
As opioid overdoses exact a higher price, communities ponder who should be saved - jseliger
https://www.washingtonpost.com/world/as-opioid-overdoses-exact-a-higher-price-communities-ponder-who-should-be-saved/2017/07/15/1ea91890-67f3-11e7-8eb5-cbccc2e7bfbf_story.html?hpid=hp_hp-top-table-main_narcan745pm%3Ahomepage%2Fstory&utm_term=.3bde9933f670
======
tcj_phx
(this article can be read by searching for the title on
[http://twitter.com/](http://twitter.com/), then opening the link in a private
window)

> Two doses of an injectable form of naloxone, Evzio, cost $4,500, up from
> $690 in 2014. The price of other forms of the drug, including the nasally
> administered Narcan, typically range from $70 to $150 per dose, officials
> say.

The cost of naloxone [1] is an insignificant part of the cost of reviving an
addict. The rest of the costs mentioned in this article are pure profiteering.

[1]
[http://www.sigmaaldrich.com/catalog/product/sigma/n7758?lang...](http://www.sigmaaldrich.com/catalog/product/sigma/n7758?lang..).

If you buy 5 grams from Sigma Aldrich, a 2mg dose costs $0.588. Add a few more
cents for salt, water and packaging brings the cost per dose to $2. An EMS
supplier sells a single "kit" with an intranasal atomizer for <$48 [2]...

Someone on Reddit sent me 4 vials of naloxone. I sent them <$20 to cover
postage. [Edit: these vials have .4mg naloxone. Needles were also included. I
think the standard intranasal dose is 2mg.)

[2] [http://www.dixieems.com/Economy-Naloxone-
Kit.asp?pid=2086](http://www.dixieems.com/Economy-Naloxone-Kit.asp?pid=2086)

Naltrexone is very similar to Naloxone. It is used to keep people from getting
high on opiates. Big Pharma has found a way to jack the price of this generic
drug too. 15 days ago I posted about the Naltrexone rip-off:
[https://news.ycombinator.com/item?id=14672338](https://news.ycombinator.com/item?id=14672338)

~~~
Clubber
I don't know how long this country can survive with this rampant corruption
and profiteering. When do we hit a breaking point, and what does that look
like?

I mean I read your response and think, "wow, that's horrible." Then realize
absolutely nothing is going to be done about it.

~~~
joshlemer
I guess one way it could play out is that as the corruption becomes more and
more obvious, together with increasing differences in political ideology
between red and blue states, an appetite for seceding from the United States
could develop in some states, and if that sentiment becomes common enough, it
could become a reality?

~~~
Retric
It's IMO more likely than most people think. I really hope we don't see a
civil war in our lifetime, but historically democracy's are highly unstable.
This time it might be different, but then again it might not.

~~~
Clubber
A Civil War today would look like Afghanistan or Iraq, not like the one we had
before. It won't be pretty and will probably end in authoritarianism the likes
we've never seen.

~~~
Retric
~50% of all US war casualties occurred during the Civil War. It was very
nasty, even if only 3% of the total US population died in direct fighting.

~~~
Clubber
Yes, it was a gruesome war. By Afghanistan and Iraq, I meant more insurgent
type war rather than sanctioned armies fighting. Liberal states would have
insurgent right wingers and Conservative states would have insurgent left
wingers. Insurgents would be fighting the opposite faction of insurgent, and
everyone will be armed to the teeth. We saw a glimpse of how that would play
out in rural areas with the Oregon stand off. I suspect the cities would be
something like we saw in Ukrane with their stand in the main square with the
firewall, except a lot more shooting. There would be massive food shortages.
It would be crazy and unpleasant and not a damn thing will have been resolved.

I realized I was being vague.

------
ivanbakel
How can it be acceptable that you would declare people too expensive to save,
rather than challenge the prices of a profit-making company that is bringing
those costs in the first place? Shouldn't you be able to detect the sheer
amount of corporate worship in such a statement before it leaves your mouth?

