Tag Archives: Drug

Marijuana for Millionaires

by JorjaHartigan Posted on November 1, 2015

Mother Jones

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Yesterday a friend emailed to ask if I had any thoughts about Ohio’s Issue 3, which would fully legalize marijuana cultivation and sale in the state. Ohio? I barely pay attention to California, let alone Ohio.

But Issue 3 turns out to be surprisingly fascinating—or venal and repellent, depending on your tolerance for sleaze. Apparently one of the authors of the initiative came across a Rand report on marijuana written by a bevy of drug-policy worthies, and it offered up a dozen possible options for legalization. One of them is called “structured oligopoly”:

It is natural to ask whether there is some way to get for-profit businesses to behave in the public interest. The answer is “Perhaps.”

….States might prefer [] to offer only a limited number of licenses, creating artificial scarcity that makes the licenses valuable—valuable enough that firms will have a strong incentive to cooperate with regulators rather than risk revocation….Limiting the number of licensees also makes monitoring their behavior easier. A rogue company could more easily break the rules if it were one of 1,000 licensees than if it were one of just ten.

….So a structured-oligopoly strategy might involve licensing a limited number of firms, monitoring them closely, and not being shy about rescinding a firm’s license if it behaves in ways contrary to the public interest.

This might not be your cup of tea, but let’s stipulate that it has some potential. How would you distribute these licenses? The straightforward approach is to auction them off for set periods. Unfortunately, this has a big drawback: it maximizes the payment for licenses, and thus minimizes the profit of the oligopolists. This is obviously vexing.

So how about this instead? Pick out ten rich friends. Each is required to put up $2 million to help pass a ballot initiative. In return, you promise to write the names of the investors directly into the initiative, giving them a perpetual and exclusive right to grow marijuana in the state of Ohio.1 In addition, you write a special, unalterable flat tax rate into the law, as well as a minuscule annual licensing fee. Now that’s an oligopoly you can believe in! Keith Humphreys, who brought this to my attention, has a few comments:

It has taken the alcohol industry decades of lobbying to roll back many of the restrictive, public health-oriented regulations established after the end of Prohibition. Booze industry executives must look with envy upon the emerging marijuana industry, which can use the ballot initiative process to achieve complete regulatory capture from day one.

….No one should be surprised that in a country with an entrepreneurial culture, a commitment to free markets, and a political system highly attuned to corporate donations, legalized marijuana would develop a significant corporate presence. Indeed, many drug policy analysts, including me, expected this to happen eventually. But the rate at which the change is happening is truly startling, and will become even more so if the Ohio initiative passes.

If the marijuana industry ends up being a clone of the tobacco industry, will legalization supporters experience buyers’ remorse? It depends who you ask.

Well, you could ask me. I don’t care what they’re legalizing. This stinks. It’s crony capitalism without even a veneer of decency, and if it applied to anything else nobody would have the gall to ever let it see the light of day. If this is the price of pot legalization, count me out.

1Technically, no names are actually in the initiative. Instead, it limits marijuana cultivation to ten specific parcels of land that are owned by the ten investors. Also, individuals are allowed to cultivate small amounts for their own recreational use if they get a license.

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Marijuana for Millionaires

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While You Were Watching Donald Trump, Bernie Sanders Just Called for Legalizing Weed

by GusBelstead Posted on October 29, 2015

Mother Jones

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You may have missed Bernie Sanders’ town hall at Virginia’s George Mason University on Wednesday as the GOP presidential contenders duked it out in Boulder, Colorado. But he made some news. Sanders called for the full decriminalization of marijuana at the federal level, a move that would allow states to regulate the drug the same way they handle alcohol or tobacco. “Right now marijuana is listed by the federal government as a schedule-one drug, meaning that it is considered to be as dangerous as heroin,” Sanders said. “That is absurd.”

Sanders, while touting the possible civic benefits of decriminalization (such as providing a funding stream, through taxation, for treatment of more dangerous substances such as opioids) took pains to frame legalization as a matter of racial justice:

Let us be clear, as is the case in many other areas, that there is a racial component to this situation. Although about the same proportion of blacks and whites use marijuana, a black person is almost four times more likely to be arrested for marijuana possession than a white person. Too many Americans have seen their lives destroyed because they have criminal records because of marijuana use. That is wrong. That has got to change…A criminal record could include not only time in jail, but a criminal record makes it harder for a person to get a job, harder for a person to get public benefits, harder for a person to even get housing. A criminal record stays with a person for his or her entire life.

