
Ohio Sues 5 Major Drug Companies For 'Fueling Opioid Epidemic' - CrocodileStreet
http://www.npr.org/sections/thetwo-way/2017/05/31/530929307/ohio-sues-5-major-drug-companies-for-fueling-opioid-epidemic
======
twakefield
I think I've seen this movie before. This looks like it's headed down the path
of the Tobacco Master Settlement Agreement [0].

Here's the playbook:

1) A.G.s and private lawyers start filing lawsuits.

2) Defendants realized there is potentially catastrophic liability here and
start negotiating a master settlement agreement ("MSA") whereby the states
agree not to sue in the future in exchange for a set payment schedule to the
plaintiffs.[1]

3) States A.G.s realize this is a great publicity opportunity to leverage
their career into other elected office and governors realize this a real
revenue stream.

4) So, interests aligned and there is a settlement.

5) Lawyers make a TON of money on their fee schedule set forth in the MSA. So
much so, the Tobacco MSA lawyers were securitizing their future fees in
private markets.

6) Bankers swoop in and start pitching states on the securitization of MSA
payments for states to cover current deficit shortfalls.

7) Bankers make a point or two on the securitization deal proceeds ($10s or
$100s of millions).

8) States leverage their future payments under the MSA to fill budget gaps
where ever possible. Some allocate a small portion of the proceeds to the
victims of the malfeasance but many do not because there are better ways to
get future votes.

</rant>

Full disclosure: I was once a young public finance analyst working 80-100 hour
weeks building financial models to securitize Tobacco MSA payments...slight
grudge still held.

[0]
[https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agre...](https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agreement)

[1] Tobacco stocks jumped on news of the settlement because a large known
liability is much better than an unknown one.

EDIT: slight clarification.

~~~
zdrummond
Super interesting insight, and fascinating walkthrough of the finance side..

However, you paint the whole thing as a corrupt failure. Hasn't smoking use
dropped dramatically? Sure, lots of people got paid/power along the way, but
we did make a large dent in the problem.

~~~
Tuna-Fish
As a part of the deal, the tobacco companies were "exempted from private tort
liability regarding harm caused by tobacco use". A much more just settlement
would have allowed everyone who was harmed by tobacco (at least the ones who
started smoking in the period between when the tobacco companies knew that
tobacco was harmful, and when the publicly acknowledged it) to sue the
companies for the cost of their harm.

This would of course have immediately bankrupted every tobacco company.

~~~
twakefield
The perverse outcome of the tobacco MSA was that state's payments were tied to
tobacco usage. So if tobacco usage went down, so did their payments.

This pretty much obligated the states to transfer their interests to investors
of the securitizations in order to reduce the obvious conflict of interest.

------
sanguy
After watching a 30 year old female overdose in a parking lot and not being
able to be saved by first responders or emergency responders I've realized
this problem is far more prevalent then most of us realize. This is a epidemic
that is playing out under our very noses all across America.

This is just as dangerous as terrorists or any other think that goes bump in
the night - it will destroy this country if not stopped.

Not sure what the solution is but this looks to be a good start to push for
controls needed.

~~~
delecti
There were less than 150 terrorist deaths in the US this decade [1] and tens
of thousands of opioid deaths every year in the US [2]. Terrorism is closer to
the threat posed by crush deaths from vending machines [3].

[1]
[https://en.wikipedia.org/wiki/Terrorism_in_the_United_States...](https://en.wikipedia.org/wiki/Terrorism_in_the_United_States#2010.E2.80.93present)

[2] [https://www.drugabuse.gov/related-topics/trends-
statistics/o...](https://www.drugabuse.gov/related-topics/trends-
statistics/overdose-death-rates)

[3]
[http://journals.lww.com/jorthotrauma/Abstract/1992/06000/Sod...](http://journals.lww.com/jorthotrauma/Abstract/1992/06000/Soda_Pop_Vending_Machine_Injuries__An_Update_.9.aspx)

~~~
bjoyx
> Terrorism is closer to the threat posed by crush deaths from vending
> machines

This is a fallacy. In the case of terrorism "past performance is not an
indicator of future results".

An attack with e.g. a biological weapon could cause, on a single day, 1000x
the cumulative number of deaths we had over the past decade.

There is no possibility of the number of crush deaths from vending machines
rising like that.

