DECONSTRUCTED 2. NIH $344 MILLION OPIOID CRISIS MEGASTUDY “SECONDARY ANALYSES” REAFFIRM LETHALITY OF EXPERT GOLD STANDARD TREATMENTS
Demanding explanation, intervention group overdose deaths from opioid use don’t drop but do decrease for combined opioid + stimulant use, pointing again to lethality of medical and other expert gold standard treatments.
by Clark Miller
Published December 20, 2024
After predictable outcomes of no benefit from the National Institutes of Health (NIH) study that implemented in treatment communities (versus randomized control communities) expanded provision of MAT medications (substitute opioids methadone and buprenorphine) and of opioid fatal overdose reversing drug naloxone (Narcan), investigators announced intentions to explore “secondary outcomes” by further analyses of the data.
That type of post hoc scrambling for results that you really, really needed is never legitimate in research practice, less so with $344 million in resources to design and implement the research properly to evaluate the identified hypothesis.
What was actually conveyed, messaged, following the outcomes that failed to validate “proven”, “gold standard” medical and other “treatments” that have increasingly been administered to diseased brains over decades of worsening, increasingly lethal substance use epidemics was something like – in intent if not in tone and word choice –
SOMEBODY GENERATE A F##KING SUBSET OF THIS DATA THAT GIVES US A F##KING P VALUE WE CAN USE!
That is to say, there would have had to have been some level of elevated consternation to be faced with what has been established for years, that there never has been and is not now a body of evidence pointing to effectiveness of America’s expert consensus treatments for problem substance use and the associated epidemics, those approaches instead established as fueling the lethal public health crises.
It is important to not avoid the obvious, in this case the pressing question demanding answers that lives depend on:
Why would expert gold standard, proven, medical treatments designed specifically to treat problem, compulsive opioid misuse constituting high-risk use not provide any benefit for high-risk opioid use, while in those intervention communities, somehow overdose deaths were lowered for high-risk use of stimulants with opioids?
We’ll get to those answers, it turns out we already have them.
It is said that one should “be careful of what you wish for”, and that is what may come to mind as we consider the meaning of the results of the analyses for secondary outcomes, described here and elsewhere as providing new outcomes –
The HEALing (Helping to End Addiction Long-Term) Communities Study tested how the implementation of evidence-based tactics has impacted the overdose death epidemic in Ohio, Kentucky, Massachusetts and New York. . . .
Researchers reported in June on the main outcome of HCS – that the intervention did not result in a statistically significant reduction in opioid overdose death rates during the evaluation period. In this study, the authors found that intervention communities had an 8% lower rate of all drug overdoses compared to control communities, which was estimated to represent 525 fewer drug overdose deaths. . . .
Fewer people died with an opioid and a non-cocaine stimulant in their system — like methamphetamine — in areas with the programs. The rate of death fell from 14.1 deaths per 100,000 to 8.9 per 100,000 people in areas with targeted interventions.
The researchers state the finding is statistically significant, and that interventions did not reduce opioid overdose deaths when opioids were mixed with other drugs like cocaine.
“With the prescription medications that started the opioid crisis harder to obtain by the time the trial began, fentanyl was rapidly entering the illicit drug market in combination with methamphetamine, cocaine, counterfeit pills and other stimulants,” states Bridget Freisthler, lead author of the new study and a professor at Ohio State University, in a news release.
“Now we have a whole new group of people developing addiction to opioids,” said Freisthler, Ohio’s principal investigator for the HEALing Communities Study. “It was nice to see that we were able to achieve reductions in overdose deaths involving this combination of opioids, primarily fentanyl and psychostimulants, not including cocaine, because that’s the most recent wave in the epidemic that we’re seeing.”
That background will be important in understanding the differential nature of the outcomes, that –
“Now we have a whole new group of people developing addiction to opioids, . . . involving this combination of opioids, primarily fentanyl and psychostimulants, not including cocaine, because that’s the most recent wave in the epidemic that we’re seeing.”
