Labarin Purdue Pharma ya bayyana a matsayin bala'in Shakespearean. Kamar Julius Kaisar, wanda waɗanda suka ci amanar sa daga baya suka yi hawansa, Purdue ya tashi a kan yunƙurin gwamnati don kula da ciwo mai yawa - "zafi a matsayin alama ta biyar mai mahimmanci" - da amincewar FDA na samfuran ta.
Kamfanin ya magance wata halaltacciyar buƙata ta likita amma ya zama abin kunya lokacin da hasashe (na dogon lokaci) rikicin opioid ya barke. Cibiyoyin da suka taɓa goyan bayanta a baya, Purdue ya ɗauki nauyin fushin jama'a da na shari'a (kamar King Lear's Cordelia, don ƙara misalin Shakespearean), yayin da al'amurran da suka shafi tsarin da suka ba da damar rikicin-rubutun da ba a kula da su ba, magungunan kwaya, cinikin miyagun ƙwayoyi (heroin, fentanyl), da magungunan kulawa da gwamnati ke tallafawa - sun kasance ba a taɓa su ba.
Purdue Pharma: Opioid Crisis Villain, ko Easy Target?
Purdue Pharma ya zama daidai da rikicin opioid, galibi saboda manyan kararraki da kuma hotunan kafofin watsa labarai a ciki. Ciwan painkiller da kuma Ciwon ƙwayar cuta. Duk da haka, Purdue's OxyContin ya kasance yana riƙe da kashi 4% kawai na kasuwar maganin kashe zafi na opioid, dwarfed da kamfanoni kamar Mallinckrodt, Actavis, da Endo Pharmaceuticals, wanda tare ya samar da kashi 88% na opioids.
Purdue ya tsaya ba saboda ya mamaye kasuwa ba, amma saboda ya haɓaka samfurin "boutique" (kuma mafi mahimmanci a bayan haka, a farashin "boutique".) - wanda aka ƙera don mayar da martani ga tunanin likita na lokaci, wanda ya jaddada buƙatar opioids na dogon lokaci don kula da ciwo mai tsanani. Karatu kamar 2001's Opioids masu dogon aiki don Ciwo na Zamani kammala da cewa "opioids masu tsayi suna ba da fa'idodi daban-daban akan opioids masu gajeru” ta hanyar haɓaka yarda, ingancin rayuwa, da kwanciyar hankali na jin zafi.
Purdue's 1996 OxyContin ya yi daidai da wannan yarjejeniya ta likita.
A cikin 2010, Purdue ya ci gaba da tafiya tare da ƙaddamar da ƙaddamarwa "tsarin hana cin zarafi" (ADF)- abin da za mu iya kira "OxyContin II”—wanda aka ƙera don yin tambari da wahala da rashin amfani da shi bai cancanci ƙoƙarin ba sake magana, wanda ya buƙaci zuba jari mai yawa da ƙirƙira, shine irinsa na farko kuma ya tabbata Nan take tasiri wajen dakile cin zarafi.
A cikin masana'antar da masana'antun keɓaɓɓu suka mamaye waɗanda ke samar da analogues mafi sauƙi na morphine, ƙirar Purdue ba ta da yawa, kuma FDA ta ga cewa yana da tursasawa cewa an yi amfani da irin wannan ka'idodin ADF ga magungunan da gwamnati ta amince da su kamar Suboxone (don hana kwafi na sauƙin karkatar da methadone).
"((OxyContin II ne)…mataki zuwa madaidaiciyar hanya,” in ji mai FDA's Bob Rappaport, MD, A 2010.
Bisa ga kara(s), Ayyukan Purdue "sun ciyar da jaraba" na tsararraki, suna haifar da lahani da yawa. Duk da haka wannan mayar da hankali kan Purdue ya yi watsi da mafi girman mahallin, kama da zargin donuts don kiba yayin gudanar da gidan burodi.
