EPIDEMIC AND LETHAL CURE – LARGE STUDY: MAT INVOLVEMENT AND DRUG TREATMENT TIED TO SURGE IN USE OF ILLICT FENTANYL WITH PRESCRIPTION OPOIDS, PANDEMIC OD DEATHS

 

The large survey affirms predicted lethal outcomes of increased, less restrictive provision of diverted and misused opioids dispensed as Medication Assisted Treatment (MAT) and fueling the lethal epidemic: buprenorphine (Suboxone) and methadone

by Clark Miller

Published January 19, 2022

With the sheen of trust awarded from the beginnings of the opioid crisis in their certainty and confidence for response to a public health threat, America’s medical and addiction experts, public health institutions, and major media acted quickly in early weeks of the COVID-19 pandemic to push forward, manufacture consensus, and celebrate the wisdom of the logical response: radical relaxation of safeguards on distribution of American Medicine’s life-saving opioid medications with proven benefit: buprenorphine and methadone.

Below – large survey results strongly congruent with the established role of medically-prescribed substitute opioids failing as “treatment” in the opioid crisis, instead fueling economies of illicit opioid use and mounting deaths

Results of the large representative study employing objective evidence including presence (“positivity”) of prescribed and non-prescribed (illicit) drugs in nearly 900,000 clinical specimens provide high confidence that specimens from “substance use disorder facility” and “Medication Assisted Treatment Patient” are tied to pandemic period surges in illicit fentanyl use with other opioid use and associated overdose deaths. 

New York Times Building

In a consensus of media outlets ranging from The New York Times, The Nation, STAT, Vox, NPR, Forbes, and UNDARK, the measures were celebrated as coming none-too-quickly, the only concern arising – without need for evaluation of outcomes of the easing of restrictions – whether the changes would be able to persist post-pandemic, to increase national dose of the known medical cure to diseased brains trapped in America’s unforeseeable public health crisis created by the Sackler family.  

That loosening of safeguards described here, for example, on those miracle medications in use for decades included by the end of March, 2020:

Increases in number of doses of prescribed methadone or Suboxone dispensed at one time

Prescriptions written and refilled, including for new patients, without personal contact, including allowing initiation of new prescribing by telephone contact (audible) only

No requirement for monitoring including urine or other drug screens

Prescriptions delivered to patients

Addiction experts noted that within weeks users of Suboxone and methadone were taking advantage of the increased availability of the opioids and the changes. As were telehealth addiction companies like Boulder Care, reporting  after the reduced safeguards sharp increases in enrolled clients and a 100 percent increase each week in potential customer inquiries about more easily getting supplies of the euphoric, abused, addictive opioids methadone and buprenorphine, serving as commodity and currency in the illicit opioid economies driving the lethal epidemic.

Boulder Care offers “Compassionate Care”, for example with assistance getting on the Medicaid insurance (public healthcare dollars) that will pay for the online-supplied opioids and with “peer coaches”.

 As overviewed in STAT,

Thousands of Americans who have long begun every single day with a taxing trip to an addiction clinic for a single dose of methadone, another highly regulated addiction drug, are now receiving 28-day take-home supplies, rendering the in-person visit and potential coronavirus exposure unnecessary. In New York City, some clinics have even delivered methadone supplies by courier — a 180-degree shift away from the federal government’s longstanding and heavy-handed regulation of methadone, an opioid that’s used to treat both addiction and pain.

woman at laptop

We’ve known all along how all that would work out,

mounting deaths predictable from a decade ago, from a century ago.

We are obligated to examine the grim forensic evidence, post-mortem.

Starting with this evidence, from a data-rich study of medical-setting drug testing in 2020

Methods, excerpted – 

Methods

This study analyzed urine specimen results from the Quest Diagnostics medMATCH reporting methodology for clinical drug testing. medMATCH reports indicate whether the prescribed drug(s) specified by the ordering provider, or other drugs, are detected in a specimen.

