It is a bitter side effect of our justice system that some people aren't punished for acts that ought, reasonably, be punished. What would be the impact of implementing retroactive laws? If nothing else, it may undermine our social sense of predictability in law.

As a thought exercise, what bounds might cordon these retroactive applications of law? If we can agree that unchecked use risks (a) politically motivated attacks and (b) inefficiency created by the fear of violating laws not enacted, what parameters might guide when and how this exceptional process is allowed to progress?

Some ideas:
Severity of impact (casualty count? economic impact?)
Ability to be foreseen (should this not already be covered by laws on negligence? how might that be expanded?)
Corporate use only (eliminate the fear that this could be used against an individual who is not a corporate officer)

Other ideas? Problems?

As with other principles, creating exceptions breeds conditions for those exceptions growing to abuse.

Here's an article from a Michigan State scholar on ex post facto exceptions relevant to sex registries.

A. The Ex Post Facto Clause

The ‘Ex Post Facto Clause’ states, “[n]o state shall . . . pass any . . . Ex Post Facto law.” 10 The clause only applies to criminal sanctions and “assures that citizens are on notice of criminal statutes so that they can conform their conduct to the requirements of existing laws.”11 As Blackstone stated, “it is impossible that the party could foresee that an action, innocent when it was done, should be afterwards converted to guilt by a subsequent law; he had therefore no cause to abstain from it; and all punishment for not abstaining must of consequence be cruel and unjust.”12 Thus, Ex Post Facto laws are unfair because they deprive individuals of notice of the wrongfulness of their behavior until after the fact. 13 The Clause ensures that legislative acts “give fair warning of their effect and permit individuals to rely on their meaning until explicitly changed.”14 Such notice is vital in the context of criminal law where deprivations are greatest.15

The Supreme Court’s first interpretation of the Ex Post Facto Clause was in Calder v. Bull. 16 Justice Chase described the specific categories encompassed within the clause as follows:

1st. Every law that makes an action, done before the passing of the law, and which was innocent when done, criminal; and punishes such action. 2nd. Every law that aggravates a crime, or makes it greater than it was, when committed. 3rd. Every law that changes the punishment, and inflicts a greater punishment, than the law annexed to the punishment, than the law annexed to the crime, when committed. 4th. Every law that alters the legal rules of evidence, and receives less, or different, testimony, than the law required at the time of the commission of the offense, in order to convict the offender.17

In the past, the Supreme Court has focused on two major elements when deciding if a statute violates the Ex Post Facto Clause. First, the Court is guided by the overall purpose of the clause. Second, the Court looks to specific tests and factors developed over time.

1. Historical Purpose of the Ex Post Facto Clause

As noted in prior commentary, there were few Ex Post Facto cases in the first two hundred years after its enactment.18 However, when the Court did deal with Ex Post Facto Clause challenges, it identified two major purposes: “1) preventing ‘arbitrary and potentially vindictive legislation’” and 2) “providing notice to the general public that their actions have been criminalized prior to prosecution.” 19

The goal of preventing vindictive legislation surfaced in the first case to consider the Ex Post Facto Clause. In Calder v. Bull, which contains the classic Supreme Court take on the clause, Justice Chase, speaking of the history of Ex Post Facto Laws, stated, “[w]ith very few exceptions, the advocates of [Ex Post Facto] laws were stimulated by ambition, or personal resentment, and vindictive malice. To prevent such, and similar, acts of violence and injustice, I believe, the Federal and State Legislatures, were prohibited from passing any bill of attainder; or any Ex Post Facto law.” 20 Additionally, in Miller v. Florida, 21 the Court stated that the first historical purpose of the Clause, as derived from Calder v. Bull22 was to “assure that federal and state legislatures were restrained from enacting arbitrary or vindictive legislation . . . [and to] preventing legislative abuses.” 23

The second historical purpose, also derived from Calder and other early sources, is to “‘give fair warning of their effect and permit individuals to rely on their meaning until explicitly changed.’” 24 This is essentially a notice requirement.25 The two historical purposes of the Clause have traditionally been discussed in Court cases as a foundation or a framework for the specific Ex Post Facto analysis.26