The legalization he proposed would also eliminate one of the roadblocks to decriminalization in places such as Washington state or Colorado, by allowing marijuana distributors to use the banking system like any other business.

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While You Were Watching Donald Trump, Bernie Sanders Just Called for Legalizing Weed

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It’s Really Hard Not to Hate the Pharmaceutical Industry

by AngieKerns Posted on September 28, 2015

Mother Jones

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Another day, another drug. Today comes news of Nitropress, a generic blood pressure drug that was priced at $44 per vial way back in 2013. Then it was sold to Marathon Pharmaceuticals, which raised the price to $257. A few months ago it was sold yet again, this time to Valeant Pharmaceuticals, which raised the price to $806. But no worries! According to a spokesman, no one will ever be denied this medication:

“These are drugs that are only used by hospitals — they are not sold in pharmacies — in accordance with specific surgical procedures. This means that whenever the protocol calls for use of these drugs, they are used. Patients are never denied these drugs when the protocols call for their use.”

And there you have it. Hospitals have to use it, and no one else makes it, so Valeant can charge whatever they want. Satisfied?

Anyway, Democrats are “demanding answers” from Valeant, which will probably do about as much good as it did when they demanded answers from Marathon last year about their price increase. Or all the other companies they’ve demanded answers from ever since 10x price increases became the pharmaceutical industry’s favorite new sport. That is to say, none.

It’s a funny thing. I’ve probably read just about every reason in the book explaining why national health care is supposed to be a terrible idea. Most of these reasons are pretty lousy—either unsupported by the evidence or else directly contradicted by it. But there’s one exception: the argument that a national health care plan would drive down the price of drugs—as it has everywhere else in the world—and this would stifle innovation in the pharmaceutical biz. There’s some real merit to this claim.

It’s not quite that simple, of course, and it would take a longish post to go through this topic in detail. Nonetheless, you can put me in the camp of those who want to tread pretty carefully when it comes to regulating pharmaceutical pricing. But these guys are sure making it hard to maintain that position, aren’t they?

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It’s Really Hard Not to Hate the Pharmaceutical Industry

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How Much Is 1.6 Months of Life Worth?

by kfjghgjkjkfdsgfdsdfdsflok Posted on August 27, 2015

Mother Jones

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From Carolyn Johnson at Wonkblog:

With some cancer drug prices soaring past $10,000 a month….

Hey, that’s me! A friendly FedEx delivery person just delivered this month’s $10,000 supply to me an hour ago. So, what’s up?

With some cancer drug prices soaring past $10,000 a month, doctors have begun to ask one nagging question: Do drug prices correctly reflect the value they bring to patients by extending or improving their lives?

A study published Thursday in JAMA Oncology aims to answer that question by examining necitumumab, an experimental lung cancer drug….in a clinical trial, researchers found that adding the drug to chemotherapy extended life by 1.6 months, on average.

….In order to estimate what the price of this drug “should” be based on its value to patients, the research team modeled various scenarios….one additional year in perfect health in the U.S. is worth somewhere between $50,000 and $200,000….Based on their calculations, the drug should cost from $563 to $1,309 for a three-week cycle.

….There are many variables that go into the price of a drug, but mounting evidence suggests that the value it brings to patients is not the biggest factor. “How they price the drug is they price it at whatever the market is willing to bear,” said Benjamn Djulbegovic, an oncologist at the University of South Florida.

Well, sure, but this raises the question of why the market is willing to bear such high prices. Why would an insurance company approve a large expenditure for a drug that has only a tiny benefit?

There’s a lot that goes into this. Obviously some people benefit from necitumumab by a lot more than 1.6 months—and there’s no way to tell beforehand who will and who won’t. And it costs a lot to develop these drugs. And patients put a lot of pressure on insurers to cover anything that might help. And, in the end, insurance companies don’t have a ton of incentive to push back: if drug prices go up, they increase their premiums. It doesn’t really affect their bottom line much.

There’s also the size of the total market to consider. The chemo drug I’m currently taking, for example, is only used for two conditions. There’s just not a whole lot of us using it. In cases like that, a drug is going to be pretty expensive.

