EPIDEMIC AND LETHAL CURE – PREDICTED OUTCOMES CONFIRMED: PANDEMIC INCREASES IN OPIOID DEATHS FUELED BY PRESCRIBED MAT OPIOIDS
Eased safety restrictions have predictably increased deaths by opioids prescribed in MAT and established pre-pandemic as without benefit, instead fueling the crisis
by Clark Miller
Published February 18, 2022
In Canada as in the U.S. COVID pandemic conditions quickly led to media-medical-institutional consensus that easing safety restrictions on the addictive Schedule II opioids prescribed in opioid substitution treatment (OST or MAT) was the right thing to do to protect public health. As established by that same consensus, MAT opioids buprenorphine and methadone are a “proven cure” for opioid dependence and are evidenced as saving lives by reducing high-risk opioid use, constituting a fix for the opioid crisis by use of these life-saving medications.
All of that is clearly established and goes without saying, just as it went without saying not so long ago, as affirmed by the same trusted, authoritative consensus, that prescribed opioid painkillers were safe and effective for all pain including common chronic pain.
It’s just that, unfortunately, there has never been evidence supporting benefit for opioid dependence of those doctor-prescribed addictive, diverted, abused opioids. Just as it turns out that there never was evidence for effectiveness or safety of opioids for centralized pain (common chronic pain), all lines of relevant evidence indicating against their use and available for decades prior to their runaway prescription by America’s licensed medical professionals.
You thought they would get it right this time?
Instead, all lines of relevant evidence consistently and congruently point to those prescribed opioids in MAT (OST) programs serving as commodity and currency in street economies of illicit, high-risk opioid use, fueling the increasingly lethal epidemics. Like this evidence. And this.
That’s why new data from Ontario, Canada was predicted. And why, as in America’s top medical journal, efforts were required to attempt to distort the outcomes, to distract from and hide them. That was predictable too.
Let’s take a look.
Half of Ontarians who died of an opioid overdose in the early stages of the pandemic had interacted with the health-care system in the month before their deaths, a new report shows.
And one in four had seen a doctor, gone to an emergency department or been discharged from hospital just a week prior, the research shows.
That’s no surprise, because health care settings are where opioid users are, with increasing ease and suspended safety restrictions, being supplied the MAT opioid buprenorphine (Suboxone) that functions as consumable, commodity, and currency on the street used to obtain heroin and fentanyl. Which is why, in a large survey, increasing pandemic-period overdose deaths and illicit fentanyl use with prescribed opioids are linked to user involvement in a MAT program (where Suboxone is dispensed).
In Canada and the U.S., medical and public health campaigns have ensured that Suboxone is increasingly handed out when possible to high-risk opioid users anytime they can be, especially in emergency department (ED) settings.
Like in this community in B.C., Canada, where opioid OD deaths doubled last year.
The health authority said it recently introduced a new program at the Penticton Regional Hospital Emergency Department to connect people who have opioid use disorder with OAT (Suboxone To Go Packs).
Nurse prescribing was also implemented in May 2021.
“We now have a nursing team able to write prescriptions for Suboxone (OAT medication) for a person with opioid use disorder,” said IH.
That is, ER staff are making sure that high-risk opioid users head back to the streets with the highly abused, diverted, opioid functioning as currency in street economies of illicit opioid use. Suboxone To Go Packs
OAT (opioid agonist treatment) is another acronym for MAT (medication assisted treatment).
Handing out Suboxone – the MAT addictive, abused opioid helping fuel the opioid crisis – is such a good idea that nurses are enabled to prescribe it in healthcare settings.
From the CTV News report –
The researchers detected a five-fold increase in non-pharmaceutical benzodiazepines in fatal opioid overdoses during the pandemic.
“It’s not that people are getting prescribed anti-anxiety medication, but that the unregulated drug supply is really being contaminated by benzodiazepines,” Gomes said.
The addition of benzodiazepines has further complicated the response to an overdose and subsequent treatment, she said.
“We’re hearing people who are so highly sedated for the benzodiazepines in the drug supply that they can’t be roused for hours and hours at a time even after administering Naloxone because that only reverses the opioid effect,” Gomes said.
