As the Purdue bankruptcy ends in disgrace for the Sacklers, a physician who has treated and covered the American opioid catastrophe reflects on the company's relentless promotion of addiction
P.S. In the past several months, at least where I practice, the number of overdose deaths has decreased dramatically. Fantastic thing. I suspect that tightening the border, plus blowing drug-runners out of the water, is a successful strategy. Makes me feel sorry for the fish, though…
I’m 78. Left knee replacement a year and a half ago. Certainly not discomfort-free but definitely no narcotics needed. Cold, elevation, movement and Tylenol
This year changed diet and started personalized fitness training to build muscle and strength. Aerobics I’m doing on separate days on my own. The transformation is exquisite. Have discovered that age (although physical) is not about the date of birth AT ALL!
My mom had (and died from) pancreatic cancer quite a while ago now. Opioids in her case were a godsend. In general they are awful as this article makes clear. Her choice was function for ~8 months and die (possibly) addicted, or be in agony.
I have no love for opioids or the Sackler family. But I can tell you from first hand knowledge that their strategy of marketing opioids was no different from the strategy followed by every pharmaceutical company for every drug. The only difference was the hazard inherent in their drugs. I've sat through marketing presentations in my previous jobs, and let me tell you, it's all about maximizing scrips and getting as much product out the door as possible. Whether it does the patient any good is a secondary consideration at best. Patient welfare is more of a marketing talking point than an actual goal. If you don't believe me, just look at the DTC marketing of cancer drugs. I've personally know a number of late stage cancer patients, the types that these drugs are generally targeted at. The imagery used in these commercials is laughable compared to the reality of it.
I am not defending the Sacklers and never would. But then, I'd never defend any pharma company's marketing of any drug. My point is that they were just acting like any other pharma company would act. Same thing goes for the aggressive bankruptcy strategy. In that respect they are not exceptional.
I’ve worked in Pharma for 30 years, including 8 months with a pain med company that was actually very mindful of the inherent dangers of their drug, so I can attest to this comment. Marketing exists to maximize sales and just about every drug, whether it’s a statin, cholesterol med, etc. is titrated to the weight of the patient. I want to disagree that whether it helps the patient is secondary to the sale (it could be that I’ve worked for ethical companies), but then I remember Insys and crazy shit they were doing. There are several bad actors that taint the industry. It may also be that pain med companies are inherently crazy in that they utilize common Pharma marketing strategies that shouldn’t be employed with products that carry this amount of risk.
Spare me the idea that doctors were “tricked” or “pressured” by the drug companies to write the opioids. They’re freaking opioids! Even if they have a built in deterrent (can’t crush them , long acting, etc.), they’ll always have addiction concerns. I’m no MIT scientist and I knew very quickly there was a huge risk and left that market as quickly as I could. Again, I’ve been in Pharma 30 years; when it comes to products that have a narrow therapeutic range or high potential for death, I have yet to find a doctor that is going to take the word of a Pharma rep without doing their own research.
I’ll end with this - If the doctor doesn’t write it, the patient doesn’t get it. There was a large amount of doctors who ran pain clinics who were no different from your local drug dealer. There were doctors with clinics down south and out west (Florida, etc.) who would fly in from other states for a few days a week to run their clinics and have lines out the door. They made millions. There is a doctor in Rhode Island doing 10 years in prison for keeping his patients on a fentanyl product called Subsys even after they asked to be dc’d, leading to several deaths. His son worked for the company. There were/are bad actors on all sides that contributed to this and the bottom line is they did for the money.
If this is an add to see if I would subscribe to this guy, the answer is NO. I know this subject very well as I lived through it, and with 40 year career as a physician.
Prior to the JACHO adding pain to the vital signs of a visit, with expectations of "no pain" and there emphasis on it and articles from VA showing opioids were underused for pain control is how this started. Use of opioids has always been controversial, and for the first 20 years of my career they were used sparingly, but with this administrative pressure the flood gates opened and the pendulum swung to major over prescription. The population was older, fatter and there was lots of musculoskeletal pain that was not easy to treat. Organized medicine pushed the over use. My physician coworker had an investigation lunched into him by the AZ Medical Board in 2011 for REDUCING a whooping dose opioids by small amount. Medical Board letter said he did not emphasize taking the patients pain seriously enough. We all suspected the patient was selling his prescriptions.
