Not really. Someday they or their loved ones will pay for what they did to so many innocent people. And they will have nobody to blame except themselves.
4 місяці тому
@@small_joys2022That money will be long gone from the country as it collapses from the politicians they bought off before
They have been found guilty on a number of occasions. The biggest one was a case in 2007 in which the company paid about $900 million (inflation adjusted) and a large part of their leadership suite was fined between $10-50 million. Multiple other cases with multi-hundred-million fines followed. The company is in bankrupcy negotiations right now. The main legal battle is about how much financial liability they will maintain even after bankrupcy. It took far too long, but they did not walk away unscathed.
Purdue Pharma went bankrupt in 2019 and was dissolved in 2021 because of the massive wave of fines that added up over the years. The Sackler family (main owners of Purdue) have paid BILLIONS in fines and are still in a legal battle about how much further financial responsibility they have to take after the bankrupcy. If things go well, they will get truly ruined. I agree that things went too slow and too many rich people remained rich. But it amounted to a lot more than a mere slap on the wrist.
For any of you who want supplemental reading on this topic, I would recommend reading "American Cartel". If you wanna find out how these people got away largely unscathed, the book lays it out in great detail.
I live on a third world country, I was prescripted opiods after surgery, generic, no any brand, not expensive , the Doctor was very adamant about using it for a few days with carefull instructions on writing and I had three post surgery appointments where the focus was on my recovery, the use of more meds than those strictly needed wasnt even considered....compare that with your "first world" doctors pushing the patients to buy and demand expensive, big laboratories brands of opiods for dangerously extended time periods, oh, and by the way, prescription drugs on my country cant be promoted to the public on any way shape or form.
Yeah, but you can also buy most prescriptions over the counter in similar Latin America countries and in a lot of smaller undeveloped nations The controls aren't much better, though it is worse if a doctor tells you lies
@@highbread817i am much happier to see people consuming harmful drugs by choice, than to see them consume harmful drugs under the false guidance of a medical professional.
While very informative I think he should have gone further into the claimed' difference between "OxyContin" and generic oxycodone. "OxyContin" was a release by "Perdue" pharmaceutical corporation as a result of their patent expiry of the drug oxycodone. The way "OxyContin's" marketing differs from generic oxycodone is because of their newly patented time release coating. Now as an enthusiast of the occasional pleasant psychoactive or psychedelic substance and I would never try to dictate any adult's personal prerogative. I have however known people with opioid habits which have caused them unspeakable pain and suffering. My entirely unqualified advice for opioid use would be along the lines of; to only use opioids for highly acute and short term pain or for end of life pain. For people who suffer long term chronic pain, be aware that opioids will quickly cease to be an effective analgesic while still often leading to dependence. Much better options for long term chronic pain do exist, these therapies can include but are certainly not limited to; meditation, massage, THC, CBD, Chinese traditional herbs, counseling, exercise, diet and even just buying a fancy orthopedic mattress.
@@TillyRhodes-Mayo totally agree! I thought about pointing out the differences between oxycodone and long-acting oxycontin but ultimately either can be abused, though unlikely in controlled settings and/or taken as prescribed in conjunction with non-narcotic analgesics. Distraction is also a very powerful pain management tool!
No doubt. As an engineer myself, I haven't been impressed by the typical doctor's math skills. They also get lazy about things. I've seen doctor's guidelines on things before and have said, "Hmmm, why didn't my doc do this? He latched onto one number and just started shooting from the hip."
To be honest, whether you need a log scale or linear scale would depend on whether the effect of the drug on your brain is linear or logarithmic (or even something else). In chemistry, you barely ever have linear relationships.
I would be interested to know what proportion of doctors actually failed to recognise that vertical axis was a log scale - that is such an old trick that surely all medical students get taught about it. But were they just too contented by their meal and refreshments to look at it critically?
I'm a pharmacist from Germany and I thought the same. I looked at sooo many graphs plotted like this during Uni. But a doctor that has been working for 20, 30 years is probably just out of the loop, although the shouldn't be.
I'm sure most of them were looking at their food and barely even glanced at the chart. From my experience, doctors tend to not be very good with numbers. I got a prescription one time for antibiotics where the usage instructions were so screwed up that the pharmacist told me, "You need to go back to your doctor's office and get clarified instructions on how many of these to take and how often per day. I can't decipher what the hell he's trying to say, so I can't give you usage instructions. I know what the typical dosage is but I'm not going to guess, please get more guidance." I've also seen doctors completely misinterpret the ratio between good and bad cholesterol and try to prescribe me meds I didn't need. If the ratio is out of the normal range high or low, they're supposed to take a harder look at the numbers and make some calls based on which one is too high or too low. They don't, they just look at the percentage and start shooting from the hip. No two ways about it, it's frickin' lazy. I'm not going to go into my resume here, just suffice to say they're not going to slip bad math past me. The math skills of most doctors is pretty lacking.
This is what happens when you get your 'continuing education' from the company selling the drug and the information is curated through the marketing department. This will continue until physicians insist that new information about medications come from disinterested scholars who receive no compensation of any kind from the companies making the medications. Until then, it is up to the audiences to be skeptical, thoughtful, and well informed. Remember for-profit companies and 'the boys in marketing' have no professional ethical code they are expected to live by - nor should they. But physicians do, and that includes the ethical obligation to be critical and sophisticated in their thinking.
I got an opioid prescription for ACL surgery the nurse went as far as saying to take it before i even felt pain so I won’t wake up that night. It definitely didn’t hurt enough to warrant taken any at all, so I didn’t. I know that’s not the case for every one but I’m still shocked at how freely they were giving it away
As a nurse I'll say that some pre-medicating is great after surgery, especially when it comes to getting quality physical therapy. And if you aren't able to sleep, your pain should be treated. But if you aren't hurting and you're resting comfortably, good on you for saying no thanks! Wish more patients were thinking like you.
Good. If you've ever been in severe pain, you would know that it's better to get pain meds you don't need than to need pain meds you don't have. The entire narrative being pushed by this video and the media at large is bullshit. Nobody ever became a junkie because they got a pain pill from the doctor. Drug "addiction" is 100% psychological, which is why people are "addicted" to drugs like cocaine which do not create physical dependence, and why people are "addicted" to behaviors like gambling or sex.
Post surgery they do tell you take it before pain gets started because it’s better at suppressing pain than relieving it. A few days after surgery is not the way you become a junkie. Your doctor wasn’t even one of the evil ones.
Since fooling myself with making the wrong mental image from a log-log plot I now repeatedly tell my students to always plot things on linear-linear scale at least once just to avoid getting fooled by this. Then they can plot stuff on lin-log or log-log scale if necessary to show stuff that varies by many orders of magnitude.
@@UncleKennysPlace In this case it seems (I'm a physicist, not in medicine...) that the drug-producer directly lied about that 12-hour (24?) effectiveness, when it had a rather normal fall-off-rate. And that lie stuck...
Agreed. Another plotting trick that can distort things is having the origin (base) of the plot not be zero. If there's a value that varies +/- 5 around 100, the deviations look a LOT bigger if the range of the plot is 90 to 110 rather than 0 to 110.
Sometimes the lin-lin plot is just unreadable because the relationship is exponential though. Or because the range is so large that you can’t see most of the data and it’s squeezed in the corners. But here there was no reason beyond obfuscation.
I’m just trying to imagine Porter and Jick’s horrified reaction years later when they found out that their “landmark study” was being used in this manner.
Bio- and material engineering graduate student here. My dream job is to work in the pharma/biopharma industry. There has been a lot of distrust towards big pharma for some years now, and it is unfortunate that cases like these turn up, breeding more distrust. It seems like dishonesty in research is prevalent in just about every field, which makes you wonder what product we are using right now that is based on fraudulent or unreliable data.
Great vid man. It would be interesting to see a video discussing Merck's manipulation of Finasteride's safety profile which resulted in serious adverse events in patients. Reuters has a big article on it in which one man sadly ended his life due to the adverse events.