Our understanding of the meaning of these outcomes, with clear implications for the lethality of an ongoing epidemic, depends on attaining an accurate view of how and why and by whom these drugs and drug combinations are being used.
Let’s start with material from this NPR piece –
The mix of stimulants like cocaine and methamphetamines with fentanyl – a synthetic opioid 50 times more powerful than heroin – is driving what experts call the opioid epidemic’s “fourth wave.” The mixture presents powerful challenges to efforts to reduce overdoses, because many users of stimulants don’t know they are at risk of ingesting opioids and so don’t take overdose precautions. . . .
“The number one thing that people in the U.S. are dying from in terms of drug overdoses is the combination of fentanyl and a stimulant,’’ said Joseph Friedman, a researcher at UCLA and the study’s lead author. . . .
People often use stimulants to power through the rapid withdrawal from fentanyl, Friedman said. And the high-risk practice of using cocaine or meth with heroin, known as speedballing, has been around for decades.
Other factors include manufacturers adding the cheap synthetic opioid to a stimulant to stretch out their supply, or dealers mixing up bags. . . .
The researchers surveyed more than 260 people in Rhode Island and Massachusetts who use drugs, including some who manufacture and distribute stimulants like cocaine.
More than 60% of the people they interviewed in Rhode Island had bought or used stimulants that they later found out had fentanyl in them.
In 2022, Rhode Island had the fourth highest rate of overdose deaths involving cocaine in 2022, after D.C., Delaware and Vermont. according to the U.S. Centers for Disease Control and Prevention (CDC).
People who don’t regularly use opioids have lower tolerance, which puts them at higher risk of an overdose.
And many of the people interviewed in the study also use drugs alone, so if they do overdose they may not be found until it’s too late.
And there’s this, from the San Francisco Chronicle –
Chi Minie overdosed on fentanyl for the first time four years ago, at age 32. But the near-death experience didn’t stop him from using — or from taking the even riskier step of escalating to speedballs, packing rocks of crack cocaine into a pipe along with the super-powerful opioid fentanyl. It’s pricier to smoke the mixture, because he has to shell out cash for two drugs instead of just one, he said, but the high is “smoother.”
Minie overdosed again in April. Still, whenever he gets a few extra dollars — not an easy thing to do, considering he is homeless — he treats himself to a speedball or a goofball, mixing fentanyl with methamphetamine.
“I’ve known plenty of people who died of speedballs or fentanyl, but I think I know what I’m doing,” Minie said one recent day on Mission Street as night fell and he prepared to head into the Tenderloin. “And on a night like this, when I’m walking around, I’ll need a speedball. It makes sure I don’t fall asleep where I smoke up, and get all my stuff stolen. That little bit of crack cuts the nods.”
Combining drugs or using them in succession, what researchers call polysubstance use, isn’t a new phenomenon. But it is becoming much more deadly with fentanyl now often a part of that concoction — whether or not the user is aware of its presence.
. . .
The main factor driving speedball overdose deaths, Coffin believes, is the desire by users to counteract fentanyl’s overwhelming sedation effect — the so-called nods, which are more severe than from heroin or other opioids. Right after injecting heroin, users will often get very sleepy for several minutes, with their heads slumping forward, but the nods from fentanyl often cause users to bend over double and seem to be unconscious.
Adding cocaine or meth to the mix mitigates that severe slumping, Coffin said. But if the stimulant actually has or just is more fentanyl, that combination is deadly.
The risk becomes even more pronounced because users need to take fentanyl more frequently than other opioids to stave off dope sickness — every few hours as opposed to every six or more. Every time a user smokes a mix of unpredictable street drugs, he or she is rolling the dice.
Meanwhile, some people use stimulants as a form of protection, said Ryan McNeil, director of harm reduction research at Yale University. People who become homeless, he explained, might turn to methamphetamine to stay awake at night, when they’re more vulnerable to assaults or thefts.
Some reassuring news is that the potentially lethal opioid overdose reversing drug naloxone (Narcan) is effective for reviving these opioid overdoses with stimulants involved.