methadone da gwamnati ta amince da su da Suboxone sun daɗe suna faɗaɗa tushen masu amfani da narcotic, suna haifar da rikicin opioid. Tushen wannan annoba ta samo asali ne tun a shekarun 1960, tare da sauye-sauye zuwa jarabar "likita" ta hanyar hanyoyin kwantar da hankali, wanda ya kara yawan amfani da narcotic na asali da dogaro. Don cikakken hangen nesa na tarihi da nazarin kasuwa, duba na "Kula da Methadone Ya Hana Rikicin Opioid na Amurka. "
Abin baƙin ciki yana da ƙarfi: duk da riƙe kawai a 3.3% kasuwar kasuwar, Purdue ya biya ƙauyuka a cikin ƙimar 43 fiye da mafi girma mai samar da opioid. Daidai kamar ma'aurata masu arziki a cikin kisan aure mai ɗaci, Purdue ya ɗauki nauyin fushin jama'a da shari'a, yayin da 'yan wasan masana'antu matalauta ba tare da dabarun hana cin zarafi ba sun tsere daga bincike. Gwamnati ta kashe Purdue, duk da haka (kamar yadda tare da taba sigari) opioids sun kasance tare da kalubale (misali fentanyl) mafi girma fiye da kowane lokaci.
Purdue asalin sunan farko
Manufar Purdue Pharma a cikin tallan OxyContin ba shine ƙirƙirar (ko faɗaɗa) annoba ta opioid ba. Opioids koyaushe sun kasance abin dogaro na musamman - yin daidai kamar yadda aka yi niyya, akai-akai yana kawar da zafi - da haifar da jin daɗi, ko daga jin daɗin jiki ko na hankali, mai ƙarfi yana iya samun masu karɓa "suna dawowa don ƙarin;" sau da yawa zuwa ga jaraba. Ba kamar kowane magani ba, opioids suna isar da wannan tasirin a duk duniya, a cikin daidaikun mutane da ko da a fadin jinsin, yana mai da su duka masu ƙarfi da haɗari. Wannan daidaitaccen tasiri, daidaitaccen tasiri yana haifar da hadadden kasuwa tare da nau'ikan masu amfani guda uku:
- wadanda ke da halaltaccen ciwo bukatu,
- wadanda suka fara da ingantattun takardun magani amma sun shiga rashin amfani, kuma
- mutanen da ke neman opioids kawai don abubuwan nishaɗi, ba tare da jin zafi na farko ba.
Nazarin a lokaci (1990s) ya nuna wani karkashin maganin ciwo, musamman ciwo mai tsanani, kamar yadda likitoci da yawa suka yi taka tsantsan game da rubuta magungunan narcotics.
Purdue's OxyContin ya nemi magance wannan buƙatar tare da tsarin sakin lokaci da nufin rage cin zarafi. Wani mai amfani da “na nishaɗi” ya lura, “Yawancin mutanen da na sani ba sa amfani da OxyContin (II) don ƙara girma. Sun koma tabar heroin. " Daga cikin waɗanda ke amfani da opioids don "ɗauka," amfani da OxyContin ya ragu yayin da amfani da tabar heroin ya kusan ninki biyu. Bisa lafazin Theodore Cicero et al. (2012), "Daga cikin dukkanin opioids da aka yi amfani da su sun yi girma a cikin kwanaki 30 da suka gabata, amfani da OxyContin ya fadi ... yayin da amfani da tabar heroin ya kusan ninki biyu." Tsarin hana cin zarafi ya yi nasarar magance rashin amfani da OxyContin…
...duk da rashin tsoro Times 'yan jarida' tips don solo "masu amfani."
Tallace-tallacen Tarihi na Purdue
Ƙoƙarin tallace-tallace na Purdue ya dogara ne akan nazarin da ya nuna cewa jaraba shine ƙananan haɗari lokacin da aka yi amfani da opioids yadda ya kamata don kula da ciwo. Maganar da ba ta da kyau a yanzu ita ce wannan Harafin 1980 zuwa New England Journal of Medicine wanda ya yi iƙirarin haɗarin jaraba ga marasa lafiya waɗanda ba su da tarihin shan miyagun ƙwayoyi ya kasance ƙasa da 1%.
Yayin da aka soki daga baya, wannan binciken da sauran irinsa (kamar yadda aka shigar a cikin Cibiyar Magunguna's Kwamitin CiwoRahoton 1987 “Ciwo da Nakasa… Ra’ayoyi") ya taimaka tura Purdue (da magani a gaba ɗaya) zuwa ra'ayin cewa za a iya ba da izini ga opioids a amince da yanayin da aka saba bi da su tare da ƙarin taka tsantsan ko kuma ba a kula da su ba.
