Woah... just woah, so am I mathing this wrong, or from 2006-2012 there were ~250 pain pills per person (man, woman, child) sold in America? Because if so, I don't know how on earth any executive couldn't be fucking liable for knowing the vast majority being manufactured and sold were being used illicitly.
I was reading another discussion among physicians about this and the number isn't that excessive.
50M Americans have chronic pain, assume 10M (20%) are on opioids. 76B pills over 10 years is 7.6B per year, so 760 pills per [chronic pain + opioid] person per year. Take 4 pills per day or 120 per month or 1440 per year. So basically 6 months of therapy for every chronic pain patient in the US.
But that's one of the big lies - or minimally very misleading marketing: long term opiate treatment isn't as remarkably effective for chronic pain as Purdue had us believe and carries a LOT of downside: https://www.ncbi.nlm.nih.gov/pubmed/30313000
I have a relative with 2 artificial hip replacements and many issues with his other organs which were injured durring a war from machine gun fire in Vietnam. About 8 months ago his opiate pain meds were reduced by over half. We now often visit and help him with chorrs as he can barely move. Opiates are a very important treatment and there is a stigma currently hurting needing patients.
> For a number of Key Questions, we identified no studies meeting inclusion criteria. Where studies were available, the strength of evidence was rated no higher than low, due to imprecision and methodological shortcomings, with the exception of buccal or intranasal fentanyl[...]. No study evaluated effects of long-term opioid therapy versus no opioid therapy.
> No study evaluated the effectiveness of risk mitigation strategies on outcomes related to overdose, addiction, abuse, or misuse. Evidence was insufficient to evaluate benefits and harms of long-term opioid therapy in high-risk patients or in other subgroups.
> CONCLUSIONS: Evidence on long-term opioid therapy for chronic pain is very limited but suggests an increased risk of serious harms that appears to be dose-dependent. More research is needed to understand long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and risk mitigation strategies.
Very true. It's also true that Medicare and Medicaid, used by the majority of disabled and elderly does not provide coverage for most alternative therapies. Medicare recently approved 'dry needle' treatment, a less-effective cousin of acupuncture. Massage therapy is a proven pain reducer but not covered at all. The list goes on.
Some of the issues activists are still working on are quality of life aspects of health care: for instance, Most policies will pay for the amputation of a diabetic patient's foot but NOT for a $50 pair of properly fitting shoes.
This is my 2 cents: I was looking for access info on the DEA database referenced here and found your discussion interesting. Thanks for the tips on getting past WAPO's paywall!
I (non-US) am on (up to) 8 per day, or 2920 per year. To get an average of ~42 pills per year (250/6), it only requires 1 in 70 to be on a similar regime (2920/70 ~= 42). Given that 8% of American adults have high-impact chronic pain (frequently limits life or work activities)[1], that doesn't sound that excessive.
Sanity check: 19.6 million people * 4 pills per day * 6 years ~= 172bn pills. That's over _double_ the actual number, suggesting high-impact chronic pain sufferers are, on average, only taking 2 pills per day.
Edit: I overlooked that this only covers oxycodone and hydrocodone, and not the other opioids, but as they account for 3/4 of the total opioid pill shipments[2], it doesn't change the picture much (76bn * 4/3 ~= 101bn, which is still well under the number I posited above).
That's not to say there isn't an issue with diversion, but in terms of raw numbers, it doesn't seem excessive.
> I don't know how on earth any executive couldn't be fucking liable for knowing the vast majority being manufactured and sold were being used illicitly.
The answer is plausible deniability. Nobody in the chain has specific knowledge of wrongdoing and nobody seeks it out.
People with chronic pain will usually need multiple pills a day. And some of these pain pills might lose their effectiveness with long term use. What alternatives do we have for these people?
Doctors prescribed them unnecessarily under perverse incentives from pharma leading to the addiction and deaths of innumerable people who trusted them to do the right thing, that's what you know.
You know, that's one of the few valid points against the legalization of all drugs. I don't care how many die or overdose or whatever (it's a moral issue of owning one's own body, much like abortion) but antibiotics seem to throw a wrench into the whole thing. By misusing antibiotics, you are not just affecting your body, but everyone else's on earth as well.
An interesting problem that I still haven't resolved.
