Opioids

Everything else!

Moderators: Bakhtosh, EvilHomer3k

User avatar
Chrisoc13
Posts: 3992
Joined: Fri Oct 15, 2004 7:43 pm
Location: Maine

Re: Opioids

Post by Chrisoc13 »

stessier wrote:
Chrisoc13 wrote: Tue Apr 24, 2018 9:50 am Honestly the crisis is not fabricated, it's certainly real. On the prescriber side I can say the awareness has increased dramatically as have the hoops we have to jump through to prescribe. But along with this there has been a significant amount of research into opioid usage and requirements. In my field (urology) we are actively moving away from narcotics completely for many procedures. The research conducted has shown that the risks outweigh the benefits for much of what we do.

The entire shift requires a huge culture change and a change in mentality, as well as a lot of education. When we initially started drastically cutting back on narcotics prescriptions we would routinely get called by the post operative nurses who were incredulous that we weren't giving narcotics and this not adequately managing the patient's pain after surgery. But now they have seen that the vast majority of our patients have their pain managed by non-narcotic means and have bought in largely as well.

Another compounding issue is that the average lay person has many misconceptions and a general lack of knowledge of what narcotics actually do, what they are good for, and the differences between various narcotics. Most people are completely ignorant about narcotics. We need a much better education strategy aimed at patients. I tend to have to spend a fair amount of time educating patients about why narcotics won't actually solve their problem. Like I said it's a dramatic shift in mentality and culture going on.

In Maine (and most States I presume) all narcotic prescriptions are carefully tracked and we have access to the state database where we can see what people have been prescribed before. With this tracking now mandatory (as of the last couple years) there have been lots of meetings in conferences educating prescribers. One in particular was interesting because the high volume prescribers in Maine were largely dentists. It's a problem they are trying to tackle from multiple fronts, and honestly it's a worthwhile and worthy cause.
So what are opioids good at compared to other options? Are there some cases where they are the drug of choice?

I had oral surgery twice and both times I got vicodin that they wanted me on for 24 hours, although it seemed like the Advil/Tylenol alternating schedule was just as good at controlling the pain (granted, I only started that 24 hours after the surgery).
At work now but I'll post my thoughts and what I do later today when I get a chance.
User avatar
Chrisoc13
Posts: 3992
Joined: Fri Oct 15, 2004 7:43 pm
Location: Maine

Re: Opioids

Post by Chrisoc13 »

stessier wrote: Tue Apr 24, 2018 11:29 am So what are opioids good at compared to other options? Are there some cases where they are the drug of choice?

I had oral surgery twice and both times I got vicodin that they wanted me on for 24 hours, although it seemed like the Advil/Tylenol alternating schedule was just as good at controlling the pain (granted, I only started that 24 hours after the surgery).

Opioids are good at pain relief, and that is all. Clearly the best way to treat pain is to actually treat the underlying cause, rather than just the pain. So for many things people want narcotics when really they would be better off with another medication. Take for instance in my field ureteral stent pain. We place small plastic tubes called stents up into patient's kidneys which go down to the bladder. Normally this is done because of kidney stones or some other obstruction. These can by themselves be quite pain for some patients. The pain comes and goes (or as we call it is colicky in nature) and many many many patients want narcotics for stent pain. The thing is narcotics have been proven to not work well for stent pain. In fact they end up just constipating patients and leading to other issues while they still have stent pain. What patients really need is anti-inflammatory medications (NSAIDs such as Ibuprofen). So over and over and over again I tell patients their go to for stent pain will be Ibuprofen and Tylenol (not anti-inflammatory but still much stronger for pain than people give it credit for) around the clock. On top of that if that doesn't kill the pain I will prescribe a non-narcotic medication that relaxes the smooth muscles of the ureter that the stent is in called flomax (normally used for the same properties in the prostate so old men can pee). After those three medications very few patients have intolerable stent pain. But with narcotics largely the same stent pain but other issues. There are many times people want narcotics because they think they need something prescription because over the counter cannot possibly work, but research shows that Ibuprofen and Tylenol together work the best. This is just one example.

Largely I can only speak for my specialty, since I don't use it for other things. But in Urology we actually have been drastically cutting back on narcotics usage in a variety of ways. We do a wide variety of different surgeries and procedures from small procedures to soem of the biggest surgeries people can have, and largely avoid narcotics successfully now for the majority of our cases. Some of which is new. So where are some areas narcotics have been cut? Any cystoscopic procedure (working within the bladder with scopes, either removing tumors or stones or prostate tissue), any ureteroscopy (working up within the kidney with scopes removing stones or tumor, normally stones), and vasectomies we use zero narcotics now in my practice. Even very large procedures such as radical cystectomies (a case where you remove the entire bladder, and form a new reservoir using bowel, one of the biggest surgeries anyone can ever have) Urologists in general avoid narcotics almost completely. There are better options. For instance for cystectomies we have anesthesia place an epidural prior to the case which stays in until the patient can tolerate oral medications again (normally 4-7 days after surgery). And despite this surgery having a very large incision by this point most patients do not require any narcotics. In fact for cytstectomies in general the newest protocols call for avoiding narcotics as much as possible because narcotics have been proven to keep patients in the hospital for an extra 2-4 days and actually delay recovery by slowing down the bowels, the slowest part of the surgery to return to normal anyways.

