
Drug firms poured 780M painkillers into WV amid rise of overdoses - uptown
http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amid-rise-of-overdoses
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imglorp
Not that pharma is angelic here, but don't the doctors have the largest
measure of blame for writing unnecessary scripts, failing to monitor for
abuse, and failing to encourage alternate options?

I'm in favor of maximum MD power. I think they should be allowed to prescribe
everything from cocaine to bleach, or any other chemical compound, as suits
the patient care, if they know what they're doing.

But they should also bear maximum accountability for what they prescribe,
including abuse potential.

~~~
chillwaves
A more helpful line of inquiry to me is the culture of Rx usage. As a society,
our patients expect drugs when they go to a doctor and a doctor's average time
per patient is around 10-15 minutes. Does not seem like enough time to
understand the patient's needs and create an individualized solution. Further,
RX medicine is highly profitable and encouraged from the pharma.

In this case it looks like they are incentives for pain pills to be issued on
both sides -- money maker for pharma and time saver for doctors (a third side
-- convenience and feel good for the patient).

It is not as useful to find so-called bad actors but instead we should
evaluate the medical system as a whole and put in safeguards to do less harm.
Patients have generally too much influence on doctors for their treatment
(otherwise why would direct to consumer marketing exist?), that doctors are
not educating patients enough on the risks of narcotics and that pharma has $$
incentive to push medicine. That things like physical therapy and lifestyle
changes will better deal with root causes than drugs that only address the
symptom (but feel better and are easier to swallow). It's a recipe for a
disaster.

I was in a motorcycle accident a few years ago and broke over 10 bones. The
worst part of my recovery was kicking my addiction to narcotics. I did not
understand what I was getting into and I was never given a path to get off
them (not in a coherent way, not until I called to say I was going through
withdrawals). This should not be.

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nradov
Patients tend to give doctors higher customer satisfaction scores when the
doctor writes a prescription, regardless of whether the patient really needs
it. Patients like to feel that the doctor is taking their problems seriously
and doing something. This is one of the negative aspects of moving to a more
consumer-driven healthcare model. Providers try to optimize their customer
satisfaction scores to bring in more business, and large provider
organizations sometimes use those scores as one factor in paying doctors.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581314/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581314/)

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1024core
I think the drug dealers could learn a thing or two from our pharma industry.

When I had back pain, the doctor handed me a prescription for 100 hydrocodone
tablets. I took none; just some physical therapy and stretching gave me
immense relief. Later, I was shocked to find out from a friend that the street
value of these tablets was $5/each.

~~~
dx034
Probably more a fault of your doctor or the laws. There should be limits on
that kind of painkillers, especially if you use it first time. If the doctor
restricts the amount to a few days' usage, potential misuse is much easier to
detect.

~~~
chillwaves
They could start with mandated patient education on the effects and addiction
potential of these drugs, as well as a treatment plan to taper off. I had a
severe injury in late 2013 and received neither of these things. We should
work on the basics before pushing for more restrictions.

To expand: I had maybe 4 different doctors writing me RX for pain meds at the
time and none of them were coordinating. I remember having far more drugs than
I needed for the first few months -- I had prescriptions to spare. This is
because I had several doctors treating me but again, none were coordinating.

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seibelj
I was expecting to write a comment advocating for personal responsibility and
not rushing to judgement. Then I read this:

> The unfettered shipments amount to 433 pain pills for every man, woman and
> child in West Virginia.

That is incredible. What a damning article.

~~~
snrplfth
Well, 433 over six years, 2007 through 2012. Which is about 72 per year, per
person.

I mean, what is supposed to be done about this? Cut off WV from painkillers?
Have the DEA raid a bunch of pharmacies?

~~~
Clubber
You can tell it was a tabloid style article by the headline:

"Drug firms poured..."

>Which is about 72 per year, per person.

That doesn't sound unreasonable. I would guess the average prescription is 2-4
a day per person per year.

~~~
VLM
Chronic pain can use a lot of pills per year. One every couple hours perhaps.

I knew WV was a bit militaristic but some google results and some division
imply 10% of the population are military veterans. Its almost believable given
how many WV residents I met in the Army, generally extremely nice people BTW.
So if no one in WV takes pain pills but military vets, then the vets get a
whopping two pills per day and everybody else gets precisely zip nada nothing.

Yeah sure most vets are not taking pain pills. But the guy with no working
knees or limbs blown off in an IED, he's probably taking more than two per
day, the casualties from one IED explosion could make up for a whole retired
company or even battalion of people not ever taking pills. And of course the
general population has its own segments of people who have permanent physical
problems, or temporary, or are painfully slowly dying of cancer, etc.

Here's another interesting depressing bottom up analysis. Lets say a third of
people die of cancer after a year of horrific pain taking ten pills per day
and they die on average at age 50 (think of all those heavy smokers and heavy
drinkers with annihilated livers, plus the numbers are simpler and to one sig
fig don't matter anyway). So if it takes 3650 pain pills per cancer death and
a third of the population dies of cancer, that means the average dead took
1000 or so pain pills in the year before they died, and unless we suddenly
become immortal that divided by 50 year lifetime means the average person is
taking 20 pills per year over the course of their life, even if they never
take a pill in their lives until the last year of life before a cancer death
and 2/3 of them never take a single pill in their entire lives if they die in
car accidents or whatever not from cancer. Now of course not every terminal
cancer diagnosis takes an entire year to die and not all medical interventions
including cancer in remission take zero pills and not everyone with terminal
cancer takes ten pills per day, but none of these assumptions are more than an
order of magnitude off on average.

Not really the season for depressing analysis like this, but math is math and
the general public is utterly innumerate, so its relevant to the discussion...

I would suspect from this bottom up analysis that dozens of pills per person-
year is not too far off from other states numbers and by playing games with
careful selection of subgroups you can manufacture all sorts of crazy
"surprisingly high" numbers that are anything but.

~~~
Clubber
It's a shame that this journalist, trying to make a name for themselves, feels
it's perfectly OK to manipulate the numbers so that it sounds like it's worse
than it is. When people read this dramatic account, who don't bother examining
the numbers get it in their heads that "something must be done!" it's the
people who are in chronic pain that suffer.

Also, since this is coal country, I assume black lung plays a big part in the
need for these scripts.

As an aside, I have a family member who had a horrific injury who is on a pain
killer script. This person isn't allowed to take an extra pill on days when
the pain is worse than normal because the DEA is cracking down so hard on
this, her doctor is afraid to subscribe over the government imposed "limit."
Pretty sad. Her doctor even suggested she go to a pain clinic because he is
concerned about getting heat for total subscriptions.

Didn't we learn anything from the immensely stupid and still ongoing drug war?
F __k this journalist.

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commentzorro
These are rational people making a decision for themselves if the pain relief
is worth and side effects or other Iissues. Let the people of WV make up their
own minds and let the market speak for itself.

~~~
kelvin0
'Mama' Rand would be so proud of you :-)

Seriously though, 'rational' people can also be misinformed by a large
corporation and a system which does not necessarily incentivize getting people
healthy, and only wish to make their shareholders happy. The 'market' will
always try to optimize for profits even at the expense of everything else.

