12. It's important to understand this basic distinction between the two. Side effects for the meds work the same way. You don't get the "high" feeling addicts experience as quickly with the extended release formulation as you do with the immediate release formulation. Imagine you are a code-head and you are jonesing for some opioids and you get one that takes up to 6 hours for you to feel your high. The actual people who are addicted to this stuff and abuse it all go for the immediate release

13. formulation. As I mentioned in a previous thread, I dispense up to 1000 prescriptions per day. We currently only have one patient on a monthly prescription of purdues formulation. a 60 year old lady with severe cancer pains.

14. Oxycontin is also dramatic in price. This is from our distributor. So to paint a picture. a strung out drug addict living in squalor would have to pay nearly 1500 dollars for 100 pills of something that will get them high 6 hours after they take the pill. This is simply not happening. The drug of choice for addicts are the immediate release formulations made by companies such as KVK or mallinkrodt that cost less than 10% of the price.

15. I would also like to point out the name of another medication called buprenorphine. This is a medication that is designed specifically as an anti-addiction drug. It has shown to be very effective in weaning patients off of oxycodone. It is the gold standard treatment for addicts that go to the the clinics for help(in adjunct with behavioral therapy and mental therapy of course)

Follow

16. I've had many patients from treatment clinics that are put on the sublingual formulation who have successfully stopped taking oxycodone completely. Who is the company that creates this medication you ask?

17. How silly of a company who's goal was to get the population addicted and make money off oxycontin irregardless of human life to then in turn create an effective drug that will make the patients stop taking their product.

18. Conclusion: So did purdue pharma have a role in the opioid crisis? in my opinion, even if they did, it was minimal. If you're going to go the route of "oh it's big pharma's fault for creating the drug in the first place", purdue is probably one of the least culpable for the opioid crisis with their extended release formulation that very few abusers(if any) actually use. But it does seem like they will likely be scapegoated and sacrificed in order to make a point.

19. The fall of purdue for this reason is not a good thing in my opinion. American pharmaceutical innovation is responsible for helping and extending the lives of billions across the globe. They do so with profits created from doing the exact same thing purdue did. If we want the same innovation that has kept the US light years ahead of other countries, pharma companies can't be scared to create, market, and sell their products.

/END

addendum, my thread was broken up in to three parts for some reason. I pinned it all to my main page
Part 1: 1-9
Part 2- 10-11
Part 3 - 12-19

Enjoy!

@watch4thedrop

Thank you, Drop great explanation. True, addicts want their high now — no waiting. I have taken the quick release for dental issues it works and only need it for a couple of days. Your expertise is appreciated. 💕

@JM No problem! wish there was a way to pull together my threads 😂 oh well, i'm sure the people who are interested will find a way to read it

@watch4thedrop @JM

the only way to put it together is to rewrite it. I learned that the hard way.

@watch4thedrop @JM

I know! That is why I wait until a threader is finished and writes [end] before replying. That's how I got jammed up....by threading to replies instead of the last toot of the thread. If that makes sense.?

@Kathleen @watch4thedrop @JM

[This is not directed at you, Drop...nor is it directed at anyone...just info]

Actually a very good point for both Quod Threaders and Quod Readers. Previously, did not understand the discontinue that could happen responding in the middle. Then learned, and now try not to interrupt a Quod who starts with THREAD, until they write /END. If one threads, and a Quoder comments in the middle, it is important to go back to the last thread toot and add next toot there.

@barrsniffsatjejuneanalysis @Kathleen @JM ahh is that how it works? very possible thats what happened with my thread

@watch4thedrop @Kathleen @JM

No worries, love. Lot's of evidence of activity on Quod where we went where we needed to, to get the full information of your thread. We are smart, a smart circle... not infallible... but darn smart.

@watch4thedrop good thread
Generics being least expensive were one's that I know were coming from pill mill doc's, say 6 months worth in 1 appt to take home with you. Think they will be next?

