
Anti-addiction drug maker found a captive market in the criminal justice system - Geekette
https://www.propublica.org/article/vivitrol-opiate-crisis-and-criminal-justice
======
zkms
"Drug courts" don't help addicted people (nor the people around them) --
they're mostly a way for the criminal legal system to whitewash itself and
pretend that it cares about drug users in a "medical" way (and not just by
slamming them in the clink), and there's a decent article about this:
[https://psmag.com/news/how-america-overdosed-on-drug-
courts](https://psmag.com/news/how-america-overdosed-on-drug-courts)

Besides the inherent issue of non medically-trained people coercively
prescribing medication for behavioural modification, there's the fact that
drug court judges tend to disfavour opioid maintenance therapy and value
abstinence from drug use over everything else; which severely increases the
risk of fatal overdoses and other bad outcomes. Abstinence-only treatment does
not work well for opioid addiction ([http://projects.huffingtonpost.com/dying-
to-be-free-heroin-t...](http://projects.huffingtonpost.com/dying-to-be-free-
heroin-treatment)), and coercive abstinence-only treatment doesn't work well
either.

Drug rehab in US is a fucked up industry where degradation, isolation, and
humiliation are commonplace and are seen as best practice, and this is the
case because, well, their "patients" are literally captive -- it's either that
or literal jail.

~~~
CodeWriter23
Your black and white thinking does not reflect the truth. I personally know
dozens of people who have turned their lives around as a result of drug court.
True, the success rate isn't very high, which is the direct result of the
variability of whether each individual possesses the tiny bit of willingness
to change, which is essential to the recovery process.

~~~
zkms
> True, the success rate isn't very high, which is the direct result of the
> variability of whether each individual possesses the tiny bit of willingness
> to change, which is essential to the recovery process.

"If our process hasn't worked for you, you didn't want it to work enough" is
unfalsifiable and can be used to defend any sort of quackery. Indeed, there's
no way to generate a counterexample -- of someone who had "willingness to
change" but for whom the drug court didn't work -- because the defender of the
drug court can always claim that they "didn't want to change enough".

Pseudoscience of this sort has no role in anything as fraught and complex as
drug use/addiction.

~~~
0xcde4c3db
> "If our process hasn't worked for you, you didn't want it to work enough" is
> unfalsifiable and can be used to defend any sort of quackery.

Notably, it _is_ routinely used to defend 12-step programs. The standard set
of slogans includes the phrase "it works if you work it" (which I've more
recently seen applied to cognitive-behavioral therapy).

------
tcj_phx
Naltrexone - the active ingredient in this $1000 reformulation of a generic
drug - can also be injected as pellets under the skin for the same time-
release effect.

It's been a while since I ran across this option. Here's a random site about
this therapy:

[http://www.naltrexpellet.com/](http://www.naltrexpellet.com/)

The active ingredient costs <$2, so Vivitrol is 90% price gouging.

Edit: IMHO, Naltrexone is a good prescription drug that actually helps people
physiologically. People's pain receptors get overloaded; naltrexone helps to
reset them. Naltrexone helps with alcoholism, and apparently with meth
amphetamine [1] too.

[1] [http://newsroom.ucla.edu/releases/ucla-researchers-
identify-...](http://newsroom.ucla.edu/releases/ucla-researchers-identify-a-
potentially-effective-treatment-for-methamphetamine-addiction)

With that said, Naltrexone doesn't address the fundamental emotional problems
that underlie most cases of addiction. So it doesn't do them a whole lot of
good to force them to take it, without also helping them find stability, the
lack of which probably led them to self-medicate in the first place.

~~~
refurb
_Vivitrol is 90% price gouging_

So you're saying that the only cost associated with bringing a new drug to
market is the cost of the ingredients?

~~~
saas_sam
It's shocking how confident people are in their understanding of economics
when they clearly have never read a book on the subject or taken a 101 course
on it. People have some kind of instinct for how much money is "too much" in
different contexts and they fully believe they are right without any external
frame of reference. Ask them what the "correct" margin should be based on and
they'll say something like "the cost plus a little bit more to cover
overhead." No understanding of supply/demand whatsoever.

~~~
Dylan16807
> Ask them what the "correct" margin should be based on and they'll say
> something like "the cost plus a little bit more to cover overhead." No
> understanding of supply/demand whatsoever.

Are you saying that's not the correct price in a competitive market? After
accounting for all costs, of course.

Maybe you should read those people as saying "this market is lacking in
competition to make prices reasonable".

~~~
logfromblammo
My primate sense of fairness says that charging 100% of costs is actually a
form of charity, 105% of costs is hyper-competitive, 110% of costs is quite
respectable and meritorious, whereas 150% of costs is getting to be overly
ambitious.

10000% of costs is, quite simply, asking for someone to put a shiv in your
kidney.

The only way to achieve such margins is by literally suppressing all
competition with armed force, with an unquenchable, non-substitutable demand.
In the case of pharmaceuticals, the feds provide that force.

~~~
saas_sam
Feds provide force sometimes, but other times it's just a matter of time. When
you produce a new product or service, you have a 'monopoly' on it until other
people move in. Thus, margins start high and quickly lower even in a maximally
competitive environment. Just wanted to share that concept in case others
didn't make that connection!

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thatcat
Judges are essentially prescribing medication without an MD for behavioral
modification. Who will be liable when a patient/defendant experiences a
complicated reaction as a result? You would think judges would be aware of
their exposure to the legal risks of their actions, so maybe they have
insurance.

~~~
sleepychu
Don't judges have immunity from legal retaliation to their actions as judges?

