The OxyContin problem: how racism can have positive effects

I was reading this BBC article and was really struck by the "Prescription killers" secion about the morality rate from perscription OxyContin (an opiod painkiller pretty much like heroin, designed to be safer but not at all safe). In particular I was struck by the fact that it is almost exclusively poor white women. It seems that racism in the medical profession is such that doctors assume African-American or Latino patients will abuse or sell the drug, and so are much more resistant to give out opiates, and so much fewer people get addicted.

I do not know what is more messed up:

In a country that has demonised heroin basically the same drug is being given out in vast quantities by the medical profession.

There are so many poor people in chronic pain, and to whom the medical profession is offering (only?) opiates. The article says "10 to 12 million Americans [are] on opioids chronically."

The best way to be protected from your doctor drugging you to death (if you cannot arrange to be rich, or possibly a man) is for your doctor to think you are a potential drug dealer / abuser.

In coming up with potential reasons for this situation, I feel forced to consider some pretty unpleasant possibilities, please consider this just me throwing ideas out there. I am a white, not poor brit, I eed yo to tell me why this is.

First you have to look at the medical setup that is present in the US. I have to assume that this high level of chronic pain in the poor is a result of acute medical problems that are not treated quickly and aggressively (or whatever is appropriate) turning into long term problems. I am lead to believe that it is very much more expensive to treat a long term condition than a short term one.

Is this he fault of the front line doctors? Do they know they will get more money from a chronic condition than an acute one so do not take the correct action? I have to say I have known many doctors, both professionally and personally, and I would not attribute this motivation to any of them, far from it. Also, if they only cared about the money, why would they not give the drugs to African-American people?

Is it the fault of poor people? Are they just not going to the doctors early even when in the long run it is costing them much more which they can obviously afford)? I guess I can believe that, if going to the doctors means living on 1500 calories of rice a day for a month, and it is probably nothing (yeah, it probably is, but it might not be).

Is it the fault of the bigger medical establishment of setting it up so it is easier to get long term treatment than short term? I could believe this much more than front line doctors, but how would they actually do it? I would if it is enough just to NOT advertise how important prompt medical treatment is. I think I learned that in school, so is just getting that off the school syllabus enough?

And then we have the racist thing. I am shocked that in a country that elected Obama has such a high level of racism in a highly educated and not at all sheltered section of society that being black almost completely protects you from opiate overprescription. I am not sure I have anything more to add to what is possibly the more interesting side of the situation.

Thought?

"Rates of overdose deaths [from opioids generally] begin to soar: from 1999 to 2014, 250,000 Americans have died of an opioid overdose. Today there are more Americans dying of drug overdoses than dying from motor vehicle crashes,

"This is the worst drug addiction epidemic in US history. We have about 10 to 12 million Americans on opioids chronically, so many that drug companies can now make money selling medicines to treat the side effects from being on opioids chronically.

"We've seen a very sharp increase in prescription opioid overdoses in women. I think one of the reasons is that middle-aged women are more likely to receive treatment for a chronic pain problem from a doctor, [and] they're more likely to be prescribed prescription opioids.

"This epidemic is almost completely white. It's so white that it's fair to say that it's protective in some ways to be African-American or Latino.

"What I think may be happening is that if the patient is black, the doctor is more concerned about the possibility of the patient becoming addicted or of the patient selling their pills.

"Racial stereotyping is having a protective effect on non-white populations."

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There's a man I've known since I was a teenager. Call it 35 years or so. He started working for his father after school in highschool installing flooring. Carpets and tile. After highschool he did it full time during the day, and then did 'side jobs' in the evening. Cash jobs not reported to the IRS. So he was working 60-80 hours a week, and was quite good at it. But flooring is physically hard and demanding work. And he developed early onset arthritis. And so came the OxyContin. And then came the addiction. And then came the crashing and burning of his entire life.

OxyContin is legal because the government decided that for profit companies are good enough at regulating themselves. And so they don't need to check on the company's claims. The human toll of this has been terrible.

