October 27, 2017

"The founder of an Arizona-based pharmaceutical company has been charged with spearheading a 'nationwide conspiracy' to illegally distribute fentanyl, a powerful prescription painkiller."

WaPo reports on the charges against the billionaire, John Kapoor, founder of Insys Therapeutics:
Kapoor’s company manufactured Subsys, a type of fentanyl that is sprayed under the tongue. It is meant exclusively for cancer patients who are carefully monitored. Prosecutors allege Insys was not pleased with its sales numbers, and aggressively marketed the drug for use in other patients. That allegedly included the use of bribes and kickbacks, typically in the form of expensive dinners for doctors.

“As alleged, Insys executives improperly influenced health care providers to prescribe a powerful opioid for patients who did not need it, and without complying with FDA requirements, thus putting patients at risk and contributing to the current opioid crisis,” said Mark A. McCormack, Special Agent in Charge of the FDA Office of Criminal Investigations’ Metro Washington Field Office....
Meanwhile, in The New Yorker, there's "The Family That Built an Empire of Pain/The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts," by Patrick Radden Keefe:
A 1995 memo sent to the launch team emphasized that the company did “not want to niche” OxyContin just for cancer pain. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management.... In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.”...

Purdue had a speakers’ bureau, and it paid several thousand clinicians to attend medical conferences and deliver presentations about the merits of the drug. Doctors were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Such spending was worth the investment: internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t. The company advertised in medical journals, sponsored Web sites about chronic pain, and distributed a dizzying variety of OxyContin swag: fishing hats, plush toys, luggage tags. Purdue also produced promotional videos featuring satisfied patients—like a construction worker who talked about how OxyContin had eased his chronic back pain, allowing him to return to work. The videos, which also included testimonials from pain specialists, were sent to tens of thousands of doctors. The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company....

The sales force was heavily incentivized to push the drug. In a memo, a sales manager in Tennessee wrote, “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!” May, who was assigned to the Virginia area, was astonished to learn that especially skillful colleagues were earning hundreds of thousands of dollars in commissions. One year, May’s own sales were so brisk that Purdue rewarded him with a trip to Hawaii. As prescriptions multiplied, Purdue executives—and the Sackler family members on the company’s board—appeared happy to fund such blandishments. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses.....
Yesterday, President Trump declared a national emergency (NYT), but spoke in terms of reaching the addicts (as opposed to arresting the billionaires):
To combat the epidemic, the president said the government would produce “really tough, really big, really great advertising” aimed at persuading Americans not to start using opioids in the first place, seeming to hark back to the “Just Say No” antidrug campaign led by Nancy Reagan in the 1980s.

“This was an idea that I had, where if we can teach young people not to take drugs,” Mr. Trump said, “it’s really, really easy not to take them.” He shared the story of his brother Fred, who he said had struggled with alcohol addiction throughout his life and implored Mr. Trump never to take a drink — advice the president said he had heeded. “We are going to overcome addiction in America,” the president said.
It’s really, really easy not to take them.... I know that's out of context from the entire speech and the NYT is trying to make him seem like an idiot. He knows very well how hard it was for Fred, and he said so repeatedly.

Here's the full speech:



ADDED: Hearing Trump going on about how he's never used drugs or drink, a million substance-influenced Americans have the same thought: If kids look at him as what happens to you if you don't drink or use drugs, he's a walking pro-drug, pro-drink advertisement.

79 comments:

donald said...

No we're not.

Kevin said...

To combat the epidemic, the president said the government would produce “really tough, really big, really great advertising” aimed at persuading Americans not to start using opioids in the first place

Oh God. If only he hadn't said the advertising ws going to be "really tough", "really big", and "really great", we might have had a shot. Now the people trying to stop this scourge will be hampered in their efforts given the outrageous expectations the American people will have. If only Trump had used more conservative word choices like "some", "try", and "attempt to", the really smart people who work for this idiot might have been able to solve the problem.

But now the opioid crisis is likely to persist and it's all that orange idiot's fault! He literally just killed millions of American children with his ridiculous, uncontrolled mouth!

--------------------------

Now that I've posted that for him, Chuck can use his posts for something else.

Ralph L said...

I blame the doctors more than the drug companies.

patients who were “opioid naïve.”...
I looked that term up. It means they haven't taken it regularly recently.

