The patent is for sublingual buprenorphine, which has appears to have been available since the early 80's, while buprenorphine has existed for 50 years.[1] It seems like we're getting the exactly patent ever-greening behavior we have incentivized.
I disagree that this is not novel. It's an immediately dissolvable buprenorphine. I discussed this in my top level comment, but subutex has been abused because it does take some time to dissolve, so patients will sometimes take it out of their mouth when the healthcare provider is not looking in order to inject later. This version avoids that to some extent, which is novel enough to be patentable.
Eh. Bupe isn’t that abusable, so you very quickly get a couple weeks of take-home doses. So if you’re going to IV it, this new patent makes zero difference.
sublingual buprenorphine like Subutex is only indicated for take-home if the patient can not tolerate suboxone (oral buprenorphine/naloxone). If you're prescribing subutex take-home just because, you're not following the preferred prescribing practices. Suboxone and subutex are not used the same way, as I described in my top level comment in this thread.
Subutex is for patients that are not clinically stable, so they get daily doses from their treatment center and are watched as they take the medicine. You could argue that the providers should watch them until they have dissolved it, and thus this patent is over-engineering a solution, but that's not what you argued.
Suboxone is for patients that are clinically stable, compliant, and/or are unable to make frequent visits to their treatment center, so they are able to take-home their medication and take it as prescribed. These are patients that you as the healthcare provider are relatively certain wouldn't abuse it.
And yes, while buprenorphine isn't as abusable as most other medications, and is far more forgiving than methadone, it's not perfect, and there is still some liability for abuse, especially with subutex. So while I agree that this patent makes very little difference (again, check my longer comment), it's not all that bad of an idea, hence why Purdue likely patented it.
Which is why I said "bupe" instead of naming either formulation. Suboxone is just as IV-abusable as Subutex itself. It makes little difference in practice. (I'm on Subutex, but that's because I'm on 0.8mg daily -- down from 32mg originally. I've never abused mine, because I really don't see the point, but I've seen enough people who have). Subutex is barely prescribed at all in Australia, where I'm from, but it makes effectively zero difference in IV usage -- the naltrexone does nothing compared to how strongly bupe itself binds to your receptors.
Sure, they're both IV abusable, but my point was that for the patients that are still addicted to opioids the more immediate dissolve of the patented formulation would make it more preferable to subutex for providers, simply because they know that a patient couldn't take the tablet out of their mouth since it would have dissolved immediately. It's those patients we're trying to get back on track with something better, not the patients we know are able to manage on take-home regimens.
> the naltrexone does nothing compared to how strongly bupe itself binds to your receptors.
What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them. And secondly, it's very, VERY well known that naloxone/naltrexone have far more binding affinity to the mu-opioid receptor (the type that we think causes euphoria/analgesia) compared to any sort of opioid we have on the market (maybe not sufentanyl, but even that I'm fairly certain is weaker affinity). That's exactly why we can use Narcan effectively to combat opioid overdose.
> What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them.
I always get them mixed up, but it really isn't changing my point. And yes, no kidding, you brought up Suboxone as well as Subutex which is why I'm discussing it! I'd really prefer if you read my comments with a little more charity. Anyway, it doesn't appear as if you're listening to my point here, and that's okay :) Have a good day
You'd be surprised. It's definitely being sold on as an opiate to addicts in UK prisons, both from being smuggled in (small, easily concealed, innocuous looking pills) and diversion from maintenance scripts (although I would have thought in a prison environment they would simply stand over you and wait until you swallow, or force you to drink a glass of water, since unlike someone on a treatment program voluntarily there are no issues about personal liberty etc. From what I've heard, the 8mg tablets are crushed into powder, divided into eighths and sold as 1mg doses for snorting (maybe injecting, but works in prison are pretty dodgy...)
Interestingly, although the treatment center I'm with offers both Methadone and Subutex/Suboxone I was never actually given the choice between the two, or informed of the pros and cons of either. I asked, and basically I was put on Methadone treatment because I happened to mention it in one of my admission interviews. No idea if this is policy driven due to pricing or something else?
Actually, I suspect it may just be a lack of training due to low funding levels, poor compensation for staff which leads to high turnover and lower quality. Thanks, NHS.
People will abuse anything that helps to numb painful emotions. Demonizing the drug isn't helpful; if you get rid of one, people will lean on something else. The solution to drug addiction is very simple: give people better ways of dealing with their emotional pain. Of course, actually accomplishing that is the hard part.
