
The Family Making Billions from the Opioid Crisis - traek
http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/?src=longreads
======
Animats
_... Medical Advertising Hall of Fame..._

This is a real thing.[1] They really give out awards for medical advertising.
Typical writeup: "Ambien dominated the insomnia market like few products ever
have. Our goal was to introduce a new way of thinking about sleep, and to
introduce Rozerem as a new option for the treatment of insomnia. In order to
take down Goliath, Rozerem needed to spend BIG. $200 million in broadcast
media spend big. With millions of eyeballs being driven to the website we had
to ensure that we provided a seamless, immersive brand experience with
absolutely no tradeoffs."[2]

It's am award program for scumbags.

[1] [https://www.mahf.com](https://www.mahf.com)

[2] [https://www.mahf.com/digital-pioneer-award-
winners/](https://www.mahf.com/digital-pioneer-award-winners/)

~~~
EvanAnderson
Ick! This reinforces my belief that direct-to-consumer advertising of
prescription drugs should be illegal.

~~~
hawkice
I'm more concerned people dragoon their doctors based on some half-incoherent
Super Bowl ad. They can't possibly be convinced that's ideal for their health
in most cases, but I think health insurance hides the costs of wasting your
doctor's time.

(Which is to say, I wouldn't be concerned about making it illegal if it
stopped being so effective.)

~~~
tryingagainbro
That's why they advertise on Superbowl, TV shows and everywhere else. To make
people think they have something and their pill can make it go away. Doctor
Johnson doesn't prescribe it, another one will.

Otherwise they'd _only_ target doctors, in their offices, trade mags and all.
[http://www.businessinsider.com/infographic-america-is-
over-m...](http://www.businessinsider.com/infographic-america-is-over-
medicated-2012-2)

~~~
refurb
Are you saying it's bad when patients take an interest in their own health?
Doctors aren't mind readers.

~~~
tryingagainbro
It can be. Does the average patient have a medical license, know of all the
side effects...etc etc? NOPE. Ask questions of course but like buying frying
pans you saw on a 4am infomercial with "Only 2 left, hurry!!!" demanding the
meds you saw on tv is a bad idea.

Stats say that we're way over prescribed.

------
nsedlet
The Sacklers have ingratiated themselves at the highest levels of society
using a fortune that's at best built on a product of dubious value, and at
worst obtained at the cost of the lives of tens of thousands of people. I
think this piece points to a big problem: we worship money and those that
accumulate it, and often ignore the question of how much societal value was
created in exchange for it. The least we can collectively do is not confer
status and prestige upon those who make money in a destructive way. I love the
line of inquiry in this piece because it puts pressure on the high-society
keepers-of-culture whose admiration the Sacklers likely most crave.

FYI you can also see an interview with the author on Democracy Now:
[https://www.democracynow.org/2017/10/19/who_profits_from_the...](https://www.democracynow.org/2017/10/19/who_profits_from_the_opioid_crisis)

(disclaimer: I am friends with the author)

~~~
joering2
I definitely don't wanna play devils advocate for these scumbags, but can't
you apply your logic to basically any product? I mean, Coca-Cola. Its at best
product of dubious value, and at worst produced for the need for sugar by tens
of thousands of people.

~~~
nate_meurer
Not sure how deliberate your example was, but you can't hardly beat Coca Cola
as a damaging influence on society. Coca Cola spends millions on propaganda
disguised as research, designed to convince people that their product is not a
health hazard. They're no better than the big tobacco companies.

And let's not forget that the sugar industry as a whole has done this on a
vast scale over decades, bribing scientists and funding shoddy research in
order to encourage abusive consumption of the substances they promote [2].

I don't think it's at all controversial to state that the sugar industry has
cost millions of Americans their health or their lives.

1 - [https://arstechnica.com/science/2016/12/the-food-industry-
is...](https://arstechnica.com/science/2016/12/the-food-industry-is-
gaslighting-us-on-the-harms-of-sugar/)

2 - [https://arstechnica.com/science/2016/09/sugar-industry-
bough...](https://arstechnica.com/science/2016/09/sugar-industry-bought-off-
scientists-skewed-dietary-guidelines-for-decades/)

~~~
Theodores
We have been too kind to the Coca Cola brand. We tell ourselves that Coca Cola
started out as the product we know and love but originally there just so
happened to be trace amounts of cocaine in there. These would have been
harmless quantities, not likely to have any type of effect. This is the quaint
legend we have arrived at.