But here’s something I’m curious about: who puts more pressure on insurance companies to cover expensive drugs, patients or doctors? My doctor, for example, was totally gung-ho about my current med. I was much less so after I read some of the clinical studies online. Why? Because most chemo drugs have unpleasant side effects (though mine has turned out OK so far), which means that, like many patients, I’m reluctant to take them unless the benefit is pretty clear cut. Doctors, on the other hand, just want to do whatever they can to help, and have no particular incentive to hold back. So maybe it’s doctors who need to be in the forefront of pushing back on expensive drugs. They’re the ones in the doctor-patient relationship who know the most, after all.

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How Much Is 1.6 Months of Life Worth?

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The Scary Law That Allowed Pharmacists to Deny This Woman the Drugs She Needed After Her Miscarriage

by John Graham Posted on April 16, 2015

Mother Jones

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When Brittany Cartrett lost her pregnancy in March, her doctor prescribed Misoprostol to help her complete the miscarriage. The drug, which would allow her to avoid a more invasive surgical procedure, is the same one used to induce many abortions. Which is why, Cartrett suspects, two different pharmacies in central Georgia refused to fill her prescription.

Cartrett slammed one of those pharmacies, the Walmart in Milledgeville, Georgia, in a Facebook post published last week. When she asked the pharmacist why she wouldn’t fill her prescription, Cartrett claims, “She looks at me over her nose and says, ‘Because I couldn’t think of a reason why you would need that prescription.'” Cartrett says she then explained that she’d had a miscarriage, and the pharmacist replied, “I don’t feel like there is a reason why you would need it, so we refused to fill it.”

Cartrett is blaming the incident on a law, passed 15 years ago, that guarantees pharmacists the right to refuse to provide contraceptives or abortifacients on religious or conscientious grounds. Georgia is one of six states with such a law on the books. Six other states have broad “refusal clauses,” as they are known, that don’t specifically mention pharmacists but would likely protect them in the event of legal action, according to the Guttmacher Institute, a pro-abortion-rights think tank.

Walmart, however, disputes that its pharmacist refused to fill the prescription on principal. She refused, says Brian Nick, a company spokesman, because the prescription did not follow FDA guidelines.

“The customer had a specific theory as to why the drug wasn’t filled, which gets into what some call the conscience clause,” Nick told Mother Jones. “The reality at the store level is that the pharmacist had a professional judgment call against filling the prescription, not any other reason. They’re well within their rights, the pharmacists, to not agree that a specific prescription should be filled.”

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The Scary Law That Allowed Pharmacists to Deny This Woman the Drugs She Needed After Her Miscarriage

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Someone Needs to Invent a Great Non-Opioid Painkiller

by JulianaWillifor Posted on December 22, 2014

Mother Jones

Austin Frakt writes about the stunningly widespread use and abuse of narcotic painkillers in the US:

Opioids now cause more deaths than any other drug, more than 16,000 in 2010. That year, the combination of hydrocodone and acetaminophen became the most prescribed medication in the United States. Patients here consumed 99 percent of the world’s hydrocodone, the opioid in Vicodin. They also consumed 80 percent of the world’s oxycodone, present in Percocet and OxyContin, and 65 percent of the world’s hydromorphone, the key ingredient in Dilaudid, in 2010. (Some opioids are also used to treat coughs, but that use doesn’t seem to be a major factor in the current wave of problems.)

When I got out of the hospital a couple of months ago, I was in considerable pain. The answer was morphine. For about two weeks, I took a couple of low-dose morphine tablets each day. Then the pain eased and I stopped.

I resisted the morphine at first, and my doctor had to argue me into using it regularly. “You broke a bone in your back,” she told me. “Your pain is legitimate. We have a lot of experience treating pain with morphine, and you’ll be all right.”

I finally listened, and the morphine did indeed work as advertised. But it somehow got me thinking. Morphine? That’s the best we can do? This stuff was invented 200 years ago. And while there are newer painkillers around, they’re all opioids of one kind or another with all the usual horrible side effects1. How is it that in over a century of research, we still know so little about pain that we haven’t been able to create a powerful, non-opioid painkiller?

I’m not really going anywhere with this. I’m just curious. Are there any good books, or even long magazine articles, about this? Why is that even after gazillions of dollars of effort, we’re still relying on variants of the opium poppy for serious pain relief? It’s the 21st century. How come we can’t do better?

1Addiction, nausea, wooziness, constipation, etc.

