Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.
I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids.
I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous.
I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime.
There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately necessary feature of our medical system until we invent painkillers strong/good enough to replace them. I say this as someone who was personally addicted to opioids in general and Oxycontin in particular and feel very lucky to have only one dead friend as a result.
Opioids can't be banned until we can replace them with something equally generally effective. But what we should do is reinstate the taboo around prescribing them, and probably stop offering take home fentanyl prescriptions at all (it's still useful for anaesthesia, in hospitals). Perhaps more importantly, I think the cat is kind of out of the bag on prescriptions. I haven't been around that world for a long time, but it seems to me like pharmaceuticals aren't the primary entrypoint to opioid addiction anymore - people just start with fentanyl.
Dealing with fentanyl seems to me to be basically impossible. One kilogram of pure fentanyl is ~2,000,000 doses, for someone without a tolerance. This is impossible to interdict at the border. It is also fully synthetic, with no great choke point on synthesis routes. I have heard that there are other, even more dangerous, compounds like https://en.wikipedia.org/wiki/Etonitazene that are also even easier to synthesize. I don't really know if there is a good way out of this other than doing the slightly less impossible thing, which is curing addiction.
That last thing was their crime
Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game.
Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?
Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game.
No. There are many legal and bad things.
Laws are a boundary, that few of us need.
Laws are not a target
I would argue that fiduciary responsibility mandates that corporate leaders do everything right up to the legal boundary in pursuit of their shareholders interests. In fact profitably violating regulations would also be the right thing to do in this case. Certainly most shareholders seem to appoint executives that do exactly that.
corporate leaders do everything right up to the legal boundary in pursuit of their shareholders interests.
Yes, that happens
Those are evil, short sighted people, sociopaths, who should not be emulated
Sociopaths and other dark triad types have been the driving force in unifying and leading people since prehistory. It takes exactly that kind of person to unite tribes of strangers in order to go conquer, subjugate, and murder your neighbours.
"Evil" is immaterial. Markets and society are ecosystems, and the optimal patterns of behaviour in ecosystems are as ruthless as they are predictable.
"Evil" is immaterial.
No. Never
Taboos are not simply undesirable things, they are rules which carry severe penalties if you break them. The difference is that rather than going through the effort of getting society on the same page and agreeing what is okay and what isn't, you instead leave ambiguity that harms the well meaning and benefits the malicious. If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule. If you aren't willing to ban something by law, then it ought to be permissible.
I am not a lawyer. I am from a legal family (three generations) and I understand jurisprudence
you instead leave ambiguity that harms the well meaning and benefits the malicious.
Two points
1. Law advantages those with access, and often benefits the malicious and harms the good. Case in point: Drug law. Another is IP law
2. Law is not objective. The words that form it are in black and white, but there are courts and judges because the application of the law is subjective. The boundary cases are numerous and important
More generally....
If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule.
Sotp, just stop! This is the idea that we must punish and scantion people into being good.
I think of things that are good (like treating drug addicts as ill, not criminal or imoral). I think not of "bans". They accomplish little.
Permissible, impermissible, these are blunt concepts that are not very useful. We can be, and should be, aspirational and collegial not judgemental and competitive
Sotp, just stop! This is the idea that we must punish and scantion people into being good.
You're not understanding what this conversation is about. Taboos punish and sanction people into being good. We are in full agreement that this is undesirable. There are some things that should be banned, and if they should be banned, they should be banned explicitly. There are many other things that should not be banned, and if it should not be banned it should not be a taboo, which is a form of ban.
You give a perfect example for my argument - treating drug addiction as an illness that should be treated instead of a moral failure to be punished. Where drug use is a taboo, you can't treat it; eliminating the taboo and accepting that these are people in need of help is, in my and many other people's opinion, the correct course of action. Most would agree that making drug use legal but ostracizing drug users would be an absurd strategy.
Taboos are fundamentally about what is permissible and impermissible, there is no other framework in which to talk about them.
Purdue aggressively marketed OxyContin as having a very small rate of addiction to doctors who weren't pain specialists and thus had little experience with controlled medications, while providing a dosing regime that was almost designed to cause addiction. (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)
"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)
"The Family That Built an Empire of Pain" (https://www.newyorker.com/magazine/2017/10/30/the-family-tha...)
. (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)
The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.
Thankfully most doctors will willingly prescribe a small after lunch short acting dose.
There is a large delta between the average response curve and an individual's response curve!
The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.
Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.
There is a large delta between the average response curve and an individual's response curve!
True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.
There are a lot of sources of variability, but variation does not actually make it very difficult to detect improper opioid prescribing behavior. Just like the variation in people's weights would not tell you much about the strength of asphalt roads. These things are not measured in the same scale.
The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.
Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.
True, my point more was that false advertising about "duration of extended release action" is a problem across multiple types of prescription drugs.
True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.
The marketing material doesn't care. "All day", "24 hour", "12 hour" are the phrases that get used.
Meanwhile reality is that every person who takes a drug is different and doctors need to be aware of this and just ask the patient how well things are working out.
The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.
Yeah it got out of hand, but I'd imagine that this wasn't happening from day 1.
Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.
Blindly listening to a company trying to sell you something has never been a good idea. Doctors doing just that despite the clear, obvious, conflict of interest is their failure, not Purdue's.
Thinking that an individual or organization with a vested interest will not bullshit you at every turn is absurdly naive. This is why third-party testing, accreditation, certification, and audits are a thing.
doctors who weren't pain specialists
Then they should have insisted on third party, board approved, usage guidelines; especially when it became obvious that OxyContin is highly addictive. It doesn't take that long. Doctors have not however been held responsible for their abject failure towards their patients, and continue to prescribe a month's worth of Oxy for minor issues. This will continue until doctors start losing their licenses.
Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?
This is a nice idea, but most Oxycontin is not prescribed by someone's doctor (it is prescribed by a doctor, but it is power-law distributed, most of it is sold by dealers). There are a small number of doctors in the country at any given time that prescribe almost all of the supply. This is not something you can readily fix with responsibility at the doctor level. It may seem like you can, because you could just prosecute "those doctors", but the problem is that the incentives are too concentrated.
That isn't to absolve these individuals of responsibility. They are responsible, and we should prosecute them legally. The problem is that we already do and always have. We should keep doing it, but I don't expect it to fix anything.
EDIT: To be clear I'm not necessarily for or against this settlement. There was a time that we might have stopped the opioid crisis at the corporate or pharmaceutical level, but that time has long since past. We could criminalize all opioids tomorrow and it would make almost no difference. Most opioid addicts use fentanyl now, and most fentanyl is produced/sold illegally. Heroin, for instance, has been Schedule I forever - the only thing that reduced its popularity was a cheaper substitute in fentanyl.
If we are going to bother prosecuting or civilly charging Purdue or its principals, it would have to be for purely punitive reasons. Corporate behavior unfortunately does not matter anymore.
The on-ramp from minor pain or surgery; to a massive, blindly-renewed, over-prescription of Oxy; to an opioid addiction that spirals into street drugs is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
a small number of doctors in the country at any given time that prescribe almost all of the supply
The fact that medical boards allow these doctors to retain their licenses is the core of the issue.
we already do and always have
I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
The on-ramp from minor pain or surgery to a massive, blindly-renewed, over-prescription of Oxy to an opioid addiction that spirals into street drugs
This is mostly not a thing. I have known hundreds of current and former opioid addicts. I don't think I know a single one that was "on-ramped" from Vicodin or Percocet in any truly meaningful sense. It is the case that people almost always use these first. But it is relatively rare to become an opioid addict as the result of a one-off, acute vicodin prescription, per se.
is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
I hope that is true! It doesn't seem like that to me, but I admit to not having carefully studied the data. Casually, there are 1.6 million opioid addictions currently in the US [1]. There were ~50,000 overdose deaths in 2019. That is, 1/1600 opioid addicts died in 2019 alone. To a first approximation, 0 people overdose annually from vicodin/percocet and other short term acute pain treatments.
It would be fairly surprising to me if (much) more than 1/1000 strong opioid users (per year) dies from an overdose. If the numbers were substantially higher than this, the epidemic would burn itself out in the population rather quickly. We can infer from this that most active opioid addicts are users of strong opioids, which are basically never prescribed for acute use. Hence, the overwhelming majority of current addicts are users of strong, non-acute opioids.
This doesn't mean there can't be some gateway effect (I do in fact think there is), but it does mean that "the problem" is mostly the presence of the strong opioids, not the Vicodin prescription for your wisdom teeth.
I'd be open to contrary data on the matter, though.
The fact that medical boards allow these doctors to retain their licenses is the core of the issue
It is an issue, and we should absolutely try to improve it. It's just unlikely to materially dent the larger issue.
I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
I can personally attest to this being false. It was really quite annoying - I had to find new doctors on a number of occasions as a result, and that was ~15 years ago. Things have gotten much, much tighter on the pharmaceutical side since then. Every doctor who wrote me something was in prison or dead (from suicide, in prison) within 2-3 years of the last time I saw them, and I didn't even turn them in.
It is true that at any given time the Oxycontin prescriptions are power-law distributed, with most of the scripts being written by a small number of doctors. But this is a little bit like looking at the profits in the high frequency trading industry, or the cartels in Mexico (not to morally equate these things). Yes, there are a small number of them and they seem to make a lot of excess profits, but that does not mean you can knock them off and change anything. Nature abhors a vacuum, as they say.
Nobody is forcing you to see any doctors for any of your problems.
That's pretty reductive, right? Well so is what you are saying.
Taboos are part of how a society functions. Taboos can prevent the 'tragedy of the commons' in a way that rules and laws cannot. Think about it - people break the law all the time. They rarely break taboos.
Thank you for the reply! I am honestly not informed about this stuff and not asking to covertly push an agenda.
Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely? Are there certain formulations that have been or should be removed from the market? How do we reinstate the taboo on prescribing them?
For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.
Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?
(My instinctive answers here are that we should make opioids illegal for much of their current use pattern, and that post-bankruptcy Purdue is approximately as gross as Sackler-era Purdue, for what it's worth.)
I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature.
Is this really what the question was about? Reflections on a personal experience? Those are perfectly valid concerns. Nobody is stopping you from asking any of the professionals you interacted with about addiction, if you are worried, go and ask!
No, my question is about how people judge our opioid status quo: a medical system that prescribes addictive opioids for routine and low-grade pain.
I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!
If you want a poll, this court case was a poll. A majority of victims who had ample time to participate in litigation agreed to the settlement terms. They told you that addiction is bad, the new Purdue would help, and that money from its owners was sufficient justice. That some agitator basically played the Yogg-Sauron of this meta, the Supreme Court, and cast 5 fireballs against his opponent versus 4 fireballs on himself, isn't super material to the seeming success of the hard political work of this bankruptcy judge.
My question is specifically about the judgements that uninvolved people have formed. I can't learn about this from my doctor, or from the victims' decision in the context of a highly-constrained kabuki dance.
It seems most commenters here are fine with a settlement that clears Purdue to sell opioids (for the benefit of victims), but not with a settlement that lets the Sacklers off with a fine. That is exactly the opposite of my moral intuitions. What gives?
Some questions are message board questions.
its easier to ask random people from home then go to a provider when I have no such problem or need to physically introduce myself to a highly educated provider. it's like a google search.
What I wonder is why someone like you wouldn't know this?
I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!
Are you sure they'll give "better answers" when they're the ones prescribing like that?
Oxycontin was, and still is, a prescription drug. I'm not sure if you're aware, but at least in the United States (where this court judgment was), it is doctors that write prescriptions. Listening to them is how the first opioid crisis happened. McKinsey dangled some shiny slides in front of Purdue, Purdue dangled them in front of doctors, and then doctors prescribed them en masse. This has, arguably, not gone well.
Correcting in the other direction is way worse. I had a huge surgery last year in Germany and 8 days later when released from the hospital, bones still not yet fused, I was given no industrial-grade painkillers whatsoever.
I had to cop on the black market to keep from going insane from insomnia and screaming, until I could check myself into an inpatient clinic that would dispense them legally.
There is more harm in making them difficult to get.
I got a vasectomy recently and was told to expect a day or two of pain
I didn't get anything after mine. I nearly fainted outside the clinic waiting to be picked up when the feelings all suddenly caught up with me.
Neither did I. "If you have pain then take ibuprofen"
np,
Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely?
The simple answer is "less and with better monitoring". The first half of that was the equilibrium that Purdue intentionally shifted in the medical establishment. The cascading effects of that are what caused the modern day opioid crisis. Unfortunately, the modern-day opioid crisis as I understand it is mostly no longer related to pharmaceutical availability. So, while we should improve and lock down that supply chain route, unfortunately I don't expect it to make a large dent in the overall problem.
Are there certain formulations that have been or should be removed from the market?
Take-home fentanyl is probably unnecessary, but again, I wouldn't really expect this to be a silver bullet. The DEA/FDA has gotten much tighter on their prescribing rules for powerful opioids, but their doing so has largely coincided with the expansion of the illegal heroin, and then fentanyl markets. It is now too late to fix by choking off supply, because the market has mostly moved outside of the regulatory regime (though we should still do that, to the extent we can).
How do we reinstate the taboo on prescribing them?
These answers keep getting worse but we largely already have. We could probably do more, but if you are an MD and you are not "opioids are dangerous actually"-pilled, I think you need to go back to medical school. There was a short period in the mid 2000s where doctors were convinced otherwise by Purdue among others. Doctors who "think otherwise" today are almost without exception just outright criminals.
For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.
Overprescription like that (which that definitely is) is bad and unfortunately common. It's hard to say exactly how much addiction is caused by that variety, though. Most serious opioid addictions that I am aware of didn't get that way from a one time moderate overprescription of things like Vicodin or Percocet. It is possible to get "mildly" addicted from a month's supply of that and when you run out you might have a slightly unpleasant day or two, but not worse than that. If the illicit market wasn't there, that 30 day supply would be the end of any binge, and that would be "mostly fine", as such. That is not an endorsement or to say that it is at all a safe thing to do, but the risk comes primarily from not wanting to quit when you run out, and having other options available.
Two things changed with the introduction of Oxycontin:
1. It started being prescribed for chronic, not acute pain. This meant that people had permanent, ongoing prescriptions for them. Which meant that people built up a very large tolerance, which led to..
2. Oxycontin is pure oxycodone, it is not formulated with an NSAID (like Percocet is). The presence of an NSAID limits the amount you can take before you get sick, and prevents you from (straightforwardly) consuming it via non-oral routes of administration, which is exponentially more addictive.
Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?
Legal but discouraged, definitely. They are an important tool in the treatment of acute pain. They can, more rarely, be an important tool in the treatment of chronic pain (cancer / chemotherapy being a good example of a sufficiently serious condition). And finally, they are absolutely worthwhile for palliative care. For these reasons and what is now the magnitude of the illicit market, I don't think there is a lot of value in a total restriction.
Take-home fentanyl is probably unnecessary
Nah, a friend and colleague needed fentanyl lollipops at one point. You'd be at lunch and he's like "Oh I can't eat food, they had to remove my entire stomach" sucking on the lollipop, and he'd calmly explain that you mustn't touch his weird lollipop because while he can suck on it for a normal person the dose from doing so would be fatal, he'd just used so many strong painkillers for so long that it was now necessary because the painkillers they give regular people did nothing.
Weaned himself off eventually too. Amazing willpower, probably related to why he's not dead.
Opioids can't be banned until we can replace them with something equally generally effective.
Opioids should not be banned
Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids
The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles
Great Britain for many y4ars managed Opioid addiction with opioids, principally methadone and heroin
Nineteenth century society managed it with laudinum
We westerners in the twenty first century are failing to manage it with cruelty
The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs
Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids
I don't entirely disagree with you, but I have also seen enough people stop, who probably wouldn't have if that were the typical treatment, to be pretty cautious about that. There are a number of promising addiction treatments in the wings at the moment, in particular Ozempic and the general GLP-1 agonist class.
Transitional opioids like Buprenorphine are fine as a detox strategy, and maybe even fine for the medium term, but committing to them for life I think is a mistake (in most cases).
The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles
There is a lot of truth to this. It is, in fact, what I used to say when I used them. And it is and remains true. It is also true that prolonged opioid use is mostly physiologically harmless (overdoses notwithstanding). However, there are psychological elements that come with long term use that these measures do not capture, and are not fully internalized by the transaction costs (or literal costs) associated with obtaining them.
Nineteenth century society managed it with laudinum
Ask China why they fought that opium war, and how they feel about such things lately. They are still mad about it.
The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs
Agree on the Sacklers although personally I'd place more blame on the McKinsey consultants that wrote the original deck that proposed the strategy. I don't know how much the Sackler individuals personally made these decisions, but those people certainly did.
Re: irrational attitudes to drugs, I agree, but the situation is substantially more nuanced than it might superficially appear. Laudanum did used to be over the counter, as did cocaine among other things. However, these things were not criminalized for no reason - heroin wasn't criminalized in the 60s/70s anti-hippie craze, or for racist reasons in the 1930s (like marijuana).
Heroin was first criminalized for over the counter sale in 1910 - 15 years after Bayer first marketed it. Easily the fastest criminalization of a novel pharmaceutical compound in the history of the world. This is not an accident or a product of some temporary social hysteria. And unfortunately, it was also not criminalized because all of its harms were due to its being illegal.
If criminality were the problem we would expect things to get better, not worse, with the introduction of fentanyl which is far cheaper and more readily available. I could be misreading the data, but that does not seem to be working out.
An agree fest ensues
I am not advocating pure herion (ironically quite a safe drug aside from addiction) or cocaine powder as modern consumer products.
Opium caused upheavals when used as a wedge by Westerners in China, but remember it had been present, and used for millenia in Arabia.
The same, roughly, with cocaine and coca
It is not a choice between continued sadism or free reign herion and cocaine dealing.
We can do better
And I think the "psychological elements that come with long term use" is largely confusing cause and effect.
From my experience people having drug problems recover when the problems recede. Hence advocating treating drug addiction with drugs
One size does not fit all, and some halt and are abstinent. Good on them, I know no-one like that
I mostly agree!
I'll quibble on two points. "used as a wedge issue by foreigners", while perhaps true in some moral sense, it does not really make much sense, on closer scrutiny. To reduce things down to being some foreign imposition is to suggest that it could have been any product. But it couldn't - only opium has the special properties necessary to become this kind of product. Nobody fought a war over tobacco, or even cocaine.
It is also true that Arabia, and even the ancient Greeks ('land of the lotus eaters') were aware of and could obtain Opium. However, I'd inquire as to how it is that the primary opium growing regions of Arabia are doing lately, or say, ever.
It is true that Opium has been available to varying degrees, at various times, in various places without a total social breakdown. However, widespread, sustained, cheap availability of pure Opium without total social breakdown is, as far as I know, unheard of. The over the counter stuff in Europe and the early US were mixed with other things, as in Laudanum. Almost all of high society at the time was addicted anyway, and this was the mild form.
The Chinese discovered that they could smoke it, and changing ROA from oral to smoking is a radical step change in addictiveness. I'm not entirely sure why this didn't catch on elsewhere at the time, but the fact of the matter is it didn't, and the difference between these things is a difference in kind, not degree.
It is not a choice between continued sadism or free reign herion and cocaine dealing
I hope you're right! But I don't observe anything in the world that would support it, unfortunately. I quit because I was arrested, for instance. I want to be careful about causal meaning here, I didn't stay off because I was arrested, but it was the excipient that proximately caused and also facilitated it. It was a structural break that allowed other things to change around it.
That's not to say that the judicial system is a good way to deal with things - it's not. But the credible threat of the judicial system cannot really be done away with here without courting disaster. When dealing with highly physically addictive substances, shaping short term behavior by force is often a necessary ingredient in having any hope of shaping medium or long term behavior via therapy, life circumstance changes, or anything else.
without courting disaster
Too late?
weeping...
opium growing regions of Arabia
The centre of civilisation for centuries
But I don't observe anything in the world that would support it,
Portugal
Legalisation of capabilities across the globe
Coca in Bolivia (I am on thin ice, I know too little, but they elected a coca grower as president)
I think there is plenty of evidence that a considered thoughtful approach to drugs is better
But the psychopaths and sociopaths that make up the bulk of our governments (here in Aotearoa and in the USA) refuse to pay attention
“Opioids can't be banned until we can replace them with something equally generally effective.”
