> 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  is an insignificant part of the cost of reviving an addict. The rest of the costs mentioned in this article are pure profiteering.
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 ...
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.)
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
The docs that I found to prescribe it for me really wanted me to subject myself to antabuse (Disulfiram) which is a profoundly sadistic strategy that creates a major sensitivity / negative reaction to even small amounts of alcohol that can be incredibly distressing and even life threatening.
Naltrexone on the other hand simply took away most of the euphoric experience I was getting from drinking and after a 4-6 weeks of using it every time I drank, I quit after a night of heavy drinking and morning of regret. After decades of quitting only to find myself drawn back to it, it was a profoundly liberating experience to actually be sober and not want a drink at all. It still is actually (though in a different sort of way).
I have to say that drinking while taking Naltrexone was a pretty weird experience because many of the signals I'd grown accustomed to for gauging my intoxication were muted... so I "felt" kinda sober but at the same time clearly was not. I think if there is a major risk in this it's possibility of deciding to drive because of "feeling sober". So that's the thing I think people need to be really cautious about.
Johann Hari has pointed out that it's very effective to just give heroin addicts pure heroin and a safe place to inject it. Switzerland has 'essentially'  eliminated opiate deaths with this strategy:
[edit: added 'essentially' in response to tptacek's comment below because the swiss probably haven't gotten rid of 100% of their opiate deaths]
I have edited the comment above to add a word.
The friend who taught me about her opiate addiction knew how to manage her dose pretty well. Then the mental health industry got her addicted to benzodiazepines, which changed her tolerance. She overdosed on me when trying to get off the benzos. The fire department revived her, then disappeared into the night. Those two doses of Naloxone stabilized her for about 2 weeks...
A lot of the deaths in the United States' present opiate overdose epidemic has to do with contamination of the heroin supply with more powerful synthetic opiates. When the supply includes elephant opiates, addicts don't know how much to use.
The thing I see reports saying Switzerland has effectively eliminated is deaths due to needle contamination. That's not hard to believe (but then, you could get that effect by giving addicts clean needles).
In the article you posted, I see Hari saying that Switzerland's practices have eliminated wounds and abscesses he attributes to drug contamination. That, too, is very plausible. But most opiate fatalities are not caused by injection site wounds; they're caused by overdose.
I think there might be some confusion. Switzerland itself claims that nobody has died from overdose of officially prescribed heroin. That, too, is totally plausible. But Switzerland still has a street opiate drug market problem!
The planet's various governments created the street drug marketplace by making desired substances illegal. The United States government created the country's drug culture by lying to people about the actual hazards of these desired substances.
Perhaps Switzerland has not eliminated opiate deaths, as my comment originally indicated, but the Swiss are doing better than everyone else in making progress at helping people with opiate addictions.
Results from the Swiss studies, however, show that
mortality among patients in heroin assisted
maintenance programmes is low, and lower than for
patients in other maintenance programmes.14 In
addition, the wider safety concerns could not be
empirically confirmed in Switzerland or the
Netherlands.15 Finally, the incidence of heroin
dependence has decreased greatly in Switzerland
since the start of the trials, and currently
heroin has a more negative image than it did 15
ref #14 (above) says:
CONCLUSION: Mortality in heroin-assisted treatment
was low compared to the mortality rate of Swiss
opioid users 1990s (estimated to be between 2.5
and 3%). It was also low compared to mortality
rates of opioid users in other maintenance
treatments in other countries as reported in the
literature. The SMR was also lower than that
reported in the only meta-analysis in the
literature: 13.2 (95% C.I. 12.3-14.1). The low
mortality rate is all the more noteworthy as
heroin-assisted treatment in Switzerland included
only refractory opioid addicts with existing
severe somatic and/or mental problems.
In 2015, there were about 10 cases of needle-borne HIV infections in Switzerland, out of a bit more than 500 overall.
I mean I read your response and think, "wow, that's horrible." Then realize absolutely nothing is going to be done about it.
So far it has been 241 years.
My mother broke her wrist 6 months ago, and was given opiates to deal with the pain of having a plate put in her wrist. She did not become an opiate addict. I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life.
Where would we be if they hadn't circumvented the constitution and just let people use the drugs they wanted? We would probably (maybe) have more drug deaths, but we wouldn't have this 1984 like society. I think I want a do-over.
> I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life.
While circumstance and upbringing are factors for addition, I think it's accepted that there is also a biological component; your mom may be inherently less prone to becoming addicted to opiates.