My personal belief is that we need a two-fold attack:
1) Harm reduction: provide people with less harmful emotional anesthetics (like Kratom)
2) Fix the underlying problem: provide people with better mental health care, better coping strategies, more community and more human connection.
Most people agree that #2 is needed, but #1 is controversial. I think that we should treat emotional injuries like physical injuries. When someone breaks their leg and they ask for painkillers, we don't tell them "sorry, but you know that painkillers aren't going to help you heal any faster."
Sometimes people need palliative treatments, but we're unwilling to provide these when it comes to psychological pain. As far as I can tell, this unwillingness is based entirely on an aphoristic assumption: "if you want to heal it, you have to feel it." Okay, great, but where's the science? Where's the research? Do you have to feel it completely to heal it, or can you take a drug that helps you feel it a bit less? What's the exact relationship between experiencing distress and healing that distress? We can't allow slogans to guide the treatment of psychological trauma.
Addiction is physiological. You're describing psychological dependence. You can die from drug withdrawal. Given that, medicine which aids in weaning off addictive drugs seem useful.
If you read the patent, this is simply a faster dissolving suboxone, which is already an extremely common form of substitution therapy. This isn't anything radically new. I would say it doesn't deem itself worthy of patent, but I know nothing of patent laws.
This is the type of "research" Big Pharma often does that needs all of those billions of dollars and 4,000% price increases of life-saving drugs, according to some.
The correct course of action is to charge the manufacturers of addictive drugs for the recovery costs.
It would discourage pushing over prescription, encourage more work into accurately identifying addictiveness (and presumably reducing it), and if all else fails would encourage them to develop cheap drugs to recover from addiction.
A more abrupt correct course of action comes to mind
followed by seizing all assets even tangentially related as inadequate compensation for horrific damages.
ya know, to make an example,
like we do with the little people.
So if a manufacturer produces a drug which saves tens of millions of people from suffering and a few million of those don't follow manufacturer or doctor instructions and abuse it, the drug manufacturer should be shut down?
If a drug dealer sells a drug that people enjoy and use to improve their quality of life, but a few people don't follow his advice and become addicted and die as a result, the drug dealer should go to prison for manslaughter?
No, I don't think they should, if what they're selling is what they claim to be selling. If it's laced with fentanyl or some other adulterant, that's another story (regardless of whether they were aware it was adulterated or not).
You are home, sleeping after another boring day at work.
You wake up being beaten back unconscious, extremities broken, ribs kicked in. They dial 911 and leave.
When you get back from the hospital they will come take your drugs.
Why? Nothing personal,
just that unlike many of your rural brethren, you have insurance.
People deliberately created your guests and are profiting even now from your pain, should they be shut down?
Urban legend. With broken bones and enough injuries to be prescribed an amount of take home opiates that would be worthwhile for an addict, you'd be in hospital fora day or two at least, maybe more. One thing about addiction is that immediate access to the drug is more important than anything else. No addict is going to bother with this sort of thing just to get a dozen or so Codeine pills...
Yes, if they’ve contributed to the opioid addiction of a few million people, they should bear some responsibility. Of course the distributors supplying the black market and pill mills should also bear responsibility. But if you penalize the drug companies, you can be sure they’ll tighten up their distribution.
This is a total whitewash of the role pharmaceutical companies played by intensely pushing opiates while downplaying negative ramifications they were well aware of.
What number of deaths is ok? There were 63,632 fatal overdoses in 2016 and nearly two-thirds of those deaths involved a prescription or illicit opioids.
That just won’t happen in America (look at equifax).
But making manufacturers responsible for covering costs for recovery/withdrawal from drugs they sell would encourage them to work to make drugs less addictive (currently making an addictive drug is a perpetual money printing machine), and result in them coming up with better/faster/cheaper drugs to withdraw.
I mean if an individual stage did this of course they’d just bribe (I mean support) some senators to make such a rule unenforceable at a federal level.
Opiates are fungible. Heroin and oxy are interchangeable, how do you determine what liability Purdue has if someone started using heroin but also buys oxy or starts on oxy and switches to heroin?
There would be an expected prescription rate for geographic areas, specialties, doctors etc. I’m sure it’s very easy to tell who is going through a lot of it and potentially causing harm. Knowing this and continuing to provide the drug is where the line is crossed in my opinion.
Wait wouldn't that mean expecting them to profile and essentially engage in redlining /from the upper supply chain/ instead of the patients and subscribers?