If only doctors took this advice! When the CDC made its first recommendation against using opioids there was a chilling effect and thousands of chronic pain patients who desperately in need of opioids to function were cut off. There were suicides.
It wasn’t until 2022 that the CDC loosened its recommendations and, in my experience, only a few doctors have caught up.
I could not agree more. Fentanyl enforcement is obviously not feasible to anyone that has been, or known, an addict. Its incredibly cheap to buy, and you can store enough to kill 1000 people in a bag in your pocket.
You might as well have cops trying to arrest the pollen in the air.
I think there's a misunderstanding in what the settlement is about. As part of Purdue's bankruptcy, the Sackler family is voluntarily providing 6 billion dollars to help settle claims opioid victims have brought against Purdue Pharma.
As a condition to provide the 6 billion dollars, the Sackler family has asked the bankruptcy judge to not even allow any new suits against the Sacklers related to the Opioid epidemic. This is something bankruptcy courts do regular for the company Purdue Pharma, but it is irregular when it comes to the Sackler family (this is not the entity going bankrupt!)
This is the issue that went up to the Supreme Court, and the Supreme Court ruled that the protection given to the Sackler family is not something that can be given by a bankruptcy judge during the bankruptcy of Purdue Pharma.
Matt Levine has a much better explanation here: https://www.bloomberg.com/opinion/articles/2024-06-27/purdue...
My question is not about the settlement; it's a question about moral judgements people have around Sacklers/Purdue, including judgements I see on this comment page. I already understand the mechanical details you've explained and they don't answer my question.
Do you think there is/was a realistic way to prescribe opioids routinely and safely?
Oxycodone is routinely and safely administered right now, to tens of thousands of people, every day. But this is kind of like, an FDA question, no?
Which is why going after the Sackler's is about politics and not about the law.
Or maybe it's about the horrible crimes against humanity committed by the Sacklers?
You said:
I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
As GP noted, that is not the conclusion of the settlement - not even close. If you want to better understand comments on this page, perhaps reply to them asking for clarity?
To try to illustrate the (bad) principle with a starker hypothetical:
1. Scrooge McDuck owns a thousand different corporations that are restaurants and eateries.
2. A one-taco-stand company is in bankruptcy court, after recklessly inflicting severe food-poisoning on a dozen customers.
3. Scrooge McDuck says: "Out of the goodness of my heart, I will charitably donate $X of my personal funds to help these poor unfortunates... If you give me personal immunity to any lawsuits somehow involving recent food-poisoning problems anywhere."
4. The dozen hospitalized taco-eaters are puzzled but OK with this, since they'll at least get something. The judge shrugs and things move forward.
5. Meanwhile a million other customers of other restaurants see the news on their phones, which they have out because they're stuck on their toilets with raging diarrhea. Plus maybe a few whistleblowers that can't get work anywhere because Scrooge blacklisted them.
6. All of them are justifiably outraged that their rights to seek justice/compensation have been (partly) signed-away in the bankruptcy of some unrelated tiny taco stand case that they didn't--couldn't--participate in.
I don't understand why your analogy requires multiple taco trucks. So if I'm missing something please explain.
Otherwise, I find your analogy helpful and illustrative of my confusion. Here is the simplified analogy:
1. Scrooge owns a nasty taco truck that makes everyone sick. He runs to the bahamas and is gone. 2. A dozen customers take it to bankruptcy court and get ownership of the taco truck and Scrooge's "charitable" donation, but Scrooge would get immunity, and so would the taco truck. 3. Meanwhile, the victims that weren't in the settlement are outraged that Scrooge might be immune. Not everyone was a part of the first suit -- plus, the taco truck is still selling tacos, and people are still getting sick!
This illustrates my confusion.
To me it seems like we should shut down the taco truck, and not give it immunity. I'm kind of a utilitarian and I don't much care about Scrooge, though I wish I could take his money away and put him in jail.
But it seems like most of the people who are mad about the diarrhea are not talking about the taco truck's continued operations and immunity??? And they are chiefly concerned about Scrooge, who is no longer involved with the taco truck??? What gives?
multiple taco trucks
Trucks? The lawsuit involves one discrete corporation, and its small size is underscored by how it's just one stand/kiosk. (I suppose it could be mobile, but that's not what I was thinking of.)
However same owner/investor happens to be involved in many un-enumerated companies, some of which might easily be guilty of the same problems, including ones that would normally "pierce the corporate veil" and affect investors directly.
but Scrooge would get immunity, and so would the taco truck.
The taco-stand corporation isn't immune, it's going bankrupt paying judgements. CEO/Owner Scrooge is coming in from the sidelines to preempt a personal lawsuit, and also trying to get someone in authority to (wrongly) grant him immunity from other potential lawsuits from other claimants.
plus, the taco truck is still selling tacos
Oh, I think I see: No, this isn't a duck-ified version of the entire national controversy, I'm just trying to illustrate the how an "immunity" grant can be bogus.
In other words, the taco-stand is not a 1:1 analogy placeholder for Purdue Pharma, you can assume it's been bankrupted into Chapter 7 and broken up and sold off.
+1 for Levine's explanation. As usual he is insightful, great at communicating a complex topic, and just fun to read.
Matt Levine is a treasure. He is tied only with Derek Lowe for being a fantastic writer who makes complex topics understandable, interesting, and enjoyable.
This is an excellent ELI5 explainer, thanks.
Loaning money at 8% interest to informed parties is OK. Loaning money at 200% interest to vulnerable people is usury and should be illegal. Where in the middle is the right line to draw, legally? Does the intent of the lender matter? Does it matter if the lender is intentionally trying to keep people uninformed and vulnerable? These are hard questions, but that doesn't change the basic facts at the extreme ends of the spectrum.
Clearly the Sacklers' behavior was in the realm of exploiting vulnerable people as much as possible in order to create a cycle of dependence. I think they're villains who destroyed lives. I don't think that means no pharmaceutical companies should be allowed to sell opioids, or that Purdue should be shut down for that reason. Clearly giving birthing women access to epidurals (fentanyl!) is OK. Clearly bribing doctors to over-prescribe addictive opioids to vulnerable people is villainous and should be illegal. It's a hard problem to find the exact right line in the middle, but it's a problem worth attempting. Obviously it involves a lot of regulatory oversight.
Loaning money at 200% interest to vulnerable people is usury and should be illegal
Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed. We're all grown ups, let people make their own decisions.
Setting upper limits on interest rates simply makes it so that high-risk borrowers are unable to access credit. This harms those borrowers more than anyone else, by limiting their opportunities.
Regarding the Sacklers, they never prescribed any drugs to anyone. Doctors did. Why aren't we holding them responsible? It is doctors who have a duty of care to their patients, not pharmaceutical companies.
Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed.
Any? Can I sell my kidney?
You are arguing an extreme minority opinion, consumer protection laws exist because it is not possible for an average consumer to understand all safety implications of vehicle design, house construction or a medical procedure.
Can I sell my kidney?
I don't see why not. Me saying you can't would imply that I have a stronger claim to your own kidney than you do. This is a pretty hard claim to substantiate. The majority can be, and often is, wrong.
Interesting
if I can sell my organs, Essential for survival, That I’m selling my life
logically I should be able to sell my life in other ways. So I should be able to sell myself into slavery.
If so, Then your idea of freedom creates more un-freedom.
If not, Then you must have a logical reason why selling my liver and dying after that is okay but selling myself and living after that is not okay.
And it cannot rely on the fact that it’s been hammered into us from a young age that slavery is bad. It has to be consistent and logical
So I should be able to sell myself into slavery.
No, because that would imply that a person can own another person. Free, morally equal, people cannot own each other. It would also imply that present-you can obligate future-you in a way that fundamentally compromises future-you's freedom.
Present-you can however terminate his own existence, since present-you has the strongest claim on it.
Interactions must be consensual with the possibility to opt-out backed by bankruptcy protection. If you agree to donate your organs in return for compensation (presumably to your estate), but change your mind on the operating table, you should be perfectly entitled to do so. You may incur a bankruptcy protected obligation if you signed an agreement to that effect
Consent should be the fundamental principle guiding all interactions. It also conveniently precludes slavery.
Interactions must be consensual with the possibility to opt-out backed by bankruptcy protection
So student loans, as they are not discharge able in bankruptcy, are a form of debt bondage / slavery?
Also in UK you have to pay to declare yourself bankrupt, which is also questionable.
Also you can’t back-out of an organ sale, you are under Anastasia and then you are dead. The idea that it’s better than still being alive seems morally myopic to me.
Student loans are not dischargeable by bankruptcy because an education is not an asset that can be seized and sold during the process. There should be (and are) pretty strict limits on how your wages can be garnished to repay this debt. However I do agree that student loans are a form of debt bondage, and are questionably ethical for that reason. I would much prefer student loans not be given special protection. That would at least help us stop subsidizing educations that do not lead to productive careers.
I would not be opposed to licensed professions (eg. doctors, lawyers) adopting policies that would revoke licenses for members defaulting on their student loans via bankruptcy. I don't imagine any intervention would be required for such policies to arise if the special status of student loans were to be reconsidered.
Also you can’t back-out of an organ sale
Yes of course you can only back out up until the point you are rendered unconscious. You have to reconsider before then. The idea that "life" and "death" are somehow morally important states is what has been "hammered into us from a young age". Morality is a relationship between (free and equal) moral agents. The important concept is therefore agency and its expression via consent.
Unfortunately the people who make the laws don't understand the safety implications either.
Letting people make their own choices, on net, probably is better than the alternative (and that included selling their own kidneys)
it is not possible for an average consumer to understand all safety implications of vehicle design
and that is why there is and must be independent regulation. The consumer doesn't need to understand vehicle design, they just need to understand safety _ratings_ that must be assessed via third parties (typically, a gov't institution).
So why did the FDA fail to assess the drug properly?
I like this analogy. How does it apply to the status quo of opioids? What rate of interest is the present-day Purdue business charging? This year I was prescribed 30 days of opioids for post-vasectomy use and guided to expect low-grade pain for 1-2 days. Is this like 8% interest or 200%? Does anyone here feel like they know the answers to these questions?
It seems to me like the emergent answer I get is that the old Purdue was charging 200% interest and the new Purdue is charging 8%. But why does anyone think that? It seems like the core doom loop (dumb opioid scrips -> addiction -> fentanyl) is still in place, from what I can tell.
I mean I have been prescribed opioids many times and I just take them as prescribed and they help the pain of the surgery or whatever. I don’t even take the whole bottle. What will replace the opioids if we don’t allow them to be prescribed?
Could you have recovered without pain killers? Or maybe used a pain killer that is much weaker that doesn't kill all the pain but is much safer like marijuana?
Are there scientific studies that shows that opioids help patients recover quicker?
Why is this question important? The primary purpose of pain medication is not to facilitate recovery, but to reduce suffering and increase quality of life.
Exactly! Opioids increase suffering and ruin the quality of life for hundreds of thousands of Americans. 80k+ yearly overdose deaths, plus a percentage of those using opioids for recovery become addicted to it.
Is that a worthy tradeoff? I presume (could be wrong) but we did fine recovering with surgical operations 80 years ago without opioids.
Morphine was commonly administered for post-surgical pain 100 years ago:
"The after-treatment of surgical patients, by Willard Bartlett and collaborators." (1925)
https://babel.hathitrust.org/cgi/pt?id=mdp.39015071056918&se...
One of the first complaints made by the postoperative patient on returning to consciousness is pain. This if due to the actual operative procedure should be at once relieved. William J. Mayo taught us long ago to give morphine during the first twenty-four hours for the pain which we make; viz., by cutting, retracting, suturing, etc. The discomfort caused by such procedures is relieved best by this drug and it is given by us if there be no contraindications for its use, regardless of the amount until full relief is experienced or its physiologic effects obtained.
Most countries do without them now and have always done without them except in special cases such as palliative cures. You get opioids during recovery in the hospital, but not once you're discharged. You might get codeine rarely, but that's it.
Ibuprofen, paracetamol, rest?
From https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...: if you "no longer feel the pain you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals".
One thinks you have never had a really damaging surgery. For obstructive sleep apnea I had the back of my tongue microwaved, my deviated septum repaired, and my uvula and back of throat removed. Ibuprofen and Tylenol would not have been sufficient for recovery from that. And that is even nothing compared to other more damaging surgeries.
I don't think it s a black or white on opioids. But more of a being honest in the marketing and recommended dosages. For instance, Morphine is an opioid that often gets used in end-of-life care, this is a 90 year old on hospice actively dying from terminal cancer, so morphine to ease the suffering. No reason to not give them opioids. However, before the opioid crisis became a known crisis, my dad who is a disabled vet would get like 300 pills mailed to him a month, at the time to be indefinite, from the VA. This was when marketing was telling everyone percocet and vicoden were safe and non-addictive.
These heavy hitters do have a purpose. But it should as narrow as necessary.
I understand two answers to your question:
1. Nothing will replace the opioids, but we should make most routine use illegal anyway, because the usage you described causes addiction, abuse, and death in some cases, which overrules your QOL improvements.
2. Nothing could replace the opioids, so we should keep the status quo. The addiction, abuse, and death are a relatively minor downside to an important bundle of benefits. The Sacklers marketed them illegally, but we've course-corrected as best as possible, and the new status quo is uncomfortable but OK.
These are, I think, the first two buckets of people I listed. I understand them both. I think you're in the second camp. I'm in the first. But I think most commenters here are in neither camp???
The settlement was not at all about Purdue operating as is. Purdue was going to be turned into a legal fund and treatment provider as part of the settlement agreement.
Under the bankruptcy settlement, Purdue will continue to sell opioids. The ownership will change (profits will be used to fund the causes you listed) but the operations will not. Right?
You know I can't actually find a lot of details about what the "new" Purdue was supposed to operate like - my understanding was that it was going to turn into a receivership under the court.
But that's kind of the weirdness of all of this - at no point was OxyContin itself banned or been made illegal.
I understand there's fraud and bribes and such, but it seems to me that in the end it is doctors and the medical system, with a bit of help from government regulators, that decide prescriptions, dosages, limitations and such. Purdue could have been making pure poison, but they don't prescribe anything.
Is it fraud if the pharmaceutical company falsely claims that the addiction rate is very low? If the company aggressively pushes a dose regimen that is almost designed to produce addiction?
Here is a good resource on it [1]. My understanding is that Purdue pushed hard for marketing, including paying doctors to market for them. This paragraph sums up most of it.
“Purdue admitted that it marketed and sold its dangerous opioid products to healthcare providers, even though it had reason to believe those providers were diverting them to abusers,” said Rachael A. Honig, First Assistant U.S. Attorney for the District of New Jersey. “The company lied to the Drug Enforcement Administration about steps it had taken to prevent such diversion, fraudulently increasing the amount of its products it was permitted to sell. Purdue also paid kickbacks to providers to encourage them to prescribe even more of its products.”
Is purdue solely at fault here? Absolutely not. Does it seem that Purdue likely knew what was happening, but put profits above public health? In my opinion, yes.
[1] - https://www.justice.gov/opa/pr/opioid-manufacturer-purdue-ph...
I understand the contents of the link; that judgement prompts my question rather than answering it.
The DOJ found that old Purdue's problem was illgal marketing, kickbacks, etc. I understand that as a legalistic thing.
But as far as human judgement goes: I thought the problem here was opioid addiction, which is continuing to rise in the "new Purdue" regime. We all think old Purdue should not have been doing the illegal stuff. But was the illegal stuff the real problem here? It seems like the "new Purdue" reforms are not affecting the growth of the opioid epidemic.
The only way is if it is done without a profit driven system incentivizing their overprescription. But this requires a gigantic systemic overhaul of healthcare to a nationalized system. And there seems to be a lot of peer reviewed evidence in favor of such a system, and there seems to be broad popular support for such a system. Yet we never manage to get there. It's almost like there's a group of people who simultaneously benefit from its existence and have the capital to influence legislation in their favor. Feels almost undemocratic.
That's not the settlement. The settlement is that purdue pays 8+ bn and shuts down, but the sacklers are immune personally. The supreme court threw out that deal saying that the sacklers can't be given immunity as a part of the deal.
I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
This is an extremely easy answer that doesn’t require any details of the case.
The supreme court clarifies what the law is, not if the Sacklers are villains and if Purdue should continue.
So the people who think the the Sacklers are Villains and that Pursue should continue are people who believe the settlement is not legal and dont believe in legislating from the bench.
Here's a way to help you understand. Let's say I gave you 1 million dollars to help you understand. Then would you understand? That's likely how other people started understanding the situation. Something along those lines. Something this obviously wrong, some sort of coercion or bribery or some other shady thing has got to be a part of it.
The ruling was only about whether or not a bankruptcy court has the legal authority to declare that the individual members of the Sackler family are immune to being sued directly, which is an agreed-upon condition of the bankruptcy settlement. SCOTUS ruled that it did not, so the settlement as it stands is dead.
Purdue is not going to be operating in any capacity regardless of this ruling (except as a bank account holding the settlement funds).
1) I don’t think this is an accurate read of the situation but others discuss that
2) a company is a set of processes and infrastructure, with some legal rights to employ people etc. The decisions of a driver of a car are the drivers fault not the cars. The car itself may be unsafe and should be adjusted if it’s possible. But there is no point in destroying the car if it has utility with different drivers and safety. Revenge isn’t a good reason to dismantle infrastructure. Revenge can only be taken on humans.
3) yes if you know people with chronic pain opioids are the difference between a full life and an early suicide. The consequence of all this is all opioid use is treated as potentially criminal by everyone involved from pharmacies to doctors to patients. This isn’t a feature this is a flaw. And the lack of legal opioid access is leading chronic sufferers into fentanyl from the street.
I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is
I’ve got a friend that’s the same in Afghanistan - he thinks it was right to go in, and it was right to abandon it - which to me sounds like moral myopia. Surely it was either wrong to begin with, or you have to stick around.
I find the Supreme court decisions to be fascinating reads and overall much more interesting and complicated than most news services make them out to be.
Especially since this 5-4 decision didn't follow the "conservative" or "liberal" split at all.
And honestly, while we like to lump them into "conservative" and "liberal" camps for simplicity, it's easy to get the correlation wrong. Like anyone else, their moral and legal philosophies might make them lean one way or another politically, not the other way around. Even for the most extremely political justices, to hear them expound on the legal principles of federalism or human rights is very fascinating.
It's easy to forget that, while they are political appointees, they have to have fairly long careers as acting judges to even qualify for the appointments.
Liberal vs. conservative has always been the wrong take. The stronger dividing line is textualism vs pragmatism.
In fact Scalia famously said this coming from a textualist perspective which I think most people can agree with even if they hate him: “ If you’re going to be a good and faithful judge, you have to resign yourself to the fact that you’re not always going to like the conclusions you reach.”
This seems absolutely correct, but when is the last time ypu ever saw a commentator observe this? Critique has been reduced to “i dont like the effect so the interpretation of the law is wrong.” Put the other way, a fair observer must eventually say “i really hate the conclusion but they got it right.”
The stronger dividing line is textualism vs pragmatism.
They should be doing what is right for the American people. There are clearly laws on the books today which infringe on individual freedoms (abortion), harm society as a whole (citizens united), etc.
The 'justice system' is supposed to be the government branch protecting the little guy from powerful elites. I've not often seen that. I see the opposite. If the legal system won't deliver justice, well, people are going to take things into their own hands whether that's 'justice' or not. If you bury your child, and you see the people ultimately responsible get away with it, I'm not sure I could really blame them.
Strong but respectful disagree from me. Justice is supposed to be blind. And if right and wrong were so clear cut there would no need for democracy at all.