~~~
justinjlynn
You make a good point. Surely there's a way statistics account for this
"damage potential". How do statistics treat things like nuclear incidents,
etc?

~~~
ComputerGuru
They're called "black swan events."

Apart from writing difference of books and publishing hundreds of papers on
the subject (see Nassim Talib), the tl;dr is economists and sociologists still
really have no way of truly accounting for them besides being cognizant of
their existence.

~~~
Banthum
Good to reference Black Swan, but Taleb would call these events gray swans,
not black swans.

A true black swan is something that's basically inconceivable before it
occurs. It is outside the mental model used to evaluate outcome probabilities.
Black swan events include things like:

\---Your enemy in a war invents the nuclear bomb and drops it on your cities
(this happened to Japan in 1945)

\---You are a turkey. The farmer comes, as he does every day. Instead of
feeding you, he slaughters you (something which you've got no experience or
conception of).

\---It's 1994 and you own Blockbuster Video, a solid earning company. Then
someone invents the Internet...

Biological warfare attacks are quite well-known as a concept, making them gray
swans. Also in the gray swan category are asteroid strikes, supervolcanoes,
etc etc.

I try to spread this distinction because if we start calling gray swans black
swans, that will hide from us the most important part of Taleb's argument,
which is that true black swans are the most important events. The idea of the
black swan is hard to keep in your mind (how do you keep in mind the
inconceivable?) so it's very easy for a pretender concept to sneak in and
steal the label.

~~~
anovikov
Nukes have also been a very well-known concept, then have been theoretically
invented in 1939 and by 1941, it was well-proven that one can be made. If
anything in nukes was a black swan event it was the isotope mix of reactor-
produced plutonium which made detonation of plutonium bomb without a fizzle
incredibly difficult - something which no one had an idea before it happened
and it almost doomed the project - in 1941, making the bomb looked a lot
easier than it proved to be.

It was also well-known that U.S. is the world leading scientific and
industrial power, that it absorbed huge number of well-educated Jews fleeing
Nazis, and it was least affected by ongoing WWII of all major powers.

So if anyone was to make a bomb it was U.S., every rational actor should have
expected it to happen. Only 'if' was timing.

~~~
nostrademons
I think the big black-swan event with nukes was dropping one on a city. It's a
pretty big mental leap from "Yes, nuclear fission is possible" to "Our enemies
have achieved it in practice, turned it into a weapon, and are about to drop
it on one of our cities." Even among the top physicists working on the
Manhattan project, it was uncertain if detonating the bomb would ignite the
whole atmosphere and kill off all life on earth.

Wormholes, for example, have been theorized for decades. Nevertheless, "The
earth is about to fall into a wormhole and end up in another dimension" would
probably fall into the category of black-swan events.

~~~
bluejekyll
> it was uncertain if detonating the bomb would ignite the whole atmosphere
> and kill off all life on earth.

This was known before it was dropped on a city. The Trinity test happened
about three weeks prior to dropping the first bomb on Japan. The second bomb
was dropped with full knowledge of the potential casualties after the
devastation of the first.

We Americans always justify these bombs, but really, there is no
justification.

~~~
dsfyu404ed
>We Americans always justify these bombs, but really, there is no
justification.

So you'd have volunteered to be the first wave on the beach?

~~~
bluejekyll
You presume that a beach landing was necessary. By this point in the war, the
US had air superiority (the fire bombing of Tokyo...), and all sea lanes under
control. The US had other options.

The best explanation for why the US wanted to have a swift end to the war with
Japan was to deny the USSR the option of dividing Japan like was Germany.

There is no good way to justify killing civilians during the war, and it's
impossible to say what would have happened if these bombs were not dropped and
some other path was taken.

~~~
Bakary
From a purely strategic perspective, the potential to avoid a costly land
invasion must have seemed much more tangible than the at the time hypothetical
and uncertain PR fallout (no pun intended) that would result from use of the
new weapon.

Arguably keeping the USSR out of the islands may well have caused less misery
over time for the Japanese people, from the purely utilitarian perspective of
looking at how populations under Soviet rule fared.

------
kartan
"accuses the companies of engaging in a sustained marketing campaign to
downplay the addiction risks of the prescription opioid drugs they sell and to
exaggerate the benefits of their use for health problems such as chronic
pain."

