NALOXONE SAVES CREATE A SOOTHING LIE OF PROGRESS AGAINST A RAGING LETHAL EPIDEMIC
Every naloxone save measures the increase in high-risk opioid use as more and more gold standard medical cure is dispensed, now by phone call
by Clark Miller
Published March 8, 2024
You may have noticed that any leveling or slowing, any appearance of downturn in opioid related deaths in the lethal crisis is seized upon by compliant, helpful media as evidence – legitimized by trusted, recognized experts managing the crisis – of some beneficial effects due to America’s gold standard, proven treatments for addiction and the crisis: 1) opioid substitute treatment, OST, (aka medication assisted treatment, MAT, medications for opioid use disorder, MOUD, also now “safer supply” along with 2) “rehab” or “addiction treatment” programs with treatment provided by addiction counselors.
That type of causal relationship and evidence is pretty important, beacuase generally, overall, trends have been steady, significant expansion and provision of those gold standard treatments for compulsive problem substance use over past years and decades, funded by $billions in public health care funds, not just for facilities and clinical capacity, but for Medicaid expansion, greatly increasing access to those proven approaches.
Without some credible evidence of at least some moderation of deaths and other costs of the opioid crisis, uncomfortable questions might increasingly arise. And who better to provide the credible assurances of such gains due to the publicly funded treatments themselves, than identified top medical experts and others public healthcare trusted authorities?
So of course, with all of that invested – our health, lives, public funds and trust – some signs for optimism are important, and we can count on American Media to provide them.
Let’s take a look.
“The fact that it does seem to be flattening out, at least at a national level, is encouraging,” said Katherine Keyes, a Columbia University epidemiology professor whose research focuses on drug use.
It’s “encouraging”, the apparent moderation of increasing deaths, but Dr. Keyes declines to explain why it is encouraging. Is it because America’s proven approaches to the crisis and to substance use have become more effective over the past recording period? And if so, what factors have kept those gold standard cures from having more beneficial effects over the decades of their steadily mounting provision and of steadily mounting deaths? Deaths steadily mounting pre-fentanyl, pre-COVID, through COVID, now post-COVID?
More expert endorsements of optimism –
“We’re catching up and the tide’s turning — slowly,” said Kanter [ Dr. Joseph Kanter, the state health officer for Louisiana] whose state has one of the nation’s highest overdose death rates. . . .
“We’ve thrown a lot at this 20-year opioid overdose problem,” he said [Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco]. ”We should be bending the curve downward.”Ciccarone said he believes overdose deaths finally will trend down.
Dr. Ciccarone attributed the moderation of lethal overdoses to, first of all, “improvements in innovations in counseling and addiction treatment” but did not share what “innovations in counseling and addiction treatment” have occurred over the past year, or over the past decades.
Results have been variable, the AP article noting that –
While the overall national number was relatively static between 2021 and 2022, there were dramatic changes in a number of states: 23 reported fewer overdose deaths, one — Iowa — saw no change, and the rest continued to increase.
Eight states — Florida, Indiana, Kentucky, Maryland, Michigan, Ohio, Pennsylvania and West Virginia — reported sizable overdose death decreases of about 100 or more compared with the previous calendar year.
So it might be valuable to take a look at some state-level differences, focusing on opioid overdose deaths.
For example, Ohio and Arizona are two of the few states in which relaxed safety standards for dispensing methadone to diseased brains, have resulted in increased provision of the “miracle molecule“.
Opioid overdose deaths have continued to surge in Arizona, and in Ohio, methadone overdose deaths increased over the period of predictable increase, despite naloxone campaigns that were effective enough to moderate death trends for other opioids.
And, clear patterns of worsening opioid crisis outcomes including lethal overdose are evident in states using Medicaid expansion to increase access to the gold standard treatments, compared to states not expanding provision of MAT and addiction treatment with Medicaid expansion.
