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Opioid crisis: Johnson and Johnson hit by landmark ruling (bbc.com)
261 points by onemoresoop 52 days ago | hide | past | web | favorite | 267 comments

These court-cases have two worthy objectives: Correcting this behavior in pharmaceutical co.s in the future and compensating the states & people harmed in the past.

Incentivizing restraint and honest advertising is only possible by punishing executives, personally [1]. Especially those in sales.

And fair compensation is many, many times this number. So I fail to see how this is anything other than an injustice, and fear that it will take the pressure off of other court cases against opioid sellers.

Reading the book "Dreamland" [2] on the opioid crisis changed my life. Even as someone from a part of Ohio hurt by opioids, it's hard to imagine the venality of these people, the callousness of the Mexican drug dealers who swoop in behind them, and the magnitude of suffering their perfect storm concocts.

[1] https://news.ycombinator.com/item?id=19669453 [2] https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

There can be no "honest" advertising of drugs. We need to start banning ads for drugs completely. It probably wouldn't hurt to do the same for alcohol, etc. It's not like people still won't drink or asking for drug X but it stops the patients from demanding it. We've already made some strides by banning the pharma reps from sending super models to doctor's office to flirt and convince them to push drug X but we need to push further.

Instead we should be spending more money at the FDA level. The surgeon general should have the resources that say that condition X, the approved drugs are A, B, C, D and E. You can also do in a phased fashion. You always prescribe A. Only if that fails do you prescribe B, etc. There are lots of treatment plans like this already (usually driven by insurance costs) but these could be built by leading physicians in each specialty. There are providers that have the knowledge of what works and doesn't but we do an awful job of capturing it. Most doctors just know what they learned in school 30 years ago or what they can google. We need better codification of successful treatment options for each condition X.

Am confused by this whole thing, As someone who grew up in Australia I've never seen drug advertising, the closest would be supplements / vitamins that you can buy over the counter

Is the idea that a user sees a drug advertised then goes to their doctor to ask for that specific one? Wouldn't the doctor give you a yay or nay for needing it then perscribing it?

Do doctors in the US let the patient decide whether they should be perscribed the drug despite not agreeing with it?

I know several people who have been diagnosed with, say, fibromyalgia, Crohn’s disease, PCOS, or some other chronic problem and would be happy to know about new, potentially more effective medication. In theory, they’re the primary audience for these commercials.

Additionally, some commercials are targeted at people who have undiagnosed problems, who may not even realize that what they have is unusual. Those commercials start with a list of symptoms, a recommendation to talk with a doctor, and a note that if you do have a particular condition a new drug could potentially help.

And, of course, there are ads for things that people can readily self-diagnose, like erectile dysfunction.

In practice, the ads leave a lot to be desired. Probably the worst marketing campaign I remember was Nexium, which ran ads for several years encouraging people to talk with their doctors about “the purple pill,” without ever mentioning what it could treat. The tag line — “little, purple, different” — didn’t help.

The other issue is that sometimes the new, more-expensive, under-patent medications are less effective than something that already exists. But they don't say that in the ad. Or to doctors when they're wining and dining them.

> Probably the worst marketing campaign I remember was Nexium, which ran ads for several years encouraging people to talk with their doctors about “the purple pill,” without ever mentioning what it could treat. The tag line — “little, purple, different” — didn’t help.

IIRC, this trick lets them avoid the big list of disclaimers and side-effects, as they're not making any medical claims in the ad. Nasty, IMO.

It took a while for me to remember, but let me correct something: Nuprim’s tagline was “little, yellow, different” ( https://youtu.be/kPYACe8I-T8 ). Nexium was just the purple pill with mysterious ads.

Doctors in the US generally won't prescribe medications they deem unnecessary, but there's a few issue that reduce the effectiveness of that. Two big ones are:

1. If an individual sees drug advertisements with particular symptoms they might think that they have them, which would make their concerns sound more probable to doctors when they complain about it.

2. In the US medical malpractice suits are a big issue, so that fear often causes things that might be considered on the edges of unnecessary in most countries to be converted to "maybe, I don't want to get sued if something does happen". This is magnified by point 1.

Take more people thinking they are sick, multiplied by multiple conditions, multiplied by doctors effectively excessively afraid of false negatives in diagnosing, and you have one big public health concern and some big marketing bonuses.

"Doctors in the US generally won't prescribe medications they deem unnecessary"

I'm not sure about this statement. Pharma is literally paying doctors to push their drugs. Obvious conflict of interest no?

E.g. https://www.abcactionnews.com/news/full-circle/pharmaceutica...

The sibling comments cover advertising to the general public, which is allowed in the US. And yes, many of us in the US find it just as strange as those of you in other places.

There is another problem, and I don't know how it is resolved elsewhere. Pharma companies have paid sales rep that travel to medical offices, and push their product directly to doctors. This is ostensibly in the name of educating the MDs, but they hand out free samples. The hope is to convince the MDs that this drug is better than its predecessor.

Free samples is just the start. Big prescribers get cushy dinners, "educational" retreats at resorts, "speaking fees", and the like.

I'm in the US, I see drug commercials all the time, but I don't understand how they work.

Am I just supposed to go to my GP and ask for a drug I saw on TV? Are there really that many drugs so that any decent GP doesn't know most of them?

I think that's exactly how its meant to work. I'm sitting at home, and I have a bad stomach, an advert comes on the TV: "Do you have a bad stomach? Ask your GP about engorgolate today!". So I do. 2% of GPs then end up prescribing it

Ah that makes sense, thanks for writing this out

With liability for deviating from the plans?

Having experienced a vaguely diagnosed condition that the doctor treated with intuition, I hope you don't get put in charge.

Keep in mind that the magnitude of the fine cannot be known ahead of time. These Fight Club-esque arguments that corporate civil liability can not possibly curtail bad corporate conduct ignore the fact that killing people carries an almost unbounded punitive penalty in front of a jury. The confidence interval on the damages is very large, which makes doing things with practically unbounded civil liability actually dangerous for companies, and actually deters behavior which might appear otherwise profitable.

Considering the A) relative minor role that J&J played compared to the other original defendants, B) the relatively small size of the aggrieved population compared to the potential population with a cause of action, and C) the particular law they brought suit under... this is in fact a pretty spectacular result overall for the State.

Really the bigger question is why the State settled with the other defendants for so little. That tells you all you need to know about whether the State thought this verdict was likely, and what they thought the scale of damages might be for the major players, let alone the side-show that was J&J.

> These Fight Club-esque arguments that corporate civil liability can not possibly curtail bad corporate conduct ignore the fact that killing people carries an almost unbounded punitive penalty in front of a jury. The confidence interval on the damages is very large, which makes doing things with practically unbounded civil liability actually dangerous for companies, and actually deters behavior which might appear otherwise profitable.

Your argument ignores the fact that when this "unbounded liability" hits the company, it might bankrupt the company, but that is completely irrelevant to the responsible people, who usually get to keep the fat bonuses they earned and go on to work in another company, doing the same things. A company has, in principle, a strong incentive to prevent this, which is why there are CCOs and compliance departments. But in practice, this too often loses out to the stronger incentive to maximise profits.

The shareholders certainly consider bankruptcy to be relevant. One would think they would find the hiring of "responsible" people who bankrupted their previous company to be relevant also.

I realise this might sound like a circular argument, but: Any fine imposed on a rational company for criminal conduct must be insufficient, because had the fine been sufficient, a rational company would not have engaged in the criminal conduct.

In other words, if a company gets hit with an $X fine for Foo, the options are:

1. The company determined the profit from Foo was greater than $X multiplied by the probability of getting caught.

2. The company's governance meant decision-makers on Foo received bonuses for its profits, but were insulated from the costs/fines, and acted in their personal interests but against the company's interests.

3. The company underestimated $X or the probability of getting caught.

4. The company or its employees were irrational.

And if you're the efficient-market-Homo-economicus type that believes 3 and 4 are impossible, that only leaves 1 and 2 - requiring fines larger than $X irrespective of what $X is or personal executive liability respectively.

Of course, the downside to this argument is the results if you transfer it elsewhere in the justice system; by this logic, every crime should have infinite punishment - but an automatic death penalty for speeding is an absurd result.

Efficient market theory in no way claims that all companies must always act rationally.

And even more so, you can attempt to make a rational decision, and still be wrong.

It’s also often said about the market, that it can remain irrational longer than you can remain solvent.

The parent comment doesn't just say "efficient market". It also explicitly mentions "Homo economicus" and "rational company". A rational company makes rational decisions, pretty much by definition.

The saying that the market can remain irrational longer than you can remain solvent directly contradicts the efficient market hypothesis.

> Of course, the downside to this argument is the results if you transfer it elsewhere in the justice system; by this logic, every crime should have infinite punishment - but an automatic death penalty for speeding is an absurd result.

But, the penalty for a crime isn't set by logic, it's set by legislative process, which prevents the absurd result.

Right, which sadly means it is not bound by any logical structure and will likely be very unbalanced.

Ex, Enron execs went to prison for years, yet no one died due to their actions. Big Pharma knowingly oversells a highly addictive substance that results in people's death....and yet the corporate veil is not pierced (where's the 10+ year prison sentences).

You just need to change the probability of getting caught.

While the number seems small (still much bigger than what Purdue and others ended up paying by settling early instead of dragging it), it's worth noting that it's only in one state. They could potentially all go through the same process in all states, as this was a widespread issue. But even then I agree that it still doesn't come close to the amount of pain and suffering they caused.

