MEDICAL AND MAJOR MEDIA TURN EVIDENCE OF WORSENING OPIOID CRISIS INTO CLAIMS OF GAINS AGAINST THE EPIDEMIC

Experts and media mouthpieces spin the increasing emergency use of naloxone to slow lethality of steadily surging high-risk opioid use as progress against the crisis

by Clark Miller

Published  June 28, 2024

Finally, progress! Reassurance. We can relax a bit. 

And hold some confidence that the gold standard methods of modern medicine and public health will, after all, provide real treatment benefits and freedom for Americans trapped in high-risk opioid use. 

And can strengthen our trust in the top experts we depend on to understand the crisis and use public resources to slow the deaths and pain. Here’s what they had to say in the CNN piece about the decrease – 

After a steep rise during the Covid-19 pandemic, preliminary data shows that drug overdose deaths in the United States ticked down in 2023 for the first time in five years.

About 107,500 people died from a drug overdose in 2023, according to data from the US Centers for Disease Control and Prevention’s National Center for Health Statistics — about 3,500 fewer than in 2022. . . .

“It is a hopeful trend in some ways,” said Dr. Katherine Keyes, a professor at the Columbia University Mailman School of Public Health whose research focuses on substance use epidemiology. “We know that this drug epidemic is dynamic and changes quite quickly, so any time you see a leveling off or a slight decrease, it is promising.

Yeah, for sure. Except . . . two data points, a single tick downward, is actually not a trend. Just isn’t 

And, for a “dynamic” epidemic with some drops and persistent rises within an overall trend – in this case of decades long increases in high-risk opioid use and deaths while gold standared cures have been increasingly dispensed and provided – portraying a “slight decrease” as “promising” is an indication of something, but not a turnaround or trend. 

Maybe some other top American medical and healthcare experts can be more credibly reassuring. 

“This progress over the last 12 months should make us want to reinvigorate our efforts knowing that our strategies are making a difference,” CDC Chief Medical Officer Dr. Deb Houry said in a statement . . .

The number of deaths due to fentanyl remains “alarmingly high,” Keyes said. But the more promising trends reflect significant, multi-pronged efforts from many different sectors, she said, including use of treatments for opioid use disorder, expanded access to naloxone and other harm reduction programs and reducing opioid prescribing.

“I think that has been a real success story for public health,” she said.

That’s helpful, isn’t it? To know that not only does the decrease represent “progress” against a lethal crisis, but that it proves that we only need to fund and provide more and more of the expert strategies that are “making a difference”?

The difference must be proof of that. 

It must, right? 

We are assured that is true, that the small decrease is due – as supported by research evidence our experts understand – to their proven approaches including “treatments for opioid use disorder” and “reducing opioid prescribing“. 

Here’s more reassurance – 

“The decrease could provide a glimmer of hope amid an otherwise devastating drug overdose crisis.”

It could, it certainly could point to the expectation of gains in use of proven, successful treatments reducing the prevalence of compulsive, high-risk opioid use fueling the lethal crisis, depending I guess on what it represents and means, that decrease in overdose deaths. 

We of course have no reason to doubt expert explanations that attribute the decrease to those treatments. The evidence for that will surely be provided soon. 

It will be right? 

Overdose deaths in the United States declined slightly last year, the first decrease in five years, according to preliminary federal data released Wednesday.

The rare good news in the decades-old addiction crisis was attributable mostly to a drop in deaths from synthetic opioids, chiefly fentanyl, said researchers at the National Center for Health Statistics, who compiled the numbers. . . .

“Good news” of course. That goes without saying. 

How could it possibly be other than good news

And there’s this from the same NYT report – 

The report from the health statistics agency, an arm of the Centers for Disease Control and Prevention, did not offer reasons for the drop. But naloxone, a drug that reverses opioid overdoses, has become more widely available: In 2023, 22 million doses of Narcan, the best-known brand, were distributed in the United States and Canada. . . .

Dr. Bruce Hurley, president of the American Society of Addiction Medicine, a professional organization of more than 7,500 treatment providers, said that the group appreciated what he called “the leveling of the overdose curve.”

Oh yeah, there is the naloxone and the associated intensive, universal, highly successful campaigns to increased its availability and use, each use – verified by direct observation, reports and  documentation – decreasing incidence of a death by lethal overdose by 1. And each recorded use also recording the high-risk use of opioids that would have otherwise counted as an opioid-related death if not for the dramatically increasing, emergency use of Narcan to reverse that overdose. 