Yes and that was for a hospital setting where supply of the opioid is better controlled, addiction would be more likely outside of hospital. This video focuses on how Purdue exaggerated effectiveness, it doesn't say enough about downplaying addiction.
Reading from one of the study pages you displayed, 4% of placebo, 27% of 10mg, and 32% of 20mg patients dropped out. Sounds like that means percentages of each of those respective groups, not percentages of the total, so adding the percentages to conclude that 63% of total patients dropped out might not be accurate interpretation. Thanks for a great presentation!
I spent 40 days in an Australian hospital back in 2005 suffering from a massive case of pancreatitis, 33 of which were nil by mouth. The pain was indescribable. They put me on a self administer Oxycontin dose, but after three days of hallucintions and deeply intrusive thoughts, i made them take the button away. Nasty, nasty stuff. I dodged two bullets
@@SeekingTheLoveThatGodMeans7648 Yes, and the commenter obviously doesn't understand much about it. It almost definitely wasn't oxycodone either, it was probably morphine. I'm sorry it affected him so poorly apparently, but calling it "nasty stuff" is rather myopic, it's critically important stuff.
@@Tinil0it's critically important, yes, but it's extremely poor judgement to give *anybody* a "dose me with morphine right now" button, especially somebody who has all the reason in the world and all the support of their loved ones to push that button as often as possible. That's a recipe for crippling addiction that will riddle the brain with many times more damage than the untreated pain would have. "First, do no harm."
@@tissuepaper9962I had a morphine drip when I was 14 after my 2nd full abdominal surgery that month and I was in too much pain to talk. All I could do was lay there and groan for what felt like an eternity. I couldn’t even think. It was worse than death. I had sepsis and my whole body was dripping sweat like a waterfall. It looked like someone dropped me into water I was so soaked with sweat. I had a 104 fever. I remember clinging to that button with gritted teeth. Some people need it to survive. Did I feel any need for it once I was healed? Absolutely not.
"What happens next"? Mr. Pete, you keep an eye on your six. They'll be digging the dirt at the very least. Watch out for honey traps. Keep it coming. Stay safe.
I have to agree with @Morbius1963. Be careful, you have made yourself a target of one of the most powerful, influential, and wealthiest industries in the world, they very likely want you to stop, and if you don't, there is enough at stake financially, for them to feel like they should try and make you stop. Please be careful. It's scary because time and time again through out history, ancient and modern, we've seen others just trying to let people know the truth silenced in one way or another.
It's funny how lazy inept useless people who never worked a day in their life can sit around and comment online about how hard working people who worked all their lives got injured and need medicine to ease the pain blame the pain and inject their autistic views and narriatives on what they are going through. These lazy annoying people are such a pest
"Criminal" is a meaningless word if you have enough coin, connections, crews, clout, computer code, control, corporate cronies, and opulent opportunities. ANYTHING can be achieved, scheduled, sold, made, etc. Even if murr-durr is involved... lol... who cares?! 😂🤣😂
Finally, someone is looking skeptically at pharmaceutical research. While this particular drug is important, the greater scandal is the way the research on psychotropic medications has been manipulated. I hope that you will turn your attention to that topic.
Can you provide the citation for the study that includes the graph shown at 8:30? I want to share with my stats class as a great example of how presentation of data can be both technically accurate and misrepresentated.
You may want to look into the 1996 law proposed and passed that encouraged doctors to prescribe narcotics prior to physical therapy for injuries that previously were never considered severe enough to warrant narcotic pain medication. Injuries like strained muscles , and even migraines. It was heavily lobbied for by "the American pain alliance" and two other lobbies with similar focuses that were created and funded by major pharmaceutical companies.
Pharmaceutical companies spreading lies like this is a very dangerous game. It's like they don't care that it will erode public trust in pharma companies. This is why regulations are so incredibly important.
My friend and I had dental surgery about 2 months apart. They were 18 at the time, I was 17. Because I was a minor, I got prescribed ketorolac and they, being an adult, got prescribed codeine. Since we had a similar-ish surgery, the pain levels we experienced were pretty similar. And the painkilling effects of the painkillers were similar. And yet, simply because my friend was an adult, they got prescribed an opioid when they could’ve done just as well with an non opiate one. That being said, while I was pretty ok taking my painkillers, my friend decided to bear the pain if possible rather than take the painkillers. Which really sucks, because I know how much that stuff hurts. That was earlier this year.
Is that Matthew Broderick in The thumbnail? Pretty sure it should be as he was involved in the deaths of two people in Ireland and faced no repercussions at all.
With all do respect how intelligent are these doctors if they don’t read the y axis? I don’t think it’s a question of intelligence, it’s money and not asking questions..
I really can't remember where, it was in some article about cognitive biases, but I remember that someone studied how well doctors did at understanding probabilities and statistics, and they didn't do so well.
Also trying to be respectful: I think doctors are not scientists. They are not taught to think outside the box they are taught to memorize ALOT of information and follow procedure. But I get what you're saying.
There is a lot of assumptions here that doctors, specifically physicians, understand and know how to interpret the data and would have made different clinical decisions based on getting the "real" story from the data. That is not true most of the time. Most of what doctors learn is from MCE courses and conferences. They tend to trust whatever the speaker says in those conferences and papers. So I doubt if Purdue was more honest with their findings we would have seen a major difference. The real issue was the fact that Purdue paid so many speakers to repeat the false and misleading data to other doctors.
Thinking on it, man, that 12 hour thing is absolutely inexcusable and probably led DIRECTLY to so many addiction problems. I always assumed the bigger issue was the lack of education about tapering doseages at the end of the prescription since without that taper you are VERY VERY easily going to experience withdrawal almost guaranteed, thus leading to a demand for non-prescribed drugs and the slip into addiction. But just the fact that they would prescribe it for once every 12 hours and yet the drug would not work well for the level of pain for 12 hours is just as bad, that encourages patients to redose early and thus run out early and thus that same path to addiction and demand for non-prescribed opiates. Doctors are going to trust the fraudulent studies and deny the patient any additional relief earlier than 12 hours even if they need it. This one lie is a direct pipeline between safe use of the drug and addiction.
Hey Pete! Great video, as always. What do you think of the role that McKinsey had in all this? Apparently they had quite some influence in the process and even have already paid like 600 million in different states in the US given their role in this whole crisis.
It's despicable, but also, having worked for a similar company in the past, I can see how this wouldn't even register on a lot of consultants radars when they got the project.
“Less than 1%”. That already doesn’t pass the sniff test, as it is so extreme. Lots of MDs forgetting their biostats (which are tested on USMLE step 1). And not to mention the tiny fact that it’s from an anecdotal source (no placebo controlled RCT).