Assuming that it is 'easy' to tell who is abusing drugs in itself sounds like a way to do a lot of harm.
I hate this profit seeking marketing BS and I think it's kind of evil. They must know better. I can't believe they don't have data on actual use of Buprenorphine specifically the number of patients who take it long term and have huge issues tapering off Buprenorphine itself.
Getting off suboxone itself is very difficult. It seems most users describe the withdrawal as harder than heroin because it lasts a much longer time. [1] [2]
I'm perfectly fine with the idea of replacement therapy. And in fact I actually think we should just provide pure morphine to users for free it would actually be pretty safe for long term use (and WAY cheaper).
Long term Suboxone replacement therapy also sounds like a great tool if it weren't for the marketing lies and profit. That's where my huge beef is.
Yet again making big profit by marketing the (at best not the whole truth, I think truth is closer to false and morally corrupt) idea that this is temporary. Maybe after they make a few billion and get people hooked on subs they will pivot to sell another expensive patented drug to 'wean off' suboxone and continue the profits. Of course there are examples of users being able to taper off. But there seems to be far more examples of users not being able to wean from Buprenorphine itself.
There was a prominent doctor here in Topeka who was fired from the hospital for keeping folks on Suboxone. The idea of course is that you can have a nice gentle taper, same with methadone, but the reality is you can't "beat" withdrawal. So people stay on it. The euphoria from these drugs doesn't come close to heroin, so people are continually going back and forth. There's an added danger because buprenorphine binds tighter that if it's in your system it takes a lot more dope to kick the buprenorphine off the receptors, so lots of overdoses. This, I believe, is the reality.
Of course Suboxone and methadone are so much safer to use than street heroin. And doctors will help those who want to, to taper. I just don't think that describes most sub/methadone users.
I don't think the issue is a lack of safer alternatives. It's whatever is driving the person to seek out the effects produced by those drugs in the first place.
Very few of us want to be on subs or done, and even fewer enjoy being an addict. Even if it is safer than H. Your “I think” doesn’t really align with my experience at all, at least here in Australia. Shout out to Biala, they saved my life.
Also, all forms of buprenorphine (aka Suboxone) often end up being a heroin substitute rather than weaning the addict from heroin. Kinda like how Oxy functions in real-world application.
The difference is, Suboxone is mandated in alternative sentencing programs by the judiciary of certain states. And in some states, with no consideration of whether the addict was addicted to opiates/opioids.
Do you have a source on that last part I could read more about? The idea of a court mandating opiate treatment because someone smoked weed is terrifying.
plenty of people successfully use buprenorphine to taper off heroin. some people do end up going on long term buprenorphine maintenance, but the harm there is radically less than an active oxy/heroin addiction. even in the worst case scenario, any day that an opioid addict takes buprenorphine is a day where they have far less risk of fatal overdose.
It also drastically decreases the likelyhood of potential harm from the government's use of violence in it's drug war. This is not an insignificant part of the danger of opioid use.
Exactly. Additionally, methadone increases cardiac mortality by increasing the QT interval, so the drug with better efficacy and safety profile should fully replace it.
Buprenorphine is good. And someone can’t get on it if they’re too addicted to opiates because as a partial agonist it can precipitate accelerated withdrawal, which acts as a protective mechanism, I imagine.
Buprenorphine also increases cardiac mortality by increasing the QT interval. Buprenorphine is used over methadone mostly because its a partial agonist of the mu-opioid receptor which basically limits how high you can get.
You’re right! I hadn’t known that buprenorphine also caused it, but it seems all of the drugs used for that purpose. I did find a 2013 study stating that the effect was significantly less than that from methadone, but it’s good to know that both come with cardiac risks.
I would disagree that buprenorphine is safer than oxycodone or pharmacologially pure heroin. Buprenorphine has more dangerous potential side effects than either of them, meaning it would be safer to use heroin or oxycodone. Also, the reduced risk of overdose isn't because of the drug, it's because the user isn't dosing it themselves.
This happened to a friend of mine. He does heroin recreationally and isn't addicted and doesn't get withdrawal symptoms. The court mandated he go to treatment and was basically required to take buprenorphine during treatment regardless of him needing it. The treatment facility also didn't believe him when he told them how much he used and thought he was still using in the facility because he didn't have withdrawal symptoms even though the drug tests said otherwise.
On the methadone program I'm on, before they could start the treatment, I had to take multiple toxicology screens to show I was addicted to heroin. These places are incredibly worried about opiate-naive individuals overdosing, which can happen even with the small initial doses on these programs. Note that this is in the UK, which has a much less litigious medical culture USA as well...