Right. It may be important to think about that and what it means. 

But that assertion by one of our top experts in the field of Addiction Medicine, the assertion that the 2023 decrease represents a “leveling of the overdose curve”? Something is off there, because we have no indications from the reported CDC data on OD deaths whether overdoses by fentanyl or other opioids have decreased or increased. The report is of overdose deaths, not overdoses. 

But we are able, with near certainty, to consider the evidence and confidently conclude that the dramatic increases in those reversals by naloxone became desperately required – are direct evidence of – continued increases in the high-risk use of opioids that result in overdose, that is, direct evidence of a continuously worsening crisis.

That’s not good news at all, is it. The reckless or differently understood confounding of “overdose” with overdose deaths in the context of the accurate understanding of the meaning of increasing naloxone saves that more than account for any moderation of deaths is a form of lethal idiocy, or worse. 

PORTLAND (WGME) — A sign of hope in the opioid epidemic. A new report from the CDC shows a three percent decrease in drug overdose deaths across the country, the first drop in numbers since 2018.

Maine was a leader in that charge, one of four states to see a nearly 16 percent drop in deadly overdoses from 2022 to 2023.

State leaders hope it’s a sign that initiatives to address the opioid epidemic are starting to work. . . .

The recovery community has seen big changes over the last five-and-a-half years, like the distribution of hundreds of thousands of doses of overdose-reversing Narcan . . .

There we have it again. It’s actually the Narcan, not American experts’ proven, gold-standard treatments to cure high-risk opioid use – can’t be because all those extra, increasing Narcan saves are the result of their lethal failure – and that reality, those real trends should per expert assertions and media spin reassure us that We are on the right track

See how that works? 

More reassurance, from the Boston Globe – 

“I literally cried when I saw the CDC [report], it’s like ‘Holy moly,’ that’s good news,” said Deirdre Calvert, director of the state’s Bureau of Substance Addiction Services. . . .

Calvert pointed to what she called improvements in the state’s prevention and overdose safety efforts, which included distributing more than 250,000 doses of naloxone — a drug that can reverse certain overdoses — improving access to housing without a sobriety requirement, and distributing fentanyl test strips.

Let’s make something clear at this point. Every prevention of a death by opioid overdose is a good thing, an important thing, ethically compelled. That is not in question. 

The question we are addressing is entirely different than that. Again, it is about how we understand and react to the inescapable facts that: 

–  Narcan campaigns and reversals have increased over decades and years, more rapidly recently precisely due to and in response to persistently increasing prevalence of high-risk opioid use in the crisis. 

–  The evidence is clear that the magnitudes of increases in those saves over time, and differentially tied to circumstances, more than accounts for any moderations observed in opioid-related overdose deaths. 

– There are no analyses or interpretations required to establish each successful  emergency use of Narcan as causing, as accounting for 1 less opioid death per month or year. 

– Considering especially the magnitude of downward ticks in opioid deaths, compared to those increasing reported saves, there are no reduced deaths left to attribute to gold standard treatments or other factors. 

– Each Narcan save is also evidence of an instance of high-risk opioid use, reduction of high-risk opioid use the only means by which America’s gold standard “treatments” (or supports like housing or fentanyl test strips) can have beneficial effects.

That evidence and trends can only mean one thing, and it is not good news.

Nor is it “unequivocally  good news”. It is the lethal opposite of unequivocally good news.  

From the Boston Globe report – 

Leo Beletsky, director of Northeastern University’s Action Lab at the Center for Health Policy and Law, said the apparent decrease is “unequivocally good news” after watching overdoses climb for years. . . .

“There’s been substantial progress, so that could certainly be the case, that things are finally yielding or bearing fruit…. There’s also trends in the drug supply that we could be seeing reflected in overdose numbers,” Beletsky said. He added that with increased awareness, the “fentanyl-fueled surge in overdoses is leveling off.”

It’s tedious, isn’t it? Having to persistently call out the obvious, the benighted, lethal distortions?

We have no evidence from the CDC report or elsewhere to suggest that overdoses – due to high-risk use of opioids – have decreased, only that there was a small decrease in those ODs that resulted in deaths, fully accounted for by desperate, dramatic increases in distribution and use of emergency overdose-reversing naloxone, those surges evidence of continuing increases in high-risk opioid use. 

