Bitter Pill to Swallow? Try the Shot.

December 17, 2009 at 11:16 am 12 comments

Facing the impending expiration of its bestseller Zyprexa’s patent, Eli Lily has just introduced their newly approved Zyprexa Relprevv, a long acting injectable, for use in adults diagnosed with schizophrenia. While it may be good business, it may prove for many to be bad medicine.

From the Wall Street Journal:

If a classic pharma strategy holds true, the drug may also extend Lilly’s ability to make money from its Zyprexa franchise.

The company is likely to face generic competition on regular-selling Zyprexa in 2011. But a key patent on the extended release version of the drug is valid until 2018, a Lilly spokeswoman told the Health Blog.

Drug makers have long brought out extended-release versions of drugs (often branded XR or CR) as a way to fight generic competition. Antipsychotics were the  top-selling class of drugsin the U.S. last year, and they’re losing patent protection left and right these days. Drug makers are bringing out extend-release versions of several drugs in the class, including AstraZeneca’sSeroquel XR and Johnson and Johnson’s Risperdal Consta.

Well, if “classic pharma strategy holds true,” we’ll see this drug touted off label for everything from dementia to depression and to  suppress unruly conduct in children. The injectable is geared toward people who are deemed “non-compliant” and appears to have been introduced with more of an eye toward administration than patient health. From the Associated Press:

For the new version, patients will visit their doctors every two or four weeks — depending on their dosage — to receive the injection, spokeswoman Janell Smith said.

She said the longer-lasting version makes it easier for patients to stay on the medication, and it allows doctors to track whether they’re doing that since they have to make office visits for the injections.

Given the list of risks and side effects, I wouldn’t say it makes it easy for patients but it does make it easy for their doctors to monitor and carry out their drug regimen. This effectively clears the hurdle of a person’s choice to discontinue the drug if, for example, the side effects prove too brutal or they choose another path toward their own wellness. While force isn’t the only intended purpose for this drug, you’ll find it’s the perfect companion (from the pro-drug and pro-force perspective) to the growing national trend toward forced outpatient treatment, more kindly termed by its proponents in government and industry as “assisted” outpatient treatment. A term not unlike calling solitary confinement assisted “me time.” AOT laws are currently in place in most states and are in the works in many of the remaining few.

This new injectable appears to be the first of its class approved for “acute agitation” a point laid out in this little fear-blurb from The Medical News.

Acute agitation is a well-recognized behavioral syndrome with a range of symptoms, including hostility, extreme excitement, poor impulse control, tension and uncooperativeness. The syndrome can occur with a number of conditions, including schizophrenia and bipolar disorder. Patients suffering from agitation in its severe forms are usually in an emergency situation and require immediate treatment to alleviate personal distress and to prevent harm to themselves and others.

“Well-recognized” just means “medically baseless but agreed upon” and their idea of agitation is a clear case of pathologizing human behavior. The “symptoms” of acute agitation are just a list of how any person might respond to forced treatment and incarceration. Unfortunately, our system is so tilted in the medical establishment’s favor that once it’s called a disease, a disorder or a syndrome, all bets are off and it can be treated with drugs and your consent is irrelevant. Disease debate aside, approving a long acting injectable for episodic behavior is a bold step toward an increasingly blatant use of drugs as control. No one should be on a month’s worth of drugs for a day’s worth of being hostile and uncooperative, regardless of the cause.

Interestingly but not surprisingly — US News directs readers not to Eli Lily for more information on the drug but to NAMI. That’s some clever positioning for a “grassroots” patients’ advocacy group. They are looking more like a drug makers’ advocacy group every day.


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Poor Children Given Antipsychotics 4:1 Over Privately Insured Back to January


  • 1. dogkisses  |  December 18, 2009 at 9:32 pm

    Hi, very good post. I’m glad you are writing. It’s so hard for me to actually read the reality. You would think I could easily read it and even write more about it, but as I said it is hard. I think I hate the word “injection.” It is definitely all about force when it comes to antipsychotic injections. They are designed for patients who do not “comply,” which means they may not be willing to take the medications or they may not be depended on to take a pill every day and it is amazing all the eloquent language psychiatrists and social workers use to talk about how freaking lucky we are to have these injectable forms of antipsychotics! It is also all about controlling a person 24/7.
    Thank you for writing. I appreciate your work and it helps me to gain a better perspective on what I really believe in. I believe there are so many different ways we can help people with schizophrenia, ways that our modern day psychiatrists (and now social workers) do not even want to discuss.

  • 2. Tony  |  December 20, 2009 at 12:22 am

    Certain people don’t respond to medications at all. It will be very interesting to see what happens in a case such as this. The psychiatrist well no longer be able to say the patient was off his meds and may be required to take responsibility for the patient’s bad behavior.

    • 3. dogkisses  |  December 20, 2009 at 8:16 am

      Hi, I’m wondering why– as Tony has commented, would a psychiatrist have to take responsibility for a patient’s “bad behavior,” if the patient does not respond to medication or if he or she doesn’t take medication? I know a psychiatrist can be sued and many have been, one here in my town for allegedly not providing a patient with a follow up visit with a new doctor as the doctor who got sued was blamed for doing. The doctor was just about retired, but lost his license because of this case. But is a patient’s behavior (as a result of not taking or responding to medication) the responsibility of a psychiatrist?