I've never seen Oxy advertised on TV, but Lyrica painkiller is for several ailments.

What I don't get is the frequent ads for rare illness treatments.

Ann Althouse said...

"Really tough, really big, really great" is the language of a huckster. How can the huckster of sobriety possibly counter the hucksters of drugs and alcohol?!

I'll beat them at their own game: Advertising!

Quaestor said...

Trump isn't cool. He's just rich, powerful, and President of the United States.

But he ain't cool.

Ralph L said...

You had me going there, Kevin.

Bob Ellison said...

My son tells me he's been offered prescription drugs regularly at college. "You want some Percs?"

David Begley said...

The swag, trips and other drug company marketing techniques are not all that effective with the doctors I know. A doctor is not going to prescribe a bad drug for a patient in return for a fishing hat or pen.

Kevin said...

ADDED: I'm picturing a million substance-influenced Americans hearing Trump proclaim he's never had used drugs or drink and joking: If kids look at him as what happens to you if you don't drink or use drugs, he's a walking pro-drug, pro-drink advertisement.

Really? Just put together a commercial with Trump and Melania juxtaposed with the typical drug addict and his drug addict wife.

Melania
Strung out heroin user
Melania
Woman who lost all her teeth
Melania
The mother of your kids behind bars

Melania!

rhhardin said...

Usually the evildoers are the ones identifying the evildoers.

Quaestor said...

It’s really, really easy not to take them.... I know that's out of context from the entire speech and the NYT is trying to make him seem like an idiot.

The editors at NYT are the idiots. Either not taking drugs is easy or Trump is some kind of superhuman. There's no logical way to wedge idiocy into that claim unless you maintain that Trump's sobriety is purely accidental.

rhhardin said...

DeQuincy, Confessions of an English Opium-Eater is good.

Ralph L said...

What does that make you, rhhardin?

Oh, crap!

MayBee said...

We really have glorified the use of drugs in our culture. Through music and entertainment.
Even though the rock n' rollers od and the entertainment industry, as we see, is a sex mill.

I don't think we can tell kids just not to take drugs and they won't, but we can sure do a lot better job not making it look like drug use- and I'm talking Opiods and Benzos, too, is just a fun lark. It's too often deadly.
We see young hollywood and young comedians die, and we just keep glorifying.

Quaestor said...

How about a "rock 'n' rap" tax? Is it constitutionally possible to make the entertainment industry shoulder it's fair share of the burden of the drug culture?

MayBee said...

And I just want to say: If you have someone in your life who seems like they may be addicted, get yourself to AlAnon, then find resources to get them help. If they are young, you may be surprised to see the number of groups of young NA and AA and PA people in recovery. There is life outside of drugs and alcohol, even if it is all-pervasive in our culture right nows.
Someone addicted to Alcohol or Benzos needs medical intervention, but someone addicted to opioids *can* detox themselves.

There is a different life out there, but someone in the middle of using often cannot see it. Read "Addictive Thinking: Understanding Self-Deception", available through the Althouse portal.

David Begley said...

Most of this fentayl is coming from China. A giant fentayl bust at the Omaha train station this month.

David Begley said...

“OMAHA, Neb. (AP) — Federal authorities have arrested a man after what officials say is was the largest seizure of the drug fentanyl ever in Nebraska.

Drug Enforcement Administration agents arrested 27-year-old Edgar Navarro-Aguirre on Wednesday after seizing about 33 pounds of the drug, which is an opioid up to 50 times more potent than heroin. Even tiny doses of the drug can be fatal.“

Lost My Cookies said...

I don't like how they take the sales manager's emails to be proof of some kind of conspiracy when they are just typical sales team emails. You can find the equivalent in any salesperson's inbox right now, it doesn't matter if they are selling soap, paper, educational resources for the handicapped, girl scout cookies, or spent nuclear fuel rods.

MayBee said...

Watch Bob and the Monster. It's a documentary about Bob Forrest, a punk rocker and friend of the Red Hot Chili Peppers and a 1980's sensation. He became a junkie and went through rehab sooooo many times. It finally took, and now he's a counselor and he helps musicians and people in the music industry find rehab support.
The documentary is really well done and inspiring, and it also a great counterpoint for people who think you can't get clean if it isn't your idea, and for those who think it isn't worth paying for repeat rehabs.