I wonder if it's limited to all states. Feels like a door is open for individuals, and perhaps other things like cities, counties, etc. I'm imagining some sort of J&J all-hands-on-deck meeting tommorow.

And yet somehow opioids are still legal.

They've had a Opoid conference in Boston the past few years.


This seems to be an attempt by the states to reign in egregiously bad behavior by these businesses/ doctors that are supposed to be federally regulated (which frankly seemed to be lacking). Opioids things seem addictive enough to warrant some review on if there aren't other pain-killers that can replace them completely perhaps excepting in a few exceptional circumstances.

Opeoids work when used correctly. No one is arguing that they should be banned. Doctors just need to not be lied to so that they don't prescribe highly addictive substances thinking they aren't.

Why would you want to make them illegal? What do you plan to give terminally ill cancer patients or people with extensive burns for example?

Because making a substance illegal has worked so well!

The war against illegal drug makers has had no effect. All you'll do by punishing pharmaceutical companies is have them exit the opiod business, and pray that you don't acquire a very painful condition.

The opioid business is only a subset of the analgesic business. If this forces pharma companies to target their research on non-addictive painkillers, that’s a good thing.

Non-addictive? The elderly commonly receive opioids. They are not addicted to them, only physically dependent. You can get physically dependent on almost all medications, even, say, beta-blockers or proton-pump inhibitors.

There is nothing wrong with opioids, we do not need a replacement. The issue stems from questionable products from the black market. Plus, why should we ban X or look for a replacement of Y just because there are people who consume it recklessly? This hurts everyone, and is a terrible "solution". If anything, we need harm reduction policies. I would rather not deprive people from the legal access of effective painkillers because some reckless people overdosed on them. There will always be reckless people. Always. This is not a reason to hurt innocent and non-reckless people.

Future research is not available now. Pray you don't get an extremely painful condition.

Europe seems to manage this fine. There are plenty of companies manufacturing opioids, and they are widely available for people with severe pain.

But companies are not allowed to advertise them. Same rules as we have for cigarettes and politicians, and it completely bypasses the question of whether a given advert is biased / truthful.

How casually prescription meds are advertised on TV in the US was really shocking to me being from Europe.

Only OTC medications seem to be advertised here in Eastern Europe. This includes NSAIDs. They are more harmful than opioids due to the risk of virtually everything, such as: myocardial infarction, stroke, erectile dysfunction, gastric ulceration/bleeding, kidney failure (incl. hypertension). They also cause raised liver enzymes, and so on.

None of the aforementioned side-effects exist for opioids. The only major concern is constipation (especially in the elderly), nausea, aaaaand euphoria. Yes. That is it. Respiratory depression and other severe adverse effects are not really an issue if you are taking therapeutic doses, especially if taken orally. If you are taking it intravenously, then you are properly under medical supervision anyway. There is a reason for why the elderly usually receive opioids instead of NSAIDs. It is more effective, and it has a better safety profile. The issue is with questionable products with adulterants and unknown purity. Harm reduction policies, and the end on the War on Drugs can improve the situation tremendously. Portugal is a great example of this.



As for addiction: https://global.oup.com/academic/product/addiction-and-choice...

An excellent book, it is worth reading. According to my experiences many people have lots of misconceptions regarding addiction.

Considering nobody can get these drugs unless a physician prescribes them, when are we going to see a wholesale round up of doctors?

So far it’s been a few high profile cases, but obviously the problem runs deeper than that.

And J&J is by no means a major opioid manufacturer. As the article states, their drugs were less than 1% of all prescription opioids.

I think J&J got hit because they have deep pockets.

> And J&J is by no means a major opioid manufacturer

The had the non-hospital fentanyl market cornered for a while. Their patches were only for chronic use by patients already tolerant to opioids.

Even if they had less than 1% of the market, they would have had a much larger proportion of the high-dose market, where mortality risk ramps up.

Doctors already are being rounded up. That's like going after the atreet dealer. Have to go for the head.

You can arrest the dealers all you want, but to actually stop the problem you need to stop the suppliers/cartel.

They are scapegoats. I just read majority of case files - there is not much of a proof that JJ did anything more than what law allowed them to do! Tune as old as Congress itself - you think a corporation acts immorally? Change the damn law! Don’t expect for-profit corporation to have a soul.

Finally - the reasoning here should he similar to gun and a murderer. If guns don’t pull triggers but people do, then similarily here only responsible people should be these that abused said drug, especially when it was manufactured and sold accordingly with laws and doctor’s prescription.

Guns are a public policy aberration in this regard.

Lawn darts killed one kid and got banned. Cars got forced to be safer with seat belts and airbags, with the industry kicking and screaming throughout.

You right and to contextualise this - do gun shops who sold the guns that did the crime make them as guilty when the gun shop followed the law. Case with most (sure some exceptions) Doctors, they prescribe the drugs, the patient abused them or what has transpired is the patient did what the doctor said, just couldn't get off those drugs and that is were doctors may well be foul. Equally they may not have the tools or resources to cater for such instances. After all addiction treatment is often a waiting list a World away for many in that position.

But would banning opioids have more positive than negative - who knows. Hence your gun analogy fits this situation perfectly. Though some would say banning guns would be easier than banning opioids.

Equally most things banned, end up shifting them into criminal distribution and quality. Though I've yet to find a lawn dart dealer, I dare say that somebody somewhere sells them illegally - nature of banning something alas. Hmm, just had a quick look and Amazon has many lawn darts for sale :(.

> do gun shops who sold the guns that did the crime make them as guilty when the gun shop followed the law

That depends. We had a case locally where a shop was repeatedly robbed, made little effort to improve security, and wound up shut down for it.


> As a result, MCSO investigators obtained a court order to close down the business and take control of its inventory, which Baxter described as "hundreds of guns and pallets of ammunition."

> "For more than a decade, the Monroe County Sheriff’s Office has attempted to work with the owner to improve security for his facility, Baxter said.

For clarity: Metal-tipped lawn darts were banned. You can get a foam Nerf one now, sure.

Ah I looked at the UK site: https://www.amazon.co.uk/Unibos-Garden-Outdoor-Family-Tradit...

Thought they were banned in the UK as well, seems not so...yet.

[edit add] https://www.crowndarts.com/ sells them (metal tips) and will ship to the USA and Canada! that was just a quick look, so guarantee more avenues to procure them.

Cars kill 40,000 people every year in the USA. Nothing is done about that number.

> "Cars kill 40,000 people every year in the USA. Nothing is done about that number."

Nothing? Much has been done and continues to be done to make roads and cars safer. US road deaths, per population, have fallen by almost 2/3 since their peak in 1969. By miles travelled, deaths have fallen almost 80% since the 1960s.

This has largely been a result of regulation, including:

- Standardized crash testing

- Compulsory seatbelts

- Compulsory electronic traction/stability control

- Compulsory airbags


Automatic Emergency Braking (AEB) is currently in the process of being adopted, and will be fitted in all new US passenger vehicles by 2022. Further significant improvements from things like lane keeping and self driving technologies can be expected in the coming years/decades.

Things are being done, but the most effective one would be to reduce speeds and number of cars.

Since USA is big distances, 1 has strong opposition, and 2 even stronger.

They could also make the drivers license short time, like 2 years requiring a refresh exam, but that'd be a real pain in the rear.

You could mandate built in breathalyzers, but they would routinly be failing or bypassed... Though it's a good attempt.

Ultimately getting rid of reducing number of unsafe human drivers would be good.

Bypassed? Unlikely. Breathalyzers are all about tamper-detection. If you know of a way of bypassing one, contact a lawyer. Somebody will pay you boatloads of money as an expert witness.

> Cars got forced to be safer with seat belts and airbags, with the industry kicking and screaming throughout

Where can I read more about this?

Seat belts: https://www.pewtrusts.org/~/media/assets/2011/03/industry-cl...

> Automakers objected, contending that manufacturing costs would rise, seat belts would imply increased accident rates and safety wasn’t a selling point with customers.

Decades later, they did the same with airbags, ironically trying to get out of it by pushing mandatory buckle-up laws to shift responsibility from the industry to consumers.


He's exaggerating.

Car companies want to sell cars and therefore they want to minimize the overhead spent on regulatory compliance. It's really easy to sit here in 2019 and clutch your pearls about the evil car companies not wanting air bags in everything but the reality is that those car companies were catering to consumers (or at least a fairly accurate approximation of consumers). Consumers regarded airbags and seat-belts as minor incremental safety improvements in their day (the way we would think about something like blind spot detection today) and generally cared more about price than they did about the presence of those specific features and would gladly forgo airbags in exchange for several hundred dollars of the purchase price.

1st gen airbags also have a well deserved reputation for turning accidents you could have walked away from with bruises into a trip to the hospital so many people actively didn't want them.

Edit: Yes, I'm totally wrong and everybody in 1965 was tripping over themselves to buy a new car specifically for the seat-belts and everyone in 1985 could not get enough airbags and the car companies totally misread what consumers wanted. <eyeroll/>

1. Everyone should read Dreamland. Even if you think you know the Opioid story, you don't know half of it. And completely aside from that, it's really well written.

2. One thing I took away from Dreamland was that there wasn't one factor to blame. Instead it was 4-6 separate factors that came together in a nightmarish perfect storm vortex to create this crisis.

Which means the pharmaceutical companies have plenty of blame here, but still only 20-30% of the total.

4-6 sounds like it could be summarized without reading an entire book. :)

Sure, but where is the fun in that :) Also, I don't think I can do it justice from memory.

