I don't think Howard is entirely wrong about when this became a 'big deal', meaning when it started receiving a lot of press. The actual problems have been known for a very long time, but the sorts of extensive coverage that trickles down to the general populace is only a couple years old at best.

I remember arguing about this stuff with ikes (lol ikes, 1 year gone and almost completely forgotten) in the LC thread before those LA Times articles came out, and I got the impression it was brand new information to most people. And also that many thought it was some silly edge case thing I made up or whatever.

in ohio, at least by some metrics it has exploded in the last year. npr had an interview with the local exchange and they will give out 3-4x as many needles this year from last year. and, yes, as you zikzak do argue, the year before this was the worst ever at that time.

also, ofc, ods have exploded to the point where I think (could be wrong) there are like a couple hundred od deaths per week. thats not even counting the ppl who get saved and ohio has done very well to put narcane kits in all police and emergency vehicles and administer it to family, friends, and neighbors.

now, I think ods is not a great indicator since they can be attributed to more dangerous and potent substances like fent or the terrifying carfentanyl.

in short, ya, it has been bad for a few years and was not getting much press, but things have really fallen apart recently.

Blaming others for your personal deficiencies or issues never ends well for that person.

did you actually read the la times articles?


but the probley was that oxyC didnt last for 12 hours. to combat this, and so that the company stayed within fda regulations and so that insurance would continue to shell out money for the bogus 12hour version, they instructed doctors to simply use higher dosages, but not more frequent dosages.

this created immediate side effects like overdoses and simply being nodded out opiate high, but it also drove tolerance way up and caused higher likelihood of addiction. this compounded the problem of the drugs wearing off early bc the now addicted patient would end up suffering from withdrawal symptoms in between doses.

iir, havent seen this in awhile, this pretty much summarizes the la times article and accusations.

the most interesting, and heartbreaking, part is when the oxyC promotional interviews are replayed and the patients describe how happy and functional they are on the new drug.

the show catches up with them many years later and all of them went thru hell and I think some are dead.

And that's just wrong. There were already 12h and even 24h extended release morphine products on the market. Oxycontin's advantage over those products is that oxycodone is better* than morphine.

*better meaning it avoids some of morphine's annoying peculiarities (histamine release, more allergy interactions, etc)

It didn't pop out of nowhere, its been a slow burn with steady momentum. When I first started prosecuting 11 years ago, everything was crack/cocaine. Heroin was very rare. Now, I almost never see cocaine anymore, its all opioids and heroin. Nearly every property crime i prosecuted, defendant is an opioid addict. Nearly every violent crime I prosecuted had its genesis or was in some way related to opioids. Every one of my witnesses and my victims on homicides, all opioid/heroin addicts (most of my homicide victims.... heroin dealers). The story I'd hear would almost always be exactly the same. Someone leading a relatively normal life has an injury of some sort, gets prescribed opioids, needs more and more, doctor cuts them off, they start buying pills ont he street, someone points out that heroin is cheaper and easier to get and has the sam effect, and they switch to it... or someone just starts on opioids recreationally and then switches to heroin because it's cheaper and easier to get. This is absolutely the fault of big pharma, i"d say 99 percent of the heroin addicts I've dealt with (hundreds and hundreds over the years) got their start with pills. OxyContin was initially marketed as being not addictive. That is the biggest crock of **** lie by a corporation since "cigarettes are not harmful to your health."

Vastly worse imo. You expect tobacco companies to lie to you, but when it's your own doctor telling you it's okay to take opioids? Just insidious. Like, everyone has known for generations that smoking is unhealthy. Probably we didn't appreciate just how dangerous and addictive, but you could argue that a lot of people should have known better. But some retired factory worker who goes to his doctor and gets some pills for his back pain, that guy had no chance.

And of course the doctors can point to research studies that showed these drugs are safe. It's like all the people you're supposed to trust failed to do their job.

