Pushing opioids over lunch
Support for the electric toothbrush comes from today. Explain no in another way. Support for today explained. Today comes from the clip electric toothbrush over a million people have purchased it. Some at get quip dot com slash explained where the quipped starts at just twenty five dollars. And your first set of refills is free G E T Q IP dot com slash explained. Several years ago. I had this surgery. They cut open my face. It was pretty intense when it was over the hospital sent me home with the prescription for Oxy Kotome for the pain. It was way more intense. I took one of the pills. I got dizzy I got anxious. I started slurring my words. It was way. Worse. An experienced the surgery. I stopped taking the Oxy and realized I didn't even need the drugs. I wasn't even in pain. But then I started wondering why I was given such potent painkillers in the first place. My best guess was pharmaceutical companies are really powerful. And now there's a study that suggests my guess wasn't all that bad study found recently that there seems to be a direct correlation between marketing for opioids. So like, these drug companies, send representatives to these doctors directly marketed, I'm telling them, hey, prescribe, drug, it's going to be safe fact of excetera, and there's a correlation between that kind of marketing and prescribing rates and opiate overdoses a year later, her Lopez writes about legal and illegal drugs for vox. He says this new study isn't the first to suggest the doctors are influenced by marketing from pharmaceutical companies one. Study that came out last year looked at sending these doctors to conferences giving them paid travel speaking fees that kind of thing, but one of the points in this paper is that some of the most effective marketing might be more subtle things. Like just buying a meal, and that alone will influence whether doctors prescribe the drugs marketing, these jagged little pill starts to really ramp up in the mid nineties. In the mid nineties Oxycontin came out, and that led Purdue pharma, which created it to really start ramping up advertising marketing campaign for it does no question that I best strongest pain medicines all the opioids. They don't wear out. They go on working. They do not have serious medical side effects. And so these drugs, which I repeat our best strongest pain medications should be used much more than half of patients in pain. It said that the drug was safe and effective that doctors could prescribe it, and they would see these dramatic benefits for people suffering from both acute pain and chronic pain. And at the same time other pharmaceutical companies jumped in started advertising their opioids started saying, hey, joining with Purdue like these are safe and effective. We have these new types of drugs ready to go out to patients, and this is really where we saw the opioid crisis. Start. It started with with these doctors because not only did these drugs go out to patients, but because patients had so many of these pills. They would sell them. They would keep him in a medicine cabinet where they're teenagers. Could then go on and steal them. They would give them to friends or family and since a lot of the advertising a lot of the marketing at the time was like, hey, these drugs really aren't that dangerous? A lot of people were genuinely duped by the thought that for whatever reason these opiates on the market at the time were safer and more effective. These are the same drugs that have a reputation for causing. Fiction and all the terrible things. Now. In fact, the rate of diction amongst pain patients who are treated by doctors is much less than one percent. This is part of a campaign at the time to really just take pain more seriously. There had never been very good treatments for chronic pain. And so when opioids came in, and they were advertises news sexy safe effective drug a lot of people were ready to buy them. What was the major difference between say Oxy and the pre existing painkillers that were out there. Why did it take off in such a big way? So the big thing that they advertise that they use extended release formula and they're slowly absorbed into the body and it slowly taking effect. Yeah. That's going to be less risky than if they take a pill that takes effect all at once. Right. Yeah. That was the thinking and the thing he's like well patient will also need fewer of these pills since the only had to take one for eight to twelve hours. I should clarify that a lot of this is turns out to have been extremely misleading Purdue had evidence fairly early on that it's drug was not working as long as it advertise and the Los Angeles Times at a great report on this basically finding that they kept advertising long-lasting, anyway, even they knew it wasn't. Yeah. Even when they knew it really wasn't. But the key thing here is that even with extended release Formula one way to get around it is to crush the pill and snorted or injected and so that would make all the opioid. They're take effect at once. It's an extremely easy way to get around the medication essentially not getting it was highs you'd want to right away. Did Purdue know what it was cooking up in the nineties when it came up with Oxy didn't know that it had like this blockbuster drug on his hands. It certainly seemed to based on how aggressively marketed really wanted to sell as many opioids as possible get as many doctors prescribing them as possible. I mean, how big an industry does this become up to this point Perdue on its own as may tens of billions of dollars from Oxy other companies are probably making way more because in the end Oxy is still only a part on a small part of the overall opiate market. I mean, there's Percocet morphine is still big part of our patients. Get opioids in hospitals Fendt Knowles products. Yeah. Vica din. Codeine Demiral did these companies have any idea? How addictive these painkillers were? They definitely. Should have known. I mean, we've known for centuries that opioids are addictive just about everyone who's been using opium for thousands of years. Could tell you that