She said opioids mixed with benzodiazepines have been shown “to increase respiratory depression and sedation so it can make you more likely to have an overdose and a serious overdose because you’re still heavily sedated and your breathing is you know, slowed even further.”
That’s a lie. It’s not contamination of the “unregulated drug supply” that explains benzos showing up in drug screens and opioid overdose deaths. It’s the use of benzos, described as early as early as 2011, to augment euphoric effect in abuse of prescribed MAT opioid Suboxone. From an earlier (2019) post –
The other problem, and focus of this post, is that the word on the street – the direct accounts of users, sellers, and direct observers enmeshed in drug use and culture – of use of the prescribed substitute opioids, the medical fix for the opioid problem, is . . . different. Radically different from the word of medical authorities and their popularizers. Contradictory.
Someone is not telling the truth.
On one point there is little dispute – the potential for buprenorphine, or any other potentially mood-altering substance to be diverted and abused by individuals strongly compelled to gain the desired effects.
From the street –
“You can cook anything down.”
From the research literature –
The combination of a benzodiazepine with buprenorphine/naloxone (Suboxone in the U.S.) appears to moderate or compensate for any deterrent effects of naloxone in the formulation:
“In 2006, the Malaysian government replaced buprenorphine, which was introduced in 2001 [102], with buprenorphine/naloxone to address concerns of buprenorphine misuse and injection [55]. After the transition to buprenorphine/naloxone, there was no reduction in injection risk behaviors among IDUs, but an increase in their use of benzodiazepines [55] (see Table 1). The concomitant use of benzodiazepines has been identified elsewhere, and has been attributed to an increase in euphoric effects of buprenorphine [53] . . .” expanding abuse potential of buprenorphine formulations.
Let’s take a look at the report.
One relevant finding is that the proportion of opioid OD deaths occurring in private residences decreased over the pandemic period with associated increase in deaths in public spaces like homeless camps –
That’s consistent with evidence that belies the fabrication that isolation is an explanation for increased OD deaths over the pandemic, a subject of future posts.
The MAT opioid methadone, with “increased prevalence of take-home OAT doses during the pandemic” was found to have been directly involved in 179 OD deaths pandemic period, compared to 132 pre-pandemic, an increase of 36 percent.
That type of evidence required construction of a lie about the established role of MAT opioids, as was required in America’s top medical journal.
Authors of the report dismissed the 36 percent increase in pandemic OD deaths due to methadone and associated with relaxed safety standards for provision of methadone as “small”, and rationalized it (we’ll get to that). They focused on the “reduction in the proportion of opioid-related deaths with methadone as a direct contributor during the pandemic (from 13.0% to 9.9%, p=0.012)” a decrease in percent of total opioid-related OD deaths by 24 percent. But that decrease in percentage of total opioid OD deaths is clearly an artifact – of the large increase (about a doubling) of total opioid OD deaths and those involving fentanyl (Table 1). An artefact. The meaningful question, of course, is whether opioid OD deaths tied to the MAT opioid methadone, dispensed under relaxed safety protocols, led to more deaths, and the measure of that outcome is provided by the change in prevalence (absolute numbers) of deaths.
We previewed, above, the results for and established role of combined abuse of benzodiazepines with the MAT opioid Suboxone. The results in Ontario –
These results are worth considering, pointedly the discrepancy between the picture of severity and meaning of outcomes in lethal opoiod death involvement depending on how data are filtered and results reported.
Due to evolving methods and best practices around quantifying and defining toxic levels of non-pharmaceutical benzodiazepines, these substances may not be consistently characterized in the cause of death. Therefore, we also explored opioid-related deaths where benzodiazepines were detected in post-mortem toxicology but not determined by the death investigation service to be a direct contributor to death. In this analysis, nearly half of all opioid-related deaths during the pandemic had a benzodiazepine detected (47.3% compared to 31.9% prior to the pandemic; p<0.001), and detection of non-pharmaceutical benzodiazepines rose 5-fold from 5.2% prior to the pandemic to 28.7% during the pandemic (p<0.001).
