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AS OPIOID DEATHS MOUNT, GROUP THINK AND SCAPEGOATING PROTECT THE REAL SUPPLIERS GENERATING CRISES

New reports show Big Pharma scapegoating and fentanyl fabrication by Media are successful – protected, empowered medical prescribers continue recklessly prescribing opioids

By Clark Miller

Published June 18, 2021

America’s entertainment/mass media/medical collusion, echoed by social media, has spoken, has delivered the truths that Americans need in order to understand an increasingly lethal opioid epidemic that confusingly worsens the more medical cure is provided.

Fortunately, it’s not complicated, and because it’s not – the cause clearly identified – we should expect remarkable gains in the medical and public health response as the sources, the perpetrators, of the crisis are held to account and stopped from continuing. Those perpetrators, clearly identified now, are of course known to most Americans as the big, and greedy, pharmaceutical manufacturers and their owners, most culpable Purdue Pharmaceutical owned by members of the Sackler family. 

It’s clear now that the evil Sackler family, operating in America as opportunistic capitalists to supply a product for which there was increasing demand, provided a dangerous, excessive supply of addictive opioids to Americans who didn’t need them medically, were provided way too much in any case, and without medical monitoring and controls that would prevent the widespread diversion and abuse of those addictive pills by the patients and, it turns out, whoever could get their hands on them.

Protests against the Sacklers

Except they didn’t, of course

The Sacklers did not, could not, open a chain of retail outlets Americans could walk into and buy the opioids off the counter. No. Not a single opioid pill provided to living or dead Americans came to them from the Sackler family, from Purdue Pharmaceuticals, from any employee of a pharmaceutical or opioid manufacturing company. The only originating suppliers were licensed medical professionals meeting with patients in exam rooms, providing medical services to them, then writing prescriptions that supplied them with the opioids. Without their signatures, no opioids were dispensed.

Instead, what the evil Sackler family did was pay pharmaceutical reps – pill salesmen – to visit doctors (medical prescribers) in their offices during and between visits with patients and hold guns to the prescribers heads to force them to prescribe the opioids. And the reps forged their signatures on prescriptions, and they threatened harm or death to the families of licensed medical professionals if they refused to prescribe the opioids.

Ha! Funny. Of course they didn’t.

They didn’t need to. Instead, the pill salesmen – with exactly the level of qualification to understand and evaluate medical need and the research bearing on safety of the opioids as you would guess, that is, none – explained to the doctors that, against all longstanding evidence, these opioids are effective and safe for all forms of pain. And? Those helpful pill salesmen, conveying clinical understanding of opioid safety and use to America’s medical professionals, took them out to nice dinners, and lined their pockets with speaking junkets, where the newly educated doctors would explain to their colleagues the safety and need for the opioids, based on what they had learned, from salesmen.

Those physicians relied, with the health and safety of their patients at stake as with any medication and certainly for controlled substances, on the information provided them by those pill salesmen. Salesmen, not healthcare professionals or researchers.

Take just a minute to think about that.

But that truth is far from the accepted fabricated reality, buried under lies

Here’s Colbert, shoring up some ratings, and asserting the obvious, what Goes Without Saying about Big Pharma, to the applause of his audience, “It’s their fault”.

Everyone Knows it Now

Those are remarkable words – part of a headline, beyond any specific description of content of the piece, asserting, a slip in the Freudian sense, to message: 

We’ve Instilled that Belief in All of You Now

How could there be any doubt about the truth? When top, trusted American institutions and authorities including medical, political, justice system, mass media, entertainment, and healthcare are in consensus? How could that type of authoritative consensus be off, disserve or endanger the public?

This Wall Street Journal  piece lists all the “villains”, all those culpable and with some share of responsibility . . . except for one group, the only group acting as gatekeepers, or with the ability to act as gate keepers between the supply of manufactured opioids and the consumer, those vulnerable, trusting patients who would become dependent, or allow excess pills to get to others who would, would develop devastating habits, would die by overdose. Except for the only group who could decide whether those patients would receive the opioids or not – America’s physicians and other licensed medical providers writing the prescriptions. They weren’t mentioned.