The Mafia and other manifestations of "traditional" organized crime is exactly what I was referring to.
Two years ago, when a new friend was teaching me about her addictions, I bought Johann Hari's book, Chasing the Scream: The First and Last Days of the War on Drugs . Hari says that after heroin was made very difficult to obtain (circa 1915), organized crime became the supplier for most addicts.
The Los Angeles Times Op-Ed A 1930s California story shows why the war on drugs is a failure also covers how the Mafia swooped in to supply the needs of addicts . This is the primary article I was thinking of when I wrote the quip you responded to.
> > I presume she managed to avoid becoming a junky because she has a pretty stable day-to-day life.
> While circumstance and upbringing are factors for addition, I think it's accepted that there is also a biological component; your mom may be inherently less prone to becoming addicted to opiates.
My mother is inherently less prone to becoming an addict because she has meaningful things to do: job, family, friends, trips, etc. My friend who taught me about addictions (mentioned above) was vulnerable to the street pharmacy because she was exposed to meth amphetamine as a pre-teen, and her brain chemistry never fully recovered. She says she was very depressed as a child/teen, and was made suicidal by her doctor when he injected her with Depo-Provera around age 20 (this is a chemical castration drug used for 3 months of "birth control"). This friend is doing well now because I provided the "connection" that Johann Hari says is so important for helping addicts out of their pit.
Having meaningful things to do is not "inherent."
I never heard of Depo-Provera before but calling it "chemical castration" and putting "birth control" in scare quotes seems like hyperbole and inflammatory. The drug is a progestin, a synthetic hormone that is administered in a number of forms. Depression is one of the possible side effects of the shot, but that doesn't necessarily mean it would exacerbate an existing condition and you've not mentioned whether the doctor was also treating her depression.
The intention is to point out the absurdity of our situation, where much-desired plant-based substances can only be obtained with the assistance of organized crime.
> It's also rather beside the point when talking about today's epidemic.
The point is that the epidemic is entirely artificial. It is created and maintained by stupid politicians. It could be ended in a few months by implementing the same solution as is used in Switzerland.
> I never heard of Depo-Provera before but calling it "chemical castration" and putting "birth control" in scare quotes seems like hyperbole and inflammatory.
The same drug is given to male sex offenders  explicitly for the purpose of chemical castration. Many women lose their libido when they're put on this drug. No hyperbole is enough to warn about the dangers of this FDA-approved substance.
But synthetic vs. plant-based doesn't mean shit, plenty of plants can kill you. I'm all for treatment over criminalization but you sound more like you're advocating for legalization of heroin.
> No hyperbole is enough to warn about the dangers of this FDA-approved substance.
Sure, if you're willing to ignore all the other information on that Wikipedia page. Every patient should be well-informed about possible side effects before starting a medication. The injection form is longer lasting so it may take longer for bad effects to subside but loss of libido for a few months is not the end of the world.
The worst thing about chemical castration of sex offenders is it's forced.
My friend did not transfer her addiction from pills, she was a good old-fashioned heroin addict. The present body count stems from the synthetics. Many fewer people died when the street pharmacy's products were purer.
> I'm all for treatment over criminalization but you sound more like you're advocating for legalization of heroin.
I don't think legalization is necessary, just an acknowledgement that present policy is actually a make-work program for organized crime.
As for your comments about Provera, I say that doctors should not play Russian Roulette with women's health.
"Heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015. The largest increase in overdose deaths from 2014 to 2015 was for those involving synthetic opioids (other than methadone), which rose from 5,544 deaths in 2014 to 9,580 deaths in 2015. One of these synthetic opioids, illegally-made fentanyl, drove the increase. It was often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge." 
But the rate of increase for death by prescription opioid has been greater than non-prescription so they are nearly half of all deaths.
This is almost always linked to developmental and shock trauma earlier in life.
I wish the justice system would consider this factor when deciding whether to send people for gratuitous punishment...
But they are arbitrary. The talk radio in the rural conservative parts and the Internet circlejerks in the liberal ones have divided peoples way worse than they were a hundred years ago by putting the soft-reds and soft-blues into echo chambers of the most ardent idealogues and turning many into adherents that place their personal identity into their politics.
The other problem is those of us guilty of that - the framing of our identity on high-brow concepts like ideology - don't want to change. Who wants to revert back to ignorance on how you personally think the world is best ordered?