Not to cast aspersions on your friend, but have you considered that he may be lying to you about only using recreationally, and using this story to explain why he's on a treatment program? One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted. As a heroin addict myself I know that unfortunately deception can easily become a normal part of your life.
> You said pretty much impossible which means it's possible.
Is that how it works? If the sentence had been "walking through a wall via quantum tunneling is pretty much impossible" would you have also translated that to "walking through a wall via quantum tunneling is possible"? Would this have been a helpful translation?
A test to show you are addicted to opiates does not exist, and also your own experiences do not represent the experiences of every person that ever used drugs.
Yes, technically the tests are to show the opposite - that you are (not) opiate naive. Someone who can pass multiple closely spaced toxicology screens for heroin (i.e. opiates are not detected) is never going to be admitted to one of these maintenance programs due to the incredibly high risk of death by overdose.
> One thing about heroin is that it's pretty much impossible to use regularly without becoming addicted.
I'm happy to hear that your treatment is going well -- opioids can be incredibly hard to kick. On the other hand, you might be interested in some of the newer science of what drives addiction:
Not every person who uses a particular drug recreationally can or will get addicted to it. It depends on brain chemistry and a variety of other factors.
As far as noticable withdrawals, it takes a lot longer than 4 days for someone who’s new to it. If you’ve ever been an addict to opiates before though, yeah that’s about right.
If they were immediately addictive, everyone that got a morphine shot in the hospital would need to seek treatment. It isn't a "one use and you are addicted" or even "occasional (recreational) use will get you addicted". A portion of folks will seek it out more often, but most folks will just seek it out occasionally.
With opiates, the bigger danger is daily or consistent use over a period of time. The period depending on how often you take it and how you are using it and the strength of your dose.
Yes, but it is the same with things like alcohol. Most folks that smoke pot daily don't start out that way either. Most folks that wind up with a coke habit only do it occasionally at first as well. Lots more people do these things in an actual recreational pattern - every so often. Only a portion get addicted because only a portion ever do it that often.
Yet, if someone has an incident with alcohol (for example), they might be required to attend AA meetings even if they aren't a regular drinker. Same with other drugs.
This is true even if heroin withdrawal symptoms start after just a few days. Recreational use generally isn't daily use or two days in a row.
Oxycodone (present in oxycontin and percocet) is a full opioid agonist. Buprenorphine is a partial agonist and actually blocks most of subsequent opioid's effects.
During the bird flu scare, a bunch of countries said that they were ready to ignore the patents on Tamiflu and produce it on their own if they don't get shipments of it - Taiwan, India, Indonesia...
Economic incentives were likely the only reason for this development, though. Claim civil asset forfeiture on drug patents and watch how quickly the well dries. Oxy won't be the last dangerous, addictive drug that society faces.
Cibil forfeiture would be seizing the assets of these drug cartels for their intentionally criminal behavior of bribing doctors and lying to regulators.
To be fair I wouldn't want that either - especially depending on the state. The state positions are far too subject to demagoguery for the sake of career advancement. An appointed and tenured agency like the FDA is at least better in that respect that they are more likely to act based upon actual problems with some degree of caution and attention to evidence instead of stirring up panics for the sake of advancement. Unlike literally every 'tough on crime' politician and the abhorrent historical trends. Precisely the reason why they are appointed instead of elected officials.
You are right, of course, generally speaking. It -- corruption -- seems to be one of humanity's most intractable problems. But just talking only about the FDA specifically, they are clearly in the pockets of the pharmaceutical industry. The FDA makes policy decisions that are highly influenced by pharmaceutical companies and completely counter to the body of scientific evidence. Just go read Scott Gottlieb's Twitter feed. Or do even the most minimal, cursory research on the FDA's history. This may not mean anything to you, but I personally believe that regulatory capture is greater in the FDA than it is in the CPUC, California's hilarious "public" utilities commission.
Yeah it is all heuristic at this point. There is one radical theoretical solution for regulatory capture that I can see which could have its own issues both economically and incentive wise: regulatory jobs are the last job one takes. In exchange for a lifelong pension they can never work or accept any form of compensation ever again. This would include running their own business and indeeed all forms of compensation including speaking fees and even amenities. You are free to go speak at every Ivy league after retirement but that is essentially just a hobby. It would no doubt be expensive in itself but it could pay off in reduced corruption costs.