But the really problematic formulation of oxycontin was the extended release version. The FDA and prescribing providers were told that this new formulation was basically completely resistant to misuse because it couldn't be easily broken apart, injected, snorted, or smoked. The first version could actually be smoked pretty easily. So they released a new version with a more flame resistant binder. But the _primary_ issue was that the medication can easily be misused orally. Whether by taking an intact high dose pill or by chewing or otherwise breaking the pill. When the pill is chewed, the binder actually aids in misuse by creating a gelly substance that easily adheres to mucous membranes. Absorption via the gums and cheeks causes the medication to enter the blood stream much more quickly than it otherwise would with normal digestion. Which results in a high that's more similar to snorting. It's not uncommon to believe that snorting is intended to inhale a substance into the lungs, which would result in an absorption that's similar to smoking or vaping. But it's actually about coating the nasal mucous membranes in the substance. Some of the substance is absorbed through the GI tract via post nasal drip. But most of it is absorbed through the mucous membranes of the nose. If you actually were to inhale powder or liquid, you would have an extreme "down the wrong tube" coughing fit as soon as the substance made contact with the flap that covers the larynx and protects the lower airway (aka the epiglottitis). _Anyway_, new formulations were eligible for patents. Which meant that no generics could be manufactured for 20 years. If you're familiar with the US healthcare system (I'm sorry lol), then you know that brand name medications are appallingly expensive. Generics are much less expensive, ranging in price from dirt cheap to still extremely expensive but much more affordable than the brand name. The idea is that these companies are investing tons of money into research & development, with many of these heavily funded medications never making it to market, so they should be allowed to recoup some of their overall investments by eliminating competition for drugs that do make it to market. Which is terrible, but it also _does_ kinda seem fair. So Purdue Pharma made bank off of the patent status. Even though the development of both formulations didn't cost them very much. And it was complete BS that the immediate release formulations received patent protections, considering that all they did was remove the acetaminophen etc. But it doesn't end with getting a bunch patients on a substance with a high likelihood of intense physical and psychological dependency. The US healthcare system had been extremely squimish about opioids starting in the 1950s or so. They were originally only used for surgery, in hospital pain management, and terminally ill cancer patients. And it genuinely was extremely messed up how much they just allowed patients to suffer needlessly. So this new "abuse deterrent" formulation combined with willful misinformation about the addictive and dependency properties rapidly helped _everyone_ become way more comfortable with these medications. They even exploited the very valid concept that patients should not be left to suffer needlessly. This exploitation had catastrophic consequences for patients further into the crisis. This newfound ease with such serious medications opened providers & regulators up to other new formulations that _clearly_ crossed an ethical line while providing pharmacy companies with that sweet sweet patent protection. Fentanyl lollipops arguably should have never been approved.
I’d like to see you make a video about the impact of living with untreated/under-treated chronic pain. Talking about the dangers of opioids is important, but it’s a softball topic that countless media sources have covered. Chronic pain ruins 100 times as many lives as all opioids combined, but almost no one in the media talks about it.
Another major issue with that letter is that it doesn't explain how they tested if the patients developed an addiction. My guess would be that they only used the clinical records that were produced during the patient's treatment at the hospital, with little follow-up. So patients who did develop addictions probably either would not tell their physician or already switched to a physician outside of the hospital. And if such a patient had developed an addiction during treatment in another hospital and then switched into this one, they would be considered to have a 'history of addiction' and therefore be no longer counted.
Thank you for this angle. In 2004, I believed the addiction potential was high, and I found a SAMHSA brief I can’t locate now that seemed to suggest it was 30%! That’s probably close.
They also gave CMEs (continuing educational classes for doctors) with their misinfo about addiction, pushed it for chronic/long-term pain even though it increases pain when used long-term and you build up a tolerance, and would tell doctors that signs of addiction were actually signs patients needed a dosage increase.
When I was in high school, I broke several bones in my hand. The doctors prescribed some oxy or hydro, I can't recall. But what I do remember is they didn't do shit for the pain. I felt high for a few minutes but that eventually faded and I still felt the pain. I just stopped taking them after they offered me a refill. Turns out, I have that redhead gene that nullifies painkillers.
People love to hate on Purdue Pharma, but the true problem is much more complex. Doctors saw patients getting addicted, and they continued the prescriptions. Now it’s hard to get OxyContin prescriptions, and the addiction crisis is worse than ever using imported drugs. The deeper issue is why so many people want these drugs. If there’s a demand, there always will be a supply.
From wiki so you know who's behind it: Richard Sackler started work at the company in 1971. He was named president in 1999 and became co-chairman of the board in 2003. Richard oversaw the research department that developed OxyContin and managed the sales and marketing unit. Craig Landau was appointed CEO on June 22, 2017. He joined Purdue Pharma L.P. in 1999 and was chief medical officer and as vice president of R&D innovation, clinical and medical affairs. In 2013, he was appointed president and CEO of Purdue Pharma (Canada). In 2018, eight members of the Sackler family were listed as active or former members of the board of directors. Steve Miller became chairman in July 2018. By early 2019, the Sacklers had departed the Purdue Pharma board, leaving a board of five members.
Having a time release drug would be more addictive because your body would get used to constantly having exactly that amount in you. Then your body will rely on having exactly that amount. How anyone can deny this really baffles me.
That y axis is deceitful period. We're all conditioned by seeing how data is almost always presented to see the midpoint between 0 and 100 as 50 not 10. First time I've seen data relevant to treatment presented this way...
I *think* I was on an oxycodone epi in 2007 after an operation. The dosage was maybe too high because 1) I didn't have even a *hint* of pain in the operated area and 2) I had nightmares until the epidural was removed. I must say that the 10 mg capsule I got a couple of nights later when I had terrible back pain (where the epidural had been; oxy was only allowed basically because I had had epidural) worked in 15 minutes, and since I had had some azolam as a sleeping aid I was basically *very* happy and slept most of the next day, excluding when I was bothered with food and such. :D FWIW, that's the only time opioids have properly worked for me. Maybe I'm insensitive. 🤷♀ And anyway, I don't like sedatives, I don't like the feeling. Except when I need to sleep.
Opioids do have their uses, in intense, temporary pain after surgery, trauma and in end of life cancer pain relief. But pushing it for chronic use is ridiculous and really harmful.
It's a shame the backlash to the epidemic has been just as damaging as the epidemic itself. It's absolutely brutal to get important pain relief these days, both in the social stigma from ignorant people who think opiate use = addiction and doctors being unwilling to prescribe it ever because they fear to lose their license. Countless people are suffering and have diminished ability to live life when there is a solution that would help them simply because we don't rely on reasonableness, we have to go extreme to one side (overprescription) or the other (underprescription).
Hello, I would like to ask for the title/doi of the Purdue funded research of the oxycodone that you showed in your video in point 3. Also thank you for you insightful videos, very good to watch and learn.
I am sure that your analysis is sound. But that does not make the physicians who prescribed these medications blame free. They accepted their "education" regarding these products knowing that it was coming from the company that makes them and their marketing department, instead of insisting upon a more balanced and disinterested presentation by scholars who are not making money off of sales.
Every due level of well deserved contempt has been poured upon purdue and its executives , though due retribution has yet to be meted out to them and likely never will. There is another villain in this sad tale. There was only one buffer between patients and pharma , that buffer failed miserably, doctors . All previous reservations about opioids were cast aside , for which they can't claim to have been blinded by science as there was none. But in a system where insurance is loathe to cover therapy or procedure , the prescription pad is the only recourse left . After that word of mouth , advertisements, a 60 second slot during the superbowl no less , sales reps beating down doors , and a crisis was born. So there are three co defendants in this indictment, purdue, health insurers, and doctors . You could throw in the regulators as a fourth, but their ineptitude is always taken as a given.
why is even the settlement of this to be allowed into the court? because there is enough evidence of fake advertising, false claims and negative effects because of it that it should be a criminal case
Ah "safe and effective". This might come across as some anti vaxxer, covid-hoaxer. But I begin to understand everyone who questions some medical operations ....
4:11 and I hate to be nit picky, but the letter actually does refer to oxycodone. Percodan is a combination of oxycodone and aspirin. Of course, percodan was one of the medications implicated in causing an addictive-like presentation in a patient. So it was negatively referenced lol
Purdue exaggerated oxy's effectiveness, not so much its safety. I found it to be more like 8 hour drug after surgery and would supplement with acetaminophen, not more oxy. I've also used it as a sleep aid because the benzo type drugs foul up my ability to recall information and make me useless until the following afternoon. The narcotic doesn't do that. The "adverse event" for use longer than three or four days Q12 or Q8 is constipation, which is easily anticipated and dealt with. Nobody made people work to circumvent the social guardrails we have in place around drugs like this; they did it because they like it. We should ask why they like oxy more than they like life in general. THAT'S the crisis, not the opoids. The trouble for politicians is the real crisis is not susceptible to legislative solutions on any timescale that matters to people living today. The standard legislative response (prohibition) has once again made things worse by people substituting fentanyl.
Everyone is heaping a lot of blame on the Purdue executives. No doubt they oversold the drug and minimized its risks. But doctors have brains, and they could see addictions happening and back off on writing prescriptions. Now it's hard to get prescriptions for OxyContin, but the drug epidemic is worse than ever due to imported drugs. There's a whole generation of addicted people who never got a prescription for OxyContin.