The rift will only grow until dissolution does happen unless all participants admit that they want to preserve solidarity in society. They will not be able to change themselves, but they can train future generations to not base themselves so heavily in politics such that they do not segregate themselves such. But it would take everyone agreeing on something nobody wants to have happen. So... yeah right.
I realized I was being vague.
Except for biologics, many drugs are not that expensive to manufacture. The cost is in proving they will do what they say they do on the package.
With modern technology, trace ability and all that is really not that expensive for commodities. Returning to the topic, it would be predictable if OPs re-invention of the concept of generic drugs were maybe 1/10th the price of name brand. Oddly enough that's not unusual for generic pharma to be shockingly cheaper than name brand. The real question is why aren't generic overdose drugs incredibly cheap? I would guess profiteering, but who knows. Maybe they're not shelf stable, perhaps extremely temp or UV sensitive?
So, yes, there always is some reason. The pharma company needs to cover the costs to their whole business with the revenues from their whole business, and they'll play whatever games help them do that. The price for a drug does not correspond to the cost to produce (or develop or get approval for) that particular drug, the price corresponds to maximum revenue for that drug.
With all the max revenue from all drugs, they need to cover research for a bunch of drugs that won't work out, marketing, board of directors, and other expensive hires to power the rotating door between regulation and industry, etc.
It would obviously be better if prices paid for long-existing well-known drugs did not mostly go to cover inept big-business shenanigans. "Real competition" would fix this, but the health care industry is fucked up in 10 different ways and we can't agree which direction to go to fix it. (In this case I'd say the problem is that the end-user is not paying for it, so bureaucracy and politics decide how much of which brand to buy, and the result is so bad the end-user would never pay for it, so we're stuck - it's unfixable.)
NB: I have no association with outline.com, nor do I even know who's running this, though if anyone has information on that, I'd like to know.
It is ... staggeringly useful.
Take a look at what companies make these generic drugs. It's not big Pharma at all. It's small companies. Most big pharma give up on a drug once it goes generic.
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.
A lot of drug purchasing things are codified. For example, Medicare is banned from negotiating drug pricing with manufactures. So even though they're buying billions of dollars worth of drugs in bulk, they're literally paying the retail price, which is just whatever the Pharma companies ask for.
In terms of why they're buying the branded version in the first place, not entirely sure what the exact situation is right now. I'm sure someone will write a great article on it in a few years though after all the money has already been siphoned off.
For injected drugs, Medicare pays no more than the average price that private insurers pay. They basically piggy back on the deals. If you look at heavily discounted drugs, Medicare is paying no where close to list price.
For peals, Medicare doesn't negotiate because they buy them. Private insurers adjudicate all claims and they certainly do negotiate drug prices. Those lower prices get passed to consumers who purchase their plans.
And this doesn't even include the 340B discount which is mandatory.
Medicare doesn't negotiate, it creates laws that lower it's drug costs.
Probably doesn't take a psychic to see its because the brand bought the right politicians at the right time.
Where can I read more about this? I've heard the exact opposite.
So yes, it is quite inexpensive.
For a less dire example, when people stop making progress in physical therapy, insurance stops paying for it. Not because there is no chance they will benefit from further therapy, but to control costs.
But the important point is what exactly is making this drug scarce for local authorities. Opiod addicts are not rapidly consuming all the reserves of the drug on earth; companies have just set high prices and left the people to take the burden.
Accepthing that this resource is scarce for governments means inherently agreeing with the price set by the pharmaceutical company - and I don't think that's what we should do at all.
So if they are spending for the branded version something else is going on.
Not a common or planned outcome, but an unfortunate byproduct of nationalized healthcare.
"The government" has no say in life support. The government has given Charlie Gard world class medical treatment. The government has also paid for Charlie Gard to have his own legal representation - independent of his parents - to protect his legal rights.
You might want to learn more about the case because nothing in your comment is true.
Here's the GOSH statement which lays out the facts:
> 7. Charlie’s parents fundamentally believe that they alone have the right to decide what treatment Charlie has and does not have. They do not believe that Great Ormond Street should have had the right to apply to the Court for an independent, objective decision to be made. They do not believe that there is any role for a Judge or a court. They believe that only they can and should speak for Charlie and they have said many times that they feel they have been stripped of their rights as parents.
> 8. GOSH holds and is bound by different principles. A world where only parents speak and decide for children and where children have no separate identity or rights and no court to hear and protect them is far from the world in which GOSH treats its child patients.
