FOR A DEADLY, WORSENING CRISIS – MYSTIFICATION TO HIDE CAUSES AND CURES
Consistently, evidence identifying forces driving recent trends in fatal and nonfatal opioid overdoses points to a worsening crisis, requiring medical/media collusion to mystify causes
by Clark Miller
Published November 22, 2024
Exciting news! From NPR –
For the first time in decades, public health data shows a sudden and hopeful drop in drug overdose deaths across the U.S.
“This is exciting,” said Dr. Nora Volkow, head of the National Institute On Drug Abuse [NIDA], the federal laboratory charged with studying addiction. “This looks real. This looks very, very real.”
National surveys compiled by the Centers for Disease Control and Prevention already show an unprecedented decline in drug deaths of roughly 10.6 percent. That’s a huge reversal from recent years when fatal overdoses regularly increased by double-digit percentages.
Even better news! More exciting.
“In the states that have the most rapid data collection systems, we’re seeing declines of twenty percent, thirty percent,” said Dr. Nabarun Dasgupta, an expert on street drugs at the University of North Carolina.
According to Dasgupta’s analysis, which has sparked discussion among addiction and drug policy experts, the drop in state-level mortality numbers corresponds with similar steep declines in emergency room visits linked to overdoses.
“corresponds with similar steep declines in emergency room visits linked to overdoses.”
Remember that, it will be important.
Those analyses and insights from recognized, top experts can only support the decreases in opioid overdose deaths as even more positive and meaningful, more real, possibly even more real than “very, very real”.
We’ll get to that.
But, oh bummer!
After years of wrenching drug deaths that seemed all but unstoppable, some researchers, front-line addiction workers, members of law enforcement, and people using street drugs voiced caution about the apparent trend.
Roughly 100,000 deaths are still occurring per year. Street drug cocktails including fentanyl, methamphetamines, xylazine and other synthetic chemicals are more poisonous than ever.
“I think we have to be careful when we get optimistic and see a slight drop in overdose deaths,” said Dan Salter, who heads a federal drug interdiction program in the Atlanta-Carolinas region. “The last thing we want to do is spike the ball.”
Oh, never mind! Whatevs!
Because
But most public health experts and some people living with addiction told NPR they believe catastrophic increases in drug deaths, which began in 2019, have ended, at least for now. Many said a widespread, meaningful shift appears underway.
Excited again, for what seems again very, very real, the widespread, meaningful shift.
By the understanding of “most public health experts and some people living with addiction”
With that type of consensus, how could we not be confident and excited?
And with even more experts affirming the positive, meaningful developments through their understanding of the research.
In a deep dive into the trends, street drug scientist Nabarun Dasgupta and colleagues at the University of North Carolina found that non-fatal overdoses have also fallen significantly and that trends are relatively consistent at the state level – all signs that help experts feel that the overall trend is solid. . . .
Data compiled by the CDC on the rate of emergency department visits for overdoses shows a 24% year-over-year decline in April and a 13% annual decline through June. And data from 911 calls and other emergency medical services responses suggests that non-fatal opioid overdoses are about 17% lower this month than they were in September of last year.
“A 15-20% decrease in non-fatal overdose and a 10% decrease in fatal overdose is a major impact. There is barely any public health intervention that has credibly achieved this magnitude of decrease,” Dasgupta and his colleagues wrote in an analysis published Wednesday on the website for the University of North Carolina at Chapel Hill’s Street Drug Analysis Lab.
“Our conclusion is that the dip in overdoses is real, and not a data artifact. It remains to be seen how long it will be sustained. If it is sustained, whatever caused it would be one of the strongest ‘interventions’ ever witnessed in this domain of public health,” they wrote. “Yet, -15% to -20% decreases in overdose would be unprecedented. To our knowledge, no public health intervention in the United States has ever achieved this benchmark.”
There is not one single factor that can explain the rapid decrease or its timing, experts say. Instead, it’s probably the result of a wide range of persistent efforts starting to make an impact.
“If this is real – and I hope that it’s real and will continue – it’s because of the sustained efforts of many different multilayered interventions,” Wakeman said, citing interventions such as expanded access to naloxone to reverse overdoses, flexibilities with medications to treat opioid use disorder and promotion of fentanyl test strips.
