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76 Billion Opioid Pills Manufactured in USA 2006-2012

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  • PhirrgusPhirrgus Posts: 1,839Member Member Posts: 1,839Member Member
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.
  • AnnPT77AnnPT77 Posts: 11,478Member Member Posts: 11,478Member Member
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose.
    We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    To the bolded: Even though I'm personally a big fan of living a purposeless life, I think you have a point. The (limited) number of people I've known with a illegal-drug addiction problem were mostly either not seeing a point to their lives, or self-medicating some form of past or current trauma, or both. I see that many people around me (non drug addicted) seem to require a purpose to feel good about themselves (it's the reason some of my friends give for not retiring, though they could afford to and don't like their jobs much), even though I kind of don't get it.

    In particular, I feel like our culture has missed some boat about rites of passage, and about a sense of belonging. (In some communities, gangs fill that gap, I gather.) Among younger people I know, there seems to be a level of rootlessness and undirection, and it seems to be worse among working-class/blue collar/traditional families' kids, and especially young men (don't know why, but wonder if there's a connection to the reasons so many traditional cultures had formal rites of passage for young men (young women at least have biology to usher them into womanhood)).

    Maybe on average we've moved so far up the hierarchy of needs** that physiology and security are mostly OK (in a global and historical sense), some aspects of modern culture are interfering with belongingness (less neighborhood/extended family bonding, for example) and esteem (the photoshopped IG celeb phenomenon, among other things), and self-actualization seems out of reach (in the gig economy and worse).

    ** Using the Maslow scheme just because it's familiar, not because I think it's gospel. I'm not even remotely suggesting that the individuals affected by addiction parse their experience in these terms.
    edited August 8
  • CSARdiverCSARdiver Posts: 5,848Member Member Posts: 5,848Member Member
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.
  • PhirrgusPhirrgus Posts: 1,839Member Member Posts: 1,839Member Member
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.
  • CSARdiverCSARdiver Posts: 5,848Member Member Posts: 5,848Member Member
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.
  • PhirrgusPhirrgus Posts: 1,839Member Member Posts: 1,839Member Member
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.
  • CSARdiverCSARdiver Posts: 5,848Member Member Posts: 5,848Member Member
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.

    I just learned about this about 2 years ago and have been in the industry for over 15 years, but largely in the R & D or regulatory functions (I rarely if ever get involved in sales). Learning this was a tremendous eye opener and really shows exactly why medicine is so expensive - it isn't, but there a multiple middlemen in the game making a completed unnecessary profit.

    What's really disturbing is that different departments within the larger three letter agencies are in conflict with one another - with the enforcement branch attempting to shut down a facility, while the product sustainability branch is telling the same facility to ramp up production.
    edited August 12
  • PhirrgusPhirrgus Posts: 1,839Member Member Posts: 1,839Member Member
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.

    I just learned about this about 2 years ago and have been in the industry for over 15 years, but largely in the R & D or regulatory functions (I rarely if ever get involved in sales). Learning this was a tremendous eye opener and really shows exactly why medicine is so expensive - it isn't, but there a multiple middlemen in the game making a completed unnecessary profit.

    What's really disturbing is that different departments within the larger three letter agencies are in conflict with one another - with the enforcement branch attempting to shut down a facility, while the product sustainability branch is telling the same facility to ramp up production.

    It's quite the eye opener for sure, and answers a lot of questions as to why meds are so expensive as well as why there's such an issue for US citizens being able (or not) to buy their medications over a national border.

    How would we even begin to "clean" this up? Assuming it can be fixed in the first place.
  • AnnPT77AnnPT77 Posts: 11,478Member Member Posts: 11,478Member Member
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.

    I just learned about this about 2 years ago and have been in the industry for over 15 years, but largely in the R & D or regulatory functions (I rarely if ever get involved in sales). Learning this was a tremendous eye opener and really shows exactly why medicine is so expensive - it isn't, but there a multiple middlemen in the game making a completed unnecessary profit.

    What's really disturbing is that different departments within the larger three letter agencies are in conflict with one another - with the enforcement branch attempting to shut down a facility, while the product sustainability branch is telling the same facility to ramp up production.

