Monday, October 27, 2008

Oxycodone

An interesting story that I have known about for years - but which has only just resurfaced - oxycodone is replacing heroin as the drug of choice among former heroin users. It has most recently resurfaced at Sydney's "Safe Injection Room" AKA the Labor Party shrine to Stupid Public Policy. Oxycodone is a opioid pain killer legally produced and provided on a subsidised basis under the PBS. Some doctors prescribe it without a great deal of care. The community gets left with the bill for this dangerous addictive drug that, when properly used, is an effective analgesic but which can provide a longer, cheaper fix for dope fiends than heroin.

It is preposterous that the public have to pick up the massive bill for abuse of this drug. Doctors who dispense this drug carelessly should not be practising medicine - indeed they should be charged with supplying opiates illegally, the SIR should be shut down and those addicted to the drug should be legally forced to detoxify. It isn't difficult - detoxify with assistance or go to jail. Once detoxification is achieved all ex users should be subject to random drug tests to confirm their abstention with a 'do not pass go' implication.

I have made several attempts to understand the implications of the heroin drought and its seeming success at permanently weaning addicts of heroin. One possible explanation is the rise in the use of substitute prescription pain-killers. I have searched the literature quite a bit but comprehensive data and analysis seems unavailable. The evidence is overwhelming that use of such drugs is skyrocketing but the extent to which this is displacing heroin is unclear.

BTW these trends are occurring around the world.

The interesting economic story is that pharmos large pharmaceutical firms have moved into an illicit drug market and now supply legal close substitutes for heroin. The perfect product since people rapidly become addicted and the government foots the bills paid to these pharmos large firms for the life of the addict. Isn't capitalism marvellous?

People have suggested that the switch away from heroin involved a move toward addictive stimulants such as cocaine and amphetamine. This seems implausible to me as levels of usage of such drugs have not increased enough to suggest this is plausible. But the role of prescription analgesics has not been properly examined. It should be.

14 comments:

jc said...

harry

just a casual question.. Are you for or against Viagra?

I am asking as Viagra is basically a pleasure drug too.

sir henry casingbroke said...

Percodan (i.e. Oxycodone) has been around for some time, as you well know.

No self respecting junkie will use Percodan if good smack is available. See "Who'll stop the rain" film (with Nick Nolte).

Desperates have used morphine, demoral, dilaudid, meperidine, Dr Collis Browne Compound, when smack is/was not available.

I do not believe in the "rise" phenomenon. This is propaganda.

"The interesting economic story is that legal pharmos move into an illicit drug market and supply legal close substitutes for heroin..."

Again you cite no evidence to support this bald assertion of the family chemist-as-pusher; there is no economic story here, just hysterical tabloid rubbish.

Be that as it all may, it is far preferable for junkies to wean themselves off smack with pills, and loonies to self medicate with the help of a humane doctor, instead of injecting themselves with some unspeakable poison and die in the gutter.

Injection is bad because of associated risk of HIV, hep, abscesses and the fact that it is in the hands of criminals. And here is another thing for you to think about: the Taliban grow it. No money for their product, no money for ammo.

And what a lovely authoritarian you turned out to be. "Should be forced to detoxify"? Perhaps re-education camps as well?

How about you be forced to detoxify from drinking 12-year-old-scotch? Alcohol is a lot more harmful to health and many times worse for society.

Yobbo said...

The interesting economic story is that legal pharmos move into an illicit drug market and supply legal close substitutes for heroin. The perfect product since people rapidly become addicted and the government foots the bills of the pharmos for the life of the addict. Isn't capitalism marvellous?

[ ] Capitalism
[x] Nanny State

conrad said...

"AKA the Labor Party shrine to Stupid Public Policy"

Feel free to work out the economics on this if you think it's stupid. I believe you'll find injecting rooms save money (I'll try and find a link to a similar Canadian program which shows how much they save the community). In addition, try and remember the late 90s in Collingwood (presumably to come back soon given decreasing prices) with junkies on the street all over the place and then wonder how much better they would all be swept up into a room you didn't have to see them. Good for them, good for me (and you).

hc said...

Sir Henry, By 'pharmos' I meant the large pharmaceutical companies that produce these analgesics.

Why do a majority of addictsd at thye SIR use Oxycodone? It is cheaper and gioves a longer stone. The rise phenomenon is fact not assertion.

Good to here from you Yobbo. I thought you had gone rather quiet - embarrassment at the failures of free market finance?

Sir henry casingbroke said...

I am sorry Harry, your response makes now even less sense.

The evil Pharmo-Industrial Complex is pushing the opiates onto the market?

And what - they have engaged retail agents (pushers) who operate outside the shopfront pharmacy system, darting in and out of dark doorways?

NB. Oxycodone has been around since World War I, it is not something just invented and pushed onto the market by Big Pharma.

WWI spurred the Germans to produce a range of pain-alleviating medication, most of it opiate and synthetic opiate (after they lost Turkey as a poppy source).