The court is not a democratic institution and exists to uphold the textual rule of law as determined by lawmakers. If a pragmatic ruling by the court can circumvent a politically logjammed congress, so be it. But the courts deciding what is right or wrong for the American people is a very slippery slope that leads to disaster. And a court that just rules against the (existing) elite every time is a junta.
The 'justice system' is supposed to be the government branch protecting the little guy from powerful elites
The justice system. Not necessarily the courts. Our courts definitely weren’t designed to be a political body.
The country gave up on change through legislation a long time ago so now it's down to trying to sway the court.
This is exactly it.
Both sides have their merit, but some people want to have it both ways - do you want pragmatic judges or more democracy? They can often be mutually exclusive.
The stronger dividing line is textualism vs pragmatism.
Except when it came to "textualism vs pragmatism", I've seen that the "textualist" judges have, in many cases, no problem being "pragmatists" when it suits their desired outcome on an issue.
For example, when Scalia dissented in some famous gay rights cases (I'm thinking of Lawrence v Texas specifically) his basic disgust at the thought of same sex relations was laid bare. Ironically, in Lawrence v Texas his dissent was basically correct - striking down laws against sodomy was a step towards gay marriage - but the gist of his argument was that gay marriage was such a god awful, horrible, unthinkable thing that any decision that allowed it must be prima facie wrong. He was basically warning "This decision will force us to allow gay marriage" as if, instead of that being a good thing, it was akin to allowing the apocalypse.
Scalia also authored the 5-4 decision in District of Columbia v. Heller, a major second amendment case that held, for the first time, that individuals had a private right to own guns (not just "a well-regulated militia"). Read up on that case, as tons of "conservative" judicial scholars argued that it was "pulled from thin air" just as much as Roe v Wade was. From the Wikipedia page:
Richard Posner, judge for the United States Court of Appeals for the Seventh Circuit, compares Heller to Roe v. Wade, stating that it created a federal constitutional right that did not previously exist, and he asserts that the originalist method – to which Justice Antonin Scalia claimed to adhere – would have yielded the opposite result of the majority opinion.
> The text of the amendment, whether viewed alone or in light of the concerns that actuated its adoption, creates no right to the private possession of guns for hunting or other sport, or for the defense of person or property. It is doubtful that the amendment could even be thought to require that members of state militias be allowed to keep weapons in their homes, since that would reduce the militias' effectiveness. Suppose part of a state's militia was engaged in combat and needed additional weaponry. Would the militia's commander have to collect the weapons from the homes of militiamen who had not been mobilized, as opposed to obtaining them from a storage facility? Since the purpose of the Second Amendment, judging from its language and background, was to assure the effectiveness of state militias, an interpretation that undermined their effectiveness by preventing states from making efficient arrangements for the storage and distribution of military weapons would not make sense.
Save for at least one current sitting Justice: Amy Coney Barrett. They only had ~3 years of experience being a judge, Seventh Circuit Court of Appeals (2017–2020), before being nominated to the Supreme Court. Yes, they have experience in other law related roles, however your comment explicitly stated, "...fairly long careers as acting judges...," so that is what I'm speaking to.
Fair point!
Amy Coney Barrett only served 3 years as a judge - that doesn't seem very long at all.
It's easy to forget that, while they are political appointees, they have to have fairly long careers as acting judges to even qualify for the appointments.
This is objectively false. There are no requirements like this and there have been several appointees throughout history without many, if any, qualifications for the role.
How they voted(Name and the party of the administration that picked them):
Majority
Neil Gorsuch (Rep.)
Samuel A. Alito Jr (Rep)
Clarence Thomas (Rep)
Ketanji Brown Jackson (Dem)
Amy Coney Barrett (Rep)
=======
Minority
John G. Roberts(Rep)
Sonia Sotomeyer(Dem)
Elena Kagan(Dem)
Brent Kavanagh(Rep)
Whats really surprising is how Gorusch is quite the wildcard, he also authored the majority decision that said that 1/2 of Oklahoma belongs to Native Americans - https://www.npr.org/2020/07/09/889562040/supreme-court-rules...
Its almost like they arent just a political body.
Nah… thats unthinkable
Either that, or it's almost like politics have more dimensions than party affiliation.
Kavanaugh can also be a bit of a wild card. Been surprised by him quite a few times. many of the others are entirely predictable.
Yes, indubitably. It's easy to lose sight of (if one doesn't read the rulings regularly) the fact that SCOTUS's job is to come to rational and deliberate rulings grounded firmly in textual and common law dating back over a thousand years. Even when one doesn't agree with the conclusion, one rarely sees a ruling that isn't reasonable (though sometimes seeing the reason involves entertaining a fact pattern other than the one you believe to be true!).
Yet, during oral arguments they use some of the most juvenile thought experiments to prove their 'slippery slope' opinions
Nonsense.
Oral arguments are the lawyers making arguments. The justices ask questions and collect answers. Their proofs are in their opinions.
Please make your substantive points without swipes or calling names. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html.
Your post would be fine without that first bit.
Haha. Sure. Like when they make up Qualified Immunity which is a completely made up special status/protection given by the Courts, not by law or common law but abusing the concept of Judicial immunity and expanding it to all governmental officials.
See Pierson v. Ray (1967)
Please make your substantive points without swipes (like "haha sure"). This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html.
My bad. I can no longer edit/delete my comment to fix it.
I haven't responded that way in the past but was responded to that way a couple of days ago and guess it took hold. I can see why you have to clamp down on it, it easily spreads.
Lol, they're also quite ideological. Don't fall for the trap that these people are enlightened philosophers. They have a lot of flaws in their own right.
Ask good lawyers about their thoughts on SCOTUS Justices, it's not always peachy.
Even if they are ideological, they are not usually political hacks (cough Thomas cough).
Honestly though, for as much flak as this current court gets, there is at least a certain consistency where they at least mostly stick to arguments about the letter of the law. In previous courts you would see some truly wild written arguments about how, like, a specific word in the Commerce Clause or whatever could mean whatever you wanted it to.
This is going too far I think.
There are some partisan hacks on the bench and the institution’s legitimacy is in pretty bad shape.
But in this case they got an issue that didn’t have as much partisan alignment so maybe they did some good work.
Most of the current legitimacy damage stems from a perception that the Court has members that are arbitrating law over bribery while simultaneously engaging in behavior that looks suspiciously coercive. I think that's a major issue, but it's a bit orthogonal to the question of whether they use sound judgment to arrive at rulings like, say, US v. Rahimi 22-915.
(The other source, to my eyes, of questions of legitimacy is that the appointment of three judges in a narrow amount of time under one party's dominance of Congress and the Presidency has fundamentally shifted the "flavor" of the way the Court interprets law. Rather than bringing their legitimacy into question, that's rather the point of the process by which the US appoints Justices and the length of their term; the Court's "personality" is stable over long stretches of time, but it can shift and it does go through eras. People complaining about the new era don't seem to realize that for many Americans, the previous era was strange times that called to question in their minds the legitimacy of the Court).
one rarely sees a ruling that isn't reasonable
Not so true of this incarnation of SCOTUS. It's amazing when they dont delay or rule (by majority) via ridiculous interpretation.
The interpretations break with precedent but they are rarely ridiculous.
As detestable as I find the outcome, Roe v. Wade built a right to privacy out of whole cloth where none existed before, and whether that was good law has been hotly debated ever since it was decided (https://scholarship.law.missouri.edu/cgi/viewcontent.cgi?ref...). It's within the purview of SCOTUS to go "This was bad lawcraft done by our predecessors, and we reverse it based on this reasoning..."
We can disagree with their reasoning, but my main point is you rarely see a ruling from SCOTUS that is nakedly "Because I said so," even though that's de facto the power they have. The initial Roe decision was shaky. "That was a shaky decision, so we have reversed it" was at most equally shaky. It's hard to argue that one is well-reasoned and the other not (though I think there's room to disagree on what facts the two Courts considered).
They're also eminently readable, which (to me) shows the massive skill of whoever writes these. The fact that I, a layman, can easily understand them speaks to the quality of the writing.
Or to how unexceptionally average most of the judges actually are.
If you're willing to entertain these are skilled brilliant jurists with some kind of mystical levels of elucidation, maybe they're actually just people who failed upward into a job with a fancy robe
The difficulty of understanding a text isn't proportional to how skilled the person is at their job (I think it's inversely proportional, if anything), but to how familiar a field is.
It doesn't take a good developer to describe a system in a way that nobody can understand it. It does take a great one to describe a system in a way that a layman can understand it.
If you've been around the valley long enough to hear pitches, you've surely met some remarkable bullshitters who can convincingly describe with clarity and crispness something that is actually nonsense and simply is not real.
There's a group of attorneys that host a podcast on SCOTUS that present a pretty convincing case for this interpretation, at least to me. Here's the most recent episode
https://podcasts.apple.com/us/podcast/5-4/id1497785843?i=100...
or
You mean articles with headlines like “ Supreme Court Nukes Hunter Biden Laptop Conspiracy in Brutal Ruling” arent actually substantive? https://newrepublic.com/post/183140/supreme-court-hunter-bid...
I’m surprised that wasn’t
“Supreme Court NUKES Hunter Biden Laptop Conspiracy in BRUTAL Ruling” (with “NUKES” and “BRUTAL” in obligatory red font.)
I studied international politics in college and as a result I read not only a ton of news, but often the primary sources they were based on, and I was shocked by the amount of omissions and oversimplifications. I've never understood people who don't "trust" the news given that it is provably accurate and factual nearly all of the time. But I've long despised the arrogance from mainstream media wherein they confidently decide what to print and what not to print with no explanation or accountability on those decisions.
I added the SCOTUS oral arguments to my podcast feed. They are a great listen!
We detached this subthread from https://news.ycombinator.com/item?id=40811187. Nothing wrong with your post but I wanted to pin https://news.ycombinator.com/item?id=40811187 to the top of the thread, and this subthread is a bit generic.
Try listening to the audio recordings of the arguments on https://www.oyez.org/
I totally agree. I have also been captivated by the oral arguments. To the extent that I find myself pre-researching some of the cases' background beforehand. Makes for compelling entertainment when you have a sense on why the justices approach questioning the way that they do. Beats any podcast I know.
I could see shielding from future civil liability as an option, but only after a true bankruptcy has occurred. Liquidate everything, and by that I mean everything, and then you can move on with your life. Definitely no shielding money in offshore accounts.
If you're not willing to do that ... well, see you in court. Over and over, because every individual you hurt should have a chance to come at you with a liability claim.
One problem of which I was unaware is that the Sackler family has largely fled the United States.
Pursuing their assets introduces vast complexities of international law.
"In a brief filed on behalf of the relatives of Mortimer Sackler, most of whom are based overseas, lawyers warned of “significant litigation costs and risks” in seeking to enforce any foreign court judgments against the family if the settlement were thrown out."
Considering the patience the US has with getting justice against other individuals who have fled our jurisdiction, we could do the same here. We also have an enormous amount of influence in the financial sector in other western nations, so we could at least make their lives less lavish and comfortable.
Throwing up our hands and declaring it an unsolvable issue just encourages others to misbehave and then escape the same way.
The question is whether to allow a smaller settlement immediately, or pursue a less-likely and possibly larger set of judgements in the future. It's not clear that it is possible to get more money out of them.
The EPA values one human life at $10M. A conservative estimate of the number of people killed by the Sackler family's companies (testified in court) was ~~245,000~~ Edit: probably at least 100,000, see below. So if opiates were environmental pollutants, the Sacklers would be on the hook for $1T in damages. Their immediate settlement was $6B.
Roughly three orders of magnitude too small.
Attributing every single opioid overdose to solely the Sackler family is so laughably ludicrous it's hard to take this comment seriously.
ok, so now you are just arguing percentages. What is an appropriate amount of the harm to be apportioned to the Sackler family?
The number of opioid overdoses between 1999 and 2021 was 645,000, according to CDC. Purdue Pharma brought in $35B in OxyContin revenue from 1995 to 2017. OxyContin was prescribed to 6.2 million people in 2002.
I'll edit the number above to ~100,000 as an estimate of the number of victims, since it looks like I misremembered 645,000 as the number of Purdue-related deaths. Still, that's assuming only 1.6% of those 6.2 million people taking OxyContin in 2002 developed an addiction, which seems low.
If we can seize Russian oligarch's money, why could the US Gov't not seize assets of a US citizen even if living abroad?
Nit: the assets were frozen, not seized. There was recently hand wringing in the EU over using the principle or interest to fund Ukraine, and they settled on interest because seizing assets scares any foreign investors who might someday disagree with a government.
Because US citizens have rights that are not granted to non-US citizens.
Hey, it's not like they shared copyrighted movies on a server or something.
With that first sentence, I thought this might be doing down the road of, "boy, there sure is a lot of 'democracy' that needs to be spread."
Come to think of it, it's mind blowing when you compare the slap on the wrist of a punishment the Sacklers have received against what Julian Assange had to endure. One is responsible for the deaths of more than half a million people while the other is responsible for zero. The justice system really needs to get its shit together.
We just need to convince people they leaked a couple videos of the war state doing bad stuff
"In a brief filed on behalf of the relatives of Mortimer Sackler, most of whom are based overseas, lawyers warned of “significant litigation costs and risks” in seeking to enforce any foreign court judgments against the family if the settlement were thrown out."
I understand your point, but basically they are saying: "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
Can you imagine a member of Congress or the President saying this? Forgoing immunity is a scorched earth tactic, but it is also one that will dissuade future abusers. We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them!
"We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them!
This is conflating two things.
It is not criminal to move money offshore, and nothing suggested any money laundering occurred, because it is not necessary to launder money to move it offshore. And it is also not money laundering to obfuscate money's origin or destination. Money laundering requires a criminal origin and then obfuscation.
Despite how much the US has convinced its entire culture to stigmatize the concept of moving money, the US is operating in its own bubble of hubris to suggest money has to stay within its ecosystem. It doesn't make any sense at all when you say it out loud does it?
To your second point, the US has reporting laws on money held offshore legally, for US citizens. For banks, this is merely an additional compliance burden that disincentivizes them from dealing with small accounts because its not worth it. But at Sackler money, it is worth it. It is not hard to find someone to bank you as an American. And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction.
Or when you have a second citizenship, you can just not tell the US about it, and you can just not tell the foreign bank about your US citizenship. Prosecute that on its own, if you find out.
and finally, there are gaps in this reporting framework. FATCA treaty was a broad expansion of a country's power, to the limit of our global society in the continuum of history. And its not completely as omnipresent as the American psyche imagined. Just like the global sanctions attempt on Russia showed, its a nice try but now everyone can see how much is hubris in plain sight.
And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction.
Renouncing your citizenship because you owe the US government money is generally not seen as a valid reason by the US government to renounce your citizenship.
That’s not the reason you would say in your renunciation ceremony
Even if they let you go through with the ceremony, it doesn't actually stop them coming after you.
Nor should it be. These people are leeches whose very existence is antithetical to a healthy and just society. They've done immeasurable damage and then hide behind the courts to avoid any repercussions. Disgusting, the lot of them.
Consider a few issues:
- the foremost among the perpetrators are dead
- the rest of the family is culpable, but less so
- the settlement money will now be entirely repurposed for legal defense
- meanwhile the victims get nothing
Does justice demand punishment or compensation?
That's basically the argument made in the dissenting opinion. I find the split among the justices here very interesting as it is not along party lines, as such splits usually are.
Does justice demand punishment or compensation?
Which outcome provides the greatest disincentive against anyone else even contemplating doing something like this ever again?
It generally demands deterrence. Helping the victims out is great, and the proceedings should do that as best they can, but the largest benefit that can be brought to society as a whole is showing that doing these kinds of things will be bad for you.
"We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
Can you imagine a member of Congress or the President saying this?
Yes.
Well, we haven't gotten to that part just yet. Right now, we're still in the stage of deny deny deny even in the face of evidence and convictions. They are still in the deny stage.
Can you imagine a member of Congress or the President saying this?
definitely. The 2012 STOCK Act is routinely violated by members of congress who insider trade on information from congressional committees before laws are enacted. that money the openly argued about the legitimacy of in congress and Pelosi, for one, and Tommy Tuberville, for another argued that it should be allowed. Pelosi later changed her stance, but continues insider trading. you can find datasets for all this at (no relation...just interesting data) https://quiverquant.com
The US are proud of getting some terrorist in the middle of Pakistan or putting pressure on whistleblowers internationally but when big money is involved getting a criminal scumbag responsible for ~1m deaths is suddenly a huge problem.
Listen, we can't spend like we did going after Julian Assange on this. It's just business people doing business.
El Chapo is crying.
El Chapo was free to form a corporation and then create an indemnification agreement between that company and himself. That he chose not to is on him.
Didn't stop them with Julian Assange or Kim Dotcom, and these people are actually evil.
I think you're mixing up the Purdue bankruptcy and individual, personal bankruptcies for the Sacklers. This case was about the corporate bankruptcy.
WASHINGTON — The Supreme Court on Thursday blew up the massive bankruptcy reorganization of opioid maker Purdue Pharma, finding that the settlement inappropriately included legal protections for the Sackler family, meaning that billions of dollars secured for victims is now threatened.
Does anyone find it strange that this is described as a loss for the victims?
Well, it is. The victims had a settlement agreement worth billions of dollars, which the Sackler family was going to willingly provide in exchange for legal protections.
Now that legal protections are off the table, it is very unlikely that any new settlement will be as generous, and in fact quite unlikely that any settlement will be achieved at all.
But also very likely that the case will go to court and the damages will be substantially higher.
Not really, it will be played out in a number of separate cases and each case is in a weaker position separately simply due to scale and resources. The Sacklers have an estimated $1bn liquid available to fight these things.
The $6bn ruling was significant and not an amazing outcome for either side (so, a compromise).
Additionally most of the Sacklers are well into old age, so they'll probably die before losing $6bn.
The $6bn ruling was significant and not an amazing outcome for either side (so, a compromise).
I find this framing extremely bizarre. A $6bn ruling means the family profits $5 BILLION. In no universe is that not an amazing outcome for them.
It's a loss of ~1/2 of their net worth. That's significant.
They are now likely to pay much less by settling smaller individual cases, which will take significantly longer and cost claimants significantly more to pursue.
When they die (which will be soon, most of them are 75+) it'll become even more difficult to get anything.
The deal that was overruled was certainly not justice, but reality will likely be worse. There's no outcome that will render them not billionaires within their lifetimes.
They are now likely to pay much less...
So then why did they choose to settle? That makes no sense. The only reason a defendant settles is to minimize potential losses.
predictably of asset distribution, the end of a long campaign of bad pr, and government pressure (which is now fairly deflated)
the settlement was also in the interest of the government, which may now end up with tens of thousands of separate suits to manage and $6bn less to help manage the crisis unfolding in the meantime
don't get me wrong, the sacklers could end up worse off... but it's a big if and will take much much longer
The only reason a defendant settles is to minimize potential losses.
???
It's a loss of ~1/2 of their net worth. That's significant.
It's a gain of billions of dollars that everyone agrees they should not have had in the first place. That's really much more significant.
It's pretty telling that literally nobody says that the Sackler family should actually have this money, just varying degrees of it being hard to claw back from them.
If someone walks into my house, stabs me with a knife, and steals the money on my dresser, keeping half of the money they took from me is the exact opposite of a loss for them.
There's no strong legal structure to allow it, the US justice system strongly favors the rich and corporations. Loose consensus isn't enough if there's no legal mechanism to do so.
The deal was pragmatic in the absence of a clear path for actual consequences.
It would be easier to rally an angry mob at this point.
Victory is not guaranteed, and even if the victims do win, going to court takes a lot of time and costs a lot of money. The victims agreed to the settlement because they preferred that option to going to court.
OK - but the individual payouts are going to be small and do little to compensate for the harm caused.
The primary goal for the suit is to punish the wrongdoing and disincentivize similar future behavior by others. Higher costs and uncertainty does that.
In your opinion. I think those owed restitution would feel differently about the primary purpose.
Yeah. I looked up the settlement - it amounts to tens of thousands of dollars per individual. I can see how that would be important to many people.