Cutlass said:

There's a man I've known since I was a teenager. Call it 35 years or so. He started working for his father after school in highschool installing flooring. Carpets and tile. After highschool he did it full time during the day, and then did 'side jobs' in the evening. Cash jobs not reported to the IRS. So he was working 60-80 hours a week, and was quite good at it. But flooring is physically hard and demanding work. And he developed early onset arthritis. And so came the OxyContin. And then came the addiction. And then came the crashing and burning of his entire life.

OxyContin is legal because the government decided that for profit companies are good enough at regulating themselves. And so they don't need to check on the company's claims. The human toll of this has been terrible.

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That sounds like a horrible situation. I hope I am not being insensitive in saying that from my limited medical knowledge it is possible that long term opiate use is the only answer in the case of such a progressive disease, which is always going to come with a risk of addiction.

I have to ask, what about it would you say took the toll? If it was the cost of the drugs then the drug laws are criminal, opiates should be cheap if you need them.

The drugs aren't that expensive. But the addiction comes with the loss of the ability to work. So the absolute price is low, but the relative price is high, since the income goes away.

Doctors were told these news opiods were not addictive, and well distributed them for all required from War veterans, people recovering from surgery, pain relief and stress. By the time they found it it was too late.
Mistakes by the corporations, marketing, federal government and lack of political will are all there. In California though the Liberal drug laws made matters far worse.

I watched Anthony Bourdain and this is how it was explained.

Cutlass said:

The drugs aren't that expensive. But the addiction comes with the loss of the ability to work. So the absolute price is low, but the relative price is high, since the income goes away.

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I hope it is OK to ask, I am really interested. Why did the drugs stop him working not the pain. I would have thought that installing flooring is the sort of thing you would do a lot easier in a than a mild controlled opioid state than with arthritis.

[EDIT]

FriendlyFire said:

Doctors were told these news opiods were not addictive, and well distributed them for all required from War veterans, people recovering from surgery, pain relief and stress. By the time they found it it was too late.

Mistakes by the corporations, marketing, federal government and lack of political will are all there. In California though the Liberal drug laws made matters far worse.

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They said the same about heroin*. Any doctor who believed that any drug that binds to the alpha and or beta opioid receptor is not addictive is not really thinking, or not suitable to be a modern doctor.

* I guess I should look it up, but it is late here. I think heroin was originally designed as a healthier, less addictive form of morphine. Did not turn out that well I hear.

[EDIT 2]

And the other thing, the only reason they get to call these drugs "non-addictive" is that they have defined addictive so much more strictly that the general use of it as "really hard to stop after you have been taking it for a while". Doctors should really know about that difference.

Samson said:

I hope it is OK to ask, I am really interested. Why did the drugs stop him working not the pain. I would have thought that installing flooring is the sort of thing you would do a lot easier in a than a mild controlled opioid state than with arthritis.

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That assumes that the person, once addicted to the drug, is sufficiently coherent to work. I wouldn't make that assumption, were I you.

That is Because Oxycotin was marketed as abuse proof drug. It was also cheap, and seen as a breakthrough in the way of dealing with pain. By the time Doctors found out it was too late.
In its pill form it would slowly release opiates over a long period of time, instead people were crushing it into powder and taking it like heroin hit.

Is The Era Of OxyContin Abuse Over?

Released in August 2010, the new OxyContin turns into a gummy mush when you attempt to crush it, instead of the fine powder of its predecessor, which addicts snorted or injected to get a swift and powerful high. The original OxyContin was, initially, seen as a breakthrough in pain relief because it would slowly release its active ingredient, oxycodone, over 12 hours, allowing people with chronic pain to be able to take fewer pills, sleep through the night, and generally be less tortured by their condition.

But if you defeated the time-release mechanism, you’d get the impact of the drug all at once. This is what made it so attractive to addicts

the failure to anticipate that the first version of OxyContin would be abused in the way it was

Most of the victims he had examined had a history of drug abuse and overdose deaths reflected a wide range of drugs. Whaley said that from 2007 in Virginia, the pathology data showed 16.8 percent of drug overdoses were for oxycodone alone.