What your saying is contrary to my experience. MDs often prescribed oxycodone to me, starting in 1970, from wisdom tooth pain to kidney stones. I was on it for as long as 4 months, never got any addiction. It wasn't till the last few years that MDs stopped an automatic Rx of oxycodone for kidney stones. I know people who have taken a controlled dose for chronic pain for 25 years, and they must go without for days on end now.
Dude you have no idea (ok you definitely have some idea) at least 3 of my friends/acquaintances have died of overdose, but it's hard to say because families usually keep it quiet and say "medical complications".
If I go to the doctors for any sort of prolonged pain the first thing thr Dr says it "we aren't going to give you an opioid." Of which ok, good because I wasn't asking for one. I'm hoping for a referral for an x-ray or something of that sort to figure out why I'm in pain. Like I get the issue and completely understand not getting an opioid, but don't just flatly assume that what I want is an opioid because no I really don't. It's more helpful to know why I'm in pain rather than just scripting me a medication as s sorta bandaid fix.
Oh.. Doctors are so clever but they don't understand the logarithmic scale... I think that the blame stays with the FDA which did an abysmal job and made it possible to prescribe opioids to the wrong patients. I think I read that some states regulate it better, even simply asking to keep track of prescriptions in 3 copies (doctor/patient/opioid register, as in Europe) and in those states the problem is less serious. I'm an oncologist in Europe, we can only prescribe Oxycodone to terminal cancer patients and a few other specific pathologies that are listed and both the doctor has to be a specialist in that discipline and the patient has to be registered as affected by the listed pathology. Blaming the company is ok, but here the real issue is the FDA evaluation and its poor oversight when approving that kind of use. That means it's a structural problem in the system in place, not a rogue company. Perdue submitted the same papers in Europe and it is only allowed for proper use. Is not understanding logarithmic scales one of those metric VS imperial things? I'm kidding. It's because the only job of a politician is to campaign for money, and if they don't have happy donors they don't get re-elected. And anyway, I guess now, after Chevron, the FDA doesn't even matter anymore, so it's going to be even easier.
One really horrible side effect of this situation is that now no one can get any pain control other than Tylenol or Advil in the usa. This does nothing to help post surgery pain, amputation pain, post accident pain etc. It's really terrible. And if you are in horrific pain and ask for pain relief they mark that you are drug seeking. It's aweful! They just watch people writhing about and screaming in pain and are all like, F you!
Fentanyl patches, on the other hand, aren't a super egregious product. Because, contrary to what law enforcement prattles on about, fentanyl absorption through the skin is slow and inefficient. So patients can receive a relatively low and stable dose of invaluable pain management. I think that the patches were a genuine attempt at balancing the extremes between callously ignoring treatable pain and getting as many people as possible in a precarious, at best, relationship with opioids. Unfortunately, people started doing things like putting multiple patches on simultaneously and chewing on patches.
Oxy is a horrible pain killer. After my ankle surgery in 03 I was given 10mg to take every 4 hours. Ibuprofen was more effective. But it did make me sleep.
Oxycontin and oxycodone are not exactly the same. Oxycodone is the base synthetic opioid, while oxycontin is a time-release formulation. Nothing justifies the way Purdue marketed these drugs.
Yeah...and really old people who actually could be helped by low dose...guess what...nothing...zero ...unless they are in congress... I was one off those babies who mom took a drug mmmitnleft me with basically bad bones and teeth..at 70 I was tired of constant dental work ...my whole life..and had all my teeth pulled for implants...I literally had zero pain meds..it was HORRIBLE...I WAS IN AGONY ..BUT I LIVED...ALL BECAUSE PEOPLE ABUSED DRUGS...now at 80 I'm hurt so much every single day I wish I was dead....but doctors won't even consider prescribing anything for it...im so fucked...and I could go on and on...but seriosly my quality of life is ZERO.
It's always so strange to me to see videos from the USA, where kids coming home from the dentist are tripping balls, but if you get the same kind og surgery in Denmark you just have a numb jaw but are otherwise entirely yourself. So why use the mind altering stuff?
It's not mind altering 🙄🙄🙄🙄. It doesn't make you high and it's not psychedelic. It works by slowing the nervous system which removes your inhibitions and makes you feel tired, heavy and sleepy. It's generally considered non addictive but as with anything that alters your perception if you use it regularly, you could eventually become addicted to it. Since you can only get it at the dentist office and because it's hard to use, it's not used regularly! It would bear out to learn a little bit anyhow dental surgery is done in the USA before making ignorant statements. Only local anesthetic is used and no opioids are given to children. Instead they are given nitrous Oxide. A short action, non addictive gas that doesn't even help with pain management, it just relaxes you and makes you not care about what's happening to you. so when your local anesthetic wears off in the middle of the procedure you won't care that it hurts like hell. The kids seem to be high because they have zero inhibitions, brain sorting happening so they say in a stream of consciousness whatever their little brain imagines rather than editing it to make sense or just not saying whatever is unreasonable. It also wears off in a short amount of time. They have the same thing available in Europe for children, I know, because I live in France where specialists in children with strong fears will do all dental work with nitrous....
![Lp. Сердце Вселенной #60 РОЖДЕНИЕ ЛОЛОЛОШКИ [Финал] • Майнкрафт](http://i.ytimg.com/vi/YoR0pAV9FVQ/mqdefault.jpg)
I think that the CEO of those companies with this conduct should receive a lifetime sentence in prison.
The law agrees, but the enforcers do not
Yes!
Jews don’t go to prison. Good luck with that.
More like capital sentence. They are no different than the stuff cartel
@@robertbeisert3315 that’s like politicians having actual consequences. Never gonna happen.
And they walked away unscathed
Ot course. Rich gotta rich. No consequences.
Not really. Someday they or their loved ones will pay for what they did to so many innocent people. And they will have nobody to blame except themselves.
@@small_joys2022That money will be long gone from the country as it collapses from the politicians they bought off before
They have been found guilty on a number of occasions. The biggest one was a case in 2007 in which the company paid about $900 million (inflation adjusted) and a large part of their leadership suite was fined between $10-50 million. Multiple other cases with multi-hundred-million fines followed.
The company is in bankrupcy negotiations right now. The main legal battle is about how much financial liability they will maintain even after bankrupcy.
It took far too long, but they did not walk away unscathed.
@@T33K3SS3LCH3N : They PERSONALLY walked away unscathed. The individuals responsible haven't been reduced to poverty, let alone properly imprisoned.
And barely anyone will be held accountable and many more just will have a slap on the wrist.
Correct.
Purdue Pharma went bankrupt in 2019 and was dissolved in 2021 because of the massive wave of fines that added up over the years.
The Sackler family (main owners of Purdue) have paid BILLIONS in fines and are still in a legal battle about how much further financial responsibility they have to take after the bankrupcy. If things go well, they will get truly ruined.
I agree that things went too slow and too many rich people remained rich. But it amounted to a lot more than a mere slap on the wrist.
For any of you who want supplemental reading on this topic, I would recommend reading "American Cartel". If you wanna find out how these people got away largely unscathed, the book lays it out in great detail.
I live on a third world country, I was prescripted opiods after surgery, generic, no any brand, not expensive , the Doctor was very adamant about using it for a few days with carefull instructions on writing and I had three post surgery appointments where the focus was on my recovery, the use of more meds than those strictly needed wasnt even considered....compare that with your "first world" doctors pushing the patients to buy and demand expensive, big laboratories brands of opiods for dangerously extended time periods, oh, and by the way, prescription drugs on my country cant be promoted to the public on any way shape or form.
Same here in Bharat.
Let's hope the US of A doesn't do a coup in your country and put a pro Big Pharma guy as president/dictator.
@@small_joys2022 why are you lying bro? You know oyher indians can see you right?
