FULL POST – LETHAL LIE: THAT IT’S THE SCARCE AVAILABILITY OF EXPERTS’ PROVEN TREATMENTS WORSENING EPIDEMICS
The longstanding, industry-standard, expert approaches that define addiction treatment in America are available every day, in every city, everywhere, to anyone, cheap or free, and lethal
by Clark Miller
Published April 19 , 2024
Opioid medications are safe and effective for all pain.
SSRI antidepressants are safe and effective treatment for depressed mood.
Expert responses to the COVID pandemic were necessary and effective.
The SARS-CoV-2 pandemic virus originated in nature, not in a lab, and was not related to U.S. funded bioweapons research.
There are medications effective in treating addiction, a disease of the brain.
More and more Americans die each year in drug epidemics because they can’t access the proven, gold standard addiction treatments.
Trusting Americans came to know these important, health-related truths because the media sources they depend on conveyed to them the trustworthy assurances of the consensus of medical and health experts identified by media as recognized competent authorities.
Naturally.
As in so many areas, American Science and healthcare are at the top in the world. That goes without saying.
So when there is consensus of recognized experts, there is really little need for “fact-checking” or following and thinking critically about the research and evidence underlying the expert positions, or challenging those positions.
And then it’s too late, anyway!
Wait . . . I take that back, didn’t really mean it. Let’s not get distracted.
Because the veracity of American expert positions can be taken at face value, there is little point in not conveying them as established fact, without need to evaluate or question.
As here, for example, in this helpful NPR report.
Doctors and researchers have known for decades that safe, easy-to-use medications are a game-changer for people addicted to opioids.
Buprenorphine and methadone reduce cravings for opioids and ease withdrawal symptoms, helping people avoid relapses and deadly overdoses.
“If somebody has access to these life-saving medications, it cuts their mortality risk by 50 percent,” says Dr. Linda Wang, a researcher who treats patients with addiction at Mount Sinai Hospital in New York City. . . .
But as fatal opioid overdoses surge in the U.S., topping 80,000 deaths last year, access to these medications remains severely limited.
“access to these medications remains severely limited“
That is unconscionable! When so many are trapped in a lethal opioid crisis, literally at risk of death each day, the cure unavailable to them. The “safe, easy-to-use medications” that are a “game-changer”, a life-saver, as “Doctors and researchers have known for decades”.
Reality check.
Those of course are all lies, predictably so precisely because they are the authoritative assertions of top, identified American healthcare experts and conveyed to the public via useful idiots.
They are necessary to protect those researchers, experts and mass media popularizers from their inevitable culpability for the harms and deaths their incompetence and ethical impairment have contributed to.
How do we know that?
Because the evidence, consistently and for decades, has established it.
Let’s review.
It turns out – precisely as in the generation of American Medicine’s decades-old increasingly lethal opioid crisis – that for medication assisted treatment (MAT) by dispersal of methadone, then buprenorphine, there never has existed a body of evidence compelling or even strongly suggestive of beneficial or life-saving effects. Just as there never existed anything remotely like a body of evidence that opioids were safe and effective for pain.
In both cases, the same approach was taken – accept and message to a trusting public the interpretations of research and evidence provided by the same designated experts whose gross incompetence and clinical, research, ethical and intellectual deficits gave us the opioid crisis and, for example, a population poisoned by SSRI antidepressant medications with no efficacy.
The research, from the start, was never not confounded by a variety of factors rendering the expert assertions unsupported and worse, including lack of external validity, lack of adequate follow-up monitoring, other confounding factors, some outlined here and here and here.
Most disallowing of claims of benefit and overlooked as a confounding factor from the beginning (from the expansion of MAT in the 1970s) are concurrent initiation and expansion of naloxone campaigns, each OD death-reversing save accounting directly for the prevention of an opioid-related fatality. And each naloxone save associated with the differential availability, provision and use over time and circumstances. Simply, as naloxone use and OD death reductions increase over time, and with intentional, organized campaigns to supply and train individuals most at risk, most involved in MAT programs, along with professionals and para-professionals having regular contact with them, it became impossible from the start to credibly attribute reduced opioid-related deaths to MAT treatment effects instead of the known, directly measured, differentially probable naloxone saves.
As in American Medicine’s creation of the opioid crisis, the eventual vaporization exposing the lie of the fictional, fabricated evidence base for safety and benefit necessitates one of the biggest and most transparent of current opioid crisis lies, that if only the proven, gold standard treatments that make up American addiction treatment – addiction treatment medications and “rehab” or “recovery” services for opioid addiction – were not so limited in availability, so “severely limited”, then of course instead of an increasingly lethal crisis, there would be progress toward ending epidemics.
“Who needs Suboxone? I got Suboxone,” said another man, who was apparently trying to sell the brand name medication for addiction treatment.