This is very relevant, from the article. This is the accusation. I have seen
very generic comments in this thread that don't take this information into
account.

~~~
mhb
It's not mentioned in the article, but were the people who are addicted
initially prescribed opioids for pain relief? Or did they initially try them
recreationally?

~~~
nine_k
I read that the amounts recommended by producers are often such that the
effect reliably wears off before the next dose is due. This is a sure way to
form an addiction.

~~~
keebEz
Re: How this forms addiction - the levels prescribed are for a 12 hour period,
but since the drug only lasts 8 hours, a patient is getting a dose above the
recommended level that it should last.

Marketed: 120mg over 12 hours or 80mg over 8 hours

Reality: People that take the 120mg over 12 hours realize it only lasts 8
hours thus they are taking 40mg more than they should be on the schedule that
makes sense to them to avoid pain.

~~~
dismantlethesun
Well, the reality seems to be even worse.

Rather than taking 40mg at the end of the day, the drugs companies caution
doctors to prescribe _more_ medication initially rather than give any
indication that the drug only lasts for 8 hours.

They care more about their approach to marketing, than the efficacy of the
prescription schedule.

It's this that creates addicts: the extreme high of the unneeded extra initial
dosage, followed by a lower low when the drug runs out.

------
pacaro
The pharma companies have some liability, but there was a perfect storm

The "war on drugs", and the racially motivated moral panic about crack cocaine
and addiction created a social attitude that casts addiction as a moral
failing

Inadequate safety net healthcare provisions lead people to the cheapest
treatment option, generic opiates fit this bill

~~~
frozenport
The "war on drugs" has little to do with our opioid epidemic. These are people
who were given "medicine" (mostly painkillers) and got hooked.

~~~
aqme28
I disagree. Look at Portugal, which decriminalized opioid use and started
viewing it as a treatable medical condition. They went from the highest to one
of the lowest rates of opioid use in Europe.

~~~
x00x00
Portugal didn't have pharma companies and doctors selling opioids as being
safe to regular people.

That is what makes the USA unique - it's almost impossible to be prescribed
strong opiates anywhere else in the world, let alone to be told that they're
safe.

~~~
koolba
I'm pretty sure we're the only country that has commercials for "Opioid
Induced Constipation" drugs as well.

You know something is prevalent when the drugs to treat its side effects are
worthy of prime time advertising.

~~~
pacificmint
> I'm pretty sure we're the only country that has commercials for "Opioid
> Induced Constipation" drugs as well.

Well, we're one of only two countries in the world that allow direct to
consumer advertising for drugs at all, so your statement is probably true.

(New Zealand is the other one for those curious, with Canada having some
limited things they allow).

~~~
ryall
As a kiwi myself, I'm genuinely curious about what drugs are advertised in NZ.
I can't recall any such advertisements, apart from maybe flu pills that
contain pseudo-ephedrine?

~~~
shavingspiders
We don't have many - panadol & ibuprofen combos, viagra generics, branded
asthma drugs. Generally they purchase ad spots outside of prime time (and
likely with more regularity on channels like One & Prime, where there's a
slightly older audience.

------
jaggi1
My wife was facing a burnout at the work. She was needlessly scared and
suffered panic attacks. It is something I have gone through too and coped. But
in her case because I love her more than I love myself I decided to take her
to a doctor who then refereed her to a psychologist who then prescribed her
drugs which on quick research appeared to be his plan to keep her on those
forever. My expectation was that the doctor would suggest her some mild drugs
and ask to take up Yoga or some other hobbies and assure her that everything
is in fact alright with her.

He on other hand made a big deal out of whole thing.

We decided to trash all the medicines and lived happily without any issues.

My doctors have given me opioids so many times and I typically throw them out.
Why take a substance like that if pain is bearable ?

~~~
SmellTheGlove
This is probably where cannabis would help, but I don't think even most
medical states include anxiety/mild depression on their list of conditions for
referral. Very few allow for pain without very specific parameters. Nah,
instead we'll hit people over the head with hard drugs. Forever.

~~~
dx034
While Cannabis could help, what's wrong with Ibuprofen? It's the go-to drug
for most doctors in Europe and used for the vast majority of patients with
pain. Unless you had surgery or have been in an accident, pain is rarely that
strong that you need opioids.