and even people who took like Oxy ass prescribed got addicted and some of them overdose in died. So Purdue really should have known that this product is not safe. It's not affective. It really does help some pain patients. But it just wasn't a safe and effective as produce said it was and now we're all facing the consequences of this in the opioid epidemic. This is Dr Daniel young I'm a family physician in upstate New York over the last five years, I've transitioned into teaching younger physicians during their three year training program. Doctors are visited by pharmaceutical representatives, many different companies in the office. I was seeing pharmaceutical representatives probably one or two, you know, week where they would come to the office to tell me about any new medications. They might have out on the market or the that would bring the information that way where they would. There was a lot of conferences going on. I remember going to pain conference probably in the mid nineties to learn more about how to treat chronic pain. The all of the literature in the pharmaceutical information was that we had these longer acting pain medications and patients did not become dependent or addicted to the medication. So I think definitely shifted what I was doing. I've definitely increased the amount of long acting pain medication that I was providing the patients, absolutely. I would start getting more patients coming to my office. If you were a physician who prescribed the chronic pain medications, you would fuddy start getting more and more patients as friends would refer their friends to you. So yeah, definitely like a light bulb goes off saying, hey, something's not right here. You know, these are probably patients said should not be on chronic pain. Medication? Or out there to help people not to cause them harm. And I definitely think that over the years probably been some patients that I have caused harm by creating either dependence or addiction on pain medicine. Hello. Hello. Is Tim from Brooklyn? It is. Hey, it's Sean from today. Explain Sean Tim from Brooklyn late last year. We were talking about how you were hoping someone would send you the quip electric toothbrush around the holidays. The one that over a million people have purchased the one that's been endorsed by dentists the one that's sensitive on your gums did that ever happen. We believe that it did not and several people heard me talk about it on this, very podcast and should be. But did not purchase me one. How's your tooth brushing been since I believe the last time we talked? You were brushing until the quip arrived. If you stuck with just broke a bone in my right arm, which is dominant head. Cast on it. And it's been very hard to brush my teeth with your non dominant hand because you got to move it around. It have I I have been brushing assisted the difficult. You know, it would be something that maybe electric toothbrush could solve man if ever there were a case to get him from Brooklyn, equip electric toothbrush. Get quip dot com slash explained. G E T Q U IP dot com slash explained the quickstart just twenty five dollars. And Tim's first set of refills is free. Sounds like a good deal to me. So her when exactly did the first signs that you know, Oxy and other opioids like it might be extremely addictive start to surface. So it happened pretty early on by the late nineties and in the early two thousand we had already seen opiate overdose deaths. Start rising, particularly painkiller debts. There were stories all over the news. You can like look back at archives of people talking about misusing drugs using them at parties in that kind of thing. I mean, one of my favorite things here is that if you go back to old TV shows rewatch friends, there are jokes about misusing opioids and how they're making you feel high and all that friends. Yeah. That's great. Wow. Those pills really worked not the first two. But the second to it's a bunch of like nineties shows that you would think are more innocent. They do make these kind of remarks here and there Mr President. Did you any chance take your back pills? I don't mind Jay I was little there. Which would you take, sir? The vicodin or the Percocet I wasn't supposed to take them both. I'm like really sensitive to the stuff. Obviously. I'm like what what the hell. Are they talking about these drugs are not like, okay? To just joke about like this. I mean, I was in high school when I got my wisdom teeth removed, and I got some opioids results of that. And my friends were all joking about like, hey, are you getting high? Can we try some that kind of thing? But at the end of the day, it just goes to show like these drugs are really going everywhere. And everyone at some point seemed to know that they could be misused. And yet you still saw this kind of marketing did anyone hold these companies like Purdue and its peers accountable for this in the nineties the way, let's say. You see President Trump, for example, talking about it. Now at least now it's on until the mid two thousands. Where you start seeing government law enforcement really start to crack down. So actually in two thousand seven Perdue ended up paying six hundred million dollars in fines because of its misleading marketing and some of its executives were wrapped up in this to having to pay fines on their own. And then they had to go out and do community services a result of that. So in the end, that's like peanuts compared to the billions of dollars literally that they have made from opioids. So it's a question of where the held accountable enough or for them was just like a cost of doing business as they saw their profits grow. Anyway this morning. My office filed the lawsuit in Massachusetts state court against Purdy pharma. And it's board members and executives jumping ahead to present-day opioid crisis. They are now several lawsuits that suggest Purdue might actually get in more and perhaps. More serious trouble who are the executives these lawsuits target. So you do hear a lot about the Sackler meaning the Sackler family which owns Perdue. They're really wrapped up in all of this. Because not only were they involved in the creation of Oxy, but they also were involved in the marketing of it if the Sackler is haven't done enough damage, they also just patented they new drug to help. Wean addicts opioids so. The seculars addicted to the country to opioids now they're going to profit off the cure that takes a pair of swing Sackler. 