However.

Coca Cola started as a sugary drink laced with cocaine. Much like how beer has
alcohol in it to keep you buying more, Coca Cola had that magically addictive
cocaine in it to keep customers coming back for more.

The name 'Coca Cola' is a celebration of this history, really there is no more
insane an idea than getting a nation hooked on class A drugs in liquid form.
The name and the connotations would make a right minded person want to be
disassociated from that.

In theory a 'crack pipe' could be re-purposed as a nice little vase suitable
for a small child to play with. But that would make you shudder. So why is it
that we are happy to have this denatured liquid cocaine drink as something we
give to children? We could at least change the branding, drop the 'coke' and
'coca-' drug references. With allusions to it being the real thing?

When original Coca Cola got closed down and they had to reformulate their
marketing they realised that they could do just as well getting people hooked
to sugary drinks laced with caffeine and salt, the cocaine wasn't actually
needed to shift product. Or even the sugar, fake sweeteners work too, perhaps
even more addictively. Maybe it is the marketing that is the problem and not
the product ingredients. They can even get the water hooked into buying plain
bottled water, something that was never bought back in the days when tap water
was a luxury.

------
throwaway0255
It should simply be illegal to advertise prescription medications.

"Ask your doctor about Klonopin today"

"Ask your doctor about coronary artery bypass grafting today"

One of these sounds completely ridiculous, and the other sounds commonplace.
They should both sound ridiculous, because they're both equally completely
ridiculous.

The idea that the patient should be influencing the treatment decisions of
medical professionals based on things they saw on television is just absurd.
It should be illegal. Doctors are all complicit in it, that should be
considered medical malpractice, but doctors are put in an impossible position
on this stuff and I understand why they do it.

Healthcare in general is just such a goddamn mess. There are so many
completely obvious ways to improve it, but it's impossible to implement any of
them, and in the meantime people just keep losing their loved ones early to
all the inefficiencies and waste and stupidity.

And all the politicians just want to get their stamp on it to show their
constituency how caring and benevolent they are, but they're politicians so
all they're actually capable of doing is fucking everything up. So they all
just keep grandstanding and fucking everything up and it just gets worse and
worse every year.

~~~
valuearb
The idea that the patient should be influencing their own treatment decisions
is absurd?

~~~
maskedSlacker
The idea that the patient should be influencing treatment BASED ON WHAT THEY
SAW ON TV is absurd.

It's like you didn't even read what you responded to. What is this, reddit?

~~~
valuearb
How do you think people get informed? Do you really think that advertising
isn't useful to informing people? Do you really think as many patients would
find out about viable treatments for their conditions if you ban advertising?

Advertising isn't hypnosis. People know not to take claims at face value and
if they don't, US medical ads are full of disclaimers and warnings. And once
you see an ad for a treatment, you have many opportunities to research it,
including by discussing it with your doctor.

Do you really think doctors alone should decide your treatment?

My mother in law had terminal brain cancer. She could not eat due nausea from
her chemotherapy. I accompanied her on a visit to her doctor. We told him the
anti-nausea prescription wasn't working, and I asked why he didn't prescribe
her medicinal marijuana. He angrily rejected it as a viable treatment and
huffily said he'd change her prescription to a different anti-nausea
medication. Shortly later she went on the last trip of her life, to Arizona
for some sun and relaxation, but her nausea was so bad that she threw up in
the airport and had to return home, where she died in bed a few months later,
a 60 lb bundle of bones from barely eating for months on end.

If you want to be protected from "advertising", change the channel. I don't,
so stop trying to "protect" me by restricting my right to listen to other
viewpoints.

~~~
markdown
> Do you really think doctors alone should decide your treatment?

Yes. Not necessarily one doctor, or even two doctors. Get a second opinion, or
just switch your doctor if you don't like them.

The alternative of letting profiteers peddling medicine influence a poorly
educated populace is most unfortunate.

~~~
valuearb
Just because some might not use freedom wisely doesn’t mean it should be
denied to anyone.