Once, fear of opioid addiction within the medical community meant that people suffering from the excruciating pain of metastatic cancer went untreated

shifting away from a position on opioids that condemned people to horribly painful deaths, the pendulum swung and “we may have gone too far in the other direction,”

“We need to tone down the rhetoric,” he says. “Opioids have a remarkable upside, but not for all; they have remarkable risks, but not for all.” If you can’t do the risk management, he says, then ethically, you shouldn’t be prescribing them. His favorite quote on this issue comes from Doug Gourlay, a Canadian pain and addiction expert: “Anyone who prescribes these medicines needs to be a talented amateur in addiction medicine.”

Third party payers, on the other hand, want to pay for pills and procedures. It’s easier and cheaper. And it’s not just insurance companies that must bear responsibility for the nation’s state of pain treatment, cost cutting in state Medicaid payments has had deadly consequences

Every pain expert interviewed for this piece agreed that expanding the paradigm for treatment is the way forward in balancing chronic pain treatment for the many against the risks to the few. Pharma has come through with one part of the solution – abuse resistant drugs

The age of OxyContin may well be ending, at least in terms of abuse; but America’s state of pain is only going to get worse, and dealing with that will take more than fixing a pill.

http://www.forbes.com/sites/trevorb...the-era-of-oxycontin-abuse-over/#1ed46fe16fb6

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Cutlass said:

That assumes that the person, once addicted to the drug, is sufficiently coherent to work. I wouldn't make that assumption, were I you.

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It does indeed. I knew someone who managed in the construction trade (driving cranes) with a proper smack habit, he was a bit mad though. If OxyContin is more [what is the word, to make less coherent?] than heroin then you have to ask how it is allowed. I am also sure its effects vary by person.

I guess I should say that I have always assumed that because back before opiates were criminalised many people were able to hold down good jobs and opiate habits it should be possible if they are legal. It is of course possible that that only works when you have your job because who your father is or whatever.

Some people may. But dosage may also matter. With heroin, you can vary the dose. With a pill, you take the pill. And the dose is the dose.

FriendlyFire said:

That is Because Oxycotin was marketed as abuse proof drug. It was also cheap, and seen as a breakthrough in the way of dealing with pain. By the time Doctors found out it was too late.
In its pill form it would slowly release opiates over a long period of time, instead people were crushing it into powder and taking it like heroin hit.

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I can see this argument working, but only for abuse not addiction and only for the frontline doctor not the "medical industry":

abuse not addiction : I can see someone who does not know about the "crush the pills up" trick being sold on the no abuse thing. I feel that anyone with a knowledge of modern medicine who would tell a patient who is facing a long term course of alpha and/or beta opioids that they are not at serious risk of addiction is negligent.

doctor not the "medical industry" : Crushing pills for the hit is not a new trick. I knew about it over 20 years ago at university, I am sure they had a lot of people who knew about it (and tested it?)

Cutlass said:

Some people may. But dosage may also matter. With heroin, you can vary the dose. With a pill, you take the pill. And the dose is the dose.

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So there "lets make it good" thing was to make it less fun to take, but also make it so you cannot hold down a job? Nice of them that.

Samson said:

So there "lets make it good" thing was to make it less fun to take, but also make it so you cannot hold down a job? Nice of them that.

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The makers were utterly indifferent to the negative effects on people. All they care about is the profits.

There are only so many potential high-end painkillers (because, sometime, regular painkillers are way past not enough), and most of them have a shopping list of nasty side effects and serious risks of addiction.

There are people out there who really *do* deal with intense chronic pain. Not because OMG evil doctor, but because they were dealt a crappy hand by life. My brother's got atypical brittlebone (Osteogenesis Imperfecta) disease; he's way past 300 fractures his entire life, and he rarely ever *not* have at least a few broken bones in his body (there was a stretch a few years back when he basically broke bones every weeks, every other weeks at best). At that point, regular painkiller have long since stopped being enough (because you use them so much your body grows used to them and their efficiency diminish...plus there's only so much pain they can kill).

There's no "treating acute condition" for him. There's glimmer of things that might perhaps eventually lead to answers, maybe, but any actual treatments is years down the roads...if it even work at all. Even if you DID find such a way, it would only deal with new fractures, not deal with badly healed (because ribs are hard to heal right, and spending your entire life immobilized in a hospital bed is an option nobody wants) or weak from so many fractures bones.