Yeah, but you can also buy most prescriptions over the counter in similar Latin America countries and in a lot of smaller undeveloped nations
The controls aren't much better, though it is worse if a doctor tells you lies
@@highbread817i am much happier to see people consuming harmful drugs by choice, than to see them consume harmful drugs under the false guidance of a medical professional.
As a nurse I really appreciate this information being shared more!!
i am curious, what did you learn about drug addiction in nursing school?
While very informative I think he should have gone further into the claimed' difference between "OxyContin" and generic oxycodone. "OxyContin" was a release by "Perdue" pharmaceutical corporation as a result of their patent expiry of the drug oxycodone. The way "OxyContin's" marketing differs from generic oxycodone is because of their newly patented time release coating. Now as an enthusiast of the occasional pleasant psychoactive or psychedelic substance and I would never try to dictate any adult's personal prerogative. I have however known people with opioid habits which have caused them unspeakable pain and suffering. My entirely unqualified advice for opioid use would be along the lines of; to only use opioids for highly acute and short term pain or for end of life pain. For people who suffer long term chronic pain, be aware that opioids will quickly cease to be an effective analgesic while still often leading to dependence. Much better options for long term chronic pain do exist, these therapies can include but are certainly not limited to; meditation, massage, THC, CBD, Chinese traditional herbs, counseling, exercise, diet and even just buying a fancy orthopedic mattress.
@@TillyRhodes-Mayo totally agree! I thought about pointing out the differences between oxycodone and long-acting oxycontin but ultimately either can be abused, though unlikely in controlled settings and/or taken as prescribed in conjunction with non-narcotic analgesics. Distraction is also a very powerful pain management tool!
Now I understand why they got pounded in court. Thanks for the reporting.
I’m shocked that doctors didn’t recognize a log scale plot for what it was.
Us engineers would have been alarmed by the graph but doctors can’t read them.
the doctors: 'iT'S sMoOtH'
No doubt. As an engineer myself, I haven't been impressed by the typical doctor's math skills. They also get lazy about things. I've seen doctor's guidelines on things before and have said, "Hmmm, why didn't my doc do this? He latched onto one number and just started shooting from the hip."
@@Skank_and_GutterboyThen those memes about bio majors memorizing biology to avoid math must be true then!
To be honest, whether you need a log scale or linear scale would depend on whether the effect of the drug on your brain is linear or logarithmic (or even something else).
In chemistry, you barely ever have linear relationships.
I would be interested to know what proportion of doctors actually failed to recognise that vertical axis was a log scale - that is such an old trick that surely all medical students get taught about it. But were they just too contented by their meal and refreshments to look at it critically?
I'm a pharmacist from Germany and I thought the same. I looked at sooo many graphs plotted like this during Uni. But a doctor that has been working for 20, 30 years is probably just out of the loop, although the shouldn't be.
Money creates an EXCELLENT fog of flatulent, cognitive dissonance.
The figure even says it's a log scale in the axis label.
I'm sure most of them were looking at their food and barely even glanced at the chart. From my experience, doctors tend to not be very good with numbers. I got a prescription one time for antibiotics where the usage instructions were so screwed up that the pharmacist told me, "You need to go back to your doctor's office and get clarified instructions on how many of these to take and how often per day. I can't decipher what the hell he's trying to say, so I can't give you usage instructions. I know what the typical dosage is but I'm not going to guess, please get more guidance." I've also seen doctors completely misinterpret the ratio between good and bad cholesterol and try to prescribe me meds I didn't need. If the ratio is out of the normal range high or low, they're supposed to take a harder look at the numbers and make some calls based on which one is too high or too low. They don't, they just look at the percentage and start shooting from the hip. No two ways about it, it's frickin' lazy. I'm not going to go into my resume here, just suffice to say they're not going to slip bad math past me. The math skills of most doctors is pretty lacking.
This is what happens when you get your 'continuing education' from the company selling the drug and the information is curated through the marketing department. This will continue until physicians insist that new information about medications come from disinterested scholars who receive no compensation of any kind from the companies making the medications. Until then, it is up to the audiences to be skeptical, thoughtful, and well informed. Remember for-profit companies and 'the boys in marketing' have no professional ethical code they are expected to live by - nor should they. But physicians do, and that includes the ethical obligation to be critical and sophisticated in their thinking.
This also affected a friend with cancer. Her oncologist was hesitant to prescribe adequate schedule II meds for terminal cancer pain!
I got an opioid prescription for ACL surgery the nurse went as far as saying to take it before i even felt pain so I won’t wake up that night. It definitely didn’t hurt enough to warrant taken any at all, so I didn’t. I know that’s not the case for every one but I’m still shocked at how freely they were giving it away
As a nurse I'll say that some pre-medicating is great after surgery, especially when it comes to getting quality physical therapy. And if you aren't able to sleep, your pain should be treated. But if you aren't hurting and you're resting comfortably, good on you for saying no thanks!
Wish more patients were thinking like you.
Good. If you've ever been in severe pain, you would know that it's better to get pain meds you don't need than to need pain meds you don't have.
The entire narrative being pushed by this video and the media at large is bullshit. Nobody ever became a junkie because they got a pain pill from the doctor. Drug "addiction" is 100% psychological, which is why people are "addicted" to drugs like cocaine which do not create physical dependence, and why people are "addicted" to behaviors like gambling or sex.
Post surgery they do tell you take it before pain gets started because it’s better at suppressing pain than relieving it. A few days after surgery is not the way you become a junkie. Your doctor wasn’t even one of the evil ones.
Since fooling myself with making the wrong mental image from a log-log plot I now repeatedly tell my students to always plot things on linear-linear scale at least once just to avoid getting fooled by this. Then they can plot stuff on lin-log or log-log scale if necessary to show stuff that varies by many orders of magnitude.
Yeah, I've occasionally seen log-lin plots that showed Product X to be vastly superior, when a linear plot would show a marginal improvement.
@@UncleKennysPlace In this case it seems (I'm a physicist, not in medicine...) that the drug-producer directly lied about that 12-hour (24?) effectiveness, when it had a rather normal fall-off-rate. And that lie stuck...
@@UncleKennysPlaceThe scale doesn’t change the data.
Agreed. Another plotting trick that can distort things is having the origin (base) of the plot not be zero. If there's a value that varies +/- 5 around 100, the deviations look a LOT bigger if the range of the plot is 90 to 110 rather than 0 to 110.
Sometimes the lin-lin plot is just unreadable because the relationship is exponential though. Or because the range is so large that you can’t see most of the data and it’s squeezed in the corners. But here there was no reason beyond obfuscation.
I’m just trying to imagine Porter and Jick’s horrified reaction years later when they found out that their “landmark study” was being used in this manner.
Bio- and material engineering graduate student here. My dream job is to work in the pharma/biopharma industry. There has been a lot of distrust towards big pharma for some years now, and it is unfortunate that cases like these turn up, breeding more distrust. It seems like dishonesty in research is prevalent in just about every field, which makes you wonder what product we are using right now that is based on fraudulent or unreliable data.
Great vid man. It would be interesting to see a video discussing Merck's manipulation of Finasteride's safety profile which resulted in serious adverse events in patients. Reuters has a big article on it in which one man sadly ended his life due to the adverse events.
If you need more on the subject, read Patrick Radden Keefe's Empire of Pain, a book that plays out like "a real-life version of Succession"
Considering that even 'TIME' was in on it (wittingly or otherwise) either shows how evil they are or just straight up incompetent. Both are horrible.
Eric Holder defended Purdue so Clinton and Obama administrations were in on it.
They got their kickbacks for promoting their cousin's product.
Censored… smh
Theranos chick and Bankman-Fraud were also posters boys for "Time" mahgazeen. 🙄 It's *embarrassing*.
Life without parole.
1% is a lot for a drug pushed for wide spread use..
Yes and that was for a hospital setting where supply of the opioid is better controlled, addiction would be more likely outside of hospital. This video focuses on how Purdue exaggerated effectiveness, it doesn't say enough about downplaying addiction.