It’s a success story, from the industry’s point of view. It’s also a story of villainy, with a catalog of villains—not just the Sackler family of Purdue Pharma, but their sales representatives; the U.S. congressmen to whom they made outsize donations (Christopher Dodd, the former senator from Purdue Pharma’s home state of Connecticut, is spotlighted); the former prosecutors hired as lobbyists (Mary Jo White and, somehow inevitably, Rudolph Giuliani); and officials of the Justice Department and the Food and Drug Administration—where Curtis Wright, a physician and deputy director, collaborated with Purdue Pharma executives in drafting the review of OxyContin that helped open the way to its 1996 entry into the marketplace.

The rest, as might be said, is drug-epidemic history, although “Crime of the Century,” produced in association with the Washington Post, begins with a sprint through a much lengthier history, of both the opium poppy and the drug trade . . .

American Media useful scapegoating of Big Pharma and fentanyl fabrication are successful – protected, empowered medical prescribers continue recklessly prescribing opioids

The Sacklers weren’t the gatekeepers. No matter how nice the meals and generous the bribes, any competent medical professional using clinical and ethical judgement could have declined to prescribe, based on the evidence that was available to anyone interested in verifying Purdue’s claims, evidence they would almost have to have been exposed to in medical school.

This evidence

There has never existed, not at any time, a body of research evidence to provide even preliminary support for the safe practice of prescribing opioid medications for chronic painor with the expectation of durable benefit for chronic pain.

See, for example:

Chou, R et al.  2015. The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.  Ann Intern Med. 162:276–286.

From the beginning, well prior to explosion of runaway, widespread use of prescription opioids for centralized chronic pain, all lines of evidence pointed against and contraindicated their use. There was never support for their safe, effective use due to longstanding:

I)  lack of research evidence for effectiveness long-term

 II) evidence for the potential for hyperalgesia

Hyperalgesia – increased sensitivity to pain – induced by use of opioids (OIH) is known and described extensively, beginning late 19th century.

See, for example:

Lee, Marion et al. 2011. A Comprehensive Review of Opioid-Induced Hyperalgesia Pain. Physician 14:145-161

III) established addictive potential of opioids

The high abuse and addictive potential of opioids including those prescribed for chronic pain is long-established (1), generating a history of statutory control (2) e.g. Harrison Act (1914); Boggs Act (1951) and others.

The 1970 Controlled Substances Act (3) lists opioid drugs commonly prescribed for chronic pain as Schedule II Substances (4), highly controlled as “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence”

IV) understanding of the psychogenic nature of centralized chronic pain

Chronic pain (5) – long-lasting pain that is non-cancer, not caused by acute tissue damage or inflammation – is established by decades and multiple lines of evidence and research as psychogenic (generated by mental/emotional states) in nature and with indicated treatments that are psychological (behavioral health therapies), not biomedical.

See, for example:

Dersh, Jeffery et al. 2002. Chronic Pain and Psychopathology: Research Findings and Theoretical Considerations. Psychosomatic Medicine:  64: 773-786

[Numbers 1 – 6 in parentheses in boxes link to online sources listed at bottom of post.] 

V) evidence for cognitive behavioral therapies (CBT) as the indicated treatment for chronic pain

Extensive and longstanding research (6) establishes that effective and durable CBT treatments for centralized chronic pain (long-lasting pain that is non-cancer, not due to acute tissue damage or inflammation) are psychological (behavioral health therapies), not biomedical, fundamentally targeting underlying beliefs and mood states associated with pain. 

See, for example:

Cherkin, DC et al. 2017. Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain. JAMA. 317(6):642–644. doi:10.1001/jama.2016.17814

For a critical review of the current evidence: Doxa Deconstructed:  Chronic Pain is Not What You Think

All relevant lines of evidence existed decades prior to emergence of runaway misuse of opioids and the current crisis.

Nor was the FDA the gatekeeper, the supplier who could have said “No” to protect Americans. The FDA could have authoritatively asserted that opioids are no more a risk than baby aspirin, or vitamin C, and it would have remained the ethical and clinical mandate of every medical prescriber to use their training and the longstanding evidence available to make the medically sound choice.

Some did, as described by Chris McGreal in American Overdose

As McGreal describes it, the clinical environment in medical practice settings became coercive and toxic – a collusion of patients trained by decades of programming to seek a pill for every distress including opioids, supported by the medical/hospital/insurance industrial complex to report doctors who would resist providing opioids inappropriately and threaten them with complaints and action by professional and licensing boards.