Robotic cases such as prostatectomy (removal of the prostate) we have are now moving away from narcotics completely at discharge. This actually is my current area of research and we have found that patients who have their prostates out robotically can normally go home without any further narcotics after they are out of the hospital. Why is this important? Well for 1 all those extra pills everyone has after surgeries have been found to be a big factor in the opioid epidemic, but also for practical reasons narcotics have a lot of nasty side effects (most notably that bugs us is constipation). If a patient who recently had surgery in their pelvis gets constipated they are going to strain to have a bowel movement. If they do that they are going to increase the pressure in their pelvis and add unneeded stress to a fresh wound that needs to heal.

Are there times when opioids are the treatment of choice? Well they always are just treating pain, so they never treat the underlying issue. But there are some times we will tell patients they should be using them. It's been years since I've had to treat this but rib fractures in the elderly are a really good example. As people age rib fractures actually have a very high mortality rate (as in as high as 10% for each rib fractured). The reason is that with pain patients start to splint and not take full breaths. As a result they are not fully inflating their lungs and they are prone to develop pneumonia which then ends up killing them. So adequate pain control is the treatment of choice for rib fractures, especially in the elderly.

Narcotics have their place, but they should generally be a last option, and then only to be used when it works. I think the modern shift of views on narcotics is similar to the shift in antibiotics over the last decades. We used to prescribe antibiotics willy nilly. And where did that land us? Well it contributed to resistance. Now we are highly selective with antibiotics. It has taken a huge shift in the medical industry, and with patients too. I still get calls on weekends form little old ladies who just want an antibiotic because they are positive they have an infection even though they have a urine culture that is negative. In years past those little old ladies were simply prescribed an antibiotic without even having to give a urine sample for culture. Times have changed and responsible stewardship for antibiotics has changed practice. Now we are seeing the same thing with narcotics. It is going to be an adjustment for people, it is going to take education, and it is going to take understanding of why we are doing it. It means people are going to have to stop thinking of NSAIDs and Tylenol as weak pain medications, because they are not. It means people have to realize they are going to get smaller prescriptions for pain medications because there are too many narcotics in the wild. It means prescribers have to be judicious and do their part about limiting the number of unnecessary narcotics in the wild as well.

Anyways probably a more long-winded answer than you were looking for. But yeah narcotics have their place, but we should be looking for as many ways as possible to avoid them.
User avatar
Skinypupy
Posts: 20335
Joined: Tue Dec 07, 2004 10:12 am
Location: Utah

Re: Opioids

Post by Skinypupy »

Thanks Chris, that’s great info.
When darkness veils the world, four Warriors of Light shall come.
User avatar
stessier
Posts: 29816
Joined: Tue Dec 21, 2004 12:30 pm
Location: SC

Re: Opioids

Post by stessier »

Chrisoc13 wrote: Tue Apr 24, 2018 7:21 pm Anyways probably a more long-winded answer than you were looking for. But yeah narcotics have their place, but we should be looking for as many ways as possible to avoid them.
Not at all - this was great. Thanks for taking the time!
I require a reminder as to why raining arcane destruction is not an appropriate response to all of life's indignities. - Vaarsuvius
Global Steam Wishmaslist Tracking
Running____2014: 1300.55 miles____2015: 2036.13 miles____2016: 1012.75 miles____2017: 1105.82 miles____2018: 1318.91 miles__2019: 2000.00 miles
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Opioids

Post by Isgrimnur »

Nevermind. Turns out they were different stories.
Last edited by Isgrimnur on Fri Aug 31, 2018 6:54 pm, edited 2 times in total.
It's almost as if people are the problem.
User avatar
GreenGoo
Posts: 42239
Joined: Thu Oct 14, 2004 10:46 pm
Location: Ottawa, ON

Re: Opioids

Post by GreenGoo »

Depends on the size of the baby you're giving it to, I assume.
User avatar
dbt1949
Posts: 25688
Joined: Wed Oct 13, 2004 12:34 am
Location: Hogeye Arkansas

Re: Opioids

Post by dbt1949 »

The VA just sent me a letter the other day saying GIs are using too many opioids and they're going to start lower the number of pills we get until it reaches zero I guess.
Ye Olde Farte
Double Ought Forty
aka dbt1949
Jeff V
Posts: 36414
Joined: Fri Oct 15, 2004 7:17 pm
Location: Nowhere you want to be.