I am very grateful for your videos and all the hard work that you put in them.
My jaw genuinely dropped when you showed the source perdue used for addiction rates....
I know what this means: big bonuses for the management for selling a product way above its actual (negative) value!
Reading from one of the study pages you displayed, 4% of placebo, 27% of 10mg, and 32% of 20mg patients dropped out. Sounds like that means percentages of each of those respective groups, not percentages of the total, so adding the percentages to conclude that 63% of total patients dropped out might not be accurate interpretation.
Thanks for a great presentation!
I love your videos! Do you think you could improve the audio quality? That would make it easier for me to listen to them
I spent 40 days in an Australian hospital back in 2005 suffering from a massive case of pancreatitis, 33 of which were nil by mouth. The pain was indescribable. They put me on a self administer Oxycontin dose, but after three days of hallucintions and deeply intrusive thoughts, i made them take the button away. Nasty, nasty stuff. I dodged two bullets
Isn't that a brand name for a pill, not a shot or a drip?
@@SeekingTheLoveThatGodMeans7648 Yes, and the commenter obviously doesn't understand much about it. It almost definitely wasn't oxycodone either, it was probably morphine. I'm sorry it affected him so poorly apparently, but calling it "nasty stuff" is rather myopic, it's critically important stuff.
@@Tinil0it's critically important, yes, but it's extremely poor judgement to give *anybody* a "dose me with morphine right now" button, especially somebody who has all the reason in the world and all the support of their loved ones to push that button as often as possible. That's a recipe for crippling addiction that will riddle the brain with many times more damage than the untreated pain would have. "First, do no harm."
@@tissuepaper9962I had a morphine drip when I was 14 after my 2nd full abdominal surgery that month and I was in too much pain to talk. All I could do was lay there and groan for what felt like an eternity. I couldn’t even think. It was worse than death. I had sepsis and my whole body was dripping sweat like a waterfall. It looked like someone dropped me into water I was so soaked with sweat. I had a 104 fever. I remember clinging to that button with gritted teeth. Some people need it to survive. Did I feel any need for it once I was healed? Absolutely not.
This is a recurring pattern in drug discovery. I highly recommend reading the book Power and Dependence.
Thank you for this investigatory video. Complete, understandable. Well done!
"What happens next"? Mr. Pete, you keep an eye on your six. They'll be digging the dirt at the very least. Watch out for honey traps.
Keep it coming. Stay safe.
I have to agree with @Morbius1963. Be careful, you have made yourself a target of one of the most powerful, influential, and wealthiest industries in the world, they very likely want you to stop, and if you don't, there is enough at stake financially, for them to feel like they should try and make you stop. Please be careful. It's scary because time and time again through out history, ancient and modern, we've seen others just trying to let people know the truth silenced in one way or another.
Sad how many older construction workers in my town are hooked now . The withdrawl drugs might even be worse
It's funny how lazy inept useless people who never worked a day in their life can sit around and comment online about how hard working people who worked all their lives got injured and need medicine to ease the pain blame the pain and inject their autistic views and narriatives on what they are going through. These lazy annoying people are such a pest
This is criminal... If not, it should be.
Our corruption is legally blessed, so we think everything is fine.
"Criminal" is a meaningless word if you have enough coin, connections, crews, clout, computer code, control, corporate cronies, and opulent opportunities. ANYTHING can be achieved, scheduled, sold, made, etc. Even if murr-durr is involved... lol... who cares?! 😂🤣😂
Finally, someone is looking skeptically at pharmaceutical research. While this particular drug is important, the greater scandal is the way the research on psychotropic medications has been manipulated. I hope that you will turn your attention to that topic.
That's horrific. Thankfully I'm not an American and I'm not aware of opioids prescribed as a general purpose painkillers in my country.
They aren’t here either. It was always drug users seeking these from sketchy doctors in sleazy clinics, for abuse mainly.
The Porter/Jick letter is more of a note than a letter considering its length
Can you provide the citation for the study that includes the graph shown at 8:30? I want to share with my stats class as a great example of how presentation of data can be both technically accurate and misrepresentated.
You may want to look into the 1996 law proposed and passed that encouraged doctors to prescribe narcotics prior to physical therapy for injuries that previously were never considered severe enough to warrant narcotic pain medication. Injuries like strained muscles , and even migraines. It was heavily lobbied for by "the American pain alliance" and two other lobbies with similar focuses that were created and funded by major pharmaceutical companies.
Pharmaceutical companies spreading lies like this is a very dangerous game. It's like they don't care that it will erode public trust in pharma companies. This is why regulations are so incredibly important.
Thank you Pete. Really interesting to hear the backstory on this.
My friend and I had dental surgery about 2 months apart. They were 18 at the time, I was 17. Because I was a minor, I got prescribed ketorolac and they, being an adult, got prescribed codeine.
Since we had a similar-ish surgery, the pain levels we experienced were pretty similar. And the painkilling effects of the painkillers were similar.
And yet, simply because my friend was an adult, they got prescribed an opioid when they could’ve done just as well with an non opiate one.
That being said, while I was pretty ok taking my painkillers, my friend decided to bear the pain if possible rather than take the painkillers. Which really sucks, because I know how much that stuff hurts.
That was earlier this year.
Is that Matthew Broderick in
The thumbnail? Pretty sure it should be as he was involved in the deaths of two people in Ireland and faced no repercussions at all.
With all do respect how intelligent are these doctors if they don’t read the y axis? I don’t think it’s a question of intelligence, it’s money and not asking questions..
I really can't remember where, it was in some article about cognitive biases, but I remember that someone studied how well doctors did at understanding probabilities and statistics, and they didn't do so well.
Also trying to be respectful: I think doctors are not scientists. They are not taught to think outside the box they are taught to memorize ALOT of information and follow procedure.
But I get what you're saying.
Nice one, this evil drug was manufactured only 20 miles from my house in Delhi, NY. Even their own workers became addicts!
There is a lot of assumptions here that doctors, specifically physicians, understand and know how to interpret the data and would have made different clinical decisions based on getting the "real" story from the data. That is not true most of the time. Most of what doctors learn is from MCE courses and conferences. They tend to trust whatever the speaker says in those conferences and papers. So I doubt if Purdue was more honest with their findings we would have seen a major difference. The real issue was the fact that Purdue paid so many speakers to repeat the false and misleading data to other doctors.
Yeah Purdue iirc got a lot of misinfo put into those continuing education programs
If you walked in a Doctor office back in those days it looked like a super fan's room.Nothing but oxycotton swag everywhere.
Thinking on it, man, that 12 hour thing is absolutely inexcusable and probably led DIRECTLY to so many addiction problems. I always assumed the bigger issue was the lack of education about tapering doseages at the end of the prescription since without that taper you are VERY VERY easily going to experience withdrawal almost guaranteed, thus leading to a demand for non-prescribed drugs and the slip into addiction. But just the fact that they would prescribe it for once every 12 hours and yet the drug would not work well for the level of pain for 12 hours is just as bad, that encourages patients to redose early and thus run out early and thus that same path to addiction and demand for non-prescribed opiates. Doctors are going to trust the fraudulent studies and deny the patient any additional relief earlier than 12 hours even if they need it. This one lie is a direct pipeline between safe use of the drug and addiction.
Hey Pete! Great video, as always. What do you think of the role that McKinsey had in all this? Apparently they had quite some influence in the process and even have already paid like 600 million in different states in the US given their role in this whole crisis.
It's despicable, but also, having worked for a similar company in the past, I can see how this wouldn't even register on a lot of consultants radars when they got the project.
@@PeteJudo1 Wow, that's terrible, but def good to know... thanks!
“Less than 1%”. That already doesn’t pass the sniff test, as it is so extreme. Lots of MDs forgetting their biostats (which are tested on USMLE step 1). And not to mention the tiny fact that it’s from an anecdotal source (no placebo controlled RCT).