Then there was 180 turn, the board would not answer questions from my colleague on the complaint, or respond to his response(it cost him legal fees). When I did not prescribe opioids to the satisfaction of a patient , they complained, and a administrator would tell me, " I can not make you prescribe medications, but we can not have unhappy patients". They were pressuring me to over prescribe. Then suddenly we were told not to prescribe opioids. Like all of a sudden, they figured out there was problem. The pendulum swung back against prescribing opioids so hard it almost broke our necks. The AZ Board suddenly dropped all claims on under prescribing opioids including my colleagues. The threat to take away your license is powerful way to influence your behavior. The witch hunt began on what caused the problem that someone suddenly noticed. I am retired now, but hear opioids are underutilized again.
My take is organized medicine, government actions were the cause of the problem and the resolution was when the drug cartels had enough of this sanctioned completion and called in their political favors and shut it down. Yes pharmaceuticals saw an opportunity and took advantage of a system organized medicine and government gave them, but they were not the cause. Drug companies were a side show, someone needs to overprescribe the opioids and it was pressure brought on us and bad science not from drug companies that caused the over prescription. I hope for the patients we return to a more reasoned approach.
Here are the big questions I have, Alex, as the husband of someone in what I believe to be true chronic pain. You’ve highlighted many times that Europe prescribes far fewer opioids than the US. Is there less pain in Europe? Is there a different treatment protocol that works just as well? Is “pain” simply not harped on as much? Or is it simply the thrust of this article - that Purdue/Sackler got evilly good at marketing and selling “pain” that we all fell for it in a way that wasn’t medically necessary? Sadly, it seems that Purdue/Sackler’s evil has made it immensely harder for true pain sufferers - post-surgery, real chronic conditions, etc - to get the relief they deserve. But if Europe gets by with way less, I wonder if my assumptions are incredibly flawed.
Far be it for me to claim the EU has a kinder gentler bureaucracy than the US, but my somewhat vague memory of reading general articles over the years is that the US "opioid crisis" began in concert with the War on Drugs crackdown on prescribed opioids, which led to different and poorer pain medicine prescriptions and drug smugglers turning to more concentrated drugs in a nasty vicious cycle that was predicted. Prohibition didn't work, neither does banning books, records, and movies, and the War on Drugs is just another example; all it does is increase demand from the curious and eliminate market protections such as access to legal courts and brand reputation.
Surely the EU followed suit in some manner, but I don't know the differences in the US and EU Wars on Drugs. What I am convinced of is that government played a larger role in the "opioid crisis" than government judges and prosecutors want to admit, and I'd bet a paycheck that government had a lot to do with encouraging the Sacklers, whether directly or indirectly. Judges are not known for their reluctance to ban testimony which embarrasses the government.
I’ve known addicts in many situations in my life, including in corporate law.
After seeing so many take personal responsibility for their survival in NA and AA rooms, I didn’t understand exactly why this is all the Sackler and doctors’ fault.
Now I see what they did and how the verdicts were reached. Sociopathy has to run in that family.
I practiced through this. I heard the presentation. I learned in med school (University of Washington, Seattle) that narcotics don't work for chronic pain. The presentation from Perdue that I heard with the free meal at the big fancy hotel did not dissuade me from that teaching. None of my patients were harmed by Perdue. If you want to hate Perdue and the family behind Perdue, that is fine, but if you ignored your training for a fancy meal you were a bigger part of the problem. Most of those harmed by a prescription medication, unfortunately, had a prescription.
The Sacklers aren't going to jail and they have reportedly salted away a tidy sum in Swiss banks. I suspect they will deal with their "disgrace" with equanimity. It's easy to do if you are already shameless.
I spent over 40 years in pharmacy. The over prescribing and under prescribing of opioids looked like a Sine wave, the regulatory agencies would decide that opioids were being over prescribed then in about 10 years they would decide they were being under prescribed. I felt sorry for those younger patients that were over prescribed to, but also for the patients that truly needed opioids that were caught in this regulatory over reach. But let's not give Purdue Pharma a pass, they knew and hid a lot of the data that showed the harmful downside of over prescribing opioids, that they were encouraging.
I would not subscribe to this guy. Here’s what he totally ignores.