Sorry, this is nothing more than a shake down. There is no demonstrative connection between prescription use of opioids and non medical use. prescription use has come down only to see abuse go up.

since it has become so much more difficult to divert prescriptions those seeking them have resorted to fentanyl and heroin which is not the fault of J&J or any other company.

The real cause it the drug war that too many nations practice. this has led the over dose issues we have seen. it is not legal sellers of drugs or their advertising. quit buying into this sham sold by politicians and the media, the reason it exist is to simply redirect blame and shake down the companies by relying on ignorance

> Incentivizing restraint and honest advertising is only possible by punishing executives, personally [1].

Catch it early, give warnings and fines before you have a national health crisis in your hands.

Just started listening to Dreamland, already hooked, thanks for the recommendation!

It’s good that J&J are being fined for false advertising.

What I do not feel is completely justified in this story is that the blame is put solely on the pharmaceutical.

Yes they played their part. They most likely knew how addicting their drug is from day 1 during their clinical trials.

Why is direct marketing to consumers in the USA even allowed?

Why are pharmaceutical companies still allowed to wine and dine doctors to persuade them to prescribe their drugs?

What about the other players?

Why do doctors even prescribe these heavy drugs, despite knowing that there are serious addictions risks? I doubt doctors would prescribe heroin if someone has pain.

Why do patients insist on getting the heavy drugs to numb pain instead of taking or accepting doctors advice and take a less strong pain killer and accept some pain.

I think we should have a good look at how the healthcare system is organized and scrutinize all players.

American experience with painkillers in Germany after surgery


Top comment on that video sums things up really well:

> Yeah, pain has a purpose. It stops you from doing stuff your body isn't ready yet. So making it bearable, but still tangibly is making you able to do stuff (like this video), but stops you from running down the road and injuring yourself again / lengthening the time to recovery. (Yeah, I'm a fan of that approach)

Also, this isn't just how it works in Germany - this applies to most non-US countries I'd say.

Insightful and true.

In America it's practically taboo to tell someone they don't need a thing and the tolerance for any discomfort is extremely low.

As it should be in my opinion - admittedly colored by own experiences and phobias. Hospitalization is a leading cause of PTSD. That "discomfort" can leave people pretty traumatized and messed -all because of other's puritan desires.

If you washed someone's wounds in salt water when there were alternatives it would be rightfully regarded as sadism - why the tolerance for unnecessary pain and suffering otherwise?

There is a middle ground between proper pain management and handing out scripts of Vicodin for take-home for the slightest reason.

Because our legislative system allows it and it happens to be the most cost effective way to perpetuate massive increases for shareholders.

No sarcasm and not in agreement personally, yet if I had nine 0’s before the decimal in my bank account I would play the hand the deals me the best, despite what the system needs, as long as it’s within legal means.

If we change the legal means it changes everything you listed as a problem.

I guess you would also spend a fair chunk on keeping the legal means to your liking... which is also legal. Win-win!

The best ethics money can buy, in an environment in which greed outbids all other ethical considerations.

US corporate morality is utterly broken. It's essentially sociopathy with dividends.

Sued for $17 Billion, ordered to pay 1/34th of that. In State court, by The State.

I don't know if that counts as a "landmark ruling", but maybe it will. We'll have to wait and see if anyone else crashes up on the rocks.

It’s basically the case that there are no effective punishments for corporate entities. The argument has been made elsewhere for a corporate ‘death penalty’, an actual destruction of value, brand and IP and wholesale confiscation of assets. Obviously implementation would be an issue, but imagine if there was even a possibility J&J could be sentenced to ‘corp-death’ for its role in the opioid crisis. The share price wouldn’t be going up, that’s for sure.

Otherwise I think we’ll just keep being surprised by corporate amorality, over and over again.

outright destroying a company would inflict a lot of collateral damage. some rich people would see a fraction of their portfolio go to zero, which would certainly sting, but many more middle-class workers would lose their only job.

the IP part may have some value though. it would be interesting to see what would happen if every successful judgment resulted in all relevant patents going to the public domain. play funny business with a certain pharmaceutical and it becomes a generic ahead of schedule.

I suspect "make an example out of 'em" style punishments are just not very effective. if every few years a big company gets a back-breaking fine, it would make for some good news stories, but it would also be pretty easy to design a portfolio resilient against these outcomes.

if I could wave a magic wand and set up the system exactly how I wanted, I would implement pretty much the opposite. moderate fines (maybe 1.5-2x the illicit gains) with a very high rate of conviction. raise the salary of prosecutors and investigators until you get people who can make it happen. I believe this would not only be more effective, but much more fair.

> many more middle-class workers would lose their only job.

So it'd be very much like an ordinary death penalty, then, with dependents left behind in a worse position. Well, fortunately it would also mean you shouldn't work for a bad company the same way you shouldn't assist criminals generally, in that you can share in the blame.

Fire the board, upper management, and ceo... confiscate stock from all shareholders and do an ipo with it. install new management from the industry. Ban existing management from serving in that capacity for the rest of their lives. Now let's see who f*'s up.

Think of the poor workers is such a poor argument as any worker can be laid off or fired at a moment's notice.

Yes you make a good point about collateral damage affecting workers. Perhaps there could be a ‘death row’ lasting 5 years so workers can make a soft-landing.

Fines aren’t going to work, I think that is pretty clear, as many others have said. They are very much an instrument of ‘make an example of ‘em’ aren’t they?

I bet that when a large bank thinks about their ‘worst case scenario’, they are thinking about Lehman Brothers, not a mega fine. Being a senior executive in a company that got corp-deathed is surely career ending.

Collateral damage is fine, it helps deter others from doing business with immoral businesses doing wrong.

Imprisoning a criminal causes a lot of collateral damage to their family, yet we do it all the time.

The problem is that courts are restricted by the country they reside in, while corporations can be multinational. After a certain point (say, 1 billion valuation), companies can pick and choose what countries to do business in.

If a corporate "death penalty" becomes a thing in the USA, large, profitable companies will shift their main business overseas to other, less risky countries. They may still sell their products to US consumers, but it becomes very difficult for the US courts to shut down a company that isn't officially in the US. The best they can do is forbid that company from doing business in the US.

That’s what encourages companies to pull stuff like this.

They know that at worst they’ll have a small hit on quarterly profits, but stocks won’t change and nothing serious will happen because nobody wants to hurt those poor job creators.

the point is to create a negative expected value with low variance for illegal behavior. if the expected value is positive, it is still rational to employ illegal tactics. if the expected value is negative but the variance is high (ie good chance of getting away with it), people are going to be tempted to roll the dice anyway. once you set fines to a level where EV is negative, it should be much more effective to increase the rate of conviction than to continue jacking up the penalties.

think about speeding. a speeding ticket is a meaningful amount of money to most people (usually well over $100 in the us); in some states (eg Virginia) speeding turns into a criminal offense if you are going 20+ over. and yet, most people still speed sometimes and a sizeable chunk of drivers speed almost all the time. on the other hand, speed camera tickets give a $40-50 fine but they get you every time you go 12+ over the limit as you pass the camera. almost no one exceeds the limit by more than 10mph in photo enforced zones. the fine is much lower, but the consistent enforcement makes it much more effective.

I'd add some jail time for the corporate leadership, including board members.

Just confiscate the shareholders' ownership by court ruling. The company keeps running as it did before.

Still collateral damage in the form of private savings being wiped out, but you can bet this won't happen more than once before the rest of the capitalist class wises up.

Jail time for board members and executives is probably also effective.

How about going after the executives? They've long used responsibility and even personal liability as justification for their high salaries yet continually escape punishment.

>Obviously implementation would be an issue

Civil forfeiture seems like no big deal, I dunno what the issue would be here.

There does not need to be a special case. Just higher penalties and fines.

If you sent a normally functioning company into a forced bankruptcy, another company will be more than willing to pick up the assets, manufacturing, and jobs while wiping out the top management and investors.

And wiping out the top management and investors is exactly the incentive you need so companies seek to avoid forced bankruptcy.

Jobs, capital assets, and technology are preserved. I fail to see how this is a disadvantage. Volkswagon should have been hit with a $1 trillion dollar fine, and for every shareholder and executive to be completely wiped out.

I assume that was bsder's point.

And that’s a good thing. The company that picks it up wouldn’t want the same thing to happen to itself so it would stop the bad behavior.


Nobody suggested nationalization.

Driving away or destroying businesses that harm the country is the goal, not a consequence that only you realize.

Asserting that doing so results in net capital loss is going out on a limb at best, safe havens have historically led to business flourishing.

The US isn't comparable to a powerless nation, there's zero risk of Johnson & Johnson thugs beating police in the streets.

Awfully convenient that your logic ended up justifying inaction.

Or some bitcoin under the bed

Why does somebody always take this to the extreme. Whenever there's a thread where people want to see corporations be made accountable for their actions it's shunned as socialism, nationalization, communism, etc. To me this just sounds like the news has successfully brainwashed folks into associating corporate accountability/responsibility with alt govs so that it's easier to get people on their side or something, idk.

The whole point of corporate ethics is to benefit from collective effort while pretending it's about individual talent and heroism - the kind of talent and heroism that is so unusual, so special, so dynamic, so productive, and so, well, rich it absolutely deserves a free pass from the ethical constraints that apply to lesser individuals.

It's pure special pleading, but Wall St couldn't operate without it.

Why wouldn't they be able to operate without it? I see no reason why that couldn't function without paying their dues.

How do you nationalize a multinational company?

You nationalize any domestic assets

How about a complete abolition of capital?

You always sue for more than you think you deserve to win, that's just how that works. Why lowball yourself?