Narcan use training

It’s a lot like the distribution and emergency use of the AED (automated external defribillator) used to save lives by reversing instances of sudden heart failure due to heart disease.  Imagine the desperate necessity of dramatically increasing training for use and distribution of AEDs – possibly including most public places, on street corners, elsewhere, needed to curb increasing heart attacks due to heart disease. 

From a previous post – 

That is to say, naloxone is the AED of the opioid crisis

By way of strict analogy, campaigns to increase availability and use of Automated External Defibrillators (AED) to save lives in acute emergency response to atrial fibrillation are expected to be measured as moderating acute deaths due to heart disease in America’s cardiovascular disease epidemic. Increased demand for emergency revival by use of AEDs of course would reflect a worsening heart disease epidemic, not any moderating benefit from treatments to address incidence of cardiovascular disease. Portraying any such moderation of heart disease-related mortality, moderation directly attributable to emergency use of AEDs, as progress in treatment of the heart disease epidemic that is driven largely by modifiable health behaviors would represent profound, if not pathological, deficits in capacity for research literacy, for critical thought and intellectual integrity, and for response to public health need.

That is, the CDC data heralded by lapdog media as pointing to gains against a lethal epidemic – congruent with all evidence, including data evidencing mortality-moderating effects of increased use of emergency revival of potential OD deaths (increased response to increasing high-risk opioid use) – in fact affirms worsening lethal substance use epidemics with fabricated medical “treatments” for the non-medical condition, fueling addiction and high-risk use while diverting public healthcare funding away from evidence-based psychosocial treatments and supports.

That is, evidence continues to mount establishing that the substance use epidemics trapping and killing vulnerable Americans are worsening while media accounts hide the failure of medical treatment approaches. 

Despite lethal assurances otherwise.

Back to our current post – 

That type of willful or reckless distortion – attributing to medical gains in preventing and treating heart disease reduced deaths by heart attack actually resulting from intensive increases in availability and use of AEDs – would perpetuate a worsening heart disease epidemic and failed approaches, would border on criminal, would be like, I don’t know, like American top medical experts lying about their responsibility in a reckless lab leak causing a devastating viral pandemic. And major media protecting the lies. 

Hard to imagine. And yet. 

As apt as the AED – Narcan comparison seems, it breaks down. It does not account for the observable, inevitable continuing pathogenic evolution of  desperate economies of illicit drug manufacture and use, with more potent synthetic variants and enhancers persistently, predictably rotating in, already stretching the limits of Narcan’s effectiveness. The emergency respite provided by Narcan is against a target that is not just moving, but chemically morphing. 

There is no new Narcan on the horizon. 

From a recent post – 

For America’s opioid crisis, itself the product of profitable, numbing relief that creates more pain, the analogy breaks down, apocalyptically – because the human heart is not adapting day-to-day, not changing its behavior unendingly in ways that predictably will defeat the life-saving revival biomechanics of the AED. 

On the streets of pain and lost hope and in the labs meeting demands, it’s entirely different. The opioid abuser at risk of death by overdose is a moving target by choice and by circumstance, by the vagaries of an illicit drug supply. By the deep  psychological needs and distortions including learned helplessness and the lie of his having a disease. Nothing I can do about my disease of the brain. But this new dope makes me forget that. 

The drugs he can get and that give him what he needs increasingly challenging the efficacy of Narcan, requiring multiple hits, until . . .

The fentanyl-dominated recreational drug supply and the rapid rise of overdose deaths is unfortunately not the endpoint in the evolution of the North American drug market. Non-fentanyl-derived ultrapotent synthetic opioids that are several times more potent than fentanyl, such as nitazenes, are being increasingly detected in Canada and the USA. Despite having similar (and often more acute) physiological effects to heroin, these novel psychoactive substances are not well characterised, and there is little understanding of an effective treatment approach.

. . . These developments will challenge nearly all existing harm-reduction and treatment options, from reversing overdoses with the appropriate naloxone response to retention in opioid agonist treatment programmes, underscoring the importance of proactively collecting evidence and adjusting our health-care systems.

Back again to our current post –

More recent reports only heighten and increasingly portend the potential for an uncontrolled epidemic to worsen. 

