NPR strings together touching anecdotes, empty memes and the fabrications required by America’s lethal, disintegrating healthcare systems, constructs them as “HEALTH NEWS”

by Clark Miller

Published January 12, 2022

From the NPR piece – 

Dennis Gaudet’s home in central Maine is surrounded by fields and woods, and many miles away from anyone able to treat his opioid use disorder.

What a grim, desperate image, created for readers. If he had a brain tumor, or lupus, or heart disease, or diabetes, or . . . would he be much closer to the specialist healthcare he needs, or would he be required and willing to travel to appointments in order to get the help he needs, the treatment to save his life?

“I was on a waiting list to get in to see a psychiatrist for over two years, [and] since the pandemic began, nobody was accepting new patients,” says Gaudet, 48, who’s spent over half his life struggling with an addiction that began with painkillers prescribed after he suffered injuries on a construction job.

If he was advised and believed that a psychiatrist could treat his compulsive use of substances, then there was no prognosis for other than harm,  no predicted outcome other than treatment failure as certainly as if he believed that he would benefit from an appointment with me, a psychotherapist, to establish care with me to perform surgery for for a brain tumor. That’s because, simply, and obviously for anyone who has considered the evidence, the problem of compulsive substance use is not a physical, or medical, or psychiatric condition at all, not remotely, never has been evidenced as such. And there are no medications that are evidenced as effective in treating that compulsive use.

Instead, consistent evidence that as the invalidated fabrication of medical or psychiatric treatments for compulsive substance use are continuously provided to vulnerable Americans, the worse things get, the more lethal. But that’s irrelevant really, not of importance – because what a psychiatrist can do, and will do, is only capable of doing, is to supply problem substance users with something very much desired – pills. Pills that provide euphoric relief or in any case can be traded on the street for stronger, illicit drugs. Pills because – depending on who you believe and in case you haven’t heard – their pills are a cure, the fix, for opioid dependence, provided to Americans trapped in the opioid epidemic whenever they decide they want to be cured and leave behind the pain and problems, the health costs, the daily risk of death. The pill cure that’s been increasingly provided for decades by American Medicine, while related deaths and associated illnesses mount. 

When a medication is developed that is, in fact, effective for a disease or condition, then made available for the affected population, things get better – symptoms are reduced, functioning and health regained, illness and death avoided, the benefited individuals wanting and choosing by use of the medication to, as humans tend to, avoid pain and illness, death. 

But use and increasing provision of an effective medication would not be tied to consistent worsening of epidemics of the disease state they are effective in treating. No, they wouldn’t, would they? As in American  Medicine’s increasingly lethal substance use epidemics.   

graphs of increases in U.S. drug overdose deaths and provision of opioid substitute medications

The lack of available treatment options, he says, has left a mark on his community and his own life; in the past three years, Gaudet has lost six friends to overdoses.

It seems likely that there’s more to the story. (What story? This story, this tale, this constructed, pre-determined narrative accepted as “journalism”.) Six friends dead of drug overdose, decades with problem opioid use, some of that time on the street in economies of illicit opioid and drug use. What was that like, a journalist might have asked, along with questions about treatment and any history of prescribed buprenorphine (Suboxone), and whether, as is the norm, “bupe” prescribed to him was ever used with other opioids, or other drugs, or in other ways that are high risk, or as currency to get heroin or fentanyl.

As is the norm

This NPR piece was written late this year, 2021, meaning that psychotherapy – the one evidence-based therapy for the underlying distress, the inner pain that only can explain “half his life” trapped by compulsive use of potentially lethal substances – was available by telehealth for years. That single evidence-based treatment would have been available to him, but that’s not among the “treatment options” the writer of this piece and Mr. Gaudet are thinking of –  they want you to believe exactly what America’s Medical/Big Pharma/Corporate Media collusion needs you to believe – that the “treatment” he needed to access was a script for opioids – the soothing, addictive opioids that are fueling their opioid crisis.  The opioids whose diversion, abuse and contribution to lethal overdoses has been increasing. The opioids that serve as currency on the street for illicit fentanyl.

But last year, thanks to pandemic-related relaxations of prescribing rules, Gaudet was able to get treatment from a clinic in California with an addiction specialist licensed in Maine that he says has helped him through many a mental health crisis. The telehealth clinic also fills his prescriptions for buprenorphine, a regulated drug that curbs his cravings.