2. Ex Post Facto Factors and Test

Generally, the Ex Post Facto Clause prevents Federal or State legislatures from enacting any law “‘which imposes a punishment for an act which was not punishable at the time it was committed; or imposes additional punishment to that then prescribed.’” 27 Therefore, the Court has stated that in order for a criminal law to violate the Ex Post Facto Clause it must “be retrospective, that is, it must apply to events occurring before its enactment, and it must disadvantage the offender affected by it.” 28

However, it is not always clear whether a law has criminal or civil implications. The court employs a two-part test, what has been called the “intent-effects test,” in order to make this determination.29 According to this test, the court “must initially ascertain whether the legislature meant the statute to establish ‘civil’ proceedings.”30 This inquiry determines whether the legislature either “expressly or impliedly” desired the statute to carry a criminal or a civil label.31 If a court determines that the legislature wanted the statute to carry a criminal label, then they need not proceed any further and all applicable Constitutional protections will apply. If, however, the court finds that the legislature intended the regulation to be civil, it must then determine whether “the statutory scheme [is] so punitive either in purpose or effect as to negate [the State's] intention” to deem it “civil.” 32

In order to make this determination, the court uses a multi-factor test, including:whether the sanction involves an affirmative disability or restraint, whether it has historically been regarded as a punishment, whether it comes into play only on a finding of scienter, whether its operation will promote the traditional aims of punishment-retribution and deterrence, whether the behavior to which it applies is already a crime, whether an alternative purpose to which it may rationally be connected is assignable for it, and whether it appears excessive in relation to the alternative purpose assigned.33

Each factors is relevant to the inquiry, and as the Court noted they “may often point in differing directions.” 34 In the past, the Court advised that no one factor is dispositive and that this may not be an exclusive list of considerations.35 Additionally, a court will only look at the face of the law, not its enforcement, to see if the Ex Post Facto Clause is implicated. Finally, the Court stated that the legislature’s express or implied intent that the statute be civil in nature will be overcome only by the “clearest proof” that the statute is actually punitive.36 However, as subsequent sections will describe, as the courts have dropped the twin historical aims, the multi factor test is left without a framework or foundation. Additionally, the “clearest proof” has thus far been an impossible standard to meet in federal courts.

As a thought exercise, what bounds might cordon these retroactive applications of law? — JosephS

Ooops, I must have communicated poorly...I agree there should NOT be retroactive applications of law. My post was supposed to be less about how are we going to punish Purdue than it is about fixing the laws for future scenarios.

And overall it is far less about the laws that ARE, it is discussing what the laws should be (or at least that is what I had in mind).

Thanks for helping me clarify :smile:

When you mentioned Nuremberg, I heard 'crimes against humanity'.

Did Nazi Germany sign onto any treaties that would have supported the sort of penalties they faced?

I was hoping that this was going to be a proposal on how we could augment/modify our ex post facto jurisprudence in the wake of monstrous harm.

When you mentioned Nuremberg, I heard 'crimes against humanity'. — JosephS

OK, now I am getting how I implied that. Yes, I can understand that interpretation. I was really just referring to the way a whole bunch of Nazis, holding differing positions, were tried and different punishments were given based on the determined level of responsibility.

Did Nazi Germany sign onto any treaties that would have supported the sort of penalties they faced? — JosephS

Ok, so here is where I will argue they were under a social contract of sorts. After WW1, the Geneva Convention was created (established? passed? ratified? - too lazy to google). About the same time a declarations of the rights of man was added to a type of international law. Now, I have never signed anything saying I will not steal and murder, but social contract suggests I am still subject to those laws. In the same way, whether or not the Nazis acknowledged and signed onto the Geneva Convention and international law, the mere fact of their existence would suggest a type of social contract.

I was hoping that this was going to be a proposal on how we could augment/modify our ex post facto jurisprudence in the wake of monstrous harm. — JosephS

I would be somewhat interested in this discussion, but I am not totally convinced that new laws were needed to convict the Nazis or Purdue Pharma. If the Geneva Convention covers the treatment of POWs, then it should cover the people killed during the holocaust. Surely genocide is a one sided war (in fact, "one sided war" seems like "ethnic cleansing" in that it is too nice of a term for "genocide")? Were the Jews "the enemy" or German citizens? In the Germans own words they were defined as the enemy, so the Geneva convention should apply. Just because they never fought back, doesn't change the fact that they were in a war. Obviously, this is just one way of interpreting things. But I similarly think murder/assault laws could be interpreted in a way that they apply to Purdue. If it is murder for a person to slowly poison their spouse to death over several years, then why can't that same interpretation of the law be applied to Purdue? I think it would be more a matter of setting precedent, vs actually needing new laws.