That’s from an “on the street” report from wbur reporter Deborah Becker late October of last year, about 4 months ago, from the “Mass. and Cass” area of homeless encampments and methadone clinics in Boston.
It is illustrative of the inconvenient and downplayed phenomenon known and established for decades for every American city, for every area in the U.S. where there is illicit drug use and trade.
American Medicine’s gold standard “addiction treatment medication” Suboxone (“subs”, “bupe”) is one of the most widely diverted, available, in demand, used and abused, traded and bought or sold drugs in America’s illicit street and prison economies of illicit opioid and other drug use. That’s been known and established for decades, described additionally here and here (scroll down to “The bupe economy”).
If you’re familiar with these areas of the role of Suboxone as consumable, commodity, and currency, including for fentanyl, in lethal economies of illicit drug use, scroll down to the next section, headed, “Back to our current post”.
The important and fundamental point is that for decades, from the beginning, “bupe” has been in those economies, pervasive, easily obtained, and cheap, as partly described in a recent post.
Here, for example, is another on the street description of the longstanding bupe economy from a few years ago.
“Subs. Who needs subs?” a woman called out quietly near the intersection of Kensington and Allegheny avenues on a recent afternoon. She had to be careful. This district, on the northern fringe of the city’s so-called “Badlands,” is clustered with loosely organized crews hawking pharmaceuticals from Percocet to Adderall. Drawing attention could get her banned from the corner, or possibly worse.
Like many people who are dependent on opioids in Philadelphia, the woman was freelancing—likely selling off the last of her own prescription for the popular opioid substitution medication for money to purchase heroin/fentanyl. It’s something I’ve seen countless others do during my time covering the overdose crisis.
A passer-by inquired how much. “Five dollars,” came the reply. The man kept walking. “Wait, wait,” the woman said. “Give me three.”
And with that, the man acquired his Suboxone at less than half the retail price of a customer paying in cash at their local pharmacy. . . .
Meanwhile, diverted “subs,” as they are still universally known on the street, are all over Kensington, where the sublingual orange-flavored strips typically sell for $10 a piece, equal to the cash price of the drug at pharmacy chains like CVS or RiteAid. (The pills, which are less desirable because they’re harder to split and reportedly make the mouth water, generally sell for half the price of a strip on the illicit market).
Subs are now the most commonly sold pharmaceutical here. And unlike Xanax or Percocet, which are often counterfeit pressed pills that sometimes contain fentanyl, all of the subs on the streets are diverted from legal channels. . . . Several street-level sources have told me that subs’ illicit availability has made “chipping” (using heroin only occasionally and filling in with burprenorphine) possible for them for the first time. Others carry a strip or two with them to ease the symptoms of withdrawal in jail (or turn a quick profit for the commissary) in the event they are arrested. A single 8 mg strip of Suboxone costs as much as $80 in county jail, and is typically cut into tiny pieces to maximize return. . . .
One thing seems certain though, given the sheer abundance of the drug on the street: Many people who have a prescription for Suboxone, who may get it free through county medical assistance or at a reduced cost through the Obamacare exchange, are not taking it.
From a recent post –
Buprenorphine is a synthetic opioid drug with qualities the same or similar to other opioids and some important differences.
Its inherent biochemical and neurochemical features were from the start part of the branding and selling of bupe to vulnerable compulsive opioid users and the public as a form of treatment or support for stopping problem opioid use, now for life-long opioid use of bupe or methadone.
One attribute is high “affinity” or energy of attraction and fit to molecular receptor sites on central nervous system (CNS) nerve cells in the brain, where natural neurotransmitters and molecules of mood-altering substances initiate their desired (and undesired) effects – sedative, euphoric, anesthetic, etc.). That high affinity “outcompetes” other opioid molecules that might be present like those of heroin, or fentanyl. Bupe also has lower “activation” energy once at a receptor site compared to more potent opioids of abuse, thus producing more moderate effects, including potentially dangerous or lethal CNS depressant effects. That, in theory, is the rational for the belief that bupe provided by prescription could constitute a type of treatment for problem, compulsive opioid use, a rationale that in practice with real compulsive opioid users was increasingly disconfirmed from the start, then necessarily protected by lies, with predictable results.
Early signs of failure in France and the U.S. led to a new formulation (Suboxone) with the opioid antagonist naloxone added – the drug used to reverse otherwise lethal opioid overdoses by blocking opioid effects, presumably adding a layer of safety and now the standard formulation replacing the pure bupe in Subutex.
So . . .
If you are a problem, at-risk illicit opioid user and your intent is to secure and use opioids to get the desperately needed relieving, sedative, euphoric effects you desire, you would take some Suboxone along with your heroin, or fentanyl, or carfentanyl ?