This describes my experience well. I had to fight dealers selling out of my apartments for decades and it's particularly difficult in NYC bec everyone is entitled to a renewal lease meaning I couldn't even wait until the lease expired and then evict them. So to suddenly find out from the news that it's an epidemic NOW, when it was already an epidemic to me, and that Big Pharma was to blame in large part is a head shaker. I'd considered starting a thread before and finally did bec of the Newark, NJ lawsuit, gl to them I doubt they get far.

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jman: Can you tell us if many prosecutors think that drugs should be legalized?

Lol, Purdue held the patent for ER morphine and it was running out. So Purdue developed a ER oxyC. The whole point of this fiasco from Purdue's perspective has been protecting high value patents.

I don't know what you are arguing here. Nobody is saying there isn't a way to prescribe oxycontin responsibly. The problem is Purdue specifically lobbied for years to convince docs not to do so. To this day Purdue insists that oxycontin is a 12 hour drug and there is no indication for 8 hour dosing. They specifically told docs if 30mg wasn't lasting 12 hours then up to 40mg. If 40mg doesn't work out, there is no upper limit to dosing.

The entire pharmaceutical infrastructure in marketing their products, and this goes for any of their medicines not just opioids, have certainly greatly contributed to the expansiveness of the opioid problem.

They have traditionally hard pressed doctors and pharmacies to move their medications. On top of that they provide data and information and knowledge to prescribers which although biased can be appealing to doctors. It is simply not possible for your typical PCP to stay up to date on all the ins and outs on every new treatment and medication. Add in off label uses and you end up with the pharmaceutical companies having way too much influence.

Someone in the know can clarify this but it used to be the Wild West when it came to pharmaceutical reps wining and dining doctors. Expensive dinners and trips. Expensive catered lunches to the office for the entire staff etc etc. again I think some of this stuff is no longer allowed but it used to be standard. (I will caveat this that I am not saying doctors are all so easily bought off, I’m just saying the pharmaceticual sales branches provide a constant assault in hopes of influencing decisions).

The other side of the coin is the heroin itself though. The purity of heroin has increased substantially over the last forty years. Where you could only get high from heroin intravenously you can now effectively ingest heroin in a multitude of ways which makes it an appealing alternative to prescription opioids due to black market cost.

Unlike a suggestion I saw in another thread where people might sue the Mandalay Bay for the Las Vegas shooting there is actual grounds to prove negligence and even gross negligence on behalf of drug manufacturers. Their entire sales model is based on pushing as many units as possible and getting as creative as possible in doing so. If they are needed or helping people is not a consideration for their sales arms, thus I think they are potentially liable.

I'm saying that employing a vast conspiracy to decrease your revenue doesn't seem to make sense. Seemed like you were following for a little bit.

By the way if anyone knows anyone suffering from an opioid problem who is trying to quit I suggest trying kratom. It is legal and has been shown to be an effective way to ween off opioids/heroin by blunting the withdrawal effects. YMMV

Dude it's really not that hard. Patent on 8hr oxy ran out. No more profit there.

So they came up with 12 hr oxy.

Read the articles.

Victor, zikzak and will1530 trying to win an argument about OxyContin’s drug release properties with a pharmacist.

Going how I expected.

Lol awval. Go back to jacking off daddy Trump.

So it's your contention that Purdue did not actively lobby doctors to convince them that q12h was the only appropriate way to prescribe oxy? Not only that, but they welcomed q8h schedule because profits would be higher?

Nope. I qualified my language because I knew who I was responding to. Now I'm watching the back and forth. At no point was I arguing, except now, with you, because you're trying to ride JTM's coattails without bothering to make substantive points of your own even though this is one topic where you actually do have expertise.

yep. ofc we are correct. since we do things like read and interpret words and meanings.

I know of plenty of prosecutors and law enforcement that think that marijuana should be legalized. I know of none that think that the harder drugs should be.

This is fair.

So fine, I'll answer the OP. And critique where you guys are wrong.