As your legal understanding of things seems a good deal ahead of mine, I am interested to hear where this seems wrong to you (or maybe you can point to something that show it unquestionably wrong :grimace:).

And I am happy to engage with the discussion you were hoping to have...but I may not make a great foil (you will certainly have to take the lead). I have a decent grasp of history, but much less so with the law.

The Sackler family (owners of Purdue) were the beneficiaries of the company's (family's) pursuit of profit. They are multi-billionaires. Yes, they should be punished by stripping them of their ill-gained wealth.

HOWEVER: The Sackler family didn't personally push drugs onto potential and already addicted people. Quite a few doctors (some operating out of store-front "pain clinics") are accessories. So are insurance companies. So are distributors. They too should be subject to punishment.

I'm not at all opposed to the use of narcotics for the relief of pain. The stuff works for many types of pain.

I'm not a physician or nurse or medical professional. However, I have known for a long time that narcotics are addictive. How did it come as a surprise to physicians that the narcotics they were prescribing were likely to addict? I don't care what drug salesmen told the doctors: It is just axiomatic that people's bodies develop tolerance for opioids over time. "Drug tolerance" is the key to addiction. As time goes on, a given dose produces less effect, so the dose is increased. It's a cycle leading to dependency that is very hard to overcome.

Most people who have taken opioids for pain have not experienced such a pleasant effect from the drugs that they return for more, again and again. They stop taking the drugs as soon as pain diminishes. There is a subset of people for whom opioids (and maybe other drugs like nicotine, alcohol...) produce pleasures which they can not resist. They are dead-ringers for addiction. This is not a recently discovered phenomenon.

So are insurance companies. So are distributors. They too should be subject to punishment. — Bitter Crank

Yep, entirely agreed. FOR ME, anyone that can be shown to be part of the cause, are in some way responsible, and should be punished in some way (a fine that is less than money earned is no punishment at all, it is a type of reward). Now, I can admit that many (certainly not all) of those involved may not have known about the harms (although like you said, doctors obviously knew better) they were causing. So, they should be punished LESS, but still punished (and by punished, I simply mean "deterred from similarly harming others in the future" - if we want to lock all the rich people in their mansions, I am fine with that as long as they are no longer allowed to interact with the rest of us - for any not super-rich doctors, they could just be no longer allowed to practice medicine).

Most people who have taken opioids for pain have not experienced such a pleasant effect from the drugs that they return for more, again and again. They stop taking the drugs as soon as pain diminishes. There is a subset of people for whom opioids (and maybe other drugs like nicotine, alcohol...) produce pleasures which they can not resist. They are dead-ringers for addiction. This is not a recently discovered phenomenon. — Bitter Crank

This all seems reasonable (I guess that is a given from BitterCrank), but I can't tell what exactly your position is (possibly because I did not make the OP clear enough). Is it all just too complicated to say "those responsible should be punished"? If we can say they should be punished, what should the punishment be?

The point of severe retributive justice is to insure that a person committing a capital crime doesn't, and can't, re-offend.

For a corporation severe retributive punishment serves the same purpose: to make sure that agents who operated the corporation can not again engage in conspiracies which caused great harm to large numbers of people.

One of the teams prosecuting Purdue said that it was essential that the Purdue company be dissolved and the Sackler Family stripped of its wealth. The reason, he said, is that we need to make sure that Purdue and the Sacklers don't just move their operation overseas and continue to do to people in the third world what they have done to people in the United States.

The Sacklers / Purdue conducted a particularly cynical operation--NOT in the production of opiates, but in the marketing, promotion, and distribution of Opiates. Drug distributors know about how much opiate drugs will normally be purchased in a given county. If the amount sold is 5, 10, or 20 times the normal amount, it is probably because somebody is freely writing opiate Rx. Sure enough: some "pain clinics" were producing an extraordinary volume of opiate sales.