McGreal talked to Dr. Charles Lucas, a surgeon in Detroit who resisted growing pressure to overprescribe opioids, ended up being subject to a complaint and summoned before a hospital ethics committee for failure to provide adequate pain treatment.

(from American Overdose pp 88 – 89)

The case was dropped, but it was not an isolated incident. Luca has worked closely with another surgeon, Anna Ledgerwood, since 1972. She too was hauled before the ethics committee on more than one occasion on the same charge. One of the investigations, for alleged inadequate pain management after a hernia operation, went all the way up to the state medical board. It cleared Ledgerwood, but Lucas said more junior surgeons buckled to the pressure to administer opioids just to stay out of trouble. “If they will give me a hard time, then they will surely give a young resident a harder time,” he said. “I tend to be a fighter. That’s my nature. But somebody who just wants to take care of patients, they want to be a professional physician, they don’t want to put up with all this crap; they’re intimidated. They’re also frustrated by it. The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”

Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.

Of course they knew. Or should have, or should not be practicing medicine.

But the forces driving runaway, medically inappropriate dispensing of opioids were not knowledge, competence, integrity or professional courage. There were other forces at play.

The extent to which we tolerate and enable the pretense of Big Pharma causing the neglectful over prescription of controlled substances to patients is absurd and pathological. It is terminal group think, literally, because the fearful failure to state and face what is obvious empowers continuing over prescription and predictable diversion, abuse and dependence.

 

Below: Have they learned?

 

To repeat: not a single opioid pill provided to living or dead Americans came to them from the Sackler family, from Purdue Pharmaceuticals, from any employee of a pharmaceutical or opioid manufacturing company. The only originating suppliers were licensed medical professionals meeting with patients in exam rooms, providing medical services to them, then writing prescriptions that supplied them with the opioids. Without their signatures, no opioids were dispensed.

And they wrote those prescriptions against all lines of longstanding relevant evidence.

Let’s try it more concretely:

Imagine a conversation between a trusting yet anxious parent whose child is diagnosed with a serious cancer and the treating medical specialist.

Parent: I really want to believe this medication can work and from everything you’ve said it’s what he needs. I’m just scared, with everything you read about side effects and dangers.

Doctor: Of course, but I do want to assure you that these medications are not only safe but effective as well.

Parent: It’s so confusing. My husband isn’t a doctor, but he Googled the medication and says it’s a controlled substance due to risk of serious effects, and no more effective than safer treatments, and can make the condition worse, and there are other effective treatments. He found that those things have been known for a long time.

Doctor: I would never recommend for someone not medically trained, like me, to attempt to gain information on something this important. I have years of training.

Parent: Thank you, thank you. I know you medical professionals must keep up with and review all the relevant information, especially about powerful medicines. You looked at the research thoroughly and talked to colleagues, other specialists, I’m sure.

Doctor:  Actually, I learned over several dinner engagements about the medications and how safe they are from a pharmaceutical expert.

Parent: Oh. So . . . he or she was a researcher sharing the research with you? A pharmacist, or expert on drugs or medicine?

Doctor: Well, not exactly. He was a pill salesman with no training in any of those areas. The dinners were lovely, and I’ve been compensated generously for sharing the information with other doctors.

Parent: You are joking of course?

See how that was done? It was easy. To out the absurdity, the lethal malfeasance? Anyone can. All it takes is a willingness to state the obvious, an absence of the cowardice that would otherwise prevent stating the obvious.

Have they learned ?

Learning is not supported by the December 2019 study reported on by Bloomberg Law.

Patients are still getting too many opioids to treat their acute pain because of inconsistent prescribing guidelines despite a push to significantly lower pain pill prescribing in the U.S., an FDA-sponsored report released Dec. 19 found.

Acute pain is one that a patient feels for no longer than 90 days. Although there’s a bevy of opioid prescribing guidelines floating around, the National Academies of Sciences, Engineering, and Medicine found a lot of them don’t have rigorous evidence to back them up. That’s an issue the federal government has tried to rectify in the last few years, but there’s still a dearth of data on how to best treat pain that comes from everyday procedures like dental surgery.

The biggest reason better guidelines are needed is because the U.S. still leads the globe in opioid consumption. In 2010, the U.S. consumed approximately 80% of world’s opioid supply despite constituting less than 5% of the world’s population, research found. Dentists in the U.S. prescribe opioids 71 times more frequently than their counterparts in the U.K.

