dose. Early on in the product's life cycle doctors were encouraged to increase the dose but not the dosing schedule when patients complained, in part because the alternative would have undermined the rationale for the existence of the product.
Although this was probably an undesired side effect from the point of view of Purdue, they could hardly have designed a better way to cause drug addiction. Millions of people took this product and many became addicted. Purdue went far out of their way to publicize people as criminals rather than address the fundamental problem with the way the product was administered. It seems to be evidenced that the more effective administration schedules of other already existing products cause less addiction, so at the margin, Purdue caused many more drug addicts to exists than would have otherwise.
If they had not done this, or had been willing to adequately address the problems, we would probably still have easier access now to the opioids that already existed. The problem has grown to such a scale that it is now very hard to "put the genie back in the bottle."
>I hope you're right and it's not the other way around.
Sadly, it is the other way around. Purdue spent millions of dollars advertising Oxycontin as a safe, less-addictive painkiller for chronic pain. Doctors were inundated with "FDA-approved" marketing info, telling them that this specific kind of heroin was an easy, twice-per-day way to deal with back problems, knee pain, arthritis, etc. It was so deceptive that three of their executives were found guilty of criminal charges, and the company was hit with a fine so high it was a record in the pharmaceutical industry.
After people had been prescribed what is effectively heroin on a regular basis for months or years, they were addicted.
You're still conflating the two like they have anything to do with each other. The unhealthiest part has a lot more to do with our food consumption habits and our built environment, while the amount of drugs leads from that. And this isn't even getting into the issues with opioids which started with a combo of Purdue being trash along with the general macroeconomic conditions in the Appalachian Mountains.
"I find these two positions very hard to re-conciliate"
Same as per vmception's comments.
Also, what you need to realize is that opiate drugs are almost unique amongst drugs. There are staggering numbers of them in different classes - oral, injectable, short/long-acting etc.
The tragedy is that they're all addictive and the degree of their addictiveness is directly proportional their effectiveness at reducing pain (see Burroughs's perceptive quote in my post).
Thus, titrating the right dose and determining the period for which the drug should be given becomes a very difficult tightrope act, especially so if a long period is involved. Give too little and the patient suffers pain, give even a little too much and addiction is very likely the result. It's a nightmarish problem.
Opiates are the Janus of drugs - one face shows a miracle drug - the other is unmitigated pain and tragedy - and often death.
The issue here is that Purdue deliberately peddled oxycontin, a drug that can be taken by mouth, in ways that encouraged patients to easily slip into the 'too much' side. That this should never happen without supervision is a longstanding axiom of opiate management and has been known and well understood for over one hundred years.
In essence, Purdue and the Shacklers deliberately chucked away years of best practice which then benefited them financially but to the patients' devastating expense.
The matter of what drugs should be legalized etc. is somewhat different matter (which others have covered well so I won't address it except to say that they're not logically in conflict as they address different things).
I don't think that's the case, unless you go back many decades.
Purdue was in part so effective because they spent millions 'educating' (and bribing) doctors and making up a '5th vital sign' in order to push huge quantities of drugs. This was on purpose. Those face in pain posters you see still originally came from Purdue.
This always comes up in these threads, that perhaps we've swung too far in the direction of limiting access to pain meds for legit patients.
Which definitely has merit.
But that doesn't take away from what Sacklers and Kappor et al did.
from my understanding long term prescription of opiates in modern medicine wasn't really a thing before Purdue's marketing (and still isn't outside of late stage cancer in most countries).
So that's what I was getting at in responding to 'other opiates having been stigmatized in previous moral panics,' I think you'd have to go back to prohibition to find a similar time of heavy long term use 'medically'
legalization is really an orthogonal issue. opioid painkillers are a very useful class of drugs that also have serious potential for addiction. doctors understand this and must balance the risk/benefit trade off. the problem here is not that purdue sold addictive drugs, it is that the company intentionally deceived the public about how addictive their formulation is. even if all drugs were fully legal, it still ought to be illegal to misrepresent your product this way.
Purdue never prescribed opioids to anyone. They only sold them to hospitals and doctors, after the FDA let them do it. Not sure what message punishing them is supposed to send?
But I get it. Someone dies and it’s the drug dealers fault, and punishing them will make everyone feel better. Except it doesn’t do anything about the actual problem (opioid addiction).
It feels to me like the elation here is because the Sacklers are rich and people really don’t like that, rather than any sort of victory in combating opiate addiction.
Purdue Pharma is still doing pretty damn well. The problem isn't in using opiates to treat pain - it is Purdue's marketing actively lying about the addiction potential of OxyContin.
Well, let's take Oxy. That drug, at recommended doses, was supposed to provide 24 hours of pain relief but frequently did not do so in practice. This lead people to increase doses, and down that road lies addiction.
Purdue knew this and lied to the medical community.
Unless doctors ran their own studies they couldn't know that Purdue's dosage recommendations were pure garbage.
You forgot to mention the drug manufacturers like Purdue, which aggressively promoted their opioids (e.g., Oxycontin) as presenting only a very low risk of addiction and abuse.
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