~~~
jhall1468
Only monetary damages. But they have effective immunity from prosecution
because it's (as far as I know) never happened that a prosecutor has pressed
charges against a judge for his ruling, outside of corruption.

~~~
gozur88
The system couldn't work if judges could be prosecuted for their rulings,
unless you're counting bribes, which they already get prosecuted for.

------
tp3z4u
I take Low Dose Naltrexone for chronic fatigue. It was an instant fix. A
return to an almost forgotten normal. I do get crazy vivid dreams that I
remember well and they can be a little disturbing but it is a small price to
pay for my life back. I buy the 50mg pills from overseas and dose it down to
4.5mg. It's the only thing that worked for me after years of trying
practically everything else. It is super cheap. I think the world would
benefit from more people knowing about it.

~~~
_acme
Is there any evidence of it working for this application other than your
anecdotal experience?

------
empath75
There's two parts of addiction, and chemical dependency is only a small part
of it, imo. This might resolve that problem, but it doesn't do anything about
people who just like to be high all the time. There are lots of people who
have addictions to drugs or just activities that don't have any chemical
dependency associated with them at all.

Psychology's discovery of the relationship of neurotransmitters to behavior
was a huge breakthrough, but trying to treat every problem with drugs is like
trying to fix a broken Office install by replacing RAM. Sometimes the problem
is software, not hardware.

------
CodeWriter23
The most insidious effect this has, with drugs like Suboxone or Subutex, the
courts are basically mandating prolonged opioid use by the defendants, all on
some Doctor's opinion that this is better.

They should also seek the opinions of addicts who have sought or been forced
into this treatment regime. Though I have not experienced it myself, the
general consensus from the people whom I have spoken to who have, is that
withdrawal from these drugs is much more severe than Heroin.

If the point is to help the addict through the withdrawal process so they can
get clean, it seems rapid detox protocols would be more expedient. But of
course, as we all here on HN know, the real money is in a monthly
subscription, not a one-time payment.

And that's what Drug Replacement Therapy (or as pharma PR prefers, "Medically
Assisted Treatment") is. It's switching to a dope man who wears a lab coat and
uses a prescription pad instead of balloons. And a huge payola scheme for
pharma and practitioners.

~~~
refurb
So what you're saying is there is no benefit to person from switching from
impure, potentially fatal street drugs to a pharmaceutically pure drug, free
of charge that lets them live a relatively normal life?

I take it your a proponent of drug abstinence rather than harm reduction?

~~~
undersuit
I wonder why the street drugs are impure? I wonder why you can't get
pharmaceutically pure heroin? I wonder why you think that opioid recovery is
free of charge, is that just near you?

I think what GP was trying to say was that trying to treat people in opioid
recovery programs with opioids that can be abused in the same way as dirty
street drugs is ineffectual and their use isn't being proscribed for recovery
as much as it's being proscribed because it's profitable to someone.

I agree with them. I don't think I interact with many opioid dependent people,
but I've heard good anecdotes about Kratom, Marijuana, and Narcotics Anonymous
for recovery. Two vilified plants and an organization that rejects outside
help(or how ever the local chapter interprets their traditions) versus a
potential goldmine of profits and feel-goods, I think I know which way the
government is going to enforce their minimal efforts at drug rehabilitation.

~~~
girvo
God if you think NA is a good successful program, I've got a bridge to sell
you. I was a junkie for six years. Abstinence only doesn't work (where that's
defined as working for a sizeable percentage of people who go through it). ORT
does, and the facts and numbers back this up.

Anecdotally, Suboxone saved my life. And I've got a number of dead friends to
prove it (some of which had gone through NA multiple times, and two had the
damnable Vivitrol injections). So I'm a bit biased here, but I find your
comment quite naive, albeit typical for those who have an opinion on this life
without having had much interaction with it, much less lived it.

~~~
CodeWriter23
I won't dismiss your testimonial of your experience with DRT. But it is not
the universal truth.

I would ask, are you on long term therapy presently? Or was it a short term
assist through withdrawal?

We've got plenty of studies showing how a few Oxy sends every day people to
the streets looking for heroin. The studies haven't caught up for Subs yet. I
know I'm projecting, but I'm pretty sure when the studies come, they will tell
the same story. Why am I so confident in that? This story has repeated itself
since Heroin was introduced as DRT for Morphine addiction. Then Methadone for
Heroin. It's a vicious cycle across generations of the cure is worse than the
problem.

~~~
girvo
Suboxone has been around for decades. You are definitely projecting, and you
do understand that buprenorphine is not a regular opiate, right? Partial
agonist and also an antagonist. I was on it for 4 years, as I had a 2 gram a
day heroin habit for six years prior. Please be careful making assumptions
about things you do not understand.

~~~
CodeWriter23
The truth is, opiate receptors are a lot more binary in reality than this
analog "theory" proffered by the purveyors of opioids. As with either
substance, controlling the dosage obviously changes the level of effect on the
recipient. In the U.K. they treated heroin addiction very similarly, with
heroin. They'd give you enough to prevent withdrawal but not so much that
you'd get high.

PS working the 12 Steps would likely help you with that self-righteous
condescension issue that has survived your chemical addiction.

------
girvo
I despise vivitrol. Two people I knew back when I was an addict used it to try
and get clean, they're both dead due to trying to "break through" as it does
nothing for your cravings, or the reasons you started using in the first
place.

Buprenorphine was much more effective for myself, and I broke my six year
heroin addiction using it, legally from my government for a nominal cost of a
few dollars per day.

America seems hung up on abstinence and "cold turkey" as if it's the be-all
end-all of treating addiction. Just use willpower, right? Vivitrol seems
"perfect" in that environment, as it should stop you chemically from using,
but the thing is that people don't want to be junkies, they want to live their
lives and be happy, without the noose around their neck that is addiction. But
if you don't deal with _why_ they started using, how can you expect someone to
heal?

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notadoc
Sounds like a nice gravy train for the company.