But the really problematic formulation of oxycontin was the extended release version. The FDA and prescribing providers were told that this new formulation was basically completely resistant to misuse because it couldn't be easily broken apart, injected, snorted, or smoked.
The first version could actually be smoked pretty easily. So they released a new version with a more flame resistant binder.
But the _primary_ issue was that the medication can easily be misused orally. Whether by taking an intact high dose pill or by chewing or otherwise breaking the pill.
When the pill is chewed, the binder actually aids in misuse by creating a gelly substance that easily adheres to mucous membranes. Absorption via the gums and cheeks causes the medication to enter the blood stream much more quickly than it otherwise would with normal digestion. Which results in a high that's more similar to snorting.
It's not uncommon to believe that snorting is intended to inhale a substance into the lungs, which would result in an absorption that's similar to smoking or vaping. But it's actually about coating the nasal mucous membranes in the substance. Some of the substance is absorbed through the GI tract via post nasal drip. But most of it is absorbed through the mucous membranes of the nose.
If you actually were to inhale powder or liquid, you would have an extreme "down the wrong tube" coughing fit as soon as the substance made contact with the flap that covers the larynx and protects the lower airway (aka the epiglottitis).
_Anyway_, new formulations were eligible for patents. Which meant that no generics could be manufactured for 20 years. If you're familiar with the US healthcare system (I'm sorry lol), then you know that brand name medications are appallingly expensive. Generics are much less expensive, ranging in price from dirt cheap to still extremely expensive but much more affordable than the brand name.
The idea is that these companies are investing tons of money into research & development, with many of these heavily funded medications never making it to market, so they should be allowed to recoup some of their overall investments by eliminating competition for drugs that do make it to market. Which is terrible, but it also _does_ kinda seem fair.
So Purdue Pharma made bank off of the patent status. Even though the development of both formulations didn't cost them very much. And it was complete BS that the immediate release formulations received patent protections, considering that all they did was remove the acetaminophen etc.
But it doesn't end with getting a bunch patients on a substance with a high likelihood of intense physical and psychological dependency.
The US healthcare system had been extremely squimish about opioids starting in the 1950s or so. They were originally only used for surgery, in hospital pain management, and terminally ill cancer patients. And it genuinely was extremely messed up how much they just allowed patients to suffer needlessly.
So this new "abuse deterrent" formulation combined with willful misinformation about the addictive and dependency properties rapidly helped _everyone_ become way more comfortable with these medications. They even exploited the very valid concept that patients should not be left to suffer needlessly. This exploitation had catastrophic consequences for patients further into the crisis.
This newfound ease with such serious medications opened providers & regulators up to other new formulations that _clearly_ crossed an ethical line while providing pharmacy companies with that sweet sweet patent protection. Fentanyl lollipops arguably should have never been approved.
Your videos are awesome, you should make some videos about antidepressants and psychiatric drugs
I’d like to see you make a video about the impact of living with untreated/under-treated chronic pain. Talking about the dangers of opioids is important, but it’s a softball topic that countless media sources have covered. Chronic pain ruins 100 times as many lives as all opioids combined, but almost no one in the media talks about it.
Another major issue with that letter is that it doesn't explain how they tested if the patients developed an addiction. My guess would be that they only used the clinical records that were produced during the patient's treatment at the hospital, with little follow-up. So patients who did develop addictions probably either would not tell their physician or already switched to a physician outside of the hospital.
And if such a patient had developed an addiction during treatment in another hospital and then switched into this one, they would be considered to have a 'history of addiction' and therefore be no longer counted.
Thank you for this angle. In 2004, I believed the addiction potential was high, and I found a SAMHSA brief I can’t locate now that seemed to suggest it was 30%! That’s probably close.
They also gave CMEs (continuing educational classes for doctors) with their misinfo about addiction, pushed it for chronic/long-term pain even though it increases pain when used long-term and you build up a tolerance, and would tell doctors that signs of addiction were actually signs patients needed a dosage increase.
This is also happening with antidepressants.
How the hell did it end up as a "landmark study" in Time? I feel like this is worth it's own video.
This is exactly why I make all of my students actually look up ALL of their references!
When I was in high school, I broke several bones in my hand. The doctors prescribed some oxy or hydro, I can't recall. But what I do remember is they didn't do shit for the pain. I felt high for a few minutes but that eventually faded and I still felt the pain. I just stopped taking them after they offered me a refill. Turns out, I have that redhead gene that nullifies painkillers.
People love to hate on Purdue Pharma, but the true problem is much more complex. Doctors saw patients getting addicted, and they continued the prescriptions. Now it’s hard to get OxyContin prescriptions, and the addiction crisis is worse than ever using imported drugs. The deeper issue is why so many people want these drugs. If there’s a demand, there always will be a supply.
As a former opioid addict I can answer that easily. Getting high feels good, and withdrawals don’t, so they continue to get high.
From wiki so you know who's behind it:
Richard Sackler started work at the company in 1971. He was named president in 1999 and became co-chairman of the board in 2003. Richard oversaw the research department that developed OxyContin and managed the sales and marketing unit.
Craig Landau was appointed CEO on June 22, 2017. He joined Purdue Pharma L.P. in 1999 and was chief medical officer and as vice president of R&D innovation, clinical and medical affairs. In 2013, he was appointed president and CEO of Purdue Pharma (Canada).
In 2018, eight members of the Sackler family were listed as active or former members of the board of directors. Steve Miller became chairman in July 2018. By early 2019, the Sacklers had departed the Purdue Pharma board, leaving a board of five members.
Having a time release drug would be more addictive because your body would get used to constantly having exactly that amount in you. Then your body will rely on having exactly that amount. How anyone can deny this really baffles me.
Very important video imo
Keep it up
That y axis is deceitful period. We're all conditioned by seeing how data is almost always presented to see the midpoint between 0 and 100 as 50 not 10. First time I've seen data relevant to treatment presented this way...
It's not what is being said but, how it's being said that makes all the difference.
I *think* I was on an oxycodone epi in 2007 after an operation. The dosage was maybe too high because 1) I didn't have even a *hint* of pain in the operated area and 2) I had nightmares until the epidural was removed. I must say that the 10 mg capsule I got a couple of nights later when I had terrible back pain (where the epidural had been; oxy was only allowed basically because I had had epidural) worked in 15 minutes, and since I had had some azolam as a sleeping aid I was basically *very* happy and slept most of the next day, excluding when I was bothered with food and such. :D FWIW, that's the only time opioids have properly worked for me. Maybe I'm insensitive. 🤷♀ And anyway, I don't like sedatives, I don't like the feeling. Except when I need to sleep.
Opioids do have their uses, in intense, temporary pain after surgery, trauma and in end of life cancer pain relief. But pushing it for chronic use is ridiculous and really harmful.
It's a shame the backlash to the epidemic has been just as damaging as the epidemic itself. It's absolutely brutal to get important pain relief these days, both in the social stigma from ignorant people who think opiate use = addiction and doctors being unwilling to prescribe it ever because they fear to lose their license. Countless people are suffering and have diminished ability to live life when there is a solution that would help them simply because we don't rely on reasonableness, we have to go extreme to one side (overprescription) or the other (underprescription).
"peer reviewed"
We know how little that means. It is even a bad thing.
Your channel rocks
Hello, I would like to ask for the title/doi of the Purdue funded research of the oxycodone that you showed in your video in point 3. Also thank you for you insightful videos, very good to watch and learn.
I am sure that your analysis is sound. But that does not make the physicians who prescribed these medications blame free. They accepted their "education" regarding these products knowing that it was coming from the company that makes them and their marketing department, instead of insisting upon a more balanced and disinterested presentation by scholars who are not making money off of sales.
Every due level of well deserved contempt has been poured upon purdue and its executives , though due retribution has yet to be meted out to them and likely never will. There is another villain in this sad tale.
There was only one buffer between patients and pharma , that buffer failed miserably, doctors .
All previous reservations about opioids were cast aside , for which they can't claim to have been blinded by science as there was none.