Right. Only if you wanted to interfere with its desperately desired effects and waste some of the valuable Suboxone currency you may well have traded for your fentanyl and can again next time. Using the Subs with your opioid of choice is about the last thing you would do.
Suboxone is found in some drug screens of illicit opioid abusers largely due to a primary role of Suboxone in facilitating continuing high-risk heroin or fentanyl abuse – moderating withdrawal symptoms over periods of scarcity, higher risk or a needed break from daily use of “real dope”. With a half life of about 1 to 2 days, Suboxone remains detectable for some 5 to 8 days or more, making its presence in drug screens of high-risk opioid users not unlikely and unrelated to the real risk of lethal overdose posed by the illicit opioid that is orders of magnitude more potent. Such overdoses and lethal ODs are “buprenorphine involved” not due to any significantly contributing CNS depressant effects, but because the free, increasingly recklessly and unethically, doctor-dispensed Suboxone currency supported continuing high-risk opioid use, its presence or absence in the drug screen irrelevant.
Why are “Subs” so valuable in economies of illicit opioid and other drug use?
– Suboxone strips are a safe, known dose of an opioid for use in “bridging” described above, to moderate unpleasant symptoms of “dopesick” between planned, continuing episodes of use of an illicit opioid, like fentanyl
– Because of its demand and value, it is a currency – free currency thanks to American Medicine – to exchange for fentanyl, other opioids, other drugs, cash (see “The bupe economy”, here)
– Combined with a benzodiazepine, “benzo” , the synergistic effect – the opposite as with another opioid – enhances a euphoric high
– In the nearly eliminated case of risk of required office (or probation) visit with potential for a collected drug sample, Suboxone can be used over a period of bridging or by an associate not abusing opioids to produce urine that can be frozen, stored, then with easily available cheats, used to “spike” and feign a urine drug sample that will be complaint with MAT treatment and criminal justice demands
– Suboxone, especially as sublingual strips, has been a common form of opioid more easily delivered into prison settings, increasing its demand and value
An opioid-dependent user medically prescribed Suboxone strips as “treatment” and selling them for cash or in direct trade for other drugs has been common for decades, part of illicit economies of opioid and other drug use that support continuation of abuse of heroin, fentanyl and the increasingly potent and dangerous drugs that will replace them.
Back to our current post
There are some facts that are inescapable including these – that essentially anyone, of any age, who has come to compulsively use opioids – more true the more severe, longstanding, and most importantly risky that compulsion and use – will know how and be able to obtain licit or illicit Suboxone, free or so cheap as to almost be free. Suboxone, America’s proven, addiction treatment medicine that stops urges to use other opioids, takes that risk away, ends the compulsive need to use opioids in high-risk ways. That’s why it is, like methadone, a “miracle” drug.
Right?
Let’s think about that, trying to imagine the experience of becoming dependent on opioids, gaining tolerance, needing to use daily to avoid being dopesick, experiencing some level of severity of the problems that are associated, from loss of relationships, to legal problems, problems holding a job and functioning, to high-risk use, risk of infectious disease, and increasingly of accidental death, or homelessness and desperate misery.
And, all it would take – we know because America’s experts have assured us, the assurances everywhere we read and look – would be to spend a $few dollars each day, take a sublingual strip or pill or two, and . . . that’s that. No more cravings, no more dopesick, no more overpowering, distracting impulses to find and use dope, because that’s gone, prevented by the medical cures buprenorphine and methadone.
A pill or two a day, a few dollars, and you’re free of all that. Because the truth is, American Medicine’s opioid addiction cure is everywhere and cheap. It’s like having a grave medical condition that is debilitating and with the real possibility of sudden death, like heart disease, and the option of going into remission, regaining health and functioning, essentially eliminating risk of death due to the condition, by paying a few dollars a day for pills easily available in your community even if you can’t get into a treatment setting to get them, taking a pill or two each day. Knowing they’re safe and the dose determined, like the Suboxone strips in the package. You get your life back. Would you have to think about it?
There is no scarcity. The medical cure is everywhere, safe, and cheap.
But what about the increasingly dire situation of so many young people, teens who haven’t even left home, and are unable to access America’s miracle prescription substitute opioids?
The same considerations apply, the same truths expose the lie of scarcity of treatment as a factor in an increasingly lethal opioid crisis.
The vast majority of young people who have overdosed will have access to resources and supports that the high-risk adult population does not, including stable housing, financial support and family or other social supports. Some individual within that support ecology will know someone, or know someone who knows someone, and be able to obtain the medical cures, for a few dollars a day, a pill or strip or two each day, and the disease will be in remission, it goes without saying, established by expert consensus.
But, one might object, although the medications are, in fact proven to drastically reduce risk of harm or death by high-risk opioid use, more is needed, including the use of residential treatment stays, “rehab”, inpatient or outpatient “addiction treatment” in order to sustain avoidance of problem use of substances, treatments that without good insurance may be prohibitively expensive.
