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PaperclipPerfector  10mo ago (text post)   29058 thread views

Culture War Roundup for the week of June 24, 2024

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I mean, obviously, I was being flippant in a parenthetical. But yeah, there are people in this very thread who are saying that pharmaceutical drugs have nothing to do with overdose deaths, at least. I haven't gotten them down to the nitty gritty of other types of dangerous use, but most advocates of drug legalization generally don't want to talk about any type of dangerous use.

In any event, would you praise the Sackler family for at least trying to flood the market with pharmaceutical drugs (whether they succeeded in this endeavor or not, would you praise the endeavor)? Would you say that the only real problem is that they didn't manage to sell billions more pills through millions more doctors looking the other way to millions more straw purchasers? That if only they had flooded the market enough that the street price of pharmaceutical drugs dropped to rock bottom, then it would have positively helped the opioid crisis?

In any event, would you praise the Sackler family for at least trying to flood the market with pharmaceutical drugs (whether they succeeded in this endeavor or not, would you praise the endeavor)?

Absolutely not - I come at this from the "smelly hippy" angle rather than the libertarian one, and I think that what they did was actually monstrous. I'm a proponent of drug legalisation, but I think that legalisation should be accompanied with responsible education and policies with regards to addiction and the like. The Sacklers were ultimately responsible for and made substantial profits from a legal and corporate structure that heavily encouraged and even induced addiction in cases where it wasn't necessary. I absolutely think that drugs should be legal, but I think that part of that liberalisation should include responsible management of them. Encouraging addiction because those ruined lives are extremely profitable is the part of what the Sacklers did that I object to, not so much the distribution of the drugs themselves.

The Sacklers were ultimately responsible for and made substantial profits from a legal and corporate structure that heavily encouraged and even induced addiction in cases where it wasn't necessary.

How so?

Someone else has already written this up for me, so I'll just quote them.

https://web.archive.org/web/20201004103052/https://www.newyorker.com/news/news-desk/the-sackler-familys-plan-to-keep-its-billions

With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients. This strategy was a spectacular commercial success: according to Purdue, OxyContin has since generated approximately thirty billion dollars in revenue, making the Sacklers (whom I wrote about for the magazine, in 2017, and about whom I will publish a book next year) one of America’s richest families.

But OxyContin’s success also sparked a deadly crisis of addiction. Other pharmaceutical companies followed Purdue’s lead, introducing competing products; eventually, millions of Americans were struggling with opioid-use disorders. Many people who were addicted but couldn’t afford or access prescription drugs transitioned to heroin and black-market fentanyl. According to a recent analysis by the Wall Street Journal, the disruptions associated with the coronavirus have only intensified the opioid epidemic, and overdose deaths are accelerating. For all the complexity of this public-health crisis, there is now widespread agreement that its origins are relatively straightforward.

...

Her filing was studded with damning internal company e-mails revealing that, even in the face of a skyrocketing death toll from the opioid crisis, members of the Sackler family pushed Purdue staff to find aggressive new ways to market OxyContin and other opioids, and to persuade doctors to prescribe stronger doses for longer periods of time.

eventually, millions of Americans were struggling with opioid-use disorders.

This is an absolutely magic sentence that tells us nothing about how any of this works. There is no model here. At least, there is no model that can be stated in words, in public. My suspicion for why is because the model that is implicitly being used violates the claims of people who are pro-legalization.

Did you actually click the link? I didn't include the sordid details but they do actually explain what happened and how it worked. A magic sentence like that is totally fine when you include the explanation in another part of the text.

I did click the link. I read the whole thing. They don't explain any sort of model for the intermediate steps. If you need to convince yourself of this, just try. Try on your own to reconstruct a model of how it's supposed to work from the article. Use your own words. See if you can do it.

Uh, sure? They used a variety of financial incentives to encourage doctors to prescribe higher and higher doses of Oxycontin even when it wasn't necessary, because that made them more money. They were directly(and indirectly) paying doctors to hand this stuff out even when it wasn't strictly necessary, taking advantage of the prestige and respect rightfully given to medical professionals in order to generate vast profits while directly fostering opioid addictions.

Maybe I'm missing your point, because I don't know what kind of intermediate steps you need to get from "Inducing doctors to unnecessarily prescribe high doses of opioids" to "Opioid usage epidemic".

prescribe higher and higher doses of Oxycontin even when it wasn't necessary

There is literally only one sentence in the article that refers to dosing, and that's just repeating a claim from a plaintiff. It's pretty weak even from that plaintiff. I guarantee that you, the plaintiff, the FDA, nobody has any sort of rigorous line on when it is "necessary". Their "titration" stuff is basically the same damn thing that Scott talks about doing all the time with other drugs.

But in any event, I don't think the legalization folks have premises that allow saying things like, "Oh, we'll just set it up so that people are magically only allowed to go from having 20mg pills to 40mg pills when it's strictly necessary (according to some magic definition of necessary). That'll totally be a part of how complete legalization will be an utter boon to society and not a disaster!"

Instead, I think the complete legalization folks will say that all that shit is meaningless. We should just make them all legal. The 20mg pill, the 40mg pill, hell the 10mg pill and the 80mg pill, too. That people can just buy whichever one they want. Maybe they'll choose to get a doctor's recommendation. Maybe they'll even use your yet-to-be-published, magic definition of "necessary". But they think that people will somehow be responsible in their usage, substituting away from dangerous street drugs like heroin and fentanyl and toward, I don't know, whichever of the 10mg/20mg Oxy pill your magic chart says is "necessary". They might try a higher dose, like how some people try hard liquor instead of wine or beer, but for the most part, folks will prefer to objectively and responsibly move to a reasonable dose. And it's not like their marketing is ever going to be like, "Hey doctors, you should prescribe a higher dose even when your patient responsibly wants a lower dose," or, "Hey doctors, here is @FirmWeird's objectively correct definition of 'necessary'; don't use that."

But in any event, what does your magic, yet-unknown line of "necessary" have to do with addiction? What's the model connecting this completely unknown thing to rates of opioid addiction?

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