    And yet so many people believe these agencies are competent enough to run intentional large-scale conspiracies! (In my world, never posit a huge secret conspiracy when any of regular old human laziness, incompetence, short-sightedness or self-interest will suffice as an explanation.)

    Sorry, that was a digression.
  • PhirrgusPhirrgus Posts: 1,839Member Member Posts: 1,839Member Member
    AnnPT77 wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.

    I just learned about this about 2 years ago and have been in the industry for over 15 years, but largely in the R & D or regulatory functions (I rarely if ever get involved in sales). Learning this was a tremendous eye opener and really shows exactly why medicine is so expensive - it isn't, but there a multiple middlemen in the game making a completed unnecessary profit.

    What's really disturbing is that different departments within the larger three letter agencies are in conflict with one another - with the enforcement branch attempting to shut down a facility, while the product sustainability branch is telling the same facility to ramp up production.

    And yet so many people believe these agencies are competent enough to run intentional large-scale conspiracies! (In my world, never posit a huge secret conspiracy when any of regular old human laziness, incompetence, short-sightedness or self-interest will suffice as an explanation.)

    Sorry, that was a digression.

    A very accurate and truthful digression.
  • CSARdiverCSARdiver Posts: 5,848Member Member Posts: 5,848Member Member
    AnnPT77 wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.

    I just learned about this about 2 years ago and have been in the industry for over 15 years, but largely in the R & D or regulatory functions (I rarely if ever get involved in sales). Learning this was a tremendous eye opener and really shows exactly why medicine is so expensive - it isn't, but there a multiple middlemen in the game making a completed unnecessary profit.

    What's really disturbing is that different departments within the larger three letter agencies are in conflict with one another - with the enforcement branch attempting to shut down a facility, while the product sustainability branch is telling the same facility to ramp up production.

    And yet so many people believe these agencies are competent enough to run intentional large-scale conspiracies! (In my world, never posit a huge secret conspiracy when any of regular old human laziness, incompetence, short-sightedness or self-interest will suffice as an explanation.)

    Sorry, that was a digression.

    I point to South Park - where the real conspiracy is getting the population to believe that the government is capable of pulling off a conspiracy.

    In most cases it is simply gross incompetence followed up with CYA measures.
  • CSARdiverCSARdiver Posts: 5,848Member Member Posts: 5,848Member Member
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    Phirrgus wrote: »
    CSARdiver wrote: »
    This issue originated prior to most pharmacovigilance systems in the 1990s where people vastly underestimated the impact of psychological addiction and the damage to receptor sites over long periods of time (>7 years).

    I've posted this before, but Jonathan Hari's TED talk is a must see on this topic:

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

    I suspect the root cause of much of this is a lack of purpose. We're at the point where we must pursue a collective good and find a common purpose. Opioid (or any drug) use is simply a symptom of this.

    I think the root cause is greedy manufacturers. That's in line with the info in the link I posted above.

    Applying Five Why principles - does this lead to another cause?

    Manufacturers are simply fulfilling a desire for product. This is a symptom of a larger cause.

    The DEA has known about this for decades as each shipment of schedule II pharmaceuticals is done under their purview. This is a CYA measure trying to pass blame onto another entity. Like one criminal ratting a colleague out for a lighter sentence. Are there corrupt manufacturers? Absolutely and they should be charged to the limit of the law. The only reason government took action is because public opinion shifted from "We want our drugs" to "Greedy manufacturers" - this is based upon emotion and not logic.

    What happened when the DEA began increasing the enforcement of narcotics? This resulted in an increase in heroin sales/use.

    https://www.cdc.gov/drugoverdose/data/heroin.html

    Wouldn't you agree that it's difficult to apply logic where all of the facts are not present at the time the decision is made?
    From above:
    https://www.biospace.com/article/release-of-federal-database-reveals-76-billion-opioid-pills-were-sold-in-the-u-s-from-2006-2012/
    The DEA database also revealed some surprising information about what the companies knew about the number of pills entering the market. The database provided information about the exact number of pills being dispensed, when the companies were made aware of the volume of pills being dispensed, as well as year by year and town by town information, the Post said. The evidence seems rather damning particularly as these companies are the subject of thousands of lawsuits from state and local governments. The Post noted that the companies “allowed the drugs to reach the streets of communities large and small, despite persistent red flags that those pills were being sold in apparent violation of federal law and diverted to the black market.”