's some recent lawsuits filed by Massachusetts attorney general the defining in their suggests that the sack letters, or at least some members of the Sackler family knew that these drugs were dangerous knew that they were leading to all sorts of trouble and still they tried to cover that up and that they push them to market the drugs more aggressively. They don't want to accept blame for this. They blamed doctors they blame prescribers and worst of all they blame patients when you say that you mean producer, you mean, the Sackler family or they want him the same. They went in the same in one alleged instance, then president Richard Sackler, devised what Healy describes as secular solution to the overwhelming evidence of overdose and death writing in a confidential Email we have to hammer on the abusers in every way possible there. Cooperates and the problem now pretty we'll come back into the findings in that lawsuit are misleading or taking some of that their communications out of context. But generally, we do know that produce very aggressive in marketing this the sack lers had to be involved in some way, given that they own the company in that kind of marketing is that is that lawsuit has settled or is it on going. Now, the Massachusetts lawsuit is relatively new. But there are I mean, literally hundreds of lawsuits around the country against not not just Purdue, but all sorts of pharmaceutical companies and also distributors. So like, Walgreens, for example, is wrapped up in some of these losses because the arguments also that these distributors should have known that they were supplying a bunch of these drugs to people should not be getting them a bunch of those lawsuits like again, literally hundreds are now being consolidated in Ohio. And the hope is that a lead to some sort of big settlement agreement that will once and for all tamp down on not just opiate prescription. But also provide money that can be directed to addiction treatment and. Prevention? Is the problem bigger than that though? I mean, you're talking about dealing with diction and dealing with the misleading marketing of these opioids. But like as you said, and as I said like, I got a moderately serious surgery did not need any painkillers, really. And I was sent home with Oxy, and you had a dental procedure, and you were sent home with Ozzy like this has become a part of this country's medical culture. And and you say this system, even though since two thousand ten there's been a drop in prescriptions for opiates overall. Okay. America still prescribed way more than any other country. I mean that there are different ways to measure this. But when you look at the statistics like the second-place country is is like not even close overall opioid prescriptions. America's way ahead. I mean, why the heck is it wise that even the case that were above and beyond any other country in terms of our usage of of these drugs. If you're a chronic pain patient or suffering from like, suitors pain, genuine pain. It's debilitating. You go to the doctor and the doctor wants to find a solution for you. But the dodgers also under pressure to see as many patients as possible throughout the day. That's how they get the most money out of essentially this system. So if you're face with that, are you gonna talk through the patient about how there might be psychological factors in their pain. Are you talking about how it might involve lifestyle changes and all of that stuff or you're gonna give him a pill, and like if you're under pressure to do this as quickly as possible to pill is the easiest answer. Now, there are a lot of good doctors out there who do not want to do that. Because they know that these opioids are risky, but even like, well, meaning doctors facing this kind of pressure the scales are just tilted against them. They are pressured to essentially give out these pills. It's easiest answer. In other countries. Have you talked to like Japanese doctors, for example, they will tell you that it's kind of expected that you will just have some pain and some points in your life. And if you talked to doctors here, they feel they're under more pressure to make sure that there is zero pain in somebody's life. The other thing is while there are some patients who benefit from these drugs of like acute pain specifically, and in terms of chronic pain, the evidence that they are actually better than other treatments for chronic pain is really weak like there's there's almost no scientific basis for that. Studies have been found that they're similar results. Whether you give somebody opioids or whether you put them on some other drug regimen, sometimes evolving Tylenol, and that's because over time. Opioids you grow tolerant to them. So they just become less effective. When I donate a kidney. I personally do not want because they make me nauseous. They don't actually don't help pain. I still got like I had trouble like telling the, nurses and doctors involved like please do not prescribe strokes. I mean, it's a serious surgery. So I can see why they would want to. But at the same time if somebody's telling you, I don't want these dangerous drugs. Listen to them. What would you take the pain? Instead, I just took extra strength Tylenol. Is a senior correspondent vox you heard from Dr earlier in the show, he came to us via the impact, which is another vox podcast. You should listen to Sean Rama's firm. This one's today. Explain. Thanks again to clip electric toothbrushes for supporting the show today. Let's hope Tim from Brooklyn joins the over one million people who have purchased a quip sometime soon. The quick starts at twenty five dollars at get quip dot com slash explained. That's G E T Q U IP dot com slash E. X P L A N E D And your first set of refills is F R E.