FULL POST – MEDIA COWARDICE AND GROSS INCOMPETENCE DRIVE OPIOID CRISIS DEATHS
A raging epidemic fueled by expert medical approaches remains lethal and confounding – helpfully confounded by compliant media hiding the connections
by Clark Miller
Published May 24, 2024
The headlines came quickly and emphatically as they predictably do, most importantly compliantly to validate and establish the truths understood, unquestioned, that go without saying – in this case that whatever is driving America’s persistently worsening lethal opioid and drug crises medical institutions, authorities, experts and practitioners are off the hook, uninvolved. Their policies, responses to the crises, and practices are not the problem, not contributing, no more than they did over the COVID epidemic. That’s not to be questioned, not allowed. The disrespect and threat to the public trust by such questioning in time of crisis would be a frightening act, and not without consequences.
Headlines like these.
As predictably, there are devils, in plain sight in the details.
Like this, in the Washington Post piece.
Every prescription opioid saw declines in the final five years of the data except for one, The Post found: buprenorphine, the drug used to treat opioid addiction. Shipments of buprenorphine to pharmacies and practitioners rose significantly as public health officials stressed its importance in curbing the addiction crisis — from 42 million doses in 2006 to 577 million in 2019.
“as public health officials stressed its importance in curbing the addiction crisis”
The message is clear isn’t it? In a lethal crisis taking lives every day, touching so many with loss and death, it’s not to be examined whether opioids dispensed by doctors are contributing to those deaths, because these special, miracle opioids are “curbing” those deaths.
They are, aren’t they? “Curbing” deaths? Of course they are! America’s medical experts are telling you that they are.
Buprenorphine and methadone, the miracle drugs “used to treat opioid addiction” are prescription opioids – dispensed and made available only if prescribed by one of America’s licensed medical providers (LMP). They are prescription opiods no less than oxycodone, hydrocodone, morphine, any other opioid.
Even more so – in the sense that while prescriptions of other opioid pain medications (both buprenorphine and methadone have been prescribed for pain as well as dispensed to problem opioid users) may be declining, prescriptions of “bupe” and methadone are clearly increasing, remarkably so for bupe – by an order of magnitude over the years 2006 to 2019. And still increasing.
The methadone trends in the graphic are based on data that are incomplete and to that extent inaccurate. A number of states over past years have focused on expansion of methadone provision, with predictable increases compared to other states in opioid overdose (OD) rates and methadone-involved OD deaths. And with very recent legislative and policy changes to relax safety restrictions for prescribing and dispensing of methadone, doses dispensed will steadily increase.
But we’re getting ahead of ourselves. We’ll get to that.
Based on the assurances of major media there is of course nothing to be concerned about regarding increases in medical prescriptions for and dispensing of the prescription opioids methadone and buprenorphine, because they are addiction treatment medications, “used to treat opioid addiction”. That’s on the assurance of America’s trusted medical experts and public health officials.
So yes, the message is clear – that while methadone and bupe are in fact prescribed opioids, we are not to consider their rapidly increasing dispensing under relaxed safety standards as contributing or potentially contributing to inexplicable, continuing runaway increases in the severity of the opioid crisis.
Again, there is no need to consider that, beause we have assurances from America’s top medical and public health officials that these opioids are different, they are in fact by designation addiction treatment medications, that “treat opioid addiction“.
That is to say, it is inconceivable, not under consideration, that these proven, gold standard medications would be contributing to rather than curbing, America’s increasingly lethal opioid crisis. We have that on authority.
There are some problems though, aren’t there?
Do they need to be spelled out? Order of magnitude increases in the gold standard, proven, miracle addiction treatment medication of choice , bupe – associated with no moderation of, instead persistently increasing rates of disease tied to high-risk opioid use, of opioid overdose, and OD deaths.
Let’s start with buprenorphine, “bupe”, most often prescribed as Suboxone
How could that happen – that opioid deaths persistently surge the more proven medical expert cure is dispensed to diseased brains?
Wrong question. How could it not happen? – in the context of America’s media and public health expert classes having generated the lies that opioids are safe and effective for all pain, with an ensuing epidemic; the lies that antidepressants are safe and effective for depression; that COVID came from nature and required lockdowns and school closures.
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.
The desperate rationalizations to explain the predictably increasingly lethal crisis – including that if only not for COVID pandemic effects and if not for scarce availability of expert proven cures, then associated illness and deaths would be declining – are exposed as lies, here, and here, here, here, and here, for example.