Above board doctors do not normally over-supply patients with opiates, for several reasons. One is that opiates may be used for suicide. Two, the opiates are easy to sell on the street. Three is that patients who take opiates for an extended period of time (needed or not) are likely to be addicted. Fourth, and not the least reason, is for recklessly handing out narcotic Rx a doctor may lose his license to practice.

A fair amount of corruption has to be in place for the drug producer, distributor, clinic, doctor, and druggist to be able to move very large quantities of narcotic drugs. We can rest assured that where opiate overdoses are resulting in sharp increases in ODs, the problem is stacked up several layers deep.

The point of severe retributive justice is to insure that a person committing a capital crime doesn't, and can't, re-offend. — Bitter Crank

uh oh, I don't understand all types of justice, but I thought I knew retributive. I thought it was JUST about making the violator suffer...like hell. I thought the prevention of future offenses was a different type of justice (is that even still under the realm of 'justice'?).

For a corporation severe retributive punishment serves the same purpose: to make sure that agents who operated the corporation can not again engage in conspiracies which caused great harm to large numbers of people. — Bitter Crank

Yes, besides my understanding (misunderstanding?) of 'retributive', this is what I want to be the result.

One of the teams prosecuting Purdue said that it was essential that the Purdue company be dissolved and the Sackler Family stripped of its wealth. The reason, he said, is that we need to make sure that Purdue and the Sacklers don't just move their operation overseas and continue to do to people in the third world what they have done to people in the United States. — Bitter Crank

I worry that there is a LOT they can do besides continuing to profit from dangerous prescription drugs, that could cause harm to others. They have demonstrated that they will blatantly place profits over the well-being of their fellow humans, so they should no longer be allowed to 'make profits'. I may allow them to play in the stock market a little, but even there I am not sure. And yes, I am aware that this line of thinking would implicate MANY people in our capitalist society. However, the punishment should match the degree of the misbehavior, so a car salesman that gets some 'sucker' to pay $3,000 for 'undercoating' would just be fined (yes, I get I am describing some outlandishly different society, but I am just trying to see where the ideas are wrong or unfair...you have had success in the past at talking me out of my authoritative leanings).

The Sacklers / Purdue conducted a particularly cynical operation--NOT in the production of opiates, but in the marketing, promotion, and distribution of Opiates. — Bitter Crank

And this is part of why they are MORE responsible in my eyes. I even remember the way they tried to categorize their 'customers' as dangerous addicts to avoid any responsibility for their addiction.

Sure enough: some "pain clinics" were producing an extraordinary volume of opiate sales. — Bitter Crank

Yes, I remember individual doctors prescribing individual patients ridiculously high doses (like 20 pills a day or something...unfortunately I think I learned the most on this topic from "The Daily Show', which suggests the depth of my knowledge is rather limited).

Above board doctors do not normally over-supply patients with opiates, for several reasons. One is that opiates may be used for suicide. Two, the opiates are easy to sell on the street. Three is that patients who take opiates for an extended period of time (needed or not) are likely to be addicted. Fourth, and not the least reason, is for recklessly handing out narcotic Rx a doctor may lose his license to practice.

A fair amount of corruption has to be in place for the drug producer, distributor, clinic, doctor, and druggist to be able to move very large quantities of narcotic drugs. We can rest assured that where opiate overdoses are resulting in sharp increases in ODs, the problem is stacked up several layers deep. — Bitter Crank

Your knowledge on this subject clearly beats mine, but everything you are saying is in line with my frustration. I am very interested in your direct response to 'ideally, what would be the punishment for this crime?' In using the word 'ideally' I do not expect an immediately practical solution (for example, when it comes to gun control, 'ideally' 99% of the 300,000,000 guns in this county would be confiscated and destroyed...but, practically, I am not convinced it would be worth the Civil War that would inevitably erupt (in the US)).

practically, I am not convinced it would be worth the Civil War that would inevitably erupt — ZhouBoTong

Exactly. There are any number of great ideas that will die in the cradle.

"Ideally" we would not have the kind of economy where vital goods were under the control of private individuals whose motives were monetary. The major pharmaceutical companies directors are "not interested" in research and development for new antibiotics because there just aren't enough repeat sales for high profits. Better to invent a drug for conditions which will be required for decade--like blood pressure, high cholesterol, glaucoma, and so on.