In 2014 there were about 20,000 OD deaths.
In 2025 there were about 80,000 OD deaths.
In some of the in inbetween years OD deaths approached 10Ok.
Wow. Taking the Sackler family down and Purdue out of business really did the job.
Now let’s look at the truth that he conveniently ignores.
In Oct 2014 legal opiods were moved to Sch 2, placing them in the same category as Cocaine and Meth. This was a typical govt supply side response to a demand side problem.
Despite receiving hundreds of letters from patients and doctors, many of who presciently predicted the increase in OD deaths, Congress and the FDA ignored the warnings and the results speak for themselves. A decade later, a 4-5x increase in OD deaths.
Moving legal opiods to Sch 2 didn’t fix the problem. Instead, it made it worse.
The demand didn’t go away. What went away were the legal drugs that were not dangerous if properly used. What filled the gap were illegal drugs of unknown origin. And the death rate skyrocketed.
In addition the drug companies did not stop producing these drugs. Tonnage was not reduced. Instead they moved their production offshore, and much of what they produce finds its way back to the U.S. to be sold in the street for 10-20x what it costs at a pharmacy.
So we have deaths at 5x. We have no reduction in production. What else did the change do. Well.
The people most hurt by the Oct 2014 changes were legitimate chronic pain patients and the doctors who try and help them. They are now treated like criminals, while the real criminals who jumped at the chance to fill the void roam free, selling their adulterated products which fill ERs with ODs
When the change was made in 2014 no money was provided for new research into chronic pain, no money for addiction treatment, no money for mental health. Govt did what it always does. They addressed the supply and ignored the demand.
It’s fine to blame the Sacklers. But the reality is that it’s not the legal drugs that cause the vast majority of ODs. It’s the illegal ones. And all Congress did in 2014 was ensure that illegal drugs would become the drug of choice for filling the void when the legal drugs became unobtainable.
Lastly. Chronic pain patients who at one time were able to live a pretty normal life are now faced with an impossible choice. Try and live with the pain. Go on the merry go round of expensive and intrusive injections every 3 months that over time destroy tendons and cartilage and introduce who knows what toxins into the body. Or, go out on the street and take the chance.
None of those choices leading to a fulfilling life.
There is one other choice and more suicides than you would imagine are as a result of chronic pain that cannot
The good doctor might be cheering the demise of the Sacklers. But he fails to address the real issues. Which is not surprising.
Maybe if he attended the funeral of a 35 year old chronic pain patient with 3 kids who blew her brains out because she could no longer legally obtain the medication that had previously allowed her to function, his perspective might change.
Read it yesterday…just outstanding. If you haven’t watched it, I encourage you to watch Dopesick, covers opioid addiction,Purdue Pharma and Sacklers. After watching it….you will hate them even more!
Could not agree more. Having practiced Pain Medicine during the 2 Narcotic Wars (War 1- We should write unlimited narcotics, there is no ceiling dose, late 80s to early 90s) and War 2 (all narcotics are bad, tough it out, post first Purdue settlement) the bad players were Academics and the JCAOH. The Academics started the whole thing which Purdue jumped on. They had MS Contin first and never could sell it in volume. Then NYU and Harvard started talking about how we were undertreating pain. There was no limit. Univ of Wisconsin shamed any medical board who did NOT encourage liberal narcotic prescribing. California courts allowed malpractice verdicts for not writing enough narcotics. The ER Docs were the worst. They wrote huge amounts to known abusers so the Press Gainey scores looked good. Purdue offered unlimited grants to societies if they had the Academic Professors speak on writing narcotics. JCAOH made the "Fifth" vital sign mandatory. They continued this even after their own study showed liberal narcotic use in the hospital increased ICU admissions, increased near death issues, and did not decrease pain scores. The conclusion was we must continue the standard even though it increased morbidity and did not reduce the endpoint because "the paperwork is much better". Medicare still takes Purdue's position that narcotics are not dangerous drugs and that abuse can be predicated before anyone is exposed. The LCD (local carrier determination) on urine drug testing has the Purdue bibliography and quotes authors who wrote for Purdue. Historically, the use of narcotics for pain is a pendulum. It swings between over and under prescribing. Overall the villains of this episode is not solely Purdue "The fault, dear Brutus, is not in the stars, but in ourselves"
Sorry, explain the danger of legal opiods? Constipation, psychological addiction, physical addiction, and hearing loss?