That says a lot!
An unprecedented public health achievement.
All but proven by the corroborating downward trend in nonfatal overdoses, measured as overdose visits to hospital EDs
And reaffirming the proven life-saving effects of American Medicine’s dispensing of substitute opioid drugs.
We’ll come back to that “deep dive into the trends”
Meanwhile, what about people living with addiction, on the streets,
immersed in economies of high-risk illicit opioid and other drug use?
From the NPR report –
“Some of us have learned to deal with the overdoses a lot better,” said Kevin Donaldson, who uses fentanyl and xylazine on the street in Burlington, Vermont
According to Donaldson, many people using fentanyl now carry naloxone, a medication that reverses most opioid overdoses. He said his friends also use street drugs with others nearby, ready to offer aid and support when overdoses occur.
He believes these changes – a response to the increasingly toxic street drug supply – mean more people like himself are surviving.
“For a while we were hearing about [drug deaths] every other day. When was the last one we heard about? Maybe two weeks ago? That’s pretty few and far between,” he said.
His experience is reflected in data from the Vermont Department of Health,which shows a 22 percent decline in drug deaths in 2024.
many people using fentanyl now carry naloxone, a medication that reverses most opioid overdoses. He said his friends also use street drugs with others nearby, ready to offer aid and support when overdoses occur
Okay, that makes sense. Because that’s what’s being reported consistently from everywhere, literally everywhere and not just reported by opioid users but also affirmed by data and reports from community workers and others involved in direct service to opioid users.
For example, in San Diego –
There’s a sense of hope on the horizon for people on the frontlines of San Diego County’s opioid epidemic now that the numbers appear to be dropping. Some of that credit is given to getting Narcan in the hands of more people.
A Narcan vending machine is located at the McAlister Institute in Chula Vista. It’s one of at least 16 across San Diego County. These machines are just one of many ways the county and its partners have been working to get the opioid overdose reversal medicine into as many people’s hands as possible.
“It’s one thing to know that there is a magical and lifesaving drug out there, and it’s a different thing to actually be able to access it,” said Marisa Varond, CEO of McAlister Institute, a facility that provides a full continuum of services for people with addictions.
Addiction experts credit access to Narcan for causing a drop in overdose deaths, along with other harm reduction strategies, such as making fentanyl testing strips more widely available and education campaigns, like the billboard that went up in Lakeside. . . .
Tara Stamos-Buseig is effusive in her praise of Narcan’s role. It’s why the Harm Reduction Coalition CEO has also been instrumental in getting more than a dozen Narcan vending machines installed across the county.
But there’s another trend fueled by fentanyl-related deaths that’s caught her attention.
“People are also changing the way they use drugs,” Stamos-Buseig said.
She says that change includes users looking out for each other, ready to administer Narcan, in addition to being more measured in their drug use.
users looking out for each other, ready to administer Narcan
And in Ohio, described in detail in an upcoming post –
The answer? Narcan, an opioid-reversal drug. It revives the patient within seconds.
Since last October, the Narcan distribution collaborative has handed out more than 37,000 Narcan doses to the public.
“We got this idea… ‘What would happen if we saturated the community, removed the cost, used data to put Narcan out in as many hands as possible?'” Ingram said.
Since the program started, opioid related overdose deaths decreased by 31 percent and emergency runs for overdoses dropped by 37 percent. We saw it first hand when we embedded with a team of first responders in Hamilton County. Last year, they saw at least eight overdose calls a day. This year, it’s about five. And the day we were there: zero.
Dr. Shawn Ryan helped institute the Narcan distribution collaborative. Seventy-five percent of his patients with severe opioid use disorder were once revived with Narcan.
used data to put Narcan in as many hands as possible
That was happening back in 2018 in Hamilton County. As layperson Narcan saves in community settings increased dramatically, EMS runs and ED visits went down dramatically. That makes sense right? Community reversal often or usually allowing avoidance of involving emergency medical services (EMS) response?
Actually, is what explains those and current decreases in ED-recorded nonfatal ODs. The only cogent explanation.