In a more reasonable economy, the government would quite sensibly say to the drug companies, "What do you mean -- 'you are not interested in new antibiotics'? Either you "get interested pretty damn quick" or it's off with your head!" In an ideal economy, pharmaceutical researchers would focus on established needs rather than profit.

It will probably take a civil war to get from "for profit production" to "for need production".

Restorative and/or redistributive justice is a desirable approach. But it is difficult to apply restoration to really major criminal acts. There are many environmental crimes that have been committed, but the effects are so pervasive that restorative justice is difficult to imagine. Exposing workers to asbestos after it was known that such exposure caused disease is criminal, but beyond bankrupting the companies (Johns Manville was bankrupted and later reorganized) what can reasonably be done?

It's a civil war inducing problem. The foundation of corporate America is "limited liability". The stockholders of a company are not liable for wrong-doing (or negligence, carelessness, disaster, collapse, etc.) by the company. They are 'legally safe'. Stripping protection from legal liability for the behavior of one's source of wealth would cause corporations to be a hell of a lot more careful, but... civil war again.

Nobody from the company went to jail for the the people killed in Bhopal, India. An event at a Union Carbide pesticide plant (surrounded by a neighborhood of about 600,000 people) on 12/2/1984 released 40 tonnes of toxic methyl isocyanate gas, a pesticide. About 3,700 were killed immediately; more died in the following months and years. As many as 15,000 people may have bee killed (if one includes delayed fatal diseases caused by exposure to the poison).

Adequate restorative justice for so much death and damage is difficult to imagine. I'm not sure what sort of punitive justice would be adequate, but it seems like a thorough-going transfer of wealth from the company and stockholders would be a good start.

Adequate restorative justice for so much death and damage is difficult to imagine. — Bitter Crank

I would be happy (well short-term satisfied anyway) if new rules are put in place that change things going forward...even if there is no (or little) attempt at restoration. But as you have said,

It will probably take a civil war to get from "for profit production" to "for need production". — Bitter Crank

, which is likely a big part of the "rules" I am referring to.

I think a lot of the problems you are describing are bigger than just the resistance to socialism that exists in the US (I am not trying to suggest you were not aware of this). Far more socialist-leaning countries in Europe are still going to have LLCs, and just people in general looking to exploit any legal loophole in search of profit...but I feel they are closer to a "tipping point" (they certainly seem much more on board with collectivism in general). However, my perspective is limited. You have a few more years on the planet than I, so here is a question (or 3):

Relative to other times in your life, are we closer or farther today from the types of massive changes it seems we both would approve of? My understanding of US history at least suggests communism was more popular in the first half of the 1900s. And most people at the time certainly seemed to approve of FDRs massive expansion of the role of government. I believe that unions were strong and a positive force until Reagan...does that seem right? But I feel like from Reagan/Thatcher until rather recently, things were heading in the opposite direction with corporations and individualism being the dominant forces (for dems and repubs). Today, we get a lot lip service on 'socialism', but do you actually feel that progress is being made?

I guess if the changes I hope for require Civil War, then that suggests we are no closer or further than ever, as very few people will feel Civil War is a good solution. Do you think there are other countries that can make these changes without Civil War? Or has globalism created an all or none environment?

I think we are farther away now. There are reasons.

#1, the post-WWII economic boom ended in the early 1970s. For the working classes (85-90% of the population) economic conditions have declined since then. Stagnant wages and steady inflation (at times quite high) have whittled away a large share of the prosperity that working class people enjoyed between 1946 and 1973.

Booms don't last, of course. The business cycle rises and falls.

#2. there has been a concerted effort to roll back union power for the last 40 - 60 years. A good share of labor suppression has been through law. For example, the 'Taft-Hartley' law was passed in 1947 over the veto of President Truman. It restricts union activity. A lot of other less famous laws and administrative rules restricting workers rights have been put into place. If labor is hobbled (or castrated), then that sets the whole progressive agenda back a long ways.