And to people whose lives were wrecked by addiction. Tens of thousands of dollars would be a welcome windfall to people on HN, but to these families it could even be life changing amounts of money. Sucks that their payout is now delayed indefinitely.
Even if that's the result (which is questionable), the Sacklers are almost all overseas and their assets are "hidden" in complex schemes. So, collection is as big a hurdle as coming to a reasonable judgement.
Does anyone find it strange that this is described as a loss for the victims?
I can see it going both ways, yes: this means that 6 billion dollars are not immediately available for compensation.
On the other hand, certain states (Washington was one, if I recall) argued that 6 billion dollars was such a pitifully small amount (relative to the damage done) that they declined to accept compensation in hopes that future lawsuits would yield more.
I view this decision as rejecting the immediate compensation, but opening up possibility for greater compensation in the future (with obvious risks and delays).
certain states (Washington was one, if I recall) argued that 6 billion dollars was such a pitifully small amount (relative to the damage done) that they declined to accept compensation
As the dissent notes, “all 50 state Attorneys General have signed on to this plan.” The holdouts were “a small group of Canadian creditors and one lone individual.”
I always thought of the Sackler carve-out as a scam. But the dissent gives me pause. This ruling trades restitution for retribution. In all likelihood, many classes of victims—such as small victims, small states and local governments—won’t see a penny, at least for years.
This ruling trades restitution for retribution
IMO the money is a pittance, sounds like a lot but it's just a fraction of what the federal government spends on any given day. We can afford to carve out the financial resources to help victims. The retribution is totally worth it, because it needs to be understood that behavior like this will get punished. It should be painful, not just the cost of doing business.
You may find the money a pittance, but the victims decided otherwise.
It seems the case that the interests of the victims/plaintiffs (e.g. compensation) may be different than the public at large (e.g. punishment).
If so, perhaps the interests of the public should be pursued by a different avenue than the civil case of the victims, which requires superseding the agency of the victims.
You may find the money a pittance, but the victims decided otherwise.
When you say 'the victims' are you implying they all agreed to this? So they are all okay with giving up their individual right to sue for damages? You make several points which imply that this is some kind of consensus position that everyone is okay with. That's the root of the problem, though -- this settlement in no way addresses the damage to all the victims.
Perhaps renegotiate the agreement so that it only immunizes Purdue/Sacklers from further civil action from
In any case, when I say pittance, I was clearly talking about relative to the financial resources of the US. This is a national problem, we can afford to solve it at a societal level without being forced into accepting an unjust settlement.
The case and settlement has almost nothing to do with solving the problem at a societal level, with either outcome being negligible.
Real progress would involve systemic changes to the treatment and causes of drug addiction, as well as medical treatment philosophy.
To hang the opioid epidemic on perdue is a gross oversimplification, essentially a scapegoating of a multifactorial problem. Perdue sold the same pills in Europe, but the US has an overdose rate 2,000% higher.
To hang the opioid epidemic on perdue is a gross oversimplification
The only sane comment here. It's laughably ridiculous to call for retribution against a single family as if they were personally responsible for every overdose the country has seen.
I don't excuse their unethical and potentially criminal behavior, but I do think they way people talk about it is detached from reality. The corporate choices likely had some effect on the margin, but I dont think the appropriate disclosure around addiction potential and would have moved the needle much.
I think that was because they could more effectively market their "pain is bad mkay" strategy in the culturally and politically more homogeneous market that is the US. The European healthcare market is completely different for each country in multiple dimensions. Be it political, the way insurance is structured, laws are setup and governmental agencies handle them. That means while it is entirely possible to sell the pills in Europe they won't be prescribed in the amounts necessary to jump start the "vibrant free market" for them the US has. So they are just an opioid that is prescribed in extreme cases.
I dont think the idea that patient pain is bad was unique to perdue and their drugs. Many European countries have private health insurance, with reimbursement quite similar to the US.
Like I said above, I think it would be extremely shallow thinking to claim that there is a single reason.
If I were to pick a leading difference, I would say that the US has embraced trained consumerism to a greater degree than most European countries. As such, the idea that a simple pill/product will make a problem go away has more traction, both with prescribers, patients, and abusers.
You see this difference manifest in many cultural and social forms, where people in the US are especially prone to "quick fix" marketing and products that offer escape and excitement through consumption.
This is one thing that leads into higher rates of substance abuse in the US than Europe. For example, the US has a higher rate of alcohol use disorder than most European countries, despite most of the countries having more permissive laws around alcohol and more consumption of it on average.
Does anyone find it strange that this is described as a loss for the victims?
As the dissent notes, this decision means the victims won’t get money now. When is an open question, as well as whether it will be similar, more or less after litigation costs, and to whom it will be paid.
What is certain is the Sacklers will be hurt more. (Unless a couple bizarre legal maneuvres pay off, e.g. the Sacklers extinguishing liability by way of a 2004 indemnification agreement.) So in a sense, this is deterrence and retribution winning over restitution [1].
[1] https://open.lib.umn.edu/criminallaw/chapter/1-5-the-purpose...
What is certain is the Sacklers will be hurt more.
Maybe? They get all of the billions back and now have time and a reason to start building a defense.
get all of the billions back
They never gave up any cash to my knowledge. The plan was a promise.
We can conclude the Sacklers are worse off right now given they (and the creditors) accepted the deal. They may be materially better off in the future. But the rest of their lives will be about this.
No, if it wasn't a better realization of the victims’s goals than going to trial, why would the victims have accepted it?
Its absolutely a loss for the victims.
Not just them, but they are among those losing.
This is a more complex case than I thought, and the dissent argument is actually very powerful and convincing:
https://www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf
Basically, the original judge did a good job - the settlement plan was reasonable and widely popular. And the Sackler family being released from liability by putting billions of personal dollars into the payment fund meant more victims would get more money immediately.
With this ruling, the Sacklers are personally legally liable again - which may make you or I more happy, but this means that victims have to pursue a much harder and more expensive set of lawsuits to get money from the Sackler family. It also means the victims of the deal don't get a voice in the proceedings, and it may also make future payouts and bankruptcies harder if there is no reason to cooperate with the state.
If I had lost a family member to drug abuse I would want justice (ie. jail time) not money.
I would want justice (ie. jail time) not money
Retribution not restitution [1]. “Justice” in this context is ambiguous.
[1] https://open.lib.umn.edu/criminallaw/chapter/1-5-the-purpose...
What's the point of "restitution" if it came from the victims anyways? The Sacklers would have kept all of their ill-gotten gains under this settlement. The amount they'd be paying is practically just the interest from their earnings.
Restoring what was taken from the victims is literally the definition of restitution.
Except if all you have is restitution, there's no punishment.
"Hey, I stole this money from you but since I gave it back - after a court ordered me to - we're all square, right?"
Exactly. If they're just returning the money (sans interest), where's the punishment?
If you steal $100 from a bank, you spend more time in jail than these scumbags ever will.
What's the point of "restitution" if it came from the victims anyways?
The difference between having money and not.
amount they'd be paying is practically just the interest from their earnings
Not disputing, the majority almost admits as much, but source?
I have a hard time with the concept of retribution alone, but I think if it is phrased in terms of modeling societal standards and demonstrating to others that this behavior is unacceptable, it is still valuable to society. I guess you can mark that under "deterrence", but it's less about sending a signal to future would-be criminals, and more about communicating and demonstrating societal standards to the entire society at large.
justice from whom? Just because they got a prescription doesn't mean they lost complete body autonomy. The lack of personal responsibility regarding drugs around here is insane.
Opioids are highly addictive. If you're vulnerable and your doctor eagerly prescribes them because it feeds their wallet, you can easily loose control.
Don't blame the victims.
Don't blame the victims.
Expecting some personal agency is now victim blaming? Detoxing from opioids is not fatal. It sucks. But it's doable. You don't need to take your entire prescription. Take it while you're in pain.
If you were prescribed heroin and proceeded to take it, you would end up addicted and unable to quit. Full stop. It is exceedingly rare to overcome opiates, you underestimate them greatly.
I'm not sure about the justice aspect, but I wouldn't underestimate how powerfully addicting some of these drugs can be to the point where it can override your "personal responsibility". Same thing with any substance like alcohol or cigarettes, gambling, over-eating, etc. It's very easy to slip into abuse and an addictive response and susceptibility isn't universal.
The whole basis of this suit is that a Purdue subsidiary went out of their way to market these pills as non-addicting. "Personal responsibility" in this case clearly lies on those actors, not the addicts.
why would it be harder? wouldn't it just be the next family that tries to get away with crap like this will be scolded sooner?
it seeem like if you want people stop doing bad things you can't let them get away with bad things. here, the family was trying to get away with billions. The bankruptcy court said, "yay, ok". The Supreme Court said "no, not ok"
I don't understand the dissent. unless the dissent is friends of the family trying to spin.
If you want money from the Purdue bankruptcy entity: you just file a claim while they still have money.
If you want money from the Sackler family: you need to lawyer up, prove a bunch of personal liability claims (which are very, very hard cases to win), and wait a long time. And hope they still have money.
While it may feel nice to eventually, maybe, be able to throw the Sackler family in jail, it basically just blows up the ability to do mass tort arbitration.
From the dissent, which even includes Sotomayor and Kagan:
"As a result of the Court’s decision, each victim and creditor receives the essential equivalent of a lottery ticket for a possible future recovery for (at most) a few of them. And as the Bankruptcy Court explained, without the non-debtor releases, there is no good reason to believe that any of the victims or state or local governments will ever recover anything."
If you want money from the Purdue bankruptcy entity: you just file a claim while they still have money
And as the dissent notes, this class includes the Sacklers per their 2004 indemnification agreement. So we first need to nullify that to avoid draining.
How would you propose the agreement be nullified? Was it fraudulent, or performed without shareholder approval?
It’s harder because it requires piercing the veil of protection of an LLC, a legal construct that is explicitly designed to limit liabilities. There are simply more legal hurdles to this.
Though I do agree with the conclusion that the bankruptcy court should not be able to grant immunity to the Sackler family. It feels deeply, deeply immoral
harder because it requires piercing the veil of protection of an LLC
Source?
It’s harder because they’re indemnified by Purdue, and their individual liability is far from established. (The opinion and dissent both refer to a monolithic “Sacklers,” but they’re individuals and trusts and whatever.)
An important but frequently overlooked aspect of the law is that by the time the courts are involve it is often too late for there to truly be justice. Things have often happened that cannot be undone. Often parties that are at fault do not have the resources to pay their share of damages.
No matter what the court does in those situations someone is getting screwed.
I disagree. The dissent focused way too much on emotional appeals. It shouldn’t matter if the remedy was popular amongst the primary parties if the law doesn’t allow for such a remedy, “it was popular” is not a solid legal footing.
If we want to make sure that the victims of people like the Sacklers can get some justice then let’s actually write some laws for that purpose. Let’s remove the loopholes that let them make a ton of money at the expense of a nation, and them take it all offshore. Let’s add transparency to corporate structuring. Let’s fully pierce the corporate veil for egregious situations such as this.
What we shouldn’t do is allow the powerful yet another tool to escape consequences. Whether or not this particular deal was a net-positive for victims is besides the point. It gives too much power to bankruptcy judges and is a ripe avenue for corruption. Go to a “friendly” judge and have them absolve you of any personal liability, then send them a nice gift basket full of Benjamins, now fully legally (Thanks Supreme Court!).
If we want to make sure that the victims of people like the Sacklers can get some justice
This isn't just about the Sacklers either, this could potentially impact a lot of other important cases in the future once the law is more well defined.
no reason to cooperate with the state
The idea of the rule of law + the state's monopoly on violence is that you WILL cooperate with the state if the law says you should. It may even be worth some losses to keep that up.
you WILL cooperate with the state if the law says you should
As the dissent notes, we don’t yet know what the law says about the Sacklers’ liability.
It's really not that complex. The question is NOT whether the plan was a good idea or reasonable. The question was whether the Bankruptcy Code authorized the bankruptcy judge to approve the plan. It doesn't. It's really not more complex than that.
Courts cannot legislate from the bench. Why not? Because the Constitution says so; i.e., Congress gets to say what the statutes say, while the Judiciary gets to say what the Constitutions says. That's the balance of power under the Constitution.
To me...the waaaaaaay bigger and more intriguing thing is: the story underlying this split 5-4 decision.
I mean this spit the "right" justices and the "left" justices. J Jackson came out of nowhere and sided with four "right" justices. Like, what?
Also, I can't for the life of me understand how J Sotomayor and J Kagan could ever come to the conclusion that this sweetheart deal for rich billionaires, who made their money killing $247k humans, was a good idea and totally fine. Again, what? But no the efficacy of the deal doesn't legally matter and is irrelevant.
Nevertheless, we don't know that the victims will be harmed by this decision. However, we DO KNOW that the rich billionaires would have benefited if this decision went the other way.
Remember that.
There's gotta be a Pulitzer worthy story behind this split.
victims have to pursue a much harder and more expensive set of lawsuits to get money from the Sackler family
They also have to litigate away a 2004 indemnification agreement extended by Purdue to the Sacklers in 2004, which could result in litigation and liability draining the pot before pay-outs can begin.
Definitely more complicated than I first appreciated.
Purdue made billions from OxyContin, a widely available painkiller that fueled the opioid epidemic
It's more complicated than that. They knew it was killing people and turning thousands (millions) into addicts and they kept pushing doctors to use it at all costs. I'd recommend the John Oliver special on it.
Why are doctors so easy to manipulate? They learn about addiction in medical school. Why would they believe a pharmaceutical company saying "...oh but this opioid is not addictive..."
Because physicians don't get much if any training in evaluating evidence and research, they generally believe what they're told by scientists. Which is a shame, they should be taught critical evaluation of literature
They also don't have time because of the artificial limits of physicians graduating every year, combined with more bureaucracy being pushed on them day by day
"trust the science"
edit: it's meant in sarcasm, mostly.
We can trust the process of science but we need to be mindful of how to critically examine a body of literature. When I see most lay people examine literature all they do is cherry pick what they like and discard the rest and ignore any analysis or methodological concerns
It's incredibly hard to do anything else, since it's pretty easy to cherry pick methodological concerns for any given conclusion you don't care for, since it's incredibly rare for a given body of work to be free of methodological flaws.
Something I have noticed is that non scientists don't understand the methods so when they do try and critique the methods those critiques don't make sense because they lack the understanding of the underlying principles
There is a lot of basic science that is quite solid and is replicable yet people tend to throw it out with nonsense complaints
It’s easy to overlook that OxyContin was very effective. Even a doctor acting in good faith was likely to prescribe the drug— because it worked well. It really did help people struggling with pain management. The downside, of course, was that Purdue pharma was knowingly misleading doctors on the addictiveness of the drug. Also the amount of doctors that were willing to turn a blind eye to the clear signs of addiction is very worrying.
Also the amount of doctors that were willing to turn a blind eye to the clear signs of addiction is very worrying.
No disagreement, but I think it's worth considering how stigmatized addiction is in our society. I expect many patients would hide any signs of addiction from their doctors - especially since it might result in losing their supply of OxyContin, or worse, their career.
Yes, whole heartedly agree. The social impact of addiction and the ostracism of those suffering with addiction has undoubtedly only made this situation worse. I was more leaning towards doctors/pharmacies that were operating as pill mills - I.e. the handful of regions in the Appalachias where there were more scripts for Oxy than there were people in the county
Also Purdue themselves were pushing pain management as an outcome to manage, to sell more Oxy.
Totally pain-free medical care is a bit misguided.
Because doctors believe studies and health system policies pushed aggressive treatment of pain.
And our unequal society forces a lot of people to damage their bodies in the pursuit of happiness (i.e. earning money). That damage becomes chronic pain.
And unfortunately, painkillers often have a euphoric effect. So people might use that effect to escape the grinding reality that they are trapped within. Consider how popular cannabis is, especially among older adults in states where recreational use is legal.
What a positively wonderful way to look at life.
I can't make sense of this either as sarcastic or earnest. I though GP was a fairly neutral (and imho accurate) appraisal.
Why would they believe a pharmaceutical company saying "...oh but this opioid is not addictive..."
Because the pharma company offered them direct or indirect benefits for doing so. Doctors are just as human and just as susceptible to financial incentive as anybody else, that's why for decades there were doctors advertising the health benefits of smoking.
What makes you sure doctors are "so easy to manipulate"? Is the general public more immune? Are there many professions that are more immune?
They also designed it to be more addictive. The recommended dosage and timing causes the patients to repeatedly experience minor withdrawal during normal use, which is a standard technique for conditioning someone into being an addict.
All of this is documented in emails that were presented as evidence in court.
They learned it from the tobacco industry probably.
Is there a recommended dosage and timing from the tobacco industry?
It was in jest. But part of the problem with nicotine that helps to lead to addiction is its short half-life. If you are a smoker you experience several episodes of abstinence throughout the day, so you lit just another one.
Yes - sort of. Many of the additives found in cigarettes are designed to increase the rate of absorption of nicotine. This gives you a distinct rush within seconds of consumption, as well as a more pronounced crash that triggers intense cravings.
That's very different from the effects of (freebase?) nicotine typically found in e-cigarettes which is slower to absorb and doesn't have a noticeable crash.
Designed it knowingly to be more addictive WHILE producing physician literature that denied or downplayed addiction risk.
Additionally, I recommend the book Empire of Pain for an excellent deep dive into the Sackler family and how they essentially created the opioid epidemic. You'll be infuriated as you read it.
Matt Levine has covered this several times in the past, worth reading. From memory, the Purdue family had put away their money in legally sheltered arrangements, so even an unfavorable decision (to the Sacklers) would likely not be able to claw back much money. The previous deal traded the risk of trial for a perceived as decent compensation. My read is that the majority in the supreme court disagreed that you can always financial-engineer your way out of trials
Lawyers are fixated on the money for obvious reasons, but the money will never really fix what the Sacklers did (particularly for the many victims who are now dead.) Restitution is largely a farce and we should be focusing on retribution.
I'm really not sure what other retribution you're suggesting. There's always public lynching if that's what you're after, but we've kind of decided that is not a good idea in modern society
They could be imprisoned.
Really unclear how knowingly creating a scenario where people die of overdosing for profit isn't criminal.
Because car manufacturers exist, and this isn't theoretical or a jab at cars themselves. We are 100% certain that people will die while using cars, and by cars. Vehicular manslaughter even has a high bar for real punishment precisely because driving a car has an inherent risk of killing others and that risk is legal to take on.
Knowing that some people using your product will die, and even that selling more of your product increases the deaths is something we're okay with. It's true of guns, red meat, skateboards, alcohol, lawn mowers, and industrial equipment — all sold for profit.
I very much dislike cases like this because while yes, opioids were overprescribed and Purdue sales people did go out and sell often times not in legal ways, doctors still prescribed them and we knew that people dying was necessarily an outcome. So while the crime they actually committed was about kickbacks, not doing the DEAs job enough for them, and lying with statistics they get blamed for the actual deaths which is silly. I take stimulants that double my risk of heart attack and are also known to be addictive, neither outcome is the maker's fault if those happen. It's the tobacco settlement all over again where when bad thing happens the proximate deepest pockets get blamed. I couldn't care less about the government taking money from rich people because reasons, have at it, but I think they're the scapegoat.
Except Purdue clearly stated that addiction was not an issue with their product. Car manufactures never say that death is no longer possible with their product. They blatantly misrepresented the dangers of their product in ways none of the other examples you listed come close.
They didn't though, they cited a medical journal article where an unaffiliated doctor reported the extremely low addiction rate. Which was true and misleading because short term opioid use addiction rates don't predict long term addiction rates — lying with statistics. And they should be charged and convicted for this, in fact they already were. However, since 2001 every bottle of oxy has made no claim that it's less addictive than other opioids. And we still prescribed them like candy.
And we still prescribed them like candy.
Part of the claim is that the Sacklers were involved in this portion.
Isn't that a form of punishment instead of retribution?
Jail. Jail would be reasonable for purposefully poisoning tens of millions of people.
Point of order.
Jail is for people not convicted of crimes.
Prison is for convicts.