With almost no exception, there is essentially nothing as part of “treatment” and programming in American addiction treatment settings that is related to the actual nature of problem compulsive use of substances and its treatment, the employed counselors in those programs without meaningful training or qualification to treat any type of behavioral disorder, let alone complex, difficult, life-threatening conditions. That’s why “addiction treatment” does not work, and partly why substance use epidemics have been predictably worsening for decades and decades.
“What we simply need is a a nice bulldozer, so that we could level the entire industry and start from scratch . . . There’s no such thing as an evidence-based rehab. That’s because no matter what you do, the concept of rehab is flawed and unsupported by evidence.”
– Dr. Mark Willenbring, former director of treatment and recovery research at the National Institute of Alcohol Abuse and Alcoholism (NIAAA)
That brings us to another deception, a really huge one, hidden behind a sheen of lies, institutional normalization, and mass media portrayal, a deception driving America’s increasingly deadly substance use epidemics.
The essential core, the universal programming, of almost all addiction treatment programs in the U.S. not only forms the mainstay of programming in private and publicly funded programs, but is available without charge, in every city, nearly everywhere, everyday, with free online meetings, available to anyone and everyone. It is so established as the norm for addiction treatment that courts every day – imposing risk of serious criminal justice penalty and violating constitutional rights of each mandated individual – force individuals facing charges to attend and engage in the practices and prescriptions of the meetings.
Most importantly – this treatment is not in short supply, not limited instead is, like the medical cure buprenorphine, available everyday, nearly everywhere, and even better than bupe, is free.
It is literally nearly impossible to locate a treatment program in the U.S. that does not describe itself as “12-step based” or in any case rely on 12-step groups and programming as its core provision of treatment.
It is the “gold standard” of American substance use treatment, a typical program describing its services patients will experience with descriptions like these:
12-step meetings six days a week
Obtaining and working with your sponsor to construct your own recovery program
There are many challenges to overcome when you first get clean and sober. Where will I find meetings?
A “sponsor” is a member of the religious subculture AA (Alcoholics Anonymous), a person with no training, background or ability to provide therapy, assessment, case management, counseling, or any other service that potentially would have benefit for someone affected by problem substance use.
And describing overall treatment and recovery approach with descriptions like this:
During your first month, you’ll be expected to look for employment or attend school and participate in group and individual sessions. You’ll also need to find a temporary sponsor.
That’s how central and defining of treatment in America the practices of AA are – it is treatment.
It must be highly effective!
That’s why -think about it – in the manufactured consensus of rationalizations for opioid overdoses and deaths continueing to surge through the COVID pandemic, it was conveyed without dissension or deviation in media accounts that a large factor in the pandemic-period mounting deaths was that AA participants under restrictions were not able to attend in persons their recovery treatment meetings. If only they had been able to, things would have been different, by addiction expert consensus.
So clearly, AA recovery meetings and associated engagement including working with a sponsor do constitute the core of addiction treatment in America, so much so that when restrictions curtailed continuous involvement, opioid overdoses and deaths surged.
The very important truth and point for our consideration in this post is that, just as America’s gold standard addiction treatment medication is available at negligible or no cost essentially everywhere, always and to everyone as distinct from being scarce or unavailable, so too America’s gold standard nonpharmacological recovery treatment for addiction is available at no cost, essentially everywhere in-person, or online, every day, to everyone.
And there’s more – acolytes in this gold standard treatment religious subculture will be provided and encouraged to use the services of a counselor and case manager all rolled into one – their “sponsor” – who will not only provide the therapeutic guidance treating addiction, but will serve as a resource for solving problems in living and to link to other community resources. And be available for urgent needs, by phone call. Sponsors provide, in effect, individual therapy sessions, aimed specifically at addiction and working through the 12 Steps. Please remember – this gold standard treatment is established by expert opinion and widespread media messaging as effective, adopted by America’s addiction treatment system as core treatment programming.
If these features of the AA and NA religious subcultures were not effective in addition to being unversally available and free, we wouldn’t be using public healthcare dollars to employ “peers” whose jobs are largely to provide rides and shepherding of those who are coerced or court-mandated to the meetings.
Reality check.
Let’s refocus.
In this post we addressed the widespread and expanding claim that if only the proven, gold standard treatments provided increasingly and established by consensus of America’s healthcare and medical experts were more available, we would be reading in media accounts something very different than persistently more lethal epidemics and mounting deaths, because those treatments work, of course they do.
Just as we were helped to understand that if only there had not been a COVID pandemic, the opioid crisis would be on its way to disappearing.
It’s established that the COVID rationalizations are lies, and we’ve established here that the treatment scarcity rationalization is another predictable lie.
More to come.
