Rio Fantastic
Bluelighter
- Joined
- Feb 19, 2009
- Messages
- 1,727
Dude, I know you're upset & angry, but the situation now is there is a flawed system trying to tackle a complex problem. The health care industry in the USA really, really fucked up in the 90s with oxycodone. The blame for that can be squarely placed at the feet of Purdue, a corporation that is indeed run by selfish, greedy & uncaring assholes. They brought OxyContin out and spent a fuck ton of money on marketing, throwing cash at doctors and seducing them with expensive "conferences" on tropical island resorts with all expenses paid, they selectively published research to create the misleading impression that Oxy had less abuse potential than other strong opiates like morphine, actively suppressed the research that started to show the simple fact that oxy was just as addictive and dependence-forming than morphine, and refused to remedy the situation until the government & courts stepped in and made them take some small steps towards correcting their mistakes.
Unfortunately, the fines that would be devastating to companies from practically any other industry were barely a drop in the bucket for a huge pharmaceutical company that had been raking in money hand over fist for decades by being the sole purveyor of a highly addictive opioid that they had somehow managed to sell as being a safer alternative to other strong opiates. It was a case of too little too late, as by the time it all came out in court oxycodone had become omnipresent across the USA with hundreds of thousands of people dependent on it. The situation was particularly bad in the south and especially Florida, where the notorious "pill mills" operated by amoral doctors looking to make lots of money by being the legal equivalent of heroin dealers had already written tens of thousands of prescriptions of oxy for people who really didn't need it, and outside of the pill mills pumping the scripts out doctors all over the country had been prescribing oxy under the false impression that it had less capacity to cause dependency than the previous first choice opiates for severe pain like morphine, pethidine etc.
When the FDA finally woke up and realized what was happening and set out to dismantle the pill mill practices and the regulators finally realized that we were facing an epidemic of legal opioid addiction and started to tighten the restrictions on prescribing it was way too late, and when oxycodone prescriptions started being cut off en masse across the country the main effect was to just send record numbers of young people out on the street looking for heroin. Hard to believe now, but there was a period in the 90s where heroin use was at its lowest among young people for decades, but because of one greedy, conniving pharmaceutical company and the complicit doctors too greedy, apathetic or naive to notice or care that they were being swindled, there is now this opioid epidemic that keeps getting worse & worse, causing ODs to happen left and right, ripping apart small towns & communities and ruining the lives of not just the addicts but all the people around the addicts as well.
However, that being said, unfortunately opiates are incredibly useful medications. Their applicability and efficacy for pain relief is completely unparalleled - no other medication can even come close to the consistency and sheer effectiveness of opiates for the treatment of pain. Opiates are indispensable, so it's not like thalidomide or something where the government can just decide to ban them outright. It also complicates the situation that pain is very subjective, and what may be mild discomfort for one person can be agony for another. We can't directly measure pain and have to rely on the self-reporting of patients. Though many cases, like broken bones, are obvious, there are also many cases where a patient can be in really severe pain but it's not something that can easily be detected with a scan. If doctors could just totally unreservedly trust their patients in all cases then this wouldn't be a problem, but the fact that opioid addicts will always do their best to game the system in order to get high and will be crafty and deceptive enough to put on a convincing show of pain and are clearly going to pick the very conditions that are very painful but hard to provide physical evidence for, this means that doctors always have to be wary to try to separate those in genuine need of pain relief and addicts looking for a fix. Since if a doctor is found to have consistently aided drug-seeking behavior (even unknowingly!) they can lose their medical license and their job, these regulations have made it much easier for doctors to err on the side of caution. If a few patients are sent away without adequate pain relief then the doctor may have some unhappy patients, if a few addicts are sent away with strong opiates and are then found to have lied and be abusing their prescription then the doctor can very easily find themselves without a job or a license with their whole career that they've busted their ass for years & years to achieve all gone.
Purdue and the pill mill doctors were the villains in this story. They opened pandora's box and the repercussions haven't even reached their apex yet - the opioid crisis continues to get worse. Faced with this giant issue whilst having to juggle the fact that opiates are indispensable but also being pressured incessantly from above to cut down on opioid prescriptions to fight the epidemic has left doctors caught between a rock and a hard place. A compromise is necessary. Clearly, we can't leave those with severe chronic pain to suffer, but we also cannot stand by and allow the opioid epidemic to keep getting worse, and watch as the number of overdoses per year keeps increasing and increasing. It's a very complex problem with no simple solution. If you want to be angry at someone, be angry at Purdue. Don't be angry at the doctors, regulators and the general medical industry, since most of it is staffed by people who do have a genuine desire to help people and do really care about their patients, they are just facing a really complex problem that doesn't have an easy answer. Personally, i suspect we are currently experiencing an over-correction of sorts to the massive over-prescribing of oxy in the 90s, to the point where the pendulum has swung in the other direction, leaving many who do generally require medication to be denied the only substances that can stop their pain, but I think as this is noticed and it becomes a big problem then the pendulum will swing back towards the center, and hopefully a happy medium will be reached eventually.
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