The real indicator is share-price being up 2% after the ruling. The investors think J&J got off easy.

They did get off easy. This is about 3% of J&J's annual profit. I guarantee you they are ordering hookers, blow, and cases of Dom Pérignon in the J&J boardroom after this.

It's also only for cases in Oklahoma. Oklahoma has under 4 million people, and the US has over 300 million, so it's about 1.2% of the US population.

If you extrapolate and assume similar settlements in 49 other states, that would come out to 250% of their annual profits. Which may not happen, but the point is that 3% should be viewed in some kind of perspective.

> This is about 3% of J&J's annual profit

What % of profits made by J&J in Oklahoma? Presumably the risk is that other states could decide that this could be a good way to get income too?

Opioids are a very small proportion of J&J’s sales. I wouldn’t calculate it based on their entire portfolio of cancer drugs.

> The investors think J&J got off easy.

Easy relative to the (amount weighted?) balance of probability. The stock price doesn't speak to whether they got off easy or hard relative to what's just.

Certainty alone is worth a bump in share price.

But it has to override the impact of the ruling. I'm pretty sure if they'd been fined the full $17 billion that the share price would have declined quite a bit.

Only if J&J gets no further judgments after this one.

The market had already priced in all the future judgments, it's not like these lawsuits are a secret.

> The market had already priced in all the future judgments

The market has already priced in what it anticipates the future judgements will be (but that expectation may be wrong; for instance it could be $0—in which case GPs only if there are no future judgements is literally correct—but there may turn out to be substantial future judgements.)

If the market had already priced in all future events, the price would never move.

> If the market had already priced in all future events, the price would never move.

I don't think that holds. Let's say we all knew everything about the future, and we all use it to instantaneously and perfectly compute The Right Price for every security. We all know that this stock will pay out a total of $X in dividends over the next Y years before the company goes out of business, and what all the future prices will be. Time moves forward, we pass a dividend payment. I think the price of the stock has to fall?

But since you know everything about the future, you already know that the company will pay future dividends. That would be instantaneously priced in to your perfect information scenario.

The dividend payment isn't unexpected - we all knew it would happen on that day. But since it's in the past now instead of the future, the stock is going to be paying out ($X - $d) instead of $X in what remains of the company's life.

There could be follow-up judgments that don't behave as the market would expect, and move the price. The opioid epidemic has a long and complex history. I'm not too sure this is the legal end of it for them.

$17 billion is what OK said it would cost to manage the crisis over the next 20-30 years.

J&J was only 1% of the market for these types of drugs, and also this;

> Oklahoma wanted J&J to help it address the epidemic for the next 30 years by funding addiction treatment and prevention programs.

> Balkman said in his written ruling that the award covered only one year of addressing the crisis because Oklahoma did not demonstrate the time and costs needed beyond that.

So it’s worth considering the amount that J&J was fined in that context.

Usually if a defendant loses but the damage award is a tenth or less of the ask, the defendant considers it something of a win. A couple times I've seen defendants who were sued for, say, $60M, get hit for $6M, and call it a good outcome. The calculus might be different at this scale, but probably not by much. The significance of this verdict has more to do with it being a bellwether trial with an encouraging outcome for the plaintiffs. Then again, it was a bench trial, where you usually expect verdicts to be smaller than with juries.

I had the same thought. I'm not an American, and not a lawyer, but doesn't the ruling in this case count as precedent that will allow others states to pursue lawsuits against them?

This was our lowest level of state court. I don't think it even counts as precedent in other courts in Oklahoma, though it can probably be viewed as persuasive. This ruling has no bearing in other states.

It does give a good roadmap for how to sue and win against J&J though.

EDIT: There might be a way to use this case as a basis for collateral estoppel, meaning that J&J would have a harder time disputing the liability (since they were decided to be liable in this case) but I'm not sure if that applies across state lines.

> There might be a way to use this case as a basis for collateral estoppel, meaning that J&J would have a harder time disputing the liability (since they were decided to be liable in this case) but I'm not sure if that applies across state lines.

I've never heard of someone making this argument successfully.

The "precedent" at issue is not about the ruling as a matter of common law but as an indicator of verdicts to come.

"precedent" is a term of art in law. It strictly means another court HAS to make the same ruling given the same/similar facts.

This particular case has not set such a precedent.

> I'm not an American, and not a lawyer, but doesn't the ruling in this case count as precedent that will allow others states to pursue lawsuits against them?

No, because:

(1) trial (as opposed to appellate) court rulings have almost no weight as precedent, and

(2) state court rulings on state law issues have almost no weight as precedent for courts in other states applying different state laws, and

(3) precedent doesn't allow or bar states or other litigants from pursuing cases, it just impacts the expected results.

The landmark is how little they paid.

IMO, the fine is appropriate because J&J was an inappropriate scapegoat in the first place — the damage they did is nothing compared to Purdue, for example.

Purdue and Teva were part of the same suit, and they both settled.

J&J isn't being scapegoated, they just decided to roll the dice and take it to trial.

If it's true that "the damage they did is nothing compared to Purdue, for example", then doesn't this suggest that Purdue was given an outrageously lenient settlement? Why aren't we all up in arms protesting that?

IANAL and don't know the case, but I suspect the correct strategy is to sue for as much as you can reasonably justify. If you can spin a story that outlines how you could have suffered 17 billion in damages, it wouldn't make sense to sue for anything less if you have the resources to file the suit. Or would it?

A friend recently had a minor procedure (he took a couple of ibuprofens after and that was all). But the doctor gave him about a dozen of narcotic pills that eventually ended up in the trash.

Another friend had a persistent cough getting over a cold and was given oxycodone in liquid form "to help sleep." She never took it.

Both of these were at major facilities in the Bay Area. Thinking at least some of the blame falls on the docs.

The cough syrup was probably codeine, which is a very effective cough suppressant.

In the past I had a persistent cough bad enough that it keep me up several nights. Mucinex would do nothing. Vix did nothing. Eventually each coughing spell was causing head splitting pain. Codeine was a crucial treatment option.

I have a feeling getting hooked on codeine cough syrup would be extremely difficult given a single bottle with perhaps 10 doses.

It should not be inappropriate to prescribe codeine cough syrup to an adult who actually has a serious persistent cough.

I'd like to blame the docs but I am always reminded of saying from my parents: "Only you can be your own advocate for your ____".

No, you can blame the docs. You can't be your own medical advocate because you can't just decide to go to medical school. You pay a doctor to have your best interests in mind and give you advice. You have no way of knowing whether the advice is good.

When the doctor is misinformed, or their incentive is to please pharmaceutical companies, your trust is betrayed without any warning.

My friend is a psychiatrist and says that any night of any week, she can go out and get a $100+ meal free from pharma reps. Organized meals have speakers that are marketing drugs to them. Informal meals just have the sales rep saying the same talking points.

If anyone thinks she or her coworkers can make unbiased decisions about what the describe, they're very naive.

I'd imagine that's the same phenomenon that gets antibiotics prescribed for viral colds. You're a lot less likely to get a 3am page from a patient demanding "I'm not getting better yet! Do something!"

Doctors prescibing antibiotics for viral colds should have their licenses taken away, it's pretty simple.

Countries where antibiotics can be had over the counter for people with viral colds should be shut out of international trade.

Countries where giving antibiotics to healthy livestock is allowed should be shut out of international trade.

These aren't even controversial measures.

I had wisdom teeth removed and never even filled my Vicodin prescription- shredded it. I was told by a family member that I should have filled it since, "It's good to have that on hand." No thanks.

This attitude toward this stuff makes me think that most just don't realize how bad it is. Most people mean well but don't know any better.

> ended up in the trash

Disposing medicines like this is irresponsible. You should always use a drug disposal service. Local sheriffs can take narcotics off your hands.


I often get prescribed pain relievers, because I tell my symptoms to doctors, so that they can diagnose the main illness better, not because I need a medication for the pain. . I have started to explicitly also mention, that I'd like to manage my pain without medication.

> ibuprofens after and that was all

Recent studies are pointing to this being a better pain solution than opioids.

Pray that you'll never have a severely abscessed tooth.


I'm not saying opioids should go away, but they are not always the best option.

There's no way to know a priori what the "best option" is, in any situation. Arguably it's whatever works. And that's something everyone should have the right to determine. With consultation, as they see fit. But otherwise, it's not for anyone else to say.

Medicine is one of those weird cases where "the customer is always right" doesn't hold up.

In corporate medicine, the patient is not the customer - the patient is the livestock that's being farmed.

The danger of all these opioid rulings is that it might get a lot more difficult for people who suffer from pain that needs opioids to actually get them. After seeing these rulings, what company in its right mind would actually manufacture opioid pills any more? Doctors are going to be very, very, conservative about how they prescribe.

Good. Just look at the volume of pills prescribed and you can see that overprescription is at the root of the problem.


You say good until you have a very real pain disorder and getting the medication that makes life bearable and not want to kill yourself becomes a part time job.

As someone that understands pain only too well, I agree.

I suffer from chronic pain and am prescribed (weak) opioids to help manage that pain. I've tried numerous other medications, but the ones I'm on are the only ones I can tolerate and that actually help at all.

I am responsible, only ever taking them as prescribed. Even with some pain management, life is not easy; with none, it is unbearable - I honestly don't know if I'd still be here without any pain management.

Opioids are plainly being over-prescribed in the US, but we have to be really careful not to withdraw them from those that actually need them.

Out of curiousity, have you ever tried cannabis?

I wonder how it compares when some truly needs pain treatment.

I'm in the UK, so can't legally access "raw" cannabis.