Brendan Saloner, who researches substance use disorder at the Johns Hopkins University School of Public Health, said that naloxone — known by the brand name Narcan — can still reverse overdoses caused by opioids, even if other drugs are present.
Let’s summarize at this point
Research and reports tell us that there has emerged two large groups of illicit drug users at increasing risk of opioid overdose and fatal overdose involving an opioid (most commonly fentanyl) and a psychostimulant (generally methamphetamine or cocaine) used together.
The high-risk substance use occurring is of course more varied and complicated than that. Yet there are patterns seen as described in the accounts above, one of those patterns of drug users engaging in illicit stimulant use and unintentionally being exposed to fentanyl with the stimulant, the potency and dose unpredictable, leading to increasing numbers of overdose deaths, not because those individuals have an opioid use disorder, but as a risk of stimulant misuse.
And as noted from the same SF Chronicle piece,
While there are resources to prevent opioid overdoses, treatment options for people with stimulant use disorders in addition to fentanyl addiction are limited, said Rachel Hoopsick, a substance use researcher with the University of Illinois at Urbana-Champaign. For example, there’s no medication that reduces the pain of stimulant withdrawals like there is for opioid or alcohol withdrawals.
Shover, the UCLA epidemiologist, explained that current treatment tends to focus on people who use only a single substance. One study has shown that people who start medication for opioid use disorder while still using stimulants are more likely to take opioids again.
Yes, and the actually more salient point is that those stimulant abusers would never find themselves in “medication assisted treatment” (MAT), also known as “medication for opioid use disorder” (MOUD), the gold standard opioid crisis treatment whose provision was intentionally enhanced in intervention communities of the NIH study. They are not opioid dependent and would not qualify for the substitute opioid treatment, would not benefit from it.
As expressed in the JAMA research article describing thte secondary analyses outcomes,
Naloxone, as an opioid antagonist, is likely to significantly reduce deaths related to an opioid and other substances, including opioid-psychostimulant combinations. MOUD, through occupying the μ receptors, reduces risk of opioid overdose deaths (whether alone or in combination with stimulants) by decreasing the number of times an individual uses opioids and risk exposures.
And in the states and communities that were part of the study, their potentially lethal overdose deaths due to fentanyl would have been reversed, prevented, by any responder including dramatically increasing numbers of peers and laypersons equiped with Narcan in the intense, targeted, highly successful naloxone training and distribution campaigns that were occurring there directly antecedent to and during the study period, as described here, here, here, and elsewhere here.
Another pattern described in those accounts is that of dedicated opioid users, fentanyl their “drug of choice”, adding stimulants to their use intentionally as a protective strategy, to be less vulnerable, to moderate risk of harm tied to homelessness and other psychosocial factors often associated with severe, high-risk street economies of illicit drug use. And to augment the quality of the drug effects.
Again from the SF Chronicle profiles –
Onnie Broussard, a 43-year-old Black man, said he last overdosed in June on a speedball of crack and fentanyl, and that every time he smokes the combination he feels like he’s spinning the chamber on a pistol, hoping he hits an empty and not a live round.
“There’s no right mix that’s in a book somewhere, so you just try to know what you’re taking,” he said as he got ready to light up on Leavenworth Street in the Tenderloin alongside his tent. “Fentanyl is a cheaper, better high than heroin — and when you mix it with crack it’s an even better high. But what’s cheaper than any of them is sobriety.
“I would like that. I like living. I like life. But I just can’t get there. The dope has too much of a hold on me. Too strong.”
Let’s start thinking about these outcomes and reports,
then place them in context of a decades-long lethal epidemic, toward making sense of it all.
Keeping in mind the description in the JAMA research report of America’s gold standard use of substitute opioids to cure problem opioid use and reverse the epidemic, that MOUD [can have benefit in preventing high-risk opioid use, overdose and deaths], through occupying the μ receptors, reduces risk of opioid overdose deaths (whether alone or in combination with stimulants) by decreasing the number of times an individual uses opioids and risk exposures.