But in a system where insurance is loathe to cover therapy or procedure , the prescription pad is the only recourse left . After that word of mouth , advertisements, a 60 second slot during the superbowl no less , sales reps beating down doors , and a crisis was born.
So there are three co defendants in this indictment, purdue, health insurers, and doctors . You could throw in the regulators as a fourth, but their ineptitude is always taken as a given.
why is even the settlement of this to be allowed into the court? because there is enough evidence of fake advertising, false claims and negative effects because of it that it should be a criminal case
Ah "safe and effective". This might come across as some anti vaxxer, covid-hoaxer. But I begin to understand everyone who questions some medical operations ....
4:11 and I hate to be nit picky, but the letter actually does refer to oxycodone. Percodan is a combination of oxycodone and aspirin. Of course, percodan was one of the medications implicated in causing an addictive-like presentation in a patient. So it was negatively referenced lol
I told myself once I won't get anymore in a car with a heroin addict, never again.
If the doctors did not cutoff the oxy, the people who still needed pain relief would not seek out alternatives.
And they got House MD.
OxyContin marketing sure bares an oddly familiar tactic that was used for the marketing of heroin. Non addictive and a cure for opiate addiction lol
Disgusting! 🤮
Purdue exaggerated oxy's effectiveness, not so much its safety. I found it to be more like 8 hour drug after surgery and would supplement with acetaminophen, not more oxy. I've also used it as a sleep aid because the benzo type drugs foul up my ability to recall information and make me useless until the following afternoon. The narcotic doesn't do that. The "adverse event" for use longer than three or four days Q12 or Q8 is constipation, which is easily anticipated and dealt with.
Nobody made people work to circumvent the social guardrails we have in place around drugs like this; they did it because they like it. We should ask why they like oxy more than they like life in general. THAT'S the crisis, not the opoids. The trouble for politicians is the real crisis is not susceptible to legislative solutions on any timescale that matters to people living today. The standard legislative response (prohibition) has once again made things worse by people substituting fentanyl.
Everyone is heaping a lot of blame on the Purdue executives. No doubt they oversold the drug and minimized its risks. But doctors have brains, and they could see addictions happening and back off on writing prescriptions. Now it's hard to get prescriptions for OxyContin, but the drug epidemic is worse than ever due to imported drugs. There's a whole generation of addicted people who never got a prescription for OxyContin.
What your saying is contrary to my experience. MDs often prescribed oxycodone to me, starting in 1970, from wisdom tooth pain to kidney stones. I was on it for as long as 4 months, never got any addiction. It wasn't till the last few years that MDs stopped an automatic Rx of oxycodone for kidney stones. I know people who have taken a controlled dose for chronic pain for 25 years, and they must go without for days on end now.
Force the company owners to continuously take the drug 2 times a day for the rest of their lives, since they marketed it as safe!
Dude you have no idea (ok you definitely have some idea) at least 3 of my friends/acquaintances have died of overdose, but it's hard to say because families usually keep it quiet and say "medical complications".
If I go to the doctors for any sort of prolonged pain the first thing thr Dr says it "we aren't going to give you an opioid." Of which ok, good because I wasn't asking for one. I'm hoping for a referral for an x-ray or something of that sort to figure out why I'm in pain. Like I get the issue and completely understand not getting an opioid, but don't just flatly assume that what I want is an opioid because no I really don't. It's more helpful to know why I'm in pain rather than just scripting me a medication as s sorta bandaid fix.
Oh.. Doctors are so clever but they don't understand the logarithmic scale... I think that the blame stays with the FDA which did an abysmal job and made it possible to prescribe opioids to the wrong patients. I think I read that some states regulate it better, even simply asking to keep track of prescriptions in 3 copies (doctor/patient/opioid register, as in Europe) and in those states the problem is less serious.
I'm an oncologist in Europe, we can only prescribe Oxycodone to terminal cancer patients and a few other specific pathologies that are listed and both the doctor has to be a specialist in that discipline and the patient has to be registered as affected by the listed pathology.
Blaming the company is ok, but here the real issue is the FDA evaluation and its poor oversight when approving that kind of use. That means it's a structural problem in the system in place, not a rogue company. Perdue submitted the same papers in Europe and it is only allowed for proper use.
Is not understanding logarithmic scales one of those metric VS imperial things?
I'm kidding. It's because the only job of a politician is to campaign for money, and if they don't have happy donors they don't get re-elected.
And anyway, I guess now, after Chevron, the FDA doesn't even matter anymore, so it's going to be even easier.
I just saw you on the chase.
This disaster of nod and wink prescription has also made it more difficult for physical pain sufferers who legitimately can use opium derivatives.
One really horrible side effect of this situation is that now no one can get any pain control other than Tylenol or Advil in the usa. This does nothing to help post surgery pain, amputation pain, post accident pain etc. It's really terrible. And if you are in horrific pain and ask for pain relief they mark that you are drug seeking. It's aweful! They just watch people writhing about and screaming in pain and are all like, F you!
10:32 "Safe and effective" huh?
Where I have heard THAT before? 😉
Great video
Fentanyl patches, on the other hand, aren't a super egregious product. Because, contrary to what law enforcement prattles on about, fentanyl absorption through the skin is slow and inefficient. So patients can receive a relatively low and stable dose of invaluable pain management.
I think that the patches were a genuine attempt at balancing the extremes between callously ignoring treatable pain and getting as many people as possible in a precarious, at best, relationship with opioids.
Unfortunately, people started doing things like putting multiple patches on simultaneously and chewing on patches.
Oxy is a horrible pain killer. After my ankle surgery in 03 I was given 10mg to take every 4 hours. Ibuprofen was more effective. But it did make me sleep.
This tracks for me. I was prescribed hydromorphone for kidney stones and it didn't do much.
Oxycontin and oxycodone are not exactly the same. Oxycodone is the base synthetic opioid, while oxycontin is a time-release formulation.
Nothing justifies the way Purdue marketed these drugs.
At least "safe and effective" isn't quite what it used to be. There has been progress.
you would think a doctor knows how to interpret a log plot.
Yeah...and really old people who actually could be helped by low dose...guess what...nothing...zero ...unless they are in congress...
I was one off those babies who mom took a drug mmmitnleft me with basically bad bones and teeth..at 70 I was tired of constant dental work ...my whole life..and had all my teeth pulled for implants...I literally had zero pain meds..it was HORRIBLE...I WAS IN AGONY ..BUT I LIVED...ALL BECAUSE PEOPLE ABUSED DRUGS...now at 80 I'm hurt so much every single day I wish I was dead....but doctors won't even consider prescribing anything for it...im so fucked...and I could go on and on...but seriosly my quality of life is ZERO.
Great video Pete.
What is on the list for murder?
It's always so strange to me to see videos from the USA, where kids coming home from the dentist are tripping balls, but if you get the same kind og surgery in Denmark you just have a numb jaw but are otherwise entirely yourself.
So why use the mind altering stuff?
It's not mind altering 🙄🙄🙄🙄. It doesn't make you high and it's not psychedelic. It works by slowing the nervous system which removes your inhibitions and makes you feel tired, heavy and sleepy. It's generally considered non addictive but as with anything that alters your perception if you use it regularly, you could eventually become addicted to it. Since you can only get it at the dentist office and because it's hard to use, it's not used regularly! It would bear out to learn a little bit anyhow dental surgery is done in the USA before making ignorant statements. Only local anesthetic is used and no opioids are given to children. Instead they are given nitrous Oxide. A short action, non addictive gas that doesn't even help with pain management, it just relaxes you and makes you not care about what's happening to you. so when your local anesthetic wears off in the middle of the procedure you won't care that it hurts like hell. The kids seem to be high because they have zero inhibitions, brain sorting happening so they say in a stream of consciousness whatever their little brain imagines rather than editing it to make sense or just not saying whatever is unreasonable. It also wears off in a short amount of time. They have the same thing available in Europe for children, I know, because I live in France where specialists in children with strong fears will do all dental work with nitrous....