Disputing that apparent pattern of increasingly large undercounts of nonfatal opioid overdoses (= incidences of high-risk opioid use = gold standard medical treatment failure) would require evidence that the reported surging availability and community layperson use of naloxone for reversals are not associated with corresponding large increases in unrecorded reversals.
Now, years later, those Ohio community Narcan saturation OD reversals are still occurring and still, predictably, going unreported and grossly under-recognized. –
But despite serving as a lifeline for Hunter and Ohioans for decades, naloxone data remains scant and it’s unclear just how much of the overdose reversal drug gets used or expires without ever being administered. Instead, it’s personal stories like Hunter’s that have built a case for naloxone as potentially the most critical tool in fighting the opioid epidemic.
The lack of data is due in part to the nature of naloxone, experts said. While people who are revived with it are encouraged to head to an emergency department at a local hospital to be evaluated by medical personnel, it’s unlikely that everyone does. . . .
“It’s a challenge, because recording a known reversal requires people to tell us that the reversal occurred,” Vanderhoff said. “So, we know that this data that we have … is an undercount. But if anything, given how many rehearsals we’ve been able to record … This is proving to be very important to save lives.”
So, we know that this data that we have … is an undercount
That picture – of dramatic shift to potentially fatal opioid ODs being reversed in community settings by laypersons and shift away from medical EMR response and ED contact – emerges consistently from locales as reports from those directly involved with problem opioid use and community responses become available. Including in –
Chicago – upcoming post
and Maryland – upcoming post
And in the home state, North Carolina, of the street drug experts whose analyses have demonstrated a downward trend of nonfatal opioid overdoses establishing an unprecedented public health triumph, based on ED visits?
From this recent post examining those very questions in North Carolina –
So it appears that the decrease after years of mounting deaths is correlated strongly with the dramatic increase in getting Narcan into communities, to families, and to individuals at highest risk of overdose and death.
From a different news piece, the state reported that 50 Safer Syringe Programs across the state together distributed more than 100,000 naloxone kits over 2022-2023, getting them into the possession and living spaces of some of the most vulnerable individuals for opioid overdose.
Those programs report that provision of the kits has surged markedly over the past few years, as has the number of reversals of potentially lethal opioid overdoses by individuals receiving the kits.
Some of the recipients of naloxone kits reported their use for reversals, the 16,700 reversals reported to SSPs assumed to be an underreported amount, because “many” are simply not reported, a conclusion that cannot be reasonably doubted.
Let’s do the math.
Over a one-year period leading into the 12-month period over which North Carolina recorded an apparent significant decrease in opioid OD deaths, one type of harm-reduction program distributed to high-risk opioid users about 100,000 Narcan kits, about 1/10 (one-tenth) of the over one million kits distributed statewide immediately preceding the period of decreased deaths. The cumulative effects of dramatically increased provision of kits to individuals and families in communities would have had the effect of stocking, saturating, communities with the kits.
For just the kits distributed by SSPs, and an underestimate, the most recent increase in reported reversals (preventions of OD deaths) was about 1,400 (16.7 thousand minus 15.3 thousand) and trending up.
The data and the picture painted are imprecise, also unavoidably clear.
By any reasonable estimate based on available data and reports, use of Narcan kits to reduce deaths from opioid overdoses in North Carolina over the comparison period were more than enough to account for any and all of the decrease. That conclusion, of course, is supported also by the role of American expert gold standard opioid treatments, established as providing no benefit, instead fueling the lethal crisis, recently reinforced by the definitive outcomes of the recent largest ever NIH $344 million study invalidating benefit and affirming predictable harm, as well as by that study’s desperate “secondary outcomes” analyses affirming predicted harm.
The supported conclusions are inescapable.
Each and every Narcan reversal – increasingly occurring in community settings and not reported or publicly recorded – is a case of high-risk opioid use reflecting failure of treatment and prevention approaches.
Each and every Narcan reversal is an emergency measure to prevent a death from an underlying condition or high-risk behavior – as are instances of use of an AED for sudden heart failure – and in no sense constitutes gain against that underlying condition.
