<p>But we are specifically finding that while treatment completion/compliance rates for alcoholism, cocaine and meth addiction are in the 60% range, for heroin/prescription opiates, it’s mid to upper 30s. And the physical health costs of yo-yoing between opiate use and abstinence and opiate use again are often devastating (much greater than if we simply had prescribed controlled heroin use).</p>
<p>Interesting point, Mini. I question the 60% stat, though. I thought the number was lower. I hope you are right.</p>
<p>What I hear in my affluent California community gibes with what Mini posted in post 18. Lots of kids using OC in the past, shifting to Heroin now. I’ve got to admit, I was blind to all this - until one great kid I coached in little league years ago died in his sleep a few years back (OC and alcohol) and in recent years I’ve heard from my kids that a number of other boys I remember from back in the day have been in prison, or rehab - or should be.</p>
<p>These are just regular kids, with (as far as I can see) good parents. I have to say - my heart goes out to all of them, and I’ve got no answers.</p>
<p>I had no idea how rampant pharm parties were in my area until my first knee surgery. After I came back to school, I was bombarded (blatantly, by people I barely knew) with requests for my painkillers. This was about 6 years ago before it hit the main media. The funny part is, no one approached me when they found out my parents were among the first medical marijuana patients in Michigan. Go figure. </p>
<p>I will never understand it. Pills don’t do anything for me. Vicodine makes me nauseous and doesn’t take away my pain, morphine was decent at stopping the pain but I definitely never got a high, same with a few other pills such as oxy and ultram (obviously, these are all not related to the surgery, but doctors have tried different pill cocktails for me because of different chronic conditions). I guess I’m lucky that I’ve never gotten hooked, but perhaps it’s genetic. (Both of my parents have been on long-term, addicting pain medications and stopped without any trouble). </p>
<p>Kids don’t understand the dangers of pills. They think that if their parents take it, what possible harm could it have? My parents were counseled on how to keep their pills away from their kids (even though we could have taken them at any time we wanted and I have taken some of my dad’s pain pills before when I was actually in pain), but the vast majority of patients aren’t. </p>
<p>As for this lawsuit- how can you possibly sue someone for getting hurt while you yourself were doing something against the law? Can I sue my cocaine dealer for bad coke?</p>
<p>spidy…Since my kids were little I have stored all medications in a lock box. As they grew older and their teenage friends were at our house this practice continued. When my daughter was living at home her medications were also stored away so as not to be haphazardly left around for any kid to find. I do think it is a good idea to keep meds locked because even with wonderful great terrific kids there could be temptation to swipe a few. </p>
<p>We live in a society where lawsuits are more frequent and more absurd than most people would like to think. It is a sad commentary on where our society is going in terms of how they deal with their own issues of responsibility. I just look around and wonder when it will all get real again. Our own gov’t makes laws that are common sense in an effort to protect its citizens. This was never the case when we were growing up. People had sense to police themselves and their own children. Now there are laws such as sticker placement on a car that alerts the police that the driver of the vehicle is on a provisional license. One of my favorite other laws…a parent must report a child missing within 24 hours. If someone told parents this stuff years ago it would have seemed like a joke…today it is accepted as the norm.</p>
<p>
I don’t understand the logic of this statement. Everyone has areas of responsibility and often when something bad happens a lot of people dropped the ball at least a little bit, contributing to the loss in some way. When something bad happens should only the people you feel are most directly responsible suffer the consequences, or should everyone whose failure to properly handle the factors that are within the area of their responsibility share in some proportion for their own derelictions? It seems to me that absolving everyone but the last or most directly responsible person is rewarding the irresponsibility of everyone else.</p>
<p>@kluge- I don’t buy that. Yes, a lot of people dropped the ball but the blame squarely lies with the person who made the CHOICE to take those pills. No one forced him to take them. He is responsible and should accept that responsibility, but of course in this society we don’t need to accept responsibility for anything- we have lawyers. </p>
<p>If he was some innocent bystander or something, that would be a completely different story.</p>
<p>RGE, by that logic if I hand a loaded gun to someone I lack any responsibility for what he does with it? Even if he’s a minor? Even if I have reason to believe that he’ll misuse it? I don’t think so. I think I should be responsible for the predictable consequences of everything I do.</p>
<p>The plaintiff in this case was 17 years old at the time he took the pills which were given to him by an employee of a pharmacy. Others at the party saw him pass out and slip into a coma and did nothing about it for a while.