~~~
sitkack
> use freedom wisely

How many would claim that getting a 200M drug ad campaign qualifies? Hell, I
watch a drug ad and it is all life style and vibe. Shots off my golf score!
Luxury Yachts! Happy, Well Adjusted Grand Kids!

------
andreasgonewild
I was on Oxy for about a month after smashing one of my vertibraes into pieces
in a climbing accident, I was prescribed more than three times as much. I
walked through hell to get out of that crap; nothing else I've encountered
even comes close, including heroine and cocaine. There are several natural,
less addictive and less harmful methods for treating chronic pain; cannabis,
mushrooms and meditation among others. Pharma is all about creating return
customers; profits, at any cost; the people involved in creating this mess
have some serious karma to deal with in the near future.

~~~
mabub24
Perdue Pharma, the producer of Oxy, is basically making half of its customers
into drug addicts by lying about "12-hours" of "effective" pain relief.

The LA Times ran an investigation into Perdue Pharma's claim[1] and the
article is incredibly disturbing. This is the killer quote:

> "More than half of long-term OxyContin users are on doses that public health
> officials consider dangerously high, according to an analysis of nationwide
> prescription data conducted for The Times."

Perdue Pharma has been lying about the 12-hour pain relief effect for decades.
They wanted to dominate the 12-hour pain relief market. Whenever a doctor
prescribed for a smaller interval of time, Perdue screamed bloody murder and
sought to "refocus" doctors at all cost on the "12-hour rule" to ensure the
drug stays in the 12-hour market share. To "refocus" doctors, Perdue Pharma
tells doctors to prescribe _stronger_ doses, rather than more frequent ones,
and this leads to serious problems with reliance.

[1]: [http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

~~~
andreasgonewild
From my perspective, OxyContin is obviously designed to be as addictive as
possible; and they have been lying all along. These people are not fully
functioning humans, they will do whatever it takes to generate more profits. I
promised myself to never touch their artificial crap again; if it doesn't grow
on the ground, I'm not interested.

~~~
alkonaut
Medication is thruroughly tested and there are plenty of good painkillers that
aren't as addictive. Many are synthetic of course, and still have known side
effects.

The evil here isn't that the drug is addictive but that doctors and
pharmaceutical companies prescribe it despite the known side effects. It's
almost unheard of outside the US.

~~~
andreasgonewild
They're tested by the same psychos that created the drugs and their bought fan
club, otherwise things like Oxy would never have made it to market. It's worth
repeating, big pharma is all about creating return customers; nothing that
comes out of that mess is ever going to solve problems.

~~~
alkonaut
If it was the case that these people somehow rigged the testing to make it
seem less harmful (which isn't that far fetched), then _that_ would be the
scandal. But it isn't. This is known, even in the US.

This thing is _known_ to be this addictive. That's basically only prescribed
in exceptional cases elsewhere in the world. Basically it's not prescribed to
otherwise healthy people who only suffer from pain (back pains, surgery pains
etc). It's only prescribed to terminally ill people. Because it's better to
use a slightly less potent painkiller and be in slightly more pain, than to be
addicted to an opioid.

~~~
sooheon
So what does that say about the medical practitioners on the front lines
prescribing this shit at these insane levels? Hippocratic oath means nothing?
Kickbacks from the pharma companies too sweet to ignore?

~~~
pas
[https://news.ycombinator.com/item?id=15522455](https://news.ycombinator.com/item?id=15522455)

------
iaw
Very good write-up from Esquire, I'm thoroughly impressed with the article.

That said, my visceral emotional response is strongly negative especially when
reading the following paragraph:

>In May, a dozen lawmakers in Congress, inspired by the L.A. Times
investigation, sent a bipartisan letter to the World Health Organization
warning that Sackler-owned companies were preparing to flood foreign countries
with legal narcotics. “Purdue began the opioid crisis that has devastated
American communities,” the letter reads. “Today, Mundipharma is using many of
the same deceptive and reckless practices to sell OxyContin abroad.”
Significantly, the letter calls out the Sackler family by name, leaving no
room for the public to wonder about the identities of the people who stood
behind Mundipharma.

