Opioids

Clobbering Purdue Pharma Makes Drug Warriors Feel Good, but It Won't Reduce Opioid-Related Deaths

The $8.3 billion DOJ settlement is part of a crackdown that has perversely pushed drug users toward more dangerous substitutes.

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The U.S. Department of Justice today announced an $8.3 billion settlement with OxyContin manufacturer Purdue Pharma, which admitted to lax anti-diversion practices that allowed doctors and pharmacies to distribute its timed-release version of oxycodone far in excess of what was medically appropriate. The misconduct alleged by the government, some of which the company acknowledged in a criminal plea and some of which figured in a lawsuit that has now been settled, includes promoting wider use of OxyContin even when executives knew the legitimate market was saturated, encouraging prescriptions by paying kickbacks to physicians, and disregarding obvious red flags indicating that some distributors, pharmacists, and doctors were doling out pills without regard to medical need.

"Purdue, through greed and violation of the law, prioritized money over the health and well-being of patients," said Steven D'Antuono, assistant director in charge of the FBI's Washington Field Office. "Purdue Pharma actively thwarted the United States' efforts to ensure compliance and prevent diversion," added Tim McDermott, assistant administrator of the Drug Enforcement Administration (DEA).

All of that seems to be true. Yet the commonly accepted idea that Purdue started the "opioid crisis" by introducing OxyContin in 1996 is highly dubious. So is the notion that dissolving the company and forcing it to pay billions of dollars in fines, forfeiture, and a civil settlement will do anything to address the ongoing rise in opioid-related deaths.

In its report on the settlement, The Hill says "OxyContin is widely blamed for starting the country's opioid crisis," which has "killed more than 400,000 Americans over the past two decades." But is OxyContin rightly blamed for that?

Estimates from the National Household Survey on Drug Abuse (now the National Survey on Drug Use and Health) indicate that nonmedical use of prescription pain relievers rose for 11 consecutive years before OxyContin was introduced, then continued to rise. While Purdue portrayed its product, which was designed to release oxycodone gradually, as abuse-resistant, nonmedical users quickly discovered that the original version could be crushed, then snorted or injected. But as appealing as that may have been to some people, OxyContin never accounted for a very large share of the prescription analgesic market.

Defending itself against numerous lawsuits, Purdue presented DEA data indicating that OxyContin accounted for just 3.3 percent of pain pills sold in the United States from 2006 through 2012. After adjusting for potency, ProPublica calculated that the product's "real" share of the market was more like 16 percent.

ProPublica's approach is questionable, assuming the concern is how many opportunities nonmedical users have to get their hands on prescription opioids. But either way, the vast majority of pain reliever prescriptions involve products other than OxyContin, most commonly hydrocodone pills such as Vicodin and oxycodone pills such as Percocet. Those latter two types of products also figure prominently in the pain relievers consumed by nonmedical users, accounting for 75 percent of the total in 2018, according to the federal government's survey data. OxyContin, by comparison, accounted for 11 percent of nonmedical use that year.

Contrary to the conventional depiction of bona fide patients who accidentally become addicted to opioids they take for pain, nonmedical OxyContin users typically do not get the drug that way. According to a 2007 American Journal of Psychiatry study of OxyContin users admitted to drug treatment programs, 78 percent "reported that the drug had not been prescribed to them for any medical reason."

The government, of course, argues that Purdue is responsible for selling more OxyContin than was necessary for legitimate pain treatment, regardless of how nonmedical users obtained it. But blaming the company for OxyContin abuse overlooks the crucial role of the people who choose to consume it for nonmedical purposes, who tend to have histories of substance abuse before they try OxyContin.

In the American Journal of Psychiatry study, nearly four-fifths of the OxyContin users "reported receiving prior treatment for a substance use disorder." A 2012 study of Utah deaths involving prescription opioids, reported in the Journal of General Internal Medicine, likewise found that 61 percent of the decedents had used illegal drugs and 80 percent had been hospitalized for substance abuse, including abuse of alcohol and illegal drugs as well as prescription medications.