Narcan’s days are numbered 

A moving target, high-risk opioid use continuously evolves, morphs, street supply just over the past decades shifting from “China white” heroin, to black tar and prescribed opioids, to fentanyl,  now with seemingly accelerated chemical and entrepreneurial adjustments,  to a series of new synthetics and combination non-opioids that enhance potency of desired effects. 

And increasingly defeat the only line in the sand against a tsunami of overdose and overdose deaths. 

Just within past weeks, reports accumulate to heighten signs of risk of increasing failure of Narcan to reliably prevent overdose deaths in users whose use of combinations of substances defeat the neurobiological and physiological  capacity of naloxone to prevent death. 

In New York, concerns are driven by on-the-ground experiences of responders attempting to revive overdosers. 

And “across  U.S.”,  a new drug, more potent,  entering street economies of illicit opioid use appears to be unresponsive to effects of naloxone. 

It is important to note: 

The “new zombie drug”medetomidine was not in the news last month. It is now and is raising new concerns about the effectiveness and sustainability of naloxone to reverse potentially lethal overdoses involving opioids and other drugs being used with fentanyl. 

More details here, in this news piece from Wisconsin. 

Headline on new drug concerns

Health officials in Milwaukee and Dane counties are raising alarms that a powerful chemical sedative could complicate and worsen the opioid crisis.

Health officials say medetomidine, an animal tranquilizer, is being mixed with fentanyl and other street drugs in cities around the country.

“Medetomidine’s presence in the illicit drug supply is an emerging public health issue across the nation,” said Michelle Haese, state Department of Health Services director of substance use initiatives, in an email to the Journal Sentinel. “Wisconsin remains committed to monitoring this trend closely.”. . .

Medetomidine’s entry in the state further challenges what health officials term “harm reduction” efforts, Niesen said, or how to engage people who use drugs with better safety measures. It demonstrates the swiftness with which the illicit drug market can change. The fast-changing drug scene makes “opioid-naïve” people more vulnerable, Niesen said.

“Before we had oxycontin, we had heroin, and then we had fentanyl. Now we have Nitazene, we have xylazine, medetomidine, we have ketamine in the supply, we have seroquel in the supply, we have quetiapine in the supply,” Niesen said. “There’s just an abundance of things in drugs. That definitely is very challenging to navigate.”

Medetomidine shares similar traits with xylazine, also known as “tranq,” another powerful animal tranquilizer that recently made its way into Wisconsin’s illicit drug market. Similar to xylazine, medetomidine causes negative health outcomes like sedation, slowed heart rate and difficulty breathing, symptoms that are further exacerbated when taken with opioid and non-opioid sedatives, Haese said.

One key distinction for Niesen is medetomidine’s higher sedative potency than xylazine.

And, like xylazine, medetomidine is not affected by opioid-reversing drugs like Narcan, making it especially dangerous in overdose cases.

“It makes opioids even more dangerous and harder to reverse,” said Dr. Ben Weston, an emergency physician and the director of medical services for the Milwaukee County Office of Emergency Management.

Meanwhile, new reports point to xylazine (tranq) involvement in increasing overdose deaths in combination with opioids. 

Deadly opioid abused drug combinations have been around for decades, often prescribed by doctors together. 

Our desperate user’s  free or cheap “subs” – the controlled, addictive opioid Suboxone in unlimited supply on the street for a few dollars or provided by phone hook-up with his licensed prescriber – mixed with the insurance-covered benzos provided by the same or another medical prescriber, a high-risk, naloxone-defeating combo known for decades – gives him what he needs. And defeats Narcan, contributing increasingly to overdose deaths combined with opioids.   

Known for decades, the buprenorphine, America’s gold standard cure for compulsive opioid use, instead functions as currency on the street for fentanyl  and any new synthetic or drug combination that will emerge.  

headline about opioid and benzodiazepine co-prescribing

In Massachusetts last year,  2023, 25 percent of opioid overdose deaths involved benzodiazepines. That’s included in an upcoming post, “MASSACHUSETTS – MEDIA SPIN SIGNS OF WORSENING OPIOID CRISIS AS GAINS WHILE NARCAN’S DAYS ARE NUMBERED”.

It appears that we are not on the right track, instead on a track taking vulnerable Americans to the brink.  

And that to the extent that America’s expert gold standard, lethal treatments are protected, with major media helpfully messaging useful distortions and deceptions, new levels of harm and pain are ensured. 

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.

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