It breaks my heart to keep reading about this epidemic, with such a consistent
reaction of hatred from so many people. This state of vulnerability should be
met with support, but because opiates are nominally pleasurable, everything
surrounding them must be a failure of personal responsibility - of people
getting in over their heads.

~~~
creaghpatr
This is what happens in the UK right now. The government decides when the life
support machine gets turned off- they pay for it so it's their choice.

Not a common or planned outcome, but an unfortunate byproduct of nationalized
healthcare.

[http://www.bbc.com/news/uk-england-40423371](http://www.bbc.com/news/uk-
england-40423371)

~~~
norikki
>Not a planned outcome.

Sure, but the people responsible clearly don't care, as evidenced by the tone
of the article.

Drug addiction is the result of the weak border [1], and a depressing job
market [2], which is also the result of the weak border [3].

[1] [http://www.businessinsider.com/us-heroin-coming-from-
mexican...](http://www.businessinsider.com/us-heroin-coming-from-mexican-
cartels)

[2] [http://www.gallup.com/opinion/chairman/181469/big-lie-
unempl...](http://www.gallup.com/opinion/chairman/181469/big-lie-
unemployment.aspx)

[3]
[https://www.judiciary.senate.gov/imo/media/doc/03-16-16%20Bo...](https://www.judiciary.senate.gov/imo/media/doc/03-16-16%20Borjas%20Testimony.pdf)

~~~
DanBC
The US prescribes far more opioids than any other country.

It's likely that some of the addiction problem in the US comes from this
irresponsible prescribing.

[https://www.dea.gov/divisions/hq/2015/hq110415.shtml](https://www.dea.gov/divisions/hq/2015/hq110415.shtml)

> Since 2002, prescription drug deaths have outpaced those of cocaine and
> heroin combined. Abuse of controlled prescription drugs is higher than that
> of cocaine, methamphetamine, heroin, MDMA, and PCP combined.

------
Animats
In the UK, naloxone with an injector costs £20.58, plus £4.16 VAT and £4.95
shipping, in quantity 1. Total is about US$38. The price goes down if you
order in bulk. The supplier notes "You may be able to get naloxone free of
charge from your local drug service, or GP."

Note that this, like ephedrine, is an old drug, out of patent decades ago.

There's an opportunity here for a startup. The startup doesn't even have to
make the drug; there are contract pharmaceutical manufacturers who can do
that.[3] The startup just has to handle marketing, distribution, and FDA
approvals. Here's a list of makers worldwide.[4] Auto-injectors are available
from various suppliers.[5][6]

This project could be put together by a small team and would get very
favorable publicity.

Then, on to replacing the Epi-Pen.

[1]
[http://www.exchangesupplies.org/shopdisp_prenoxad_naloxone_p...](http://www.exchangesupplies.org/shopdisp_prenoxad_naloxone_prefilled_syringe.php)
[2]
[https://www.fda.gov/downloads/Drugs/NewsEvents/UCM454757.pdf](https://www.fda.gov/downloads/Drugs/NewsEvents/UCM454757.pdf)
[3]
[http://www.contractpharma.com/csd/categories](http://www.contractpharma.com/csd/categories)
[4] [http://naloxoneinfo.org/get-started/where-to-get-
naloxone](http://naloxoneinfo.org/get-started/where-to-get-naloxone) [5]
[http://www.medicalplasticsnews.com/news/autoinjector-
landsca...](http://www.medicalplasticsnews.com/news/autoinjector-landscape-
changing-as-suppliers-re-evaluate-mar/) [6] [http://www.shl-
group.com/products/shl-medical/](http://www.shl-group.com/products/shl-
medical/)

------
laser
Why is ibogaine [1] still a fringe treatment for opiod addiction? It seems
like a heroin -> methadone -> ibogaine treatment could get the vast majority
of addicts cured. Instead, on one end of our medical system's pipeline we get
people addicted to opiods, and on the other end we've created so many addicts
we have to save them from overdosing. In this domain our "medical" pipeline is
actually a disease-creating pipeline that's clogging itself up at the end...
Research is still ongoing, but it seems likely that even the majority of
opioid painkiller prescriptions can be replaced with cannabis.

It seems then, that we can empty the pipeline by adding less opiod addicts in,
by prescribing cannabis when possible instead of opiods, and clear out the end
by actually effectively treating addicts.

Unfortunately, our federal government is so out of touch with reality that it
classifies both ibogaine and cannabis as Schedule I drugs, substances with
"high potential for abuse", "no accepted medical use", and "lack of accepted
safety for use under medical supervision". The irony is devastating, and it's
ruining countless lives.

[1]
[http://ww.iceers.org/docs/science/iboga/Alper%20et%20al_1999...](http://ww.iceers.org/docs/science/iboga/Alper%20et%20al_1999_Acute_Opiate_Withdrawal.pdf)

[2] [https://www.theatlantic.com/health/archive/2016/11/a-new-
tes...](https://www.theatlantic.com/health/archive/2016/11/a-new-test-of-pots-
potential-to-replace-painkillers/507200/)

------
altotrees
There is a big controversy about this in the area of Ohio I am from (overdose
capital of the U.S., Coincidentally). A sheriff who presides over a country
near my home is loudly deriding the use of Narcan, saying it will not be used
by his deputies, due to moral and financial concerns.

Needless to say, I have lost 8 high school classmates to the epidemic at last
count, and of those, 5 had been revived multiple times. So I can see both
sides. There is no easy answer, and this problem will not go away on it's own.

------
enraged_camel
While we are dealing with this severe public health crisis, Republicans in
Congress are about to pass a healthcare bill that will, according to the non-
partisan CBO, result in millions of people losing their health insurance.

There is really no word that adequately describes how disgusting it is.

------
darpa_escapee
Threaten to nationalize manufacturing of Naloxone, then do it if prices aren't
brought down.

If there's an epidemic and private manufacturers can't respond to the demand
without raising prices by a factor of 10, something needs to be done.

Annual overdose deaths have doubled over the last ten years. To bring a
certain brand of hyperbole to the table, 2016 saw a loss of life equivalent to
about thirty times that of 9/11.

Some see that as national crisis, others see it as an opportunity to gouge our
people, towns and country.