1. MOUD does not benefit stimulant users
As we discussed, problem stimulant users whose stimulant substances of abuse unknowingly include fentanyl do not access MOUD treatment, are not appropriate for it, would not benefit from it. They do respond to emergency use of Narcan to prevent fatal overdose.
2. MOUD is least likely to benefit the highest risk, most severely dependent opioid users also using stimulants
There are a variety of reasons this is true, each contributing to the decreased likelihood of such problem opioid users being able to effectively access MOUD, maintain compliance, and benefit from it.
Some factors include:
– As described, the opioid + stimulant combination a survival strategy representing an environment not supportive of effective access and retention in MOUD treatment including homelessness, immersion in illicit drug culture, associated psychosocial stressors driving substance use for psychological and emotional escape
– Complicating factors acting as barriers including lack of resources, mental health conditions, and physical health conditions
– Severity of psychological dependence
– Without access to or effective engagement in therapies and psychosocial supports, provision in MOUD programming of Suboxone, its qualities and role in economies of illicit drug use contributing to it’s pervasive value and use on the street as currency for fentanyl
– Repeated experiences affirming accurately for them that gold standard treatments are not effective
– Loss of hope under dire circumstances and formative life histories
– Additional factors related to problems in functioning
These users as well do respond to emergency use of Narcan to prevent fatal overdose.
The considered factors alone, independently, provide explanation for the differential outcomes of the secondary data analyses. To the extent that the crisis “fourth wave” and associated observations are valid, we would necessarily predict:
If the increased provision of MOUD in the control communities had been effective, then the predicted outcomes would have been the opposite or distinctly different than those obtained. The subset of “any opioid use” would have been equally likely to have been found to have a statistically significant outcome of fewer overdose deaths, almost certainly would have been more likely to have that outcome than for opioid + stimulant combinations.
Why? because those larger data subsets would have diluted effects of dedicated stimulant (1. above) users from the analysis and would have included opioid users in addition to those least likely to benefit from MOUD (2. above).
The trees are clear and distinct, right in front of us, let’s look at the forest.
3. For the study states and communities, it is established that any and all reductions in fatal opioid overdoses are accounted for by naloxone saves and not by MOUD.
Those states are Ohio, Kentucky, Massachusetts, and New York.
In Kentucky, initial efforts included successful, targeted community distribution of more than 40,000 Narcan units over the study period (2019 – 2020), described here.
And as described in detail in this post –
Kentucky communities achieved the greatest increase in naloxone distribution among the four participating states. The eight Kentucky counties participating in the study’s first wave implemented 104 different strategies and achieved a distribution rate of 6,400 units of naloxone per 100,000 residents — for total of 40,822 naloxone units. These intervention communities tripled their naloxone distribution compared to control communities — an increase more than twice that of any other state in the study.
The new study results showed that across all four states, communities implementing the intervention distributed 79% more naloxone units compared to control communities. The increase was driven by several different strategies including providing naloxone at addiction treatment centers, community outreach programs and increasing availability at local pharmacies.
That targeted community provision of naloxone continued with dramatic increases in units provided each year –
Van Ingram, the executive director for the Kentucky Office of Drug Control Policy, said distribution of Narcan, which can reverse opioid overdoses, in the state is key. Local health departments, recovery community centers and regional prevention centers provide free Narcan across the state. . . . In 2023, 160,000 doses of Narcan were distributed in Kentucky.
In Ohio, as described in detail in an upcoming post, it’s the same story.
From that post –
TOLEDO, Ohio — A multiyear experiment in this working-class city on Lake Erie’s banks holds clues to how America could get a handle on its overdose crisis — if politicians embrace the lessons.
Fatal drug overdoses in the U.S., driven by the synthetic opioid fentanyl, increased by more than half during the pandemic and remain near record levels. But in Lucas County, where Toledo is, they plummeted 20 percent between 2020 and 2022.
20 percent,
Toledo employing the same strategy that more than accounted for opioid death reductions in Hamilton County attributable to Narcan, years earlier.