"We share the state’s concern about the opioid crisis. While our opioid medicines account for less than 2% of total prescriptions, we will continue to work collaboratively with the state toward bringing meaningful solutions to address this public health challenge"
“First they came for the big pharma capitalists that caused opioid epidemic, and I did not speak up because I was not a big pharma capitalist that caused the opioid epidemic.” Etc.
What if I work real hard and become one of those guys one day. I don’t wanna get executed.
That sounds literally identical to 'If you're not doing anything wrong do you haven't anything to hide.' or 'Don't commit crime if you don't want to be raped in prison.' "Lets just throw out civil rights." is an incredibly dangerous notion.
Don’t see anything anti “civil rights” about using a punishment often given to people who kill a single victim to people who kill hundreds of thousands, just because the more efficient killers do so from an office building.
People post this quote all the time, but he never actually said that. It's a misinterpretation of one of his stories where the "temporarily embarrassed millionares" are people that voted to have a socialist society thinking that everyone would become wealthy, but in reality everyone became poor except for people in the government. They consider themselves temporarily embarrassed because they believed that giving the government full control of their lives would be better than capitalism, and they don't want to admit that they were all naive.
I was prescribed Oxycondon (the generic) for kidney stones and it really helped me get through excruciating pain. (My stones are not seriously enough to require surgery but you gotta sit through the pain to wait for them to pass through).
But as soon as the pain become remotely manageable I stopped it and just used NSAIDs.
Because it doesn't take a genius to look up online what you're taking and know the side effects (I'm counting addition as one)
To this day I keep the unused pills close just in case but I honestly never once tempted to use them for recreational purposes.
I guess my point is that it takes two to tango and let's not throw personal responsibility out of the window when talking about opioids.
So you're saying you disobeyed your doctor's recommendations in managing a common type of acute pain and you think that justifies demonizing other people who have had different experiences? That seems not only callous but also extraordinarily naive and self-absorbed. You can't know what other people's experiences were like, especially those with chronic or more severe pain.
your anecdata doesn't account for the range of experiences that can lead others into trouble.
different people have individual relationships with opiates. Some have no trouble keeping recreational enjoyment occassional. Some are able to use them therapeutically then taper off. Others are more susceptible to problematic abuse, irrespective of whether they were prescribed or sourced elsewhere.
your anecdata is as much about good luck as a morally superior appreciation of responsibility.
All anecdotal, but I had severe kidney stone issues as well - I know the pain!
I had several kidney stones while I lived in Sweden, and they did give me opiates for it - but only at the hospital. I was prescribed Diclofenac (an NSAID) as a fast-acting suppository to take home, with instructions to take that and then go to the hospital if I had another stone.
The next time I woke up with cramps, I did as told, and the meds worked quickly to reduce the pain to manageable levels until I got to hospital.
Perhaps there are medical reasons to prescribe some patients a take-home opiate for this.. but I can't help but wonder if kick-back programs and so on are playing a role here for what treatment path doctors choose.
Last time I was prescribed opiates, I got a standard prescription. There were about 20 pills, inside a box. The box had 20 bubbles, each with one pill in it.
Unsure of how long the pain would last, this worked. I was able to sleep a few nights and work out the pain since I had a few things to do. I had an xray planned just in case, but it wound up being necessary.
I don't see the point of taking more pills than I have needed, so they are in the cabinet. I also don't see the point of breaking up a bubble package at the pharmacy. They are made to both keep costs down and ensure pill safety. No pill miscounts, for example. Bubble packs have shown to help slow down suicides as well (people have to work harder to get the pills out, giving them time to rethink things at the last minute). I don't have a history of asking for pain medicine.
The time before this was for gall bladder surgery some years ago. As soon as I didn't need the pills, I stopped taking them. This was in the US, so they were loose pills, but I*m not sure they numbered more. I did need one later when I returned to work as the first day was rough. I assume the prescription I received was standard procedure after the operation. Just because I didn't need that many doesn't mean that someone else didn't.
The preponderance of people who developed an addiction to prescription opioids were following their doctor's instructions in good faith — which instructions were taken from Purdue's disclosures, and included things like "take every 12h" for a drug they knew was only effective for 8.
In that context, "it doesn't take a genius" and "personal responsibility" are rather victim-blaming.
i'm curious whether you experience chronic pain yourself. opioids are a dangerous class of drugs, and the decision to use them is based on weighing the severity of a person's pain against the inherent risks of using the drugs. in a certain sense, i find it quite inhumane that this decision can only be made by someone who has no accurate way of knowing how much pain the patient feels.