      • 4. Tony  |  December 21, 2009 at 10:44 pm

        I believe the patient’s bad behavior most certainly is the psychiatrist’s responsibility if the psychiatrist wants to interfere so obtrusively in the patient’s life. Why should the patient be required to take responsibility for the psychiatrist’s behavior if the drugs don’t work?

  • 5. abellve  |  December 20, 2009 at 10:26 am

    It will be interesting indeed to see how this plays out. Except for a few rare occasions such as dogkisses has pointed out, psychiatrists are seldom held responsible for a patient’s behavior and when they are, it’s for not treating them. I’m pretty sure as long as you treat someone’s problems chemically and aggressively, you’re off the hook. Then, if their behavior gets out of line, they are just labeled “treatment resistant.” People that don’t respond to the current line of on-patent and marketable drugs seem to just be an indicator to the biopsych crowd that we need to push harder and come out with more powerful drugs.

    • 6. Tony  |  December 21, 2009 at 10:52 pm

      Amusingly, psychiatrists have yet to find a neurobiological basis for good old-fashioned evil. And happily in my case, when a patient is labeled “treatment resistant”, he’s finally left alone.

    • 7. dogkisses  |  December 22, 2009 at 9:26 am

      Hi, I wanted to write on here my thoughts on psychiatrists and why I said some are not all about drugs. I should have said I believe there are only a few in this country. Only a few. I get so upset about life and not having anywhere to turn that I feel incredibly emotional as you may notice in my articles. I get angry, sad, scared, hopeful then hopeless, etc… Honestly, I have only met two psychiatrists who speak as though they are individuals. Most of them all say the same thing. I guess the psychiatrist who told me that my son would be better off without medication is a rare gem! Still he sent him home with a prescription– obviously so he would not get sued if my son did something wrong.
      Again, I want to thank you for this particular blog. It has inspired me to write and give attention to my own beliefs around these issues.

      • 8. abellve  |  December 22, 2009 at 11:09 pm

        You may want to look into the work of Peter Breggin and Loren Mosher if you haven’t already. Madness Radio has a great episode with Peter Breggin available on or on Itunes. With such a polarizing issue, it’s easy to forget that psychiatry didn’t always mean the sick brain model and for some dissident psychiatrists, it still doesn’t. They really are rare gems in a field full of like-minded followers of the accepted model. That model pays very well.
        It may seem like you have nowhere to turn but if you keep looking you’ll find there are a lot of listening ears and some people that have good information to offer and a wealth of experience.
        Thanks for the kind words. It’s encouraging and I’m glad you found something of value here. I look forward to reading more of yours as well. Stay inspired any way you can. What you have to say needs to be heard. Your emotions are valid and can lead to great things.

  • 9. dogkisses  |  December 23, 2009 at 9:12 am

    Hi, I have actually read the works of both these men. I absolutely loved what I learned. B/f my son ever became “ill,” I had depression. I was a firm believer in natural health care. Then when he became ill I simply had no clue what to do. I think my life must be coming full circle, so to speak. It seems like I am going back and will again be standing up for what I really believe in. My son’s psychiatrist, who I cannot say I think a great deal of, makes fun of Peter Breggin. Actually, she isn’t the only doc who does. She also mocked people who she said call themselves, “survivors,” saying how” they are just a bunch of people who hate psychiatry.”
    I would like to add that my son is presently doing better than he has ever been. He is not taking medication. He did however get a girlfriend and made two new friends who are like our old friends from the mountains (kind of hippies). I believe that friends, meaningful relationships and sex helps “mental illness.” I know any moment everything could blow up in my face, but I’m trying not to think of that and be grateful for the days I’ve had lately. After six years of hell, it is hard to know how to experience a good day, much less a good week! Those doctors better watch out for me ’cause if I get my opinions back then I will be the one to be reckoned with!

  • 10. abellve  |  December 24, 2009 at 10:57 am

    Maybe instead of mocking, your son’s doc should really question why there are so many survivors that hate psychiatry. It couldn’t possibly be justified, could it? Show me another field of so-called medicine that has such an uprising and call for reform or abolishment from its patients. You can’t just dismiss that.
    I’m glad to hear your son is doing better. I think most of us have some fairly universal needs that do wonders for our emotional state. Don’t worry about what comes next. The future, whatever it holds, is coming whether you spend today worrying about it or enjoying yourself.

    • 11. dogkisses  |  January 6, 2010 at 9:27 am

      Hi, sorry I haven’t had time to visit. I’m working on a writing project that is difficult. I wanted to tell you that the town where my son was Tasered for not feeling good one day is now going to train their police officers in responding to mental health crises.
      I quote: “Crisis intervention team training will be offered in January to 27 local law-enforcement officers. The purpose of the training is to better prepare officers for encounters with people with mental illness and to increase the chances that those with serious mental illness will receive treatment rather than incarceration.”
      just wanted to share that here.

  • 12. abellve  |  January 11, 2010 at 3:26 pm

    Well, good that they are offering the training. I hope it is well thought out training that proves and useful and wise Thanks for putting that up and I hope your writing goes well.


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