Still, Lucas County defied the pandemic trend. It was one of 67 counties in four states to participate in HEALing Communities Study, a National Institutes of Health study that spent $350 million starting in 2019 to reduce fatal overdoses by 40 percent. . . .
in Toledo, a data-focused approach showed promise. Federal funds paid for iPads to help collect and share data and offer videos to train people to use the opioid overdose reversal drug naloxone. It bought a mobile van for educational outreach and naloxone distribution. And it came with access to a staff who coordinated and analyzed data, designed interventions and helped with marketing.
The data provided a clearer view of Lucas County’s drug problem, showing which ZIP codes and demographics were seeing the most overdose deaths.
Those dramatic, targeted community-based efforts continued, with additional dramatic outcomes –
Ohio’s Project DAWN — a network of opioid overdose education and naloxone distribution programs— increased its distribution of naloxone 42% from 205,584 kits in 2022 to 291,289 kits in 2023, according to the Ohio Department of Health. That increase in kits led to an 11% jump in known overdose reversals, going from 18,244 in 2022 to 20,289 in 2023.
Although the data is piecemeal, it still makes a compelling case for naloxone, said Dr. Bruce Vanderhoff, director of the Ohio Department of Health. And Ohio’s efforts must be working, Vanderhoff said, as the number of overdose deaths dropped 5% in Ohio in 2022 to 4,915 while increasing nationally by 1%.
. . .
Ohio spent more than $51.2 million to provide 723,574 naloxone kits from 2019 through 2023, according to the Ohio Department of Mental Health and Addiction Services. That doesn’t include naloxone sold through pharmacies and other nonprofit groups that don’t get federal funding.
Efforts in Columbus focused on making Narcan available and where it was needed most.
While making sure there’s enough naloxone to go around is critical, figuring out how to get it into the hands of Ohioans who need it has proven to be another issue.
The FDA helped solve part of the problem in 2023 by making Narcan, the name-brand type of naloxone, available to be sold without a prescription over the counter in stores. But some Ohioans may be shy about purchasing naloxone at public stores and at $45 per kit, may also find the overdose reversal drug cost prohibitive.
Around Columbus, vending machines with free naloxone aim to alleviate those issues, said Dr. Mysheika Roberts, Columbus Public Health commissioner. Vending machines are located at Equitas Health on Long Street, Huckleberry House on Kenmore Road, Community Medical Services on Dublin Road, at SAFER Stations on Park Avenue and at the Central Outreach Wellness Center on Broad Street. Naloxone is also available at Columbus Public Health headquarters on Parsons Avenue and via mail order, Roberts said
“It’s a great service that we have and allows us to get (naloxone) to people who might feel a little uncomfortable talking to someone about getting what they need,” Roberts said.
. . .
Some branches of the Columbus Metropolitan Library system also have the boxes on site.
“(We) wanted it in as many public locations as possible, just like you would have an AED in case someone would have a heart attack,” she said.
The remarkable numbers for Ohio statewide are worth considering.
“That increase in kits led to an 11% jump in known overdose reversals, going from 18,244 in 2022 to 20,289 in 2023.”
That’s an increase of about 2,000 reversals for one year, representing some portion of total reversals in the increase, many known to go unreported.
In New York, described in this post from 2020 –
Governor Andrew Cuomo of New York generously offered his clinical understanding of the evidence:
The figures are for areas outside of New York City and for the years compared – 2017 to 2018 – represent a decrease of 346 deaths in 2018. That same year in New York, outside of New York City, there were an estimated 9,831 uses of the opioid overdose death-reversing opioid antagonist naloxone (Narcan) administered, considered to be an underestimate. That availability and application of Narcan appears to have expanded rapidly and recently in New York as nationally with prescriptions doubling over the same years.
That is, as for national trends, rapidly expanding use of Naloxone more than accounts for any deceases in opioid-related overdose deaths, leaving no reduced deaths to be attributed to medical “treatment”. Deaths reduced – 346; opioid overdoses prevented from resulting in death by use of Narcan – 10,000 or so.
