
The lucrative business of America’s opioid crisis - dpflan
https://www.nytimes.com/interactive/2017/12/27/business/addiction-inc.html
======
SnowingXIV
It does not take much, I had injury that resulted in a prescription and once
it's no longer hitting just the pain receptors (I don't really understand how
this all works or claim to) and you feel the "calming" effect you can pretty
quickly see why it can become so addictive and scary. Even being educated,
happy, well-off, and aware you can fall to these type of addictions, I can't
imagine how hard it must be for many others.

~~~
MichaelMoser123
i am a foreigner trying to understand this issue: why don't they just stop
prescribing opium based pain killers to the general public and limit them to
cancer patients - like they do in the rest of the world, wouldn't that scale
down the crisis? How did the problem get this large? Even Imperial China went
to war when Britain started pushing Opium to the public, why wasn't this whole
thing stopped much earlier?

~~~
rand_r
Opium-based pain killers are the most reliable way to ease pain without
causing organ damage in the near term.

Drugs like Advil and Tylenol cause organ damage even at small doses and are
thus unusable for extreme pain.

Opiates are used the world over for pain relief, not just for cancer patients.
If we had a way to ease pain with something non-addictive that didn’t cause
immediate organ damage that would be great.

~~~
zoul
The key difference is the easy availability in the US. It seems to me that the
GPs are eager to prescribe you some opiates, whereas here in the Czech
Republic they would have to go through quite a lot red tape to do that. Which,
given the potential harm, seems like a good idea. (Even though we do have some
problems with opiates not being used often enough. But compared to the US
situation that’s a great problem to have.)

------
quantumofmalice
_> The industry of addiction treatment is haphazardly regulated, poorly
understood and expanding at a rapid clip, bringing in $35 billion a year._

Why not focus on the root company and family actually getting rich off selling
the damned opioids (Purdue Pharma and the Sacklers, respectively)?

I don't understand how this company and family haven't been sued into the
ground yet.

~~~
malchow
The family are all Democrats.

That isn't the sole reason, but if you compare the "shadowy financier" tone of
many stories about right-of-center families to the stories about opioids,
you'll see that the "shadowiness" component of the reporting suddenly
disappears.

~~~
fzeroracer
This seems objectively false after even a brief cursory search and I'm curious
as to why you think it has anything to do with this topic.

~~~
dahdum
It's false, but fair to say the family is involved in both political parties.
They seem to lean more towards the Democrat side, but that's to be expected
given Obama's two terms.

The reason it matters is that political clout and general goodwill helps
shield them from legislative action and judicial inquiry.

~~~
pyre
The original comment practically said "they are Democrats, and the media is
liberal-controlled, so _obviously_ they get a free pass."

------
jijji
Heroin is a Schedule I (in the US) which means no medical benefit, and its a
20 year felony for distributing it. There is also the Federal Analogue Act, 21
U.S.C. § 813, which is supposed to group similar drugs in the same category.
So, how do these companies get away with selling analogs of heroin? Shouldn't
the people who work there and make money off these opioid drugs be arrested?
Why haven't they?

~~~
Alex3917
I mean there obviously is a medical benefit to heroin, it's all just arbitrary
politics based mostly on graft.

~~~
TylerE
And it is used medically in many countries for things like end-stage cancer
pain.

~~~
rwmj
In the UK it's given to some women during childbirth (although it's coyly
known as "diamorphine").
[https://www.babycentre.co.uk/a1026346/diamorphine](https://www.babycentre.co.uk/a1026346/diamorphine)

~~~
Fifer82
I really didn't know that is what it was. "Heroin" because it is dirty?
"Diamorphine" because it is clean?

~~~
rwmj
Because it is the "British Approved Name" of the substance apparently:

[https://en.wikipedia.org/wiki/Heroin#Names](https://en.wikipedia.org/wiki/Heroin#Names)

------
nwah1
This one is interesting because it deals with a young short seller, Chris
Drose, that caused a lot of share price decline in a stock I once held,
likewise by writing an article for SeekingAlpha.

[https://www.nytimes.com/interactive/2017/12/27/business/drug...](https://www.nytimes.com/interactive/2017/12/27/business/drug-
addiction-rehab.html)

This is the other stock he did that to, but his article was retracted... of
course, only after the stock tanked huge, and continued to tank more
afterwards. He must have made a fortune.