While OxyContin's contribution to opioid abuse is routinely exaggerated, the government's assumption that reducing the availability of this particular drug will reduce opioid-related deaths is demonstrably wrong. Deputy Attorney General Jeffrey Rosen declared that the Purdue settlement "re-affirms that the Department of Justice will not relent in its multi-pronged efforts to combat the opioids crisis." Gary Cantrell, deputy inspector general for investigations at the Department of Health and Human Services, vowed that "we will continue to combat the opioid crisis."

How has that been going so far?

In 2011, the Food and Drug Administration approved a new version of OxyContin that was designed to discourage nonmedical use. When the reformulated OxyContin is crushed and mixed with water, it forms a gel. The old version of OxyContin was withdrawn from the market when the new one was introduced, a switch that coincided with a post-2010 spike in heroin-related deaths.

In a 2017 paper published by the National Bureau of Economic Research, Wharton School health economist Abby Alpert and two RAND Corporation researchers investigated whether those developments were related by comparing states with different pre-2010 rates of nonmedical OxyContin use. "We estimate large differential increases in heroin deaths immediately after reformulation in states with the highest initial rates of OxyContin misuse," Alpert and her colleagues wrote. "Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010″—perhaps as much as 80 percent—"can be attributed to the reformulation of OxyContin." They concluded that the increase in heroin-related fatalities offset any decrease in OxyContin-related fatalities, "leading to no net reduction in overall overdose deaths."

More generally, as the government succeeded in curtailing opioid prescriptions in recent years, the upward trend in opioid-related deaths not only continued but accelerated. Meanwhile, patients who relied on opioids to relieve their agony increasingly found that the government preferred they "take some aspirin" and "tough it out." The perverse effect of restricting access to prescription opioids should not have been surprising, since the crackdown on pain pills pushed nonmedical users toward black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable.

Illegally produced drugs now account for the vast majority of opioid-related deaths. In 2018, according to the National Center for Health Statistics, the category of drugs that includes fentanyl and its analogs was involved in more than two-thirds of those deaths, while heroin was detected a third of the time. Prescription opioids like hydrocodone and oxycodone turned up in 27 percent of the cases, and many of those deaths also involved fentanyl or heroin. After a slight decline in 2018, opioid-related deaths seem to be on the rise again.

In this context, Purdue's punishment, however unethical and dishonest its business practices, cannot reasonably be expected to have any noticeable impact. The problem, as always, is not that psychoactive substances are available from one source or another but that some people use them in ways that disrupt their lives, hurt the people close to them, and sometimes kill them. That problem, which is rooted in misery, despair, and social isolation, cannot be solved by making an example of one pharmaceutical company—or dozens.

NEXT: Virginia Passes Bill To Make it Harder for Problem Cops To Jump to New Departments

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  1. Some folks get off on buying gasoline, and huffing it!

    Some folks get off on buying glue, and huffing it!

    So then, the people who get off on self-righteousness, and satisfying their punishment boners, THEY, in turn, will get off on trying to outlaw the dastardly sellers of gasoline and glue! And PUNISHING those less Noble than Themselves! While doing NOTHING to solve the root problems of hopelessness (and selfish laziness etc., truth be told) among the huffers and puffers and the HuffinPuffin stars of “Hairy Pothead and the Bowl of WeedFire”!

    Well anyway, let’s outlaw self-righteousness and punishment boners! It stands a BETTER chance of success, than trying to outlaw people getting an illegal buzz!

    1. I think you fail to understand just how powerful the addiction to self-righteousness and punishment boners really is. Heroin, meth, nicotine are mere predilections compared to the siren song of the naked power to sit in judgement of others. Power junkies will lie, cheat, steal, commit the most foul and depraved acts, gladly consign their souls to the deepest pits of Hell, to get just a little taste of that power.

      1. Power junkies will lie, cheat, steal, commit the most foul and depraved acts, gladly consign their souls to the deepest pits of Hell, to get just a little taste of that power

        Hence, politicians.

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    2. SQRLSY One
      October.21.2020 at 5:50 pm
      Some folks get off on buying gasoline, and huffing it!

      Some folks get off on buying glue, and huffing it!

      You huff gas and glue? That explains how you ended up eating shit, but not your racism or support for Hitler.

