In "honour" of 420 day a marijuana poll

[Jacob]

Isn't there the bit about pain management and the fifth vital sign being (at least partially) driven by Purdue sponsored groups?

[Malthus]

That is all true, but it is only half the story. The way this is often described, it is said that the whole thing was a profit-driven scam by these shady companies.

The shady companies existed and they did over-promote (by lying about the addiction potential, offering various incentives to push their meds, etc.). They made money knowing full well what the impact of their practices would be (and are now getting sued by multiple states and provinces, to claw back some of that cash).

But what is often missed, is that even if they had not, the problem would likely have occurred anyway. The pill makers were just taking advantage of a genuine shift in medical practice, which saw pain management as significantly more important than it had been in the past (check out "pain as the fifth vital sign"). This wasn't done sort of self-interested marketing conspiracy, but a real compassionate movement centred on a change in philosophy of patient care. The unintended consequences were terrible.

Companies like Perdue took advantage of this to peddle their allegedly non-addictive opioid (that was just as addictive as any other) ... to take advantage of a medical system much more willing to use drugs to control pain. But they didn't create that willingness, that was created with the best of intentions by actual medical practitioners, who only wanted what was best for patients.

It is very tempting to make the whole scenario a morality tale of capitalism gone bad, which it is in part, but doing so risks missing some of the nuance.

If the fraudulent claim that the pills were not addictive had not been made the pills would not have been prescribed in those numbers.  It is a nonsense to suggest it would have happened absent the fraud. 

Edit: the important take home here is that industry self regulation does not work.

I think you are seeing an either/or claim that is not actually being made.

The problem of increased addiction rates would have surfaced no matter what Perdue did, because that was a risk inherent in medicinal pain management, which was the way the pendulum of medical opinion was swinging at the time. Did Perdue and company make things worse? Absolutely.

Point is this: every time a doc prescribed an opioid for pain, there is a percentage chance the patient will become addicted. Basically nothing can be done about that. It's a risk, but depending on the condition, it may be a risk worth taking - problem was that this risk was not rated seriously enough, against the benefits of pain management.

Now Perdue lied and said it's products did not have any risk, which fed into and took advantage of an already existing pattern, and made the problem much worse. But even products that are not OxyContin were prescribed without enough weight given to addiction risk. The problem would have existed without Perdue (although I can see the attraction of making a simple greed-driven morality take out of this saga).

The problem was that everyone - doctors, regulators, and scientists - greatly underestimated the risk of opioid addiction, which fact only became evident over time. It did not help that the pill makers were actively encouraging everyone else to underestimate that risk, of course, but it is complete nonsense to suggest that they *created* out of whole cloth that underestimation. They simply could not have done what they did, if the medical professionals and regulators had not, with the best intentions in the world, underestimated those risks.

Take the manufacturers out of the equation and the disaster would still have happened, albeit to a lesser extent, because it was inherent in the pendulum shift in pain management.

[Malthus]

Isn't there the bit about pain management and the fifth vital sign being (at least partially) driven by Purdue sponsored groups?

Way it worked was something like this.

Patient groups and medical professionals alike began agitating that the medical profession is not patient centred enough - they tend not to treat patients subjective symptoms, only the objective signs. In short, they treat patients as machines, and only care about keeping them working. Thus leads to a great deal of dissatisfaction, particularly around pain management. Traditionally not seen as a priority (the pain may indicate something is amiss, treat that something so you don't die, but lots of people suffer chronic pain that not much can be done about).

The pendulum swings in their direction. 'Progressive' doctors, heeding the voices of their patients, elevate pain management to equal status with (say) keeping a patient's airway clear. This becomes the medical establishment.

Thus leads to an upswing in prescription of pain medication. As it turns out, while pain can be managed in many ways, nothing actually works as well as opioids on certain kinds of pain.

Unscrupulous companies like Perdue see there is a market for opioids. They do a bunch of research and their own research tells them that their products are addictive. They lie about their products deliberately, claim they are not addictive.

In addition, they create all sorts of incentives for docs to prescribe their stuff, and shove money at already existing groups to promote pain management as a positive good. They did not create this shift, but rather, they encouraged the shift for all they were worth.