~~~
wozniacki
In the Massachusetts episode of Parts Unknown, Bourdain talks to a general
physician who explains how patients who were administered OxyContin for
routine procedures & injuries quickly developed a habit for the drug and when
they couldn't find it post-treatment moved to illegal variants like Heroin and
now Fentanyl.[1][2]

Bourdain travels to Franklin County to explore the heroin epidemic that’s
spreading throughout this and other New England towns.[1]

Dr. Ruth Potee of Greenfield, Massachusetts talks about how they were taught
in their residency that their ER / Hospital performance was tied to their pain
scores and the generous administration of pain medication to patients.[1][2]

Purdue Pharmaceuticals promotion from 1996 can also be seen.

[1] Video - Parts Unknown - Massachusetts

[https://archive.org/details/AnthonyBourdainPartsUnknownMassa...](https://archive.org/details/AnthonyBourdainPartsUnknownMassachusetts)

22:16 Purdue Pharmaceuticals Promotion from 1996

25:10 Dr. Ruth Potee of Greenfield, Massachusetts

[2] Transcript - Parts Unknown - Massachusetts -- CNN

[http://transcripts.cnn.com/TRANSCRIPTS/1502/20/abpu.01.html](http://transcripts.cnn.com/TRANSCRIPTS/1502/20/abpu.01.html)

Edit: Another link to the same Parts Unknown - Massachusetts video

[http://www.dailymotion.com/video/x58d4ci](http://www.dailymotion.com/video/x58d4ci)

~~~
yourapostasy
> ER / Hospital performance was tied to their pain scores and the generous
> administration of pain medication to patients...

Trace back how these performance metrics were chosen, look in history if there
was any advocacy or studies funded by Sackler-controlled/-influenced parties
to tilt the selection of performance measurements towards subjective pain
"scoring". It would be interesting to find out if Arthur's insight of nebulous
broad applications was generalized to pushing for these kinds of metrics.

After reading how Epipen configured a _de facto_ monopoly, I've wondered where
else this kind of corporate behavior shows up within our economic landscape.
None of it breaks any laws, but I have to wonder if anyone involved regrets
the consequences engendered.

~~~
Spooky23
That more about managed care and managing ER outcomes like help desk tickets.
The old fee for service models are going away as costs increase.

Medicare and Medicaid HMOs pay for “results”, not visits. So you need to
either get admitted or get the hell out and don’t come back to the ERir they
lose revenue.

------
joemag
Aren’t the doctors to blame for this as well? It always surprised me how
quickly and easily they prescribe serious painkillers. A few years ago I had a
tooth pulled, and the doctor gave me prescription painkiller. In the end, I
ended up using regular ibuprofen, and that was more than enough.

I wonder how much of this comes pharmaceutical sales reps pressuring the
doctors to use their medicine. That whole system seems broken and unethical to
me.

~~~
mavhc
Capitalist medicine is to blame, when you can vote with your money you can
pick the doctor who does what you want, not what's best for you.

~~~
refurb
What? Even in single payer systems you can choose your doctor!

~~~
maccard
Not always. I recently moved, and was forced to change doctor (NHS in the UK).
My new GP surgery is farther away from my new apartment than my old surgery
was, I’m far less happy with the doctors there, and it’s far more
oversubscribed than my previous GP was.

------
brucelidl
"Behind every great fortune there is a crime." —Balzac (apocryphal)

~~~
sumedh
Is Warren Buffett's fortune a crime as well?

~~~
seem_2211
Warren Buffett has made his money through a few businesses that aren't quite
in line with his folksy image.

For example, his Mobile Home Empire: [https://www.seattletimes.com/seattle-
news/times-watchdog/min...](https://www.seattletimes.com/seattle-news/times-
watchdog/minorities-exploited-by-warren-buffetts-mobile-home-) empire-clayton-
homes/

Berkshire Hathaway have the largest single stake in Wells Fargo:
[https://www.bloomberg.com/gadfly/articles/2017-10-03/wells-f...](https://www.bloomberg.com/gadfly/articles/2017-10-03/wells-
fargo-s-board-draws-buffett-s-ire-is-ceo-sloan-next)

And here's a charming bit about one of his Kidney related investments and some
of their practices: [http://money.cnn.com/2017/05/15/investing/davita-
dialysis-jo...](http://money.cnn.com/2017/05/15/investing/davita-dialysis-
john-oliver-warren-buffett/index.html)

Finally, an interesting column in the Financial Times:
[https://www.ft.com/content/fd27245a-9790-11e7-a652-cde3f882d...](https://www.ft.com/content/fd27245a-9790-11e7-a652-cde3f882dd7b)

One question stands - can you ethically deploy the amount of capital Buffett &
Berkshire Hathaway have? I'm not sure.