The real danger and death comes when the drugs are not available and the grey and black market take over. Overdoses cause the deaths from illegal fentanyl.
When will we admit that our present policy is a failure?
Yes, the Purdue Pharma pushed the drugs but doesn't Merck push vaccines ?
I watched Dope Sick, and am aware of the evil wrought by the Sacklers. It’s shocking in its depravity. I consider myself reasonably intelligent. I fell for the line “only 1% of people taking Oxy become addicted” and used the argument to say the addicts had no one to blame but themselves. I’m very sorry about that.
I've used both oxycodone and hydrocodone temporarily numerous times to deal with both acute pain and chronic pain. I have never had any issues. In fact, except for relieving the pain, neither drug makes me feel "high" at therapeutic doses. When I've taken a lot of hydrocodone, as part of a surgery without general anesthetic, it just made me woozy. Ditto to when I had a different surgery with only Versed and Fentanyl. My issue is that aspirin (gastro), ibuprofen (kidney), and acetaminophen (liver) are all contraindicated in me, except in very rare circumstances, like high fever or acute pain requiring only a single dose. So I find myself a lot of times in a situation where it's either tough it out or take hydrocodone or oxycodone. Mostly, I tough it out. But not always. Being in severe chronic pain destroys my ability to work, earn money, and support my family. I can't afford to take weeks off being miserable after surgery, or when I injure myself. I feel bad for all the people whose lives have been ruined by too many opioids, and illegal drugs are a serious issue that I'm glad we are getting a handle on. But for people like me, I resent anyone, whether the pharma companies or the government's overreaction, who gets in between me and my doctor to dictate what I can and cannot be prescribed for my individual case.
I hope you understand where I'm coming from, Alex. It's not that I don't love your work, or your book "Teach Your Children", it's just that I don't like being treated as a child by the government without evidence that I am, in fact, behaving like a child--or an addict.
P.S. In the past several months, at least where I practice, the number of overdose deaths has decreased dramatically. Fantastic thing. I suspect that tightening the border, plus blowing drug-runners out of the water, is a successful strategy. Makes me feel sorry for the fish, though…
Think of them as flying fish – at least for a while…
Well said!
Fish gotta eat too. Think of it as chumming the water.
My wife has had both knees replaced. She managed with cold, ibuprofen, and acetaminophen. No narcs. Worked fine!
I’m 78. Left knee replacement a year and a half ago. Certainly not discomfort-free but definitely no narcotics needed. Cold, elevation, movement and Tylenol
Bravo, young lady!
This year changed diet and started personalized fitness training to build muscle and strength. Aerobics I’m doing on separate days on my own. The transformation is exquisite. Have discovered that age (although physical) is not about the date of birth AT ALL!
My mom had (and died from) pancreatic cancer quite a while ago now. Opioids in her case were a godsend. In general they are awful as this article makes clear. Her choice was function for ~8 months and die (possibly) addicted, or be in agony.
I have no love for opioids or the Sackler family. But I can tell you from first hand knowledge that their strategy of marketing opioids was no different from the strategy followed by every pharmaceutical company for every drug. The only difference was the hazard inherent in their drugs. I've sat through marketing presentations in my previous jobs, and let me tell you, it's all about maximizing scrips and getting as much product out the door as possible. Whether it does the patient any good is a secondary consideration at best. Patient welfare is more of a marketing talking point than an actual goal. If you don't believe me, just look at the DTC marketing of cancer drugs. I've personally know a number of late stage cancer patients, the types that these drugs are generally targeted at. The imagery used in these commercials is laughable compared to the reality of it.
I am not defending the Sacklers and never would. But then, I'd never defend any pharma company's marketing of any drug. My point is that they were just acting like any other pharma company would act. Same thing goes for the aggressive bankruptcy strategy. In that respect they are not exceptional.
I’ve worked in Pharma for 30 years, including 8 months with a pain med company that was actually very mindful of the inherent dangers of their drug, so I can attest to this comment. Marketing exists to maximize sales and just about every drug, whether it’s a statin, cholesterol med, etc. is titrated to the weight of the patient. I want to disagree that whether it helps the patient is secondary to the sale (it could be that I’ve worked for ethical companies), but then I remember Insys and crazy shit they were doing. There are several bad actors that taint the industry. It may also be that pain med companies are inherently crazy in that they utilize common Pharma marketing strategies that shouldn’t be employed with products that carry this amount of risk.