#3. Conservatives were unhappy about Social Security, Unemployment, and Disability programs (1930s), and challenged the programs in court. They hated Medicare and Medicaid (1960s) and did their best to get those programs ruled unconstitutional. They failed. In the 1990s the old AFDC program (aid for dependent children) program was repealed--"ending welfare as we know it". Welfare recipients were given a time limit on benefits. About the same time there was a drive to privatize Social Security. This idea is rolled out every couple decades or so. Obama's Health Care Act was received by many people as if it had been delivered from Hell by Satan himself, and for whatever it was actually worth, it was set upon by the Republicans.

Trump (curse his black heart) wants to undo all sorts of environmental regulation too. "Get government off our backs" they said.

So yes, I think we are farther away from substantial reform now than we were during Nixon's administration.

Like a lot of people in the United States, I grew up with pretty optimistic expectations about the future. Those started to change during the Vietnam War when we saw that major social unrest (huge demonstrations, etc.) didn't make any difference. Watergate was very disappointing -- here we discovered that the President and his inner circle were doing things that were both blatantly criminal and unconstitutional. Successive administrations and changing economics have further eroded those optimistic expectations.

However, the US isn't alone in all this. I think a lot of people in other countries have also had very disappointing experiences in the last 50 years. The US isn't an exception to the rest of the world.

So yes, I think we are farther away from substantial reform now than we were during Nixon's administration. — Bitter Crank

That is the feeling I have been getting. Despite all the people 'feeling the Bern', It seems that people (like me) are unwilling to sacrifice convenience...so major change is unlikely.

Conservatives were unhappy about Social Security, Unemployment, and Disability programs (1930s), and challenged the programs in court. — Bitter Crank

Indeed, they still seem to oppose any measures designed to stop people from dying in the gutters, along with any sentiments that suggest they had help in becoming the "incredible" people that they are.

However, the US isn't alone in all this. I think a lot of people in other countries have also had very disappointing experiences in the last 50 years. The US isn't an exception to the rest of the world. — Bitter Crank

Do you believe that massive political change is possible? The older I get, the more I worry that massive political change would require such a huge change in worldview for most people, that they are unwilling to even consider the possibility. Am I just seeing the result of the last 40+ years of "individualism good, government bad"? It feels like more than that, but maybe I am a product of the last 40 years. Individualism seems like free will in that it automatically seems true until you do research...and MOST humans are generally opposed to 'doing research', unless it is about their favorite celebrity couple.

Do you believe that massive political change is possible? The older I get, the more I worry that massive political change would require such a huge change in worldview for most people, that they are unwilling to even consider the possibility. — ZhouBoTong

Of course massive political change is possible. "Possible" does not mean "probable". Massive political change seems quite improbable, unlikely, remote, etc. It will probably take something like Arthur C. Clarke's CHILDHOOD'S END to trigger massive political change. Have you read it? Great story. Aliens arrive and things start to change.

Short of that...

I am a product of the last 40 years — ZhouBoTong

All of us are products of and captives in our own times and places. There just isn't any way around that. What saves us all from irrelevance is that our own time and place generally works by the same rules that most other people's times and places work.

What will happen? Man... I wish I knew!

I'd have to read more about it, but what did Perdue Pharma do that should make them liable for anything?

I could see if they knew there was a risk of physical addiction but they didn't let physicians know this. But is that the case?

If they did let physicians know it, then it would be up to physicians to inform their patients, and then it's up to the patients to take the risk or not.

What I have gathered from the news [NYT for example is that Purdue Pharma (and the Sackler family) did two things:

1) they misrepresented oxycontin as "less addictive"
2) and "less likely to be abused"
3) and they promoted the drug very vigorously
4) for two decades

when, in fact, the company was aware from 1996 that oxycontin was as addictive as any other opiate and immediately became a drug-of-choice for addicts (it could be crushed and snorted, like cocaine).

It isn't clear to me how a high-dose opiate could be described as "less addictive"; opiates are by definition "addictive", and anybody in the medical field with a pulse knows that. (Opioids are addictive because opioid receptors in the brain become tolerant to the drug fairly quickly; this results in a need for more of the drug to achieve the same effects as previously. When used for terminal cancer or other patients, addiction is irrelevant. For young-to-middle-aged-chronic-pain-relief-patients (such as pain resulting from bone/joint injury or arthritis patients) addictiveness is a major issue.

Oxycontin became a street drug at once -- because the tablets could be easily re-sold, then crushed and snorted in several sessions--like cocaine.

