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Old 23rd July 2019, 04:26 PM   #41
Minoosh
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Originally Posted by JeanTate View Post
Yeah, me too. Sorry, I don’t know what went wrong; I’ll try and get a link which works ...

How about this: https://www.washingtonpost.com/inves...1e9_story.html

I have no idea what the 5f29 ... stuff is, or means ...
Thanks! It worked!

I'm not at all sure why the drug companies were so zealous in attempting to suppress this database. Some of that information has already been made public ... at least, I remember news stories about small-town pharmacies dispensing huge amounts of opioids.
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Old 24th July 2019, 01:55 PM   #42
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This new WaPo article has a bit of insight into what at least some employees were thinking at the time: https://www.washingtonpost.com/inves...f64_story.html
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Old 24th July 2019, 03:51 PM   #43
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Originally Posted by TomB View Post
My wife has had chronic pancreatitis for ~20 years now.

[snip]

For those who suffer from chronic pain, opioids are a miracle. Patients should not be forced to jump through hoops like criminals on probation for their healthcare. So find a solution that doesn't do that.
I know you didn't share this to garner sympathy, but you have it. Not just for dealing with a ****** chronic disease in your family but for dealing with a ****** system for treating that disease.
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Old 26th July 2019, 09:08 AM   #44
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Originally Posted by JeanTate View Post
This new WaPo article has a bit of insight into what at least some employees were thinking at the time: https://www.washingtonpost.com/inves...f64_story.html
Poor Aunt Sandra, she must have been in excruciating pain.
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Old 26th July 2019, 06:30 PM   #45
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Originally Posted by Darat View Post
Poor Aunt Sandra, she must have been in excruciating pain.
I can easily defend high doses for some patients with tolerance but this is the largest oxycodone dose I've ever heard of.
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Old 30th July 2019, 03:41 AM   #46
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Well, not this pisses me right off. I've had chronic pain for a while now -- and it is affecting my mood majorly at times, in case anyone was wondering why I'm a flaming ass hole -- and you mean I could have been higher than a kite the whole time? Elder gods dammit...
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Old 30th July 2019, 08:44 AM   #47
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Originally Posted by HansMustermann View Post
Well, not this pisses me right off. I've had chronic pain for a while now -- and it is affecting my mood majorly at times, in case anyone was wondering why I'm a flaming ass hole -- and you mean I could have been higher than a kite the whole time? Elder gods dammit...
Having chronic pain for over 20 years, an additional challenge is trying not to be ass to others. The pain meds help. The hoops I must go through to obtain them from my doctor annoys me. Contracts to sign, urine and blood samples every two months, and so on.

However, I really do try to not take it out on others.
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Old 30th July 2019, 09:49 AM   #48
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Originally Posted by Skeptical Greg View Post
You could save a lot more lives by making the legal driving age 21 than by making it such a hassle to get effective pain medication.. ....



Originally Posted by Elagabalus View Post
What, exactly, do you think the manager of pharmacy should do when the doctor prescribes a medication and all the paper work has been filled out correctly - not give them the medication?
They knew what was going on.

Originally Posted by NYT
According to the legal filing, a D.E.A. worker told the Actavis employees “to visit pharmacies who were receiving their products in South Florida, in order for them to witness the long lines at pain clinics, out-of-state license plates, questionable clients, security guard(s) in the parking lots, and signs stating cash payments only.”

But little changed. Actavis’s ethics and compliance officer later said in a deposition, cited in the plaintiffs’ filing, that the “tone and tenor” of the meeting “made it less productive than it could have been” and that the D.E.A. officials had treated the employees “as street dealers.”
In the big Washington Post story (I can't find it now), they cited one large national chain pharmacy that had patients waiting in line outside for the store to open each morning. They had a waiting line system, a security guard outside, and they cut off opiod prescriptions at 3PM to outsiders, so they could save the pills for their "real patients" that might come in after work. Again, they knew that something fishy was going on.
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Old 31st July 2019, 06:31 AM   #49
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Originally Posted by Elagabalus View Post
What, exactly, do you think the manager of pharmacy should do when the doctor prescribes a medication and all the paper work has been filled out correctly - not give them the medication?
Originally Posted by Minoosh View Post
Possibly, give the DEA a heads up. It's not about a given patient; more about a doctor's prescribing patterns.
Originally Posted by JeanTate View Post
I am not a pharmacist.