Masu sauraron Purdue Pharma na OxyContin ba su taɓa zama alƙaluman jama'a ba amma waɗanda ba su da rai a cikin ainihin zafin jiki ta hanyar rashin lafiya ko rauni.
Matsayin Purdue (da sanarwa) waɗannan majiyyatan sun bambanta da masu amfani da muggan ƙwayoyi, suna mai jaddada cewa idan likitoci sun kula da magunguna yadda ya kamata, haɗarin jaraba zai kasance ƙasa kaɗan. Kuma Purdue ba lallai bane yayi kuskure. Masu suka suna jayayya cewa ya rage haɗarin jaraba kuma ya ɓata layin tsakanin amfani da magani da na nishaɗi; duk da haka, kamar bautar da aka yi a baya da kuma aikin tiyata na jima'i na yau, tsarin Purdue ya nuna lokacin kansa: yanayin kiwon lafiya wanda ya ga jin zafi a matsayin buƙatar gaggawa.
Kamar yadda jami'an tsaro da amincin mutum suka dogara da bindigogi, opioids suna riƙe da muhimmiyar rawar da suke takawa a cikin kula da ciwo - ko da haɗarin abubuwan cin zarafi sun ci gaba da mamaye ingantaccen amfani da irin waɗannan kayan aikin. Don laifin Purdue shi kaɗai ya rasa babban ƙalubalen da ba a warware shi ba: daidaita ingantaccen buƙatun likita tare da haɗarin dogaro. Rarraba tsakanin warkewa da amfani da opioid ba bisa ka'ida ba ba halittar Purdue bane amma matsala ce ta al'umma har yanzu ba'a gama magance ta ba.
Wannan ginshiƙi yana ba da haske game da zato waɗanda ke ƙarƙashin labarin anti-Purdue-musamman da'awar cewa Purdue ya yaudari jama'a ta hanyar rage haɗarin jarabar opioid (duba. ja kwalaye, kasa). Waɗannan masu sukar suna fassara Purdue tare da nuna son kai. Ainihin harshen da aka yi amfani da shi a cikin kayan ilimi na Purdue, kamar yadda aka nuna a hagu, yana yarda da haɗari ba tare da ba da shawarar yin amfani da shi ba. Haɓaka amfani da kwaroron roba baya goyan bayan cin zarafin jima'i; Mayar da hankali ga Purdue akan halalcin jin zafi baya ƙarfafa karkatar da opioid.
Lokacin da Niyya ta Haɗu da Gaskiya: Fitowar Magungunan Kwayoyin Kwaya da Cin Hanci da Magunguna
Laifin samfurin Purdue bai yi yawa ba a cikin niyyarsa ta farko, amma a cikin abin da ya faru da zarar OxyContin ya shiga cikin tsarin kiwon lafiya da kasuwa. A ka'idar, ana nufin likitoci su sa ido kan marasa lafiya a hankali, tabbatar da cewa an yi amfani da takardun magani don dalilai masu kyau. Amma a aikace, tsarin ya zama cikakke don amfani. Wasu likitocin, waɗanda ƙwaƙƙwaran kuɗi ko halin ko in kula, suka yi, sun fara ba da izini ga miyagun ƙwayoyi. "Pill Mills” ya karu a fadin kasar, inda likitoci zasu rubuta takardar magani jimlar allurai na OxyContin tare da ɗan hujjar likita ko hulɗa.
A matsayina na likita mai kula da firamare, na shaida majinyata sun shigo ofishina suna da'awar "Allergy" (sic) zuwa ƙananan magungunan opioid (kamar Percocet), a ƙoƙarin samun ƙarin ƙarfi OxyContin. The kasuwar baƙar fata na OxyContin ta bunƙasa, a ƙarshe ta daidaita a ~ $1 kowace gram. Gudun OxyContin wanda aka haɓaka ta hanyar "alama ta biyar mai mahimmanci" ta haifar da raɗaɗi, mafi gasa wuri mai faɗi don narcotics. Dillalan Heroin sun daidaita ta rage farashin da kuma faɗaɗa tushen "abokin ciniki" na "masu amfani."
Babban Hoto: Shin Purdue shine bindigar shan taba na gaske?
