You have to wonder who was on duty at the FDA when instructions that essentially read “Don’t even consider the possibility that the delayed release mechanism isn’t working as planned, just chase the dragon a bit harder if pain persists.” went through the office.
‘If tolerance develops, take more’ is practically a parody of good practice in dealing with addictive and dangerous compounds.
Were there recommendations from the company about frequency or potency of doses?
ETA, oops, never mind. I see that @jerwin got to the point more quickly. 
Those are actually from Mundipharma and refer to how the drug is prescribed in Ireland…
Weeeelllllll, not quite: the problem was that, yes, the ‘mechanism’ didn’t last 12 hours for some patients (actually, most but not all patients). The non-addictive, relatively safe solution was to take it more often.
The ‘solution’, as vigorously pushed by Purdue Pharma, was force the physicians to stick to the 12-hour schedule come hell or high water - which was almost guaranteed to result in addiction for the patient - and tell the physicians to increase the dose instead - which was almost guaranteed to eventually result in death.
Purdue (and the Sackler, along with all the other companies) was touting Oxycontin as 12-hour solution and thus much better than the old cheap drug it replaced. It wasn’t. They should be sued into oblivion
Well that and time-released oxycodone has been out of patent protection for several years, so anyone is free to use the exact same process to make generics.
Oxycotin isn’t that common street drug in the US either. Very few people get their oxycotin from a dealer. Getting them from friends is the most common source.
Plus, once they reformulated oxycotin to prevent snorting, those with habits switched to other, cheaper opiates like heroin, morphine, methadone and codeine which is why you see a jump in heroin-related deaths worldwide starting in 2010. In the US, it has increased five-fold.
I don’t understand. How is time-released oxycodone more addictive than regular oxycodone? The article seems to imply that taking 2 of these a day is more addictive than taking 6 regular oxycodones per day.
It isn’t that it is more addictive. It is that there is a 4-hour withdrawal period every day which the company told doctors to fix by upping the dosage on the medication. You end up taking far more at a time which of course increases all the pleasurable aspects of the opiate - theoretically increasing addiction rates.
Perhaps there needs to be a heck of a lot more research into techniques for time-released medication (and making meds go exactly where they are needed for that matter). I wonder if this is being looked at systematically by independent researchers, or is it only just big pharma looking for ways to extend their patents? If there was a real effort being made into drug delivery options, maybe we’d get better solutions (ha) that depend more on science than the bottom line.
If I were to consider cruise missiles, the space program, the V-1, and any other form of rocket science I can think of… I’d have to estimate that fewer people have died from, and fewer lives have been ruined by, abject failures of rocket science.
Whatever happened to Quaaludes?
That was the scene where I decided the little twerp had finally learned to act.
I’m actually reading Paolo Bacigalupi’s The Doubt Factory right now (on your recommendation Cory) and this seems lifted right out of its pages.
Something as precise as “does this particular drug last for eight or twelve hours when given to humans?” is the sort of thing that would require human trials rather than bench or mouse work.
Human trials are expensive and difficult…which is why the human trial phase is often where the pharma money steps in and takes over the development of the new drug from the independent university labs that initially developed it through in vitro work and animal trials.
so are addiction, law school, marketing, parenting, medical school, and funerals.
of all the various people undergoing expensive and difficult tribulations… I only see one group dropping like flies. I’m going to make sure to save some compassion for that group, no matter how much I identify with the other groups personally.
As I recall from asking a psychiatrist about a different addictive medication (xanex), addiction also stems from the reaction of the brain and body when it gets the medicine. You are more likely to exhibit symptoms of addiction when you are experiencing the relief-then-pain (or anxiety, in the case of xanex) instead of a steady level of no pain because your brain is connecting taking that pill with relief and the dopamine release relief brings. Your brain is then trained to associate the taking of the medicine with relief in a really physical way, including a dump of all sorts of chemicals in your brain. This is why, for a person who has to take an addictive medication on a regular basis, it is better to have a steady stream of medication. It avoids the association between the physical act of taking the pill and relief+dopamine dump. It helps avoid addictive behavior, leaving the patient with just the physical dependence. The physical dependence can be dealt with if the person has to go off the medication by doing it very slowly, without the patient also having to struggle with ingrained addictive behaviors.
Sigh. The psychiatrist explained it much better.
Any idea how much variation in extended release mechanisms is required between different types of drugs?
Obviously, when a real drug is involved, doubly if the drug is actually supposed to be treating a real condition in the test patients, it’s both harder to recruit and less viable to take risks that might deliver less-than-standard-of-care results; but if what you really want to test is the extended release mechanism, rather than the drug it will be used to deliver, you’d have markedly better options if it is possible to test the release mechanism with some sort of minimally biologically active taggant; allowing you to use run-of-the-mill healthy volunteers rather than having to recruit specific flavors of sick people and ensure that your mechanism ins’t worse than the standard of care.
If XR mechanisms are highly drug-specific, of course, that wouldn’t work at all; so I’m curious to what extent they are largely drug agnostic(eg. pill geometry fiddling, slow-dissolve encapsulants, that sort of thing) and to what extent they are highly specific(packaging the drug as a compound that gets metabolized into the actual active ingredient, that sort of thing).
I’m describing what is, not what should be.
If you want to fix it, fund your public labs, unfuck the patent system and crack down on big pharma manipulation of research.
Sorting out the catastrophe of for-profit scientific journals wouldn’t hurt, either. That’s more of a science-in-general issue than pharma-specific, though.
Purdue, is, Ibelieve, privtately held - there are no shareholders.