However, I have read that there are guidelines for what to do in such circumstances, both internal company ones and from the professional organisation to which many pharmacists belong.
Originally Posted by wasapi View Post
This actually happened once... I had 'bed-head', and had thrown on some old clothes, and looked like a mess. They refused to fill it for me, based on my appearance.
A large part of a pharmacist's job, and what they're trained in during their multi-year training programs & internships, is indeed about going against doctors' orders. The reason why they're there, and not just anybody who can read a label and reach a container on a shelf, is exactly that: to check when a doctor might have prescribed something dangerous... or even not-exactly-dangerous-but-less-than-ideal. Former ISF member Paperskater has told stories on FaceBook about already needing to fight doctors while she's still an intern. Simple errors like misplacing a decimal in the dosage or switching two similar drug names tend to get fixed quickly without any hassle, but debatable decisions about patient health can lead to disputes in which the pharmacist can and must stand up against the doctor. Usually the result of these kinds of fights, with a good doctor, is that the doctor handles it like a specialist consultation and takes their advice so the doctor & pharmacist agree on the best solution (dome doctors even call pharmacists to ask for advice before writing anything at all in tricky cases). But if you're a pharmacist and you get a doctor who stubbornly insists on doing what you know is wrong, you are not only allowed but obligated to simply refuse to go along with it. (Nobody I know of from reading Paperskater's stories and working at drug stores myself has needed to report a doctor to the authorities for a pattern of needing to be fought over the same thing repeatedly, but I presume that the duty to do so must also go hand-in-hand with the above.)
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Old 31st July 2019, 10:53 AM   #50
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According to a pharmacist, I was actually prescribed a combination that could have killed me at one point. So, yeah, kudos to those guys.
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Old 31st July 2019, 11:28 AM   #51
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Originally Posted by HansMustermann View Post
Well, not this pisses me right off. I've had chronic pain for a while now -- and it is affecting my mood majorly at times, in case anyone was wondering why I'm a flaming ass hole -- and you mean I could have been higher than a kite the whole time? Elder gods dammit...
You might be better off than if you had gone down the opioid path, especially in the 2000s or so.

An article I read yesterday (will try to find) laid the blame on the FDA. A small panel got cozy with Purdue Pharma salesmen and approved a labeling change that upended traditional protocol for managing chronic pain with opioids. They had pretty much been limited to end-of-life care and episodes of acute pain such as you might have for a week or 2 due to surgery or a broken leg.

This abundance of caution (which may in itself have been too restrictive) was abandoned as Purdue Pharma began marketing OxyContin for management of chronic pain. It was billed as round-the-clock medication with a lower risk of addiction than short-acting opioids such as Percocet or Vicodin. This was based on sketchy data and really had not been evaluated well enough to justify the labeling change. A big problem was the ease of getting around the time-released formula which made it appealing to shoot or snort, but even used as directed, of course there's a risk of addiction. Especially since it was labeled for once every 12 hours, which also wasn't particularly justified. Clinical evidence was that some people needed dosing every 8 hours but Purdue Pharma fought that labeling change because twice-a-day was a big part of their marketing plan. And, as I've said, the doses prescribed far exceeded the traditional 5 mg or 10 mg every 4 hours given for acute pain (surgery, dental work, injuries).

Now, I'm not saying the old paradigm was ideal, either, because with proper management opioids for chronic pain may be appropriate but care must be taken due to issues like tolerance that can result in escalating doses with no end in sight. That can be managed and so can any resulting physical dependence. But the pendulum swung so hard the other way that many people without tolerance OD'd on the amount of oxycodone in one pill (equivalent to 16-32 Percocet).