Every death prevented (reduced) by use of Narcan is a death that was not prevented by “treatment” of any type, in fact represents the failure of treatments to prevent high-risk use. Every use of Narcan represents the high-risk use of opioids resulting in overdose, that high risk use claimed to be prevented by publicly funded medical provision of substitute opioids.
Looks like NIH HEAL study state New York fits the pattern.
In Massachusetts? The same, with targeted community naloxone beginning years earlier than the study.
From a January 2020 Massachusetts Department of Public Health report, “Overdose Education and Naloxone Distribution (OEND)”,
Since the start of the OEND program in 2007, there have been a cumulative total of 92,840 individual participants trained and given a DPH-purchased naloxone kit and 25,064 reported opioid overdose reversals using DPH bystander naloxone. This data is current as of 11/25/2019. . . .
Opioid-related overdose deaths in Massachusetts continue to decline, falling an estimated 6 percent in the first nine months of 2019 compared to the first nine months of 2018, according to preliminary data released by the Massachusetts Department of Public Health (DPH). Continued improvements to naloxone availability statewide are a critical strategy in Massachusetts to reduce fatalities from opioid overdose.
As described in detail in this post –
Massachusetts recorded a significant drop in opioid-related overdose deaths in 2023, forging a potential turning point after the state’s fatality count hit a record high the previous year.
State officials say there were 2,125 confirmed and estimated opioid-related overdose deaths last year, or 30.2 per 100,000 residents. That marks a 10% decline compared to 2022, when the epidemic claimed the lives of 2,357 Bay Staters, at a rate of 33.5 per 100,000. . . .
Goldstein attributed the declining fatality rate in 2023 to the state’s distribution of naloxone, a medication that reverses overdoses, as well as syringe service programs, an overdose prevention hotline, and a drug-checking program that allows officials to understand the lethality of the drug supply here.
“We have one of the best naloxone distribution programs in the country, and we have naloxone everywhere in every community, so that people can use it,” Goldstein said. “We have really pioneered the use of syringe service programs in this state, and to use a harm reduction lens in everything that is being done.”
DPH said it has distributed more than 196,500 naloxone kits, with each kit containing two doses, since 2023. The effort has led to at least 10,206 overdose reversals, officials said.
Let’s keep those dramatic numbers and claims in mind –
Goldstein attributed the declining fatality rate in 2023 to the state’s distribution of naloxone, a medication that reverses overdoses, . . .
“We have one of the best naloxone distribution programs in the country, and we have naloxone everywhere in every community, so that people can use it,” Goldstein said. . . .
DPH said it has distributed more than 196,500 naloxone kits, with each kit containing two doses, since 2023. The effort has led to at least 10,206 overdose reversals, officials said.
The trends, numbers, reports and data for NIH HEAL study state Massachusetts are the same that consistently have been seen in every other state and locale reporting, establishing a robust, replicated body of evidence that can support only one conclusion, facts including –
– That each of the increasing instances of an emergency reversal of an otherwise lethal opioid overdose (each a welcome and important life-saving act) is a direct indication and measure of and instance of high-risk opioid use, reduction of high-risk opioid use the only means by which gains can be made against the epidemic
– Small reductions in opioid OD deaths corresponding to the increased Narcan saves
– Number of reported saves much larger than numerical decrease in OD deaths
– No indication of non-confounded, more direct measures of high-risk opioid use (i.e. measures of severity of the opioid crisis) decreasing, such as incidence of opioid injection-related infectious disease (a measure of high-risk opioid use) or of total (lethal and non-lethal) overdoses, also a valid, non-confounded measure of severity of the crisis.
Those locations include
Those reversals are happening in desperate, highly targeted, and successful campaigns precisely because opioid high-risk use continues to persistently increase, making the campaigns necessary as a new form of harm reduction, reducing established harm of expert, gold standard treatments driving substance use epidemics. The same surging naloxone reversals that are thankfully saving lives and reducing deaths are hiding mounting nonfatal overdoses (= high-risk opioid use) as the reversals increasingly occur in community settings where they are not reported, are hidden.