      1. He IS heavily brain damaged.

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    4. “… practices that allowed doctors and pharmacies to distribute its timed-release version of oxycodone far in excess of what was medically appropriate.” WHO determines what is “appropriate?” ME, the doctor, Pharma or someone on the street (law makers)? It is I would live or die with the consequences of my actions.

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  2. We need a section 230 for pharma manufacturers. I mean one other than the FDA regulatory process. A real section 230 that protects the right manufacturers from the wrong consumers. That way, corporations will be protected from their miscreant consumers in all cases except cases like this one. Congressionally-enacted corporate protections by the right TOP MEN and then doubling-down on those protections right up until the wrong people are being protected is the libertarian way.

    1. Congress wants to go the other direction. Both sides aren’t friendly to 230. Democrats want to make gun manufacturers liable for misuse of their products. I expect calls for auto manufacturers to be held liable for global somethinging in the future.

      1. I’m waiting for someone to sue the auto manufacturer in a DUI case. That would be the most direct parallel to the suits they keep trying to bring against the gun manufacturers.

    2. “We need a section 230 for pharma manufacturers. ”

      You’re gonna have to do without as long as ‘public health’ informs policy and questions of right and wrong. The idea is that sound public health trumps the detrimental effects of the choices made by frivolous or self destructive individuals.

      Libertarians don’t recognize the notion of public health so they are bound to be confused by the issue.

      1. “Libertarians don’t recognize the notion of public health so they are bound to be confused by the issue.”

        Libertarians recognize lefty bullshit when the see it.

        1. You’re too confused to recognize it.

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      2. Fuck off slaver.

        1. ‘Public health’ is a contradiction in terms. Or a Chinese hoax. Or something.

      3. Libertarians don’t recognize the notion of public health so they are bound to be confused by the issue.

        The longer the self-contradictory stupidity surrounding COVID goes on, the more apparent it becomes to even simple-minded morons that public health officials are confused by the issue. Libertarians knew they would be before they got confused.

        1. Addiction, suicide etc are public health issues. This doesn’t seem to confuse people who recognize these are threats to public health, ie non libertarians.

      4. “Public health” is the aggregate of individuals health. What is a group health? WHAT gives gov the authority to make decisions for individuals?

        1. It’s more than that. The aggregate of individual health is medicine.

  3. Joe Biden approves all drug use so he can get his name off the crime bill he didn’t write. He swears he wasn’t groping his aides or smelling their hair during that phase of his life.

    1. Time is NOW to decide… Sad to say, Jo isn’t going to get elected, it is safe to say that… Given that, although I do ‘fess to “throwing my vote away” here most of the time, to libertarians…

      Time is NOW to decide, do you want a Pussy-Grabber In Chief, or a Hair-Smeller in Chief?

      1. Biden has been actually accused of not only grabbing but digitally penetrating a woman’s pussy without her consent (and against her explicit wishes). So I think both your uninformed nicknames apply to Biden.

        1. Also there is accusations he took bribes funnelled through his son and the same son exposed himself multiple times to his underage female relative and told Biden about it and Biden did nothing.

          1. But Trump’s 26 accusers are all making it up, right?

            1. Did anyone but the voices in your head say that? No! I m pointing out Biden has been accused of sexual assault as well. Portraying him as just a hair sniffer is disingenuous.

              1. That fact that you are even making an argument supporting “whataboutism” by basically insinuating that if Biden does it then it’s ok for Trump as well is disingenuous to say the least.

                1. Or

                  He is destrying the idea that Trump’s behavior is different from Biden’s and you hate that he’s right

            2. So … are we really arguing not about which of the major party candidates is a sex offender, but which is the worst sex offender? For woke-Christ’s* sake, is this where we find ourselves?

              *woke-Christ is like regular Christ but totes not stale-thinking, irrational middle-America clinger bigotry.

          2. https://www.usatoday.com/in-depth/news/investigations/2020/10/21/trump-sexual-assault-allegations-share-similar-patterns-19-women/5279155002/

            19 women have accused Trump of sexual misconduct. Here’s what their stories have in common.
            Allegations of women who’ve accused Trump of non-consensual sexual contact share many details, from forced kisses to where it took place.