~~~
sumedh
A follow up question would be, is he personally running the companies which
you have mentioned and doing those "crimes" or covering up for them or is it
the people who are actually running those companies doing it?

~~~
valuearb
His job is to assess the long term value of the business, part of that is an
evaluation of the content of managements character. He's bought at least a
hundred businesses, and invested in hundreds of public companies. He's proven
a great judge of character, but that doesn't make him perfect.

Clayton Homes makes mobile homes, which are super cheap homes for low income
people. Their customers are poor credit risks and default frequently, so
Clayton compensates by charging high interest rates.

So is Clayton preying on their desire to have a home?

Or is Clayton offering people who can't afford traditional homes the
opportunity to have their own?

Should their customers instead save their money for many more years till they
are able to afford a traditional home and improve their a credit score to get
a better loan?

Critics of Clayton greatly over-simplify the ethics of its business and how it
runs it.

------
chmaynard
In America, we worship people that create great fortunes. We idolize them and
consider them geniuses. The source of their wealth is not important, even if
it is obviously illegal or immoral. The only consideration is whether they
built a successful business and managed to retain most of their money. This is
the dark side of capitalism and the profit motive.

~~~
tehlike
This is why the US is so ahead in entrepreneurship. It also can be seen in
individuals: Bill Gates was claimed to be ruthless at early times, but now
he's known for his philanthropy.

------
herodotus
In my experience with local philanthropy, there are donors who have no
interest in "naming opportunities" and those for whom it is all about the
name. To me it says a lot about the character of the donor if they
specifically want as little fuss as possible about the donation, and
especially if they do not want something named after them. It is the cause
they support, not their own egos. Personally, the more often I see a
particular donor's name attached to a building, the less admiration I have for
the person. So for me the ethical defects of the company are consistent with
the desire for the family name to be emblazoned everywhere.

~~~
dsacco
I’m more of a consequentialist; I consider a larger philanthropist who cares
about public attribution to be more admirable than someone who is a smaller
philanthropist but doesn’t care about public attribution. Personally, I would
absolutely like to have my name on something if I were to donate tens or
hundreds of millions of dollars towards it.

In my opinion the intention or ego of a philanthropist is approximately
negligible when it comes to their charity and donations. If a billionaire
wants to solve a problem out of a sense of personal grandiosity, or in a vain
attempt at figurative immortality: so be it. At least they have the capability
to do something good and are actually following through with it. In a vague
sense there might be more nobility in anonymous charity, but nobility doesn’t
contribute real resources to a problem.

Phrased another way: if a billionaire donates $100M to a charity and a pauper
donates $1 to the same charity, but the billionaire requires his name to be
affiliated, which of the two is doing more “good”? If you believe the answer
is the poorer person, your axioms are fundamentally incompatible with
consequentialism, because you’re incorporating selflessness into your
definition of good. But if you believe that the billionaire is doing more good
in this example despite his vanity, you’re a consequentialist - as they say,
we’ve established terms, and now we’re just haggling.

~~~
rhizome
It's not about doing "good," they're both doing "good." It's about milking the
charity like you can't give money away without getting something in return.

~~~
dsacco
My point in this line of questioning is purely dialectic; in essense, I am
indirectly targeting the question, “Why is something undesirable, if it is not
bad?”

So we have a few possibilities:

\- Is demanding attribution in philanthropy bad? If it’s bad, how does it
decrease the concrete “goodness” of the philanthropy?

\- Is it not bad? Then why is it undesirable?

\- Is it neither bad nor undesirable? Then why is it relevant?

People have (normative) reasons for personal admiration, and they can’t really
be right or wrong. I’m interested in digging at the normatives.

Generalizing this further, we can say that people are easily offended by
grandiosity and vanity, or at the very least find it distasteful. As a
philosophical question I consider it interesting to wonder why that is the
case, in a scenario where that person is not doing anything “bad” from a
consequentialist perspective. As it turns out, anonymity and attribution in
philanthopy seem to be a good real-world setting for this question, because
narcissism appears to become invalid as a signalling heuristic.

