Doc, Homless in LA

[_Analytics]

Free market economics has given us a pharmaceutical industry that is making billions off of drugs that are addictive. They have zero incentive to invent painkillers that aren't addictive.

It's an interesting suggestion I hadn't heard before.

Are you saying that if a non-addictive painkiller were invented that policy couldn't simply stamp out its competitors? Or would the taxes received from the competitors ensure the government would never have an incentive to create such a policy?

Now that I've clarified the problem, I'll address your question here.

I don't see the pharmaecutical companies working hard to invent pain medication that isn't addictive. Likewise, I don't see tobacco companies working hard to create cigaretts that aren't addictive.

Could the motivation of the pharmaceutical companies and the tobacco companies be the same? It seems to me that if you sell a highly profitable highly addictive drug, you have little motivation to create a non-addictive alternative.

[_EAllusion]

The most free market solution to pharmaceutical companies making harmful substances is tort law. The fines Perdue has paid up to this point for their deceptive marketing would be dwarfed by the potential of robust tort exposure.

While opiates are way over prescribed in the US, I very much worry about people who truly need opiate based analgesics losing access in order to fight addiction. Don't forget the benefit side of risk benefit.

I know people whose life would be an unimaginable hell if not for significant opiate use, and we worry that eventually doctors will feel so squeezed by DEA pressure that they just won't prescribe already as it is.

Part of the story of the opiate epidemic is pharmacuetical marketers convincing doctors, illlicitly, that time release mechanisms eliminate addictive potential of their products. But another part of it is medical practice catching up with the need to do something about serious untreated pain. It's only recently that nursing practice added pain assessment to basic vitals. That part still has merit.

[_Gadianton]

Analytics,

I think it's a good point. And I've also had a mission friend if not two die from heroin OD. As an aside, a half lifetime ago I was in the hospital a couple weeks where i ran myself into a problem pressing the morphine button constantly. Prior to that I had several outpatient surgeries (some but not all pulling teeth) where I was pumped up with various narcotics as I always opt to do it awake rather than asleep. During a nasal procedure, I told my mom they were putting cocain up my nose and she flipped out that I'd say that but the Dr. agreed with me.

I've never thought about it until your posts but, I don't have the slightest interest in any of the narcotics I've taken and I deny that they help that much with pain. One time I had 3 different kinds at once. After that 2 week stint, I passed out taking Vicodin on an empty stomach, which I only took because I was told to, and that was that, I toughed it out from there; not for me at all. Perhaps it's my disbelief in God.

Anyway, I agree with you, that these drugs may very well respond to market forces looking for addiction. What I was saying is that why doesn't the government make it a race to a non addictive pain killer? First one there gets to remain in business. Goodbye everyone else.

[_Themis]

Could the motivation of the pharmaceutical companies and the tobacco companies be the same? It seems to me that if you sell a highly profitable highly addictive drug, you have little motivation to create a non-addictive alternative.

Creating a non-addictive alternative, when you already sell a highly addictive, would mean less money. If I use a non-addictive pain killer I will stop using it when the pain goes away, but a highly addictive one I will keep using for as long as I can get it. It means motivation to not create a product that will mean less money. What company would invest billions to make less money?

[_EAllusion]

Could the motivation of the pharmaceutical companies and the tobacco companies be the same? It seems to me that if you sell a highly profitable highly addictive drug, you have little motivation to create a non-addictive alternative.

Creating a non-addictive alternative, when you already sell a highly addictive, would mean less money. If I use a non-addictive pain killer I will stop using it when the pain goes away, but a highly addictive one I will keep using for as long as I can get it. It means motivation to not create a product that will mean less money. What company would invest billions to make less money?

People (and their prescribing doctors) generally don't want to be drug addicts and will choose a less addictive alternative if they believe it available. That's where the incentive for non habit forming pain meds is at.

[_Themis]

Anyway, I agree with you, that these drugs may very well respond to market forces looking for addiction. What I was saying is that why doesn't the government make it a race to a non addictive pain killer? First one there gets to remain in business. Goodbye everyone else.

Not sure how the government could enforce that, but this shows one of the essential needs for government intervention. There are many areas that private money will not be spent to deal with a problem, which is why Government needs to be a part of medical and drug research.

[_Gadianton]

Themis,

I'm being incredibly cynical here, and what I'm saying is the government makes way too much money from drugs to have the incentive to make such a law. They can't get rid of drugs for the same reason they can't get rid of guns.

[_Analytics]

People (and their prescribing doctors) generally don't want to be drug addicts and will choose a less addictive alternative if they believe it available. That's where the incentive for non habit forming pain meds is at.

In theory that sounds great. The empirical evidence of this incentive actually motivating drug companies to create non-addictive pain killers can be summarized in two words: aspirin and Tylenol.

[_Analytics]

Analytics,

I think it's a good point. And I've also had a mission friend if not two die from heroin OD. As an aside, a half lifetime ago I was in the hospital a couple weeks where i ran myself into a problem pressing the morphine button constantly. Prior to that I had several outpatient surgeries (some but not all pulling teeth) where I was pumped up with various narcotics as I always opt to do it awake rather than asleep. During a nasal procedure, I told my mom they were putting cocain up my nose and she flipped out that I'd say that but the Dr. agreed with me.

I've never thought about it until your posts but, I don't have the slightest interest in any of the narcotics I've taken and I deny that they help that much with pain. One time I had 3 different kinds at once. After that 2 week stint, I passed out taking Vicodin on an empty stomach, which I only took because I was told to, and that was that, I toughed it out from there; not for me at all. Perhaps it's my disbelief in God.

Anyway, I agree with you, that these drugs may very well respond to market forces looking for addiction. What I was saying is that why doesn't the government make it a race to a non addictive pain killer? First one there gets to remain in business. Goodbye everyone else.

My personal experience with opioids is similar to yours. I've taken them on occassion, but never really noticed anything. I don't know if that means I'm just not sucepltible or if the doses were too low. I joke that I want to die in hospice care with an extremely serious addiction to morphine, but I don't want to know what an opioid high feels like until then.

On your last point, I'm totally with you. An effecitve "war on drugs" doesn't mean throwing blacks in jail for using marijuana. It should mean spending $xx billion a year on federally funded research to find non-opioid painkillers and better treatment options for addicts.

But that isn't going to happen because too many people with power are addicted and too many people are making money off of those addictions. So let's ignore this real issue and make up problems and reasons to put the blame on the poor, the blacks, and the Mexicans.

[_EAllusion]

People (and their prescribing doctors) generally don't want to be drug addicts and will choose a less addictive alternative if they believe it available. That's where the incentive for non habit forming pain meds is at.

In theory that sounds great. The empirical evidence of this incentive actually motivating drug companies to create non-addictive pain killers can be summarized in two words: aspirin and Tylenol.

There are lots of other types of pain meds developed that are not addictive. Do you want a list of non-narcotic analgesics?

Gabapentin isn't addictive.

It's just that opiates happen to be very good at pain management. But the specific neuron signaling they work on also affects the reward/motivation circuit in the limbic system. Drat.

If a pharmaceutical company could develop a class of drugs that work as well as opiates in the same medical contexts, they'd make a fortune. You make it seem like it is an issue of will. The endogenous opiod system controls pain. It also is involved in reward/motivation. Therein lies the problem of finding something equally effective as opiates. It's not as though that's a biologically easy thing to do that is simply ignored because researchers don't see money in it.