~~~
cjeane
Taking ibuprofen for your pain today is perfectly acceptable. Taking it
everyday in an attempt to treat chronic pain is not. There are heart and liver
disorders linked to long term ibuprofen use.

------
AceJohnny2
I have a friend who lives in Columbus, going to Ohio State University. He
regularly "regales" us of stories of the social and economic blight there.
It's hard to imagine from the west coast.

Last week, he posted a picture of the Columbus Dispatch (the local newspaper),
which featured a _full-front-page_ ad for painkillers.

Seriously.

Of course, the newspaper isn't what it used to be, and has been recently sold
due to lagging sales by the private family that owned it.

And when I shared this NPR article with this, he added _" well maybe things
got better, there are no longer overflow trailers in front of the City Morgue.
But maybe they just moved them out back, I didn't search for them"_. And:
[https://coroner.franklincountyohio.gov/opiate-crisis-
summit/...](https://coroner.franklincountyohio.gov/opiate-crisis-
summit/2016-opiate-crisis-summit)

~~~
muninn_
In South East Ohio, things are particularly bad, true. Somewhere like
Columbus? Not as bad as you're portraying it to be. There are definitely
problems, but "hard to imagine from the West Coast"? You mean, like, homeless
people shooting up in downtown San Francisco hard to imagine? It's cool that
your friend goes to Ohio State. It's a great school. I'm sure he's seeing a
lot of economic and social blight as he looks around and sees brand new
construction, half-million dollar houses, and one of the youngest, most
educated groups of people in the country. But hey! Let's paint a stark picture
of those poor people in flyover country. That'll give us something to talk
about.

~~~
yttrium
I went to Ohio State, and the above poster is presenting a point of view that
only someone who has never lived there and probably never visited can hold.
Nowadays you can walk from the OSU campus in Old North Columbus all the way
down Short North into downtown Columbus on any night of the week and see
nothing but restaurants, bars, clubs & so on.

------
lr4444lr
I have a hard time with the notion that doctors themselves were conpletely
innocent bystanders merely "duped" by disinformation on these drugs.

~~~
zzalpha
Well, let's take Oxy. That drug, at recommended doses, was supposed to provide
24 hours of pain relief but frequently did not do so in practice. This lead
people to increase doses, and down that road lies addiction.

Purdue _knew_ this and lied to the medical community.

Unless doctors ran their own studies they couldn't know that Purdue's dosage
recommendations were pure garbage.

~~~
aianus
You'd think their patients would tell them that it wasn't lasting 24h, no?

~~~
hwillis
They did, Purdue instructed the doctors do prescribe higher doses if it wore
off too soon. They actively discouraged prescribing more than one dose a day.
This dramatically increases the addiction potential.

I have to say, the doctors have some plausible deniability. When the drug
company tells you how to prescribe, there are good reasons to listen.
Pharmokinetics is heinously complex and unpredictable. Unfortunately in this
case the drug manufacturer outright lied.

~~~
aanm1988
The problem I have with this is that Opiates have been known to be highly
addictive for how long?

I do feel like doctors should have questioned the notion that these drugs were
completely safe.

~~~
penagwin
(This reply only concerns the US AFAIK).

But who else do we trust? These drugs have the government's approval (FDA) as
being safe, and a very large cooperation who makes the drug says it's safe.
Did I mention the FDA approved it? What's the alternative here? I know my
family doctor can't just run his own studies with drugs, he'd never have the
resources for that.