But what about that “miracle” addiction treatment drug methadone,
so effective in treating opioid use disorder and curbing the opioid crisis, that longstanding safety controls for its dispensing have recently been relaxed?
It was experineced as a miracle indeed, a gift from heaven, by the Xalisco heroin network based in Mexico in the days of exploding growth and profits from black tar heroin brought into the U.S., a story told by Sam Quinones in his account Dreamland.
From Dreamland –
Methadone clinics gave Xalisco Boys the footholds in the first western U.S. cities as they expanded beyond the San Fernando Valley in the early 1990s. Every new cell learned to find the methadone clinic and give away free samples to the addicts.
One Xalisco Boy in Portland told authorities of a training that his cell put new drivers through. They were taught, he said, to lurk near methadone clinics, spot an addict, and follow him. Then they’d tap him on the shoulder and ask directions to someplace. Then they’d then spit out a few balloons [packaged black tar heroin]. Along with the balloons, they’d give the addict a piece of paper with a phone number on it.
“Call us if we can help you out.”
The value of each Xalisco heroin tiendita was in its list of customers. “This is how they would build and maintain it,” said Steve Mygrant, a Portland-area prosecutor. “It was an ongoing recruiting practice, in the same way a corporate business would identify customers.
And in Indianapolis and Columbus, Ohio (pp 143-144) –
Camping out in front of the town’s methadone clinic, he gave away samples of his dope and soon had a client list of desperate junkies avid for the black tar they’d never seen before.
. . .
They met at the town’s methadone clinic off Bryden Road the next morning. The clinic was a hive of illegal dope trading. Almost anything a user wanted was for sale. He gave Chuckie a few free samples and his beeper number.
That afternoon, Chuckie called.
“That’s some killer stuff you got,” he said. “I gotta whole buncha people want some of that.”
Reporters glimpsing dimly the writing on the wall and missing, blinded to, the graffiti next to it. The signs and reports everywhere, of what should be obvious, signs of why bupe seemed, at least on a superficial and unexamined level, to make sense as a safer alternative to methadone. Methadone, highly regulated and dispensed in clinics, in Appalachia the gathering places for illicit trade and use of opioids and other drugs.
From Beth Macy’s Dopesick (pp 215, 218) –
“I’m walking around the methadone clinic parking lot for two hours with a four-day-old baby,” Patricia said. “And it was loaded with addicts. It was a place where Tess’s circle of addicts would become even bigger than it already was.”
. . .
As early as 1963, progressive researchers conceded that designing the perfect cure for addiction wasn’t scientifically possible, and that maintenance drugs would not “solve the addiction problem overnight,” considering the trenchant complexities of international drug trafficking and the psychosocial pain that for millennia has prompted many humans to crave the relief of drugs.
the psychosocial pain that for millennia has prompted many humans to crave the relief of drugs
That’s different than using another addictive opioid to moderate withdrawal symptoms, isn’t it?
Also from Dreamland –
What types of outcomes might we predict from easing patient safety regulations and controls on dispersing of methadone, an opioid with significantly greater euphoric effect, greater potential for abuse and lethal overdose than buprenorphine?
Here’s one clue, from Quinone’s Dreamland (p 190) –
Generic methadone, for years strictly an addict-maintenance drug, suddenly started killing, too. As media reports of OxyContin abuse and overdoses spread, some doctors began prescribing methadone for pain instead. . . some doctors figured that methadone was an equally long-lasting painkiller. Plus methadone was generic and cheap; insurance companies covered it. Methadone prescriptions more than quadrupled – from under a million in 1999 to 4.4 million in in 2009 nationwide – mostly for headaches and bodily pain.
. . .
As methadone prescriptions rose, so did overdose deaths involving methadone – from 623 in 1999 to 4,706 in 2007.
That just doesn’t fit with the narrative, does it? The narrative that major media uniformly message to you from America’s top addiction experts that the miracle medication methadone is cubing the opioid crisis, is overly restricted by safety standards in its dispensing, and will help solve the crisis if only it can be more freely dispensed, now that safety protocols are being relaxed.
Nor do these more recent research and outcome results fit with that narrative –
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.
Focusing on opioid OD deaths in Ohio, with trends approximated over years of loosened safety restrictions for methadone –
Methadone overdose deaths increased over the period of predictable increase, despite naloxone campaigns that were effective enough to moderate death trends for other opioids.
