J and J ordered to pay

[Goalpost]

https://finance.yahoo.com/news/j-j-found-guilty-opioid-123600220.html

So this is a tricky one to me. J and J provided drugs that were approved by the FDA but is held responsible. Some estimated their liability could have been as high as 17 billion but the judge ordered a much lower amount, albeit guilty. Another case is pending in Ohio next. Doctors will tell you that opioids were obviously addictive and they knew this as far back as the 90's. They will also tell you that they were effective treatments for a variety of pain issues be it broken bones, cancer treatments, etc.

[*michaelsean*]

so it was their aggressive marketing? A patient can't go get them because they saw it on TV. They still need a Dr to write a prescription. But you can't get that kind of money out of a doctor.

[GMDino]

The way one doctor explained to it me is that these kinds of medicines were "pushed" to be used by the associations.  

That's a one sentence summation of a two hour conversation.

There was a lot of back door money between manufacturers and, for lack of a better term right now, the bosses above the doctors and hospitals.  The administration had more to do with it than the docs themselves.  And everyone was working based on what was publicly known and being told to ignore the "fake news" about the addiction problems.

[Au165]

It is right out of the tobacco playbooks of the 90's. It is one of the reason tobacco advertising changed greatly after those cases.

[CJD]

I've heard from a few of my friends who are doctors or work in doctor's offices that drug reps constantly come into the hospital/doctor's office and bring free food, free merch and try to persuade people to prescribe their drug instead of other drugs. If you accept their free stuff, then they will follow up with you if they see that you either aren't prescribing their drug to people or are prescribing other competitors' drugs instead. It's pay for play without technically being pay for play.

In addition, doctors will be sponsored by drug reps to go give speeches or presentations at conventions (and paying them to do so), which is...shady and kind of grey in terms of its ethical nature.

There are also rumors of actual bribes, but that's just straight unethical behavior that is harder to verify.

I think that's probably the kind of behavior that they are being held accountable for.

[*Nately120*]

(08-27-2019, 11:47 AM)Crazyjdawg Wrote: I've heard from a few of my friends who are doctors or work in doctor's offices that drug reps constantly come into the hospital/doctor's office and bring free food, free merch and try to persuade people to prescribe their drug instead of other drugs. If you accept their free stuff, then they will follow up with you if they see that you either aren't prescribing their drug to people or are prescribing other competitors' drugs instead. It's pay for play without technically being pay for play.

In addition, doctors will be sponsored by drug reps to go give speeches or presentations at conventions (and paying them to do so), which is...shady and kind of grey in terms of its ethical nature.

There are also rumors of actual bribes, but that's just straight unethical behavior that is harder to verify.

I think that's probably the kind of behavior that they are being held accountable for.

Do no harm, my ass!

[Belsnickel]

(08-27-2019, 11:47 AM)Crazyjdawg Wrote: I've heard from a few of my friends who are doctors or work in doctor's offices that drug reps constantly come into the hospital/doctor's office and bring free food, free merch and try to persuade people to prescribe their drug instead of other drugs. If you accept their free stuff, then they will follow up with you if they see that you either aren't prescribing their drug to people or are prescribing other competitors' drugs instead. It's pay for play without technically being pay for play.

In addition, doctors will be sponsored by drug reps to go give speeches or presentations at conventions (and paying them to do so), which is...shady and kind of grey in terms of its ethical nature.

There are also rumors of actual bribes, but that's just straight unethical behavior that is harder to verify.

I think that's probably the kind of behavior that they are being held accountable for.

I know about this more from Purdue than I do from Janssen, though. Purdue, the makers of Oxycontin, were highly shady in what they did and actually misled the feds regarding their product. They said that because it was an extended release thing, it wasn't able to be abused. Meanwhile, the coating was being removed and people were getting at the juicy, high potency center with ease causing what I believe that the second wave of the opioid crisis.