I know it’s the exact opposite of the point you were making, but I think those people had a responsibility to do (or not do) things that they did (or failed to do) and their failure to conduct themselves in an appropriate manner should carry appropriate consequences.</p>
<p>My kids are a bit older than 17 now, but I remember the logic processes of teenagers. I think that anyone who gives dangerous drugs to teenagers should be held responsible for their actions. You appear to be asserting that they should have no responsibility whatsoever for their own actions, that 100% of the consequences should be shouldered by the teenager (and, let’s be realistic, his family) for the rest of his life. I think you’re wrong to say they have no responsibility for what their actions, and if it takes lawyers to make that point clear, that’s why we need lawyers.</p>
<p>“I question the 60% stat, though. I thought the number was lower. I hope you are right.”</p>
<p>That’s treatment completion/compliance rate. Half of them (or so) will relapse. But among the those addicted to opiates, the rates are much worse.</p>
<p>
</p>
<p>While we were growing up, it may not have been the case that there were lots of laws passed that seemed to legislate common sense. However, the fact that we now have such laws is evidence that the common sense you’re pointing to did not, in fact, work. These laws were passed specifically because people were not, at some level, complying with common sense. </p>
<p>If most people had common sense, you wouldn’t need double yellow lines on a sharp curve on a hill with a 65 mile per hour speed limit.</p>
<p>In terms of safety, there is a lot more that we could be doing with laws. In fact, liability insurance that municipalities and other government entities and private parties buy protect them from lawsuits and they don’t enforce or implement laws that would protect our children. It is cheaper to buy the insurance.</p>
<p>"This was never the case when we were growing up. People had sense to police themselves and their own children.’</p>
<p>There were no drug company ads on tv. Pharmaceutical salespeople weren’t even every doctor’s office virtually daily. There were few physician junkets to Aruba. Pharmaceutical companies hadn’t yet learned to eat at the public trough for research dollars. </p>
<p>It is “common sense” for a child to believe that a drug prescribed by a physician isn’t likely to harm him. It is “common sense” for an adult to believe that a drug prescribed by a physician is going to be less harmful if abused than so-called “street” drugs. </p>
<p>And so it goes. Of course this is just one little area of our lives. But increasingly, “common sense” is not common, and reliance on “common sense” just doesn’t cut it.</p>
<p>There are now prescription monitoring programs in 36 states, some just getting off the ground. It allows doctors and pharmacists to check in real time (or close to it) what other drugs have been recently prescribed to patients. It looks like it means more work for docs and druggists. But in 2-3 years, they’ll discover that they are going to get sued if they don’t check and something untoward happens. (This is already happening in Kentucky.) It means they’ll be more careful, and likely to prescribe more conservatively. Probably a good thing. However, the missing link is better physician education about pain, about which, especially with a rapidly ageing population, many docs are at a loss (and hence at the mercy of the drug companies.)</p>
<p>For the record, drug reps and docs keep their distance these days. I haven’t had a pen, sticky notes, a mug in years. I have probably had at least a part of a sandwich, not sure who from, but that Aruba stuff seems sort of like a legend, and I graduated med school in 1984. They haven’t been a presence at academy meetings for at least two, maybe three years, and don’t seem to be supporting much research, at least in psychiatry.</p>
<p>Yay!</p>
<p>Wow! Psychiatry must be getting pretty poor these days. My family doc (with a small practice, though she is on a street row with maybe 250 docs across from the local hospital)) says she gets calls from at least one drug rep a day, and the last three prescriptions I’ve had were filled with drug samples she had in the backroom from the reps. She says she never took them up on the Aruba trip. </p>
<p>But it’s probably true that the money is in pain meds, arthritis, and in new (repackaged old) cancer drugs. In this town, however, the main business of the drug reps is to coordinate with the lobbyists to get on the state formulary. So in December/January, they turn into mini-lobbyists, lobbying the docs to lobby the legislators (they’ll even write the letters for the docs, on the doc’s own stationary.)</p>
<p>Primary care docs are always better targets than specialists. </p>
<p>And yes, there are samples of non generic drugs as “booty”, but not much else. Good for patients, at least short term, but your doctor has to decide if it’s worth the time with the reps to get them. No more “free” lunches. And I’d be curious about the last time she was invited to Aruba. Me? Never. I DID use to get some decent pens, though.</p>
<p>"…and in new (repackaged old) cancer drugs."</p>
<p>mini, until this statement your posts made sense. You are quite an educated person, but you seem to imply that formulation does not affect the drug’s pharmacokinetics. :rolleyes: Yes, there are “old” drugs, but the “repackaging” is much more than meets the eye.</p>
<p>Many people who work in pharma don’t do it for the big bucks (what is the % of VC capital that goes towards biopharma funding vs the new dot com funding?). The education required to work in this field takes many years of post-graduate work, the hours are long, and the failures are much more common than successes. Sure, it is easy to find a scapegoat and blame all ills of the modern society on the big pharma.</p>