People are worth saving. "Bob and the Monster" (available via Amazon video)

Ralph L said...

In the 90's, former Drug Czar Bill Bennett said he was surprised to discover the Fed govt wasn't paying for any research into medical treatments to stop addiction. I hope that's changed since the 80's.

Kevin said...

Watch Bob and the Monster. It's a documentary about Bob Forrest

I used to watch him on Celebrity Rehab, which ended when Dr. Drew got tired of people giving him a hard time about celebrities he treated relapsing and dying.

Frankly, that show probably did more to educate the public about the harmful effects of drugs and the costs of getting addicted than anything else. The point that many people go through rehab time and again only to die from their addiction is a message that has to be shown rather than simply told.

MB said...

You can look up your doctors to see what payments they've gotten from drug companies - https://projects.propublica.org/docdollars/

Ann Althouse said...

"Just put together a commercial with Trump and Melania juxtaposed with the typical drug addict and his drug addict wife."

You think young people look at Trump and Melania and identify with that?

I've seen beer commercials. They never — not even just to be different — show Trump and Melania or Trump or Melania type people enjoying the product. Yeah, they don't show messed up addicts, but they show normal looking people having fun doing things like laughing with friends in a comfortable (but not glitzy) interior or outdoors around a campfire or on a beach.

Trump and Melania do not look happy, normal, or particularly healthy. I cannot think of a product that would employ either of them as a positive model. I could imagine Melania as a negative character in a commercial — perhaps a tyrannical boss or a girlfriend who is hurting the feelings of the character the consumer is supposed to identify with.

Ralph L said...

Can addicts walk in stiletto heels?

David Begley said...

$15 million of drugs. And this.

“With that in mind, the amount seized by authorities in its pure form would be enough to kill approximately 4.9 million people, or nearly the entire populations of Iowa and Nebraska.”

Matt Sablan said...

Most people aren't addicted or will ever even be tempted to become addicts. He's right. You don't need to expend effort on most people to keep drugs away from them. But, rather, you need to target the people at risk or already addicted. Which makes me wonder at the efficacy of Just Say No Electric Bugaloo.

I Have Misplaced My Pants said...

I'm picturing a million substance-influenced Americans hearing Trump proclaim he's never had used drugs or drink and joking: If kids look at him as what happens to you if you don't drink or use drugs, he's a walking pro-drug, pro-drink advertisement.

Swing and a miss, Althouse. Pretty sure your average substance abuser isn't locked into the typical elite TDS buffoonery in this country but rather looks at Trump and sees billions of dollars, five pretty grown kids, the presidency and a supermodel wife.

I don't think that poverty stricken hopeless opioid users in Shithole, West Virginia who are overdosing at their kids' softball games are exactly looking down their noses at Trump.

Ann Althouse said...

I only said "a million." I didn't say a hundred million.

There are a lot of people in this country and many of them loathe Trump. The million that I picture are in this group.

Lloyd W. Robertson said...

Funny to think Trump (and Melania?) might be seen as examples not to follow. These are the unfortunate effects of not taking drugs or alcohol: poor impulse control, apparent lack of awareness of simple social graces, especially for someone in a leadership position (don't launch personal attacks on families of dead service members), obsession with a small set of issues, most having to do with oneself, "narcissism." Is it true that Trump and Melania would not be effective spokespeople in advertising? For homes/condos? Vacations or resorts? Furniture? Clothing? Are they a little too Addams Family without the humour?
I don't know, I tend to be anti-anti-Trump. People I respect have said Trump suffers from poor impulse control--referring I guess to the 4 a.m. tweeting, hiring and firing, probably pussy-grabbing. I would say his career as a whole speaks to disciplined, controlled pursuit of objectives. He bet big on Atlantic City without knowing much about the gambling business (another vice which he apparently shuns), but otherwise he has made money. The Toronto Star has run a tut-tutting series about the condo/hotel that was formerly known as Trump Tower in Toronto. Believe it or not, of the original investors, most of them naive about real estate, Trump is the only one who made money. In fact, shock! horror! he didn't even invest! He just made money from a licensing agreement, allowing the group to use his name! His name (no doubt because of past success) lured naive investors into buying units--and by God, they're still in court over this! In fact, once or twice he lied and said he had invested his own money, when in fact he hadn't! The only person to make money out of the entire deal. Not a fool. A few lies that take in suckers don't make him Hitler. Cool and calculating rather than out of control.