Re: Opioids

Post by Jeff V »

Wait, you're NOT growing your own poppies?
Black Lives Matter
User avatar
Daehawk
Posts: 63530
Joined: Sat Jan 01, 2005 1:11 am

Re: Opioids

Post by Daehawk »

Ive hurt a lot this month and taken an extra one at night to help stay asleep and now Im out a week early. I dont go to the doc until the end of next week. So not only am I going to be in a hell of a lot of pain Ill also suffer 8 years of withdrawal....sweats cramps insomnia anger boredom hot/cold vomiting just tons of shit. Not going to enjoy this Labor Day weekend or next week. About the time I start to feel any different Ill be at the doc again and start again.
--------------------------------------------
I am Dyslexic of Borg, prepare to have your ass laminated.
I guess Ray Butts has ate his last pancake.
http://steamcommunity.com/id/daehawk
"Has high IQ. Refuses to apply it"
User avatar
Kasey Chang
Posts: 20750
Joined: Sat Oct 30, 2004 4:20 pm
Location: San Francisco, CA
Contact:

Re: Opioids

Post by Kasey Chang »

IMHO (and I'm not in the medical field), the opioid prescription is like "institutional momentum" that takes a lot of time and effort to turn around... Back then we don't know about all these symptoms and side effects and addiction and all that caused by opioids... or we can keep coming up with synthetic stronger ones (like fentanyl) so doctors keep prescribing them, and patients keep demanding them. Obviously there are tons of shades of gray in there, but that's my outsider's view.
My game FAQs | Playing: She Will Punish Them, Sunrider: Mask of Arcadius, The Outer Worlds
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

CDC
[The director of the Centers for Disease Control and Prevention, Robert Redfield,] said that the stigma around opioid use now is greater than the stigma around AIDS.

“It’s nothing compared to what we’re confronting with drug use,” Redfield said.

For him, the issue is personal — his son has been in recovery for drug use for three years.

“I pray for him every day,” Redfield said. “People don’t realize that addiction is a medical condition, it’s not a moral failing. People don’t realize it’s a chronic medical condition.”

Redfield compared it to another disease, like cancer. We don’t stigmatize people whose cancer goes into remission and then flares back up, he said, so why do we stigmatize people who relapse after treatment for drug use?

He said that treatment for addiction should be integrated into primary care.
It's almost as if people are the problem.
User avatar
Daehawk
Posts: 63530
Joined: Sat Jan 01, 2005 1:11 am

Re: Opioids

Post by Daehawk »

My inside view is they work. But long term they lose their power and you need stronger and stronger ones. They have offered me stronger stuff and I have refused. I plan to be off them one day and I dont want to be on stronger stuff thats harder to quit when the time comes.

I kid myself though as my disabilities are permanent but I still have hope. But my opiates work and Im glad for them.
--------------------------------------------
I am Dyslexic of Borg, prepare to have your ass laminated.
I guess Ray Butts has ate his last pancake.
http://steamcommunity.com/id/daehawk
"Has high IQ. Refuses to apply it"
User avatar
dbt1949
Posts: 25688
Joined: Wed Oct 13, 2004 12:34 am
Location: Hogeye Arkansas

Re: Opioids

Post by dbt1949 »

I was only getting 8-10 5mg pills a month but the VA said "There's a crisis! Take everyone off!"
Now I'm back to aspirin.
Ye Olde Farte
Double Ought Forty
aka dbt1949
User avatar
Daehawk
Posts: 63530
Joined: Sat Jan 01, 2005 1:11 am

Re: Opioids

Post by Daehawk »

I take 120 10mg a month. I could use double that in either amount or dosage.
--------------------------------------------
I am Dyslexic of Borg, prepare to have your ass laminated.
I guess Ray Butts has ate his last pancake.
http://steamcommunity.com/id/daehawk
"Has high IQ. Refuses to apply it"
User avatar
gameoverman
Posts: 5908
Joined: Wed Oct 26, 2005 2:21 pm
Location: Glendora, CA

Re: Opioids

Post by gameoverman »

Regarding the stigma of addiction, in my experience it's because many addicts didn't need to take the drugs. Obviously this does not include people who have medical conditions where long term use is a given.

If I break my ankle and they give me a prescription for 30 pain pills, it does not mean I need to take all 30 of those pain pills. In fact I don't have to take any at all. They are an option if I absolutely cannot tolerate the pain. So how do I get addicted if I take one or two here and there during my recovery? When my recovery is all said and done I may have 25 pills left over.

On the other hand, if someone gets a prescription and they take one every however many hours that the label says they can until the bottle is empty, then duh, addiction is a possibility. And almost all the addicts I've known fall into this category, the "I have the bottle of 30 so I'm taking 30" category. People notice this and that's where the stigma of a moral failing comes from.

