Increasing Narcan saves confound opioid OD death trends, demonstrably an invalid measure hiding severity of the crisis. Valid, direct measure of high-risk use as opioid injection-related infectious disease persistently increases.

by Clark Miller

Published July 1, 2024

As reported in major media – 

FRIDAY, July 21, 2023 (HealthDay News) – In the two decades since the opioid epidemic took off, the addiction crisis has claimed the lives of hundreds of thousands of Americans.

Now, new research points to another grim outgrowth of the crisis on American health: a skyrocketing risk in pregnant women for hepatitis infection (HCV).

That’s because the main risk factor for contracting hepatitis C — a liver infection spread by blood contact — is injection drug use.

Between 1998 and 2018, prevalence of HCV among pregnant women shot up 16-fold, researchers found, driving up the risk for poor fetal development and fetal distress, as well as preterm birth.

And that’s just the broad picture among pregnant women of all ages. Among those between 21 and 30, hepatitis C risk shot up more than 3000%

That link has been found, consistently, over diverse locations and populations, and continuing over more recent years. 

The original JAMA research report –

As important to public health as the accumulating evidence and replicated trends and links from infectious disease incidence to high-risk opioid use, equally important are implications of this growing body of research for valid, accurate assessment and reporting of a continuously worsening opioid crisis. 

From an earlier post – 

It’s critical  to understand the importance of this type of evidence

The more deaths mount, the more pressure mounts to divert public healthcare resources to the unvalidated medical model provision of addictive, diverted and abused substitute opioids. Perversely, tragically, and criminally, it seems, because it has been established that provision of American Medicine’s fix for American Medicine’s opioid crisis predicts, rather than harm reduction or saved lives, worsening of increasingly lethal epidemics

That’s established partly because trends in opioid-related overdose deaths are not a meaningful measure of effectiveness of OST (MAT). 

For reasons discussed in this post and additional posts – each post with detailed explanation linking to primary research and other sources.

There is no body of evidence with results that control for the most likely of confounding explanations for any slowing of mortality – increased availability and use of the OD death-reversing drug naloxone. 

On analysis of the evidence, naloxone use – its reduction of deaths acting and measured directly, unlike presumed benefit from OST – directly accounts for all apparent changes (= decreases) in opioid-related overdose deaths. This result holds when results are available on a local level (e.g. here, here, here, and here) and when national data are examined.

Attributing benefit to OST requires evidence of reduced high-risk use of opioids. 

As described in detail in this, this, and other posts, that is the mechanism by which OST could possibly provide benefit.

When outcomes are critically analyzed, the evidence points consistently to provision of the medical model fix or “treatment” for problem opioid use  worsening, not protective for, high-risk use and associated harms including opioid-related mortality. Because high-risk use, measured as non-lethal overdose incidence (eliminating the confounding, established effects of expanding naloxone use and campaigns) has increased nationally and consistently in multiple locales where data are available as dose of the medical cure increases.

As explained and established by multiple lines of evidence in this new post, emergence over past years of the potent opioid fentanyl in street economies of illicit opioid use does not qualify those invalidating results – fentanyl cannot explain away the failure of increased provision of the medical “treatment” to reduce high-risk opioid use

Another direct measure of high-risk use of opioids

is incidence of opioid injection-related infective disease, like endocarditis.

Think about it – incidence of infective diseases caused by injection of opioids. That use of opioids is high-risk. If OST provides benefit to at-risk users, the mechanism is by reducing risk and associated problems related to opioid use.

Trends of decreased incidence of an injection-related infectious disease could be attributed to a variety of factors including: changes in public health, prevention, or medical interventions; decrease in high-risk opioid use including use by injection; clean needle exchanges; behavioral health treatments; others. Identifying the factor(s) any decreases could be confidently attributed to would require that multiple congruent, well-designed studies and other lines of evidence point to those factors and not others.

Increases in incidence, like those we’re seeing, are different. If increases of significant magnitude occur over the same time period that an intervention, like the medical OST fix, hypothesized to be a “treatment” or protective factor has also increased, then that constitutes strong evidence against that intervention as beneficial in reducing high-risk use.

As we would predict from everything we know about problem substance use and the failure of medical approaches to provide benefit for that non-medical problem, those diseases are increasing in prevalence.

Back to our current post – 

It’s established, as well, that the necessary, fabricated rationalizations that attributed to COVID pandemic stressors and effects the persistent, increasingly lethal opioid crisis are invalidated. More here about that. 


Incidence of opioid injection-related infectious disease has increased over past decades and years

Use by injection represents high-risk use, and its persistent increase in incidence is a direct measure of a worsening opioid crisis, not confounded, like overdose deaths, by the increasingly moderating effects on OD deaths of Narcan reversals

That distinction and value of valid measures of changes in severity of the crisis are highlighted and heightened by medical and media distorted portrayals of small decreases in opioid overdose deaths as representing gains against the epidemic of high-risk opioid use

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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