Additional recent evidence and outcomes including over pandemic years of relaxed controls for methadone dispensing are predictable and consistent with methadone’s history.
Including in Washington DC
with clear trends in methadone and bupe involvement in OD deaths over the period –
The data is from the DC Office of the Chief Medical Examiner (OCME) –
The DC Office of the Chief Medical Examiner (OCME) investigated a total of 17071 deaths due to the use of opioids from January 1, 2016 through August 31, 2021. This report examines the presence of opioids (heroin, fentanyl, fentanyl analogs, morphine, prescription opioids and the general category of opiates) in deaths observed at the OCME.
The two primary opioids forming American Medicine’s cure for American Medicine’s opioid crisis – Buprenorphine and Methadone – became comparable to or significantly more involved in lethal overdoses in 2020 and projecting for 2021 will far surpass lethal involvement of all other prescribed opioids recorded in DC. The clear trend is increase over the years 2018 to 2021 (remember that the values for 2021 in Figure 4 are for January through August only) for the two MAT opioids.
More consequently, remembering that those figures and trends represent changes for incidence of lethal overdose, we know that the values represented in Figure 4 above are underestimates of high-risk opioid abuse and misuse. That is because, of course, nonlethal overdose is and lethal overdose is not a measure of high-risk opioid abuse and misuse due to intractable confounding effects of shifts in use of naloxone to prevent opioid overdoses from becoming lethal. It’s established that naloxone use has increased significantly over recent and pandemic years – necessarily moderating the values for lethal overdose and misrepresenting to that extent trends in abuse and high-risk use of methadone and other opioids.
These are the predictable results from continued, increasing and less restrictive provision by American Medicine of the prescribed opioids established as fueling America’s increasingly lethal opioid epidemic.
Here are the projected levels for methadone and buprenorphine involved deaths based on 4 remaining months in the year 2021 – those projected levels almost certainly underestimates of the involvement of MAT opioids in potentially lethal ODs because of the increasingly moderating effects of naloxone campaigns and naloxone saves over these periods.
These are the predictable results from continued, increasing and less restrictive provision by American Medicine of the prescribed opioids established as fueling America’s increasingly lethal opioid epidemic.
And from Ontario Canada,
where safety standards for pandemic medical dispensing of methadone and bupe were relaxed and discussed in this prior post –
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.
And in Colorado, U.S. –
From this prior post,
“The number of new admissions at highly regulated opioid treatment programs in Colorado increased from 1,388 in 2013 to 3,566 in fiscal year 2017. According to federal numbers cited by The Denver Post, there were more than 5,000 methadone patients across the state as of last week.”
By additional measures, provision of the medical substitute opioid “treatment” increased over that time frame – number of waivered (approved) prescribers of substitute opioids buprenorphine or methadone had been increasing, to 702 in 2017.
And the average daily census of opioid dependent patients treated with substitute opioids in Opioid Treatment Programs (OTP) was expanding rapidly
Over that same period of expanded provision of the medical substitute opioid “fix” for the medically generated opioid crisis, opioid-involved overdose deaths were also increasing, including for heroin as distinct from OD deaths attributed to fentanyl.
As in other locales consistently, any apparent moderation in increasing trend of opioid-induced OD deaths can be attributed to the directly acting and observed life-saving effects of increasing distribution and use of naloxone (Narcan).
That is, as is consistently evidenced in other locales, emergency responders are saving lives, often repeatedly, by reversing opioid overdoses, accounting for all moderation in lethality trends, leaving none to attribute to OST, while the invalidated medical “treatment” continues to fuel street economies of high-risk opioid use.
The mounting, consistently invalidating pattern was predictable, all along, because there has never been credible evidence to support effectiveness for OST, instead all lines of evidence disconfirm effectiveness and point to increasing harm.
And in a nationwide U.S. study
with very large sample size –
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.
What is an “odds ratio”?
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.
And in Ontario, Canada
as described in this previous post, the non-randomized, uncontrolled study that “should be interpreted cautiously” spun by media as supporting relaxed high-risk opioid dispensing.
The study detected no apparent gain in lowered risk for methadone users attributable to the program compared to new patients at highest risk.
Huh! That’s a lot of evidence and research outcomes that don’t fit with the expert medical/media collusion narrative.
And any evidence that on critical examination does support the lethal narrative?
No, none. But no matter, really. Its continued fabrication can be depended on.