One of my molars worked itself loose, which hurt like hell, and my mom had some OxyContin laying around from when she broke her wrist so...on that particular day I was very happy my mom was displaying "early addict behavior".
to clarify by just in case I meant for the kidney stones: some argue it is more painful than labor or getting kicked in the nuts (luckily I didn't experience neither)
I downvoted because you can't see this situation through anything but your own lens and decided to victim blame. It's great that you didn't get addicted, but it's awful that you're saying it takes two to tango.
Drugs prescribed to you are not illegal to possess. Nor will someone you live (or is visiting you) with get in trouble for being in the home with them.
While I'm interested in anything to halt or stop the opioid crisis, anything from the owners of OkyContin must be treated with a large grain of salt. OxyContin was nominally supposed to be a slow release low risk opioid for chronic pain sufferers. Not only has that not worked out so well, it's pretty clear that they understood the risks and basically straight up lied to doctors about the risks. They have the capability to create these compounds, but they also have very low trustworthiness.
If you understand who Richard "Dirty Dick" Sadler is, the story makes a lot more sense:
Sackler joined Purdue Pharma in 1971, as assistant to the president.[8] He became head of R&D and head of marketing before becoming president in 1999, and co-chairman in 2003.[8] Sackler was in charge of the research department that developed OxyContin. As president, he approved the targeted marketing schemes to promote sales of OxyContin to doctors, pharmacists, nurses, academics, and others. Shelby Sherman, an ex-Purdue sales rep, has called these marketing schemes "graft".[2]
In 2015, Sackler was deposed by four lawyers in Louisville, Kentucky. The deposition concerned the development and marketing of OxyContin under the watch of him and his family, who were and are active board members of their private company, Purdue Pharma. The marketing and prescribing of OxyContin in Pike County, Kentucky, was of particular interest.
Before the case could go to trial and thus before the deposition could become a matter of public record, Purdue settled for $24 million, admitting no liability, sealing the deposition, and requiring the Kentucky prosecutors to destroy, or return to Purdue, millions of pages of internal documents obtained from the company during discovery. The medical news website STAT then sued to unseal Richard Sackler's deposition. A state judge ruled in its favor. Purdue appealed, and, as of October 26, 2017, that appeal remains outstanding. The deposition cannot be made public unless the appeal is decided in favor of STAT again.[9]
Sackler has donated to both Republican and Democratic politicians, though chiefly to Republicans.[3] His charitable foundation, the Richard and Beth Sackler Foundation, has donated to anti-Muslim organizations, as well as to organizations that have promoted the falsehood that millions of undocumented immigrants voted in the 2016 presidential election.[3]
Sackler is a member of the board of advisors of the Koch Institute for Integrative Cancer Research.[7]
--------------------
Even when they were developing opioids, they knew that that long term care was ineffective and that the risks outweigh the benefits for long term care. This guy does not care. Politicians are on the take so they don't care. As long as companies can patent and profit off of prescription drugs, this problem will continue. It's that simple, yet no one in government has the guts to take these people on. For starters, someone get that damn transcript because I'm sure it has plenty of information to blow the lid off of this.
Been there, done that; went through hell to get off OxyContin after a climbing accident.
Repeat customers are created by doing long term harm while providing short term relief, expecting corporations to actually solve problems or have a conscience is beyond silly.
I was switched from Oxy (liquid) to morphine after tongue cancer surgery and months of mouth and neck radiation treatment. Was on a maintenance plus "break through pain" prescription for 6 months. It took a week to get withdrawal symptom free with the first 3 days being the worst. It wasn't terrible but I don't want to have to do it again.
Just some background information on the drug patent (which washington post's link to the patent is paywalled, so here: https://patentimages.storage.googleapis.com/85/96/76/8ba72da...). It's basically buprenorphine (an opioid agonist that is technically non-addictive and indicated for pain control in opioid dependent patients) in a different delivery package that is quite frankly superior to our current versions of buprenorphine.
Our current methods of providing buprenorphine are via sublingual (under your tongue, Subutex) or orally (Suboxone, which is actually buprenorphine plus naloxone).
It's a wafer that immediately dissolves when taken delivering the drug orally.
Now, these methods of administration are pretty good. Subutex will dissolve relatively quickly and you've got good pain management in recovering addicts. However, patients will sometimes take these out of their mouth quickly before the healthcare provider notices, so that they can inject it later (which can definitely provide the euphoria associated with opioids).