            More of the same can be found “out there” on the internet. Sad to say, as we’ve known for some time now, ANY politician or judge-candidate (right, left, or middle) attracts these kinds of accusations from opponents. And we, the common “little guy” have few reliable means of sorting fact from fiction. It is indeed a sad thing…

            1. And? That absolves Biden’s charges? It is disingenuous to portray Biden as just a hair sniffer.

          3. …not including the 5 Ms. Teen USA competitors who claim he walked in on their changing rooms while they were unclothed.

            https://www.latimes.com/politics/la-na-pol-trump-accusers-fact-check-20161019-snap-htmlstory.html

            1. Keep arguing a straw man based upon an imaginary arument I never made.

            2. Hi

              We are capable of actually being disgusted by both of them.

              You should try it.

              1. Not only capable. WTF is wrong with you if you aren’t?

              2. DOL is a dishonest piece of lefty shit, that will consistently post comments critical of Trump, and never post anything critical of Democrats, then lie that he’s not a leftist.

                1. He’s a stocky for Pedo Jeffy, AKA Chemjeff.

            3. Yet you have no concerns about Biden actually raping a woman.

  4. $8.3 Billion sounds about right for Perdue’s campaign in the 1990s and 2000s lobbying to allow/encourage doctors to prescribe far more pain pills than were necessary, which flooded the market and resulted in far more opioid addicts.

    But the sharp increase in fentanyl deaths requires harm reduction opioid alternatives for addicts. While methadone is very effective, very few politicians (who decried the opioid epidemic) have endorsed/encouraged methadone.

    Perhaps regulated doses of pain pills should be made available to addicts similar to methadone.

    1. The only thing missing from your analysis is sources.

      1. Welcome to Reason – – – – – – – – – – – –

      2. If only doctors were capable of thinking for themselves. Then we could put them through some sort of class on medical ethics. Then, to reinforce what they’d learned in their ethics class, we could make them take an oath. And then for the poor unthinking Dr. Schmucks who sat through classes on medical ethics and mindlessly ambled through the oath and, somehow, still managed to have their programming altered by pharma hackers, we’d set up a licensing system and revoke licenses of those poor, unthinking bastards that Big Pharma had mercilessly and illegally hacked.

        The $8.3B fine levied against Purdue is nothing compared to the thousands of medical licenses that got revoked from or were forfeited by doctors who avowed to do no harm, right?

    2. “$8.3 Billion sounds about right for Perdue’s campaign in the 1990s and 2000s lobbying to allow/encourage doctors to prescribe far more pain pills than were necessary, which flooded the market and resulted in far more opioid addicts.”

      Did you drag that strawman all the way from home or find it outside the door?
      Fuck off, slaver.

    3. Methadone’s not an opioid alternative, it’s an alternative opioid. Pain pills similar to methadone? Methadone is a pain pill, primarily.

    4. I’d like to see some real statistics on Methadone. Everyone I know who has to interact with Methadone clinics, say people never get off Methadone once they start. It appears to a layman to merely be switching an illegal addiction for a legal one. Which may be good for keeping you out of trouble with the law, but any addiction treatment that only has that going for it, isn’t really an addiction treatment.

      1. You can find the studies on that and the other drug used buprenorphine. It does switch one addiction for another. Just as nicotine gum or vaping does for cigarettes only less harm.

        Both have been proven to reduce risk of overdose and result in better function. There is still a failure rate as both drugs produce less of a buzz and some people will relapse.

        Opiate addiction produces permanent changes in neurobiology. It rewires the brain in ways not yet completely understood.

  5. Next up; DOJ gets a consent decree and big bucks from the ‘illegal’ drug guys.

  6. “That problem, which is rooted in misery, despair, and social isolation, cannot be solved by making an example of one pharmaceutical company—or dozens.”

    It’s sending a message to the pharmaceutical companies, ‘we have all the opiates we need, thank you very much.’
    These problems are not going to be solved by more people using more opiates, thus saith the court.

    1. “These problems are not going to be solved by more people using more opiates, thus saith the court.”

      And, amazingly, the result is exactly what you think was a ‘solution’. Lefty shits are stupid that way, and many others.

