Accumulating evidence of ongoing threat to public health decades into the lethal epidemic consistently points to medical malfeasance, incompetence, and diminished capacity for clinical and ethical judgment as primary factors fueling the crisis

by Clark Miller

Published January 8, 2024

As responsively, reliably, compliantly as American media, entertainment and health and research institutions have generated distracting fictions and cultural drama to protect forces generating, now perpetuating the increasingly lethal opioid and other health crises, it’s not enough. 

There are tears in the matrix, rips in the thin sheen of illusory fabrications of truth, competence, and trustworthiness created to cover what is real, cover the mounting toll of vulnerable Americans trapped in lethal epidemics, continuing to suffer and die, the more medical cure is administered to them. To their diseased brains

Exposed under that thin sheen, the numbers don’t lie, and it’s not about fentanyl

Quest study data on misprescribing

Explained here, fentanyl overdoses are highly correlated with users being in a MAT program or in treatment for substance use, that is, highly correlated with use of MAT opioids methadone and buprenorphine (Suboxone), American Medicine’s proven, life-saving cure for the opioid crisis (How’s that going?). Not with other factors. 

That may not be surprising,  should not be given the long-established diversion and misuse of doctor-prescribed “bupe” as consumable, commodity, and currency – including for fentanyl – in illicit economies of high-risk opioid and other drug use (see “The bupe economy” in this post).  

And it’s not “pill mill” doctors. Never was. 

And Suboxone, the proven, gold standard, opioid medical cure that’s been supplied increasingly, now almost without restriction or safeguard, by phone call, as the overdoses and deaths it is proven to prevent mount steadily?  Try finding it included in any survey or report of “prescription” drugs or “prescription opioids” involved in or contributing to those overdoses or OD deaths. You won’t. Unless you really look. Because it’s not an opioid? Because it is available OTC, not requiring the signature on a prescription by an American licensed medical provider (LMP)? Ha. Funny. 

There must be other reasons it’s excluded, generally along with methadone, yes? 

Even though, as established for decades, it has been or is one of if not the most common and available drugs of abuse on the street, in illicit economies of opioids and other drugs. And even though for decades its abuse potential has been known, including by augmentation with use of a benzodiazepine, increasing risk of overdose and death. 

Or, we might want to say, Because, as established for decades . . .”

Line graph in trends of buprenorphine provision

Right, and then there’s this – 

But we’re getting ahead of ourselves.


Let’s go back. 

As with America’s vaping and mental health epidemics and the epidemic of mass poisoning by medical provision of SSRI and other “antidepressants”, the opioid epidemic has been driven by the medicalization of a condition that is entirely not medical or physical – the condition of chronic pain, that is, long-lasting pain that is not tied to cancer, that is, almost all chronic pain. 

From the beginning, always, there has never been adequate or even strong evidence to suggest that opioid drugs are effective or safe in use for chronic pain. Opioid drugs do have powerful physiological, emotional, cognitive, perceptual, attentional, and psychological effects on users during intoxication including euphoric, sedative, anxiolytic, and anesthetic. 

That is to say, opioids are not and never have been evidenced as a treatment for chronic pain (“centralized pain”), a complex, psychogenic condition treated by CBT, behavioral activation,  and other forms of psychotherapy. 

That is to say, opioids are a “treatment” for chronic pain in exactly the same sense that alcohol is a treatment for chronic pain. 

As Sam Quinones outlined in Dreamland, it required that America’s Medical/Insurance/Pharmaceutical complex delegitimize and demonetize the few, pioneering, effective programs successfully treating chronic pain from a psychosocial/behavioral model in order to displace those effective approaches with billable medication prescribing and make those institutions and professinoals appear helpful, important, and legitimate, with the social costs of becoming predictably and increasingly  lethal. 

Those predictable social costs never mattered, of course, until it became too late, still don’t matter as much as preserving and protecting other interests.  As if the forces at play – those driving research, healthcare resources, the fabrication of constructed research conclusions and spun lies, compliant media protection of lying experts and required narratives of centers of power -were ever grounded in values dedicated to public health, safety and wellbeing. 

It doesn’t matter now, decades into an increasingly lethal opioid epidemic, worsening year after year while provision of the proven medical cures increases, deaths mounting for decades pre-pandemic, through the pandemic, and now post-pandemic, giving lie to the feeble fabrications to rationalize the predictable lethal failure of any and all medical approaches for the entirely non-medical condition of compulsive substance use. The predictable lucrative failures of “addiction medicine” and the cronyism employment system “addiction treatment“. 

medical professionals at a conference

The evidence is everywhere. 

Including as described in this post, a presenting physician at a an annual medical meeting warning colleagues of their continuing overprescribing, that they “shouldn’t be surprised” at mounting deaths, with questions coming from his medical colleagues in the audience on how to safely prescribe opioids – in 2022.

Last year, in 2022. 

In that post I posed the rhetorical question, 

Why, with clear evidence over those decades of the runaway misprescribing of opioids generating the crisis and continuing to worsen it, has nothing been done to effectively control misprescribing, instead to distract from and protect it?