Suboxone gets around that somewhat, by combining the buprenorphine with naloxone, an opioid antagonist. This works because if the provider wants to give the patient a longer term supply, the user can't abuse it by dissolving the med and injecting it. Why? Because the opioid antagonist that is built in only works when injected, causing severe withdrawal. The issue with this, however, is that opioid addicts are smart. They burn off the naloxone and then inject.
So this drug patent offers an alternative: give wafers of buprenorphine at addiction centers that dissolve immediately in front of the healthcare provider. This avoids the hiding issue of subutex, and provides the same route of administration which is the benefit of subutex over suboxone.
Now, at the end of the day, does any of this matter? Not really. Subutex is still hard to get covered by insurance, so most providers stick with Suboxone (or generics, as I think that's available now) anyways. Do you think that this new medication will make it into practice? We don't even have phase 1 trial data on the drug, just a patent.
If you're really outraged over a drug being patented, though, then the discussion becomes far more complicated. Smarter individuals than myself argue that on HN all the time.
Crazy. Sub clinics are sad places. Gray-faced junkies paying $3-400/month to stay hooked. A buprenorphine script is probably $10/month. It's a racket. Capitalism at work.
Wow! This makes slightly less angry about the hoops I had to jump through to get on a treatment program with the NHS in the UK. (Well, the part of it where prescriptions are still free.) At least they don't add to the problem by making you pay to get help...
This seems much more related to the specific political economy of government health institutions and their interaction with electoral systems, than a specific causal attribution to systems based on capital. That is to say, there are many failure and success modes of a government response to drugs that are orthogonal, or at least only loosely correlated, with the specific marker system that is implemented.
Jack Donaghy: Imagine that your favorite corn chip manufacturer also owned the number one diarrhea medication.
Liz Lemon: That'd be great, 'cause then they could put a little sample of the medicine in each bag.
Jack Donaghy: Keep thinking.
Liz Lemon: [beat] Except then they might be tempted to make the corn chips give you...
Jack Donaghy: Vertical integration.
Build the poison, with the antidote to (much) later follow ... A perfectly sound business model. Reinforce the pathways that ensure that an industry's products (prescription drugs) will never fall out of vogue as the mechanism to solve all of people's problems, and make (a lot of) money all the while. Subjugation through palliation, a textbook case.
Remember when Oxycontin was supposed to be a pain pill that was "impossible to get addicted to"? Yeah... I'm trusting this "relief measure" about as much as I trusted that line in the 90s.
This is just gonna be their new wave of "milder" Oxy, that people get hooked on first. Sure, we're sold that its for helping things now... But give it a few years and this will be just another prescription opiate slung by street dealers. "Oh its safer!"
Buprenorphine has been available for as long as oxycontin. Subutex (the trade name) is sold on the street, and is a commonly abused drug in UK prisons currently, usually as fractions of a pill taken nasally.
Really, this patent is nothing to do with the drugs involved - even the idea of adding Naloxone isn't new, this is available as Suboxone, nor is the idea of sub-lingual administration. As far as I can tell what is being patented is administration in a gelatin-film matrix that dissolves very quickly, preventing diversion and resale on the street.
Remember that these drugs are not just handed out as a month's supply of pills like you would get antibiotics. Instead, they are 'supervised delivery' where the user must take the pill in front of a pharmacist. The fear is that if the pill takes 5m to dissolve, then it could be spit out and sold on once the pharmacy or treatment center has been left, so dissolving in seconds prevents this. Personally, I'm not convinced this is a problem except perhaps in prisons (see above) but then I'm also not convinced the idea is patentable...
> Remember when Oxycontin was supposed to be a pain pill that was "impossible to get addicted to"? Yeah... I'm trusting this "relief measure" about as much as I trusted that line in the 90s.
Huh? Oxycodone is extremely addictive, just like every other opioid. This has been well known since always.
I don't know that they ever flat-out phrased it as extremely as "impossible to get addicted to", but Purdue Pharma definitely made puffed-up claims that the extended-release nature of OxyContin drastically lowered addiction potential compared to immediate-release opioids. They were fined $600M for aggressively misleading marketing about its addiction potential and reduced side effects [1].
It's been known forever that all opiates are addictive, varying only by degree to some extent. At least with Methadone there was the excuse that it was chemically different...
While that was my first thought on reading the headline, consider this scenario:
Man makes a drug to help people in pain. Turns out this comes with some nasty side effects. Feeling guilty, he works on a way to help undo what he made.