This third wave, from Fentanyl, I find difficult to put at the feet of Janssen/J&J. The majority of Fentanyl overdoses, from my understanding, come from illicitly produced Fentanyl or Fentanyl imported from China.

Anyway, here is a writeup I did on the causes of the opioid epidemic for something here in Virginia:

Quote:CAUSES
Prescribed opioids opened the door to the epidemic

The use of opiates—the more naturally derived products from opium plant—has a long history as an analgesic. Modern scientists have developed several pharmaceuticals from these that are called opioids—the synthesized products from the opium plant—that are considered to be “the most widely used and effective analgesics for the treatment of pain and related disorders” (Al-Hasani & Bruchas, 2011, p. 1). The biggest change occurred when a brand was approved for chronic, non-terminal pain. OxyContin was supposed to be abuse-resistant and so was approved and marketed heavily because of that. The truth, though, was that the drug could be crushed and abused (Macy, 2018, p. 63). Because this opioid was able to be prescribed more liberally than others, it became widely available. The first phase of this opioid epidemic was kicked off due to the availability of prescription drugs (“Understanding the epidemic | Drug overdose | CDC Injury Center,” 2018).

While the epidemic is growing with heroin and fentanyl here in Virginia rather than pills, there is still a steady mortality rate due to prescribed opioid overdoses. It is also important to note because using opioids as prescribed for pain is often the first step down the path to addiction. From the 1990s to around 2010, there was a steady increase in the use of opioids for chronic, non-terminal pain management (Boudreau et al., 2009). This increasing use of the drugs increased the potential for addiction as not only were more people prescribed the drugs, but those taking the drugs were often taking more of them. There was even a rise in Schedule II narcotic use, which has more restrictions than OxyContin did during this period.

It is vital to understand why opioids became so readily available. For many years, people were feeling like pain management was not something being taken seriously by medical practitioners. Doctors treating patients that were dealing with chronic pain were feeling unable to help their patients due to the laws surrounding the issue associated with the War on Drugs (Clark & Sees, 1993). This perceived need in the medical community to treat pain with opioids is what opened the door for Purdue Pharma. They introduced OxyContin in 1996, marketing it—pushing it may be a better description—as an opioid that would not have the same chance of addiction and could not be abused. That was not the case, though, and Purdue Pharma knew that from early on (Meier, 2018). Because Purdue Pharma pushed so hard for doctors to prescribe their medication, it became easy to get your hands on which led to the abuse of the drug.

The changing landscape of the epidemic to heroin

In the 2010s, there were many changes to how doctors prescribed opioids around the country. Some of these changes were voluntary and some required regulation. There was also a change in formulation of OxyContin make it more abuse resistant. All of this caused the abuse of prescription opioids to drop off due to a lack of supply and a significant price increase (Macy, 2018). Because those addicted require drugs to function and medicine-assisted treatment (MAT) is hard to come by, they turned to heroin.

Heroin abuse is not new, but it has remained an urban drug for most of its history. However, when the pill supply ran dry the rural addicts started making the trek to urban centers such as Baltimore to get their fix (Macy, 2018). This resulted in the entrepreneurial minded recognizing a market that needed supply. Whether it was user-dealers that brought back extra for others in their area or it was a dealer that came from outside the area and set up shop, heroin became a permanent fixture in rural areas affected by opioids.

Fentanyl making heroin cheaper and stronger

Fentanyl is a drug that has a much higher potency than even heroin and it comes at a very low cost. This creates a large appeal to use the drug to cut heroin as it allows it to go further and generate more profit. The result has been drug users taking the fentanyl laced heroin without knowing how strong the drug is. Already, heroin is riskier than pills because the potency is an unknown, but fentanyl creates even more uncertainty. If an addict used to a certain amount of heroin injects the same amount of fentanyl cut heroin, there is a much higher likelihood of an overdose (“Fentanyl | Drug overdose | CDC Injury Center,” 2018). This has become the third wave of the opioid epidemic as public health resources struggle to keep up.