<p>Pain management is a real issue for people who do suffer from chronic, debilitating pain. What makes me upset is that certain docs, especially dentists, keep prescribing these powerful meds to people who really do not need them for conditions that do not require anything other than OTC pain meds, such as wisdom tooth removal. Really, Advil will do for most dental surgeries!</p>
<p>DH is not in marketing, but recently he had to attend a long seminar on marketing ethics. Before the seminar, he was sure their marketing folks were treating docs to the Aruba trips described by mini. It was quite an eye opener for him that a lot of things listed by mini the marketing folks were strictly prohibited from doing.</p>
<p>Oh, don’t get me wrong. I tried to make it clear that this is just one little area of our lives (in fact, I think that’s exactly what I said.) And I used to work for our state board of health and we were (and still are) extremely concerned about the undertreatment of pain. In fact, one of the reasons we think we got into this mess is that docs had and still have very little training about available options. The biggest screams we got (at least partially justified) when the legislature essentially said that docs had to get pain consults when prescribing opioids at more than 120 MED was that pain specialists were/are so difficult to find.</p>
<p>We have all watched the drug companies looking for ways to repackage pharmaceuticals as they go off-patent. It is become a regular part of pharma practice, and an understandable one, given the incentives and the difficulty of bringing new drugs to market. </p>
<p>The ‘new’ way to attract docs (and dentists) to the Aruba seminar (and you can google them and see for yourself) is to not have the company sponsor themselves, but to hire (or “support”) a seminar company to do it for them. Then the seminar company in turn “discounts” the cost of the seminar, and then have the hotel “discount” the costs of the hotel, and have the travel company “discount” the cost of the airfare. (If you choose a snowy location, you’ll also get massive “discounts” on your ski lift tickets.) It’s all legal, and above board, and puts a layer of insulation in place. In fact, these changes are in keeping with the new “voluntary” guidelines (often not honored), put in place to head off more stringent federal action (or so is my understanding - I honestly haven’t followed it in the past two years.)<a href=“http://fpn.imng.com/fileadmin/content_pdf/fpn/archive_pdf/vol38iss21/71356_main.pdf[/url]”>http://fpn.imng.com/fileadmin/content_pdf/fpn/archive_pdf/vol38iss21/71356_main.pdf</a></p>
<p>Now living in the Northwest, I would be the first one to say that docs deserve a break from the rain! And there is no particular reason why they should be prohibited from learning in a nice resort environment. And, heck, at least in the area of pain management, CME is definitely a good thing these days.</p>
<p>Our Attorney General’s office is still living well on money from the massive multi-state OxyContin settlement with Purdue Pharma (and there were multiple settlements with at least half a dozen generic drugmakers, resulting from the material misrepresentations to the federal patent office that prevented generics from making their appearance.) There are still multiple cases pending, as the suits get tossed around from state to state.</p>
<p>“We have all watched the drug companies looking for ways to repackage pharmaceuticals as they go off-patent. It is become a regular part of pharma practice, and an understandable one, given the incentives and the difficulty of bringing new drugs to market.”</p>
<p>Can you please give some specific examples of this? New formulation =/= “repackaging”.</p>
<p>It takes close to 10 years above and beyond undergrad education for someone to become a doctor. If such an educated person can be easily bamboozled by rogue pharma reps, what good does this education do?!</p>
<p>When it comes to “repackaging”, there really isn’t any need for reformulation, but rather finding new therapeutic applications for the extant drugs (or at least, that’s what I understand Mini to be saying. Am I wrong?).</p>
<p>I don’t believe these are “rogue reps.” As far as the “bamboozling” of doctors, pharmaceuticals are not really their area of expertise. They really do depend on the drug companies to educate them on the chemical and biological mechanisms of any given drug, and to provide the data from research and clinical trials, etc.—at least that’s what I understand to be true from my BIL (who is an executive for a top bio-pharmaceutical company).</p>
<p>"But it’s probably true that the money is in pain meds, arthritis, and in new (repackaged old) cancer drugs. In this town, however, the main business of the drug reps is to coordinate with the lobbyists to get on the state formulary. So in December/January, they turn into mini-lobbyists, lobbying the docs to lobby the legislators (they’ll even write the letters for the docs, on the doc’s own stationary.)"mini #34</p>
<p>That is wrong in multiple ways, and with the health care legislation such an issue right now, I think it is irresponsible (and very tea partyish) to make such statements. What you are discussing is a very small area of health care, and it is not close to being where the main money is. Also, the under treatment of pain has little to do with the abuse of pharmaceutical pain killers or street drugs. </p>
<h1>39, that may be true with new drugs, but an experienced doctor relies on his own experience and knows that the clinical trials and research are limited. A pharm rep might like to brag drugs aren’t a doctors’ area of expertise, but it is more their area of expertise than any other health care provider.</h1>