Not that I believe this was the case, but this is a damned-if-you-do-damned-if-you-don't situation.
Sometimes I wonder what it would be like to go through life with no conscience. I don't really want to be a sociopath but I admit that to be free from guilt or anxiety over my actions at even a level one tenth of this guy would be nice.
Opioid pain drugs are life savers for people who actually need them, so I think this is a bit more complicated than capitalist Satan-incarnate vs. the poor helpless fools duped into taking his wicked drug.
It is certainly more complicated, but that doesn't necessarily make the manufactures look better. From all accounts, they marketed their drug as non-addictive, in spite of evidence they had to the contrary.
Now after getting people addicted to their safe medication, they've made a "cure" for it. Who's to say the cure isn't worse than the disease? I wouldn't trust them to make that judgement call. It isn't as if Oxycodone is the only way to manage pain either.
Purdue were aggressively pushing oxy to people who didn't need them though, and were describing it as non-addictive even though they knew it was addictive.
People always say "what about those who have pain at the 8, 9 or 10 end of the scale?" Well, the US could probably cut prescribing by 80% and leave those people still on the meds.
I'm not denying that opioid drugs are useful, but the way Purdue Pharma actually acted is much more in line with a capitalist Satan-incarnate view, regardless of the benefits of opioids.
If one only cares about oneself, then yes, mild sociopathy would probably be beneficial, but that's somewhat of a tautology. It's definitely better for society as a whole to minimize sociopathy though.
The above notwithstanding, labeling a desire not to be a sociopath as "self-sabotaging feelings" is quite a spin; It would be like calling a charitable donation self-sabotaging since you end up with less money for yourself. True, but misses the point. I expect the downvotes are because you don't provide an argument for that label besides the assertion that sociopathy is deemed beneficial to a sociopath.
> mild sociopathy would probably be beneficial, but that's somewhat of a tautology
Correct. Then why are people acting in contradiction to a tautology? Are they blind? Plagued by cognitive dissonance? Brainwashed? What gives?
> It's definitely better for society as a whole
And this would be relevant if humans were, say, communally telepathic, such that anyone and everyone actually experienced the point-of-view of "society as a whole".
But, since this is the real world, and we are humans not ants? That point-of-view is little more than an artifice or a shorthand; and the only eyes we see through, the only footsteps we make, the only muscles we command, the only pain we feel ... are all eachwise our own.
So helping "society as a whole" doesn't matter except to the extent that it helps oneself.
(That said, I do sometimes find it entertaining to consider, elsewhere, for discussion's sake, this artificial point-of-view.)
> It would be like calling a charitable donation self-sabotaging since you end up with less money for yourself. True, but misses the point.
True indeed, and I see no other point to miss.
Not even our government's "tax deductions" (which should really be called "deductions from taxable income") are enough to sway this assessment.
> an argument for that label besides the assertion that sociopathy is deemed beneficial to a sociopath
"Sociopathy is beneficial to a sociopath, therefore it is in any- and every-one's interest to be a sociopath, at any cost less than the benefit provided by sociopathy." is the elementary reasoning that basic mathematical intuition sends into my head.
Non-sociopaths actually do derive happiness from the well-being of others though. I think that's likely what you're missing. This happiness from the well-being of others makes sense from an evolutionary perspective because not only individual survival traits are favoured, but communal ones as well. Although, the persistence of a small percentage of sociopaths also makes sense, as they are able to free ride to some extent on the good will of society. However, an instinctive negative reaction to such behaviour by more neurotypical people is also a survival trait, hence the negative reaction you're getting here!
> If everyone is sociopathic, everyone is worse off.
In the world of sticks, stones and endurance hunting from which humanity evolved ... this would be true.
But recent centuries' economic artifices have made a mockery of it; insofar as being "pro-social" has ceased to be necessary to produce generally-valuable things nor to trade the generally-valuable things for a specific basket of things that are valuable for one's survival.
Generally, modern technology and economics have changed humanity's environment much faster than we can evolve to adapt to it; otherwise, (for example) either Coca-Cola wouldn't be addictively successful, or our brains and bodies would be less stingy with energy (and therefore better in myriad ways).
Luckily we still have some semblance of "rule of law" rather than "rule of mob", else vindictive people would throw medicine (among other industries) back into the Stone Age.
Theft is both. Except when the mob decides that someone is "too rich" and should "have their wealth be distributed for the common good", then it mysteriously becomes legal.
*https://en.wikipedia.org/wiki/Buprenorphine#History