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Someone Needs to Invent a Great Non-Opioid Painkiller

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Everyone Loves Charts! Except For Those Who Don’t.

by DonnyLangston Posted on November 28, 2014

Mother Jones

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This post is going to end up being insufferably nerdly, so bear with me. It comes via Justin Wolfers, who tells us about a new study showing that if you present information, it’s more persuasive if it includes a chart. Since my Wikipedia entry says I’m known for “offering original statistical and graphical analysis,” this is thrilling news—especially since I’ve never really believed that my charts have influenced anyone who didn’t already believe what I was saying in the first place.

So let’s go to the source. First off, I love the title of the paper:

Blinded with science: Trivial graphs and formulas increase ad persuasiveness and belief in product efficacy

Trivial graphs! Roger that. And sure enough, the researchers’ first experiment suggests that if you tell people a drug reduces illness by 40 percent, they’re more likely to believe it if you include a bar chart that shows one bar 40 percent lower than the other. Unfortunately, this conclusion comes via a tiny, non-random sample, and the responses are weirdly contradictory. On a scale of 1-9, the chart group rates the drug only slightly more effective than the non-chart group. But on a question that directly asks if the drug works, the chart group is far more positive. What’s up with that?

But this isn’t yet the truly nerdly part. I’m just picking the usual statistical nits. Next up, the researchers tried to find out if the chart group is more persuaded simply because the chart helps them remember the information better. Long story short, that’s not the case. Everyone remembers the information about equally well. But wait: this group is even worse: it’s a tiny, non-random sample of university freshman lab rats, who are very much not typical of the population, especially when it comes to assessing quantitative information. What’s more, assuming I’m interpreting the typo-laden concluding sentence correctly, the chart group displays 79 percent retention vs. 70 percent for the non-chart group. That sure sounds like a possibly significant difference. It’s only the tiny sample size that makes it worthless. But frankly, the tiny sample size probably makes this whole study worthless.

But this still isn’t the truly nerdly part. Here it is, and I’m going to excerpt directly from the study:

Say what? This molecule allegedly has 29 (!) helium atoms? Come on, man. I took one look at that and just laughed. Then I looked at the fake chemical formula, and they got it wrong. It’s got 29 hydrogen atoms. Or does it? Who knows. Now, it’s true that the group for this study was recruited at a shopping mall, and I’ll grant that your average mall rat isn’t too likely to notice this. Still. WTF? That’s at least two typos; a ridiculously small and non-random sample; and contradictory results depending on how the participants were queried.

I’m going to keep using charts because they convey a lot of information efficiently to people who like charts. Plus, I like charts. But are these charts actually persuading anyone of anything? I’m unpersuaded.

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Everyone Loves Charts! Except For Those Who Don’t.

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Would Joe Biden Put His Son In Prison For Doing Coke?

by DollieBrigstock Posted on October 17, 2014

Mother Jones

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So the son of our Vice President was booted from the military for doing coke. This must be an awkward situation for Joe Biden, given his role in cracking down on drug use over the last few decades. Joe Biden created the position of “drug czar,” a key step in the drug war. As the Chairman of the Senate Judiciary Committee in 1986, he played a major role in passing mandatory minimum sentencing guidelines. He was the main sponsor of the RAVE Act in 2003, meant to crack down on MDMA use, which would have held club owners liable for providing “paraphernalia” like glowsticks and water. He still vocally opposes marijuana legalization.

To be clear: Hunter Biden wasn’t caught with actual cocaine. He just failed a drug test. But what if he’d happened to be found with a little bag in his pocket? Would Joe Biden would find it fair for him to serve 87 months, which is the average federal sentence for drug possession?

Of course, were Hunter Biden to be caught with powder cocaine, he would likely fare better than someone caught with crack. To his credit, Joe Biden himself has pushed for reducing the longstanding sentencing disparity between crack and regular cocaine, but possession of 28 grams of crack still triggers a five-year minimum sentence. It takes 500 grams of regular cocaine to trigger the same sentence. That’s an 18-to-one difference. (African Americans make up 83 percent of people convicted for crack offenses, even though the number of white crack users is 40 percent greater than that of black users, according to a National Institute on Drug Abuse study).

America has more prisoners than any other country—a quarter of all people behind bars in the entire world are in US prisons or jails. Nearly half of all federal prisoners are serving sentences for drugs. Many of them won’t have a chance to “regret” their mistakes and move on, as Hunter Biden has said he will.

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Would Joe Biden Put His Son In Prison For Doing Coke?