I realize some people have a low pain threshold. I don't hold that against anyone. However, these people need to be especially careful, since they will be the ones most tempted to abuse the drugs. In other words the first line of defense against addiction is the effort of the person taking the drug.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

CNBC
The Food and Drug Administration began its crackdown on the opioid epidemic Tuesday with a warning letter sent to drug distributor McKessson for allegedly shipping "illegitimate" product, taking the agency's first formal enforcement action to curb abuse.

Specifically, the FDA is accusing McKesson of failing to identify, quarantine and investigate drug shipments that had been tampered with. Some of the illegitimate products were discovered at a Rite Aid pharmacy in Milford, Michigan.
...
In its warning letter, the FDA cited three examples where McKesson shipped prescription drugs that were supposed to be opioids and pharmacies discovered the opioid pills were removed and replaced with other products.
It's almost as if people are the problem.
User avatar
LawBeefaroni
Forum Moderator
Posts: 55316
Joined: Fri Oct 15, 2004 3:08 pm
Location: Urbs in Horto, outrageous taxes on everything

Re: Opioids

Post by LawBeefaroni »

A warning letter!? The war on opioids has gone too far!
" Hey OP, listen to my advice alright." -Tha General
"No scientific discovery is named after its original discoverer." -Stigler's Law of Eponymy, discovered by Robert K. Merton

MYT
morlac
Posts: 3898
Joined: Wed Nov 03, 2004 4:25 pm
Location: Just outside the ATL

Re: Opioids

Post by morlac »

gameoverman wrote: Thu Oct 25, 2018 3:23 pm Regarding the stigma of addiction, in my experience it's because many addicts didn't need to take the drugs. Obviously this does not include people who have medical conditions where long term use is a given.

If I break my ankle and they give me a prescription for 30 pain pills, it does not mean I need to take all 30 of those pain pills. In fact I don't have to take any at all. They are an option if I absolutely cannot tolerate the pain. So how do I get addicted if I take one or two here and there during my recovery? When my recovery is all said and done I may have 25 pills left over.

On the other hand, if someone gets a prescription and they take one every however many hours that the label says they can until the bottle is empty, then duh, addiction is a possibility. And almost all the addicts I've known fall into this category, the "I have the bottle of 30 so I'm taking 30" category. People notice this and that's where the stigma of a moral failing comes from.

I realize some people have a low pain threshold. I don't hold that against anyone. However, these people need to be especially careful, since they will be the ones most tempted to abuse the drugs. In other words the first line of defense against addiction is the effort of the person taking the drug.

I mean I guess you can blame the patient but maybe the first line of defense is in NOT prescribing 30 pills when 10 would be plenty. If the patient really needs more after the initial 10 a quick call or doc visit and another 10 can be doled out as needed. Starting with prescribing for the worst case scenario is what has flooded the market and lead to this crisis. People trust their Doctors to prescribe what they need; no more no less. If it says to finish the bottle than as a patient I am finishing the bottle. Nope, the first line of defense is with the Doctors over prescribing and the Drug Companies enticing them to do it.

Of course this being America we are now over reacting and making it difficult for people who are in need to get them.
User avatar
Daehawk
Posts: 63530
Joined: Sat Jan 01, 2005 1:11 am

Re: Opioids

Post by Daehawk »

Of course this being America we are now over reacting and making it difficult for people who are in need to get them.
Been this way for years. Its a big big reason why I simply gave up and quit when my wife died. She knew I wanted off them someday but wanted me to get my kidney surgery first. She knew if I simply quit id be in bad pain with it plus my damn back and then in the hospital after surgery they'd pump shit into me . So Id have 2 withdrawals to go through and a lot of pain.

But when she had her stroke I cold turkey stopped taking my meds because I wasn't sleeping for days and I was driving 1 hour home then 1 hour back to her at the hospital each day. But when she died I didn't start again. I was so tore up over it the withdrawals didn't touch me..if they did I didn't notice.

Im in pretty severe pain now from my back and then my kidney is jumping in too. I still need the surgery. So just the worst scenario my wife envisioned and tried to help me avoid I jumped head on into. But in this age of opiates are the devil I dont feel like bothering again. I dont even want to be on the planet now without her. If pain stresses me to the point of a heart attack or something more power to it. F it all. Im under more stress than the rest of my life combined right now. And Im not getting over my wife in the least. Its probably worse now than ever. Screw money for my pain meds and doc. I lost my wife. That counts..they and I dont. I always worried how the opiate war was going to affect my wife and her pain. Well now she is pain free and can run like the wind and be happy.
--------------------------------------------
I am Dyslexic of Borg, prepare to have your ass laminated.
I guess Ray Butts has ate his last pancake.
http://steamcommunity.com/id/daehawk
"Has high IQ. Refuses to apply it"
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

CNN
Purdue Pharma has agreed to pay over $200 million to settle a historic lawsuit brought by the Oklahoma attorney general who accused the OxyContin maker of aggressively marketing the opioid painkiller and fueling a drug epidemic that left thousands dead in the state, a source familiar with the case tells CNN.