Right!   Except . . .  1)  an “addiction specialist” is someone without training or competence in the treatment of any behavioral health condition, let alone a life-threatening psychological compulsion to use potentially lethal substances  – but who knows how to push the paperwork to make subscriptions for bupe or methadone happen, and 2) said “addiction specialist” would be entirely out of scope of practice to respond to any “mental health crisis”, but perfectly able to understand, quite likely from direct experience, how reasonable and pressing the approach of getting a script for addictive, euphoric opioids would seem facing withdrawal symptoms, 3) just not remotely capable of providing any form of evidence-based (= effective) treatment for opioid or other substance use disorders.

Without it, he says, “I would’ve gone back on the streets and done heroin and fentanyl again.”

Wait . . .  you were on the streets, getting heroin and fentanyl and will go back if need be? But without the ability to get to a therapist’s office? Or any program or services for substance use disorders? Because, you know, remember? About the “surrounded by fields and woods, and many miles away from anyone able to treat his opioid use disorder”? Were the “streets” out in the woods? On those streets, BTW, free bupe, by prescription, is a main currency for sought-after  fentanyl, as we know.

The thought may arise, especially for a journalist or news organization, that a guy whose buddies are drug users and who knows how to score heroin and fentanyl on the street, who gets to the street regularly enough to get those drugs, could get himself into a program, a facility, or even to evidence-based treatment, that is, actual, effective treatment for substance use – some form of psychotherapy – if he really wanted to? Or into an office to see a waivered prescriber for some Suboxone? Or methadone? But that’s complicated isn’t it? With the physical appearance and check-ins and urine drug screens right? When a Facetime hook-up with a medical opioid supplier or even a phone call gets him free opioids and without any risk of a drug screen? Unless that is what is wanted, the goal – a supply of medically dispensed opioids without the need to provide samples for drug screening.

It could be relevant to this story that the abuse of prescribed Suboxone is increasing, and that overdose deaths involving buprenorphine, and buprenorphine with illicit Fentanyl have been increasing, and that over pandemic months presence in a MAT program (in which bupe is provided) is strongly associated with the presence of illicit fentanyl with other opioids in drug samples. And in Maine? Overdose deaths involving Suboxone and Suboxone with illicit fentanyl have been increasing. since around 2011, as provision of MAT opioids has increased. 

Wow! Okay. I need to lighten up, don’t I? This is just disrespectful. And that anecdote, that tale from an opioid user – okay, so it’s not entirely congruent, not entirely credible – was right at the top of this important story from America’s trusted corporate media – NPR! The very first 5 paragraphs of this incisive, investigative piece. That can only mean that the tale – the self-report from the opioid user gaining subscriptions form medical providers for addictive opioids that are the fix for America’s opioid problem – that testimonial serves as evidence for the legitimacy and effectiveness of American Medicine’s fix for American Medicine’s opioid crisis. That goes without saying.

Doesn’t it? It does, right? It is evidence for the effectiveness of MAT, right?

Let’s keep going –  

A growing number of Americans with opioid use disorder have benefitted from a rule change early in the pandemic that allowed them to access prescriptions of their controlled medications, via telehealth. These medications, which are themselves opioids, are regulated heavily by the Drug Enforcement Administration.

That’s a declarative statement, isn’t it? That, “A growing number of Americans with opioid use disorder have benefitted” from the rule changes allowing them to get their addictive, widely diverted and abused opioids, like the bupe that serves as commodity and currency on the street in economies of illicit, lethal opioid use. There must be some evidence for that benefit, as opposed to harm, and additional deaths? I don’t see a link, but surely NPR would be able to cite some research that supports the benefit of MAT and provision of bupe? Right? A randomized clinical trial (RCT) or two?

But let’s not get distracted. Or become disrespectful, because after all, there is a solid consensus among America’s Trusted Sources, scientific and healthcare experts, science writers, and watchdog media that substitute opioids dispensed in MAT programs are a cure for opioid dependence and the fix for their opioid crisis. How could that possibly be doubted? 