Their involvement may well end up discrediting these groups by association, and the pendulum of medical opinion may well swing back again ... but I think it is a mistake to think that the original point (pain management) was simply a greedy sham. It was, I think, more a case of good intentions with bad unintended consequences, with the bad consequences helped along by the greedy companies.

This isn't unprecedented in the medical field - think of the good intentions behind clearing out the old lunatic asylums, with the unintended consequences of filling the jails and the ranks of the homeless.

[Rex Francorum]

Legal - never used it.

[Admiral Yi]

He Rex.  Some of us were just talking about you.

[crazy canuck]

That is all true, but it is only half the story. The way this is often described, it is said that the whole thing was a profit-driven scam by these shady companies.

The shady companies existed and they did over-promote (by lying about the addiction potential, offering various incentives to push their meds, etc.). They made money knowing full well what the impact of their practices would be (and are now getting sued by multiple states and provinces, to claw back some of that cash).

But what is often missed, is that even if they had not, the problem would likely have occurred anyway. The pill makers were just taking advantage of a genuine shift in medical practice, which saw pain management as significantly more important than it had been in the past (check out "pain as the fifth vital sign"). This wasn't done sort of self-interested marketing conspiracy, but a real compassionate movement centred on a change in philosophy of patient care. The unintended consequences were terrible.

Companies like Perdue took advantage of this to peddle their allegedly non-addictive opioid (that was just as addictive as any other) ... to take advantage of a medical system much more willing to use drugs to control pain. But they didn't create that willingness, that was created with the best of intentions by actual medical practitioners, who only wanted what was best for patients.

It is very tempting to make the whole scenario a morality tale of capitalism gone bad, which it is in part, but doing so risks missing some of the nuance.

If the fraudulent claim that the pills were not addictive had not been made the pills would not have been prescribed in those numbers.  It is a nonsense to suggest it would have happened absent the fraud. 

Edit: the important take home here is that industry self regulation does not work.

I think you are seeing an either/or claim that is not actually being made.

The problem of increased addiction rates would have surfaced no matter what Perdue did, because that was a risk inherent in medicinal pain management, which was the way the pendulum of medical opinion was swinging at the time. Did Perdue and company make things worse? Absolutely.

Point is this: every time a doc prescribed an opioid for pain, there is a percentage chance the patient will become addicted. Basically nothing can be done about that. It's a risk, but depending on the condition, it may be a risk worth taking - problem was that this risk was not rated seriously enough, against the benefits of pain management.

Now Perdue lied and said it's products did not have any risk, which fed into and took advantage of an already existing pattern, and made the problem much worse. But even products that are not OxyContin were prescribed without enough weight given to addiction risk. The problem would have existed without Perdue (although I can see the attraction of making a simple greed-driven morality take out of this saga).

The problem was that everyone - doctors, regulators, and scientists - greatly underestimated the risk of opioid addiction, which fact only became evident over time. It did not help that the pill makers were actively encouraging everyone else to underestimate that risk, of course, but it is complete nonsense to suggest that they *created* out of whole cloth that underestimation. They simply could not have done what they did, if the medical professionals and regulators had not, with the best intentions in the world, underestimated those risks.

Take the manufacturers out of the equation and the disaster would still have happened, albeit to a lesser extent, because it was inherent in the pendulum shift in pain management.

Before the fraudulent claim of not being addictive was made, Doctors rarely prescribed opioids for pain management because they understood how addictive it was.  That was the reason the fraudulent claim was made.  We will never know what resources would been poured into the pain management field to find other treatments.  All that become unnecessary and impractical because of the fraudulent claim.  We are now basically starting from scratch.

[crazy canuck]

Given the age demographic of this group I am surprised by the number of people who have never tried it.  Less surprised by the fact that most of the people don't now use it.  We are aging.

[KRonn]

"Recreational marijuana is regulated and taxed but legal in Massachusetts, with retail sales from licensed dealers becoming legal on November 20, 2018. Legalization occurred in staging, with decriminalization followed by legal medical marijuana before full legalization."

I had to lookup just what the laws were in my state. I don't use it, have tried it when younger, smoked a bit just a couple time. But I had pot brownies once or twice and damn those things were potent!! 

[Tonitrus]

That was the Clinton method. 

[KRonn]

That was the Clinton method.