The settlement which was first reported by Reuters, comes after Purdue fought the attorney general in court, seeking to delay the start of the trial, which is scheduled for May 28.

The source would not say whether other drugmakers named in the suit would follow Purdue's lead.

A spokesman for Oklahoma Attorney General Mike Hunter declined to comment. The attorney general has planned a news conference for Tuesday afternoon in Tulsa.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

NPR
Opioid manufacturer Insys Therapeutics has filed for Chapter 11 bankruptcy protection, just five days after agreeing to pay $225 million to settle the federal government's criminal and civil cases against the company for bribing doctors to prescribe its fentanyl-based painkiller.

In documents filed Monday, Insys asked the court to allow it to sell its assets to pay more than $250 million in debts. But the move also means the government may not collect all the settlement money it is due.
...
It is the first time a drugmaker has sought bankruptcy protection due to legal action related to the opioid crisis. Under Chapter 11 protection, the company will be able to keep operating — paying employees and vendors — as they devise a plan to pay mounting legal expenses, including more than $11 million spent to defend Kapoor against criminal charges by the government, according to court papers.

Kapoor and four other top executives at the company were found guilty of widespread racketeering conspiracy last month.

The bankruptcy filing also comes on the heels of a guilty plea by Insys last week to five counts of mail fraud and the admission that it bribed doctors to boost sales of the powerful and highly addictive opioid, Subsys. The sublingual spray was developed as a pain management drug for adult cancer patients who are already tolerant to around-the-clock opioid therapy.

The scam involved paying doctors through a fake "speakers program" between 2012 to June 2015. Company employees enlisted physicians to prescribe the medication, which is 100 times stronger than morphine, in high doses and often to people who did not need it. They also lied to insurance companies to ensure they would cover the Subsys prescriptions, which can cost $10,000 a month or more.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

NPR
For the first time, a federal court in Ohio is releasing a trove of data that offers far more detail about the size and scope of the nation's opioid epidemic — and about the role played by drug companies and pharmacies like CVS, Walgreens and Johnson & Johnson that profited from the rapid growth of prescription opioid sales.
...
Some drug companies fought in court to keep the information secret, arguing that it contains proprietary details about their business practices. The U.S. Drug Enforcement Administration also resisted releasing the data, arguing that it included sensitive information used by law enforcement.

But a large portion of the searchable database, known as ARCOS, is set to be released in an order signed by Judge Dan Polster on Monday. Once available to the public later this week, it will offer a transaction-by-transaction account of how opioid pain pills were made, distributed and sold by pharmacy chains from 2006 through 2012 when the addiction epidemic was growing fast.
...
While much of the media scrutiny and recent high profile lawsuits have highlighted how drug manufacturers allegedly fueled the epidemic, the ARCOS data is expected to clarify the role played by distributors and pharmacies.
It's almost as if people are the problem.
User avatar
dbt1949
Posts: 25688
Joined: Wed Oct 13, 2004 12:34 am
Location: Hogeye Arkansas

Re: Opioids

Post by dbt1949 »

How is it the fault of the pharmacies? They can't sell them to people without a prescription.
Unless of course they are.
Ye Olde Farte
Double Ought Forty
aka dbt1949
User avatar
Blackhawk
Posts: 43501
Joined: Tue Oct 12, 2004 9:48 pm
Location: Southwest Indiana

Re: Opioids

Post by Blackhawk »

I dunno. But:
While much of the media scrutiny and recent high profile lawsuits have highlighted how drug manufacturers allegedly fueled the epidemic, the ARCOS data is expected to clarify the role played by distributors and pharmacies.
(˙pǝsɹǝʌǝɹ uǝǝq sɐɥ ʎʇıʌɐɹƃ ʃɐuosɹǝd ʎW)
User avatar
em2nought
Posts: 5309
Joined: Fri Oct 15, 2004 5:48 am

Re: Opioids

Post by em2nought »

If I was being prescribe opioids, I'd definitely at least try bulking up on turmeric. Badia has it for cheap in the spice isle, and I'd go with something like Qunol high absorption turmeric in a capsule. I had some pain in my hands which I believe turmeric has totally eliminated. I only take half the daily dosage of capsules and I sprinkle the spice liberally on my three bean salad or nuts.
Spoiler:
walnuts
Sam's Club has their members mark version of Qunol Turmeric for much cheaper than Qunol so I'm going to try that when my Qunol runs out.