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Arizona Executioners Had To Use 15 Doses of Lethal Drugs Before Inmate Finally Died

by BrittanM91 Posted on August 2, 2014

Mother Jones

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Documents released Friday afternoon in the case of Arizona’s botched execution of Joseph Wood—who gasped for air and struggled, according to witnesses, repeatedly during the two-hour process—show that executioners used 15 separate doses of a new drug cocktail before Wood finally died. Lawyers had warned that the combination of 50 milligrams hydromorphone (a pain killer) and 50 milligrams of midazolam (a sedative) was rife with potential problems. (The state also has a long history of failing to follow its own protocol.) The documents suggest they were right.

“Instead of the one dose as required under the protocol, ADC injected 15 separate doses of the drug combination, resulting in the most prolonged execution in recent memory,” said Dale Baich, Wood’s lawyer. “This is why an independent investigation by a non-governmental authority is necessary.”

Ohio used a similar drug cocktail in January to execute Dennis McGuire, who gasped and snorted for 25 minutes before finally succumbing, the longest execution in Ohio history. Arizona apparently increased the dosage of midazolam from what Ohio had used, but it doesn’t seem to have gotten any better results.

When officials in Ohio and elsewhere first expressed their intent to experiment with the midazolam/hydromorphone combination, experts predicted, as Mother Jones‘ Molly Redden reported, that little was known about how the new drug combinations would work in executions. She wrote:

Jonathan Groner, a professor of clinical surgery at the Ohio State University College of Medicine who has written extensively on the death penalty, says effects of a hydromorphone overdose include an extreme burning sensation, seizures, hallucination, panic attacks, vomiting, and muscle pain or spasms. David Waisel, an associate professor of anesthesiology at Harvard Medical School, who has testified extensively on capital-punishment methods, adds that a hydromorphone overdose could result in soft tissue collapse—the same phenomenon that causes sleep apnea patients to jerk awake—that an inmate who had been paralyzed would be unable to clear by jerking or coughing. Instead, he could feel as though he were choking to death.

Because hydromorphone is not designed to kill a person, Groner says, there are no clinical guidelines for how to give a lethal overdose. “You’re basically relying on the toxic side effects to kill people while guessing at what levels that occurs,” he explains.

The new Arizona documents suggest that these assessments were dead on.

State officials are using new drug combinations because pharmaceutical companies have been refusing to sell or export the drugs traditionally used in executions. The US has seen a shortage of those drugs for several years now, and death penalty states have gone to increasingly desperate measures to kill their condemned, everything from illegally importing the old drugs to buying them from dubious compounding pharmacies. Arizona illustrated the latest gambit—using new combinations of other available drugs, something critics have called an unethical human experiment.

States have also gone to great lengths to hide information about the drugs they’re using in executions and how they’re getting them. In Arizona, Wood was just the latest of many death row inmates who have tried and failed to force states to be more transparent. The 9th Circuit Court of Appeals sided with Wood in late July and agreed that he had a right to know how he was going to die. But the US Supreme Court overruled that decision and allowed the execution to go forward.

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Arizona Executioners Had To Use 15 Doses of Lethal Drugs Before Inmate Finally Died

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Arizona Is the Latest Front in the War on Abortion Drugs

by CelindaKinchela Posted on April 1, 2014

Mother Jones

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On Tuesday, the nation’s toughest law on abortion drugs took effect in Arizona. The measure—which passed the state legislature in 2012 but was temporarily blocked by a federal lawsuit—requires doctors to prescribe the most common abortion pill, RU468 or mifepristone, exactly as called for on its FDA label, which was approved 14 years ago. Studies by the World Health Organization and independent scientists have since found that the drug works equally well at a third the original dose. It can also be safely used nine weeks into pregnancy, rather than just seven, as the label states. Both the WHO and the American Congress of Obstetricians and Gynecologists have updated their guidelines accordingly, with lower doses and fewer doctors’ visits than suggested by the FDA.

By compelling healthcare providers to stick to the outdated label, Arizona will make medication abortions—which can be performed earlier than other readily available options—more expensive and difficult to access. The Arizona law also requires that a doctor be present when the pills are taken. Women’s health advocates say this will make it impossible for some women in rural areas, where doctors and abortion clinics are scarce, to access abortions at all.

Arizona is hardly the only state to clamp down on abortion drugs. According to the Guttmacher Institute, in recent years at least 39 states have passed bills limiting access. Below is a state-by-state breakdown.

A state-by-state LOOK AT abortion drug restrictions

Hover over a state to see a breakdown of restrictions in place there. Source: Guttmacher Institute.

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Arizona Is the Latest Front in the War on Abortion Drugs

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