DKWalser said...

Taking a doctor to dinner is now an attempt at bribery? They're criminalizing everyday, routine, business practice. I frequently take clients out to dinner. We always go some place nice. My clients are wealthy. I'm NOT taking them someplace they wouldn't go on their own. I never viewed what I was doing as bribery. Nor do I feel any of the attorneys, life insurance agents, and other professionals that have bought me meals were attempting to bribe me.

rehajm said...

People who can't make it to 9 o'clock in the morning without a wallow of Trump hate are addicts. It is frightening how many 'normal' people have been exposed as addicts.

Bad Lieutenant said...

There are a lot of people in this country and many of them loathe Trump. The million that I picture are in this group.

Then I guess they'll die. Sad!

As the Professor Brothers rapped about George Washington,

He'll save children,
But not the British children!

https://youtu.be/l7iVsdRbhnc

Kevin said...

Trump and Melania do not look happy, normal, or particularly healthy.

Your point was that the image of Trump would be a disincentive to abstain from drugs. Not that he's the Madison Avenue perfect pitchman for something.

He's 71. How many 71 year-olds are pitching anything?

My point is that he looks fabulous compared to the drug addict. Melania looks fabulous compared to the drug addict.

The commercial can't be about good-looking younger people abstaining. People contemplating drugs know many good-looking younger people who don't do them, and yet they choose to do drugs anyway.

What they need is a real picture of what people on drugs look like. Because that's the community they're joining when they start taking them. Those will be your fiends. Those will be the people you hang out with. Those are the people you'll be in rehab and holding cells with.

You'll wish they looked like Donald and Melania.

Kevin said...

There are a lot of people in this country and many of them loathe Trump. The million that I picture are in this group.

I'm picturing them shooting heroin and pledging not to get clean until Trump is out of office and a Democrat is elected.

Much like the straight people who wouldn't marry until gays got the right to do so.

Those people still aren't married. It was never about the gays.

Dust Bunny Queen said...

It’s really, really easy not to take them.... being opiates

The epidemic needs to be broken into a couple of demographic areas
1. Those people who have legitimate pain and need some temporary relief.
2. Those who are in chronic pain that cannot go away or are in a terminal illness state
3. Recreational users

Any of those groups can get addicted but it is the #3 group who are the biggest part of the problem

Group 1 is me....I was in an auto accident not too long ago. My SUV was totaled. Hit by a loaded logging truck. Lucky to be alive. The Dr. prescribed some pain killers, which I really needed for the first few days, mainly in order to sleep. Knowing that they are addictive, I restricted my use and only used them at night and for about 4 days. The pain was a reminder that I didn't DIE in the accident. A good thing. Embrace the temporary pain. I still have about 15 of the little guys left.

I can SEE how they can be addictive. The seductive idea to say to yourself....well....maybe just one more. I am in pain after all. I deserve it. Or it says every 6 hours....but every 4 hours won't hurt. It could be easy to get hooked. Most people in group one will not get addicted as long as their Doctor doesn't continue to prescribe beyond the need.

Group 2 Let them have the pills. They are not going to get better. They are going to die. Palliative care

Group 3 Starts out as a recreational thing. Have a couple of pills, drink some booze and get high. Get high to forget your shitty life for a while. Forget that you have no future. Forget that you are just a deplorable, do nothing, dead-ender. Live on government cheese. Steal some of those pills from Group 1 and 2 and sell them because you don't have a job anyway and get more recreational drugs. (I've been told that my small stash of left over pain meds are worth about $40 per pill! Wow)

Do this long enough and it becomes your lifestyle and a giant hole that you cannot get out of without a lot of help. Voluntary or not...rehab (No No No Amy Winehouse reference)

Help is what the Government and Trump can try to provide.

AllenS said...

If everyone in this country knew you, Althouse, how many millions would loathe you?

tim in vermont said...

The neighborhood where I am staying in Boston, every couple of days you run into someone so intoxicated that they can hardly notice the people around them, and walk into poles. It's heartbreaking to see young strong people laying sprawled on a stairway like a dead body. I am considering carrying Narcam.

Dust Bunny Queen said...

Kevin. Here you go.