I might add that there were a few million people in pain as a result of the horrific injuries visited upon them by exploding artillery shells.

hc said...

Oh Sir Henry you are kidding!

The company Purdue Pharma is making a killing on this abuse and has already been prosecuted in the courts for various abuses. It has been marketing the product intensively and successfully.

Quoting from the wikipedia entry on the drug:

"Purdue Pharma and its top executives pleaded guilty to felony charges that they misbranded and misled physicians and the public by claiming OxyContin was less likely to be abused, less addictive, and less likely to cause withdrawal symptoms than other opiate drugs. The company also paid millions in fines relating to aggressive off-label marketing practices in several states".

Naturally the product becomes more attractive as a substitute for heroin as the latter increases in price and as penalties for use of heroin increase.

derrida derider said...

According to you, the heroin drought has forced users to seek a substitute. Fine - but surely the right question is not whether the substitute is a Good Thing but whether it's a Less Bad Thing than the heroin its substituting for.

And Sir Henry is right - its a Less Bad Thing precisely because it's more-or-less legal.

You never seem to get the point, Harry, that most of the really bad effects of illegal drugs arise from them being illegal, not from them being drugs.

sir henry casingbroke said...

Yes, well, not much new here.

Bayer Pharmceuticals widely advertised its own proprietary medicine (the ownership of which it lost at the Versailles Treaty) to wit, heroin, as a cure for morphine addiction. I might add, it was extremely effective!

Indeed, written on a label stuck to the bottom of the bottle, that would ingeniously become visible as you ran out of smack was: "Now is the time to get your replacement bottle of Heroin to stop the ill-effects of morphine addiction".

Why would we want to favour Elli Lilly (methadone) over Purdue (Oxycodone) anyway? Why not let them compete instead of interfering in the market? Are you some kind of commie, Harry?

Yes, I know, Harry, you are just concerned about the cost to the taxpayer. Is it the same taxpayer who is bailing out the stockmarket and guaranteeing banks?

Myself, I am not in the least perturbed in contributing to saving junkies' lives. It's just a tiny, tiny contribution, well spent, compared to what the retirement funds have cost me in just two weeks and will cost me a lot more before the year is out.

Francis Xavier Holden said...

Harry you are sounding like moralistic Salvation Army prohibitionist to John Howard's Task forc. You want to ban anything that is percieved as pleasure inducing by shortcuts?

The idea that heroin addicts get "high" is sadly perpetated by the street lingo. It would be much more accurate to say people get "low" or "normal". Spend any time with addicts and you'll see that no one gets "high" and happy - people just get less anxious or less fearful or less self loathing - for constant users there is no nirvana accompianing the dose, no shortcut to a state of joy not attainable by "ordinary" non users.

Why not oppose Oxy variants for cancer sufferers? Or those with severe paindue to car accidents? The effect isn't any different.

Why not do what many good researchers have done over the years - take a bit of Oxy codone yourself in the spirit of research. You can do it legally. Hell - it's even simpler than you think. Buy some Nurefen Plus @ 13.5 % codeine. Crush 10 tablets up and soak them in cold water and filter through a normal coffee filter paper. It will filter out all but teh codeine. It won't doy ou any harm. It won't get you addicted and it won't destroy your life. Be open minded - then write it up subjectively.

Your thinking on the economics of the illicit drug trade is valuable, probably underappraciated and world class. Your Rechabite rantings sell you short.

Francis Xavier Holden said...

Sorry about the spelling and typos in the rant above.

WRT Injecting rooms - would you want alcoholics reduced to drinking Nugget amd Metho from rusty tin cans in back laneways ?

hc said...

Sir Henry & FXH,

I couldn't care less about the cost to me of paying out to a bunch of pathetic junkies. But I do worry about the arrival of a 'new' opiate that will keep dead-heads addicted to dope on an ongoing, legal basis.

It's my simple view that all of us are better-off seeing the world as it is.

And of course I have no opposition to the legitimate use of pain-killers.

I don't like SIR's because they accommodate stupid drug-taking. We are all better off without these irrelevant chemicals.

Francis Xavier Holden said...

But none of us even see the colour blue as the same thing. We all have filters, some filter through ideology and see Howard as a great man others idieology sees him as an evil bastard - me with little ideology see him as a small man, small ideas and small achievments.

Others the the world through their religion and arguable these ones cause far more harm than any poor addicted user does.

Others see it througha haze of cigar smoke or a bleery gaze of alcohol - others see it with the certainty that comes from drinking soy lattes that come from close to home and eating only vegetables.

Other see it with the certainty that economimcs grants the practicer, others see the world through the clarity theology offers or psychology allocates degrees of deviation along with sociology.

We are all a bit blinkered by either physical, moral, religious, ethical, emotional, and class based prisms - why are those who occassinally see the world through opiates any worse than the rest of us.

hc said...

FXH,

If you really believe that having a growing number of people addicted to prescription pain killers is a reasonable situation then we will disagree.