To those in jail, I doubt it matters
But a scorched earth destruction of their assets would be an appropriate end result.
We don't put killers in prison because 10 years will make the dead person alive again.
We do it because we don't like them.
We actually do it because they're a danger and people tend to age out of criminal impulses.
If there was zero risk of recidivism, we still would.
Removing the profitability angle mildly dissuades this sort of behavior in the future.
I'm all for rendering the Sacklers paupers. Whether that money is given to surviving victims or piled up and burned matters less.
Matt Levine wrote again today, this time about the decision that just came out:
https://www.bloomberg.com/opinion/articles/2024-06-27/purdue...
He quotes and explains parts of both the majority and dissenting opinions.
It was closely submitted, but didn't win the votes (4 points, 7 hours ago) https://news.ycombinator.com/item?id=40813446
They were (apparently) sheltering money specifically to pay for personal legal damages, and they voluntarily offered it back during the bankruptcy proceedings in exchange for giving up their liability.
The court ruling is not about the legality of their financial shenanigans, but the authority of the bankruptcy court on deciding such matters.
For those claiming the Supreme Court is a political institution, I'd like to note that this was indeed a 5-4 decision.
But one with Justices in the majority who were appointed by Biden, Trump, Bush 43, and Bush 41, and in the minority who were appointed by Bush 43, Obama, and Trump.
It was Jackson, Gorsuch, Barrett, Alito, and Thomas in the majority and Sotomayor, Kagan, Roberts, and Kavanaugh in the minority.
Four decisions were released today.
We had a decision on the SEC vacating some of its enforcement powers, 6-3 with only the 3 liberal justices dissenting.
We had this decision, which was 5-4, although it wasn't a clear ideological split.
We had a 5-4 decision vacating an EPA regulation, with the 3 liberal justices and one of the more moderate conservative justices dissenting.
We had a 6-3 decision on the EMTALA-abortion decision, with the 3 most conservative justices dissenting. (Technically it's per curiam, and the "majority" opinion is unsigned. But every justice signed onto a concurrence or a dissent, so we know exactly how every justice voted in this case).
Yesterday, we had a decision on social media which was 6-3, with the 3 most conservative justices dissenting.
Yesterday, we also had a decision on bribery which was 6-3, with the 3 liberal justices dissenting.
Out of the most recent 6 decisions, we have 4 decisions that clearly evidence a 3-3-3 ideological split between 3 liberal justices, 3 more moderate conservative justices, and 3 very conservative justices that would be able to pretty fully predict how they would vote on the cases, and there's another case that it's partially predictive on (a 5-4 that peels off either Roberts, Kavanaugh, or Barrett doesn't contradict this lineup). Furthermore, the one case that the ideological breakdown doesn't work on is the case that is the least politically charged (it's literally resolving a circuit split, as opposed to please-intervene-in-this-politically-charged-case).
So yeah, this doesn't disprove the thesis that SCOTUS has become increasingly politicized over the past few years.
Is there any corruption law that this court won't overturn? They seem extremely "pro" on quid pro quo.
They didn't "overturn" this "corruption law." This was a prosecution under 18 USC 666, which is titled "theft or bribery concerning programs receiving federal funds." In this case, the question was framed to the Supreme Court whether 18 USC 666 applies to so-called "gratuity" payments. That framing was because the prosecution in the case below could not prove that the defendant had anticipated a payment in the future when he undertook the official act. (The defendant himself maintained that the payment was for subsequent consulting.) Federal law makes a distinction between those two things.
You can still bring an 18 USC 666 case for bribery, you just need to prove that the payment had some ability to influence the official act.
In this particular case a mayor rigged the competition for a garbage truck contract so that one particular company would win it. That company then overcharged the city and gave a kickback in the form of $13,000 to the mayor. The Supreme Court said this was fine and let the mayor off of the hook.
If you can't prosecute with this level of evidence the law is effectively dead.
That's not what the Supreme Court decided, and its extremely misleading to suggest that.
At trial, the government alleged the mayor had "rigged the competition." But the government argued, and the jury was instructed, and the Seventh Circuit agreed, that the government did not need to prove that. Because, under the Seventh Circuit's view of the law, it did not matter whether the subsequent payment actually influenced his official act. So on appeal, the Seventh Circuit upheld the jury verdict on the assumption the government did not need to prove that the competition was actually rigged.
So the case that came up to the Supreme Court didn't have the issue of whether he rigged the competition. The jury was told it didn't matter, and we don't know what the jury would have decided had they been told something else. The question before the Supreme Court was only whether 18 USC 666 requires proof that the payment did or could influence the official act. It did not consider the factual scenario under which he rigged the competition because we don't know if the jury would have found he did that.
Now the case goes back to the trial court to see if the government wants to retry the case, where they actually have to prove corrupt influence.
The question before the Supreme Court was only whether 18 USC 666 requires proof that the payment did or could influence the official act.
And the Supreme Court's finding is that it did not because the payment happened after the action. Certainly corrupt officials in the future will never figure out a way to exploit this loophole.
This isn't the first corruption case before the court where the standard of proof seems to be "they need to write 'This is a bribe' on the notes line of the check for it to count".
And the Supreme Court's finding is that it did not because the payment happened after the action.
It doesn’t have to do with the timing of the payment. It has to do with whether the defendant had a corrupt motive at the time he took the official act.
The government could have prosecuted this case under the same statute by saying: “he knew he was going to get paid later so he steered the contracts to this company.” They had the evidence to pursue that theory of the case. The jury could have inferred under the circumstances that the after the fact payment effected the official act. If they had done that this Supreme Court decision would’ve had no effect on the outcome.
The government instead made the choice to prosecute this case by having the jury instructed that it did not matter what the defendant was thinking at the time of the official act. That was the government’s choice.
This case just means that when the government brings a case under 18 U.S.C. 666–which is titled “theft or bribery”—they actually have to prove bribery, which requires corrupt motive at the time of the official act.
If the government wants to target the appearance of impropriety that can result from payments for official acts that weren’t corrupt at the time, there’s different laws for that (18 U.S.C. 201(c)).
> Out of the most recent 6 decisions
That is not a representative sample of Supreme Court decisions. This is one of the last few opinion days of the year, the opinions being released are the most contentious ones the court is dealing with.
Of the first 6 decisions of the year, 4 were unanimous, 1 was per curiam, and one was a 6-3 split with the dissenters being Gorsuch, Sotomayor and Jackson.
Those 6 decisions would also not be a representative sample.
Politicization and ideological polarization are two different things. Take Dobbs for example. That was an ideologically polarized decision, not a political one. Roe is the product of a judicial philosophy that conservatives think is fundamentally wrong, even if they don't oppose abortion. For half a century, conservatives were unified in saying they would overturn Roe, even though--as we have seen subsequently--there was a lot of intra-party conflict about what abortion law should actually be. Dobbs hurt the party that appointed the justices that voted for it. Trump would probably be cruising to the election in 2024 if Biden didn't have that card to play.
Most of the cases you identify split along ideological rather than political lines.
We had a decision on the SEC vacating some of its enforcement powers, 6-3 with only the 3 liberal justices dissenting.
What the case actually held was that the executive branch imposing fines without a court order violated the Seventh Amendment. It's a separation of powers case, and reflects the same ideological debate about separation of powers that we have had for 100 years. Do you believe that the Constitutional three-branch structure should be respected, or is it obsolete in light of modern society?
We had a 5-4 decision vacating an EPA regulation, with the 3 liberal justices and one of the more moderate conservative justices dissenting.
This is an executive agency decisionmaking case. Again, same debate we've been having for 100 years.
We had a 6-3 decision on the EMTALA-abortion decision, with the 3 most conservative justices dissenting.
This was probably the most idiosyncratic and ideological case, but it's not political at all. It's Thomas and Alito willing to die on an ideological hill, not caring that virtually nobody in their party wants to follow them t here.
Yesterday, we also had a decision on bribery which was 6-3, with the 3 liberal justices dissenting.
It was actually a decision on whether someone could be prosecuted under a bribery statute for a payment he received after taking the official act. Where other parts of federal criminal law make an express distinction between bribery (which corrupt official acts) and gratuities (which create the appearance of corruption but can't directly influence official acts).
This one is probably the most overtly political. Liberals voting to expand the scope of criminal law and conservatives voting to narrow it is weird. But it's worth pointing out that the Court's conservative wing has a strong libertarian streak these days, especially Gorsuch.
I guess this is not a topic that is politically divisive, so the judges were free to vote as they saw fit. Which doesn't say anything about how they will vote on other topics, like abortion, environmental protection etc.
The justices don't vote on "abortion, environmental protection, etc." They vote on the legal vehicles that have been used to address those things. And views on those legal vehicles map onto judicial philosophies that have nothing to do with the substantive issues.
To use an analogy: there's people who think operating systems should be microkernels, and people who think they should be monolithic kernels. Windows NT was created to be a microkernel. But around NT 4.0 they shoved the GUI into the kernel space. If you're on the "Supreme Court of Windows NT," how do you view that? One camp might say, "NT is supposed to be a microkernel, get that GUI out of there." Another might say, "yeah but here in the real world, customers demand a fast GUI so it's fine to cut corners."
Constitutional law is basically that, except we're talking about cutting corners with the highest law in the land.
Hmmm, I’m not sure pointing to singular rulings like this really demonstrates that the Supreme Court isn’t getting increasingly political.
Increasingly political compared to when?
And I don't think it's a singular judgement. If anything, the "ideological split" types of decisions are rarer, so it's more accurate to say that a few decisions on hot political topics doesn't mean that the SCOTUS is increasingly political.
For those claiming the Supreme Court is a political institution, I'd like to note that this was indeed a 5-4 decision.
Is there a name for this type of fallacy, in which a single data point is used to argue that a global trend does not exist? (Another prominent example is "it snowed somewhere, therefore climate change is not real.")
Is there a name for this type of fallacy
It's a type of non-sequitur, i.e. a formal fallacy. General conclusions can't be drawn from a single datapoint.
I won't argue against the Supreme Court being a political institution. However, I do think the court is more nuanced than popular opinion realizes. The article below shows a nice graphic of how often justices rule together on non-unanimous decisions.
https://www.politico.com/news/magazine/2024/06/02/supreme-co...
A single vote means little and being partisan doesn't mean 0% voting with the other side. By this logic Congress is not a partisan institution given that people from both sides frequently vote together, but anyone who remotely follows national politics knows that it's a deeply partisan time.
Being a judge in the US is a political job. There's not even a universal requirement that one has to be a lawyer.
However, "political" how liberals are using it currently is a euphemism for "current disputes between the Democrat and Republican party management." If you don't accept that framing, or assume that these people are wind-up toys set into motion by the Presidents that appointed them, things can be very political without this split that the punditocracy project onto the court.
Whether bankruptcy courts can dictate a settlement for something this wide-reaching, and simply indemnify someone against future lawsuits is a very political question. What if the courts had settled with the Sacklers for $10, and indemnified them against future suits? Why are the bankruptcy courts allowed to improvise restrictions against what other courts and other victims are allowed to do?
It's redolent of one of the most disturbing elements of Epstein's first conviction, during which they immunized unidentified, unindicted co-conspirators. In order to avail yourself of this immunity, you had to be guilty of child trafficking with Epstein. Otherwise, you wouldn't have been a co-conspirator. Can a court name a sacrifice to suffer for others?
I'm not concerned in this case that some of the victims' lawyers were clamoring for it. Those lawyers could very well be paid for by people with another agenda. Why should the Sacklers be left with anything? The main guilty parties in their family are dead - now we're arguing with the people who are inheriting the proceeds of the crime. Why argue? Just seize it all; the damage far outstrips their worth, and their worth isn't even from their own labor, it's inherited.
Meanwhile, the descendants of slaves are mocked over 400 years of stolen wealth. And we can't even take the proceeds of the most horrific crimes from people who don't even work for a living, and will likely be left wealthy if every dime of that inheritance is taken away.
Most decisions are mixed or more one sided than following the standard "political lines", but those cases never get spoken about.
This is the only reasonable outcome... you can't deny some people justice just because other people think it's fine.
The sacklers have done immeasurable damage to the country. All of their wealth should be removed. Their foundation should be dismantled and used to fund damage and mental health services for addicts of the opioid crisis that they went on to create.
And perhaps some of the individual pushers/purveyors of the drugs, too.
The Sacklers were absolved of financial liability, not criminal. A DA that thought there was a strong enough case could have brought charges this whole time irrespective of the settlement agreement.
Their foundation should be dismantled and used to fund damage and mental health services for addicts of the opioid crisis that they went on to create.
Part of the settlement agreement was that they were going to turn Purdue into a treatment organization. But right now it's back to the drawing board and plaintiffs will have to pursue separate and much harder cases to get reparations directly from all the individual members of the Sackler family.
Last time I looked into things, the fines they were going to pay is a tiny slap on the wrist compared to the obscene money they made. They can put the billions in an account and use just some of the interest for the fines. The biggest hit to them so far was having their name removed from some museums. Let that sink in. They've lost some slight prestige with other wealthy folks.
They took in something like $11 billion and were going to fund something like $6 billion.
As far as purely pragmatic solutions go this was not a bad deal for victims. There are a lot of members of the Sackler family and a lot of them have a lot of money despite personally not being connected to the Purdue business in any way.
Even if they could all be connected to wrongdoing actually getting money from, like, the second step-grand-nephew who lives in Copenhagen is going to be really, really hard.
$6 billion dollars is a lot of money, but it's also just half of what they profited from what was effectively mass murder. Is that really something you want to let people buy their way out of for less than they profited?
Think of it this way - if you found out your great-grand-uncle was a Nazi official, and that the house you grew up in or the favorable college you got into or whatever lifestyle you had growing up was initially partly funded by his misdeeds? Could your assets be targeted by descendants of the victims and you personally be made bankrupt?
That's a bit of an exaggeration, but a lot of the wealth of the Sackler family is distributed this way. The original brothers have died, there is a huge lump of easily gotten money from the direct family, and then there is a lot of money that has been spread around 2 or 3 generations removed. At a certain point if you want the full $11 billion you are going to have to go into the weeds.
I don't think "partly funded by his misdeeds" is an accurate description.
Members of the Sackler family ran Perdue Pharma and they aren't dead. Sure, a relative of the Perdue Pharma executives should be off limit for liability. But there's still plenty of actual executives that should be held accountable.
and that the house you grew up in or the favorable college you got into or whatever lifestyle you had growing up
Are we talking about wealth I inherited? About wealth I wrongfully inherited from the wrung necks of the dead? When in this framing do we start to consider where that money should have been vs where it is now? I presumably in this scenario did nothing wrong personally, and yet what wealth do I _deserve_? Do I _deserve_ this wealth extracted by mass destruction enacted by my relatives, granted not by myself, but that someone else would otherwise have?
645,000 people died due to opiate abuse while their company was promoting opiates, and their prescriptions peaked at 6.2 million prescription users pee year. Under EPA standards for damages they would be liable for trillions.
The Sacklers were absolved of financial liability, not criminal
I don't understand how this changes anything; why would it make any more sense for the subset of the victims who settled to absolve the Sacklers of financial liability towards to the victims who didn't settle? The type of liability doesn't change the fact that victims not part of the settlement shouldn't be restricted by the terms of it; being able to push their own case separately is the entire reason why people are allowed to opt out of class action settlements.
As the dissent pointed out, getting voluntary concessions from parties is generally considered a good outcome in bankruptcy court and part of the reason it exists in the first place. Any time you can take a million lawsuits and turn it into one saves a lot of legal fees for everyone and frees up our court system.
Another thing the dissent pointed out is that anyone who doesn't participate in the group settlement is only going to get the money first-come/first-serve. In bankruptcy court you can split the money more or less evenly. If everyone litigates separately, only the people with more senior claims get their money before the funds run out.
Agreed, they should be made an example of. Everyone involved in the fraud of getting this medication approved and then marketed to millions of people should face a fair trial and should be made an example of if found guilty. There is no reason that this medication should have been approved or marketed the way it was, especially considering what the medical community already knew about opioids and the harm they can cause.
Considering the three strikes rule and other extremely punitive judgement against drug offenders, how are the sacklers still not in solitary?
The immunity deal on the table here was for civil litigation, not criminal trials. The Sackler family can still declare bankruptcy on their own, they just can't use the bankruptcy of their company to extend protection to themselves- which does make sense. But nothing that was proposed would have shielded them from criminal prosecution.
Yes, although in theory the justices are ruling on what the law means, rather than ruling on what they think it should mean for justice to be served.
More narrowly, a judge can’t impose an outcome or settlement on someone where the law does not allow for it.
The court on a 5-4 vote ruled that the bankruptcy court did not have the authority to release the Sackler family members from legal claims made by opioid victims. As part of the deal, the family, which controlled the company, had agreed to pay $6 billion that could be used to settle opioid-related claims, but only in return for a complete release from any liability in future cases.
Is this actually a positive outcome or a kick-the-can?
Positive outcome. They earned hundreds of billions from their actions which resulted in the deaths of thousands.
Giving them permanent immunity was insane.
deaths of thousands is a massive understatement. Just overdose deaths is probably getting close to a million. But they are also responsible for:
The people who don't OD but have their lives destroyed by opiods.
The family and friends who suffer because someone they know is an addict.
The time, money and energy society has spent trying to help addicts.
All the crimes, victims of crime and criminal justice costs that are a result of addiction.
They didn't kill thousands of people, they killed millions, affected every single person in the country negatively and contributed to the destabilization of our society.
Justices Brett Kavanaugh, Ketanji Brown Jackson, Elena Kagan and Sonia Sotomayor dissented.
resulted in the deaths of thousands.
The number the Supreme Court used in its decision was 247,000 deaths over a twenty year period. That's the verified number and therefore almost certainly lower than reality.
US$ 6bi to be disbursed across hundreds of local governments to use for settlements over millions of individuals is nothing compared to the damage the Sacklers inflicted. On top of that having a sweet deal to never see any future liability case is an egregious misjustice.
The minimum would be for them to be arrested, if we pushed drugs to someone who eventually dies from it we wouldn't be getting just a fine. At the scale they did it's simply inconceivable to me that paying a fine which is less than their profit is anywhere close to justice.
It really depends on what you mean by "pushed drugs". If you or I recommended that someone should get an oxycodone prescription from their doctor, and they eventually died after getting that prescription, I don't think we'd get arrested or fined. (And the Sacklers were never getting criminal immunity in the first place.)
That doesn’t describe what happened.
It depends on what your personal views are here.
If you wanted the outcome of the case to be at least some money going towards opioid treatment, then this decision could jeopardize that outcome.
However, if you thought that the Sackler family being able to escape any personal liability despite the myriad of evidence of many of their involvement in stoking the opioid epidemic— and they still got to keep a very sizeable amount of the family fortune— is morally repugnant and legally dubious, then this court decision is a positive.
I would personally prefer many of the executives and members of the Sackler family to be held liable, their assets seized, and formal charges brought against them. But that’s unlikely
I wouldn't be opposed to similar outcomes as the Chinese baby milk scandal in the end.
From Wikipedia:
A number of trials were conducted by the Chinese government resulting in two executions, three sentences of life imprisonment, two 15-year prison sentences, and the firing or forced resignation of seven local government officials and the Director of the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ). The former chairwoman of China's Sanlu dairy was sentenced to life in prison.
Yeah, that sounds nice :-)
Negative outcome. Some important points that the article here did not emphasize: 1) The Sackler family was not actually a party to this litigation. They came to the table (with most of the settlement money) specifically to get these so called '3rd party releases'. 2) Purdue is basically broke. It's also an LLC. Thus, in order to go after the Sackler family's money, you basically have to claw back money that Purdue paid out to the family over the years. It's not impossible to do, but it requires a whole more litigation, the outcome of which is not at all certain.
Now, 3rd party releases are a genuinely weird thing: a court ruling that a party that's not directly involved in the case is immune from future lawsuits. Partially the reason it went all the way to the supreme court is that there was a circuit split - they were allowed in some circuits, but not others. However, (and this is according to a friend who represented the victims in the settlement), it's really unfortunate that THIS is the case where they get struck down. If the Sacklers walk away from the settlement, it makes the victims getting their payout much less certain, and certainly delays that payout by many years.