Nor is he an alone case. There are other diseases with similar effects, and all of them, eventually, require heavy-duty painkillers, far beyond the usual over-the-counter stuff. And there's no good painkiller of that sort. Only a wide variety of poisons to pick from.

FriendlyFire said:

That is Because Oxycotin was marketed as abuse proof drug. It was also cheap, and seen as a breakthrough in the way of dealing with pain. By the time Doctors found out it was too late.
In its pill form it would slowly release opiates over a long period of time, instead people were crushing it into powder and taking it like heroin hit.

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The bottles came with a don't crush warning sticker. I find it hard to believe that doctors, pharmacists, and pharmaceutical companies were unaware that the don't crush sticker means "you should crush this, probably" to the drug-enthusiast. Oxy let the medical industry blame the patient for addiction ("s/he must have used the medication in a manner other than prescribed, such as crushing"). A secondary issue would be that oxycontin was addictive even when used exactly as prescribed.

contre said:

The bottles came with a don't crush warning sticker. I find it hard to believe that doctors, pharmacists, and pharmaceutical companies were unaware that the don't crush sticker means "you should crush this, probably" to the drug-enthusiast. Oxy let the medical industry blame the patient for addiction ("s/he must have used the medication in a manner other than prescribed, such as crushing"). A secondary issue would be that oxycontin was addictive even when used exactly as prescribed.

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Oxycontin was released in 1995 some 20 years ago, an estimated 7 Million American use it as a drug. That is a massive failure on the national level at all levels, from the corporations seeking profit to Federal government seeking cheap solution to medicare, to doctors medicating pain to the user whom is using it as a drug.

Yes there is a profit motive, but that was not the sole cause.

Doctor David Kessler, who ran the FDA from 1990 to 1997, doesn't hold back when talking about the explosion in opioid use in the last two decades.

"This has been one of the great mistakes of modern medicine," said Kessler, who went on to say opioid addiction in the U.S. amounts to an epidemic.
axlerodfdapainkillers.png "FDA has responsibility, the pharmaceutical companies have responsibility, physicians have responsibility. We didn't see these drugs for what they truly are," Dr. Kessler said.

CDC didn't issue prescription guidelines until this past March.

Kessler said. "Because drug companies took a small piece, a sliver of science and widely promoted it as not being addictive. That was false."

While pill mills are among the most visible signs of the epidemic, Kessler said two-thirds of painkiller prescriptions are written by well-intentioned physicians trying to do right by their patients.

http://www.cbsnews.com/news/former-...mic-one-of-great-mistakes-of-modern-medicine/

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The article says that they reformulated the drug in 2007, do we have any information on whether that improved things? That is, are the mysteriously dying white American women people who became addicted to the old batch, or to the new one?

Samson said:

"We've seen a very sharp increase in prescription opioid overdoses in women. I think one of the reasons is that middle-aged women are more likely to receive treatment for a chronic pain problem from a doctor, [and] they're more likely to be prescribed prescription opioids.

"This epidemic is almost completely white. It's so white that it's fair to say that it's protective in some ways to be African-American or Latino."

Thought?

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My first thought is that this is utter and complete bull. The drugs people get addicted to are high end drugs. The only thing racist here is this inane comment. (Apart from the completely flawed logic employed in that sentence.)

Agent327 said:

My first thought is that this is utter and complete bull. The drugs people get addicted to are high end drugs. The only thing racist here is this inane comment. (Apart from the completely flawed logic employed in that sentence.)

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You did see that the whole thrust of the article was that poor white women in particular have a declining life expectancy, as opposed to just about every other demographic. I would be interested if this was wrong, but you do get that it is not me saying this but "Dr Andrew Kolodny [who is] is a leading expert on opioid addiction and executive director and co-founder of Physicians for Responsible Opioid Prescribing. " Not exactly unbiased, but probably knows something.

Flying Pig said:

The article says that they reformulated the drug in 2007, do we have any information on whether that improved things? That is, are the mysteriously dying white American women people who became addicted to the old batch, or to the new one?

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Reformulation of drugs is primarily a scam to keep the patents from expiring. It's not about changing the drug itself.