
OxyContin's 12-hour problem (2016) - nikunjk
http://www.latimes.com/projects/oxycontin-part1/
======
merraksh
Previous discussion:
[https://news.ycombinator.com/item?id=11649195](https://news.ycombinator.com/item?id=11649195)

------
elipsey
Published May 5, 2016.

Article argues that OxyContin caused strong withdrawal symptoms when used as
directed. Important, imo, because at a societal level we substantially blame
addiction on "drug abuse" which is not always an adequate model.

~~~
Alex3917
> at a societal level we substantially blame addiction on "drug abuse" which
> is not always an adequate model.

While I agree that this model is not accurate, I'd also point out that just
because you're taking a drug as directed doesn't mean you're not abusing it.

For whatever reason most people in the U.S. seem to have a wildly
unjustifiable level of faith in western medicine, either way too much or way
too little. Belief and disbelief in various forms of medicine have been
successfully marketed as personal identities, which is easy to see from
reading most HN comment threads on health issues.

~~~
pavel_lishin
If my doctor tells me to take Pill A every 8 hours, and I do so, how am I
abusing it? It might be drug abuse, but it's not on my part.

~~~
keyboardhitter
I believe the point is that many people have A LOT of faith in the doctor's
hands, and/or "what the label says on the prescription". For some people there
is an unwavering sense of "but doc told me to take this, so I must HAVE to",
or even "But the doctor prescribed this, so there's no way it could harm me".
So, they may stop holding themselves accountable for the drugs they're taking
and may not even notice negative side effects (dependence and withdrawal
included).

------
waterside81
For those interested in this topic and how the opiate epidemic has stretched
across the US, read Dreamland by Sam Quinones
([https://www.amazon.com/Dreamland-True-Americas-Opiate-
Epidem...](https://www.amazon.com/Dreamland-True-Americas-Opiate-
Epidemic/dp/1620402521))

There are a multitude of reasons to explain how this happened but to quickly
sum up an excellent book:

\- Purdue created the whole "sell-direct-to-doctor" phenomena that is now the
norm in the US medical profession

\- One bad study that showed opiates for pain relief are NOT addictive and
this study kept being cited by sales people

\- Mexican drug dealers from a very tiny area in Mexico importing black tar
heroin

\- A prevailing idea in the US that people should never be in pain and
managing it through lifestyle changes is not acceptable; a quick fix is needed

\- economic depression in the Midwest and Appalachia regions

But really, read the book. It's eye opening and well written.

------
politician
Tldr: Oxycontin doesn't last for 12-hours unless doage levels exceed
thresholds known to induce addiction and higher risks of death. The 12-hour
claim is a marketing gimmick that the company will go to war over regardless
of the collateral damage. Moreover, the US court system has repeatedly
permitted the company to continue, and works with the company to seal these
findings.

Good to know.

------
mtdewcmu
Doctors should be more skeptical of pharma companies' marketing claims, right?
Who believes everything they read? There's probably a case to be made that the
FDA should have been more involved, too.

The data on how fast OC released its drug would have been available to the
FDA, if not doctors.

~~~
jschwartzi
Every time one of these articles comes out, people say that the FDA should
have been more involved. Every time we hear about some new drug that Europe,
India, or China has that is still being cleared in the US, people say that the
FDA needs to step back and let pharma companies innovate.

Which is it? I honestly don't think the FDA is culpable in this. They're there
to ensure that the manufacturer is meeting a minimum standard of proof, and if
the manufacturer is falsifying that proof and ignoring clinical feedback then
the manufacturer is solely responsible and needs to be held accountable. But
to say that the FDA isn't doing its job here isn't particularly accurate,
because they're doing their best to apply the law and ensure that the claims
being made are accurate.

~~~
marcosdumay
The article paints the FDA as very involved with this. To the point it claims
the person that approved the drug moved to work in the company shortly after.

Besides, "stepping back and letting pharma companies innovate" is not the same
as not participating. The FDA can make drug development cheap by many means,
and the required fiscalization or catching that kind of behavior is not done
by increasing the weight of the approval process.

------
racl101
I hope I never have to take this stuff.

Watching how dependent my mom has become on this has been painful to watch.

~~~
stronglikedan
Search "kratom" (Mitragyna speciosa). It helps people kick their opiate
addiction every day. It's not a magic bullet by any means, but it helps by
mitigating the withdrawals to a tolerable point. Good luck - I know how you
feel.

~~~
sergior
I think it is worth mentioning that it actually kills pain and I am yet to
experience any side effects. Only problem is to find the right dose, but it is
a minor obstacle in comparison to the hell offered by pharmaceuticals. I have
been taking Kratom for a month now and after a week dropped all pain
medication prescribed by doctor. I feel like I am getting my life back. I feel
that there are forces out there trying to make it illegal, because it
interferes with the profits of pharmaceutical companies.

~~~
MacsHeadroom
> I feel that there are forces out there trying to make it illegal, because it
> interferes with the profits of pharmaceutical companies.

Sadly this harmless opiate replacement is schedule 1 in seven states and
counting.

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passivepinetree
Fantastic article, but this should have a [2016] in the title.

As noted elsewhere, this isn't new content.

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Spivak
I'm sure this is an easy question to answer, but it was bugging me during the
whole article.