~~~
lr4444lr
He doesn't have to run his own studies. When patient after patient starts
suffering from withdrawal symptoms, and he reads common journals and talks to
his peer doctors and other medical professionals about it (let alone the
mainstream media reporting), given his training and intelligence, he'd have to
be a fool, lazy, or outright unethical not to question the prescribing
practices recommended by the manufacturer. There's an ethical responsibility
here.

~~~
penagwin
I'm wondering how often people who become addicted - after prescribed use -
tell their doctor (Serious question, I don't have any clue as to what the
answer is). Mine specifically seems to be smart enough to avoid opiates if
possible, however when I had my wisdom teeth removed (few months ago) they
prescribed a bottle of Norco - enough for maybe two weeks or more.

I only took them for less then 3 days - even that was longer then needed (not
that I knew this, you don't know how painful the results of the surgery are
until you stop the painkiller, which could cause incredible pain you are in
pain (physically).

Let's say the doctor doesn't have many client complaints, reads journals and
memos that promote opiates (this is called advertising, something J&J spent 3x
more money on then research), it seems like there should be an independent
organization that researches, tests (or validates studies), and validates the
results and usage instructions. Oh wait that's the FDA job.

I want to emphasize my criticism of the FDA's current performance of what I
believe their job is: to make sure that the drugs sold do what they say they
do, don't cause serious side effects unless they are clearly listed, have
dosages that do as they are supposed to (without _purposely_ causing
addiction).

------
drugpusher
I would think a key piece of evidence would be the IMS reports which show
doctor level prescription data. The companies had to know that there were a
lot of outlier doctors prescribing huge amounts of opioids way above the norm.
(For those that don't know, you can buy data which shows what individual
doctors prescribe. All drug companies buy this to know their market share and
plan salesforce activities. You better believe they knew when things were
going off the rails.)

------
DisposableMoi
I'm going to chip in here as I feel I'm qualified to do so as a recovering
hard drug addict (clean almost a year).

Addiction like most human conditions is complex, to debate this article it
helps to have a clearer understanding of what causes addiction. I'm going to
state my beliefs as truth, they are after all my truth.

Addiction comes in many shapes, substance misuse, alcoholism, food addiction,
porn addiction, consumerism and gambling to name some. They are not caused by
the substance (or object etc) per se, i will paraphrase from a talk i will
link to, if your grandma breaks her hip and is given medical quality opiates
to relive her pain, she doesn't suddenly become a junkie.

Addiction is borne from the inate human desire to form relationships. If we
cannot form relationships with people (because we are socially isolated,
homeless and have no one to turn to, have issues that no one else understands
for example) some people will substitute those relationship with people for
relationships with "stuff". You may recognise in yourself that you do this
with technology.

For some people the bonds they form are with more destructive thinks that $400
juice machines or the latest apple product, they are with substances that
provide temporary feelings of acceptance but simultaneously corrode your very
human-ness.

It's not strictly correct to say that one drug leads to another; shit,
disconnected lives lead to substance abuse (rich and famous people can be
isolated too) it's also not fully correct that medicating those people
Addicted to opiates with a controlled amount of pharma grade opiates is the
answer also, that just gives them A life sentence into opiod jail.

The answers to the problem require analysing why the problem exists.. whether
you are wealthy or poor, it's clear that we are further apart as people and
further isolates into the imaginary world of the internet more than ever. It's
not a political question, similarly the answer is not political but
sociological.

For anyone who has 15 minutes to listen to a powerful TED talk that will
explain why the homeless guy and the middle class college kid both develop
drug problems, watch this:

[https://youtu.be/PY9DcIMGxMs](https://youtu.be/PY9DcIMGxMs)

It could equip you with a completely different perspective about problems and
solutions to addiction and also introduce you to the Portugal way of beating
the problem.

Peace and Love (off to deanonymise)

------
gehwartzen
Seeing a lot of comments sugesting that strictly controlling the supply side
is bad because lots of people legitimately in pain would be suffering. So how
do other countries deal with this? The US consumes something like 80% of the
worlds opioid supply

~~~
gens
In my experience.

In Croatia you have to be very much in pain to be prescribed opioids. The
strongest pain killer i got is Voltaren, for toothache. A friend got opium, or
some derivative of, when he got chopped up because of cancer (same goes for
other major surgeries).

We have good, state employed, doctors.

I have seen some heavier drugs prescribed by shrinks, but i don't know how
(physically) addictive they are.

If you ask me, the whole USA medical thing is broken by design.

------
menacingly
There is a dangerous knee-jerk "but my grandma is in pain" reaction when this
topic is brought up. I'm confident that we can settle somewhere between people
dying in agony and _deliberately_ engineering super addictive dope then lying
about it.

------
kristofferR
Here's a fantastic article which makes it clear why the drug makers deserves
getting sued:

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

------
skookumchuck
Attacking the supply doesn't work and never has worked. Even worse, it
sentences a large number of people to die in agony because they cannot get
pain relief.

~~~
jonknee
What are you talking about? We have successfully gone after numerous
companies/industries who knowingly sold products they knew were dangerous and
said were safe. Examples include tobacco, lead paint and asbestos. Last time I
checked it was pretty hard to install asbestos in your house...