It’s important to affirm, as reported widely, that a primary and successful desired outcome of Medicaid expansion has been to increase enrollment of individuals trapped in compulsive opioid use and the crisis on the rationale that state insurance paying for increased access to America’s gold standard, proven treatments for opioid use disorder (OUD) including medications for OUD (MOUD) would benefit them and predict gains against the lethal crisis.
But let’s take a look at a state with one of the most remarkable decreases in incidence of lethal opioid overdoses – Utah.
In the last decade, Utah went from having one of the country’s highest rates of opioid overdose deaths to one of the lowest, bucking the national upward trend that came to a head in 2022, likely the deadliest year for overdoses in the U.S. ever.
In 2012, the Beehive State had 16.1 deaths from opioid overdoses per 100,000 people, tied with New Mexico for second highest rate in the country, according to data analyzed by the Kaiser Family Foundation. Only West Virginia was higher, at 27.1.
“They referred to Utah as Appalachia West,” said Jen Plumb, a physician who started the nonprofit Utah Naloxone after her brother died of an overdose in the late 90s.
By 2021, the most recently available public data compiled by the Centers for Disease Control and Prevention, Utah had 14.1 deaths per 100,000 people, falling to 40th overall, and well below the national average of 24.7. . . .
But perhaps the easiest explanation for the drop in deaths, according to Plumb, is the amount of naloxone in Utah, a life-saving opioid overdose reversal drug that can be administered via nasal spray or syringe.
Between 2017 to 2021, the state recorded 297,881 doses of naloxone distributed, according to Department of Health and Human Services, or DHHS, data. A whopping 80% of those doses came from Utah Naloxone, and the rest came from DHHS programs.
“I’m going to say most of that — going from fourth to 42nd — was Dr. Plumb flooding Utah with naloxone,” said Riley Drage, who teaches naloxone training classes for Utah Naloxone.
That’s the nonprofit’s mission — flood the state with naloxone.
“Give out as much naloxone as possible, especially for people who are currently in their addiction or using, unsheltered people — really try to get it into the places where it’s going to be used,” Drage said to a class on Tuesday.
Since the nonprofit started, Plumb says there has been nearly 10,000 overdose reversals. That’s 10,000 second chances.
“If you die from an overdose, you don’t have a chance to get into recovery,” Plumb said.
Let’s do the math.
The population of Utah in 2020 was 3.27 million. The 16.1 lethal opioid overdoses per 100,000 people translates to an approximation of 161 per million X 3.o million = 483 overdose deaths in 2012 if we guess that total population may have been closer to 3 million then. For 2021, at 14.1 deaths per 100,000, an approximation might be 141 per million X 3.27 million = 461 deaths.
We would not expect the difference of about 20 deaths per year to be constant over those years, instead gradually increasing as incidence of lethal ODs declined. Let’s err on the side of decreased deaths and estimate that over the 9 years, lethal ODs were about 9 X 20 = 180 fewer than if lethal OD rates had not changed.
Dr. Plumb cites a figure of 10,000 potentially lethal opioid overdose deaths reversed by use of naloxone increasingly distributed and used in Utah’s naloxone campaigns. That is to say, reversals of opioid OD deaths by naloxone saves more than account for moderation Utah’s opioid-related death trend
A couple of points.
That figure of 10,000 reversals is almost certainly an underestimate, as policy, legislation, and implementation have increasingly made naloxone easily available not just to first responders and health care professionals, but also to individuals, family members, and peers, anyone in a community, predictably increasing saves that are not reported anywhere.
And – research on naloxone campaigns evidences that figures like these from Utah are the norm across locales and states.
Naloxone (Narcan) saves are directly observed, measured and reportable. Each naloxone save accounts for the prevention of an opioid-related death, directly.
What the data seem irrefutably to demonstrate is that at local and national levels, naloxone saves more than account for any moderation or decreases in incidence of opioid -related deaths, and that there are no prevented deaths left to be attributed to treatments of any type.
That is to say, naloxone is the AED of the opioid crisis
From a post published April, 2021 –
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.