My understanding is that Piercing the Corporate Veil has gotten easier over the years. The more egregious the robber baron class has gotten the less sympathetic the courts have been.
If you rob a bank and can pay the bank off with interest from the money you stole, was justice served?
If you sell drugs and use the interest from your profits to pay a fine, it doesn’t sound like punishment.
Part of the problem with this is that much of an old money wealth is from less than reputable sources (slavery, piracy, war, crime, smuggling, opium and alcohol).
How is there such a big divide in the court on this? Is the law really this unclear on the matter?
The opinion and dissent are actually relatively approachable and lay out exactly what the disagreement is about: https://www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf
It seems to come down to whether the sentence "[A chapter 11 bankruptcy plan may] include any other appropriate provision not inconsistent with the applicable provisions of this title" means "A plan can contain anything anyone can imagine as reasonable as long as it isn't expressly forbidden" or "A plan can contain other types of provisions that follow the same general theme as the concrete list given just before this sentence".
The Sacklers argued that the law says they can take away other peoples rights to sue them, since the law says these bankruptcy plans can include "anything", and the majority opinion of SCOTUS was that that's not the right way to read the law.
It also seems to turn whether the Sacklers seek a third-party “release,” which is precedented, or “discharge,” which is not. (The Court also assumes Purdue’s indemnification of the Sacklers will not hold, which would allow the Sacklers to drain Purdue as they fight the various claims against them.)
Interestingly, the argument for is textual. The argument against is pragmatic. (Both argue history, in my opinion, unconvincingly. They’re talking past each other on release vs discharge, a delineation neither side bothers to delve into.) The dividing line defies easy summary. (Gorsuch, Thomas, Alito, Barrett and Jackson concurring, Kavanaugh, Roberts, Sotomayor and Kagan dissenting.)
the argument for is textual
And here's the language: "any other appropriate provision"
The Sacklers: the law says we can take away other people's rights to sue us as part of a bankruptcy settlement.
SC: Yeah, no, the text doesn't say that.
the law says we can take away other people's rights to sue us as part of a bankruptcy settlement
As the dissent notes, third-party releases are part of the law. The turn is on whether the Sacklers are having third-party liabilities discharged versus released.
The solution may be in re-drafting the Plan so it’s more clearly a release. That might mean the Sacklers can be sued for fraud, but not other things.
If this decision was just about third-party releases, it wouldn't be before the court. And you know that.
If this decision was just about third-party releases, it wouldn't be before the court. And you know that.
What is the difference between a discharge and release as it relates to the §1123(b)(6) “any other appropriate provision” power this case is about? You seem to have clarity the Court’s members couldn’t find.
The argument for is a mixture of textualism and moral repugnance at the idea of letting the Sacklers keeping billions in profits they made from killing a quarter of a million people. I suspect the second part was strengthened to swing Jackson's vote and aside from her, it's a fairly standard split.
Bankruptcy is a unique creature. It's created directly in the Constitution as a federal system. Bankruptcy is inherently "equitable," which means that judicial decisions are guided by case-by-case considerations of fairness rather than strict legal rules. Bankruptcy courts have wide latitude and discretion to basically do what makes sense in each context.
Here, the majority overturned something the bankrutpcy code approved, because, in its view, the remedy of a non-consensual third-party release conflicted with the structure of the Bankruptcy Code. The dissent disagreed, pointing out there were no express prohibitions on the relief the bankruptcy court had granted, and explaining that, in their view, the bankruptcy court should have been given discretion to authorize such a release if ultimately it would make the creditors better off. Basically the majority was focused on the structure of the Code, while the dissent was focused on the practical fact that the creditors would probably get more money from the Sacklers this way than if they had pursued direct lawsuits against them.
the creditors
Thanks, that word helps clarify my major problem with handling this as a bankruptcy case. I don't see the destroyed lives as an issue of creditors, I see them as victims. Calling off the corporations coming after an individual for unpaid debt is a whole different issue than barring individuals from going after a corporation for actual injuries.
The law surrounding Chapter 11 reorganisation plans only covers the relationships and responsibilities between debtors and creditors. It doesn't say anything about third parties.
But it does include a term saying a plan "may" also "include any other appropriate provision not inconsistent with the applicable provisions of this title" - subject to the approval of a judge.
Applying the broadest possible interpretation of this catch-all wording would produce absurd results - a bankruptcy plan would be more powerful than the constitution itself. So courts have to figure out just how broad an interpretation to apply.
law surrounding Chapter 11 reorganisation plans only covers the relationships and responsibilities between debtors and creditors. It doesn't say anything about third parties
Yes it does. It covers third-party releases—there is ample precedent for that. The Court held this isn’t a release, but a discharge. (Idk.)
IANAL but most contested Supreme Court decisions I've read (going all the way back to AP gov class) sounded like they could have reasonably been decided either way depending on who had control over the court. The law is ambiguous and complex enough that there's just so many logical ways to approach a decision and little in the way of prioritizing or disambiguating them. Whatever their bias, judges have lots of ways of reasoning themselves to their predetermined outcome. This is true up and down the courts but most judges are at least somewhat worried about their reputation and their record with appeals courts, which at least mitigates their biases but the SCOTUS is free to do whatever it wants.
As much as each side likes to bloviate about originalism and activist judges, SCOTUS often decides at the whims of ideology and personal bias because the law gives them lots of room.
What really stuck out to me was how soft the opinions were. Especially the dissent. Rather than dry legal reasoning, it was argued much like a politician would. Maybe this happens fairly often, but usually when I read the actual decision from SCOTUS is is very specific and sober, even if I disagree with the conclusion.
I don't understand the hatred directed at the Sacklers. Oxycodone is, just like all other opiates, highly effective at suppressing pain, potentially addictive, and deadly in large enough doses. This has been common medical knowledge for millennia. Why do so many people believe that they are responsible for overdose deaths?
Exactly. It took the collaboration of many different people, all of which also profited from it, to bring about the opioid crisis.
The vendor who sells many different things seems to be at least a bit less culpable than the provider who sells just their thing while lying about certain effects of it. Yes, we can examine how we got into this situation where doctors take drug advice from the people who make the drugs but the people who lied for profit deserve the lion's share of the criticism.
In practice, even many of the general public knew that what the vendor was selling was addictive and dangerous -- there are some reports even in this thread. So it's hard for the vendor to claim ignorance, even more so when often they also stood to profit from the lie (repeat customers).
Because they marketed an opioid as an "extended release" form when they knew from their own internal studies that the pain relief only lasted the standard 6 hours instead of the 8 hours that were claimed. As a result, people would find themselves taking more to stay on top of their symptoms and the resulting ramp in use would leave people debilitated.
It was also pitched as abuse resistant (something about it being hard to grind up the pills), which they also knew to be untrue.
This provides a good overview of how Purdue accelerated opiate marketing: https://www.newyorker.com/news/news-desk/the-sackler-familys...
A recent study, by a team of economists from the Wharton School, Notre Dame, and rand, reviewed overdose statistics in five states where Purdue opted, because of local regulations, to concentrate fewer resources in promoting its drug. The scholars found that, in those states, overdose rates—even from heroin and fentanyl—are markedly lower than in states where Purdue did the full marketing push. The study concludes that “the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.”
This is a correlation study—I understand that increasing marketing efforts leads to an increase in physician prescription, but those overdose deaths were caused by a tiny fraction of patients refusing to follow the script as issued by their physicians. Whose fault is that?
How much of this issue have you investigated already?
It’s worth skimming through the Massachusetts AG complaint about their actions, and the strategies employed by Purdue (of which the Sacklers always held the majority of board seats)
https://www.reuters.com/investigates/special-report/assets/u...
Because they marketed it as a non-addictive opioid because it was extended release and encouraged doctors always to prescribe the maximum amount despite internal testing showing the extended release was bogus and it was still addictive?
because the way they encouraged doctors to push it to everyone, regardless if they needed it or not. they aggressively marketed and pushed the drug in situations that didnt call for it
It's especially tough for me because they clearly pushed their sketchy marketing and sales tactics because they honestly believed they were helping people, and in their lifetimes the medical industry lauded them as heroes for "safe" and affordable ways to ease suffering.
Right now people have no problem suppressing research they don't like about the negative effects of marijuana or anti-depressants or whatever their de jour personal treatment is - in 20 years if something bad really comes to light everyone is going to pretend that they knew all along and that everything was a smoking gun. Hindsight is 20/20 and history is written by the victors.
https://www.britannica.com/science/opioid
Although a different formulation of oxycodone, manufactured by Merck & Co., was removed from the market in 1990 because of a high risk of addiction, members of the Sackler family downplayed the dangers of OxyContin, deceiving doctors into thinking that it was weaker than morphine and convincing them to prescribe the drug liberally
There will be people like Sacklers until we start putting them away and throwing away the key. We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic.
"We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic."
And to that end, the USA must demonstrate that it's totalitarian and abuses people's rights?
I think the poster means those rich who have committed offences, but enjoy softer penalities thanks to their wealth.
Is rule of law totalitarian? Wealth is not be a get out of jail free card, and imprisonment is not inherently an abuse of rights. While the US prison industrial complex is vile and abusive, the cushy white collar prisons aren’t where those abuses are happening.
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
(squidbeak's reply is a nice example of following this guideline - https://news.ycombinator.com/item?id=40812196)
We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic.
... you do know that banana republics did this exact thing all of the time?
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
I suspect you misinterpreted what they said. We should be putting guilty people in jail, even if they're rich and powerful.
Unfortunately, this is no longer possible to a great extent.
"Purdue flourished under brothers Mortimer and Raymond Sackler, who died in 2010 and 2017, respectively."
I’m sure it was a lot more than just two people
Unfortunately, vermin like the Sacklers have access to top lawyers. The two founding brothers are dead, so you won't be able to put them away; they are already put away, permanently.
However, their despicable offspring managed to flee the country with their ill-gotten gains; good luck finding them now.
My biggest beef with this case has been that people should not be allowed to just "buy" themselves out of jail. The US does not have a concept of "blood money" in its legal code (at least, not yet anyways). This agreement amounted to blood money, practically. Blood money != justice.
Three brothers! The dynasty origin and eldest brother is Arthur Sackler.
We detached this from https://news.ycombinator.com/item?id=40811921.
It's best to avoid generic tangents in HN threads, especially generic flamewar tangents. They tend to make discussion more repetitive and therefore more tedious and eventually more nasty. This particular one has been repeated hundreds if not thousands of times in the past.
What share of the guild do the medical providers that prescribed the opioids to their patients have? There would be no opioid crisis if none were willing to do it.
Scott Alexander had a very interesting writeup about his experiences: https://slatestarcodex.com/2019/09/16/against-against-pseudo...
The US is the only place in the world AFAIK where you will get prescribed opioids for something as trivial as a wisdom tooth extraction (kind of like one of the cases cited). It is also the only place in the world AFAIK going through the opioid epidemic.
Every other country in the world has got the problem of painkillers figured out. So it can't be that complicated.
Wisdom teeth extraction is far from trivial and opioids are a very reasonable prescription for pain from that surgery.
Objectively, opioids are prescribed much less often outside the US.
Subjectively, I got four wisdom teeth extracted in two sessions of two extractions each. Both times I only needed generic acetaminophen to manage the pain.
Perhaps an US surgeon have insisted on doing it all in one session, in which case I would have found the pain and discomfort intolerable and opioids would have made more sense.
In any case, they should probably figure out why their patients are in more pain than the patients of foreign surgeons and fix that. It could be something silly like them being less gentle during surgery because they are used to their patients being on opioids.
Literally does not happen in two countries that I know of, and I bet in many countries of the world (developed ones even).
Wisdom teeth was actually one of the safer use cases. You would only get a short run so it was hard to build dependance.
The opioid crisis was really defined by people with chronic long-term pain being given it for years at a time.
The point is that people are overall too cavalier about opioids in the US.
I don't think it's necessary to get into the details of how much pain is enough pain, how acute is acute enough, etc... because this is not a problem essentially anywhere else in the world -- and not because they thought really hard about it.
I just read it (because of your link), and commend it to other people in this thread; quite a well-described and interesting position.
I changed the URL from https://arstechnica.com/science/2024/06/opioid-settlement-to... to an article that has more information and a less baity title. If there's a better (more accurate and neutral) article, we can change it again.
Seems impossible to read Washington Post articles without opening them in incognito mode.
I know that's annoying but it's allowed ("paywalls with workarounds" has been the rule for a long time on HN - see https://news.ycombinator.com/item?id=10178989, https://news.ycombinator.com/newsfaq.html). Not that we like the annoyances any more than anyone else does, but it's the lesser of two evils.
But we can change the URL if there's a better one.
i vote link to the ruling itself
I almost agree but I think probably the best place for that is as a link in the comments, with the best accessible third-party report at the top.
I don't know what the best accessible third-party report is though...
Thanks Dang!
It’s pretty wild that everyone acknowledges that the Sacklers engaged in a “milking program” going from 15% to 70% distributions after the first lawsuits in order to strip the company of assets and then hide behind the company to shield liability. This alone should allow claimants to pierce the corporate veil and go after the family directly.
allow claimants to pierce the corporate veil and go after the family directly.
This decision is a win both for that cause, and also forestalling precedent that would allow future wrongdoing corporations from 'shielding the veil' so to speak through bankruptcy. A win-win indeed.
At least initially, I'm glad to see this verdict if it means such behavior can't hide behind the corporate veil. However, it's important to acknowledge it's not necessarily a win-win-win. By reading Justice Kavanaugh's dissenting opinion, this decision seems to delay opioid victims the settlement they previously won.
"As a result, opioid victims are now deprived of the substantial monetary recovery that they long fought for and finally secured after years of litigation...virtually all of the opioid victims and creditors in this case fervently support approval of Purdue’s bankruptcy reorganization plan."
Time will tell if this ruling gives enough preventative pressure to future cases to make it worth the additional pain to the present claimants.
But now that the ruling potentially exposes the Sacklers directly, they have much more incentive to negotiate a new settlement. If the plaintiff's attorneys are clever, they will leverage this to come to a quick settlement of approximately the same amount, with the threat that delays will bring demands for higher amounts.
The Sacklers want to have their cake and eat it. They want both:
- To avoid filing for bankruptcy, and
- For a bankruptcy settlement to release them from additional liability.
And they'll get it - they stashed a lot of their gains overseas, and they'll keep those gains while continuing to live a lavish life amongst the elites of the world.
I lost a very close friend to opoid addiction, and Purdue was based one town over from where I grew up. I hope the entire Sackler family gets fined and taxed to the point of genuine destitute poverty, and then some. Genuine scum.
I think this is where the settlement went wrong. The Sacklers were going to remain billionaires after the $6B payout. In all real respects they were going to feel no pain. They already have way more money than any of them could hope to spend in their remaining years, and that really rubbed people the wrong way. With the immunity removed they will at least spend some of their retirement in court room after court room instead of sipping drinks on the deck of one of their many megayachts.
It sucks for the victims who are realistically not going to get any help before they die, but it does send a message that you can't kill thousands (probably millions) and get off scot free.
Are you talking about the Sacklers as individuals, a family unit, or in their capacity as decision-makers for Purdue? There seem to be a relatively complex set of incentives and options in each of these capacities.
Interestingly the same kinds of tactics used to push opiates on the general public are still being used to push amphetamine analogs - but the death rate from amphetamine addiction/overdose is much much lower (>1000X lower) than that from opiate addiction/overdose so it doesn't really hit the headlines, and arguably is not as much of a concern.
From a libertarian point of view, mood- and mind-altering substance use should be the citizen's choice, but for this to not result in an epidemic of addiction, it would require a well-educated public who understands that whatever short-term apparent benefit a drug (including alcohol and nicotine and caffeine) delivers, there's always a tax that must be paid afterwards, and use must be kept below the addictive threshold, meaning if you start needing more of the drug to get the same effect, the only rational thing to do is to stop using the drug until your tolerance goes back to zero.
This of couse goes against consumer society norms, where the concept of 'less is more' is almost a heresy.
I guess I'm not sure what the point of the comparison is. If the death rate from opioid addiction were 1000x lower, I would happily bite the bullet and say Purdue did nothing wrong. Chronic pain is real and terrible - it would be great to have a solution where the downside risk is no worse than an Adderall dependency.
In my experience, people who use amphetamines (and cocaine) regularly start making very bad decisions, and heavy use leads to amphetamine psychosis. A very public example of this was the behavior of the SBF / FTX / Alameda operation, where by several accounts regular amphetamine use was the norm. That doesn't mean it should be illegal, but I'd avoid associating with anyone I knew had an amphetamine or cocaine dependency.
Difference is the death rate from prescription ADHD meds is zero, and they’re not addictive like opiates.
I’m open to discussing the underlying problems that push people to take ADHD meds. Like the insane work life required to just maintain the same standard of lives as our parents generation, or modern devices eating our attention spans.
But limiting access to ADHD drugs is just going to affect the most vulnerable and the positive outcome is just for the benefit of Calvinist pushing their world view on the rest of us. Hey, while we’re at it let’s make caffeine a scheduled drug. It’s actually addicting, it’s long we half-life makes it more likely to effect sleep, and its vastly over consumed by everyone starting in middle school.
Matt Levine at Bloomberg gives an excellent explanation of what happened, the ruling, why etc without telling you what you should think is the right thing or right outcome.
His explanations from first principles covering ground you already know are just excellent. Worthwhile reading for anyone who has to explain detailed, complex & technical subject matter.
https://www.bloomberg.com/opinion/articles/2024-06-27/purdue...
The truly awesome thing about Matt Levine is how in complicated situations like this he doesn't try to pick the "right" side but instead leans in to how both sides have good points of view. In today's newsletter he quotes the majority opinion and says it's reasonable, and then quotes the contradicting dissent and says that's reasonable too. And they both are! A really difficult case with really difficult trade offs.
As a layman, I find the dissenting opinion strange -- for a judge. Sure it might be more pragmatic and beneficial for the victims of this particular case to take the deal. But a supreme court can't possibly cover all cases, so IMHO it must deal with the law on a higher more principled level. The argument that the bankruptcy court did ok in this case and should be allowed to do this in general is iffy because it fails to take into account various realities of life, e.g. corruption. Limitless authority is for me not a good idea, and I think the decision of the majority makes more sense.
A bankruptcy court’s powers are not limitless and do not endow it with the power to extinguish without their consent claims held by nondebtors (here, the opioid victims) against other nondebtors (here, the Sacklers).
But again, this is my regular Joe view on the matter. And it's true that the majority of victims in this case might be in the end worse off, but the decisions of a supreme court are relevant for a long long time.
Justices Kavanaugh, Sotomayor, Kagan, and Roberts disagreed
Fascinating split
Strong language, too, against the majority that includes Jackson ("Brown Jackson"?).
Without proper context, it’s not clear to me if this is good or bad. It bad for the victims because there’s no settlement. It’s good for justice as people with a ton of money shouldn’t be above the law.
It’s good if you think judges should follow the law more or less as written by congress. The whole concept of a 3rd party release in bankruptcy is simply not in the law. Congress could add it, but they have not.
The wild part is how the justices were split: Gorsuch wrote for the majority, joined by Thomas, Alito, Barrett and Jackson. You won't often see these 5 seeing eye to eye in a split decision.
This ruling breaks my usual test that the conservative majority will nearly always side with corporate intersts because this decision definitely isn't pro-corporate.
The settlement would essentially shield the Sacklers from all liability and allow them to keep the proceeds of their crimes while paying a fine over a long period of time essentially from future earnings on thse ill-gotten gains.
The dissent seemed to say this was bad for 100,000 opioid victims. That's not a reason to legally shield the crooks who profited from their death and suffering. I'm shocked that Kagan and Sotomayor, in particular, went for that line of reasoning.
In a just world, the Sacklers would die pennieless in a 6x8 cell. Fines are just the cost of doing business. Intentionally addicting hundreds of thousands (if not millions) to opioids for profit, knowingly, should lead the loss to both your freedom and every dollar you earned from that endeavour.