Spare me the idea that doctors were “tricked” or “pressured” by the drug companies to write the opioids. They’re freaking opioids! Even if they have a built in deterrent (can’t crush them , long acting, etc.), they’ll always have addiction concerns. I’m no MIT scientist and I knew very quickly there was a huge risk and left that market as quickly as I could. Again, I’ve been in Pharma 30 years; when it comes to products that have a narrow therapeutic range or high potential for death, I have yet to find a doctor that is going to take the word of a Pharma rep without doing their own research.
I’ll end with this - If the doctor doesn’t write it, the patient doesn’t get it. There was a large amount of doctors who ran pain clinics who were no different from your local drug dealer. There were doctors with clinics down south and out west (Florida, etc.) who would fly in from other states for a few days a week to run their clinics and have lines out the door. They made millions. There is a doctor in Rhode Island doing 10 years in prison for keeping his patients on a fentanyl product called Subsys even after they asked to be dc’d, leading to several deaths. His son worked for the company. There were/are bad actors on all sides that contributed to this and the bottom line is they did for the money.
If this is an add to see if I would subscribe to this guy, the answer is NO. I know this subject very well as I lived through it, and with 40 year career as a physician.
Prior to the JACHO adding pain to the vital signs of a visit, with expectations of "no pain" and there emphasis on it and articles from VA showing opioids were underused for pain control is how this started. Use of opioids has always been controversial, and for the first 20 years of my career they were used sparingly, but with this administrative pressure the flood gates opened and the pendulum swung to major over prescription. The population was older, fatter and there was lots of musculoskeletal pain that was not easy to treat. Organized medicine pushed the over use. My physician coworker had an investigation lunched into him by the AZ Medical Board in 2011 for REDUCING a whooping dose opioids by small amount. Medical Board letter said he did not emphasize taking the patients pain seriously enough. We all suspected the patient was selling his prescriptions.
Then there was 180 turn, the board would not answer questions from my colleague on the complaint, or respond to his response(it cost him legal fees). When I did not prescribe opioids to the satisfaction of a patient , they complained, and a administrator would tell me, " I can not make you prescribe medications, but we can not have unhappy patients". They were pressuring me to over prescribe. Then suddenly we were told not to prescribe opioids. Like all of a sudden, they figured out there was problem. The pendulum swung back against prescribing opioids so hard it almost broke our necks. The AZ Board suddenly dropped all claims on under prescribing opioids including my colleagues. The threat to take away your license is powerful way to influence your behavior. The witch hunt began on what caused the problem that someone suddenly noticed. I am retired now, but hear opioids are underutilized again.
My take is organized medicine, government actions were the cause of the problem and the resolution was when the drug cartels had enough of this sanctioned completion and called in their political favors and shut it down. Yes pharmaceuticals saw an opportunity and took advantage of a system organized medicine and government gave them, but they were not the cause. Drug companies were a side show, someone needs to overprescribe the opioids and it was pressure brought on us and bad science not from drug companies that caused the over prescription. I hope for the patients we return to a more reasoned approach.
Here are the big questions I have, Alex, as the husband of someone in what I believe to be true chronic pain. You’ve highlighted many times that Europe prescribes far fewer opioids than the US. Is there less pain in Europe? Is there a different treatment protocol that works just as well? Is “pain” simply not harped on as much? Or is it simply the thrust of this article - that Purdue/Sackler got evilly good at marketing and selling “pain” that we all fell for it in a way that wasn’t medically necessary? Sadly, it seems that Purdue/Sackler’s evil has made it immensely harder for true pain sufferers - post-surgery, real chronic conditions, etc - to get the relief they deserve. But if Europe gets by with way less, I wonder if my assumptions are incredibly flawed.