Study population

De-identified results from all medMATCH specimens with clinician-provided prescribed drug information performed from January 1, 2019, through May 16, 2020, were selected for potential inclusion. Specimens from patients for whom age was not provided and those younger than 18 years of age were excluded. Specimens with abnormal specimen validity testing results and no drug positivity were excluded as well. Not all specimens were tested for all drug classes, as ordering patterns and perceived medical necessity vary among clinicians ordering testing.

Definitions

The baseline time period included specimens from January 1, 2019, through March 14, 2020. The COVID-19 pandemic time period included specimens tested March 15 to May 16, 2020. The week starting March 15 was the first full week after a national emergency was declared on March 13. Positivity for non-prescribed drugs was defined as the presence of a positive result for any drugs not listed as prescribed by the ordering clinician, or for recreational/ illicit drugs. Noncompliance with prescribed drugs was defined as a negative result for a drug listed as prescribed by the ordering clinician. Drug misuse was defined as either nonprescribed positivity or noncompliance (or both) occurring

A total of 881,134 specimens were identified that met the criteria for potential inclusion in the study.

Under pandemic restrictions that included broad disallowance of elective in-person medical services, many or most substance use programs shifted quickly to virtual contacts and eliminated requirements for urine or blood drug samples for patients in Medication Assisted Treatment (MAT) programs and drug treatment programming.  

The study pointed to reduced positivity overall for non-prescribed drugs, but highly significant increases for certain drugs including opiates generally (but not oxycodone), including for heroin and fentanyl.

The most notable increase was for non-prescribed  fentanyl positivity in samples with other drugs, including opioids. 

Significantly, positivity of non-prescribed fentanyl with heroin was not significantly different pandemic versus pre-pandemic; while positivity of non-prescribed (np) fentanyl with “opiates” presumably including prescribed opiates was highly significant (Fig 4). That is, combined use or contamination of heroin with np fentanyl was not different pre and during pandemic.  In contrast, pandemic conditions were strongly associated with a difference in np (illicit) fentanyl positivity (presence) during pandemic compared to pre-pandemic for two distinct factors, or groups – individuals in a MAT (Medication Assisted Treatment) program -being prescribed one of the opioid substitutes buprenorphine (Suboxone) or methadone – or who were associated with a substance use treatment program, also likely to have been prescribed substitute opioids. Look at Figure 5, below.

In multivariable logistic regression analysis, non-prescribed fentanyl positivity was most strongly associated with MAT patients and treatment at an SUD facility (Figure 5). In contrast, treatment at a pain management facility and being a Medicare recipient were associated with reduced odds of non-prescribed fentanyl positivity. Tests performed during the COVID-19 pandemic remained significantly associated with non-prescribed fentanyl positivity in the model presented (adjusted odds ratio 1.55, 95% C.I. 1.43–1.67) that adjusted for age group, sex, payer type (a surrogate for income in the case of Medicaid), MAT ICD codes, clinician facility type, and select HHS regions.

 

FIG. 5. Multivariable logistic regression model: associations of predictive variables with non-prescribed fentanyl positivity. Model included 259,859 of 310,709 fentanyl-tested specimens with no missing values for any factor included in the model. Highlight text shows the Adjusted Odds Ratio of non-prescribed fentanyl during the COVID-19 pandemic. Variables were selected using a stepwise entry criterion of p < 0.05. HHS Region 1 includes specimens from Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. HHS Region 2 includes specimens from Ohio, Indiana, Illinois, Michigan, Wisconsin, and Minnesota. HHS, Health and Human Services.

What is an “odds ratio”? 

 
An odds ratio is a derived numerical value resulting from a statistical test to assign probability that a measured and reported difference in measured outcome for two different groups or conditions is a real difference, rather than due to natural variability. Confidence in conclusions that such a real difference is revealed by any study is influenced by multiple, treacherous factors related to experimental design and interpretation, with confidence more directly represented by P (probability) values and 95% confidence intervals. Generally, an odds ratio that is greater than 4 points to a high degree of confidence that the difference described is real. More on odds ratios here
 
The top two graphical bars in Figure 5 above are odds ratios, both greater than 4, for “non-prescribed fentanyl positivity” for the factors of “Substance Use Disorder Facility” and “Medication Assisted Treatment Patient“. 