Purdue Pharma became immediately aware of all this soon after the drug was introduced. Salesmen's reports from doctors reported street sales. Despite known abuse, the company continued intense promotion of the drug.

Drug companies and distributors know about how much of a drug a given pharmacy is likely to sell, and likewise how much of a drug a given community or county is likely to need. When sales from pharmacies, and in specific communities or counties grossly exceed expected use, abuse is obviously afoot.

There is nothing wrong with opioids; they are critically important drugs. They just happen to be addictive, and manufacturers, distributors, pharmacies, and doctors have to be alert to abuse.

Purdue Pharma, wholly owned by the Sackler family, apparently decided to make the most of abuse.

in addition to all that, there were bogus 'pain clinics' and cooperating pharmacies moving huge quantities of Oxytocin.

What I have gathered from the news [NYT for example is that Purdue Pharma (and the Sackler family) did two things:

1) they misrepresented oxycontin as "less addictive"
2) and "less likely to be abused"
3) and they promoted the drug very vigorously
4) for two decades

when, in fact, the company was aware from 1996 that oxycontin was as addictive as any other opiate — Bitter Crank

If that's the case, yeah, I'd agree that it's a type of contractual fraud.

But wouldn't it have been pretty soon apparent in the medical community that it's not less addictive? (If not immediately obvious because of what you're saying re "It isn't clear to me how a high-dose opiate could be described as 'less addictive')

It has been known for several decades that doctors (who are not pharmacists) rely heavily on drug salesmen (who are not pharmacists, either) for their information about a drug's effectiveness, appropriate targets, and side effects. Salesmen have an obvious bias. Apparently a lot of doctors were just taking salesmen's word for it.

Still, a lot of untrained, non-medical people know that opioids are addicting. It's a very good question as to why a doctor wouldn't know that too. But then, most people don't have patients sitting in the office complaining about bad pain and asking their doctors for relief.

Another factor is 'doctor shopping' and pharmacy shopping. Once an opioid seeker has exhausted the trust of one doctor, they go looking for another. Once one pharmacy has been "burned down" (refused to fill any more Rx for opiates) an opioid seeker looks for different pharmacies. The State does not keep track of Rx, so doesn't know that a patient has filled maybe 15 doctors' prescriptions several times. The "pain clinics" (fake ones) don't give a rat's ass about how much drug a patient is getting, as long as the "patient" keeps revenue flowing.

You know, if you like downers like heroin, morphine, codeine, oxycontin, Xanax, Ativan, Valium or whatever... you have to either get it through illegal suppliers (aka pushers) or from licensed providers (aka doctors). The doctor-pusher route gives you safe, clean, and wholesome products (until they get cut on the street). Uppers are available too, both ways.

People think the FDA is highly proactive and very thorough. They are not. (They get their marching orders from authorizing legislation.). New drugs arrive on the market with a minimal amount of human testing. So what happens? The public becomes the test group. The new arthritis or depression or weight loss or heart medication or whatever is approved for sale, promoted to doctors, and then prescribed. Drug companies collect adverse outcome information, but their threshold of concern might be a lot higher than yours. The drug companies react most strongly to people dropping dead. "Oh dear, corpses. Very bad PR." A drug that just doesn't work very well, or causes adverse outcomes that take maybe two to five years to show up doesn't amount to shit hitting the fan. Negative outcomes that can be blamed on the patient (the case of opioids) are the patient's problem, not the drug company's.

Opinions vary on just how bad the medical establishment is. It's at least a mixed bag.

I think Bitter Crank will better provide the facts of this particular case, but I just want to get at what I see as potential implications of your comments (which I am sure to have interpreted wrong, haha).

I'd have to read more about it, but what did Perdue Pharma do that should make them liable for anything? — Terrapin Station

If they did let physicians know it, then it would be up to physicians to inform their patients, and then it's up to the patients to take the risk or not. — Terrapin Station

But wouldn't it have been pretty soon apparent in the medical community that it's not less addictive? — Terrapin Station

A quick hypothetical, as I think I disagree with what you are getting at here:

Imagine that I created a drug, that made many people feel better than they have or believe they ever could in the future. The drug is extraordinarily addictive, but it only has 1 side effect - that being that on your 100th dose, you die...no way around it. Then, I marketed this as the most amazing drug ever, but filled it with bright warnings that said it is HUGELY addictive and IT WILL KILL YOU on your 100th dose. I made the warnings obvious and clear on any and all mentions of the product (in every conceivable language and mode of communication).