But, I recently got a prescription for Sativex, which is essentially a very expensive cannabis tincture.

My biggest issue with it is that you end up swallowing most of it - and eating cannabis is very different to smoking, as THC is metabolised to 11-OH-THC, which is much more psychoactive. I found it made me really anxious, which is not nice at all!

I've been experimenting with it, trying to ensure I don't swallow any of it. It does help with the pain, but only a little... and it impairs me in the process - it's really important to me that I can still function cognitively.

I also find the way it helps is different than opioids - it's kind of similar to alcohol, in that it's more like a distraction from the pain, whereas opioids actually negate some of the pain.

There is a lot of good evidence for cannabis helping with neuropathic pain, so I'd encourage others to try it if they legally and financially can.

"make life bearable" -> bad choice of words as that would justify junkies shooting up heroin too

Easy for you to say when you don't live with chronic pain.

Morphine makes life bearable and allows me to work and contribute to society.

I would otherwise be in bed all day from the chronic pain.

Having chronic pain is like being under water. And pain relief is like coming up for air.

These laws have made it so I can literally only get a maximum of 90mg of morphine daily when I really need 200mg, what I used to be on.

It's terrible that those of us who actually use these drugs responsible are being screwed over, and average joes like yourself demonize opioids when they have medicinal value.

I will agree that synthetics are bad and I specifically ask for morphine versus Oxycodone or Hydrocodone. The synthetics are pretty much just a way to make more money and they are way more addictive.

You had me until the end. There is nothing about the synthetic opioids that make them more addictive.

Friends of my that are ex-addicts say Oxycodone is the shizzle.

Also Oxycontin was marketed as having a 12 hour dosing schedule. But the half life is about 2/3rds if that. That sets up a yoyo dosing schedule that's known to be highly addictive.

Purdue knew this, too - as early as the clinical trials!


> Purdue’s researchers, meanwhile, were conducting at least a half dozen clinical trials, according to the company’s FDA application. In study after study, many patients given OxyContin every 12 hours would ask for more medication before their next scheduled dose.

> For example, in one study of 164 cancer patients, one third of those given OxyContin dropped out because they found the treatment “ineffective,” according to an FDA analysis of the study. Researchers then changed the rules of the study to allow patients to take supplemental painkillers, known as “rescue medication,” in between 12-hour doses of OxyContin.

For someone who knows how the drug industry works, that LA Times article is pretty ridiculous.

The every 12 hour dosing was approved by the FDA which looked at the clinical trial data and approved 12 hour dosing.

After it was launched, the company kept promoting 12 hours because if they didn't, the FDA would sanction them. As a drug manufacture you can't just change the FDA approved dosing wily nilly.

And if you're Purdue, you have every incentive to lower the dosing interval because you can charge more. You make more money with every 8 hour dosing (which is still better than most drugs) than every 12 hours.

> And if you're Purdue, you have every incentive to lower the dosing interval because you can charge more. You make more money with every 8 hour dosing (which is still better than most drugs) than every 12 hours.

The article addresses this.

> Company officials worried that if OxyContin wasn’t seen as a 12-hour drug, insurance companies and hospitals would balk at paying hundreds of dollars a bottle. Some already were.

> If a doctor complained that OxyContin didn’t last, Purdue reps were to recommend increasing the strength of the dose rather than the frequency. There is no ceiling on the amount of OxyContin a patient can be prescribed, sales reps were to remind doctors, according to the presentation and other training materials.

Well, Purdue's hands are tied in terms other dosing. They have state the 12 hours that's in the FDA approved label.

In terms of price, they were quite expensive, but I've never met an insurer who is happy with the price of a drug.

Their hands were certainly not tied. They could have simply withdrawn the drug or petitioned the FDA to revise the dosing schedule.

They didn't do that because they decided money was more important than hundreds of thousands of peoples lives.

That seems like a big stretch.

The FDA approves their dosing schedule after a careful examination of the clinical trial data. They are required to stick to 12 hour dosing. Based on anecdotal reports, you're suggesting they withdrawal the drug from the market?

> you have every incentive to lower the dosing interval because you can charge more

If they lowered the dosing schedule they'd be competing directly with generic opiates.

Generic opioids are doses at 4 h. Even if they dropped OxyContin to 8 hrs, they have double the duration. More than enough to compete and win.

First of all, I've taken them, so I know anecdotally.

Secondly, the bond strength is what makes them much more addictive. It's why Heroin is more addictive than Morphine. Why Fentanyl is more addictive than Heroin. And so on. Weaker drugs, one may need to take higher mg doses but tend to be less addictive.

Not 100% true, the extended release version of Oxycontin was actually more addictive than other variants.

OxyContin became popular because it was commonly prescribed and you could crush up the pills to get the entire dose at once, instead of over 8 hours.

About 8% of Americans (19.6 million people)[1] have high-impact chronic pain (chronic pain that limited life or work activities on most days or every day during the past 6 months), and the 76 billion pills figure spans six years. That figure accounts for 3/4 of total opioid pill shipments (it's oxycodone and hydrocodone only)[2], so the total shipped is around 101.3bn. So, if we assume chronic pain suffers sufferers need 4 pills a day[3], that gives us:

19.6 million people * 4 pills/person/day * 6 years ~= 172bn pills

Given that figure is significantly _more_ than the actual number prescribed, it doesn't strike me as overprescripton. Yes, there are issues with diversion, and the number of pain sufferers may be inflated by people faking pain (to get opioids or malingering for other reasons), but the volume of pills prescribed alone don't suggest there is a major issue.

Furthermore, 11.6 million 'true' high-impact chronic pain sufferers would still get you to the shipped figure[4], and I find it hard to believe that 8 million people are faking pain, especially as the data is gathered from a survey, rather than a situation that may result in opioids or any other non-clinical benefit.

[1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm

[2] https://www.washingtonpost.com/graphics/2019/investigations/...

[3] I (non-US) am on (up to) 8 opioid-containing pills per day, so taking 4 as a rough average doesn't seem unreasonable

[4] 11.6 million people * 4 pills/person/day * 6 years ~= 101bn pills

you are assuming that all sufferers of high-impact chronic pain need opioids. for some types of pain ibuprofen/paracetomol/etc is way mroe effective

This is a good point.

For inflammation-type pain, paracetamol or NSAIDs (Nonsteroidal anti-inflammatory drugs) can be remarkably effective.

For neuropathic pain, gabapentoids are likely a better first-line treatment, with SNRIs (Serotonin–norepinephrine reuptake inhibitors) or TCAs (tricyclics) as second-line.

There are of course many people for whom opioids are appropriate, but they should only be used where less potentially harmful medications have been tried first. My understanding of the situation in the US is that they are often prescribed as 1st-line treatments, or inappropriately after surgeries where NSAIDs would be more appropriate.

I did, but I felt that by picking a number of pills per day towards the lower end of the scale (4 - hydrocodone can be up to 12[1], oxycodone 5 times a day[2], and codeine 6-8[3]), and by showing that the calculated figure is significantly more than the actual figure (thus still reaching the actual figure even if a significant number of patients are better suited to non-opioid care), it accounts for that somewhat.

I also wasn't attempting to do a rigorous accounting of all prescribed pills, but show that the 76bn figure _alone_ doesn't immediately point to overprescribing. It's a big number, but in context it doesn't seem out of the question. Furthermore, it doesn't rule out overprescribing, but that would require a more in-depth analysis than just looking that at the headline figure.

[1] "the dose is usually not more than 12 tablets per day" - https://www.mayoclinic.org/drugs-supplements/hydrocodone-and...

[2] "Roxicodone: Adults—10 to 30 milligrams (mg) every 4 hours as needed." https://www.mayoclinic.org/drugs-supplements/oxycodone-oral-...

[3] "At first, 15 to 60 milligrams (mg) every 4 hours as needed[...] the dose is usually not more than 360 mg per day." At the maximum daily dose, that puts you at 6 60mg pils/day, and in my non-US experience, the lower strength pills are often used to increase the dose of the combining drug (acetaminophen/paracetamol) - I am on 90mg/day, but it is still 8 pills https://www.mayoclinic.org/drugs-supplements/codeine-oral-ro...

Don’t let the media scare you with big numbers. 76B doses is about a 6 month script for every patient with chronic pain in the US.

That's just doing the same number fuckery in the other direction.

76B doses being a six month supply would mean 416M doses a day for America's 50M people with chronic pain (not all of which have pain conditions suited to opiate treatment, incidentally). Almost ten doses a day for each and every one one of them?

The 76B is over 6 years.

And it's by dosage units, so if your doctor says "take two every four hours", you'll be consuming 12 each day.

The number isn't that shocking.

I'm contesting the "76B doses is about a 6 month script for every patient with chronic pain in the US" statement, as well as the idea that every chronic pain patient needs opiate treatment.

> if your doctor says "take two every four hours"

That'd be weird for an Q12H drug, wouldn't it?

This is all opioids prescriptions. 12 hour dosing is a small fraction of that. Most opioids are dosed every 4 hours.

Not every patient needs opioids.

The real problem isn't in the manufacture of opioid pills, it is in false advertising around them.

In particular don't advertise as 2x a day with the advice to increase the prescription if there are withdrawal effects, when the correct prescription is to go to 3x a day and do not increase the dosage. The false advertising is a recipe to increase sales but create a serious drug addiction that will need to be supplemented somehow.

Turns out doctors have better opioid options today but not all of them take advantage of such an option.