    The information in the database had long been held secret. However, a judicial order prompted the release of data up to 2013. U.S. District Judge Dan Polster said there is no basis for shielding older data, the Tribune Chronicle reported.

    If the companies knew, yet kept that info secret and kept on pumping out pills....the math is rather suggestive to me.

    I do understand your point, but the opioid crisis wouldn't be what it is today if manufacturers cut their quota to meet actual needs as opposed to profit margins. In my humble opinion of course...

    The language used in these articles is purposefully misleading (disinformation) and absolves the three letter agencies of all responsibility - despite having complete oversight of sales and distribution.

    The DEA and FDA knew this information - have always known as manufacturing of schedule II product requires a monthly reconciliation. Additionally reconciliation is required at every point along the distribution chain. Nothing was kept secret, other than to the public.

    If you're going to place the blame on these manufacturers, then you must also place equal or greater blame on the government as they approved every transaction.

    I bolded the relevant part which I assumed meant "released to the public ".

    I do place partial blame with the agencies, but it is still the dollar driving the deals.

    Oh we definitely agree, but I recognize the government at a bigger fish in this transaction. The manufacturers are simply doing the bidding of the government. All the federal and state agencies are responsible for this and everybody looked the other way even when the safety data was sending up signals everywhere. Then there is Medicare, Medicaid, and any insurance firms involved in the payment.

    Unfortunately all that will likely happen is a few executive scapegoats and some fines, while the same government that created the manufactured crisis moves on to creating a new one.

    It does sound like we agree on more than not, but doesn't the manufacturer have to submit something showing orders to justify the higher amounts being manufactured and dispersed? I thought the alphabet people only gave a thumbs up or down. How does gov determine how many, and what law authorizes the gov to dictate supply to private companies?

    I am honestly unclear on that, unless I just missed your meaning re: the bolded.

    The ordering process is absurdly and deliberately complicated. Orders are made in negotiations between the manufacturers, suppliers, distributors with oversight by various government agencies. To make issues more complicated the "price" is rarely the actual price due to the inclusion of charge-backs. This is a legal process where the suppliers and distributors channel charges off the original sales based upon volume - again all with government oversight. This is often how you see the 0.29 USD fentanyl jump to 300 USD on a hospital bill. This way it looks like the product costs way more than it does - then the bill is artificially lowered through insurance charges.

    For schedule products there is a periodic reconciliation - if the counts are off this is a career ending situation. The period is based upon the product risk and time on market, but ranges from weekly to annually.

    I'm not surprised at all by the chargebacks, but that convoluted, ridiculous (I'm assuming, safely I believe, that you've simplified it quite a bit here) process - I had no idea to be honest. Thanks for the explanation, and I really have no idea how to reply to that lol. Wow.

    I just learned about this about 2 years ago and have been in the industry for over 15 years, but largely in the R & D or regulatory functions (I rarely if ever get involved in sales). Learning this was a tremendous eye opener and really shows exactly why medicine is so expensive - it isn't, but there a multiple middlemen in the game making a completed unnecessary profit.

    What's really disturbing is that different departments within the larger three letter agencies are in conflict with one another - with the enforcement branch attempting to shut down a facility, while the product sustainability branch is telling the same facility to ramp up production.

    It's quite the eye opener for sure, and answers a lot of questions as to why meds are so expensive as well as why there's such an issue for US citizens being able (or not) to buy their medications over a national border.

    How would we even begin to "clean" this up? Assuming it can be fixed in the first place.

    The clean up is simple - remove insurance and government from the transaction. The problem is that too many believe these bodies to be helping the situation, rather than the core problem.

    The complexity of the transaction allows this to happen. There is no actual need for any of the middlemen, but fear keeps us shackled to them.
  • NorthCascadesNorthCascades Posts: 8,948Member Member Posts: 8,948Member Member
    A paper in the Proceedings of the National Academy of Sciences rates police use of force a greater public health problem than drug overdose, based on risk of death.

    https://www.pnas.org/content/early/2019/07/30/1821204116

    Because of the pay wall, here is a summary.

    https://www.vox.com/identities/2019/8/14/20803872/police-violence-mortality-public-health-black-men-rutgers
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