OxyContin abuse is way down now that the time-release mechanism has become much harder to beat. Some people moved on to heroin which is sometimes laced with fentanyl. That's driving many of today's overdose deaths.
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Old 31st July 2019, 11:46 AM   #52
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The state of Oklahoma has sued a number of pharmaceutical companies for their role in promoting and selling opioids in Oklahoma. My understanding is some of the companies but Janssen Pharmaceutical and its parent company Johnson & Johnson did not. Testimony in the trial has just concluded. Some 30 days of testimony are available on youtube. The testimony of Johson & Johnson's designated corporate witness, Kimberly Deem-Eshelman, begins at about 2:40 here:

https://www.youtube.com/watch?v=8e5nSPIQGgE&t=14054s

and continues for days.
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Old 31st July 2019, 12:23 PM   #53
JeanTate
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Originally Posted by Minoosh View Post
You might be better off than if you had gone down the opioid path, especially in the 2000s or so.

An article I read yesterday (will try to find) laid the blame on the FDA. A small panel got cozy with Purdue Pharma salesmen and approved a labeling change that upended traditional protocol for managing chronic pain with opioids. They had pretty much been limited to end-of-life care and episodes of acute pain such as you might have for a week or 2 due to surgery or a broken leg.
The other "approved use" was for cancer patients, which is a complex story in its own right. No doubt some cancer patients became addicted, but they almost always surely had much bigger things to worry about.

Quote:
This abundance of caution (which may in itself have been too restrictive) was abandoned as Purdue Pharma began marketing OxyContin for management of chronic pain. It was billed as round-the-clock medication with a lower risk of addiction than short-acting opioids such as Percocet or Vicodin. This was based on sketchy data and really had not been evaluated well enough to justify the labeling change. A big problem was the ease of getting around the time-released formula which made it appealing to shoot or snort, but even used as directed, of course there's a risk of addiction. Especially since it was labeled for once every 12 hours, which also wasn't particularly justified. Clinical evidence was that some people needed dosing every 8 hours but Purdue Pharma fought that labeling change because twice-a-day was a big part of their marketing plan. And, as I've said, the doses prescribed far exceeded the traditional 5 mg or 10 mg every 4 hours given for acute pain (surgery, dental work, injuries).

Now, I'm not saying the old paradigm was ideal, either, because with proper management opioids for chronic pain may be appropriate but care must be taken due to issues like tolerance that can result in escalating doses with no end in sight. That can be managed and so can any resulting physical dependence. But the pendulum swung so hard the other way that many people without tolerance OD'd on the amount of oxycodone in one pill (equivalent to 16-32 Percocet).
The role of other pharma companies has yet to be made fully public, but from memory what Purdue Pharma (or its lobbyists) did was find a document (not even a paper, from memory) on addition to opioids among hospital patients receiving opioids to relieve pain after surgery etc (it did not, from memory, cover cancer patients). It found just a single case of addiction. Purdue Pharma leveraged this to get approval for its new formulation. For settings beyond help with post-surgery pain, for example.

To me, as a scientist, this is one of the most egregious mis-uses of science I've come across ... and, per documents now in the public domain, Purdue Pharma et al. knew exactly what they were doing. As did, apparently, some in the FDA ... but they were over-ruled (and, from memory, resigned).

Quote:
OxyContin abuse is way down now that the time-release mechanism has become much harder to beat. Some people moved on to heroin which is sometimes laced with fentanyl. That's driving many of today's overdose deaths.
It's a complex story.

After Purdue Pharma's "success", other drug makers piled in, eventually supplying the majority of the market (Purdue Pharma's share dropped to 3%, from memory, and Johnson & Johnson's was (always) far smaller).

Then there's the Subsys story ... one version is that the CEO saw what other companies were getting away with, and so purposely set out to boost the prescriptions for its fentanyl patch; a lot of people in the company knew full well just how brazenly they were breaking laws, including the CEO (who may have been the driving force behind the scheme). Thousands died, of opioid overdoses, having got hooked on fentanyl.
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Old 31st July 2019, 02:52 PM   #54
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Originally Posted by Darat View Post
Poor Aunt Sandra, she must have been in excruciating pain.
Indeed. Several times the lethal dose of oxycodone daily...
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