Purdue Pharmaceuticals -- specifically the drug reps -- are only allowed to lobby doctors to prescribe the medication per the FDA indications. It is approved for q12h dosing. So they cannot solicit doctors to write it for q8hours. That's a fact.

It wasn't marketing that Purdue kept up the q12hour campaign. It's because that's all they have FDA approval for and all they legally can advertise for, solicit for, and advise.

Could Purdue have went back and gotten q8hour study data? Sure. But why when they were making sick profits? Clinical trials are expensive.

So, back to the OP question:

Is "Big Pharma" responsible for the heroin epidemic?

You have to work backwards.

Why do we have a heroin epidemic now and no longer an OxyContin epidemic like we did 8-10 years ago? Because we (the government, the people) crushed all the pill mill doctors. Nearly all states now require every narcotic prescription to be entered into a state database. And states now all share this data. So now you can't doctor shop anymore. The state system will flag it when you try to fill the prescription.

So street OxyContin isn't as readily available anymore. And the few that are, via supply and demand, cost much more. So the addicts go with a cheaper fix. Heroin. And the problem with heroin is that the potency isn't known. It's a white powder. Is it cut with corn starch? Or is it 100% pure.

Why didn't we have the deaths 8-10 years ago. Sure, we had the addictions, and the street crime, but we didn't have the deaths.

And that's because the addict new his/her limit. OK, I can crush and snort 40mg OxyContin and feel good. And sure, they can keep titrating up. But they are dealing with known quantities.

With heroin, fentanyl laced heroin, you just don't know. Fentanyl is measured in ****ing MICROGRAMS guys. Some hot shot drug distiller could have had a "lucky" pure batch and instead of making his crap heroin a little stronger, instead made every hit a death sentence.

Further backwards.

Why did we have an OxyContin epidemic? Because Americans are coddled to not have pain. Our doctors taught that pain is the 5th (or 6th, I don't know) vital sign. Doctors want to stop the pain. Give more narcotics. Pharmacies want to sell the pills to make more money. More prescriptions more money.

Humans become more and more tolerant to the analgesia effects of higher and higher doses of narcotics. So give them more! But not the side effects. So these patients are constipated, tired, and nauseous. Can't hold a job because they suck at work now. Go on disability. Nothing to do now but take more pills. You know how you liberals always say, a gun in the house makes the house more unsafe. It's the same thing with pills. More pills in the house more risk of theft from children, family, etc. Now more pills on the street. Cycle repeats. More addiction. More life's ruined.

Did "Big Pharma" cause Americans' heroin epidemic? No.

The opium poppy has been around since antiquity. Oxycodone has been around for one hundred years. All Purdue did was rap a fancy long-lasting coating on an old drug. So what, it didn't last for 12 hours instead maybe only 8-10 hours instead. But Purdue was just responding to demand. And if it wasn't extended-release oxycodone it would have been another drug, or another drug company. We have extended-release everything now. Fentanyl, hydromorphone, morphine, whatever.

It doesn't matter.

We stopped the pill mills. And the doctor shopping. But now these addicts just get heroin where the potency is unknown. And this is why they are all dying.

We treat pain like a vital sign. And patient's expect a pain score of 0. To get to a zero that patient feels euphoria from the opioids. And wants more and more. A viscious cycle.

Opioids have a role of course. But they are overused in this country. To deal with chronic pain. Or even ****ing headaches like JTM posted.

Anyway. We created this cycle. By wanting to be pain free from this sometimes painful life.

There ya go.

So we didn't have an opioid epidemic, and then Purdue found a way to get lots of opioids into the market, and now we do, and it's not their fault?

Turns out the real villains are coddled old retired industrial workers who don't want to have chronic, excruciating pain! 2p2's tireless advocate of downtrodden, small-town Ohio solves another case.

Hey guys, here is a direct causal sequence from A to B to C to D, but you can't blame D on A!

Lol awval. So you just retired jtms 8hr vs 12 hr conspiracy assertion with the same information myself and the others that you took shots at provided and linked to in the la times article.