@Lemonhead I would say the crackdowns have been frequent the past 3 years. Probably accounts for the decrease in prescriptions. This is how you combat the problem!
newsday.com/news/region-state/

@Lemonhead justice.gov/usao-sdny/press-re

This doctor(cubangbang) was a major problem in my area. Prescribed quantities of up to 200 oxy 30's per patient. Glad they got him off the streets

@watch4thedrop @Lemonhead
1. Thanks for the interesting thread. Great perspective.

I'm fascinated by the difference in our countries (I'm Aussie) and seems they must have much tighter controls over here. I was prescribed a variety of high dose SR opioids and other opioids for breakthrough pain for around 15 years (now off all painkillers yeay). I was only ever given 1 month's prescription and even that had to be granted by special authority by a govt dept who tracked it all.

@watch4thedrop @Lemonhead
Their were special protocols/conditions that had to be met to be prescribed i.e. had to be started by a specialist dr not just the local dr and that kind of thing. Had to also have approved reasons.

When i first started on the opioids the first prescription was by the specialist in hospital. The second was by the registrar (senior doctor who worked at the direction of the specialist) and then by my GP (local dr) they referred my care back to.

@watch4thedrop @Lemonhead
Despite it being a very low dose to begin with, they received a please explain letter notifying them of which doctors I had received prescriptions of the opioid from and when. They had to explain the situation, and help them understand I wasn't doctor shopping. Even so they had to decide amongst themselves who was going to be the one who would continue to give me prescriptions.

The system still gets abused of course but it's just interesting to me the difference.

@watch4thedrop @Lemonhead
Sorry, just realised I forgot to number my responses after the first one, oops, if anyone reads them. Sorry.

The pharmacist could not fill the prescription if it did not have the special authority number on it. Was just a matter of the local dr ringing the dept to get it, and would have to provide the reason for the prescription.

Is your system like that at all? How do they keep tabs on it?

(end) 😊

@Grammy @Lemonhead haha yes. it's just as strangulated here in the states. Over here, doctors need to register for a special ID number with the govt dept(DEA) in order to prescribe any opioids. DEA number must be on the prescription with the diagnosis. Also can only do a month at a time with 0 refills. There is also a statewide monitoring program that all pharmacists must report each dispensed prescriptions to to deter doctor/pharmacy shopping

@watch4thedrop @Lemonhead

Ok so similar restrictions, just done differently. I don't know what reporting pharmacists need to do as I wasn't involved in that process but I'm guessing similar. I know they track what prescriptions are filled so that makes sense.

So, is the reporting of over prescription of opioids by DRs overblown? If they have to follow those restrictions, can the problem be as big as they say? I'm always worried they will unduly restrict pain meds of those who truly need them.

@Grammy @Lemonhead We have the issue of doctors with actual licenses who game the system. They will open a fake practice and see addicts in their office for a couple of minutes, make up a fake diagnosis, and then give them a prescription for an obscene amount. Than the addict leaves the 300 dollars with the receptionist on their way out.
abc7ny.com/5-doctors-among-10-

@watch4thedrop @Lemonhead
How do they get their licence then if not all doctors can prescribe them? Are any formal checks done on them?

@Grammy @Lemonhead the money you can make from doing this is very lucrative. i heard one doctor took upwards of 20 million through this scam. they can apply for the dea number when their license is clean and they start doing this afterwards

@watch4thedrop @Lemonhead Seems that is the issue then rather than drug manufacturers?
Thanks for taking the time to explain to me - much appreciated.

@Grammy @watch4thedrop yae congrats for being able to go pain med free after so long. I take it you healed up? And no longer need it.

@Lemonhead @watch4thedrop

Thanks Lemonhead 🙂

1. I'm still in the process of healing - back injury from my days as a nurse (ruptured disc, surgery, long term sciatic pain and never damage complicated by the development of Tarlov cysts at the surgical site). I had a spinal cord stimulator at one point. Used walking sticks. Pain and quality of life issues were so bad I begged them to make me a paraplegic (thankfully they refused). ....cont

@Lemonhead @watch4thedrop

I'm not YET completely pain free but can cope without prescription meds.