The magnitudes of reported naloxone reversals in these locales, increasing year-by-year, literally leave no prevented opioid overdose deaths in the locations to possibly be accounted for by or attributed to other factors, factors like America’s gold standard MAT substitute opioid treatment, or rehab, or “addiction treatment”.
The prevented deaths are all accounted for by Narcan saves, accounted for many times over.
To dispute that requires supporting with evidence the argument that increasingly over recent years, thousands more each year of potentially fatal opioid ODs were not prevented in those years by successful, targeted provision of naloxone as described in the many locales.
There is no question or uncertainty
regarding how to understand the sudden, recent fatal opioid OD decrease, correlated with Narcan campaigns. The question is how to understand that the drops were so much smaller in magnitude, when over the same period of the naloxone campaigns, provision of expert, gold standard treatments in all locales was also increasing.
Astute readers already know the explanation for that epidemic, lethal outcome, established for years here.
4. America’s expert gold standard treatments fuel the lethal crisis
It turns out, as explained and established here in multiple posts, that precisely as in the avoidable – avoidable if not for the cowardice and gross incompetence of American Media – generation of the opioid crisis as we know it enabled by fabrications by America’s medical/research/media collusion, there has never, not ever, been a legitimate body of research evidence to confidently establish, let alone strongly support, the use of substitute opioids (bupe or methadone) as treatments or as beneficial for opioid dependence.
Instead, all lines of diverse evidence point to what should be obvious – the runaway dispensing of opioids that are routinely used with other, illicit opioids (methadone), and/or serve as consumable, commodity and currency in street economies of illicit high-risk opioid use (bupe) have in fact fueled the lethal epidemic.
The most potent ways in which the “miracle” doctor-dispensed pills and other magic potions predict failure is to instill in compulsive substance users the belief that passive interventions to adjust brain chemistry are “treatments”, are addressing a generic neurobiological block or deficit or disease of the brain that explains addiction, instead lethally instilling passivity, dependence and lies, and robbing compulsive substance users of the necessary factor established as central to stopping problem use, self-efficacy, the shift to belief in one’s own competence, autonomy, strength, and effective use of resources with inner psychological change to do away with the compulsion to escape distressing inner states by use of chemicals.
It could and should suffice to simply acknowledge the obvious – that over decades of increasing provision of expert gold standard cures to diseased brains, more and more high-risk use and deaths have occurred. Effective treatments and public health responses are not supposed to have those outcomes.
And the obvious point made here, that the only explanation for lack of any differences in opioid overdose deaths between intervention and control communities in the massive NIH study – despite those deaths undeniably reduced, dramatically, by naloxone saves and despite increases in provision of those gold standard, “proven” cures – is the obvious, that the naloxone saves were not enough to keep up with the increased overdose deaths predictably caused by those expert treatments.
Let’s take a bit closer look, at signs of what effects those increases in gold standard medical cures would have had for intervention communities in the NIH study states.
From JAMA, an illustration that Ohio is one of a minority or few states that increased methadone provision over past years by relaxing longstanding safety standards.
Looks like each of the 4 NIH study states – OH, KY, NY, and MA – increased provision of the “miracle molecule“, as well as Vermont.
Here’s what methadone-attributed opioid overdose deaths were doing in Ohio over those years.
Methadone overdose deaths increased over the period of predictable increase, despite naloxone campaigns that were effective enough to moderate death trends for other opioids.
And in Vermont,
For methadone-involved opioid overdose deaths:
2015 2016 2017 2018 2019 2020 2021 2022 2023
7 14 12 11 9 18 17 29 19
One could construct a line graph, but I don’t think that’s necessary.
More, a lot more, about the role of miracle molecule methadone in the worsening opioid crisis here.
In America’s worsening opioid crisis driven by institutional pathology and medically dispensed opioids, naloxone is serving as harm reduction.
At least it will keep working, continue to reduce deaths.
It will, won’t it?