That is, when distortions related to arbitrary and unwarranted clinical rationales and protocols defining designation of types of opioids and contribution to cause of OD deaths by opioid type are adjusted, radically different outcomes come to light.
That is almost with certainty the case also for reports here of the significance and role of the MAT opioid Suboxone in opioid OD deaths, established by all lines of evidence, for example here and here, to be commonly and increasingly involved in OD deaths and incongruently in this report represented as insignificant (Table 1, above).
But back to the MAT opioid methadone.
Approximately one-third of opioid-related deaths prior to the pandemic occurred among people who
had recently (prior 30 days) been dispensed a prescription opioid (31.7%; N=322); however, during the
pandemic, this declined to 25.3% of all opioid-related deaths (N=458; p<0.001). Importantly, approximately
half of people who were recently prescribed an opioid prior to death were prescribed methadone (44.4%
[143 of 322 deaths] in the pre-pandemic period; 46.2% [216 of 458 deaths] in the pandemic period)
That is, despite an apparent decrease over the pandemic period of “opioid-related deaths [that] occurred among people who had recently (prior 30 days) been dispensed a prescription opioid” the percentage of those who were recently prescribed methadone increased and, “the proportion of people who had been recently dispensed a prescription opioid rose significantly during the pandemic (from 52.7% to 63.3% during the pandemic period; p=0.047).”
The authors add,
Specifically, among people actively treated with methadone during the pandemic who died of an opioid-related toxicity (N=71), approximately two-thirds had received outpatient care and nearly 20% had seen a primary care provider in the week prior to death. In general, there were declines in the prevalence of recent outpatient visits prior to opioid-related death during the pandemic . . .
That is, despite general declines in access to prescribers over the pandemic period, users of the MAT (OAT) opioid methadone in comparison were highly likely to have accessed their source of the addictive, abused opioid, aware of significantly relaxed safety standards for the opioid that was highly regulated pre-pandemic.
“in the week prioir to death”
From the CTV report on these results –
Meanwhile, the researchers dug into further understanding why the opioid crisis was hitting the homeless much harder than other populations, after their previous report found one in six people who died from an opioid overdose during the pandemic did not have a home.
The researchers found that population was interacting with the health-care system in similar rates as the rest of the population in the days and weeks before their deaths, but was much more likely to seek help from an emergency department than outpatient care, like a visit to a family doctor.
Emergency department (ED), where, unlike under pre-pandemic conditions, the addictive, abused, diverted MAT opioid Suboxone – currency for illicit opioids on the street including fentanyl – is freely dispensed.
These results are painting a picture for us.
Aren’t they.
The authors of the report on the increasingly lethal opioid epidemic in Ontario have some explanations, including this –
Our findings related to methadone warrant further discussion because of the strong evidence that opioid agonist
treatment plays an important role in preventing overdose.⁷ However, during the pandemic, we have increasingly
observed methadone-related deaths where fentanyl was also found to be directly contributing to death, with
only moderate methadone doses typically being prescribed prior to overdose (median 70mg methadone). This
aligned with concerns that have been raised elsewhere³ that when fentanyl is the predominant drug in the
unregulated drug supply, inadequate methadone doses that do not properly account for high opioid tolerance
from exposure to fentanyl may lead people to continue relying on this supply, putting them at continued risk of
overdose.
About that “strong evidence that opioid agonist treatment plays an important role in preventing overdose” – in fact, there is no such evidence, instead consistent evidence establishing that MAT opioids buprenorphine and methadone have fueled and worsened the iatrogenic opioid crisis.
That regular abuse of fentanyl over time for users prescribed methadone, consistent with the evidence on outcomes of MAT programs and enough to generate tolerance, is predicted, additional evidence of the failure of methadone and buprenorphine MAT, now more recklessly dispensed and with more lethal outcomes.
It is invalidation of MAT, which can only have beneficial effects by reducing compulsive, high-risk use of opioids. Like any use of illicit fentanyl. If the MAT methadone had been successful, there would not have been concurrent use of fentanyl or initiation of its use. At all.
More to come.