Are you saying WHEN millions of people die that I am in no way liable because they knew what they were getting into? We all admit that children can't be responsible for their decisions, what makes most adults any better? What is the line between a child's mind and an adult's? Is it an age? An education level? A genetic marker (I just include this to suggest that SOME children WILL make better decisions than adults)?

You have WAY more faith in people than I do (or maybe you just like the idea of thinning the herd, haha). I think the drug I described above would kill half the planet, QUICKLY (assuming they all had access to the drug). And if I profit massively from their deaths, even if I was honest about how I would do it, that seems a problem to me (notice I would still consider it a problem if I did not profit at all).

I think this all ties to me being largely a consequentialist. If thousands of people died, who would not have died if the drug companies were not producing massive amounts of unnecessary drugs, then the drug companies are responsible (that doesn't mean they are ENTIRELY responsible).

Sorry, I did delete some stuff, still too long :grimace:

Medical doctors seem like pretty good people, for the most part. There are a minority, let's say 10%, who are incompetent, insensitive, irresponsible, etc. Eventually the worst cases get weeded out, but new incompetents fill in the empty slots. Still 90% of doctors are competent, sensitive, responsible, and caring individuals.

As you know, the medical industry is a huge sector of the economy. It is inconceivable that bad things will never happen even under the best of circumstances. Patients get infections in hospitals and die; they get the wrong medicine and die; they get the wrong treatment and die; they have the wrong foot amputated, are misdiagnosed; some patients are prescribed opiates and they get addicted. etc. etc. etc. But the bad news is dwarfed by all the effective treatment, good care, and cures people receive.

That this huge system is occasionally subverted should not come as too big a surprise.

Hey doc, sounds great. How long does the effect of a dose last? How many years can one stretch out the 100 doses?

Are you saying WHEN millions of people die that I am in no way liable because they knew what they were getting into? — ZhouBoTong

Correct. It's not even an issue. The people who took the drug made a decision to take it.

We all admit that children can't be responsible for their decisions, what makes most adults any better? — ZhouBoTong

I don't agree with the first part of that, even, but if we were to agree with the second part, then you certainly can't make the drug manufacturer or anyone else in the world responsible for any decision they make.

You have WAY more faith in people than I do (or maybe you just like the idea of thinning the herd, haha). — ZhouBoTong

Definitely some people would take the drug and wind up killing themselves. I think it's "evil" to not allow people to make those decisions. People should be allowed to do whatever they consensually decide to do. If you think that anyone has a right to make decisions for other people re what they should be allowed to do, then you don't think that no one is capable of making decisions about what people should be allowed to do. What would make some people capable of that and not others? Is the deciding factor your own views/whether people agree with you?

Why do you believe that you should be able to decide for others that they shouldn't be allowed to decide to risk and take their own lives this way?

Hey doc, sounds great. How long does the effect of a dose last? How many years can one stretch out the 100 doses? — Bitter Crank

Haha, yes for the cautious and meticulous person that enjoys the occasional head change, life just got better. Although not that amazing, the doses do not last more than a day (are there any drugs yet that noticeably last longer than that?) But yes, you could spread out the doses at will...but if you hit #100, you die.

We all admit that children can't be responsible for their decisions, what makes most adults any better?
— ZhouBoTong

I don't agree with the first part of that — Terrapin Station

Well, that answers that. This looks like another one of those cases where our worldviews are too different to expect reconciliation.

Why do you believe that you should be able to decide for others that they shouldn't be allowed to decide to risk and take their own lives this way? — Terrapin Station

Because I know, for sure, that huge numbers will die. Also, I don't believe in free will. So they weren't really "deciding for themselves"...they were pre-programmed to make certain decisions, and I would be wrong to exploit that.

Because I feel we probably hugely disagree, what percent of humans on the planet do you think would be dead within the next decade, assuming they all had access to this drug whenever they wanted it? (I know your answer to this does not affect your logic or your position in general, I am just interested) Like I said, I think half the planet would be dead.