~~~
nv-vn
That's an awful analogy. Opioids are a medicine, asbestos are not.

~~~
jonknee
OK, well plenty of medicines have been withdrawn from the market because of
safety concerns:

[https://en.wikipedia.org/wiki/List_of_withdrawn_drugs#Signif...](https://en.wikipedia.org/wiki/List_of_withdrawn_drugs#Significant_withdrawals)

~~~
nv-vn
You're still trying to apply this same analogy in a case it doesn't fit. A
medicine can have negative effects and still be useful (withdrawn drugs are
only withdrawn when their are no longer needed, usually because of a safer
alternative). However, if a drug that cured cancer but resulted in birth
defects existed, it would not be banned very easily. Putting asbestos in your
body will not cure cancer, and so taking them out of the market doesn't leave
anyone in a worse position ("dying in agony" in the words of the GGGP).
Attacking the supply may work when it is an industrial material, but outlawing
opioids completely would be much more catastrophic. Not only would it not work
(why does heroin exist? or why did non-alcoholics still purchase alcohol
during prohibition?), but it would also cause specific harm to patients who
are in need of the medicine.

------
OliverJones
I fear this is just another example from the century-long tradition of
politicians exploiting addiction to get their names in the news. A couple of
years ago Johann Hari write a fine book on addiction and its legalities.

[http://www.worldcat.org/title/chasing-the-scream-the-
first-a...](http://www.worldcat.org/title/chasing-the-scream-the-first-and-
last-days-of-the-war-on-drugs/oclc/881418255)

The US has systematically demonized addicted persons since the end of alcohol
prohibition. Demonizing them has served a few purposes.

1\. promoting police employment and funding. The forerunner to the US DEA was
the federal prohibition police force. Lately this has greatly expanded to
include civil forfeiture.

2\. separating people into us-vs-them classes. "Addicts are bad, so I'm good."
This was explicitly racist back when police and pols could get away with being
explicitly racist.

3\. giving US pols on the world stage the self-image of righteousness.

Now that the addiction epidemic has hit, well, white working, people, the
demonization doesn't work as well as it did when it hit people who don't look
like red-state attorneys general and governors. So ya gotta demonize somebody?
Why not big pharma? They're a juicy target.

Look. Addiction sucks. It's hard to kick. It makes people weak, silly, and
vulnerable. But it doesn't make them evil.

------
KC8ZKF
The Econtalk podcast recently had a episode about the economics of opiate
addiction. How people become addicted, how the drugs are distributed, etc.

[1]
[http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...](http://www.econtalk.org/archives/2017/01/sam_quinones_on.html)

------
vic-traill
I take full responsibility for all substance abuse in my life.

I will, however, note that doctors, pharmacists and pharmaceutical companies
make money on the front end of opioid addiction, and then the same groups make
money on the back end as addicts work to break their addiction.

There must be lots of Opioid Mansions somewhere.

------
axaxs
I've read a lot here. I live in Kentucky, which as part of the midwest, is as
or more affected than others.

Giving people access is not a solution. Prescribing opioides or heroin is not
a solution.

For all that think drug use is a personal issue and should be legal, you are
wrong. Drug use affects EVERYONE. It affects the parents, the family, the
friends first. And when a user becomes desperate, it affects innocent people.

We MUST end the drug epidemic by any means necessary. No, I'm not saying lock
people up for weed...that's stupid. But America needs to be tough on opioides,
from both foreign and our own pharmaceuticals.

~~~
plainOldText
Being tough on drugs affects innocent people as well. Just take a look at
Mexico.

I think most solutions to societal issues should be sensitive to regional
economic and educational factors. People will go to great lengths to break the
law when their economic wellbeing is threatened.