[https://seekingalpha.com/news/3189718-bearish-sa-article-
que...](https://seekingalpha.com/news/3189718-bearish-sa-article-questions-
chromadexs-value-cites-connection-stock-promoter-shares-slump-42)

I am amazed by how effective that is, and how he was able to get away with
that.

~~~
highd
Investors that investigate companies, identify hidden problems and report on
them to the public help enable more accurate price discovery. This wouldn't
happen at all if they couldn't trade against it.

For instance, I recall a story where a hedge fund sent PIs to determine that a
factory reported running was actually closed down. They can't just trade
against that info - it also has to be made public for them to realize gains. I
can't imagine how you'd consider activity like this "getting away with it",
when the alternative is companies performing unscrupulous acts in secret.

~~~
nwah1
I wasn't criticizing the act of short selling itself. I was criticizing the
concept of an individual writing what amounts to a hit piece that was later
retracted, and yet profiting off it despite the fact.

Or, in the first case, alleging that a company led to the death of an
individual, when later the charge of murder was dropped.

It piqued my interest that in both cases, the meat of his allegations are at
least highly ambiguous.

As someone whose job is not nearly as difficult as working with opioid
addicts, it would be difficult to condemn such people without damning
evidence.

That a person having respiratory issues might not be thought of as requiring
hospitalization to me seems like something that could happen without
negligence on the part of a rehab facility.

And the idea that rehab facilities are inherently motivated by greed when
compared to cheaper outpatient programs based around prescriptions seems to
infer malice when the obvious conclusion is that some people really believe
that approach is superior. This claim is the type of thing that a competitor
might believe but nobody else should.

~~~
Buge
Just because a murder charge was dropped, doesn't mean that a murder didn't
happen. The justice system doesn't convict 100% of murderers.

This is illustrated in the quote

"It is better that ten guilty persons escape than that one innocent suffer"

~~~
nwah1
They charged the _company_ with murder, which is a first for the legal system.
That concept barely makes sense. Who at the company was at fault, and why? The
company itself is a legal fiction.

------
emiraga
And now you have false allegations mounted against Kratom for the purpose of
banning it. People were using Kratom to get themself off the heavy drugs with
minimal side-effects. But we can't let all that money go to waste, instead
they want only publicly available addiction remedy to go to expensive
treatments and expensive drugs.

------
sidcool
I cannot understand why the Government is not acting against the pharmas
profiting from this crisis. And why people are not revolting. There is a clear
nexus between pharmas and doctors. Something should be done.

~~~
leakybit
There are more people who are dealing with chronic pain who need opioid than
people who are using them for "recreational" purposes.

~~~
krelian
I can't help but feel that these medications are being vastly over prescribed
by doctors.

Why is this not a problem in other countries? Either the number of people
suffering from chronic pain in the U.S is way higher (percentage wise) than in
other countries (why?) or the doctors are prescribing extremely dangerous
medicine as if it were candy.

~~~
maxxxxx
From my experience there are two factors I can see:

Due to end user advertising the US a lot of people are tuned into taking
drugs. It's just a part of life. I am 50 and people seem to be baffled when I
tell them I don't any prescription drugs unless I have something acute. I see
tons of people taking antibiotics and pain killers immediately when they have
a problem. That starts from childhood on.

Doctors in the US are really quick prescribing hardcore drugs. I have had
several occasions when I had an injury like a bruised and got a Cocktail of
vicodine and muscle relaxers. They make you feel real good quickly and I can
totally see how people can get addicted. In addition people who have
withdrawal symptoms get cut off cold turkey and get no help. I guess that's
even more so in low income populations that barely get any healthcare.

------
hesdeadjim
I have a lot of friends in the treatment business and some of the stories I’ve
heard of unethical providers are absolutely shocking.

Ignoring the urine testing schemes, in the worse areas people will sometimes
pay clients to relapse after they leave a program so that they can reenroll
and they can bill insurance all over again.

Google AdWords for treatment became such a problem that Google stopped
allowing them because unethical centers were basically killing people.

Don’t even get me started on the altnernative “treatments” out there. In a
town near me there is a place that will give you amino acid injections and
claim that’s all one needs to get clean.

It’s obscene that this happens and unfortunately as a consumer it can be hard
to separate the good from the bad if you are desperate for help.