I've radically changed my diet, my outlook, embraced natural therapies and I'm becoming more and more active over time. Have even been able to start running again - such freedom is a joy to experience again.

I know how bad pain can be and I worry for people who NEED the opioids. I pray that any crackdown on them does not make it more difficult for them to get the care and support they need.

@Grammy @watch4thedrop me too
I am off all after 5 yrs
Go to gym getting stronger with using bands as not to hurt nerves and disc more
My distance is same and i can jog a whole 100 ft
Lots of walking dog and back
Pain still here just learned to manage it most of time

@Lemonhead @watch4thedrop
So glad to hear. Sounds like you are doing really well.
I've been able to run 5km without causing any issues - still can't sit or stand for long but that's huge progress. Hoping you can get to that stage too 🙂

@watch4thedrop

tip toes in the thread to interject....

a few years ago a drug ring was busted in my area. They would go "doctoring" for oxycontin and would rob pharmacies for same.
It would sell on the streets and the junkies would crush it up and snort it. Time release be damned! For some reason 'oxies' were the drug of choice?

tip toes out.....

@Kathleen That's strange to me. While snorting it would be quicker than ingesting it, it would still be infinitely slower than just taking the immediate release formulation at less than 10% of the price. Are you sure it wasn't the immediate release? though i guess If they were robbing pharmacies, they wouldn't care what the formulation was though 😂

@watch4thedrop

It was Oxycontin they were arrested with. Thousands of pills. Strange, eh?
I was an AODA counselor. in a methadone clinic for a bit. I left the field right around the time the trend for doctor shopping went from dilaudid to oxycontin. The dilaudid they would inject. Don't know if they tried to inject Oxy. They told me they'd scrape the pills before they crushed them thinking they were eliminating the TR. Beyond bizarre the things I heard from addicts.

@Kathleen Hmm. Was this a while ago? I know the immediate release was approved a couple of years after oxycontin so maybe it wasn't even available on the market yet.

@watch4thedrop

I want to say 2003? Was the immediate release also called Oxycontin?

@Kathleen I "BELIEVE" (so don't quote me on the exact date haha) the NDA for IR oxycodone was sent in around the year 2001 and probably took a few years before approval and mass marketing so very plausible the Immediate release wasn't even available yet. immediate release is called roxicodone

@watch4thedrop

Excellent thread!I have been following this story on Perdue, but have never seen the nuances you shared. Important nuances.

@barrsniffsatjejuneanalysis Yes. The mainstream narrative is just laughably narrow minded. shows maybe 10% of the picture. Not that we expect any better from those jackals. they do the same thing with Guns and trump

@watch4thedrop
I'm in the medical device innovation industry. It is so important for our authorities to go after the correct root causes of an issue. We do not want bad drugs/devices/biologics out there, but we also do not want to squelch our medical innovation by punishing the wrong parties. Before I read your description of Purdue's oxycontin as the extended release version of the drug, I was not aware of the difference compared to the quick acting versions of oxycodone and the issues.

@watch4thedrop

Some people take both Oxycontin and Oxycodone for severe spine pain.

An intrathecal pain pump helps quite a bit with pain that comes from within the spinal fluid area, but the other related pains still need to be treated with oral opioids. The new limits have made many patients lives barely bearable.

Responsible users are paying an extreme price because of the broad brush approach

@EarlThePearls

My cousin's husband wears a morphine pump. He had an accident years ago that left him in constant pain in his back.

He's had infection problems around the pump but without a constant drip of morphine, he'd be bedridden in pain.

@watch4thedrop

@trueblueTEX @watch4thedrop

Hope the infection part got treated and cleared itself up. Being implanted inside one makes that imperative

@EarlThePearls

He was hospitalized for several days for the infection.

They had to put the pump in on the other side.

@watch4thedrop

@watch4thedrop

Thank you for taking the time to write this thread. I appreciate you sharing your insight with us and educating us on the difference between immediate/extended release drugs.

@watch4thedrop Awesome thread! Had no idea there is a slow and an immediate release drug.

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