~~~
refurb
_Threaten to nationalize manufacturing of Naloxone, then do it if prices aren
't brought down._

That should do wonders for R&D investment in the US!!

~~~
zanny
The majority of useful drug R&D (ie, not more penis enlargement pills) comes
from research grants and university labs, not from private drug companies. It
is a great meme Big Pharma has spread as a means to protect their lavish
profit structure.

The US leads in pharma research because it has the best research universities,
not because it has private drug companies and no universal healthcare.

~~~
refurb
_The majority of useful drug R &D (ie, not more penis enlargement pills) comes
from research grants and university labs_

Absolutely false. Only 24% of new, innovative drugs come from academia. 76%
come from biotech or pharma companies.[1]

And even if they were discovered by an academic center, someone still has to
take it all the way to the finish line which is where most of the cost comes
from.

[1][http://blogs.sciencemag.org/pipeline/archives/2010/11/04/whe...](http://blogs.sciencemag.org/pipeline/archives/2010/11/04/where_drugs_come_from_the_numbers)

------
flatfilefan
Compare it to the money US spent on Afghanistan invasion and the explosion in
opium production there. Where do you think the production goes and who is
running the operations? Wouldn't it be fair to divert part of those budgets to
help civilians in US to cope with the results?

The bitter thing is that even Trump will boost military budgets, not much
change here from the previous regime.

~~~
extra88
I agree about the costs of war (though I think Iraq was a war of choice, to
the detriment of the campaign in Afghanistan) but "nearly all of the heroin
available in the United States comes from Mexico and South America." [0]

This problem was also started with prescription meds, due to deception by
pharma companies and lack of attention and mismanagement by the medical
professions and government.

This sheriff is an asshole. He says he doesn't want his deputies carrying
Narcan playing paramedic, does he also not want them trained in administering
CPR or basic first aid?

[0] [http://www.politifact.com/truth-o-
meter/statements/2016/sep/...](http://www.politifact.com/truth-o-
meter/statements/2016/sep/13/donald-trump/trump-right-heroin-coming-through-
southern-border/)

------
robk
Why is the price increasing as volume has gone up? Is it FDA-type regulation
that's preventing new market entrants or patents? Or something else
artificially preventing new market entry like legal risk?

~~~
TomMarius
Not sure why you differentiate, patents are regulations too.

~~~
extra88
Patents are intellectual property rights established by law. Congress passes
laws giving the executive branch the right and responsibility to create
regulations but much of the content of those regulations are not dictated by
law.