What's preventing a pill that releases a dose immediately and one after 6
hours? Or something like a diabetic pump that dispenses medication
continuously? Surely such systems have the potential to be safer and more
effective for patients?

~~~
sloppycee
Concerta ER does something like that, I'm curious why it isn't more widely
used.

 _" The system, which resembles a conventional tablet in appearance, comprises
an osmotically active trilayer core surrounded by a semipermeable membrane
with an immediate-release drug overcoat.

The trilayer core is composed of two drug layers containing the drug and
excipients, and a push layer containing osmotically active components. There
is a precision-laser drilled orifice on the drug-layer end of the tablet.

In an aqueous environment, such as the gastrointestinal tract, the drug
overcoat dissolves within one hour, providing an initial dose of
methylphenidate. Water permeates through the membrane into the tablet core. As
the osmotically active polymer excipients expand, methylphenidate is released
through the orifice. The membrane controls the rate at which water enters the
tablet core, which in turn controls drug delivery."_

~~~
warsharks
in terms of ADHD Vyvanse/Elvanse/Lisdexamphetamine is more interesting in my
opinion, its dexamphetamine bound to lysene. your body naturally strips the
lysene away releasing the dexamphetamine over a period of 12 hours.

it doesnt rely on being mixed with something to delay its action or be pressed
into a solid pill, in fact you can open up the capsules and eat the powder
inside and there is no change in its effects (its also ineffective
intranasally or as far as i am aware even if injected) its rate of release is
difficult to change, its just how long the average body takes to strip the
lysene away from the chemical.

------
siliconc0w
This is a dupe but Pursue should be prosecuted and held accountable for the
total fucking disaster Oxycontin has wrought on our country. They should be
considered enemies of the state. This shit is worse than any drug lord in
Mexico or any ISIS leader as far as impact to US citizens and they knowingly
perpetrated it.

------
panzer_wyrm
Can somebody give some context on the root cause of the problem - the chronic
pain epidemic in US. What caused it, why it is more than in other parts of the
world and why so many painkillers?

Is it cultural?

~~~
gragas
>What caused it, why it is more than in other parts of the world and why so
many painkillers?

>Is it cultural?

That's actually a really common misconception on HN. The United States ranks
27th among countries which abuse opiates, [1] behind many first-world
countries like the UK, Italy, Spain, Switzerland, Ireland, and Russia, to name
a few.

What's the cause? A lot of HNers like to pin it on unemployment and low-wage,
low-skill jobs. I think that's narrowing the field in the right direction, but
it isn't quite right; I know many very happy people who just make ends meet.
There's something more that no one has been able to pinpoint quite yet.

1\.
[https://en.wikipedia.org/wiki/List_of_countries_by_prevalenc...](https://en.wikipedia.org/wiki/List_of_countries_by_prevalence_of_opiates_use)

~~~
stordoff
Those data for opiate use, not abuse. I suspect the percentage of the
population who have used any opiates at least once in the past year tells you
very little about about opiate-related problems - using cocodamol once a year
is obviously very different to the habitual use of oxycodone.

I further suspect that the availability of opiate-containing drugs over the
counter in some countries accounts for some of the differences in those
statistics (e.g. cocodamol in the UK).

------
tommynicholas
I just got ACL surgery and am doing the entire recovery (day 11) without any
painkillers stronger than ibuprofin. This is not because I'm so brave, but
because I know the pain associated with opioids to be so much than the
physical pain in my knee. We've got to aggressively pursue alternatives.

~~~
mhb
Or maybe your pain is not as severe as the pain for which others take opioids.

~~~
tommynicholas
That is almost certainly true. ACL surgery pain is intense and taking
prescription painkillers is strongly recommended, but certainly, there are
more intense pains people experience. I don't really think that's relevant to
my point but perhaps it is.

------
thriftwy
The real problem here is that human pain gauge is ridiculously wide. xkcd was
totally right on this part in [https://xkcd.com/883/](https://xkcd.com/883/)

Can we please fix something to add dynamic compression to pain signals? log(x)
will be a good idea past some pain level.

------
merraksh
Previous discussion has this top comment
([https://news.ycombinator.com/item?id=11652159](https://news.ycombinator.com/item?id=11652159))
by cant_kant, which I believe is worth posting here:

 _Sensible doctors do not believe drug company marketing.

I get large amounts of ad-junk from drug companies that ends up unread in the
bin. I refuse to meet with drug company representatives. I smile politely at
them if I bump into them in the corridor and suggest that they leave their ad-
junk with my secretary. My staff then file their ad-junk in the trash bin.

On Friday, I had a drug company representative attempt to tell me ( he was
hanging around my coffee area ) about the joys of Targin, a fixed-dose
combination of oxycodone and naloxone. I gently shook him off, and directed
him to my secretary.

Drug company representatives are usually decent human beings with lives and
families. However they are poorly educated, poorly informed salesmen and women
with sales targets to meet and product managers to keep happy. Even worse,
they and the drug company have no accountability if a patient dies because of
their recommendations. If avoidable death supervenes or if there are non-
lethal complications or even just therapeutic failure, I am accountable.

Instead of relying on marketing, I rely on information from good, well
performed randomised controlled studies published in reputable peer reviewed
journals ( I like the NEJM ) and on meta-analyses of these. I view the results
of these through a filter of scepticism, cynicism, pragmatism and a modicum of
hope.

Many of my colleagues do likewise. I trust that you do the same in your
respective vocations. Regrettably, there is a bell curve. I am sure that the
drug companies find enough gullible prescribers out in the wild for their
purposes._

~~~
acover
By that definition, most doctors aren't sensible.

~~~
vqc
All doctors are human. They probably have higher averages on [X things
required to make it through med school and residency] but that doesn't
guarantee they are above average on anything else. Like ethics. Or avoiding
certain biases.

~~~
acover
I meant to insult his definition. Clearly most doctors are sensible. Humans
just aren't the rational logicians his standards require.