Pictures of before and after meth. Sometimes the photos are just few years apart.

And those aren't even the worst photos. Do a search.

They could do the same with opiate addicts.

GRW3 said...

No, he's not...

Trump is a walking, talking example of a powerful New Yorker we have been seeing on TV since TV broadcasting began, and the movies before that. He's "normal" to us normal because the broadcast TV and Hollywood have made his archetype normal. Of course, stereotypes exist for a reason.

Kevin said...

Tim, there are better parts of Boston.

Kevin said...

Tim, there are better parts of Boston.

Unless it's during yet another Pats or Red Sox championship parade. Then the whole town pretty much looks like that.

Kevin said...

Maybe Trump could put everyone who doesn't do drugs into a weekly nationwide meat raffle.

Inga...Allie Oop said...


“Help is what the Government and Trump can try to provide.”

Ohhhhh, now that Trump is President, government is no longer the enemy? “ I’m from the government and I’m here to help”, no longer has you rightists running for your guns?

Fernandinande said...

DKWalser said...
Taking a doctor to dinner is now an attempt at bribery?


Yeah, that was a bit off-key - but funny! "Vendor pays" is normal business practice.

So, another wonderful war on drugs. Like other forms of socialism we'll get it right this time!

FullMoon said...

Nobody intends to become an addict.

Couple of things have always annoyed me.

The govt made marijuana out to be some kind of monster drug. Kids see friends smoking mj and not going crazy. Same with LSD. Out of millions taking it, only a few anecdotes of people jumping out of windows like superman. Result is kids naturally assume govt and media lying about every drug. Some people are addicted to drugs but lead a productive life. Real problem is, no way of telling who will become the addict who destroys their life.

Other thing is emphasis on entertainers and famous people who go thru rehab. While a good example, more emphasis should be made of addicts who are still fucked up, or dead. At academy awards, they mention people who died without saying they OD'd.

FullMoon said...

David Begley said... [hush]​[hide comment]

“OMAHA, Neb. (AP) — Federal authorities have arrested a man after what officials say is was the largest seizure of the drug fentanyl ever in Nebraska.

Drug Enforcement Administration agents arrested 27-year-old Edgar Navarro-Aguirre on Wednesday after seizing about 33 pounds of the drug, which is an opioid up to 50 times more potent than heroin. Even tiny doses of the drug can be fatal.“


Some years ago, emphasis on cold medicine, containing pseudo ephedrine, used in making meth(?). Law passed to regulate purchase amount, in milligrams. Shortly after, story in paper of ship from China busted carrying something like 30 tons of the stuff. 30 tons a whole lot more than some boxes of SudaFed

Clyde said...

It's only the people who hate Trump who need the drugs and booze. They can't handle the reality!

Fernandinande said...

@Fullmoon -

1967 Navy training film MN-10507-A. Navy physician talks about the dangers of LSD or "Russian roulette in a sugar cube."

IIRC, everything he says is false, but 50 years later some - many? - people still believe it.

Funny thing is, LSD and related chemicals show some interesting anti-addiction potential, but the propaganda resulted in it being illegal to perform that research.

HoodlumDoodlum said...

A little coke when you could get it...

The salacious details on a pharm company trying to get sales are stupid and off point. Of course they want sales! Of course they aggressively market their products!
These are highly regulated drugs. I have a very hard time believing the tons of Fentanyl flooding the nation are from legal domestic sources.
As to the US pharmaceutical companies being behind the start of the opioid crisis, there is probably a kernel of truth there...but it is MORE true that it kicked off as the medical profession/doctors made a big effort to address pain management. It wasn't some evil plot--the profession as red to address what they saw as chronic problems of not addressing patient pain. So you remember when you first saw all those "describe your pain" charts (with a scale of a happy to a frowny to a very unhappy face)? It was a concerted effort, a good faith attempt to attack a problem. Simultaneously a number of very powerful pain killers became available, and economic conditions helped cause large numbers of Americans going on disability/SSI, and simultaneously out Mexican drug cartel friends shifted production from pot to heroin and other opiods (due in part to pot legalization here and successes in making meth production tougher)...and here we are.

The view that there is a single bad actor (evil pharm co owners, etc) behind the problem is both stupid and a sure recipe for failure in adequately attacking it.

tim in vermont said...