European here: the fact that "you guys" even know who your judges are, is amazing.
Thank you. For my purpose as a reader it is editorial incompetence that the article neither provided that link, nor the name of the case to make it easy to lookup.
This is my gripe with regular news. Science paper? No link. New law bill? No link. Someone made an hour-long speech? 30 second cut, no link to the full speech. Is it almost as if they'd rather we didn't see their sources?
Discussed here: https://news.ycombinator.com/item?id=40810767
(we merged that thread hither)
I blame the doctors too. I was a teen in the early/mid 2000s and even I knew about the addictiveness of oxycodone. It wasn't called hillbilly heroin for nothing.
Court skipped an opportunity to quote Franklin, since "Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety" actually referred to a legislature entertaining a very similar Faustian bargain (i.e. value now in exchange for perpetual promise to remove responsibility from a family).
... but probably the correct choice, as that was a legislative, not judicial, circumstance and their decision in the time has no bearing on jurisprudence.
Seems like the justices missed a great opportunity here to rule in favor of the settlement and then receive $$$$$$ next year as a thank you gift.
Because buying government officials is now entirely legal.
https://www.scotusblog.com/2024/06/supreme-court-limits-scop...
Did the Sacklers forget to renew their subscription to Clarence Thomas or something?
Fraudulent Transfer...
From Reddit...
Piercing the corporate veil would mean disregarding the corporate form entirely. It usually comes up when the owner-manager of a company fails to distinguish the corporation as a separate entity with its own purpose and finances, using the company as a personal piggie bank or otherwise going about life as usual and not going through the motions required of corporations under the law.
What plaintiffs have alleged against the Sacklers is different, and specific to bankruptcy. Perdue is out of money and is bankrupt, mostly because it caused billions of dollars of damages to hundreds of thousands of people and to the states (which now have to clean up the opioid mess). But not that long before it went bankrupt, it was swimming in money. Perdue didn't use those profits to avoid harming people. Nor did it keep the money on hand to pay potential tort claims from the people it was harming. Instead, Perdue's officers and board of directors (that is, the Sacklers) approved dividends of billions of dollars to be paid to the company's shareholders (that is, again, the Sacklers).
The plaintiffs in various lawsuits have alleged that the Sacklers knew that the profits were temporary and the bill would come due, so they purposefully got the money out of the company while the getting was good. More technically: it is alleged that Perdue's owners received assets that were transferred from Purdue with actual intent to hinder, delay, or defraud creditors.
One thing you absolutely are not allowed to do is use your company to rack up a bunch of debt or liability, take all the assets out of the company, and then declare bankruptcy and expect to get to keep the money. We call that "fraudulent transfer," and if a court finds that you did fraudulent transfers from your company to your personal bank account you will be ordered to pay that money back to the company (so it can use that money to pay back its creditors and other claimants). The company still exists, it's a distinct legal person (so not technically piercing the veil), you just took the company's money as if it were a profit when you knew full well the company couldn't afford to pay out profits.
One big difference between the concepts is this: If Perdue's corporate veil were pierced, the Sacklers would be personally on the hook for all the harm their company caused -- they could lose their bank accounts, vacation homes, nice cars, artwork, everything, as if they themselves (rather than "Perdue") had been the ones going around knowingly fueling a drug addiction crisis. Whereas if they merely engaged in fraulent transfer of assets, the Sacklers are only on the hook to give back what they fraudulently took from the company during the period it can be proven that they knew of the looming liability -- limited to the statute of limitations, which I think is around 6 years. So all the money they made before that, and all the money they have from non-fraudulent sources, is safe from creditors.
Link to ruling:
nice
I’d argue it’s the opposite.
Look at what’s happened since Oxycontin was heavily regulated.
Opioid deaths in America have exploded by an order of magnitude.
There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S.
The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was).
But it’s quite clear that America had a parallel opioid crisis going on. By making OxyContin easily available, ie, a slow acting opioid (it had to be crushed to be fast acting) that was produced legitimately and had a legitimate supply chain so people were able to get exactly what they wanted, Purdue Pharma helped keep the number of opioid deaths under control.
IOW, the U.S. has had an addiction crisis that is independent of prescription drugs whose cause is not clear yet because everyone has thrown the blame on Oxy instead of researching it. This is the same kind of drug crisis that hit inner cities in the 20th century but has hit rural areas in the 21st century. By providing easy access to regulated and legitimate opioids the Sacklers may have marginally worsened the addiction crisis, but they minimized the number of deaths and severe negative impacts.
The moment Oxy and the other opioids were made less easy to get, the underlying drug crisis hadn’t gone anywhere, so instead the people suffering from the crisis had to get their opioids from illicit sources as opposed to the pharmacy, exposing them to all sorts of unregulated drugs that had all sorts of nonsense like Fenranyl mixed in, which causes the actual negative impacts of the drug crisis to explode.
The funny thing is that when the entire country was just absolutely united at making the Sacklers the big bad evil, the actual people working on the ground trying to help those who were facing this drug crisis were predicting this exact situation and were asking authorities to not clamp down on Oxy. But they were all ignored and so we have a situation where opioid OD deaths have gone from a consistent 10-15,000/year (a rate which preceded Oxy) to about 50,000/yr now.
I don’t think that’s really the case. What happened here was that peddling oxy, created the excess demand that is now met by illicit sources that cause more deaths now that oxy is regulated. But what you’re missing in your understanding is that without oxy, demand wouldn’t exist in the first place. And that’s the harm everyone is talking about.
You’re talking about the aftermath of the problem. Parent is talking about the root cause.
You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
Now, in addition to dealing with pain every day, I also have to “prove” that I’m not an opioid seeker if I end up in the ER for overwhelming pain. Because saying that you’re hurting is clearly a sign that you’re actually an addict trying to get a fix.
This might sound cold-hearted, but as someone who deals with chronic pain I’m fine with some street ODs in exchange for people who are in pain being cared for. Now we just torture patients by doing nothing.
Recreational drugs are a choice. My pain was not. Why we punished for others’ bad choices?
You can directly count the total amount prescribed opioids through time and adjust for potency.
Purdue Pharma didn’t just manufacture a drug. They did a great deal of behind the scenes manipulating so even people who did not seek out severe pain medication were prescribed extremely high doses.
In terms of long term pain management opioids suck. People need increasing doses over time until the drugs side effects become toxic. Not such a problem in hospice or someone in an ambulance after a major accident, but handing them to people with chronic conditions guarantees a downward spiral. Perdue Pharma knew this, strait up lied about it, and even pleaded guilty to mislabeling OxyContin.
This... Dr were involved too!
Opioids suck. And the medical profession was complicit. For a class that is supposed to be professional and well informed most Dr's are, shockingly, not that bright.
The actions of individual Doctors acting on their own simply don’t explain trends.
Doctors and the FDA etc were straight up lied to. I don’t think it’s reasonable to hold Doctors accountable for when some pharmaceutical company commits fraud. That doesn’t mean every doctor was blameless, but individual Doctors have always behaved poorly it was true before the opioid epidemic and it’s still true today.
Oh please.
Doctors, did not believe the preponderance of evidence that ulcers were caused by bacteria. The reason, the person who discovered it was a vet.
They had to give the man a Nobel Prize to get Dr's to pry their heads out of their self aggrandizing asses and pay attention to reality.
Opioids were addictive. They never stoped being that. Dr's were fiscally motivated to prescribe. Nothing more nothing less.
You’re wildly incorrect, nobody involved was a vet.
Barry Marshall shared that Nobel and is a Doctor. https://en.wikipedia.org/wiki/Barry_Marshall
Robin Warren received his M.B.B.S. an undergraduate degree focused on medical research. https://en.wikipedia.org/wiki/Robin_Warren He worked at: “SA Pathology, (formerly the Institute of Medical and Veterinary Science (IMVS)), is an organisation providing diagnostic and clinical pathology services throughout South Australia for the public health sector.” https://en.wikipedia.org/wiki/SA_Pathology
So whatever source you read that misinformation from is not trustworthy.
Hindsight bias here. We don’t want medical professionals to discard new information in favor of older treatments. There’s no way doctors can on their own replicate the medical research linking Ulcers with a bacterial infection and independently judge oxycodone’s effectiveness, and a dozen other drugs etc. Extended-release (ER) oxycodone was literally a new drug and described as not having the same issues associated with other Opioids on labeling approved by the FDA.
The crazy thing is how effective this all was. Medical schools were teaching students to hand out more opioids.
Chinese emporers were controlling opiates all the way back in the 1700s and the British were tied up in war for 20 years over the wreckage to the Chinese addicts.
The doctors, all college educated, some of our most studied and intelligent citizens, they knew about the history of opiates and im not talking about the dare campaign. I knew before the epidemic even got into force when I tossed the opiates I was prescribed in the trashcan.
The oxy marketing was just the wink and the nod everybody needed to convince themselves to parrot with a straight face, but they didn't actually really believe it.
This wasn’t just marketing, this was drug labeling approved by the FDA and new guidelines for pain management they where teaching in med schools.
It's a valid point. Another valid point is at that time it was known the FDA had a history of approving addictive drugs. It is not evidence based to trust FDA over hundreds of years of history countering otherwise. I knew LOTS of people who turned down or tossed opiate scripts during that time because the long history was obvious to anyone with half a brain.
Yep, many people knew all along. Many didn't know, but doctors of all people had no excuse to be among the not knowers.
“Tied up in a war” is a funny way to say “aggressively breaking Chinese law in order to hook local populations, make tons of drug money, and collapse public order.”
The Opium Wars were a cynical prototype for the modern war on drugs, which was initiated with similar designs and outcomes.
Doctors also refused to believe the germ theory of disease because it would imply they were all incompetent before then. Lots and lots of people died from infections transmitted by unwashed hands.
Even the chronic pain patients should not have had the amounts prescribed to them that they were. Doctors were incentivized to give as much as possible. Creating addicts in people who may otherwise would not have been.
I personally knew people getting more than a cancer patient should’ve been given for day to day chronic pain.
I’m sorry if you were personally affected by regulation but that doesn’t mean they didn’t cause the crisis.
When I was a teenager I had my wisdom teeth removed and was prescribed Oxy. My mother was smart enough to not fill that prescription and gave me some ibuprofen instead. I was fine, the OTC painkillers were completely adaquate. Taking that Oxy would have been totally unnecessary and potentially life ruining.
I don’t think you know the full history of how Purdue operated. They did two things: downplay how addictive oxy was & aggressively push oxy through doctors by providing kickbacks.
Chronic pain patients were actually a much smaller portion of the eventual victims. In a lot of cases, normal people would be prescribed oxy after minor procedures and they would get hooked on it and become permanent addicts. Once hooked, doctors would continue prescribing it for far longer and create a perpetual dependency. If the true effects of oxy were made public (which were known by Purdue pharma and Sackler family), oxy would’ve been prescribed with a lot more caution. And prescription of oxy for minor pain would’ve been non existent since a lot of safer alternatives existed.
I’m sorry you have a chronic condition, but not everyone who got hooked onto oxy had chronic conditions, and nor were they junkies.
To the GPs point, the cause of the regulation was the abuse of the sale. Many deaths were caused by aggressively selling oxy to folks who weren’t managing pain.
The fallout has resulted into harm with people that have a legitimate need for pain management.
Both can be true. The Sacklers are the culprits any way you slice it.
Do remember that some of them were acute pain patients, who were supposed to be on oxy for a limited amount of time but got hooked.
When a pain patient becomes an addict, their demand tends to be in excess of their prescription. I don't think anything you're saying is a reasonable response to the comment you're responding to.
Sure, OxyContin is better than Fentanyl, and banning Oxy can push people to way more dangerous opioids. But before painting Purdue as a hero of the people, let’s remember that million of people were pushed to opioids through Oxy when they shouldn’t have in the first place. Purdue played a big part in creating the epidemic in the first place. People that are now pushed to harder drugs because of an addiction they got into for the sake of Purdue making more dough.
It's the same shit practically all the way back to opium wars.
Always the drug dealers fault.
I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that. What the doc said was just what they needed to hear to lie to themselves, but this is taught in every highschool.
As a reminder, Oxy was heavily marketed, (to doctors!) as a "not bad" opioid. As in, not as addictive, not as problematic, and something that can be prescribed more easily and with less worries.
If a doctor comes up and tell you "don't worry about this one, it isn't addictive like the others", and you are in a ton of pain at the time, you are going to thank modern medicine for its new miracle pain drug and accept the prescription.
And as another reminder, most schools, until recently, just taught that "drugs are bad" and kind of left it at that. They exaggerated some of the down sides, and didn't mention any of the positive experiences.
IMHO South Park actually did the world's best anti pot ad -
"Well, Stan, the truth is marijuana probably isn't gonna make you kill people, and it most likely isn't gonna fund terrorism, but… well, son, pot makes you feel fine with being bored. And it's when you're bored that you should be learning some new skill or discovering some new science or being creative. If you smoke pot you may grow up to find out that you aren't good at anything."
-
And IMHO messages like that are more useful than what kids are being told.
There is also the social contract side of things - Since around 1950s, if people worked hard they things in return from society: A stable job, a house, the opportunity to raise a family. That social contract is shot to shit, and so it should be no surprise that more and more people are choosing to drop out of society via drugs/games/apathy.
You didn't learn about the opium wars? I'm not talking about dare which was obvious bullshit, I'm talking of learning from history. There was no weed war, that a drug caused a couple wars lasting decades should at least raise an eyebrow of any thinking person.
I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society. It's not as if US high schoolers get a comprehensive education in world history except for a few select omissions. I agree with you that this is something they ought to be aware of but I think you've kinda stretched the causality here.
Just learning about all the countries the British messed up would take at least another 5 or 6 years on top of whatever schooling is already done.
If you wanted to add everything America has done, well, people wouldn't be graduating high school until they are in their 30s.
We did learn about the Anglo-Zulu War and the East India Company, but a decision has to be made on what list of British atrocities to include in a history curriculum.
What lesson should the opium wars have taught that's applicable to oxy prescription?
We didn't study the Opium Wars in history at all throughout my education, I learned about those on my own thanks to the Internet. The entire Middle East, our influence in South America, etc, none of that was covered in school, and I went to some pretty good public schools. (E.g. in High School we edited DNA of Bacteria)
For that matter, I think China was only mentioned in passing throughout my entire education. WW1 was also only mentioned very briefly (maybe a couple weeks? Archduke is shot, shit goes down) and then we spent a fair bit of time on WW2, but less than we spent on Ancient Egypt honestly. (I think we spent an entire 2 or 3 months on Ancient Egypt).
We spent a fair amount of time on the Reformation and Renaissance, ancient Greece and Rome, and US history was mostly a ~bullshit~ censored history of the founding of the US. The Washington State history classes went into some history of the local tribes, but failed to mention any of the fun details about how Seattle was founded (prostitution, drinking, Seattle literally poisoning the wells of nearby towns to force them to join Seattle to get access to clean water)
College was better, mostly US history and World History, still nothing about the far east though.
We did an excellent segment on the US Revolution in College, including the funding source behind the revolutionary war, that was very interesting.
Edit: Sex ed was pretty comprehensive, and we ended the quarter by watching Rocky Horror Picture Show, so that was fun. (The Nerd and Goth kids formed a voting block for what movie to watch. :D) I am still surprised they talked about so much about forms of contraceptives that almost no one uses (spermicidal gels and foams), but at least they properly demonstrated how to use a condom, so that was good.
For "don't smoke" the health teacher had lots of pictures of tumors.
Alcohol wasn't really talked about, but honestly in the 90s we didn't know a much about how unhealthy it is as we do now. (Doctors knew it was bad, but just in the last few years research has come out showing that the safe amount of drinking is none)
Heroin was introduced as a cure to morphine addiction.
That’s gotta be the most ignorant opinion I’ve heard on the subject. This clearly is coming from someone who has had the benefit of good health, or hasn’t had the misfortune of a critical ER visit. When I got addicted to opioids, the doctors didn’t ask me what I wanted in the ER. I got Dilauded as they prepped the OR. I wasn’t lucid enough or cognizant enough to give informed consent. During my recovery, there wasn’t an option of alternate anything - I got a lot of morphine and then oxy. I was discharged 4 weeks later from the hospital with a 3 month prescription for 120mg of opioids per day. That would kill most people.
My story is not unique. It is so common it could be a troupe. The doctors saved my life in one way, then discharged me into a hell of addiction that it took 9 months of serious determined effort to overcome.
Then, some uninformed keyboard warrior like yourself comes along and blames people in my situation? Maybe you should have read a little less Opioid Wars and a little more Current Events. You clearly know nothing about this problem.
I've worked in the ER, held a license to work there, and spend everyday with licensed providers in addiction medicine. I assure you I have more familiarity here than even most addicts.
But you win the victim totempole height contest I guess.
That doesn’t clarify anything about your knowledge. The specialized hospital cleaning crews are in the ER every day and dozens of hours per week in the OR, but that doesn’t allow them to practice medicine or perform surgery. Proximity is not the same as practice.
The medical practice (until a few years ago) was profoundly and intentionally misinformed about the addictiveness of Oxycodone and Oxycontin. You brought up a question about why people didn't learn from the Opioid Wars, but your flippant question could just as easily be applied to the MDs who wrote the prescriptions.
Medical doctors are smart; they MUST know about the Opioid Wars and the horror the opium wrecked on Chinese society for centuries. Why would they prescribe such a dangerously addictive compound to injured and vulnerable people having the worst day of their lives?
Instead, you blame patients with little choice (or capacity to evaluate choices) in a terrible situation. And, if you talked to any addicts, you'd sure find that the top of the "victim totempole" is actually really crowded with people who got there the exact same way. That is no coincidence.
The fact of the matter is that Purdue intentionally misinformed everyone - doctors, patients, caregivers, and family. They used marketing, propaganda, bribes, recognition, and myriad other tools to convince everyone that their product was different. Doctors, knowing full well about the Opium Wars, wholeheartedly believed the propaganda. I wasn't the first patient to be discharged from the hospital with a multi-month supply of opioids. This was a common practice.
The worst part is for someone who claims to be around addicts, you think I am somehow unique in my story. My story is so mundanely typical that it should be nauseating. Medical treatment is, by far, the most common way addicts start with opioids. 75% of all heroin users whose addictions started in the 2000s reported that it began with prescriptions from their doctors.
https://nida.nih.gov/publications/research-reports/prescript...
I genuinely suggest you spend some time talking to the addicts around you rather than judging them. You'd quickly come to regret the flippancy of your statement and probably have some empathy for their situation. These were regular people with jobs, families, lives, hopes, and dreams. In a crisis, they entrusted medical doctors to make the best medical decision for them, and the price they paid was their future.
I am not sure high schools are teaching people to be distrustful of their doctor’s advice. I think what’s being taught is about the dangers of illicit drugs, not those with a medical expert’s stamp of approval.
On the plus side between oxy and COVID distrust is now at all time highs.
People have learned you can't trust the doc anymore than a quik-lube mecanico.
This is spoken like someone who has enjoyed the privilege of living without chronic pain.
Of course, I speak from the pillar of privilege and but am a lowly untouchable on the great victimhood totempole. We should instead only listen to the high priest victims, uncontrollably fented our their minds to kill the pain.
If you want to get rocked on opiates have at it, it's your body, just don't pretend you don't know they're addictive. It's ok to be an addict if you're honest to yourself about what's happening. Might even make sense if the pain is chronically awful.
Here's the thing about what they teach you about drugs in high school: lots of it is bullshit. I don't know if it's still a thing but when I was in school there was a lot of pearl clutching about weed being a Gateway Drug. For a lot of people who smoked weed and didn't progress towards any harder drugs, weed was a prime example of how drug education was a sham. No one went crazy, none of the weed horror stories came true, everyone enjoyed the concert and woke up the next morning feeling better than if they'd been drinking alcohol the night before.
Exactly. If it wasn't for the existing demand for cheap powerful opioids, Fentanyl would never have been a problem to begin with.
