U.S. court voids drug rep's conviction, cites free speech

slimvictor

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"Darkness cannot be dissipated with more darkness.
A divided federal appeals court on Monday threw out the conviction of a sales representative for promoting off-label use of a prescription drug, a ruling that could make it harder for the government to police how drugs are marketed and sold.

The 2nd U.S. Circuit Court of Appeals in New York found that the sales representative's free speech rights under the First Amendment had been violated.

"In the fields of medicine and public health, where information can save lives, it only furthers the public interest to ensure that decisions about the use of prescription drugs, including off-label usage, are intelligent and well-informed," Circuit Judge Denny Chin wrote for a 2-1 majority.

The decision overturned the October 2008 conviction of Alfred Caronia, a sales representative for Orphan Medical Inc, now part of Jazz Pharmaceuticals Plc.

Using drugs "off-label" means that they are taken for conditions other than those for which they received U.S. Food and Drug Administration approval.

Many large healthcare settlements with the U.S. government have involved off-label promotions, including GlaxoSmithKline Plc's $3 billion accord in July over several medicines, and Pfizer Inc's $2.3 billion accord in 2009 over treatments such as the anti-inflammatory drug Bextra.


(...)
Caronia had appealed his conviction by a Brooklyn, New York, jury on one count of conspiracy for introducing a misbranded drug into interstate commerce, violating the federal Food, Drug & Cosmetic Act.

He was sentenced to one year of probation plus 100 hours of community service for the misdemeanor.

The drug was Xyrem, which won FDA approval in July 2002 to treat patients with narcolepsy, a condition associated with weak muscles, and in November 2005 to treat patients with excessive daytime sleepiness linked to narcolepsy.

Prosecutors said that in October 2005, prior to the second FDA approval, Caronia had improperly promoted Xyrem for "off-label" uses including excessive daytime sleepiness, muscle disorders, chronic pain and fatigue.

But Caronia said it should not be a crime for drug companies and sales representatives to truthfully promote FDA-approved drugs for legal, off-label uses when others, like doctors, may engage in such speech without penalty.

The 2nd Circuit agreed, noting that the U.S. Supreme Court had in 2011 found that speech that aided in drug marketing was a form of constitutionally protected expression.

Chin rejected the government's contentions that restrictions were needed to stop the non-approved usage of drugs, and preserve the efficacy of the FDA drug approval process.

"The First Amendment directs us to be especially skeptical of regulations that seek to keep people in the dark for what the government perceives to be their own good," Chin wrote.

Chin made clear in a footnote that off-label promotion that is false or misleading does not get First Amendment protection.

cont at
http://www.reuters.com/article/2012/12/04/us-offlabel-conviction-idUSBRE8B21DC20121204
 
The fact is that (Xyrem)GHB can be used for basically anything except an anti-seizure medication.

It's a muscle relaxer, appetite suppressant, sleep medication, stimulant, anti-anxiety medication, narcolepsy aid, body building aid, pain relief medication, appetite enhancer, mood enhancer, and most commonly a sex enhancer.

Yet it's thrown around as "Date rape drug" and only considered by the public when used strictly for cataplexy in the US.

The only danger I see in a larger promotion of GHB is driving and "Poly drug combinations" .

Driving is the only real concern I have. I could see Xyrem users as being a major issue on the road.
Anything to avoid hindering obscene profits.

You have a point in that Jazz Pharma charges an unrealistic amount for a medication in which those hindered with narcolepsy need.
 
You have a point in that Jazz Pharma charges an unrealistic amount for a medication in which those hindered with narcolepsy need.

It's amazing that such a simple molecule, that has been around for so long, would be priced so highly. That is practically communism.

Also, doesn't each batch have to be flown in by the secret service, in the beak of a griffin or something?
 
As much as I support the legalization of all drugs, this sets a bad precedent. Just google "Neurontin off-label" and the legal mess that ensued. The fact that reps can tout such a strong controlled drug is criminal. Off-label indications exist for a reason: there is not a lot of evidence to support their use.
 
I had no idea that there was a legally protected pharmaceutical GHB"

Just read this bit from the DEA page:

Gamma-hydroxybutyric acid (GHB) is a schedule I depressant. The GHB-containing pharmaceutical product, Xyrem®, is controlled as a schedule III drug.

How the fuck does that work? Schedule I, for drugs with a high potential for harm and abuse and NO ACCEPTED MEDICAL USE. But when you slap a trade name on it, even though its the exact same compound, it suddenly has a medical use. Disgusting.

Then, to make it simultaneously more evident why and more disgusting: this, from Wikipedia.

In the US, the cost of Xyrem is $2,333.20 per 180 mL bottle (500 mg/mL). The effective dose range is 4.5–9 grams per night, which equates to $3,499.80 (4.5g) to $6,999.60 (9g) per month as of 10/2012. Xyrem is covered by most insurance plans including Medicare and Medicaid and approximately 90% of Xyrem patients have a flat monthly co-pay. 75% of Xyrem insurance copays are less than $50 and 42% are less than $25 for a one-month supply.