~~~
zanny
The patents didn't exist until the federal patent office approved them, in the
same mechanical structure a regulatory agency approves a regulation. It is
still on the authority of the executive to approve a patent or not.

------
torpfactory
I think we could add this to Jeff Bezos' ideas for philanthropic endeavors.
Hell, it doesn't even need to be philanthropic. Amazon seems to have no
problem with razor-thin profit margins: Why not create a company which has no
problem making and selling generic-only drugs at razor-thin margins? There
would seem to be a lot of room to undercut a business who sells for $4500 what
might be produced for $20.

I think our capitalism may actually suffer from too much profit taking and not
enough competition. I want the market to serve me (the consumer) not the other
way around. I'm sure the producer see things differently... There doesn't seem
to be a lot of appetite for companies to go after profitable businesses that
don't have big margins.

~~~
Noumenon72
There would be a Jeff Bezos if the drug market was as unregulated as the book
market. Because of the regulations, instead there will be a Martin Shkreli.

------
scurvy
Generally curious what the efficacy rates of opioid rehabilitation are. How
many times does it take for someone to kick heroin? For how long? What's the
cost breakdown for a turn in rehab?

------
mnm1
"In recent weeks, Butler County Sheriff Richard K. Jones has drawn national
attention for vowing that his deputies will never carry Narcan because he
doesn’t want them playing the role of paramedic."

This is one of the sickest, most disgusting, most disturbing, most inhumane
things I have ever heard. I guess police are not satisfied with just shooting
unarmed people, now they have to let sick addicts die. So they can save $50,
an amount that would be even less if it could be negotiated by a program like
Medicaid or Medicare. At least it finally confirms the fact that a lot of
police, like Jones, would rather stand around, do nothing, and let the people
they are supposed to serve and protect die while they watch. What a sick,
disgusting mother fucker. No, there's isn't a word in the English language
that even begins to describe this lowlife. And the give this piece of shit a
fucking gun? I wonder how many he's murdered so far without impunity?

------
thesz
I think it is time to (re)read The Final Circle of Paradise by A and B
Strugatskie.

[1]
[https://en.wikipedia.org/wiki/The_Final_Circle_of_Paradise](https://en.wikipedia.org/wiki/The_Final_Circle_of_Paradise)

Situation in US is quite close to one described there.

------
dredmorbius
Why are the opoid manufacturers who are creating this addiction in the first
place not being billed for it?

~~~
jtmcmc
You mean like poppy plants? This addiction wasn't created by drugs - drugs are
merely a coping mechanism for a world that people can't fucking deal with.

The root causes aren't opioid manufacturing it's whole slew of things from
poor physical and mental health care in this country, worsening job prospects
for people, a culture that ties worth and value to working hard and monetary
prosperity, etc...

~~~
DanBC
The US prescribes far more opioid medication than any other country.

> Since 2002, prescription drug deaths have outpaced those of cocaine and
> heroin combined. Abuse of controlled prescription drugs is higher than that
> of cocaine, methamphetamine, heroin, MDMA, and PCP combined.

~~~
dredmorbius
This and @panic's response, both.

Quantity and dosing of opioids.

------
justanother
Regardless of whether or not you regard opioid addiction as a disease, please
please consider the slippery slope you're sledding down if you buy into this.
Who's going to deny insulin to people whose credit card statements show more
than 3 Dairy Queen visits this month? Who's going to deny chemo to people who
smoked too many Pall Malls, in your opinion? This reeks from top to bottom,
and yes, narcan isn't nearly as expensive as chemo, so yes, the slippery slope
is pretty much guaranteed to go there. Proceed with caution.

------
berzerk5
That's why I think Kratom could be of huge benefit to a lot of people
struggling with opioid addiction. It's cheap, otc, and a ton of people have
had success with it.

------
valuearb
How bout requiring opioid makers to pay for needed Narcan doses?

------
eagletusk
Why hasn't the price come down. Can we expect the cartels to start to
manufacture opioids and anti-opioids?

------
ninguem2
Are these overdoses accidental or deliberate? The article does not seem to
address this question.