~~~
cptskippy
I had a similar experience though the treatment providers were actually trying
to work in the patient's best interest.

I had a family member who was in and out of treatment for a disorder and
discharge was largely dictated by the insurance company against the
recommendation of everyone else involved.

Without saying as much, the treatment providers strongly implied a quick
relapse and return to the facility would ultimately be the best thing because
it would reset the clock with insurance.

------
DoreenMichele
I just don't see this issue the way others do. "Capitalism" or profit motive
certainly is interacting problematically with the issue. But profiteers are
not, per se, why we have an opiod epidemic to begin with. The roots of that
look pretty complicated.

One of the roots is hopelessness. We need to pass universal basic healthcare
and solve the affordable housing crisis to make headway on that.

Another is, frankly, the success of modern medicine. You can live for decades
these days with debilitating conditions that would have just killed you
decades ago. And this often means living with a lot of pain.

Figuring out how to not just improve lifespan but also quality of life is the
answer to that. And it is no small ask. It is quite the tall order.

~~~
microcolonel
> _We need to pass universal basic healthcare and solve the affordable housing
> crisis to make headway on that._

Just like them, you jump to your own conclusions.

~~~
DoreenMichele
_Just like them,_

Them? To whom are you comparing me?

 _you jump to your own conclusions._

I am not jumping to anything. I have spent a lot of years studying and
contemplating certain problem spaces.

------
tcj_phx
Somewhat recently I visited a webpage that referenced Gabor Maté's work, _In
the Realm of Hungry Ghosts: Close Encounters with Addiction_ [0] - my local
library had a copy. Dr. Maté spent decades working with the most hopeless of
the residents of "the drug ghetto of Vancouver's Downtown Eastside".

[0]
[https://www.google.com/search?tbm=bks&q=editions:4tpUFXvV_8s...](https://www.google.com/search?tbm=bks&q=editions:4tpUFXvV_8sC)

Part I has some anecdotes from patients - virtually 100% of Dr. Maté's
patients suffered from childhood trauma. Part II goes into the science of
addiction. "'It may be said without hesitation that for man the most important
stressors are emotional', wrote the pioneering Canadian stress researcher and
physician Hans Selye."

I went to the science library to look up the reference - Dr. Selye discussed
how he came to appreciate the general syndrome of being sick, and claimed to
have originated the term 'stress' into the medical lexicon. I have to wonder
why good science gets ignored, while garbage science [1] persists for decades?

[1]
[https://news.ycombinator.com/item?id=16020617](https://news.ycombinator.com/item?id=16020617)
(my comment from yesterday about bad science)

This theory of addiction basically matches my observations of my girlfriend's
predicament. She had some childhood stress (won't get into here). After six
months of my influence she was doing fine, then she got sucked into the mental
health system. Her current drug treatment program costs $10,000/month, and is
mostly a scam. They try real hard to be helpful, though - I think they want an
'A for Effort'.

Helping people to feel safe is most important intervention of all [2].

[2]
[https://news.ycombinator.com/item?id=15024780](https://news.ycombinator.com/item?id=15024780)
\- my comment from 134 days ago about the importance of helping people feel
safe, and how drug rehab helps people feel like failures.

(minor edits)

Edit2: Dr. Maté's book tells of how one of his patients described heroin as 'a
hug in a needle'... "Chapter 14: Through a Needle, a Warm, Soft Hug" [3]

[3]
[https://books.google.com/books?id=Oew75Hp8XP4C&printsec=fron...](https://books.google.com/books?id=Oew75Hp8XP4C&printsec=frontcover&dq=editions:4tpUFXvV_8sC&hl=en&sa=X&ved=0ahUKEwiP9tupu63YAhUp6oMKHQidD7YQ6AEIJzAA#v=onepage&q=hug%20in%20a%20needle&f=false)
(pg 156)

------
WalterBright
The thrust of this is that opiod manufacturers should be sanctioned, charged
with crimes, etc. But don't we do that already with cocaine, meth, heroin,
etc.? Why should going after the suppliers work for opiods when it failed for
every other drug?

------
shawnee_
The "lucrative" aspect of many of these businesses results because they
register themselves as 501c3 orgs; yet they clearly operate for-profit
enterprises, with active solicitation at jails and courtrooms.