Nor by this report, at Fox News – 

ST. LOUIS – St. Louis medical researchers are worried about a possible spike in the opioid crisis because a growing number of doctors are prescribing painkillers to COVID long-haulers.

A joint study by the Washington University School of Medicine and the Veterans Health Administration is encouraging doctors to seek alternative treatments for COVID long-hauler instead of opioids.

“This may cascade down to be a bigger problem down the road,” said lead researcher Dr. Ziyad Al-Aly, Washington University and the Veteran’s Health Administration.

Dr. Al-Aly said the study showed COVID long-haulers were taking more opioids to manage pain than other VA patients.

. . . 

“Can you imagine that if everybody that has been diagnosed with COVID and, six or eight or nine months later, are still dealing with symptoms and then you give them the opportunity to take opioids to address some of their issues? It’s just such a slippery slope,” Coleman said.

Dr. Al-Aly said opioids should be used as a last resort, at a low dose, and for a short period of time. He said there are effective alternatives.

“Long COVID is real. The pain is real and must be treated, however, it should be treated with non-steroidals. Some patients are responding favorable to non-steroidals,” he said. “There are other options, including Tylenol and physical therapy. Some form of physical therapy that’s tailored specifically for long COVID patients.”

The report neglects to address some relevant points: that COVID conditions have been associated with increased incidence of anxiety and depressed mood; that pain and other chronic physical symptoms often are attributable to emotional disturbance; that for almost all cases of chronic pain, with exceptions, the persistence is psychogenic and indicated, effective treatment is psychotherapy, not medical or physical; that grossly negligent failure to recognize the psychogenic nature of chronic pain and fabrication of false public health information in order to medicalize it generated the opioid crisis.  

But that’s not all, there’s something missing, hidden

by mass media colluding with medical institutions, medical prescribers, and useful idiots constructed as “healthcare experts” or “addiction treatment experts” to distract the public with an opioid shell game – in which oxycontin and hydrocodone, for example, are “prescribed opioids” while methadone, suboxone, and subutex are NOT prescribed opioids – supporting the necessary lie that prescription opioids are NOT THE PROBLEM, because the real problems are the evil Sackler family and fentanyl. Because buprenorphine and methadone are NOT prescribed opioids.

Because if they were acknowledged as, identified with “prescribed opioids”, then OH SHIT do we have a problem. Because – and unfortunately the evidence is longstanding, extensive, and consistent – as routinely diverted, abused, addictive opioids, potentially lethal alone or as increasingly used in combination with benzos and other drugs, they are serving as commodity and currency on the street in illicit, lethal opioid economies. 

But remember, the opioids routinely diverted, abused, traded for illicit opioids on the street, increasingly present in opioid overdoses, and despite not being regularly even reported in overdose reports, are not of concern to you. That’s why we don’t report on them. Move along, there’s nothing to see here. Don’t think for a minute that those opioids are methadone, Suboxone, and Subutex. Prescribed by doctors and other medical professionals in increasing amounts. Now prescribed without need for evaluation or in-person contact. By video connection. Against all relevant evidence that they are fueling an increasingly lethal opioid crisis. Opioids misprescribed just as in the creation of the opioid crisis.

It is not your place to question that.

That’s dangerous thinking.

Stop it.

It was the Sacklers. 

Everyone Knows it Now.

How could there be any doubt about the truth? When top, trusted American institutions and authorities including medical, political, justice system, mass media, entertainment, and healthcare are in consensus? How can that be anything but suspect? And endangering?

We know it now, that the truths created for a trusting public by a mass media/entertainment/social media/medical collusion – created while deaths mount as provision of medical “fixes” for pain and for the opioid crisis increase – actually serve as necessary lies about worsening lethal epidemics by means of distracting fabrications and scapegoats. Truths that are lies that are believed and unquestioned, that Go Without Saying.

Numbered links to sources

1 – The high abuse and addictive potential of opioids including those prescribed for chronic pain is long-established

2 – generating a history of statutory control

3 – The 1970 Controlled Substances Act lists opioid drugs commonly prescribed

4 – Schedule II Substances  are highly controlled as “drugs with a high potential for abuse”

5 – Common chronic pain is established by the evidence as psychogenic, not physical

6 – Extensive research establishes cognitive behavioral therapy (CBT) as the indicated treatment for chronic pain

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.

Pierre Bourdieu - Outline of a Theory of Practice 1972

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