Let’s translate all of that . . .

The results of this large study employing objective evidence as described, are entirely consistent with – more than that, were predictable from – what is established about the predictable epidemiological, medical, and public health effects of relaxing safeguards on and increasing the dispensing of addictive substances established as being without benefit, instead worsening American Medicine’s increasingly lethal opioid crisis .

The results tell us something we already knew , something established for years – that increased dispensing of addictive, diverted, abused drugs without therapeutic benefit and under relaxed safeguards, medically dispensed drugs used as commodity and currency in illicit fentanyl and opioid economies  of abuse – would predict increases in high-risk use, overdose and death. 

More specifically, the results provide strong collaborating evidence that, as predicted by decades of evidence invalidating presumed benefit from MAT, provision by medical prescription of opioids under MAT is fueling an increasingly lethal opioid crisis

A fundamentally relevant and troubling body of evidence –

disallowed for public messaging and discourse – points to what the results reveal about the clinical practices of American Medicine

In a related study, surveyed medical doctors reported they were confident in their ability  to detect misuse of substances, yet 50 percent of samples indicated misuse

Telehealth offered numerous benefits to patients during the COVID-19 pandemic, providing access to care when in-person visits weren’t safe or feasible for many. But a new report shows providers worry that virtual visits allowed signs of drug abuse to slip by unnoticed.

In a report from Quest Diagnostics released Monday, 67% of the over 500 primary care physicians surveyed said they fear they missed signs of drug abuse in their patients during the pandemic.

And nearly all of them were prescribing those often-misused drugs—a whopping 97% reported prescribing opioids within 6 months of taking the survey.

Their concerns extend beyond the pandemic into telemedicine use today. Only 50% of physicians said they were confident they could recognize signs of drug misuse during telehealth visits, a far cry from the 91% that said the same of in-person patient interactions.

. . .

But Quest’s data indicates that just because a physician thinks they can spot patient signs of drug misuse doesn’t always mean they do.

While 88% of the physicians reported feeling confident they could identify patients at risk for drug abuse, nearly half of all patients tested by Quest in 2020 showed signs of drug abuse.

Here’s the report these interpretations were based on, analyzing “nearly 5 million de-identified aggregated Quest Diagnostics test results, including over 475,000 from 2020 alone, with a survey from the Harris Poll of more than 500 primary care physicians”. 

SECAUCUS, N.J., Nov. 15, 2021 /PRNewswire/ — A new Health Trends® report from Quest Diagnostics (NYSE: DGX) finds that almost 70% of physicians fear they missed signs of drug misuse during the pandemic, and, given how the global health crisis disrupted medical care, anticipate rising overdose deaths – especially those involving prescribed and non-prescribed (illicit) fentanyl – even as the pandemic subsides.

By combining an analysis of nearly 5 million de-identified aggregated Quest Diagnostics test results, including over 475,000 from 2020 alone, with a survey from the Harris Poll of more than 500 primary care physicians, “Drug Misuse in America 2021: Physician Perspectives and Diagnostic Insights on the Drug Crisis and COVID-19,” provides a unique snapshot of prescription and illicit drug misuse in the United States during the COVID-19 pandemic. The Partnership to End Addiction was an advisor to the report’s development.*

The new report comes on the heels of the approximately 96,779 drug overdose deaths between March 2020 and March 2021, as reported by the Centers for Disease Control and Prevention (CDC).i It also builds on prior Health Trends research, including a 2019 report that examined physician attitudes on drug misuse and a 2020 report that showed positivity increased by 35% for non-prescribed fentanyl and 44% for heroin among tested individuals during the early months of the pandemic.ii

The degree to which America’s Medical/Media/Institutional expert consensus is off, wrong about MAT and effective responses to substance use epidemics is as tragic, lethal, indicative of diminished capacity, and as criminal as their consensus not so long ago on opioids and chronic pain

You expected them to be right this time? 

More to come. 

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

Latest Stories

Sign Up For A Critical Discourse Newsletter

You'll receive email alerts of new or upcoming posts.

A Critical Discourse

Fog Image