>In August of 2010, Purdue Pharma replaced old OxyContin with a new, anti-abuse version of OxyContin. The new version was just as good at reducing pain as the old but it was more difficult to turn it into an injectable to produce a high. If physicians are altruists who balance treating their patient’s pain against their fear of patient addiction and downstream abuse then they should increase their prescriptions of new Oxy. From the point of view of health, the new Oxy is simply a better drug and with less abuse to worry about altruistic physicians should be more willing on the margin to prescribe Oxy to reduce pain. So what happened? Prescriptions for Oxy fell immediately and dramatically when the better version was released.

Sounds more like patients stopped asking for it by name and/or patients just switched to the black market entirely.

In my non-US jurisdiction, the big insurers used it as an opportunity to say: "Switch to something that seems less addictive than oxycodone entirely instead of switching them to some other oxycodone"

How does the prescription rate in the US compare to other countries? When growing up in Germany i never heard of opioids being prescribed besides maybe cancer patients. But in the US I was always given plenty of opioids for even pretty small problems. A while ago I had to get really serious with my girlfriend after only two weeks of them because she already couldn’t handle the withdrawal.

I've seen many times that doctors in the US are all too happy to prescribe medication to deal with pain but give exceedingly little instruction or support for how to go off these addictive medications.

~15 years ago they handed out prescriptions pretty easily. Most reputable places are pretty stingy with them now though. Last time I was in for pain they gave me a prescription for ibuprofen.

> it might get a lot more difficult for people who suffer from pain that needs opioids to actually get them

I've had severe chronic pain for over a decade from an auto accident. It's well documented as are the injuries. I've never been offered opioids and have been told by multiple doctors that surgery would be pointless and counterproductive. If I was offered opioids I'd turn them down since I understand the potential for abuse.

However it would have been nice to be asked. Fact is no doctor I've seen will prescribe them to any other than people with stage 4 cancer, people actually in the hospital following surgery, or the like.

Yet every two bit junkie creep and criminal in the area has an unending forever supply that originated in legal sources made by reputable pharma corps and sold by honest pharmacists having received a legit script.

How is this? Pain clinics. Pain clinics are prescribing these things. Not regular doctors who for over a decade have been scared to hell of prescribing them no matter how bad off a legit patient is.

So will it "get a lot more difficult for people who suffer from pain that needs opioids to actually get them"? I say no, because those people aren't getting them right now anyone. Excepting cancer, people in the hospital, and some other specific cases.

But it's OK. Because those of us with severe incurable chronic pain need to just learn to live with it. Opioids provide short term cures, rapidly develop tolerance and addiction. They are not good choices for chronic pain. Nor is anything else apparently. The field of medicine is in the medieval period, as far as how most people experience it. Propaganda about genetic cures and Star Trek like technology is fiction, mostly pushed by lying companies and speculators.

Most cancers your choice is to die without treatment since your insurance if you have it isn't going to pay for much and you'll go bankrupt on the copays. Then you die same date as you would have otherwise, probably earlier because the therapy weakens you and makes you sick and miserable. You'll also experience utter misery and horror during your last few months. Choosing to reject modern medical miracles is the best choice for most people with serious problems. Or go after stuff that at least does no physical harm, like alternative treatments, faith healing, or other quakery that's at least cheaper and less miserable. Yet the medical field peddles false hope to the overwhelming majority of people with this problem. Same goes for chronic pain. Surgery will make you worse and pills will ruin your health and may turn you into a criminal addict. Mountebanks selling such false hope really are dealers in misery and horror.

Hmm... this is contrary to my experience (US). For every single thing that was a surgery (including tooth extractions) in the past decade, I got a shitload of opioid painkillers just by default. At least 30 pills for each intervention.

I believe I was lucky because after the first surgery I had, the doctor gave me the prescription, but off the record told me that he's doing that only because of hospital protocol and I should not take the pills. He told me to my face to not fill the prescription. Because of that (which was my first run-in with pain management) I never touched opioids. In my experience, the worst offenders have been the dentists. Now I do believe there are legitimate uses for this type of medication but honestly prescribing me 20-30 vicodins for a tooth extraction is a bit overkill.

Your experience is contrary to mine in the US. I have never been given it offered more than two weeks worth for the various surgeries and injuries I have had, and it has always been hydrocodone (which I found to be useless and so stopped taking).

> hydrocodone (which I found to be useless

If you're caucasian, you might be in the 5-10% of people that lack the genes (CYP 2D6 liver enzyme) to metabolize it into something that works well.

Not just pain clinics. I went to an ortho for a bad shoulder. The doc offered them to me without asking. Granted, I did mention I can't take NSAIDs due to a bad stomach, but the pain is nowhere near the level that I'd require opioids. This happened about 2 months ago, so it's still easy to get them.

Truth be told, poppies are easy to grow. If I really wanted opioids I'd just grow them again. Yeah, it's not Oxy, but it does the job.

> If I really wanted opioids I'd just grow [poppies] again.

Did you use your poppies to make laudanum? That seems the most straightforward. If you did, was it addictive at all? Side effects, problems? Did you develop tolerance?

Nah, just mixed the latex with baby aspirin and chased the dragon. I got to find out who my opiate addicted friends were when I did that, because they kept asking me about my garden for years after sharing the results with them. I thought it was OK, not amazing, but it definitely worked. I grew them accidentally after trying to compost some unused poppy seeds I bought at the grocery store.

> Doctors are going to be very, very, conservative about how they prescribe.

Conservatively is how most strong opioids should be presrcribed. The general rule is that they should not be prescribed for chronic non-cancer pain.

This is literally the argument J&J made as their defense. It should be noted as such.

Honestly I've never heard any explanation for why something as dangerous as OxyContin is ever prescribed.

There's lots of safer alternatives. There could be some niche cases for it but as a general pain killer it should never be used.

Because it's an important tool for pain management in some individuals. I would rather train doctors to appropriately use the tools at their disposal instead of removing tools from their toolbox.

It's hard to compete with pharma marketing as Continuing Education. Yet we pretend that doctors are supposed to be immune to the effects of marketing...

Then why not change the system?

US is rather unusual in allowing direct drug marketing to consumers, and "marketing" to physicians.

The problem is this line of thinking is that it can prevent them from being used in cases when it _is_ appropriate. I have a somewhat similar situation in the UK - the prescribing guidelines say benzodiazapines generally should only be used for sleep for up to 4 weeks (as they _can_ become ineffective, and can be used recreationally), so I semi-frequently[1] have to fight being switched to the so-called z-drugs (typically zopiclone). These have much more severe side-effects for me (memory loss[2] and vision alterations vs. occasional slight drowsiness).

This is despite the dose being static for well over a year (20mg/day), and they are still effective. Going three or more days without sleep was at least a monthly incident before taking tamazepam, and missing a night was weekly - three days has only occurred once since, and missing a night's sleep is rare. This has resulted in an improvement to my other symptoms.

[1] basically anytime I see a doctor other than my regular doctors, who understand the situation

[2] I do not believe thinking you have only blinked, then looking at the clock and realising over four hours have passed is a safe situation. I suspect I just fell asleep, but I don't remember that, or even waking up -- I thought I was just checking the time, and then four hours disappeared. This happened on multiple occasions, and I'm fairly sure I didn't just misremember the time (though even that would be disconcerting), as it was also brighter outside.

Tens of thousands of US drug users (victims) get jailtime. Citizen traffickers (perps): serious jailtime. Corporate traffickers (perps) get fined for 'nuisance'.

The Arthur Anderson firm got deep-sixed for felony obstruction of justice. Enron's Ken Lay was convicted of 10 counts of wire and bank fraud. (Skilling just got out of jail.)

Tens of thousands of dead Americans: 'nuisance'? I can think of only a couple of 'justifications' for the disparity.

Arthur Anderson and Enron harmed wealthy, powerful people.

Corporate pusher's victims were just Regular Joes. Who the law protects and who the law binds aren't always in sync.

> Arthur Anderson and Enron harmed wealthy, powerful people.

Not true. Probably the biggest losers for Enron were the rank-and-file employees of the company. Not only did they lose their jobs, but more than half of the Enron employees' 401k was invested in Enron stock.

And Enron happened to freeze the 401k plan at the time where the stock started to drop and people could have sold.


It is true, lots of people were harmed, including the rank and file. But “rank and file” usually calls up images of honest, blue collar folks and factory floors. According to Smartest Guys In The Room, the rank and file of Enron were mostly MBAs in thousand dollar suits with a reputation for utter ruthlessness and extravagant pay. The electrical utility employees in that article were not truly Enron employees.

That they harmed rank-and-file is besides the point. The important point is they harmed wealthy, powerful people.

> Corporate traffickers (perps) get fined for 'nuisance'.

One of the worst cases is probably https://www.cnn.com/2014/04/02/justice/delaware-du-pont-rape...

> Though Robert H. Richards IV was convicted of rape, the wealthy heir to the du Pont family fortune was spared prison by a Delaware court in 2009 because he would "not fare well" behind bars,

The term is https://en.wikipedia.org/wiki/Affluenza. It is surprising how blatant and obvious it is.

Yeah $500M out of $80B in revenue is pocket change, about 0.6%.

What is exactly is it that you believe qualifies as criminal behavior? Opiates are a legal, and medically necessary, component of the healthcare system. Unless you want patients to suffer horrendously, somebody has to manufacture and sell opiates.

Opiates are also a fun and addictive drug. As long as they exist and are generally available, some percent of the sub-population will abuse them. We can try our best to keep them only for medical use, but once the prescription leaves the pharmacy there's not much you can do. You can't blame the legal manufacturer when that happens, if they took all required steps to keep their drugs in the legal channels. Maybe you think that's true, but that the opiate manufacturers have used their power and influence to over-prescribe their products. That assumes that opiates are over-utilized in American healthcare. And that's a narrative that simply isn't borne out by the data.