~~~
axaxs
Well, I'm from one of the least educated states. And I can see the drug users
around me every trip I take. I've never been harassed or robbed, but it's
still sad to see. But the new idea of needle exchanges and heroin
prescriptions are sickening. The governmnent should not be conducive to this
behavior. We, as Americans, should demand better. And as long as those who
make decent money, like me, or those unaffected, like most of the west coast,
project their ideas without experience at this problem, the worse it will get.

~~~
distances
Needle exchange programs definitely work. It's no use to be "tough on drugs"
and just get slapped with an AIDS or hepatitis epidemic in addition to the
drug epidemic.

Needle exchanges are very common in Europe, it's not some idea projected from
the west coast.

------
cagrimmett
I grew up in a small suburb of Cleveland. My parents still live there and they
tell me that not a day goes by without seeing another overdose in the paper.
They've become so common that they stop running stories, they just add them in
the obituaries. People I went to grade school with are among the overdose
deaths, too.

I'm not sure Mike DeWine's lawsuit will do anything, or that it is even the
best move to reducing overdoses. But damn, it is heartbreaking watching so
many people die that way.

------
bactrian
The guy who did Silk Road was involved in the deaths of 6 users. He got life
without parole.

These drug company execs belong in prison. They've directly and knowingly
destroyed millions of lives.

~~~
bobcallme
> The guy who did Silk Road was involved in the deaths of 6 users. He got life
> without parole.

Kind of funny since that is not how things went down [1] and we don't know who
really started Silk Road.

[1]
[https://en.wikipedia.org/wiki/Silk_Road_(marketplace)#Arrest...](https://en.wikipedia.org/wiki/Silk_Road_\(marketplace\)#Arrest_and_trial_of_Ross_Ulbricht)

------
pthreads
I have very little confidence this will go anywhere. If anything the
pharmaceutical companies will pay a small fine and agree to better inform
patients and doctors, control supply chain better etc.. Nothing else is going
to come out of this.

I get the feeling that this is just political showmanship. I wouldn't be
surprised if the governor of Ohio is running for office in 2020. He has been
making the rounds of talkshows trying to sound very concerned about people's
health.

~~~
vivekd
Even a small fine is a big start because if someone gets a small fine for bad
behavior in court, and they repeat that behavior, they get a much larger
penalty the second time around for willfully disregarding the court ruling
about their illegal conduct. If the pharmaceutical companies get a small fine,
it's a good bet that they won't be repeating that behavior.

------
Bakary
The question is, how did we manage to create a society hellish enough that
some citizens are reduced to having opioid abuse as one of their only means of
escape?

------
jonaswi
As an outsider the heavy use of those opioids in the U.S always seemed very
troubling to me. Can someone explain me what doctors led to prescribe those
drugs on such a regular basis? Shouldn't the doctor monitor the patients drug
use and be very careful with drugs that are known to be addictive?

------
11thEarlOfMar
This is a recurring phenomenon in the US:

Opium/Morphine in the late 1800s:

"Throughout the late 1800s, the opiates (morphine and opium) continued to be
distributed widely in patent medicines. There was also a widespread
physicians' practice of prescribing opiates for menstrual and menopausal
disorders. Too, there was extravagant advertising of the opiate patent
medicines as able to relieve "female troubles."

Women, it seemed, had become the prevalent class of opiate users. Prescription
and patent medicines containing the substances were advertised and accepted
without question. Also, this was a convenient, gentile drug for a dependent
lady who would never be seen drinking in public. "The extent to which alcohol-
drinking by women was frowned upon may also [in addition to opiate medicines]
have contributed to the excess of women among opiate users. Husbands drank
alcohol in the saloon; wives took opium at home" (Brecher, 1972)."[0]

Amphetamines in the 1930s:

"Abuse of the drug began during the 1930s, when it was marketed under the name
Benzedrine and sold in an over-the-counter inhaler. During World War II,
amphetamines were widely distributed to soldiers to combat fatigue and improve
both mood and endurance, and after the war physicians began to prescribe
amphetamines to fight depression. As legal usage of amphetamines increased, a
black market emerged. Common users of illicit amphetamines included truck
drivers on long commutes and athletes looking for better performance. Students
referred to the drug as "pep pills" and used them to aid in studying."[1]

LSD in the 1950s:

"Non-therapeutic use of LSD increased throughout the late 1950s and 1960s.
Among the first groups to use LSD recreationally were research study
participants, physicians, psychiatrists, and other mental health professionals
who later distributed the drug among their friends. Prior to 1962, LSD was
available only on a small scale to those who had connections in the medical
field, as all the LSD was produced by Sandoz Laboratories, in Basel
Switzerland, and then distributed to health professionals. However, the drug
was not difficult to produce in a chemical laboratory. The formula could be
purchased for 50 cents from the US patent office, and the LSD itself could be
stored inside blotting paper. Soon a black market for LSD in the US
emerged."[2]

On the one hand, it's tragic. On the other, these events seem to have a
similar arc and we should not be surprised to see opioids taken off the market
and criminalized, like Opium and Amphetamines.

[0]
[http://www.druglibrary.org/schaffer/history/casey1.htm](http://www.druglibrary.org/schaffer/history/casey1.htm)

[1], [2]
[http://www.pbs.org/wgbh/pages/frontline/shows/drugs/buyers/s...](http://www.pbs.org/wgbh/pages/frontline/shows/drugs/buyers/socialhistory.html)