I know that there are 'better' parts of Boston, but I like it here. I don't feel like it's dangerous, like the parts of Boston where I lived 30 years ago. It doesn't change my point.

Amadeus 48 said...

Hucksters gotta huckster.

By the way, "Just say no" is really good advice.

Millions of alcoholics and drug addicts know it.

Caligula said...

"I blame the doctors more than the drug companies."

Doctors are supposed to be the gatekeepers here, not the drug companies. The public reasonably holds a physician to a higher standard than a drug company salesperson.

And it's not just that the physician is a licensed professional but the nature of sales. No reasonable person expects a salesperson to tell "the truth, the whole truth, and nothing but the truth." At best, an honest salesperson tells just that part of the truth that promotes the sale.

Even the patient can be more culpable than the salesperson, if the patient manipulated the physician into prescribing. After all, pain is subjective and, since there are no pain-o-meters, a physician can never know for sure when a patient is lying about pain, or exaggerating its severity.

If the physician is unsure how bad the patient's pain is, is it unreasonable or unprofessional to err on the side of believing the patient? I don't think so, but then I've got a really poor attitude, because I'd rather see 100 addicts OD than see one patient who really needs pain relief denied that relief.

Bruce Hayden said...
This comment has been removed by the author.
MayBee said...

DBQ at 10/27/17, 7:57 AM

So right.

Caligula said...

Perhaps the root problem is, it's time to discard the "addiction is a disease" mantra? Because the addiction process is, at root, mostly just ordinary adaptive human neurology at work. That is, when something provides relief or pleasure then our natural evolved response is to seek more of it, thereby establishing a positive feedback path that reinforces the behavior that produces the reward.

That's how it's supposed to work. When the relief or pleasure is derived from personal achievement or personal relationships we don't call the process a "disease," because it's obviously a beneficial, a neurological process that aids human adaptability. When this system reinforces behaviors that have unacceptably high long-term costs we call the behavior "addictive." But, it's the same evolved behavior, based on the same neurological systems, that mostly operate to our benefit!

So, yes, addiction does "change the brain," but that doesn't make it a "disease of the brain"! For ordinary, healthy behaviors to which we become habituated change the brain and in similar ways. Addiction is a pathological process somehow like cancer or infection but just a normally beneficial neurological process that's become attached to the wrong reward.

So, if addiction is not a pathological brain disease but just a normally beneficial process applied to unfortunate targets, then how is it to be treated? Well, I don't profess to know, but, I'd suggest that a first step would be to acknowledge that the disease model of addiction is not a good model.

Is it so suprising that drug treatment is so dismally ineffective when it's based on faulty assumptions?

Bruce Hayden said...

Whoops. Apple spell correct got away from me.

@DBQ - your category 2, chronic pain sufferers, aren't that homogeneous. Some see the needed dosage to control their pain increase over time, maybe substantially, with no real change in underlying pain level. And then there are those who get on a maintenance dosage and stay there for an extended period of time. I am not talking people like my mother, on a morphine drip for the last couple weeks of her life, but people like a good friend of mine who had six disks in her back damaged in a car wreck maybe 15 years ago, and five of them ultimately replaced. On the flip side was the husband of another friend who had some chronic pain, and a legitimate need for some long term pain meds, but over a period of several years let it get away from him, probably, in the end doing 10x the amount of opioids that that woman is doing. My worry is that the two situations will be lumped together. Right now, the woman is only having to see her pain management doctor a couple times a year, since she is well controlled, having been on this dosage for several years. Patients who aren't well controlled are seen monthly, and that is what everyone is fearing is going to happen with the people who have their chronic pain well controlled. Worse, some states are talking about going to weekly, and not monthly, prescriptions. These aren't prescriptions that the doctor's assistant can phone in, but, rather, you need a paper script, on security paper, etc. which makes any sort of travel problematic.

I should also note that the prescription of pain meds for those in chronic pain seems to be moving fairly quickly to specialists. Partly it is apparently the liability. There just aren't that many really good pain doctors out there who have openings, and they are being pushed real hard right now by the various authorities to see their patients more often than they need to. Think of it this way, this woman sees her pain management doctor maybe twice a year, but if he is forced to see his patients ever month, instead of every six months, he will be able to treat 1/6 as many patients. As noted it is hard enough to find a good one. The demand is high enough that doctors fire patients with the slightest transgression of their pain management contract - this woman was fired by a previous pain mgt Doctor when her back surgeon prescribed her the sort of post-operative pain meds that he routinely does, after her 12 hour back surgery. Those Percocets after a root canal? Forget it.