This is AKA the body broker model. There was a discussion about it on HN not
too long ago:
[https://news.ycombinator.com/item?id=15024185](https://news.ycombinator.com/item?id=15024185)

Report body brokers: [https://www.irs.gov/pub/irs-
pdf/f13909.pdf](https://www.irs.gov/pub/irs-pdf/f13909.pdf)

------
amasad
The first story of the series about how a short-selling investor was able to
uncover a potential murder case against a rehab company and profit from it is
an interesting anecdote on how the same market incentives that we tend to
blame so much on can also be a force for good.

[https://www.nytimes.com/interactive/2017/12/27/business/drug...](https://www.nytimes.com/interactive/2017/12/27/business/drug-
addiction-rehab.html)

------
Feniks
I find it endlessly hilarious that nobody in the US is asking

WHY

Why are people taking drugs?

The country needs to do some serious soul searching. Won't happen though.

~~~
neandrake
I've been reading Dreamland by Sam Quinones, which goes into detail and
background of the past ~50 years or so about how we got into this situation. A
large part of the WHY you're referring to I'll summarize as

1\. Pain being identified as a vital sign and hospitals/institutions new-found
focus on tracking and treating pain

2\. Deceptive pharmaceutical marketing that painkillers are a be-all solution
to pain and also non-addictive (Purdue/Sackler seem to be worst offenders
here)

This lead to doctors prescribing opioid painkillers to many of middle-class
americans who would likely have otherwise not come in contact with drug
addiction. The book so far has been a really good read and also goes into
detail around how heroin started spreading through the rust belt as well
(feeding on the existing prescription addiction). I highly recommend it (about
65% through it right now).

~~~
Feniks
Maybe one day instead of prescribing sleeping pills GPs in the US will try to
find out why someone has trouble sleeping. It will even save money.

------
esaym
> Then, the new insurance laws in 2008 and 2010 transformed what had largely
> been a government-funded and charitable-minded field into an enticing for-
> profit business.

That's freaking discussing and yet another reason I refuse to pay for
insurance. I'll take the fines.

------
unabst
Capitalism is sinister like this.

It doesn't intentionally do it, because capitalism isn't a person, but when
everything is monetized by our creative entrepreneurs, it grows; our problems
being no exception.

Once someone makes money, they want more of it. Capitalism demands more of it.
And we stretch every line of the law, even cross it, just to get more from
where that came from.

Unfortunately one person suppressing their unethical behavior is
inconsequential. If an opportunity exists, eventually someone will use it.

~~~
StreamBright
Actually the opposite. Government regulations outlaw cheap non-dangerous
alternatives (like cannabis) and create a monopoly by granting patents to a
single entity.

[https://qz.com/1125690/big-pharma-is-taking-advantage-of-
pat...](https://qz.com/1125690/big-pharma-is-taking-advantage-of-patent-law-
to-keep-oxycontin-from-ever-dying/)

[http://www.washingtonexaminer.com/outdated-treatments-and-
dr...](http://www.washingtonexaminer.com/outdated-treatments-and-drug-company-
monopolies-make-opioid-epidemic-worse/article/2611739)

The solution is to make cannabis legal for everybody in every state for
medical use and since it cannot be patented there will be many suppliers who
compete with the quality and price just like it happens with almost everything
that is not under very strict government regulation.

~~~
vanderZwan
> _Actually the opposite. Government regulations..._

I'm from the Netherlands so you won't hear me disagree with the argument that
criminalizing cannabis and drugs is not the solution[0].

Having said that, the typical undertone on HN of "regulation is bad by
definition" really irks me. I can imagine that if the only perspective one has
is a dysfunctional government, one might think that, but please take a look
abroad and see how things work over there. Government regulations are a tool
that can be used for good and bad.

[0] Also, in the US these laws are historically very much set up to target
poor and black people (and I wish I had a clear picture of how things are in
my own country regarding that, actually; I'm sure there's a few laws sneakily
screwing over migrant workers or something), but I digress.

~~~
jacob019
I've always observed that HN leans pro-regulation.

~~~
hathawsh
IMHO there is a strong slant in both directions. Even HN is not immune from
the current political stratification in the US.