Far be it for me to claim the EU has a kinder gentler bureaucracy than the US, but my somewhat vague memory of reading general articles over the years is that the US "opioid crisis" began in concert with the War on Drugs crackdown on prescribed opioids, which led to different and poorer pain medicine prescriptions and drug smugglers turning to more concentrated drugs in a nasty vicious cycle that was predicted. Prohibition didn't work, neither does banning books, records, and movies, and the War on Drugs is just another example; all it does is increase demand from the curious and eliminate market protections such as access to legal courts and brand reputation.
Surely the EU followed suit in some manner, but I don't know the differences in the US and EU Wars on Drugs. What I am convinced of is that government played a larger role in the "opioid crisis" than government judges and prosecutors want to admit, and I'd bet a paycheck that government had a lot to do with encouraging the Sacklers, whether directly or indirectly. Judges are not known for their reluctance to ban testimony which embarrasses the government.
I’m so grateful for this information.
I’ve known addicts in many situations in my life, including in corporate law.
After seeing so many take personal responsibility for their survival in NA and AA rooms, I didn’t understand exactly why this is all the Sackler and doctors’ fault.
Now I see what they did and how the verdicts were reached. Sociopathy has to run in that family.
Watch the 2023 Netflix series “Painkiller”, which documents & dramatizes how the Sacklers operated. They should be in prison.
I practiced through this. I heard the presentation. I learned in med school (University of Washington, Seattle) that narcotics don't work for chronic pain. The presentation from Perdue that I heard with the free meal at the big fancy hotel did not dissuade me from that teaching. None of my patients were harmed by Perdue. If you want to hate Perdue and the family behind Perdue, that is fine, but if you ignored your training for a fancy meal you were a bigger part of the problem. Most of those harmed by a prescription medication, unfortunately, had a prescription.
The Sacklers aren't going to jail and they have reportedly salted away a tidy sum in Swiss banks. I suspect they will deal with their "disgrace" with equanimity. It's easy to do if you are already shameless.
I spent over 40 years in pharmacy. The over prescribing and under prescribing of opioids looked like a Sine wave, the regulatory agencies would decide that opioids were being over prescribed then in about 10 years they would decide they were being under prescribed. I felt sorry for those younger patients that were over prescribed to, but also for the patients that truly needed opioids that were caught in this regulatory over reach. But let's not give Purdue Pharma a pass, they knew and hid a lot of the data that showed the harmful downside of over prescribing opioids, that they were encouraging.
I would not subscribe to this guy. Here’s what he totally ignores.
In 2014 there were about 20,000 OD deaths.
In 2025 there were about 80,000 OD deaths.
In some of the in inbetween years OD deaths approached 10Ok.
Wow. Taking the Sackler family down and Purdue out of business really did the job.
Now let’s look at the truth that he conveniently ignores.
In Oct 2014 legal opiods were moved to Sch 2, placing them in the same category as Cocaine and Meth. This was a typical govt supply side response to a demand side problem.
Despite receiving hundreds of letters from patients and doctors, many of who presciently predicted the increase in OD deaths, Congress and the FDA ignored the warnings and the results speak for themselves. A decade later, a 4-5x increase in OD deaths.
Moving legal opiods to Sch 2 didn’t fix the problem. Instead, it made it worse.
The demand didn’t go away. What went away were the legal drugs that were not dangerous if properly used. What filled the gap were illegal drugs of unknown origin. And the death rate skyrocketed.
In addition the drug companies did not stop producing these drugs. Tonnage was not reduced. Instead they moved their production offshore, and much of what they produce finds its way back to the U.S. to be sold in the street for 10-20x what it costs at a pharmacy.
So we have deaths at 5x. We have no reduction in production. What else did the change do. Well.
The people most hurt by the Oct 2014 changes were legitimate chronic pain patients and the doctors who try and help them. They are now treated like criminals, while the real criminals who jumped at the chance to fill the void roam free, selling their adulterated products which fill ERs with ODs
When the change was made in 2014 no money was provided for new research into chronic pain, no money for addiction treatment, no money for mental health. Govt did what it always does. They addressed the supply and ignored the demand.
It’s fine to blame the Sacklers. But the reality is that it’s not the legal drugs that cause the vast majority of ODs. It’s the illegal ones. And all Congress did in 2014 was ensure that illegal drugs would become the drug of choice for filling the void when the legal drugs became unobtainable.