Of course there are two sides to the issue, both equally legitimate, because . . . well, actually because what passes as journalism these days is this type of pre-scripted intellectually lazy messaging that relies on emotionally appealing personal accounts, is evidence-free, and never, ever, questions the orthodoxy of American Medicine, American Healthcare, or their servants, no matter how lethal. So, of course, for an informed, competent, authoritative source on human behavior, mental health, related research and its interpretation, and the complex set of evidence bearing on these questions – an elected official in American democracy –

Telehealth’s growth — estimated by McKinsey to have expanded 38-fold since the pandemic — has spawned a flurry of state and federal legislative proposals. In deciding the future of telehealth rules, policymakers are looking for data to figure out the lessons learned — what worked, what didn’t — during this emergency period.

Absent evidence of abuse, says Senator Mark Warner, D-Va., telehealth should continue for medically-assisted opioid treatment.

“We’ve now had 18 months to have telehealth expand dramatically; it would be a huge mistake to roll back that progress,” Warner says. “If you cut off that ability to deliver those substances with appropriate protections, you’re really cutting back on the path to recovery for a lot of folks.”

Right? “cutting back on the path to recovery for a lot of folks”, that is, the delivery of “those substances”, the substitute opioids, of course, like Suboxone and methadone, in American Medicine’s opioid substitution therapy (OST), or medication assisted treatment (MAT) programs. The path that’s been the “gold standard”, increasingly administered to opioid users over decades – increasingly over decades before anyone ever heard the words “COVID” and “pandemic” uttered together –  the persistently expanding medical fix for opioid dependence and American Medicine’s opioid crisis, the “proven” cure and “path to recovery” with predictable results for those “folks”.

Trends in Kentucky in opioid overdoses and treatment

But where were we? Back to NPR’s investigative report on America’s increasing lethal drug use epidemics. 

A debate about the limits of telemedicine

The medical community, meanwhile, is of two minds about the trade offs.

No, that’s a lie. Because the medical community is not of two minds about telemedicine and opioid dependence or about “addiction” or about its treatment, nor of one mind.

That’s because there is no one within the “medical community” capable – not remotely capable – of forming a meaningful thought about any of those things, none of which are remotely medical or physical or psychiatric in nature. The medical community is entirely outside of scope of practice,  of no minds about substance use, or its treatment, or any related trade offs. The useful, rewarded construction, in this instance by NPR, that there are medical positions, understandings, or viewpoints on problem substance use and its treatment is part of the social pathology generating increasingly lethal substance use epidemics and deaths. Pathological levels of incompetence and diminished capacity – for integrity, for ethical reasoning, for research literacy, and for critical thought. Levels of pathologically diminished capacity that created an opioid crisis, now perpetuate it.  

But wait, that’s much too harsh. We would prefer a soothing anecdote, a calming tale, something validating, confirming, sedating, like a few drinks, a few hits.

Like this (thanks NPR!),  the testimonial of a medical professional, an “addiction specialist” –

There is always a risk that some patients and doctors may try to abuse telehealth rules to divert drugs, says Huntington, Calif., addiction specialist, Joseph DeSanto. But last year, DeSanto found more benefit than downside; during the pandemic, he was able to care for 20 patients living out of state.

“We could treat anyone, anywhere in the U.S.,” until California returned to its old rules earlier this year, DeSanto says. “The response was resoundingly positive, and we were able to see patients that wouldn’t normally have gotten help,” he says.

For example, DeSanto says, he treated one Tennessee man in his early 30s, who called DeSanto from a rural area where addiction doctors are practically unheard of. During lockdown, the man relapsed on opioids — something DeSanto says was common for patients. DeSanto prescribed the patient buprenorphine to fight his addiction, until the patient located a doctor in state.

“It gave him some time, and I’m not sure if he would’ve had that time if he relapsed and didn’t realize that he had the ability to see a doctor that wasn’t local to him,” he says.

So reassuring, so touching, the anecdote without follow-up or evidence (that could ruin it!). Why would we demand research, or tracking through time for outcomes, or “evidence”, when we have American expert consensus reinforced by such hopeful, inspiring accounts, tales, anecdotes, from our trusted medical professionals, from the medical community? Shouldn’t that be enough?

Shouldn’t we trust them? And the corporate media providing the edifying and confirming stories to us?

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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