Here’s a clue. 

medical professionals at a conference

I helped out by marking up the copy a bit. 

Here’s the research piece. 

Here are the reported results –

Policy implementation was associated with a significant monthly increase in new opioid prescriptions of 0.86 per 10,000 enrollees, halving the pre-policy decline in the prescribing rate. Among new opioid prescriptions, the percentage with >5 days’ supply decreased by about 1 percentage point (−0.76 percentage points, 95% CI −0.89, −0.62) following policy implementation.

So, the New Jersey law designed to stop LMPs from dangerously prescribing opioids actually was associated with slowing of an existing trend in reduced monthly new prescriptions. Of those new prescriptions, fewer were for more than a 5-day supply, but only by less than a 1 percent reduction, a good example of statistical significance without clinical significance. 

However, policy implementation was associated with a significant monthly increase in the rate of initial prescriptions with supply on day 90 (9.95 per 10,000 new prescriptions, 95% CI 4.80, 15.11) that reversed the downward pre-implementation trend.

At the same time, the rate of prescriptions associated with continued prescription at 90 days – a warning sign for risk of development of dependence or misuse – increased after implementation enough to have “reversed the downward pre-implementation trend”. 

Here’s how the journal editors had the authors spin those results, leading with the clinically insignificant (< 1 percent) change in prescriptions with > 5 days supply.

The New Jersey policy was associated with a reduction in initial prescriptions with >5 days’ supply, but not with an overall decline in new opioid prescriptions or in the rate at which initial prescriptions led to long-term use. Given their only modest benefits, policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.

Let’s repeat that –

policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.”

Because there is no recourse for patient rights and safety when LMPs choose to violate state laws implemented specifically to protect patients against medical overprescribing and misprescribing, decades into an increasingly lethal opioid crisis? 

Because . . . . ? 


Because, in fact, LMPs are protected, and they know it, precisely as if they were above the law. Because they are above the law. 

That’s what the U.S. Supreme Court has established and messaged, described in these posts

And that’s what helps explain the persistent, potentially lethal misprescribing by America’s LMPs decades into American Medicine’s increasingly lethal crisis, decrribed here, here, here, here, and here

Here’s a more recent example – 

And as reported by the OIG – 

And there’s this, from the National Institute on Drugs and Alcohol (NIDA), showing that overdose deaths over the past two decades involving prescription opioids (opioids that would not have been available and used without being prescribed by a LMP) failed to significantly decrease, instead exhibited an overall trend of increase. 

It is important to note that methadone and buprenorphine, increasingly prescribed over the decades of an increasingly lethal opioid crisis, are excluded from “prescribed opioids”. 

Here is what trends look like when methadone and buperenorphine are included. 

See this post for an explanation of the graphic including the projected values. 

overdose death graphic

And here for methadone specifically. 

These and many other examples of data and how they are represented and interpreted to generate protective opioid crisis fictions point to a lethal lie perpetuating lethal crisis – that the prescribed opioids buprenorphine and methadone, established as fueling the crisis and associated with increasing deaths are actually NOT prescribed opioids (of course they are) or in any case ARE NOT TO BE INCLUDED in reports and analyses of opioid overdoses and deaths – despite in fact being prescribed opioids – because they are constructed by America’s top experts and compliant media as “treatments” for the worsening  crisis.

Their proven and assured benefit apparently achieved  paradoxically and mysteriously, incomprehensively, by miraculous therapeutic and curative effects as they are increasingly dispensed while high-risk opioid use, associated injection-related disease, and overdoses mount. That, apparently is why they are considered “miracle” molecules – they treat the disease of addiction through paradoxical outcomes of increasing illness and deaths. The details are left unexplained, something only medical experts and media medical reporters understand. We need to trust them. Why wouldn’t we? 

Reality check. 

The lack of evidence ever establishing these substitute opioids as having benefit and evidence instead as fueling and worsening the lethal crisis are in posts including here, here, and here

Precisely as with the lies that generated runaway opioid prescribing for all pain, creating the crisis; as in the deception that SSRIs and other medications are safe and effective for depression; as in the criminal public health and public policy debacle that experts gave us for a COVID response – what can be counted on from trusted media, medical experts and institutions are incompetence,  lies and threats to the public health. 

There are no surprises here.

The same institutions and media-constructed medical experts and deceptions supporting practitioners who have flooded the American mind with toxic, ineffective “antidepressant” medications for the non-medical condition of depression, who did the same with opioids for the non-medical condition of chronic pain, whose pretense of ability to understand, form thoughts about, and use clinical judgment to treat the non-medical condition of compulsive substance use, driving lethal epidemics, and whose cowardice and/or sociopathic traits, still shielded,  drove creation and worsening of the COVID epidemic, are the same experts, media, institutions,  and trusted practitioners fueling opioid deaths by shielding and engaging in continued, lethal misprescribing.  

It is as if they have nothing to lose, all risks and costs to be experienced by others. 

As if they are protected.

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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