      1. BTW, lefty shit, see below for the result of your desires.
        Oh, and fuck off and die.

        1. You get the results you deserve. That’s how we know the big wheel of fate is turning as god intended.

      2. It’s only amazing if you are confused by what is at stake here. Regulators have long taken a dim view of threats to public health and the venal parasites who would exploit them, Snake oil, FDA, Republicans, courts etc.

  7. My sister died of an accidental Oxycontin OD in 2016. It devastated our family and left her daughter (my niece) without parents. As ‘victims,’ when should we expect to see our chunk of that $3.8 billion of shakedown mon…I mean, ‘justice?’

    Hell, my Dad was an alcoholic with a bad temper (especially when sober!) When is the DEA gonna go after Dewar’s Distillery for some justice? Clearly, they’re to blame!

    Drug Warriors are a lot like gun grabbers – only with different vices (or hobby horses, perhaps.) They don’t care about the dead or the victims; only about enforcing their own insecurities and lust for control on others. It’d be easy to hate inanimate chemicals or evil ‘big business’ drug makers, but I don’t. In both cases, I learned that people make bad choices that sometimes lead to disease states and bad ends and suffering for all involved. That’s life, and sometimes life sucks. Genetics, of course, also play a role.

    I have, however, come to despise the government’s Drug War idiocy. Especially in my sister’s case, where, instead of allowing us to marshal our own resources as we saw fit to pursue our own treatment course, they instead inserted themselves into our family business and in doing so, took a small-time weed smoker and repeatedly locked her up for mere possession where she met REAL black-market drug connects. They never missed an opportunity to waste our time and bleed us dry financially: years in and out of jail, with countless $100 phone calls and tens of thousands in ‘fees’ and 3 forced attempts at farcical, onerous, unconstitutional ‘Drug Court.’

    By letting her live with us (to avoid her living on the streets), these assholes even presumed to ‘void’ our 4th Amendment rights and search our house randomly. I called them up to explain the finer legal points of that hogwash, and they hung up on me! All their ‘help,’ and she still ended up dead and bloated in some shitty motel room.

    I could go on (and on, and on…) but I guess I should thank the government for their Drug War stupidity. If I hadn’t have had endured the constant pleasure of their ‘help’ and ‘justice,’ I wouldn’t be a die-hard Minarchist.

    1. I’m sorry for your loss. Thanks for sharing that.

      There are many levels of victimization by the drug war. My family never experienced anything as terrible as yours, but I was busted for weed when I was a minor. I remember having to listen to the cops and judges and probation officers all pat themselves on the back for how they were saving me from a near certain fate of ending up a hard drug user. When in reality, they saved me from getting into a 4 year college, which eventually led to me enlisting and going to war a few times.

      Gee thanks, judge. I almost did something really dangerous there.

      1. And there are those I have known well who got a slap on the wrist fine, record erased.

        A conviction can ruin your life forever. Every time you need a background check you need to explain it. Alice’s Restaurant.

        Even then the police for years have just decided on the spot to do nothing. “I’ll take that. You still ran a stop sign. Here is your ticket.”

        End the war on drugs.

        Addiction is a medical issue not a legal issue.

    2. Nice and honest post.

    3. I’m sorry your sister died, but your premise is flawed.

      There’s no such thing as an accidental OxyContin overdose. Addicts make a choice to get as near to the fire as they can and sometimes get burned. That’s not an accident. It’s stupidity.

      Sorry for your loss. But you need to accept that you allowed a junkie into your home and suffered the consequences.

  8. The sculpture has its roots in prehistoric civilizations, undergoing numerous changes over time and evolving simultaneously with society. During this time, the sculpture has played several roles in people’s lives. It believed that, in the beginning, sculptures had a magical role.

    From time immemorial, the sculpture has been considered a means of artistic expression, its beginnings being much more distant than those of painting. People began to carve in stone or wood either to make different tools or to create small figurines that they used for various purposes. Archaeological discoveries have shown that the sculptures dating back to prehistoric times were made of stone or ivory, but also clay.

  9. So how many people are living in pain because of the government’s crackdown on pain medications?

    Just wondering

    1. About the same as before the crackdown. That’s the beauty of inelastic demand.

    2. Not Breonna, or Tamir, nor Eric, Philando, George Floyd… In fact, there are pages listing hundreds, thousands of “unarmed black people killed by police.” The list of those convicted of murder in a court of law is WAY shorter; three names. If this isn’t a “Gentlemen’s Agreement” to facilitate racial eugenics under color of saving poor, dissolute, uncovered wretches from the Killer Weed, I cannot imagine what would qualify.

