Late stage capitalismâŚ
Indeed.
So⌠the medication itself was 100% safe. When used properly, there is minimal risk of addiction.
Itâs the way it was used that made it unsafe. And finding that out was made harder by the deliberate misrepresentation, even fraud of the companies involved.
Big Pharma? Lie to us? You sound like one of those freaking anti-vaxxers!
Itâs a good thing that these are legitimate businessmen, or the Sackler Cartel would seem to be a rather more urgent priority than those various scary Mexican onesâŚ
You have to look at the bigger picture. Think of all the extra shareholder value murdering customers provided!
"You switched the samples."
Nonsense. The drug and healthcare companies are investment companies. The shareholders are the customers. (The patients are a renewable resource.)
Look, semantics aside, I think we can all agree that the shareholders are as important as the customers are not.
Not entirely. Essentially, they used a 12-hour dose but the mechanism for delivering it over 12 hours is ineffective. In many, they would essentially get a big dose as if they were taking the ânormalâ drug (the drug w/o the different mechanism). There is still a risk of addiction even with the older, generic drugs when used properly, primarily because theyâre opioids.
The problem is then twofold. One, doctors became leery of prescribing pain medication because of the higher addiction rates. Two, doctors generally donât stay up to date on real science, and instead will just do some CME courses and listen to pharma representatives in order to stay up to date. So, you have doctors simply avoiding the problem and, when they donât avoid the problem, prescribing things that they shouldnât be prescribing (because they are using outdated knowledge).
Itâs not much different from when doctors gave people tons of morphine and created addicts, as their prescriptions ran out and they found themselves going through withdrawal.
Iâve never thought of it that way, and I worked for the FDA (devices not drugs). Very keen insight!
When she complained to her doctor, he gave her stronger doses but
kept her on the 12Â-hour schedule, as Purdue instructs physicians to do.
The change had little effect.
For a year and a half, she spent each day cycling through misery and relief. Sometimes, she said, she contemplated suicide.
There you go DOJ. Please commence investigation.
For me, someone who prescribes alot of oxycodone and morphine, this article seems sensationalist and untrue. Granted that my patients are usually dying, some faster than others, and not people injured in traffic accidents etc. like in the article. Oxycodone is sold here under the Oxycontin brand and multiple generics (itâs not like timed release opiates are rocket science).
Iâm not going to quote studies here since theâre obviously the lies of big pharma. However, I give out these drugs a lot and I have exact control of my patients oxycodone use. Iâm the only one giving them the drugs and my countryâs system is such that all narcotic prescriptions can be viewed from central database. So I know that theyâre not getting it from anyone else. Oxycodone is not a common street drug here.
Also, they almost always have a fast acting opiate for breakthrough pain on hand. The patients can take that as much they need and it is recorded/monitored so that the pain medications can be upped if needed. I try to care for my patients as well as I can and pain management is central to this. If the drugs routinely wore off after under 8 hours, why wouldnât they take the fast acting en masse in the middle of the day? Theyâre there and theyâre free to use them, even encouraged. They can literally have many syringes prefilled with liquid oxycodone or morphine in their home, verified painful tumors and still theyâre mostly happy with Oxycontin twice daily.
Particularly the argument that because cancer patients need ârescue medicationsâ while on timed release oxicodone it must be because the drug is faulty, is misleading. You can have a patient on a patient controlled analgesia pump that is giving them a very stable dose of an opiate (here usually morphine) over time and they still need additional doses. If you increase the daily dose so that they donât need any additional doses, it is common that the stable dose is too high. How could oral timed release oxycodone do better?
Did you ever see or hear a statement from Purdue Pharma to maintain the 12 hour dosing schedule?
Thereâs another factor here - the difference (and interaction) between dependence and addiction. Dependence is a physical state, addiction is behavioral. All patients become physically dependent on opioids, and must wean off the drug - not all patients then exhibit addiction behavior (only a small minority do.) In this case, the 12-hour dosing regimen didnât keep the medication levels consistent, leading to withdrawal symptoms and breakthrough pain. When doctors consulted the manufacturer, they were advised to increase the dosage, not the frequency - thus fostering addict behavior in the patient to stave off withdrawal.
No, but the company selling that here is Mundipharma.
Because not all doctors will give patients fast-acting opiates for breakthrough pain, particularly to chronic pain patients. Because we arenât dying, we are treated as though we would be better off dead than addicted/dependent on opioids, regardless that I am also dependent on SSRIs to stay alive.
I ask because one of the claims reported in the LA Times article was about company reps second guessing prescribersâ decisions about the frequency and concentration of doses. My anecdotal sense is that some docs experience some attempted micro-managing by insurance companies. I wonder, what about pharma?
I thought Perdue made chicken?
OxyContin tablets should be taken at 12-hourly intervals. The dosage is dependent on the severity of the pain, the patientâs previous history of analgesic requirements, the patientâs body weight, and sex (higher plasma concentrations are produced in females).
The usual starting dose for debilitated elderly patients, opioid naĂŻve patients or patients presenting with severe pain uncontrolled with weaker opioids is 10 mg 12-hourly. Some patients may benefit from a starting dose of 5 mg to minimise the incidence of side effects. The dose should then be carefully titrated, every day if necessary, to achieve pain relief. Given the time to reach steady state, patientsâ doses should only be titrated up after 24 hours and increases should be made, where possible, in 25% - 50% increments. The correct dosage for any individual patient is that which controls the pain and is well tolerated, for a full 12 hours. The need for escape medication more than twice a day indicates that the dosage of OxyContin tablets should be increased.
Sorry, I donât think that my situation is applicable. Socialised medicine means that the insurance companies donât have that kind of power and the goverment doesnât micromanage the cheap drugs (like opiates) like that. Unfortunately, we do still have drug reps, but they can only give the companyâs recommendations.
Yeah, well, thatâs just like, their opinion, man. If I thought a patient metabolized the drug faster than usual, I still could prescribe it 3 times a day.