Sam's has a good price on krill oil too.
Technically, he shouldn't be here.
morlac
Posts: 3898
Joined: Wed Nov 03, 2004 4:25 pm
Location: Just outside the ATL

Re: Opioids

Post by morlac »

We starting giving my Dad (stage 4 pancreatic cancer) CBD treatments right after Chemo and then a month ago combined with some actual THC infused edibles/oils. He went from 2-6 Oxy codeine a day to zero in the last 4 weeks. I don't pretend to be a Dr and I do enjoy smoking some now and then but the stuff works for treating pain. Bonus points also given to his energy levels, over all mood (happier) and appetite. Screw opioids.
User avatar
LawBeefaroni
Forum Moderator
Posts: 55316
Joined: Fri Oct 15, 2004 3:08 pm
Location: Urbs in Horto, outrageous taxes on everything

Re: Opioids

Post by LawBeefaroni »

morlac wrote: Thu Jul 18, 2019 11:39 am Screw opioids.
Quite often it's like trying to kill a hornet with a shotgun.



Yes, there are times when opioids are the only answer but they are far rarer than what is prescribed.
" Hey OP, listen to my advice alright." -Tha General
"No scientific discovery is named after its original discoverer." -Stigler's Law of Eponymy, discovered by Robert K. Merton

MYT
Jeff V
Posts: 36414
Joined: Fri Oct 15, 2004 7:17 pm
Location: Nowhere you want to be.

Re: Opioids

Post by Jeff V »

dbt1949 wrote: Wed Jul 17, 2019 1:24 pm How is it the fault of the pharmacies? They can't sell them to people without a prescription.
Unless of course they are.
I think they are supposed to try to prevent the patient from submitting the same prescription for pain meds separately issued by Dr. Moe, Dr. Larry and Dr. Curley. Not sure what interoperability there is between all pharmacies, much less with smaller indies that may still exist.
Black Lives Matter
User avatar
hitbyambulance
Posts: 10233
Joined: Wed Oct 13, 2004 3:51 am
Location: Map Ref 47.6°N 122.35°W
Contact:

Re: Opioids

Post by hitbyambulance »

Jeff V wrote: Thu Jul 18, 2019 12:42 pm
dbt1949 wrote: Wed Jul 17, 2019 1:24 pm How is it the fault of the pharmacies? They can't sell them to people without a prescription.
Unless of course they are.
I think they are supposed to try to prevent the patient from submitting the same prescription for pain meds separately issued by Dr. Moe, Dr. Larry and Dr. Curley.
(ahem... that's "Dr. Howard, Dr. Fine and Dr. Howard")
Jeff V
Posts: 36414
Joined: Fri Oct 15, 2004 7:17 pm
Location: Nowhere you want to be.

Re: Opioids

Post by Jeff V »

hitbyambulance wrote: Thu Jul 18, 2019 1:04 pm
Jeff V wrote: Thu Jul 18, 2019 12:42 pm
dbt1949 wrote: Wed Jul 17, 2019 1:24 pm How is it the fault of the pharmacies? They can't sell them to people without a prescription.
Unless of course they are.
I think they are supposed to try to prevent the patient from submitting the same prescription for pain meds separately issued by Dr. Moe, Dr. Larry and Dr. Curley.
(ahem... that's "Dr. Howard, Dr. Fine and Dr. Howard")
Point taken. :D
Black Lives Matter
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

WaPo
Cuyahoga County and nearby Summit County soon will be at the center of the most important legal test of how much responsibility drug companies bear for the opioid epidemic. Barring a settlement, the two counties are scheduled to go to trial in October as the first case among the consolidated lawsuits brought by about 2,000 cities, counties, Native American tribes and other plaintiffs.

U.S. District Judge Dan Polster, who is presiding over the consolidated case in Cleveland, selected the counties to represent the legal arguments that other plaintiffs have made. The two counties alone are asking for billions of dollars from companies to help stem the crisis.
...
To bolster that argument, they offered an array of statistics that may be critical in the case. In 2016, they said, the death rate from pharmaceutical opioids in Cuyahoga County was 3.26 times higher than the national average. In 2017, county emergency rooms treated an estimated 9,191 people with drug-related health problems, a 21 percent increase over the previous year.

As the government cracked down on the diversion of pills to the black market, heroin and fentanyl took their place. By March 2016, two people died of a heroin or fentanyl overdose in Cuyahoga County every day, the lawyers alleged.

In Summit County, whose biggest city is Akron, the surge in overdose deaths was so rapid that the county medical examiner brought in a mobile morgue in 2017 to handle the bodies, the plaintiffs wrote.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

WaPo
Purdue Pharma, the drug manufacturer accused of triggering the nation’s epidemic of opioid addiction through its sale of the profitable but highly addictive painkiller OxyContin, filed for bankruptcy Sunday.

The Chapter 11 filing is expected to lead to the ultimate demise of a company that sold a fraction of the opioid prescriptions in the United States but nonetheless is most closely identified with the epidemic because of its pioneering role in the sale of narcotic pain pills. The company used aggressive, allegedly misleading, sales tactics to push physicians to prescribe millions of doses of its dangerously addictive pills.

The company’s move to seek financial shelter, part of a tentative settlement with thousands of litigants, will shift the focus to new wrangling over how potential proceeds will be divvied up by communities reeling under the burden of addiction and overdose deaths.

