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.
Corporate pusher's victims were just Regular Joes. Who the law protects and who the law binds aren't always in sync.
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.
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%.
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. 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. 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. 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%.
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. And 20 million suffer high-impact chronic pain which severely impairs normal life function. More than 10% of suicides are linked to chronic pain. 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.
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????
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.
> 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. Codeine metabolizes to morphine. Oxycodone metabolizes to oxymorphone. Hydrocodone metabolizes to hydromorphone.
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.
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.
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.
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.
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.
You don't think that's a bit disingenuous?
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?
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.
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.
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...
Of course the punishment isn't the same.
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"?
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
> "Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain"
-- Govt-funded trial at UVA
> "Ibuprofen, acetaminophen more effective than opioids in treating dental pain"
-- Case Western Reserve University
> "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."
And after that, you're welcome to look at examples where pharma execs admitted to misleading doctors about both safety and efficacy.
Your other two sources are just subsets of pain and ignores many other uses of opioids.
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.