That is, each and every Narcan save and associated data point in fatal or nonfatal opioid overdose trends represents a life saved, or death forestalled, and as well represents a worsening public health crisis.
Heightening those uncomfortable and inescapable facts, nearly each day brings new reports on the predictable complication of emergence of new, more potent opioids and other drugs of abuse in opioid combinations, in lethal illicit economies including increasingly substances challenging the biochemical capacity of naloxone to continue to reverse overdoses.
Back to our current post –
Increasingly – dramatically increasingly – the naloxone saves that historically have been provided primarily by professional first responders and recorded in hospital emergency departments (EDs, ERs) have been eclipsed by those occurring on the streets, in public places, in residences, in community spaces, fueled by those successful, dramatic, targeted surges in saturation of those settings with Narcan. Those saves – each one a (nonfatal) opioid overdose and incidence of high-risk opioid use – go unreported, or reported to the community-based services dispensing them, not becoming part of medical or other “official” record or database. Of course, for most or nearly all of the individuals saved by unreported Narcan reversals in those community settings, there are significant to very powerful incentives to not access attention at an ED or any public health care setting and having the overdose become part of a public or public health record.
That’s described in additional detail here.
It turns out those naloxone campaigns that have surged dramatically over past years actually account for any and all of those reductions in opioid overdose deaths, more than account for them. It’s incontrovertible.
And that has to give us pause (doesn’t it?), because those thousands of extra naloxone saves year-by-year consistently in all locations, represent incidences of high-risk opioid use, that is, of treatment failure, that is of a worsening epidemic.
Those may not be the trends that nationally respected expert Dr. Keith Humphreys has in mind when he finds on evaluation the recent developments to be “definitely positive”.
“The trends are definitely positive,” said Dr. Keith Humphreys, a nationally respected drug policy researcher at Stanford University. “This is going to be the best year we’ve had since all of this started.”
We know what is driving the reductions in opioid overdose deaths, because the evidence is clear, described in multiple posts here and here.
It is the emergency use of Narcan provided in intensive, targeted, community-based campaigns that are serving as harm reduction against the established lethal effects of America’s expert “proven”, gold standard medical approaches to the entirely non-medical condition of compulsive substance use.
But our medical/expert/media collusion is not so sure.
Why the sudden and hopeful shift? Most experts say it’s a mystery.
While many people offered theories about why the drop in deaths is happening at unprecedented speed, most experts agreed that the data doesn’t yet provide clear answers.
Some pointed to rapid improvements in the availability and affordability of medical treatments for fentanyl addiction. “Expansion of naloxone and medications for opioid use disorder — these strategies worked,” said Dr. Volkow at NIDA.
“We’ve almost tripled the amount of naloxone out in the community,” said Finegood. He noted that one survey in the Seattle area found 85 percent of high-risk drug users now carry the overdose-reversal medication.
A mystery !
Who can see it?
Who will tell?
Answers occluded, obscured
Kept hidden somehow.
But that “deep dive into the trends”
from the groundbreaking analysis that points to an unprecedented benchmark in public health? Points to gains against a decades-old, worsening epidemic?
The analysis that ignored established, surging numbers of uncounted nonfatal opioid overdoses (community Narcan reversals) eclipsing reported EMS transports to EDs, relying entirely on those dwindling “hospital emergency department (ED) visits, and calls to emergency medical services (EMS); aka ambulance runs” ? That deep dive into the trends?
The same mystifying distortion that easily found its way into America’s top medical journal?
That’s no mystery.
That was a deep dive down a rabbit hole, as we’ve seen. There is no accurate way to understand how that analysis could have found its way into publication or a University website, then featured in major media other than to plainly observe that its public appearance and acceptance represents on multiple levels profound deficits in capacity for understanding, research competence, critical thought, and for formation of cogent thoughts.
Those deficits in the process and outcomes of the analysis are precisely what generated its high value and regard – as mystification, protection, useful distraction from truths.
To consider the material merely meaningless would neglect our obligation to point to the lethality of the confident, reckless claims:
Good news, we’re reversing the opioid crisis!
We are on the right track.
Our treatments are working.
That’s why you fund us.