The bankruptcy also will raise the stakes on legal sparring over how much of the personal fortunes of the billionaire Sackler family, which owns Purdue, will be available to compensate plaintiffs. Multiple states that have rejected the proposed settlement have accused the family of improperly stripping billions of dollars out of the company’s coffers in the past decade to protect the cash from expected court judgments.
...
Under the settlement announced last week, more than 2,000 small government plaintiffs and 24 states have agreed to the dissolution of the company and a contribution from the Sacklers, valued at $10 billion to $12 billion. But the settlement valuation is in dispute, and a number of states have balked at those terms.

The settlement, which does not include any admission of wrongdoing, would reorganize Purdue during the bankruptcy into a trust that would continue to produce OxyContin, as well as overdose “rescue’’ drugs that would be distributed at no cost to communities across the country.
...
The proposed minimum contribution from the Sackler family of $3 billion, which could be derived from the sale of a related, family-owned international drug company called Mundipharma, has been called insufficient by state attorneys general who have rejected the plan.

New York, Massachusetts, Connecticut and other states argue that the Sackler family has far more money stashed in a number of trusts and investment firms, including in offshore tax havens such as the Channel Islands, that should be made available to plaintiffs. Forbes has estimated the Sackler family’s total worth at $13 billion.

The family is expected to argue that billions of dollars moved out of Purdue Pharma were legitimate dividends. Levitin said there will be restrictions on what can be “clawed back’’ from the family’s far-flung financial empire, partly because state statutes of limitations prevent plaintiffs from examining transactions going back more than a few years.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

NBC News
Johnson & Johnson and its pharmaceutical subsidiary, Janssen, agreed to a $20.4 million settlement with two Ohio counties Tuesday in an effort to avoid a lengthy and costly federal trial about the opioid addiction epidemic.

The opioid manufacturer company said the settlements with Cuyahoga and Summit counties include no admission of liability and removes the Johnson & Johnson from the federal trial scheduled to begin this month in the Northern District of Ohio, according to a news release.
...
Johnson & Johnson will pay a combined $10 million settlement in addition to reimbursing the counties $5 million for costs used to prepare for litigation and donating another $5.4 million in charitable contributions to non-profit organizations in connection with opioid-related programs.
...
An Oklahoma judge ruled against Johnson & Johnson in a similar case in August, ordering the corporation to pay $572 million to the state. Judge Thad Balkman's decision accused Johnson & Johnson and its subsidiary of pushing doctors to prescribe opioids while downplaying the risks of addiction.
...
Purdue Pharma, the company that made billions selling the prescription painkiller OxyContin, filed for bankruptcy in September after reaching a multi-billion dollar tentative settlement. The filing may also remove Purdue Pharma from the Oct. 21 federal trial as any parties who wish to seek damages from the corporation with have to go through bankruptcy court.

The painkiller manufacturer is still spending millions as it defends itself in lawsuits from 2,600 governments and other entities. Twenty-four states and the District of Columbia have not signed on to the proposal to settle the suits, according to state officials.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

NBC News
A doctor who prosecutors said ran a medical practice in Virginia like an interstate drug distribution ring was sentenced Wednesday to 40 years in prison for illegally prescribing opioids.

Dr. Joel Smithers was sentenced in U.S. District Court in Abingdon.
...
Smithers was convicted in May of more than 800 counts of illegally distributing opioids, including oxycodone and oxymorphone that caused the death of a West Virginia woman.

Authorities say Smithers prescribed more than 500,000 doses of opioids to patients from Virginia, Kentucky, West Virginia, Ohio and Tennessee while based in Martinsville, Virginia, from 2015 to 2017.
...
WSET-TV reported that the judge recommended that Smithers serve his sentence in a prison close to his family and that he receive mental health treatment.

Smithers wrote in a court filing that he plans to appeal his convictions.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

ABC News
Hours before a landmark opioid trial was set to start in an Ohio courthouse, major drug distributors and a manufacturer agreed to a tentative settlement, according to lawyers representing the thousands of communities involved in the case.

The settlement deal totals $260 million, according to a source familiar with the matter.

The settlement agreement between opioid drug distributors Cardinal Health, McKesson and Amerisource Bergen, as well as manufacturer Teva, "will make significant progress to abate the epidemic by providing resources for and applying funds directly to necessary opioid-recovery programs," attorneys Paul J. Hanly Jr., Paul T. Farrell Jr. and Joe Rice, the executive committee co-leads from the National Prescription Opiate Litigation, said in a statement.

The preliminary settlement will resolve a majority of the cases brought against the four drug industry giants.

Cuyahoga and Summit Counties in Ohio are the first of the more than 2,700 communities as part of the National Prescription Opiate Litigation to go to trial, which was set to take place on Monday.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

CNN
The Supreme Court said on Monday that it would not hear an unusual case brought by the state of Arizona that seeks to stop the Sackler family, which owns and controls Purdue Pharma, from transferring billions of dollars from the company in an effort to deplete it and avoid paying claims concerning the prescription opioid painkiller Oxycontin.
...
The justices issued the order without comment or noted dissent.