> 9. Throughout this court process, Charlie has been represented by his Cafcass Guardian who has visited him in hospital, spoken to Charlie’s parents, nurses and doctors and written reports that ensure that as much as is possible for a desperately unwell baby, Charlies own viewpoint is articulated and given weight. When asked what happens to the role of the Guardian if their belief that only they have the right to decide on Charlie’s treatment is correct, Charlie’s parents answer that he does not need a Guardian because they will speak for him.
> 10. GOSH believes in its core that every patient is his or her own, unique and special person and that it owes a duty of care to each. The hospital’s mission statement is “The child first and always” and the hospital does not treat any child differently or as less of an individual because of the severity of illness or disability or because of infancy. If anything, special care is given to discover and work out with parents what is best for very vulnerable patients who cannot speak for themselves
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 , and a depressing job market , which is also the result of the weak border .
It's likely that some of the addiction problem in the US comes from this irresponsible prescribing.
> 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.
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. The startup just has to handle marketing, distribution, and FDA approvals. Here's a list of makers worldwide. Auto-injectors are available from various suppliers.
This project could be put together by a small team and would get very favorable publicity.
Then, on to replacing the Epi-Pen.
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.
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.
There is really no word that adequately describes how disgusting it is.
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.
It seems obvious this is more a case of regulations mandating the use of brand name Naloxone by a specific company, thus eliminating any free market competition in the prices since only one entity can provide Naloxone to EMTs by law.
And, naturally, the politicians that signed such a law to mandate one singular company provide all of a specific drug probably got sizable benefits from said drug company for doing so.
That should do wonders for R&D investment in the US!!
The US leads in pharma research because it has the best research universities, not because it has private drug companies and no universal healthcare.
Absolutely false. Only 24% of new, innovative drugs come from academia. 76% come from biotech or pharma companies.
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.
There's been little advance in overall mortality rates since the 1920s / 1930s. Much of that comes from public-health measures, including preventive care, water and environmental quality, food quality, risk reductions (e.g., safety standards on electrical and mechanical equipment, automobiles, etc.), through removal and reduction in contaminants (especially of environmental lead in paints and motor-vehicle fuels), an through, apropos this thread, reduction in habitual consumption of drugs, notably alcohol, tobacco, and various narcotics.
What R&D exists has focused to a large extent on chronic conditions (far better treated through lifestyle changes), in specific high-value conditions (think impotence, though that's arguably a quality-of-life issue), and in treatments which offer often only very slight improvements in treatment.
A notable exception would be the introduction of artificial birth control, notably hormonal contraception, "The Pill". In 1960. Fifty-seven years ago.
(And yes, there've been incremental advances since.)
The cancer that killed my good friend nearly 30 years ago? Still effectively untreatable. And the therapies used then were the same as had been used two, and for the most part three, decades earlier.
Directed national policy sometimes is precisely the right tool to bring to bear. C.f., China. Or Friedrich List.
Going to have to disagree with you. Penicillin wasn't discovered until the 1940's. That alone is a huge benefit to mankind.
Add on top of that the number of cancers who before were an immediate death sentence and are now chronic conditions (AML, HER2+ breast cancer, etc.)
Are there still cancers out there we can't treat? Sure, but that doesn't mean we haven't made massive strides in care.
Specificially 200 years of mortality data as compiled by the New York Department of Health & Mental Hygiene:
Note that from 1940 to 1950 the mortality rate actually rose. Much of the improvement since 1970, if you dig into detailed statistics, comes from traditionally underserved communities, most especially black males. There's a lot more to be had for seeing those who get little or no treatment, get more, than in increasing treatment of the most privileged.
Laurie Garrett, author of The Coming Plague: “In all, 86 per cent of the increased life expectancy was due to decreases in infectious diseases. And the bulk of the decline in infectious disease deaths occurred prior to the age of antibiotics. Less than 4 per cent of the total improvement in life expectancy since 1700s can be credited to twentieth-century advances in medical care.”
I'd be quite interested to know what specific outcomes progress in cancer treatment you have in mind.
The bitter thing is that even Trump will boost military budgets, not much change here from the previous regime.
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?
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.
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?
Situation in US is quite close to one described there.
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...
Quantity and dosing of opioids.
Consumers can't buy direct, can they? There's always a middleman. Why not blame pharmacies or better yet, doctors?
They mislead doctors about safe usage of their product.
I think I would put most of the blame on doctors. IIRC, doctors themselves have a pretty bad record with respect to drug abuse and addiction.