Only 0.19% of opiate-treated chronic pain patients without a prior history develop any form of abuse or addiction[1]. And remember these are chronic-pain patients who take tolerance-escalating doses over years or even decades. Virtually no one develops an opiate addiction from following their medically prescribed treatment regiment.

The death rate from prescription opiates has not budged since 2006[2]. The vast majority of opiate overdoses in America are not prescription opiates, but illicit fentanyl, and to a lesser extent heroin and methadone. Nor do chronic pain patients face any major risk of overdose. The fatal overdose mortality rate for long-term opiate-prescribed patients is 17 per 100,000[3]. And that number doesn't exclude the subset of the population engaged in abusive behavior like mixing with alcohol, snorting pills, or hoarding medication.

Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative. On the National Drug Use Survey only 18% of prescription drug abusers report doctors as their primary source. And among street prostitutes (a high at-risk group) only 5%[4].

All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America. To begin with the vast majority of the opiate crisis has to do with fentanyl, not prescription drugs. But even when it comes to prescription drug abuse, the intersection with medical users is vanishingly small.

However what there is a major problem in America is untreated chronic pain. 50 million American suffer chronic pain[5]. And 20 million suffer high-impact chronic pain which severely impairs normal life function. More than 10% of suicides are linked to chronic pain[6]. High-dosage opiates are absolutely essential for this group to live any sort of normal life. As long as there are such massive numbers of legitimate pain patients, the law of large numbers guarantees a large supply of diverted opiates. Even under the tightest controls. There's simply no way around that except by denying most of the legitimate patients treatment for their debilitating conditions.

[1] https://www.ncbi.nlm.nih.gov/pubmed/18489635 [2] http://www.ncsl.org/portals/1/documents/health/APeeples0118_... [3] https://annals.org/aim/article-abstract/745518/opioid-prescr... [4] http://sci-hub.tw/https://www.tandfonline.com/doi/abs/10.108... [5] https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm [6] https://www.ehidc.org/sites/default/files/resources/files/Ch...

> What is exactly is it that you believe qualifies as criminal behavior? Opiates are a legal, and medically necessary, component of the healthcare system. Unless you want patients to suffer horrendously, somebody has to manufacture and sell opiates.

The criminal behaviour was aggressively selling something that already sells itself.

> Only 0.19% of opiate-treated chronic pain patients without a prior history develop any form of abuse or addiction.

Your cited meta-analysis looked at nonmalignant chronic pain patients receiving chronic opiate therapy: There is not a strong indication for this therapy in that group.

When they looked at all recipients, the abuse/addiction rate was 3.27%.

" In the urine toxicology grouping, there were five studies (15,442 CPPs exposed). Here, 20.4% of the CPPs had no prescribed opioid in urine and/or a nonprescribed opioid in urine." In other words, 20% were clearly diverting to non-prescribed users, and/or already supplementing their opioids.

How could the authors suggest that there was only 3% demonstrated abuse/addiction or aberrant behaviour when 20% were diverting their entire RX or supplementing????

> When they looked at all recipients, the abuse/addiction rate was 3.27%.

The 3% figure includes includes those patients with a pre-existing history of addiction/abuse. Now it's debatable whether previous addicts should get opiates for chronic pain conditions, it's irrelevant to the specific question of opiate prescriptions create new addictions. Because by definitions those with a history already had a pre-existing addiction.

Regardless 3% is still an extraordinarily low percent for chronic pain patients treated for years at a time. For reference 3% is less than or on par with the abuse/addiction rate of long-term prescribed ADHD medication[1].

> In other words, 20% were clearly diverting to non-prescribed users, and/or already supplementing their opioids.

Your characterization of the findings are mis-leading. Opiates frequently metabolize to another active opioid inside the body. Morphine commonly metabolizes to hydromorphone[2]. Codeine metabolizes to morphine[3]. Oxycodone metabolizes to oxymorphone[4]. Hydrocodone metabolizes to hydromorphone[4].

Furthermore many of these metabolic pathways are only just recently discovered (like morphine to hydromorphone). The reality is that our current understanding and technology is not advanced enough to tell from urine toxicology which specific opiates were consumed and which are the byproducts of metabolism.

[1]https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo... [2] https://www.ncbi.nlm.nih.gov/pubmed/16620524 [3] https://www.ncbi.nlm.nih.gov/books/NBK100662/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704133/

> Your characterization of the findings are mis-leading. Opiates frequently metabolize to another active opioid inside the body. Morphine commonly metabolizes to hydromorphone[2]. Codeine metabolizes to morphine[3]. Oxycodone metabolizes to oxymorphone[4]. Hydrocodone metabolizes to hydromorphone[4].

I’m pretty sure the authors were accounting for that. Otherwise they’re not investigating anything of value. Especially if they’re lumping them in with a group that didn’t have any opiates in their screen.

> Opiates are a legal, and medically necessary

This is finally being questioned by studies. Multiple studies have recently come out that show non-opioid pain killers are as effective and sometimes more effective than opioids in both chronic and acute pain. Now, I don't think opioids need to be made illegal because they do have their uses, but they are clearly over-prescribed when more conservative options may work.



I agree that opiates are an important medical tool. But from what I've read I get the impression that they're severely over-prescribed in the US compared to other nations.

They are still severely under prescribed in nations across the world. To the point that they are not available at all in many countries due to puritanical lobbying. Which means people across the globe are still suffering an absolute horrible fate, despite how easy it is even for a developing country to produce pain medication. The world still hasnt recovered from the last US crusade against pain medication, so i am more then a bit worried about what happens in the US right now. The fact that large parts of the world today have worse pain management options available to their population then what was available in the middle ages should scare you a lot more then some guy having fun with his medication.

People misusing pain medication is a small price to pay to have pain medication available for people who need it. There wont be an optimal solution by pushing down on pharma companies and doctors, it will be quite a lot worse then today.

To put it simply, if you are lobbying to combat the so called "opioid crisis" you should think damn hard about the consequences of your actions. Because if or better when there is another backlash peoples suffering caused by a lack of pain medication will be on your hands.

At least my view from living in Europe is that medical care is at least partly cultural. In the US we put a lot more faith in technology (devices, surgery, etc) than you see elsewhere. Also the the approach of optimization is different. In Sweden when I injured my shoulder, I was given a conversation on over the counter remedies first, and if these were not sufficient would have had a conversation with a physical therapist, and eventually when these fail maybe stronger medicines would have been used. As it was the NSAIDs recommended (which were strong NSAIDs, much stronger than ibuprofen) worked for me.

I don't think it is fair to criticize medical practices across cultures. Every culture has a different view on these and optimizes for different things.

> some guy having fun with his medication.

You don't think that's a bit disingenuous?

We all are making choices in our life. Abusing pain medication is also a choice. If it was problem born only out of lack of information, we wouldnt have this discussion about the necessity of tighter restrictions. You only need restrictions if you want stop people making choices you dont like. Otherwise education would be sufficient.


Yes, and as he said, the majority of the impact is from illegal opioids, not the ones being prescribed.


The largest meta-study to date found that among long-term opiate pain patients without a prior history of abuse, only 0.19% developed any sort of addiction or abuse.

I do agree with you that many heroin users start with prescription opiates. But the vast majority are not themselves prescribed the drug. Surveys show that they're either getting the drugs from friends or relatives or buying it from the black market.

There's no evidence that doctors are "handing out oxycodone like candy", as demonstrated by the vanishingly small addiction rate among actual pain patients. If a kid raids his grandma's medicine cabinet and steals her pain medicine, how is that an indictment of the doctor or pharmaceutical company?

[1] https://www.ncbi.nlm.nih.gov/pubmed/18489635 [2] http://sci-hub.tw/https://www.tandfonline.com/doi/abs/10.108...

As someone who avoids pain medication for medical diagnostic reasons, I have had FAR too many prescriptions for opiates in my 20s and 30s. They were unnecessary 75% of the time that had automatic refills! There was no oversight or followup beyond what you get asked for a medical marijuana prescription (which is a joke). Oh, you have had some pain anywhere for anything? Here's your refill.

What did I do with the ones I didn't need, which I was originally sent home with? Sold them or gave them away for recreational use after my recovery was over.

Opiates, in general, were poorly managed for decades. Vicodin just happened to be the most popular product and the producer never bothered to be responsible about the use of it's own medicinal product, despite being in the business of medicine. I'm sure J&J aren't special, as a company that would end up being willfully negligent in the face of a successful pain medication empire, but they were.

And once you are hooked on the legal opioids, where to you go once your prescriptions run out? or your insurance? or your job. One does not start out shooting heroin laced with fentynal - one ends up there.

When you are encouraging doctors to prescribe oxycotin like it is tylenol, hiding research about the addictiveness and makeing sure its on the formulary of all insurance companies all the while making huge profits; then maybe there is smidge of responsibility to be shared by the corporations.

Most people addicted to opioids started with legally prescribed meds. Those meds may not have been prescribed to them, but that's the problem with the fucking stupidly large numbers of opioids being prescribed in the US: there are very many meds lying around to be diverted to recreational use.

So far almost every point you've made in this thread can be directly sourced to Purdue propaganda. Doesn't that worry you?

There was "The Letter that Started it all": https://www.bbc.co.uk/news/world-us-canada-40136881

That caused the VA to say "pain meds aren't addictive if used to treat pain": https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...