------
cletus
Puritanical drug policy in response to the anti-war and hippie movements on
the 1960s has a lot to answer for and is a huge contributing factor to this
current crisis.

\- Under Nixon, the Controlled Substances Act of 1970 inexplicably made
cannabis a Schedule 1 drug. Cocaine, by comparison, is Schedule 2.

\- Cannabis became harder to get and more expensive than both cocaine and
opiate based drugs.

\- In 2016, a bill sailed through Congress and was signed into law by Obama
with little discussion or concern. It was the result of pharma lobbyists. The
bill made it nigh-on-impossible for the DEA to investigate and penalize drug
companies of suspicious shipments of drugs [1].

An example of this is shipping NINE MILLION hydrocodone pills over a two year
period to a single pharmacy in Kermit, WV with a population of 392 [2].

\- A large number of people get onto heroin after becoming addicted to
prescription opiates [3], which seem to be dispensed far more frequently in
the US than in other developed nations [4].

\- Not only does cannabis seem to reduce the rate of opiate addiction, it
seems like it might help treat opiate addiction too [5].

I choose to be an optimist here. I see Trumpism as a desperate last gasp for a
declining but increasingly militant religious conservative minority in the
United States. As much as these short-term policy decisions hurt, I look
forward to the day when Puritan ideals will no longer blindly dictate policy
with no basis in fact whatsoever.

[1] [http://www.latimes.com/local/california/la-me-pharma-
bill-20...](http://www.latimes.com/local/california/la-me-pharma-
bill-20160728-snap-story.html)

[2] [https://qz.com/866771/drug-wholesalers-shipped-9-million-
opi...](https://qz.com/866771/drug-wholesalers-shipped-9-million-opioid-
painkillers-over-two-years-to-a-single-west-virginia-pharmacy/)

[3] [https://www.drugabuse.gov/publications/research-
reports/rela...](https://www.drugabuse.gov/publications/research-
reports/relationship-between-prescription-drug-heroin-abuse/prescription-
opioid-use-risk-factor-heroin-use)

[4] [https://www.cnbc.com/2016/04/27/americans-consume-almost-
all...](https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-
global-opioid-supply.html)

[5] [http://edition.cnn.com/2017/05/17/health/addiction-
cannabis-...](http://edition.cnn.com/2017/05/17/health/addiction-cannabis-
harm-reduction/index.html)

------
CalChris
Marijuana should be legal. That it is a schedule 1 narcotic and that we put
people in prison for decades and even life is immoral.

[https://www.dea.gov/druginfo/ds.shtml](https://www.dea.gov/druginfo/ds.shtml)

[http://www.motherjones.com/politics/2015/07/life-sentence-
ma...](http://www.motherjones.com/politics/2015/07/life-sentence-marijuana-
pot-prison-commuted/)

~~~
nkrisc
Interesting how legal opioids are fueling a national 'crisis' while illegal
marijuana, though widely used, is not.

~~~
trhway
Hard to find a person/family devastated by marijuana use. At least devastated
beyond what alcohol does.

~~~
cr1895
It’s not hard to find lives devastated by the illegality of it.

~~~
trhway
It is devastation by police and/or by trafficking mafia, not by marijuana
itself.

------
pmc1
> Millions of people have fallen victim to drugs, painkiller abuse,
> alcoholism, the rise of meth and the revival of heroin.

Through all this carnage somehow the left still fights for the legalization of
the gateway drug marijuana. Of course not all weed users move towards harder
drugs, but it opens the door to more lethal drugs once susceptible individuals
become accustomed to the highs. I have personally seen friends from college
smoke weed for a couple of years and then move to coke for the better highs.
Less drugs, not more would be a good step

EDIT: Its extremely well documented that marijuana usage leads to increased
vulnerability for addiction to other substances. One of many research links:

[https://www.drugabuse.gov/publications/research-
reports/mari...](https://www.drugabuse.gov/publications/research-
reports/marijuana/marijuana-gateway-drug)

~~~
1undo
That's true, but HN tends to be more liberal so you will be downvoted though.

~~~
rev_bird
It's not the fault of liberals that you believe quantifiably incorrect things,
but it's a convenient idealogical scapegoat to get out of learning anything
helpful.

------
MechEStudent
Paywalled.

------
doggydogs94
I am sure these problems with opiate addiction centers will be solved by going
to a single payer system.