Oh. So it is a way to directly funnel an obscene amount of money directly from insurance companies (or the government, in the case of the government plans) into the pharmaceutical company that "developed" it. GHB is so ridiculously easy to make and purify that it could potentially cost 5% or less of that price and still be of equivalent purity and safety. Disgust doesn't even begin to cover the reaction this warrants.
 
http://www.sigmaaldrich.com/catalog/product/aldrich/b103608?lang=en&region=US

There's reagent-grade GBL, >99% purity, which is one very short and clean (nothing that would produce a toxic by-product) reaction away from "Xyrem". $600 for 20 KILOGRAMS, which equates to $0.03 per gram. And Xyrem costs $25.9 per gram. So they have an 86333% markup, minus a small amount for the other reagents, which are all similarly cheap. What possible reason could there be for this drug, which was once legal and widely used prior to scheduling in 2000, to cost this much?
 
Let's also keep in mind that GHB penalties are unrealistic in the United States.

A single dose of GHB is enough to land a person in serious legal trouble (2grams). In court, the person would most likely be stuck accused of being a date rapist and their sentence will probably be jacked up to high heaven! It'd be pretty difficult to get the empathy of the jury with this substance.

But it's without a doubt the US's penalty on GHB is severe for both corruption and Highway safety reasons. GHB is possibly one of the most dangerous drugs for driving. However the claim of it being (very) deadly by itself and names like "Grievous Bodily Harm" are just plain ignorant and that kind of anti-drug exaggeration has no place in a world of easy access information.

GHB's full effects are actually not fully understood by science. The "GHB receptor" is so broad that the effects are not yet known. There are claims it releases oxytocin(Which is very likely), however the source for the study was questionable, so I can't say it's fact. With that said, who makes rules on something when they do not have all the facts straight yet?

I agree with all of these wonderful posts. I am a strong believer in the empathetic, healing and relaxing properties of moderate GHB use. I believe a higher availability of GHB to responsible individuals would make for a better world with much nicer people.
 
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I would absolutely love to see mixed drinks (with appropriate dosing) made with GHB or GBL being sold in lieu of alcohol everywhere. It is simply better in every way: a better sort of high, smaller required dose, gentler on the body, even has some positive health effects.
 
This is what I'm referring to, btw:

https://docs.google.com/viewer?a=v&...NX8Zrw&sig=AHIEtbRbVJajZK1ts-5wLKh8IN6XAYHGzg

That's the reason it's so expensive.

Though I think they no longer require griffins.

I wonder if they include this vastly inflated cost of a very cheap medicine when they calculate the dollar value of "money lost due to drug use". I wouldn't be surprised at all, since they include their own law enforcement and the lost wages of people who are incarcerated because of the drug laws. They call it money lost to drug use, but its really money lost to drug control policy. *sigh*
 
I'd love to.

Closest I've got was Baclofen and Phenibut, which were leagues better than alcohol imo. And they're quite shitty drugs imo.
 
Let's also keep in mind that GHB penalties are unrealistic in the United States.

A single dose of GHB is enough to land a person in serious legal trouble (2grams). In court, the person would most likely be stuck accused of being a date rapist and their sentence will probably be jacked up to high heaven! It'd be pretty difficult to get the empathy of the jury with this substance.

But it's without a doubt the US's penalty on GHB is severe for both corruption and Highway safety reasons. GHB is possibly one of the most dangerous drugs for driving. However the claim of it being (very) deadly by itself and names like "Grievous Bodily Harm" are just plain ignorant and that kind of anti-drug exaggeration has no place in a world of easy access information.

GHB's full effects are actually not fully understood by science. The "GHB receptor" is so broad that the effects are not yet known. There are claims it releases oxytocin(Which is very likely), however the source for the study was questionable, so I can't say it's fact. With that said, who makes rules on something when they do not have all the facts straight yet?

I agree with all of these wonderful posts. I am a strong believer in the empathetic, healing and relaxing properties of moderate GHB use. I believe a higher availability of GHB to responsible individuals would make for a better world with much nicer people.
GHB is so not the best drug to date rape with. I used to get shit for dosing around uninformed when I was a regular frequent doser. I think benzos+ alcohol is more date rapey but whatever. Driving on GHB is the worse idea ever. Its not like alcohol in that your coordination is lost slightly -- you dont really have any when the full effects hit but this is probably why you hear it called the date rape drug....
 
GHB is so not the best drug to date rape with. I used to get shit for dosing around uninformed when I was a regular frequent doser. I think benzos+ alcohol is more date rapey but whatever. Driving on GHB is the worse idea ever. Its not like alcohol in that your coordination is lost slightly -- you dont really have any when the full effects hit but this is probably why you hear it called the date rape drug....

I've gotta disagree on the date rape part. The first time my wife and I took GHB, I was mistaken about the concentration and our dose was too high, taken too quickly. I was okay, albeit very drunk-feeling and uncoordinated. She, however, lost consciousness for about 3 hours, totally unresponsive to being spoken to, shouting, shaking, and eventually even some slapping. I was probably the closest to total panic I have ever been. She didn't vomit, and she was breathing, so I didn't go the hospital route and she eventually woke up on her own, but with no recollection of any of my attempts to wake her. If it had been a date-rape scenario I probably could have done anything and she'd have had no idea, and then she woke up with no aftereffects.

I highly doubt GHB is used as a date-rape drug anywhere near as often as the media likes to portray, but I believe it absolutely COULD be used as one.
 
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