Here's the paper that rebuts this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ (and note this is more than 10 years old)

Here's Purdue Pharma saying, as you are here, that pain meds aren't that addictive and don't we need to use opioids to treat pain (they are addictive, and they don't work for many types of pain): https://www.feinberg.northwestern.edu/sites/ipham/conference...

You're comparing the use and trafficking of illegal drugs with the (alleged) mis-marketing of a legal product.

Of course the punishment isn't the same.

What if the product was both ineffective and dangerous, and it therefore shouldn't have been legal? And what if the studies showing that were buried by the manufacturer?

You could actually argue that someone selling heroin to an addict is doing something consensual, where both parties know what they're getting into. You can't say the same of opioid manufacturers, who intentionally buried vital info and muddied the waters of public perception.

The intention was to make money, knowing that millions of people would be harmed. Who cares if the method was "just marketing"?

Opioids are ineffective and dangerous? Not according to the government body called the FDA.

The FDA isn't infallible, and it relies on data from industry.

Yes, ineffective and dangerous.

> "Opioids are ineffective in the treatment of chronic pain, and the dangerous risks associated with using and abusing opioids have led to America's most deadly drug epidemic."

-- National Safety Council[1]

> "Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain"

-- Govt-funded trial at UVA[2]

> "Ibuprofen, acetaminophen more effective than opioids in treating dental pain"

-- Case Western Reserve University[3]

> "In summary, reliable conclusions about the effectiveness of long-term opioid therapy for chronic pain are not possible due to the paucity of research to date. Accumulating evidence supports the increased risk for serious harms associated with long-term opioid therapy, including overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction; for some harms, the risk seems to be dose-dependent."

-- NIH[4]

And after that, you're welcome to look at examples where pharma execs admitted to misleading doctors about both safety and efficacy[5].

1. https://www.nsc.org/home-safety/safety-topics/opioids/treati...

2. https://www.aafp.org/afp/2018/0301/p348.html

3. https://annals.org/aim/fullarticle/2089370/effectiveness-ris...

4. https://www.sciencedaily.com/releases/2018/04/180417181101.h...

5. https://www.wbur.org/npr/690556552/lawsuit-details-how-the-s...

Your first quote is a mis-representation of the last one - there is no solid clinical data on the treatment of chronic pain using opioids. That doesn't mean they are ineffective and there are plenty of anecdotal stories to suggest they are.

Your other two sources are just subsets of pain and ignores many other uses of opioids.

The first and last are different conclusions by different researchers.

If there's no evidence something is effective, it should be considered ineffective. I've found sources that say there's incomplete evidence and sources that say opioids aren't significantly better than placebo, but no unbiased reviewer says that they're more effective than OTC and generic painkillers.

A while ago I read a book about what they did with epogen. They definitely deserve punishment but I am afraid this will work out like the banks where the fine is just cost of doing business and not deterrent.

And their stock is up in after hours... Doesn't seem to be much of a victory considering a bigger fine was already priced in.

Exactly. This landmark ruling is the wrong way, it shows that pharmaceutical companies can enable the manslaughter of hundreds of thousands of people and pay relatively little in fines. Certainly less than the usually well-informed stock market was expecting.

The pharma CEOs are gonna use this landmark to help them navigate to a bigger private yacht and faster private jet.

Government says it's ok for Johnson and Johnson to sell opioids. Government waits until the shit hits the fan then says, "Hey you shouldn't have sold those opioids! Hey everyone, can you believe this big company is selling opioids?!" What a joke.

Johnson and Johnson annual revenue: 80bn

Fine for causing a substantial amount of those "400,000 overdose deaths": 0.5bn

Yeah, I'm totally convinced that they'll behave from now on.

As a non American can I just confirm my understanding?

JJ makes pain killers, markets them, doctors prescribe them (?), patients get addicted.

I have trouble understanding why this is primarily JJs fault. Either Drs should be looking after their patients, or these drugs need to be prescription only, if not already.

There seems to be a big elephant that's getting ignored here...

Drug companies misrepresented the research around addiction; they aggressively sold the medication to doctors and patients; they continued these sales even when they had data showing large amounts of misuse in a region.

People seem to think there can only be one point of failure, one organisation or person to blame. The opioid crisis is complex and many things failed. You're right that doctors should not have prescribed as many opioids, but that doesn't absolve the makers or the insurance companies.

There doesn't seem to be any suggestion of fraud in the linked article? Nevertheless if Drs are relying on companies for unbiased data, that again seems like that should be addressed.

I'm not saying there's one point of failure, note in my prior reply I wrote "primarily" their fault. But Drs are the professionals here, they have a duty towards their patients. If a Dr prescribes something for me, I expect them to have weighed up the pros and cons. If Amazon recommends something I have no such expectation.

These companies usually operate on a global scale and yet the opioid crisis is limited to the US. Did the companies not try pulling the same tricks (misinformation, ignoring warnings) in other countries?

the idea is that they were falsely marketed to doctors as being non-addictive, which meant docs then prescribed them without concern for potential addiction - ie not helping the patient stop the drug, prescribing them for too long.

in the UK you can buy cocodomol, which is an opioid painkiller over the counter. but it has huge text reading "no more than 3 days usage" becaues of addiction risk. it's like JJ said to docs, we got cocodomol, but you can prescribe them for months because we made them non-addictive, and that's the lie.

"The company's share price rose following the ruling as investors had been expecting a much bigger fine, says BBC North America correspondent Peter Bowes."

Plaintiffs ought to be suing federal and state governments for their puritanical and destructive drug laws. It is arguable that manufacturers promoted addictive drugs irresponsibly. And that physicians prescribed them irresponsibly.

But I doubt that most addicts overdosed with opioids obtained under prescription. Most likely overdosed on illegal opioids that they resorted to, after their prescriptions got cut off.

Regardless of the question of whether or not J&J is liable or should be find, I'll just point out this slap on the wrist is basically nothing.

Such judgements are factored into large corporations' plans from the start. The politicians get to look good for "doing something", the company gets to be absolved of blame, and they're only out a small percentage of their profits.

It might be an idea that all pharmaceutical companies with addictive products have to "donate" a percentage of gross sales to addiction treatment programmes. Also doctors that prescribe them have to also make a proportionate donation to avoid overprescription.

it really seems like a slippery slope to be fining companies for selling products that are tightly regulated to begin with. next they will apply the can-spam act to billboard and television advertisers, which might not be too far off and equally misapplied.

The Atlantic has an interesting article that claims the risk of addiction for ordinary folks isn’t that high.

What became the popular but essentially dubious interpretation of the trends was that the typical opioid victim was a patient who received Oxycontin, Percocet, or Vicodin from her doctor for a tooth extraction or sprained ankle and then stumbled into addiction.

In fact, only 22 to 35 percent of “misusers” of pain medication report receiving drugs from their doctor


22-35% is...actually quite high and pretty disturbing, given that these are coming from medical professionals who should know to avoid overprescription.

I'm not sure who this is at all relevant. Millions of people still died, and there's a very direct correlation between how much opioids were dumped in a state and the increase in death rates in that state. You can try to blur the lines by throwing statistics about addiction, but you can't deny the actual end results. It doesn't matter if you think it's addictive or not, millions of people died from opioid overdose, and communications show that the execs at these companies very explicitly pushed it heavily knowing full well the impact it had.

Of course it's relevant. The narrative is that companies like J&J promoted opioids which led to higher levels of addiction (and use of illegal opioids).

This data suggests that for the vast majority of patients, addiction was not an issue and the cause of the opioid epidemic was in fact people that used illegal opioids to begin with.

Doesn't matter if it was addiction of not, people still died of overdose, and there's a direct correlation between higher sales of opioids and deaths. They quite literally killed people for a higher profit.

Correlation doesn't equal causation or else you have to start charging Ben and Jerry for all of the murders and drownings and the whole justice system becomes the Red Queen's court.

Please stop parroting the myths created by the drug companies.

This is just parroting what the drug company reps say.

But not treating pain and also causing addiction in 30% of your patients isn't just "not very good", it's catastrophic.

> In fact, only 22 to 35 percent of “misusers” of pain medication report receiving drugs from their doctor

Because of the floods of prescription meds available many people get meds from their family and friends. The ultimate source was a doctor prescribing them, but the meds have been passed on.

Worth noting she works for a conservative think tank, so I am not sure I am going to take her at face value for defending pharmaceutical corporations...

Did you have a particular data point you’re trying to refute?

Or are you just trying to dismiss the entire article because of her political views?

The fact it tries to downplay that millions of people are dying, and continue to die, ignoring that there is direct correlation between number of pills dumped in a state and deaths.

Down playing it how? Can you quote the relevant text?

The author acknowledges it's a crisis, but simply asks questions about the true cause.

> The author acknowledges it's a crisis, but simply asks questions about the true cause.

I mean, that's been the conservative playbook for decades. Deny entirely first. Once it becomes undeniable, deny attribution. Once that becomes undeniable, claim nothing can be done anyways.

Climate change, air pollution, fossil fuels...

It is possible that some facts got distorted, but by looking at the big picture it does not look too good any way you look at it

Chinese saying. Kill one to warn hundred.

If a corporation has free speech, then a corporation can go to jail.

why didnt purdue pharma face any charges?

1. This was a civil lawsuit, not a criminal trial.

2. "Why Was Johnson & Johnson the Only Opioid Maker on Trial in Oklahoma?"

Other states are suing a range of drug makers, distributors and retailers. Here are three reasons Johnson & Johnson was the only company on trial in Oklahoma.


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