~~~
didibus
I think the answer to your question relates to the ability of the billionaire
to do what he wants on his terms.

You have to ask yourself what are the implicating consequences of this kind of
concentrated influence?

So I think in terms of consequentialism, you need to look bigger. Should the
billionaire be further rewarded for philanthropic actions? What else would he
have done with the money without those rewards? How do the rewards to big
donors affect the donations and volunteering of smaller participators? What
was the long lasting consequence of the big donation which awarded rewards to
a big donor?

The answer to that is complicated, but could change the consequence of the
system, so are relevent to a consequentialist perspective.

Of most noteworthy to me, I think is the idea that a single entity can have so
much concentrated wealth in the first place, where we now need to put
motivations in place for them to give it away. Why award so much wealth to
that entity to begin with? What consequences does this has on the moral
objective you're looking to get as a consequence of our system?

And so, if you believe having billionaires generates overall bad consequences,
then you'll want to demotivate people to become one, thus you might start by
shaming them for their wealth, by conveying to their ego that they are not
special, loved or admired for those traits, and that their big donations is
frowned upon, that we'd rather they just volunteered their time, because no
one cares to know how much they were able to donate.

But, if you frame the problem in the small, and don't explore alternatives, or
quesrion the consequences of the given frame, ya, a billionaire which gives
hundreds of million to charity in exchange for a thousand of dollar statue is
an all around good deal for the charity in terms of consequentialism.

------
gesman
Free Splunk app that shows how to detect anomalies in drug prescriptions
including anomalies in narcotics prescriptions and fraudulent providers
(doctors):

[https://splunkbase.splunk.com/app/3693/](https://splunkbase.splunk.com/app/3693/)

Comes with 2014 medicare dataset. All supporting data can be downloaded from
data.cms.gov

Story:
[https://www.splunk.com/blog/2017/09/28/building-a-60-billion...](https://www.splunk.com/blog/2017/09/28/building-a-60-billion-
data-model-to-stop-us-healthcare-fraud-with-splunk-and-machine-learning.html)

------
chiefalchemist
Regardless of how it started, I'm confused as to why/how this crisis has been
allowed to persist and grow for so long. No checks? No balance? Zero to
epidemic and nothing to prevent it?

------
toephu2
Wow, and this has been known for years...and yet OxyContin is still legal in
the U.S. and being sold every day.

------
neilk
It's interesting how HN has near-universal disdain for people covertly making
billions off an addictive product.

But much of our industry is explicitly, _openly_ trying to create addictive
experiences.

~~~
tclancy
This smells of whataboutism and whatever the ethics of making addictive
software, it's killed far fewer people so far.

~~~
neilk
I'm not equating the harms, or attempting to distract from this serious issue.

But, if we feel clear outrage about another industry, we should consider
applying the same standards to our own.

Most everyone who works in opioid marketing probably thinks they are a good
person too.

~~~
dang
> _we_

The fallacy in your comment isn't that you're wrong about addictions, it's
that you're assuming two population samples are the same: 'HN users who
complain about drug addiction' and 'HN users who create addictive technology'.
Those are two different values of 'we'. (I worry about being in the latter
group. HN is pretty addictive.)

------
cwyers
I'm reminded of that line from Chinatown. "Why are you doing it? How much
better can you eat? What can you buy that you can't already afford?" Is there
really no point of diminishing returns, where you can tell yourself you've
made enough money?

~~~
wyager
If you can’t usefully spend arbitrarily large amounts of money, it’s a
creativity problem. Sure, if your only interests are eating and watching TV
then a billion dollars isn’t going to do much for you.