Are you one of the lawyers?
None of that would’ve happened if they didn’t start the flood of opiates to begin with. It wasn’t a marginally increased issue, they flooded the market with it. People with minor pain were getting massive bottles of OxyContin and selling or using it. This led to pill mills and crooked doctors. You had normal people getting hooked on high dosages. These are not the people who were using opioids before that. Pills made it seem safer. Most users don’t start with heroin, they start with pills because of exactly that. “A doctor prescribed it, must be okay.”
This is some insane logic to absolve them of responsibility. I say this as someone who also saw the problem firsthand. Was regulation handled badly? Sure but there’s no way you can say they didn’t start the problem.
A bartender mocked my brother for getting Aspirin for his broken arm.
"man you got nothin', you should get some oxy for that!"
I'd been living outside the US and this in my first few hours back on US soil. A few hours later my friend (working in criminal defense) explained how opiates accounted for roughly 1/3rd of his income (other sources: drunk driving and domestic abuse). They all followed the same trajectory: minor condition -> prescribed oxy -> illegally obtained oxy -> heroin when the money ran out.
This wasn't normal. It didn't happen anywhere else in the world at the time, or at least not where I was living.
Not only that, some of the problem with addiction were directly caused by the dosage guidelines for oxycontin. They really wanted it to be a 12h drug, but it really isn't and it wears off after about 8 hours. Rather than admitting this and giving a smaller dosage more frequently they doubled down by using a larger dose and trying to keep with the 12h schedule.
This combination or larger dose followed by mild withdrawal then results in a higher likelihood to become addicted to opioids. So not only they marketed it heavily and got more people on opioids than necessary, they did it in a way that maximizes the likelihood of addiction.
https://www.latimes.com/projects/oxycontin-part1/
What are you talking about? Where was America getting their opioids before The Sacklers? Go ahead and pull a chart of heroin deaths vs. years and draw a vertical bar on where Purdue launched their widespread marketing misinformation and disinformation.
This is the largest and most deadly episode of addictiveness since the tobacco companies were marketing cigarettes as healthy. If this were a fire, you’d be arguing:
“Look, America has always had fires. Sure Purdue started fires in all 50 states that spread into the forest, but they were small when Purdue started them. Now, there is a blaze that has spread uncontrolled across the Continental US. So, obviously there were other parallel organizations starting fires.”
No. That doesn’t follow. Purdue stared the fires. They added tinder with marketing misinformation, then they inhibited any attempt at controlling it with active disinformation campaigns to confuse doctors and regulators about the root cause. Now, it’s a wild uncontrolled inferno, but they started the first fires.
Didn't we also invade the religious nutsos stopping Afghanistan from producing poppies and then prop up a fake regime that let it flourish, massively increasing the supply of natural opiates? If I recall, the timing works out pretty good with illegal opiate use ramping up.
We sure did. About 60-70% of all of the world's opium was sourced from Afghanistan until 2022. That supply was used to make actual prescriptions in non-OECD countries - like India & China - as well as sold to make heroin in the US, EU, Asia, and Africa.
But be careful about confusing cause & effect. The cause of the Afghani farmers growing opium was the insatiable demand for opium that was developed through legal means. Then, when countries like the US started to restrict access to opiates, addicts and patients alike started to seek alternatives to the scarce prescriptions.
More to the point, why didn't patients use something else? Because there is nothing. Purdue's misinformation actively discouraged the discovery of new non-addictive compounds for decades. No one was looking, and the R&D pipeline ran dry.
By the time enough doctors sounded enough alarms to cause a change in the late 2010s, research in non-addictive pain management solutions was decades behind. No one engaged in it because there was no need for it. Now that we realize it was all a lie and these drugs have killed millions, there are no alternatives. Very few potential compounds are even in Phase 2 clinical trials right now, let alone the half dozen that would be needed in Phase 3 to ensure we have a single alternate choice for pain management in the next five years.
So, the outlook looks bleak. Today, in 2024, we don't have good ways to manage pain that is non-addictive, and certainly no good way to reach the millions who are hopelessly addicted to opioids for pain management. But, very little of this is the patient's fault - and a lot of this is directly related to the monumental efforts of Purdue to misinform for profit.
Opinions like this are why I’m glad I don’t live in the USA anymore. Live practically anywhere else, where there is no opioid crisis, and this line of thinking sounds insane. Copy paste for other uniquely American issues like gun violence - the answer is… more guns?
To be fair, it sounds insane to many of us living in the US, too.
As someone who deals with chronic pain, I watched this situation develop: people lost access to their “safer” opioid and switch to whichever one they can get. Or suicide; there were many suicides around this time.
Thankfully opioids have never been an appropriate treatment for my pain so I didn’t have to deal with this, but I feel real empathy for the people who switched to street drugs at that time. OD is a risk but considering how consuming pain is many would probably rather be dead than experience that anyway. This is not hyperbole, on pain forums people talk about assisted suicide all the time.
We failed pain patients across the board.
It took 6 or 7 years for us even start to find therapies that work. To this day doctors have just shoveled handfuls of Gabapentin and muscle relaxers down our throats or sent us for very invasive and painful nerve blocks which both have a high complication rate and need to be repeated as frequently as every three months.
Or told us to get more exercise. I’ve always loved that one! I’ve been improving my fitness for three years, but advancement is very slow because if I go too fast it can trigger pain and be a huge setback.
Fuck the Sacklers, but fuck whoever decided that pain patients don’t deserve opioids at a rate of 100x. As is always our policy with the disabled in America, our suffering doesn’t matter anywhere near as much as the political moralization that gets people in office
Ok, I’ll get off my soapbox. This topic makes me so angry.
The black pill with chronic pain is it’s often better to off yourself depending on the condition. There’s no hope for some things like erythromelalgia.
You seem to just skip over that point in a bit of a blasé fashion, as if OxyContin's slow release formulation is somehow a defense of the Sacklers' behavior, when the exact opposite is true.
That is, a primary argument is that Purdue pushed OxyContin because they argued it was safer due to its slow release formula. Except they knew full well that "slow release" was pretty much bullshit because people were getting addicted by simply crushing the pills.
Purdue sales people deliberately pushed Oxy with the false promise of additional safety even though they knew this wasn't true.
It's much worse than that. In order to protect the big selling point (10hrs between doses, once per nursing shift) they encouraged larger doses which were more likely to cause addiction instead of more frequent doses which were actually appropriate.
Wasn't Oxycontin kind of the boot loader for the present opioid crisis in that it mainstreamed opioid use and got a huge number of people introduced to it?
Then it was taken away and things like illicit fentanyl filled the gap, but that came later.
Indeed. At the undergrad college I went to in New England in 2008 it wasn’t uncommon to see people at house parties doing lines of oxycontin out in the open. Was fairly socially acceptable.
Regulation helped cause the deaths by driving people to more dangerous sources. You're 'forgetting,' however, that the oxycontin and prescribed pills were the source of those addictions in the first place. The regulations didn't kill them. If the regulations had always been there, they would have been fine. They weren't tamping down on some mystical parallel crisis, however convenient that would be to shift the blame. They were creating a new one, using the legitimacy of the medical system and doctors prescriptions to get people hooked, to fatal effect when the regulations finally came down and people facing addiction turned to illicit sources.
morally: providing more of something that has no societal good is not commendable.
logically: this argument isn't sound at all. looking at what happened since Oxycontin was regulated is not a proper counterfactual. you would have to look at a universe in which it was never introduced to begin with
Lol fentanyl is more toxic by an order or two of magnitude. People would be on prescription opioids, lose a script, get on heroin because that was 4 to 8 times cheaper and more available than black market pills. The fentanyl crisis is a phenomenon between cheap imported precursor and Cartel economics.
The synthetic opioid demand in the US was a result of a chain of events including the purposeful stimulation of demand by marketing directly to Drs, lying about abuse potential, lying about withdrawal and addiction potential, and not introducing mediating controls when evidence of abuse and sales not meeting market demographics was clearly evident. Like they imported millions of pills to small towns with over selling pharmacies. Drs would up dosage to adjust to tolerance. But anyway it’s fentanyl that is killing people. I’d argue just let people use opium and regulate that sale.
Edit: changed and to an. Chinese precursor to imported precursor bc I honestly don’t know how many different countries are sources of a precursor. Added part about importing to small towns and upping dosage.
I would argue that it is the expected outcome of processes exhibiting: Latency... it takes a few years to actually kill their victims, and Exponential behaviour.. the most damage is done in the last few rounds of the expansion.
username "addicted" eh?
There is a lot in this post that is ...questionable in my opinion but I just have to call out as especially creative the praise for a drug that is so safe and slow-acting that it won't have harmful fast acting effects unless you... Apply a small amount of pressure with a hard object.
Truly a stupendous point.
You're really underselling it if anything. Over a million Americans have died so far in the opioid epidemic. That more than any of their wars, including their civil war.
7x as many people in the US die from cigarettes every hour, day, week, month, and year as from all opioids combined.
Cigarettes don’t even require a prescription.
If there is an opioid crisis, there is a 7x larger tobacco crisis, too.
Tobacco companies have paid out countless nine figure sums, smoking in public has gone from universal to mostly illegal, cig taxes have skyrocketed, etc…
Tobacco has been treated as a crisis, and I have no doubt that if cigarettes had been invented by one specific family, that family would be hated.
Weird that you don’t know any of this.
What’s weird is that people still think tobacco smoking is about nicotine being addictive and dangerous, when it is literally everything else in the smoke that makes it extremely addictive and mortally dangerous.
The nicotine is what makes it addictive, but everything else makes it deadly.
This distinction is well known here in Sweden where we have snus, and also lower rates of lung cancer and cigarette use than the rest of Europe by a LOT.
That is not true. It is the interaction of nicotine with various monoamine oxidase inhibitors that makes tobacco smoking addictive, to an extent that it could be stated that it is the MAOIs entirely causing the addictive behaviour: the exact same MAOIs are also found in coffee, after all.
Why are nicotine pouches and vapes addictive, then? The answer lies in the flavourings, which themselves have psychoactive properties, likely also through MAO inhibition.
God this Gwern junk will never die. There's tons [0] of evidence that nicotine is addictive on its own.
It's the nicotine.
[0]: https://duckduckgo.com/?q=nicotine+addictive+site%3Anih.gov&...
I'm not here to argue, but all top 5 links for me are about smoking. I've not heard of people being addicted to nicotine patches for example, especially non-smokers.
I looked into this previously, though it was a while ago so I no longer have the sources to hand. Nicotine is still addictive on it's own but when given to non-smokers in a non-tobacco form it's notably less addictive than smoking. Still addictive but far closer to coffee than cigarettes.
Some of this can be explained by different consumptions methods. For example in lozenges, gum and patches nicotine enters the bloodstream much slower than smoking or vaping so even if you consume the same overall amount the peak is lower slowing adaption. But that couldn't explain it entirely.
Nicotine Addiction: Neurobiology and Mechanism: https://pubmed.ncbi.nlm.nih.gov/32322429/
Neurophysiology of Nicotine Addiction: https://pubmed.ncbi.nlm.nih.gov/22454789/
https://www.fda.gov/tobacco-products/health-effects-tobacco-...
No, it's because nicotine is an addictive chemical.
https://www.fda.gov/tobacco-products/health-effects-tobacco-...
Though at the same time I would wager a larger rate of gum disease and mouth cancer than the rest of Europe by a lot.
Going by a quick skim of the 2022 WHO oral health numbers, Sweden[0] doesn't seem significantly worse off oral-health wise than Germany, Holland, or the UK. In fact it's oral cancer incident rates appear a bit better. Though the UK doesn't have great cancer incident rates, it's periodontal disease rate seem to be significantly lesser than the other three (perhaps due to close monitoring as a result of the "bad British teeth" stereotype).
Sweden male tobacco use percentages are slightly higher than the other three countries, which might be a function of the population additionally using non-cigarette tobacco substitutes perhaps as was mentioned by others.
[0] https://cdn.who.int/media/docs/default-source/country-profil...
It's not known in Australia where you have to have a prescription to buy a vape but can buy cigarettes freely. Apparently they're relaxing the prescription requirement later in the year but still only pharmacies will be allowed to sell them.
Can you please tell me which of these mandatory warning messages you feel fails to convey that cigarette smoke, on the whole, is dangerous?
https://www.fda.gov/tobacco-products/labeling-and-warning-st...
True, but it still shows that lobbyists have a lot of influence. Even if it means hundreds of thousands of death people every year. Same goes for Alcohol. And maybe also specific types of food.
A good book to read regarding this topic is "Death in Mud Lick" by Eric Eyre who was a reporter for a local newspaper in WV during the early discovery phase of the epidemic.
The book details the methods used by the drug companies to pedal these drugs into small communities, the tragic victims, and lastly the refusal of drug suppliers to admit any wrong doing. There's also a slight dose (no pun intended) of WV AG's sheer incompetence on the matter due to donations and gifts by said drug suppliers.
Super depressing book, but great read nonetheless.
*peddle
Fun fact: early opioid deliveries were actually, in fact, almost exclusively done by bicycle!
Painkiller is a great little short series on them too. does a great job at portraying all of what you mention in a six hour tv format. it can get a little on the nose sometimes but the meat is 100% true
Not to mention creating more homelessness, increasing crime and deteriorating our cities, strengthening Mexican drug cartels, providing business to suppliers in China.
They have objectively made the world a worst place.
I thought the lead guy was bad.
Which of those million died from Oxycontin overdoses, which of them died from hepatitis they caught when shooting up pills with a reused drug needle?
Don't forget McKinsey:
https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...
I always cringe whenever I see people giving McKinsey credit for stuff (good or bad). It's a powerpoint factory of 20-somethings with zero experience executing anything.
To suggest the virtuous, humble Purdue management could never have figured out how to sell oxycontin and bend regulators--without the insight of a few powerpoint slides--gives me a chuckle.
It's not like Purdue, a drug company, had any experience marketing drugs and dealing with regulators before, right? I mean, it must have been a super hard problem for them to solve. How do you sell an instant painkiller thats wildly addictive, while getting corrupt regulators to be corrupted? Impossible!
Too bad they got duped by those evil 22-year old powerpoint geniuses at McKinsey, who are clearly the real villains of the story.
You might be partially right, but McKinsey Senior Partners have a very long list of friends to call, many of them former McKinseys in positions of power. So while the shitty PowerPoint might seem as the product, the actual product might be trafficking influences and coordinating favors, getting insider information from a competitor, etc.
In this case in particular, if memory serves, they were advising the FDA in parallel, and leaking information to the Purdues. No brain-dead 24yo Harvard grad did that.
I would not give them any slack.
They also provide plausible deniability. "Look, we have independent research by a reputable firm."
In fact that's the main thing they sell.
https://archive.is/Gc1Lh
I mean they were just leveraging synergies between drug company and drug regulator.
Where was the FDA? Were the doctors all innocent? Is stupidity a good criminal defense? They should be all in the same cell.
FDA has some culpability, but the fraud was so effective Medical Schools where teaching students to prescribe more opioids.
Perdue Pharma effectively hacked the medical system. I think the real takeaway is there’s likely more of this going on than we realize. The common decongestant phenylephrine being no more effective than placebo comes to mind. Without the mass deaths there’s apparently little to stop modern snake oil salesman.
Perhaps the FDA needs to conduct direct hands on oversight of medical trials? I mean if there’s billions to be made and little chance of prison the incentives get crazy.
There is a phenomenal article in Scientific American talking about the phenylephrine/pseudoephedrine debacle: https://www.scientificamerican.com/article/how-two-pharmacis...
It's sort of a different class of failure than with opioids, but it is a notable area of weakness. Basically, for OTC drugs that were initially approved before 1962, many are still on the market despite sometimes having weak efficacy data. While the FDA has been making some progress in reevaluating these older drugs, we're still far from where we should be.
A few quotes from the conclusion of the article (but the entire piece I linked in SA is worth a read!):
I'm surprised there aren't lots of PhD students doing modern trials on these. "I was the person disproved a widely available drug" seems like it would be a great thing to have on an academic resume. From the outside, it also seems like this would be relatively easy research since the drugs are widely available, safe, and treat common symptoms.
They appear to have left the oversight up to two individuals - ones with whom there was an obvious quid-pro-quo [1]. It's a stain on the agency and they should take responsibility and make changes.
[1] https://journalofethics.ama-assn.org/article/how-fda-failure...
Some medical professional went from healers to corporate shills for big pharma in 50 years.
My favorite video about this subject:
Dr. Aseem Malhotra - 'Evidence Based Medicine Has Been Hijacked'
https://www.youtube.com/watch?v=qwovXFzUvfg
Maybe, but its more common than this one example and more than what most people can stomach. The real problem is these people are sociopaths, and the next set of sociopaths will do it again. They don't care who they hurt because they lack empathy and if killing people drives up profits then so be it.
If you really want to show concern or right a wrong then find a way to better criminalize violations of accepted ethical norms. The best way to punish sociopaths is to take all their assets, embarrass them in public, and permanently bar them from practicing in the same industry. For example if a lawyer is disbarred they do not get a second chance.
What a load of BS. Wat's next ? Burning witches? I think we are way over our heads with criminalization already and have created big underclass of people who have no second chance because of that. So no fuck you.
P.S. Sure I'd like to see many of our masters in jail for fucking up with people's lives but that will not happen
There is no criminal underclass of convicted billionaire sociopaths. What are you talking about? Of course it won't happen if we continue to permit, excuse, and enable their behavior while crying about how hard life is.
To that I agree. However you can not make laws specifically criminalizing rich for "violations of accepted ethical norms". It will just open floodgates diverting regular and poor to underclass. This whole criminal background check should be made illegal with some very specific exceptions. It hunts people for the rest of their lives. Europe handles this situation much better in general from what I've heard.
My understanding is that for regular theft, there are different classes of charges depending on the amount stolen. Perhaps we could apply a similar approach at the top end? E.g. laws that only kick in when there has been more than a billion in damages or thousands of deaths?
They all should be charged with mass murder. The corrupt judge who okayed the settlement deserves prison.
Manslaughter maybe, but not murder. They didn't want to kill people using their drugs. That wouldn't make any sense.
Also, I'd be careful about saying the judge (Robert Drain) is corrupt unless you can back that up with facts. You might be opening yourself up to a libel suit.
Just after the decision was announced, the victim's lawyers seemed to put out a statement decrying the decision since the victims are not going to be paid (soon?). Is this overzealousness on the part of the lawyers themselves wanting to get paid? Does any law person have a comment on the situation?
I like to think about it this way:
I cannot name another family that helped introduce a nationwide need for a completely new type of first aid, that being naloxone. It's not just ambulances; it's in police cars, pharmacies, libraries, schools, and workplaces. A complete deployment throughout the third-largest society in the world, in less than ten years, because of the frequency of overdose.
Just consider that for a moment.
Gabapentoids (e.g. pregabalin, gabapentin) need similar scrutiny, as they are routinely prescribed to millions of elderly people, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265598/
> gabapentinoids are increasingly being used for off-label conditions despite the lack of evidence. Prescription rates for off-label conditions have overtaken that for on-label use. Similarly, the use of gabapentinoids in the perioperative period is now embedded in clinical practice despite conflicting evidence. This article summarises the risks associated with this increasing use. There is increasing evidence of the potential to cause harm in vulnerable populations such as the elderly and increasing prevalence of abuse. The risk of respiratory depression in combination with opioids is of particular concern in the context of the current opioid crisis.
That's complete horseshit. They produced a drug of known, unvarying dosage in regulated pharmaceutical manufacturing plants, overseen by pharmaceutical engineers making sure that no illegal or unsafe substances adulterated the final product.
For once, there was a drug on the street that wouldn't cause junkies to overdose. It wasn't hot with fentanyl half the time. Jackasses didn't cut it with baby formula or laxatives. Hell, it didn't even encourage druggies to reuse needles.
But if you need empirical evidence, drug overdose deaths only spike after the DEA cracks down on pill mills. They demonstrably saved lives. Any sane person who examines this at even a shallow level would concur. You've drank the kool-aid.