"Domin a nan ne kudin suke. "
(me yasa Willie Sutton ne adam wata bankunan da aka sace)
Ta hanyar kula da methadone mai girma, gwamnati da kanta ta daidaita dogaro da opioid, samar da ƙasa mai albarka ga dillalan tabar heroin-'yan wasan kwaikwayo masu zaman kansu kamar yadda ba za a iya kawar da su kamar sauro ba. Matsalolin maye gurbin da gwamnati ke bayarwa kowace rana suna isar da “mafi girma” na OxyContin sau takwas.
Madaidaitan albarkatun Purdue da hangen nesa na kamfani sun sanya shi babban manufa don aiwatar da doka. Wannan tsarin yana nuna kararrakin da aka yi a kan masana'antar taba, har ma da masana'antar bindiga, inda kamfanin da ke ba da doka, abin da balagagge ba ne kawai - ko hayaki ko bindiga - ya zama tushen ƙarar, ba tare da la'akari da rashin amfani da masu amfani da ƙarshen ba. A gaskiya ma, yawancin lauyoyin da suka yi niyya ga Big Tabacco sun ɗauki irin wannan dabarun doka da Purdue, jefa kamfanin a matsayin yadda jama'a ke fuskantar annoba iri-iri. Musamman, masu batsa da masu yin jima'i; marijuana da dillalan psychedelic (da yawa suna aiki ba bisa ka'ida ba) suna guje wa waɗannan dabaru masu ƙarfi.
Dalilan kuɗi suna motsa wannan zaɓin mayar da hankali. NFL, duk da rashin samun mafi girman ƙimar rikice-rikice-wasanni kamar hawan keke, hawan kankara, da gymnastics wuce shi a cikin raunin rauni - an yi niyya don zurfin aljihunsa. Kamar Sacklers, an tilasta NFL ta biya biliyoyin don cutar da samfurin ta. Amma ba kamar Sacklers ba, NFL ta tsira, ana kiyaye ta da ƙaunar jama'a a matsayin 'wasan Amurka.' Sacklers ba su da irin wannan kyakkyawar niyya; hatta jami'o'i da gidajen tarihi da suka yi murna da karbar gudummawar ba su da wata damuwa yanke zumunta da goge sunan iyali (tare da ban da Harvard!) yayin da ya dace adana kuɗin.
An kori Sacklers, an kona dukiyoyinsu da kimarsu, kamar garuruwan da aka sadaukar don ra'ayin BLM. Al'ummar Fickle: shin muna magance al'amura na gaske-ko kawai muna ɗaukar maƙasudai na jama'a don ƙonawa?
Kamar Goose mai kitse da manufofin da ke ƙarfafa samun damar yin amfani da opioid, Purdue ya kasance mai cike da riba lokacin da jihar ta fitar da hanta-a. da foie gras bukin matsuguni-yayin barin zurfafa, al'amurran da suka shafi tsarin da ya taimaka haifar da ba a taɓa ba.
Addendum, QUIZ: wanne mahaluki ne ya ɓace a cikin tunanin jama'a a matsayin wakili na annoba na opioid? Duba wannan mujallar Fortune Binciken 2017, via classaction.com.
Annobar opioid ta fashe ɗari ɗari tare da gabatarwar da ba a taɓa gani ba na kulawar narcotic “fargani,” methadone-wani tsarin da ba a taɓa amfani da shi ga wasu abubuwan maye kamar barasa, cocaine, caca, ko jima'i ba.
Wannan keɓantacce na musamman, wanda ya samo asali daga ƙwarewar ƙwararrun likitocin don rubutawa da riba, yana bayyana haɗin gwiwa mai damuwa tsakanin manufofin gwamnati da ribar kamfanoni. Kamar dai yadda binciken da masu biyan haraji suka ba da hanya ga cutar ta Covid-19 ta hanyar gwaje-gwajen aiki a Wuhan, makanta na gwamnati - ko rikice-rikice - wajen haɓaka samfuran maganin jaraba da riba ke ƙaruwa yana nuna gazawarta na kare 'yan ƙasa. Lokacin da gwamnati ta yi kuskure, ba kawai ta gaza ba - tana haifar da bala'i.
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Dokta Randall Bock ya sauke karatu daga Jami'ar Yale tare da BS a cikin ilmin sunadarai da kimiyyar lissafi; Jami'ar Rochester, tare da MD. Ya kuma binciki abin ban mamaki 'kwanciyar hankali' da ya biyo bayan cutar ta Zika-Microcephaly ta Brazil ta 2016 da firgita, a ƙarshe ya rubuta "Juyar da Zika."
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