The easy way to productively spend $X billion is to invest it in
space/physics/medical research or development. If you need to blow a few
hundred billion, you could launch an asteroid mining venture with a reasonable
chance of turning that money into a few trillion and making space development
vastly more affordable for the rest of humanity.

~~~
cwyers
I mean, the most effective contribution they could make to society is to stop
lobbying Congress so effectively to protect their sales of Oxy, but sure,
let's talk about how those profits could be rolled over into speculative
investments in aerospace.

EDIT: And of course, the response to that line in the movie is "The future,
Mr. Gittes."

------
sanguy
Sad. Hope the family gets what's due -- being burnt alive would be a good
start.

------
thr0waway187
The thinly-veiled anti-Semitism of this article is abhorrent. Going after a
family like this is shameful, the real people to blame are those taking drugs
with solid medical uses and abusing them. Ever try to recover from surgery w/o
painkillers? Pray you never do, you'll be thanking the Sacklers.

------
refurb
I love how the article switches between OxyContin and opioids throughout the
article, particularly when talking about deaths. It's a clever way to include
drugs like heroin, fentanyl, etc in the numbers to inflate them and make the
story more gripping.

Of course it's silly to hold OxyContin's manufacturer responsible for all
opioid deaths.

~~~
vasilipupkin
The company and the family is responsible for dramatically increasing number
of opioid prescriptions based on fraudulent marketing and made up evidence. A
lot of people, who, as a result, got addicted to Oxy, at some point ended up
switching to heroin because it's cheaper. So, the manufacturer is not
responsible for all opioid deaths, but is responsible for a significant
percentage of those deaths.

~~~
loeg
> A lot of people, who, as a result, got addicted to Oxy, at some point ended
> up switching to heroin because it's cheaper.

Counter-point: no, they largely did not.

There is a huge population using prescription opiates and a tiny tiny
population using heroin.

Check out [https://grokinfullness.blogspot.com/2017/09/debunking-
standa...](https://grokinfullness.blogspot.com/2017/09/debunking-standard-
narrative-on-opioid.html) for a lot more detail.

> There is no convincing evidence that prior prescription opioid use caused
> subsequent heroin use. ... This is much like the argument, popular among
> drug warriors, that marijuana is a gateway drug because most users of hard
> drugs start with marijuana. There are simply so many current and past
> prescription opioid users that most heroin users will probably have had past
> experience with these drugs, but that says nothing at all about a causal
> link. Indeed, the vast majority of prescription opioid users never go on to
> use heroin, so the causal link is dubious.

> In 2015, 85 million people used prescription opioids legally, and there were
> ~200 million legal prescriptions. By contrast, there were half a million
> heroin users. But there were comparable numbers of deaths in both categories
> (~13,000 from prescription opioids and 12,000 heroin deaths, or 18,500
> heroin deaths if you add the "heroin" and "synthetic opioids" together to
> capture the fact that some dealers have been mixing fentanyl in with
> heroin). Some relevant numbers in my piece here, once again from the CDC's
> website. Deaths per legal opioid user are in the 0.015% range; deaths per
> heroin user are probably somewhere in the 1% to 3.5% range.

> In other words, the prescription opioid deaths are a very small risk applied
> to a very large population. The heroin-related deaths are an extremely high
> risk applied to a relatively small population. These are very different
> issues with very different underlying social causes.

~~~
DanBC
> > In 2015, 85 million people used prescription opioids legally, and there
> were ~200 million legal prescriptions.

In a country of 350 million people this right here is all the evidence you
need: it's obvious that US opioid prescribing is abusive.

~~~
refurb
You know what country has the highest opioid use per capita? Canada!

You know why? Codeine is available OTC. However I don't know many people that
went from codeine to heroin.

~~~
vasilipupkin
OTC Codeine is much weaker and is sold in much smaller doses than oxy.

~~~
refurb
Yes, but when you see stats about opioid use, weak opioids are included.

I would estimate a huge percentage of US opioid utilization is codeine in the
form of Tylenol #3.

~~~
DanBC
You don't think that the US using 99% of the world's supply of hydrocodone is
a factor?

You keep mentioning Canada, bu Canada has its own opioid crisis and public
health officials are working hard to reduce canadian prescribing of opioids.

You've also said that canada has higher per capita use - do you have a cite
for that? Because it doesn't match any data I've seen.