Arizona wanted the court to step in and order that the transfers are void and block any further transfers.
...
Legal experts said such a filing made directly with the Supreme Court was unusual.

"Although the Supreme Court can initially hear lawsuits in which a state is a party, it almost never does so when the lawsuit is between a state and private parties, in contrast to a dispute between two or more states," said Steve Vladeck, CNN Supreme Court analyst and professor at the University of Texas School of Law.

Vladeck said that justices generally don't like to be deprived of a lower court's consideration of the issue.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

NPR
Former billionaire and pharmaceutical executive John Kapoor has been sentenced to five years and six months in prison. His sentencing is the culmination of a months-long criminal trial in Boston's Moakley U.S. Courthouse that resulted in the first successful prosecution of pharmaceutical executives tied to the opioid epidemic.

The 76-year-old is the founder of Insys Therapeutics, which made and aggressively marketed the potent opioid painkiller Subsys.

Kapoor's 66-month prison term is substantially less than the 15-year sentence recommended by federal prosecutors, but it is more than the one year requested by Kapoor's defense attorneys, who maintained the executive's innocence and stressed his old age as reason for a short prison sentence.
...
Kapoor and four other executives were found guilty last year of orchestrating a criminal conspiracy to bribe doctors to prescribe the company's medication, including to patients who didn't need it. They then lied to insurance companies to make sure the costly oral fentanyl spray was covered.
...
Two other executives pleaded guilty and became cooperating witnesses.

The other executives received between one year and 33 months, significantly less than many of the prison terms recommended by the federal prosecutors.
...
The sales executive hired a stripper as a Subsys sales representative to help persuade doctors to boost prescriptions. The woman, named Sunrise Lee, eventually was promoted to oversee a third of the company's sales force.
That's what you get for doing the RICO.
It's almost as if people are the problem.
User avatar
Kasey Chang
Posts: 20750
Joined: Sat Oct 30, 2004 4:20 pm
Location: San Francisco, CA
Contact:

Re: Opioids

Post by Kasey Chang »

Freakonomics podcast has The Opioid Tragedy Parts 1 and 2 up, via Google Podcasts

Part 1

Part 2
My game FAQs | Playing: She Will Punish Them, Sunrider: Mask of Arcadius, The Outer Worlds
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

CNN
Purdue Pharma, the maker of OxyContin, has agreed to plead guilty to three federal criminal charges for its role in creating the nation's opioid crisis and will pay more than $8 billion and close down the company.

The money will go to opioid treatment and abatement programs. The privately held company has agreed to pay a $3.5 billion fine as well as forfeit an additional $2 billion in past profits, in addition to the $2.8 billion it agreed to pay in civil liability.
...
The company doesn't have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new "public benefit company" controlled by a trust or similar entity designed for the benefit of the American public. The Justice Department said it will function entirely in the public interest rather than to maximize profits. Its future earnings will go to paying the fines and penalties, which in turn will be used to combat the opioid crisis.

That new company will continue to produce painkillers such as OxyContin, as well as drugs to deal with opioid overdose. Deputy Attorney General Jeffrey Rosen, who announced the settlement, defended the plans for the new company to continue to sell that drug, saying there are legitimate uses for painkillers such as OxyContin.

The plan is for the company to make life-saving overdose rescue drugs and medically assisted treatment medications available at steep discounts to communities dealing with the opioid crisis.

The Justice Department also reached a separate $225 million civil settlement with the former owners of Purdue Pharma, the Sackler family. Still, the Sackler family -- as well as other current and former employees and owners of the the company -- face the possibility that federal criminal charges will be filed against them.
It's almost as if people are the problem.
User avatar
Isgrimnur
Posts: 82094
Joined: Sun Oct 15, 2006 12:29 am
Location: Chookity pok
Contact:

Re: Opioids

Post by Isgrimnur »

CNN
Purdue Pharma, the maker of OxyContin, pleaded guilty Tuesday to three federal criminal charges related to the company's role in creating the nation's opioid crisis.

Purdue Pharma board chairman Steve Miller pleaded guilty on behalf of the company during a virtual federal court hearing in front of US District Judge Madeline Cox Arleo.

The counts include one of dual-object conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, and two counts of conspiracy to violate the Federal Anti-Kickback Statute.

In pleading guilty to the criminal charges, the company is taking responsibility for past misconduct, Purdue Pharma said in a statement to CNN Tuesday.
...
The plea deal announced in October includes the largest penalties ever levied against a pharmaceutical manufacturer, including a criminal fine of $3.544 billion and an additional $2 billion in criminal forfeiture, according to a Department of Justice press release.

The company will be dissolved as a part of the plea agreement.
It's almost as if people are the problem.
Post Reply