~~~
dwaltrip
How many people have overdosed on LSD? None? I don't see why you would include
LSD on this list (I may be missing the point of the list, though).

I do understand a small percentage can have long-term, negative reactions.
However, the mechanism for this is not well understood, and what we do know
suggests many of these individuals were already at risk for mental illness.
Thus, this is something that can likely be prevented with more awareness and
research, to a large degree.

I'm discounting "bad trips" here -- my understanding is that the large
majority of people who have experienced a bad trip report learning something
from the experience and don't regret it [1].

[1] Unfortunately I don't have any sources handy, and am short on time. I
might be able to look some up later.

~~~
11thEarlOfMar
It helps illustrate that this is a recurring phenomenon and I found it
interesting that it, too, was initially promoted by '...physicians,
psychiatrists and other mental health professionals...'.

------
randyrand
Shouldn't the drug companies sue back for the state not having proper
regulations?

------
revelation
You would think persuading doctors to prescribe unnecessary opioids is the
kind of crime that has the DEA kicking down doors and arresting managers.

~~~
elipsey
They have.[1][2] This has substantially contributed to increased demand for
imported heroin and synthetic opiods which are substitutable for perscription
pain killers to prevent withdrawal.[3]

[1] Former Health Minister of Guyana, Dr. Noel Blackman, Sentenced for Running
“Pill Mill” in Long Island,
[https://www.dea.gov/divisions/nyc/2017/nyc051217.shtml](https://www.dea.gov/divisions/nyc/2017/nyc051217.shtml)

[2] Manhattan U.S. Attorney Announces Charges against Owner of Bronx Clinic
and 23 Other Individuals Involved in Illegal Distribution of More Than Five
Million Oxycodone Pills,
[https://www.dea.gov/divisions/nyc/2014/nyc020514b.shtml](https://www.dea.gov/divisions/nyc/2014/nyc020514b.shtml)

[3] Unintended consequences: Why painkiller addicts turn to heroin,
[http://www.cnn.com/2014/08/29/health/gupta-unintended-
conseq...](http://www.cnn.com/2014/08/29/health/gupta-unintended-
consequences/)

------
wnevets
Stop worrying, the free market will fix it any day now.

~~~
Omnius
Not to be that guy be decriminalizing and offering alternatives and open
treatment with out stigma would allow the free market to help this.

The government going ohs nose we have a prescription drug problem lean hard on
the doctors and suppliers just drove normal people that were given bad advice
and developed addiction because of injuries and the wrong treatments into the
black market were the only affordable alternative for many was heroin.

~~~
joefkelley
To be fair, you need both.

Going after pharma companies / doctors reduces the supply and cuts down on new
addictions. Decriminalizing and destigmatizing helps existing addictions.

~~~
Omnius
I think that's a mostly fair assessment however by reducing supply you have
the side effect of making addictions worse. You had people that may have had
physical dependency but not addiction who were 100% functional, living lives
having the carpet ripped out from under them and having to deal with physical
withdrawal.

I agree with you but i don't think anyone would argue that like always when
the government gets involved we over corrected.

------
hoodoof
x

~~~
pizza
Legal drugs are not de facto safe.

------
sidcool
May be an unpopular opinion on here, but this and some others​ are an example
of a Capitalist system with little oversight. There will always be people who
abuse freedom. They need a powerful law enforcement oversight. Same goes for
some tech Giants too. And hospitals. And gun industry. Etc.

------
c3534l
Come on, really? It's a goddamned opioid. If a doctor isn't aware that an
opioid is potentially addictive, then that is a really bad doctor. OxyContin
is better than morphine, so any drug epidemic (which doesn't really exist,
people have been doing opioids/opiates for a very long time) is lessened, not
exacerbated, by substituting older opiates with more modern opioids.