MayBee said...

Kevin- agreed. They have a podcast now, "This Life". It's good, but Bob and the Monster is great.

Too many people think addicts don't need help/don't deserve help because they made their choice. It's a way we insulate ourselves, I think, from thinking bad things can happen to us or people we love can get caught up in it.
It is a huge struggle, and it takes a lot of support to get through rehab and recovery and even relapse. But it is worth it.

MayBee said...

Prescription drug OD is how Patton Oswald's wife died. Eric Bolling's son (probably). It's a huge tragedy. Have any of you noticed how many obituaries there are in the paper of young people- in their 20's and 30's, who have died and there is no cause of death noted?
I'm shocked when I look at my young Facebook friends, and how many of them have siblings and best friends who have died. Just these beautiful young lives gone.

MayBee said...

Is it so suprising that drug treatment is so dismally ineffective when it's based on faulty assumptions?

I don't think the treatment changes whether you call it a disease or not. And some addictions- alcoholism, for example- is/are inheritable.

Bruce Hayden said...

Part of the problem with drug sales is that the field, in this country is grossly over regulated by the FDA.. Which means that it typically takes > $billion to vring a new drug to market. But they have to be prescribed by physicians, who most typically aren't all that well informed, but are the ncreasingly busy and harried, esp after Obama and the Dems mandated twice the paperwork with their requirement for electronic records. How does a drug company convince enough harried and overworked doctors to prescribe new wonder drug ABCD, when old ABC worked just fine for most of his patients, to cover that > $billion development cost. Esp when competing with wonder drugs ABCE and ABCF. The ubiquitous patient pull advertisements on TV work, at least some, or they wouldn't be so ubiquitous. But the Doctor writing the script is still the gatekeeper, and needs to be convinced too, at least to take the time to do enough investigation that he can justify trying it out on his patients. Which is why a lot of drug salespeople, male and female are good looks. And why retreats and other bribes work.

tommyesq said...

As I recall, when Bill ("I never inhaled") Clinton took office and abandoned the "Just say no" campaign of the Reagan era, drug use among teens rose almost immediately. (http://www.nytimes.com/1993/04/14/us/drug-use-by-younger-teen-agers-appears-to-rise-counter-to-trend.html). Maybe there really is something to the notion that figures of authority exhibiting disapproval serves to influence behavior.

MayBee said...

I've mentioned this elsewhere, but there is also a problem with the FDA. Drugs like Vioxx and Celebrex got pulled because there may have been heart problems down the road, taking a non-addictive yet effective form of painkiller off the market and allowing the opioids to continue.

I am thankful I had my back problem in the early 2000s when Vioxx and Celebrex were available, just before you started getting Vicodin for everything.

Big Mike said...

Trump and Melania do not look happy, normal, or particularly healthy. I cannot think of a product that would employ either of them as a positive model. I could imagine Melania as a negative character in a commercial — perhaps a tyrannical boss or a girlfriend who is hurting the feelings of the character the consumer is supposed to identify with.

I beg your pardon, Professor, I assert that you’re wrong on almost all counts. I’ll give you that it’s not normal to be married to an international model, but the two of them do look happy and healthy, and from my experience with female bosses good and bad, she calls the former to mind much more than the latter.

Amadeus 48 said...

What Big Mike said.

Althouse engages in lookism. She read too any women's magazines back in the day when she had that job.

Sad.

Martin said...

I think when Trump said it's easy not to take them he meant it's easy not to start, and in a Trumpian speech rather than a white paper he didn't get into legit reasons why someone may need pain drugs. That doesn't change teh fact that for people not in severe pain, it may well beeasier to not start than to get off, later. But of course that will be twisted by the media that hate him.

"Just Say No" was not a panacea, but it helped.

Mark Jones said...

"If kids look at him as what happens to you if you don't drink or use drugs, he's a walking pro-drug, pro-drink advertisement."

Yeah? Where's my yuuuuuuuge income and vast net worth? Where's my supermodel wife? Where's my ability to get elected President despite the best efforts of the Democrats, the Republicans, the Deep State and the MSM?