Lastly. Chronic pain patients who at one time were able to live a pretty normal life are now faced with an impossible choice. Try and live with the pain. Go on the merry go round of expensive and intrusive injections every 3 months that over time destroy tendons and cartilage and introduce who knows what toxins into the body. Or, go out on the street and take the chance.
None of those choices leading to a fulfilling life.
There is one other choice and more suicides than you would imagine are as a result of chronic pain that cannot
The good doctor might be cheering the demise of the Sacklers. But he fails to address the real issues. Which is not surprising.
Maybe if he attended the funeral of a 35 year old chronic pain patient with 3 kids who blew her brains out because she could no longer legally obtain the medication that had previously allowed her to function, his perspective might change.
Read it yesterday…just outstanding. If you haven’t watched it, I encourage you to watch Dopesick, covers opioid addiction,Purdue Pharma and Sacklers. After watching it….you will hate them even more!
Could not agree more. Having practiced Pain Medicine during the 2 Narcotic Wars (War 1- We should write unlimited narcotics, there is no ceiling dose, late 80s to early 90s) and War 2 (all narcotics are bad, tough it out, post first Purdue settlement) the bad players were Academics and the JCAOH. The Academics started the whole thing which Purdue jumped on. They had MS Contin first and never could sell it in volume. Then NYU and Harvard started talking about how we were undertreating pain. There was no limit. Univ of Wisconsin shamed any medical board who did NOT encourage liberal narcotic prescribing. California courts allowed malpractice verdicts for not writing enough narcotics. The ER Docs were the worst. They wrote huge amounts to known abusers so the Press Gainey scores looked good. Purdue offered unlimited grants to societies if they had the Academic Professors speak on writing narcotics. JCAOH made the "Fifth" vital sign mandatory. They continued this even after their own study showed liberal narcotic use in the hospital increased ICU admissions, increased near death issues, and did not decrease pain scores. The conclusion was we must continue the standard even though it increased morbidity and did not reduce the endpoint because "the paperwork is much better". Medicare still takes Purdue's position that narcotics are not dangerous drugs and that abuse can be predicated before anyone is exposed. The LCD (local carrier determination) on urine drug testing has the Purdue bibliography and quotes authors who wrote for Purdue. Historically, the use of narcotics for pain is a pendulum. It swings between over and under prescribing. Overall the villains of this episode is not solely Purdue "The fault, dear Brutus, is not in the stars, but in ourselves"
Sorry, explain the danger of legal opiods? Constipation, psychological addiction, physical addiction, and hearing loss?
The real danger and death comes when the drugs are not available and the grey and black market take over. Overdoses cause the deaths from illegal fentanyl.
When will we admit that our present policy is a failure?
Yes, the Purdue Pharma pushed the drugs but doesn't Merck push vaccines ?
I watched Dope Sick, and am aware of the evil wrought by the Sacklers. It’s shocking in its depravity. I consider myself reasonably intelligent. I fell for the line “only 1% of people taking Oxy become addicted” and used the argument to say the addicts had no one to blame but themselves. I’m very sorry about that.
I've used both oxycodone and hydrocodone temporarily numerous times to deal with both acute pain and chronic pain. I have never had any issues. In fact, except for relieving the pain, neither drug makes me feel "high" at therapeutic doses. When I've taken a lot of hydrocodone, as part of a surgery without general anesthetic, it just made me woozy. Ditto to when I had a different surgery with only Versed and Fentanyl. My issue is that aspirin (gastro), ibuprofen (kidney), and acetaminophen (liver) are all contraindicated in me, except in very rare circumstances, like high fever or acute pain requiring only a single dose. So I find myself a lot of times in a situation where it's either tough it out or take hydrocodone or oxycodone. Mostly, I tough it out. But not always. Being in severe chronic pain destroys my ability to work, earn money, and support my family. I can't afford to take weeks off being miserable after surgery, or when I injure myself. I feel bad for all the people whose lives have been ruined by too many opioids, and illegal drugs are a serious issue that I'm glad we are getting a handle on. But for people like me, I resent anyone, whether the pharma companies or the government's overreaction, who gets in between me and my doctor to dictate what I can and cannot be prescribed for my individual case.
I hope you understand where I'm coming from, Alex. It's not that I don't love your work, or your book "Teach Your Children", it's just that I don't like being treated as a child by the government without evidence that I am, in fact, behaving like a child--or an addict.