    3. Turkey River Rat,

      Lots of them.

      Basic background. Most docs go into it to it to diagnose and treat disease. Chronic pain is not a big subject for most. There are those who go there. For them this is now a hostile dangerous environment.

      The treatments are sometimes dangerous and include Risk/benefit calculations which can only be decided on an individual basis.

      The charge against this company is that they deliberately misrepresented information they knew to be untrue in marketing the product. I am not judge here but I suspect there is truth in that.

      1. Echospinner…I totally agree with your statement, “The treatments are sometimes dangerous and include Risk/benefit calculations which can only be decided on an individual basis.”

        Case in point. A family member has a severe and debilitating form of chronic illness (RA). To manage pain, this family member was prescribed vicodin. Much to this family member’s credit, after a month, he asked for something ‘not narcotic’. This was back in 2011. The alternative was tramadol, which at the time was not considered an opioid. This family member has used tramadol without issue for 9 years.

        The government has recently reclassified tramadol as a narcotic, and severely constrained supply. It is utter madness. The patient and doctor jointly made decisions and see each other twice in-person annually, with labwork quarterly (monitoring for inflammation). Now the government is stepping in and dictating the boundaries of the doctor/patient r’ship.

        I won’t excuse Purdue for whatever actions they took in detailing physicians. Clearly, they promoted off-label use, and emphasized messages about the non-addictive nature of oxycontin which were plainly false.

        But chronic pain is a very real thing for millions of people. The government should not insert themselves into the physician-patient relationship.

        1. Ouch. Mad sympathy. I’ve had RA since I was a kid, though fortunately a fairly “mild” case that only makes everything hurt “a little” all the time. But I’ve got a friend with a much worse case, whose cartilage deterioration is so bad that he had a hip replacement at 20.

  10. The sculpture has its roots in prehistoric civilizations, undergoing numerous changes over time and evolving simultaneously with society. During this time, the sculpture has played several roles in people’s lives. It believed that, in the beginning, sculptures had a magical role.

    From time immemorial, the sculpture has been considered a means of artistic expression, its beginnings being much more distant than those of painting. People began to carve in stone or wood either to make different tools or to create small figurines that they used for various purposes. Archaeological discoveries have shown that the sculptures dating back to prehistoric times were made of stone or ivory, but also clay.

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  11. Nixon’s DEA acted to reinforce the practice–since shrill 1914 NYT articles about “cocaine Negroes” on the eve of the Harrison Act–of calling all enjoyable drugs “narcotics” without regard to their mode of action. The Biden-Reagan-Kennedy-Leahy “Drug Abuse” law of 1986 discarded that. Neither LSD or cocaine are addictive or habit-forming so nationalsocialist narcs declared them “controlled,” meaning “Negro,” “Jewish,” or at best, that “violate the ethical and moral feelings of the Germanic race.” “Complete confiscation” became “asset forfeiture.” Now they act surprised that lethal, addictive drugs, like drug cops, are killing people right and left.

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  17. Heck; what’s the big deal about bribery and corruption to an end-user in a *free-for-all* system short of the consequence of a *free-for-all* drug-addiction.

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  19. The reason behind the seen is over dose of the drugs which is increasing more and more in our culture.

  20. Personal responsibility seems to have gone out the window in this country.
    If you are addicted to pills; blame the manufacturer.
    If you are obese; blame Burger King.
    If you smoke, blame the cigarette manufacturers.

    This, more than anything else is what pisses me off.

    1. Is there anything that corporations need to be responsible for, do you think?

      1. Beyond breaking very basic laws of justice? No.

        It’s takes an amazing amount of arrogance and idiocy to hate-on the very producers of what man needs/wants. It amounts to about the same sense as rioting and hating-on anyone that feeds the poor, heals the sick and comforts the cold out of charity or something. I’d suggest that everyone who wants a job not kick the boss in the nuts and tell him you’re ‘entitled’ to what he has created and is offering.

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