Inga...Allie Oop said...

Never mind Trump encouraging drug abuse by his behavior, maybe he’ll encourage decent behavior because so many young people will look at him in disgust and decide they want to be the opposite of this narcisstic incompetent. Maybe Trump will be a lesson to all Americans, don’t be like him, don’t vote for those that behave like him.

Freeman Hunt said...

"Prosecutors allege Insys was not pleased with its sales numbers, and aggressively marketed the drug for use in other patients. That allegedly included the use of bribes and kickbacks, typically in the form of expensive dinners for doctors."

Isn't that what all pharmaceutical reps do?

Earnest Prole said...

I don't understand the concern over the "opioid crisis." Once the free market works its magic, we'll be left with those strong enough to kick the habit and those smart enough to have never gotten hooked.

Seeing Red said...

Just say No. it worked, too.

But now it’s take a toke.

TreeJoe said...

I despise this kind of tripe, "The sales force was heavily incentivized to push the drug. In a memo, a sales manager in Tennessee wrote, “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!” May, who was assigned to the Virginia area, was astonished to learn that especially skillful colleagues were earning hundreds of thousands of dollars in commissions. One year, May’s own sales were so brisk that Purdue rewarded him with a trip to Hawaii. As prescriptions multiplied, Purdue executives—and the Sackler family members on the company’s board—appeared happy to fund such blandishments. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses...."

A salesforce was incentivized? Shame!
A sales manager announced a bonus program with colorful language? Shame!
Top salespeople earned "hundreds of thousands of dollars in commissions?" Shame!
A salesperson with a particular good year earned a company paid trip? Shame!
These were blandishments? The salesforce was once described in terms of being very valuable to the company? The company paid $40 million in bonuses when it was bringing in billions?

These are statements of standard - and well accepted - behaviors of corporations across the spectrum for at least 6 or 7 decades.

Molly said...

Eaglebeak

1. LSD: Not as benign as all that--speaking from personal experience, back in college. First trip--fabulous. Second trip--okay. Third trip--disastrous, horrifying, terrifying, other bad adjectives.

2. As to whether Trump is cool: Google Trump Thug Life and variations thereof. Pretty funny (to my sophomoric sense of humor, at least).

mockturtle said...

Freeman asks: Isn't that what all pharmaceutical reps do?

Yes but the actual bribes and kickbacks are now illegal. If they can be proven.

Char Char Binks, Esq. said...

Kapoor is charged with "illegally" distributing a drug they had the legal right to distribute!? The salespeople actually worked to SELL their product!? How is it their fault that doctors and pharmacists let this get out of control?

We're now supposed to deny patients in need, many suffering horrendous pain, acute and chronic, because some people get addicted to their drug? Maybe if we allowed people to used some recreational drug other than alcohol, the most dangerous of all, they wouldn't feel the need for fentanyl. We could legalize marijuana, coca leave, and poppies, while still controlling and restricting cocaine, heroin, etc., including fentanyl.

Char Char Binks, Esq. said...

I know poppies are legal. I should have said we should legalize some kind of tincture or extract of opium, while still outlawing or controlling laudanum, opium, heroin, etc., the stronger stuff.

Sebastian said...

"a million substance-influenced Americans have the same thought: If kids look at him as what happens to you if you don't drink or use drugs, he's a walking pro-drug, pro-drink advertisement." Well, yeah, "a million" "substance-infuenced" Americans might think that, being substance influenced and all, or just Trump haters--sure, they would see an active, rich, successful senior next to his super-model wife, and go, get me drugs and drink. Sure.

But no one of sound mind thinks of Donald and Melania as a "pro-drug, pro-drink advertisement," because they don't think of anyone as a "pro-drug, pro-drink advertisement."

Jim at said...

"Maybe Trump will be a lesson to all Americans, don’t be like him, don’t vote for those that behave like him."

You've already cornered that market, Princess Sky Screamer. Trump is a piker compared to the likes of you.

walter said...

Trump made that message a pretty prominent piece of his late campaign rally in Waukesha I was part of coverage)...said something along the lines of if this is the only part that gets through, Ive accomplished something.
It was a pretty poignant moment. You know, for a selfish sexist/bigot/Nazi etc.
Other memories include the 50-ish slender woman in a catsuit with cutouts along the side