OPIOID CRISIS: FOLLOW THE MONEY, TRUTH IS BURIED UNDER IT

Big-money lawsuits against fake villains are intoxicating; distract from core social forces driving compulsive substance use; reward prosecutors, politicians and media; shield misprescribing doctors and American Medicine; fund sham treatment systems worsening lethal epidemics

by Clark Miller

Published October 23, 2022

A couple of years ago news reports illuminated underneath the allowable constructed opioid crisis narrative a dark conflict of values, centers of power, and hidden interests unrelated to public health, fighting for protection and gain. Ultimately, power and money prevailed, burying any chance of slowing or turning back what would proceed predictably as the increasingly lethal crisis now still worsening after dissipation of pandemic stressors offered as cover stories for medical treatment failure.

In lawsuits around the U.S. that blame major pharmacy chains, such as Walgreens and CVS, for the country’s opioid crisis, the healthcare giants appear to be following a similar legal strategy: Blame the doctors instead.

In Florida earlier this month, Walgreens and CVS filed a third-party complaint that says that 500 anonymous physicians—Dr. John and Jane Doe—are responsible for fueling that state’s opioid epidemic, not the pharmacists who filled the opioid prescriptions.

It comes after a group of major pharmacy chains that included CVS and Walgreens, filed legal action in an Ohio court in January to shift the responsibility to physicians in a major federal opioid trial that claims the large companies are culpable for prescribing the drugs that have fueled the opioid crisis.

In those filings, the pharmacy chains, which also included Walmart, Rite Aid, HBC and Discount Drug Mart, said it was actually hundreds of Ohio physicians and other healthcare practitioners who write the prescriptions that bear the blame for providing opioids to patients—not the pharmacists who filled those prescriptions.

Florida’s Attorney General Ashley Moody was having none of that legal argument. “This stunt is simply a tone-deaf distraction by two of the wrongdoers in the national opioid crisis that is claiming 15 lives in Florida every single day,” Moody said in a statement.

She filed a motion to strike or sever the third-party complaint (PDF) filed by CVS Pharmacy Inc. and the Walgreen Company, pharmacy retailers who were named as co-defendants in a suit brought by the Attorney General’s office against Purdue Pharma, the maker of OxyContin, and other manufacturers, distributors and chain pharmacies. 

In her motion to throw out the third-party complaint in Florida, Moody said CVS and Walgreens have records that include the names of the doctors who wrote the opioid prescriptions, “Yet, CVS and Walgreens have not named a single prescriber and, instead, have filed this pleading against 500 John and Jane Doe defendants,” she wrote. “Our complaint alleges that these national pharmacies are responsible for knowingly flooding Florida with billions of dangerous and addictive pills all while the opioid crisis continued to spiral out of control.”

Like several other states seeking to recoup millions of dollars spent battling the costly opioid epidemic, Florida filed a lawsuit in 2018 that named the two retail pharmacy giants as defendants.

The defendants should have known they were fueling an opioid epidemic, the lawsuit said. A Walgreen’s drug distribution center sent 2.2 million opioid tablets to a single pharmacy in tiny Hudson, Florida, in 2011 a roughly six-month supply for each of its 12,000 residents, the lawsuit said. CVS distributed more than 700 million opioid doses in Florida between 2006 and 2014, it said.

In response, Walgreens and CVS filed a third-party complaint in January saying they are not liable for the opioid crisis and asking the court to focus on the physicians who prescribe the drugs.

“Pharmacists do not write prescriptions and do not decide for doctors which medications are appropriate to treat their patients,” the complaint says. “While pharmacists are highly trained and licensed professionals, they did not attend medical school and are not trained as physicians. They do not examine or diagnose patients. They do not write prescriptions.”

Some highlights from the report –

Florida’s Attorney General Ashley Moody was clear: asserting that America’s licensed medical professionals (LMP) bear responsibility for the prescriptions they write for controlled substances as related to effectiveness, clinical appropriateness, and safety for patients is so absurd, it is a “stunt” and “distraction”.

Ms. Moody then reasoned that the absence of  personal identification of LMPs alleged by the pharmacies as writing prescriptions for opioids that were at times excessive or clinically inappropriate invalidates the assertion that America’s medical prescribers have overprescribed or misprescribed opioid medications.

Shifting away from stunts and  to her own substantive complaint, she asserted that “these national pharmacies are responsible for knowingly flooding Florida with billions of dangerous and addictive pills”. She did not clarify whether by “flooding” she meant by filling the prescriptions coming into the pharmacies from LMPs, or flooding by some other means. 

That is to say, Ms. Moody from all appearances seemed intent on conveying the impression that she is significantly challenged by diminished capacity for thought and/or for integrity, and/or quite possibly compelled to disingenuously divert attention away from the only possible sources of the inappropriate opioid prescriptions that generated and fueled a lethal crisis, the medical prescribers, and instead on a suitable villain that – unlike the thousands of individual misprescribing LMPs in Florida – will function effectively as scapegoat, manageable legal target, and source of the types of big-dollar settlements that provide remarkable payoffs, including the type of attention an over-aspiring, compromised, know-nothing blowhard desperately needs. 

Ashley Moody press conference

But why be so harsh, you may wonder.

Harsh on a media darling and champion of vulnerable Floridians trapped in an opioid crisis? After all, surely, whomever is really responsible for the flood of misprescribed opioids, successful legal actions of this type and the big-money settlements are likely just the thing rerquired to stop the misprescribing and fund more of the treatments that have been combatting the opioid crisis – treatments that surely must be near victory if only for a few more $billions for research, salaries, and miracle cures – including American Medicine’s proven cure.

Isn’t that right? 

Let’s take a look. 

THERE ARE FLAWS

There is a fundamental flaw in the rationalization for legal action against pharmacy and distributor chains for the addictive opioids fueling America’s crisis and in the evidence base for claims of their “flooding” of American communities with those opioids. If those outlets for providing patients with the opioids their doctors prescribed them would have “flagged” the “suspicious” prescriptions or prescription histories and reported that, then the DEA or other enforcement bodies would have been able to . . . to what?

America is three decades into its opioid crisis. What benefit can be attributed to enforcement actions against “pill mill” doctor prescribing (the prescriptions excessive enough to be detectible and flagged by pharmacy or distributor employees) as the crisis continues to surge, has never moderated? In any case, all bets are off now including for legal action initiated years ago against those outliers, the scattered pill mill doctors who were to be flagged by the pharmacies, with the recent U.S. Supreme Court decision that protects them, described in this post.

Those doctors and their attorneys have wasted no time.

There’s a deeper flaw,

engendered by the impressive and triumphant protective construction of the opioid crisis narrative by America’s Medical/Media collusion and including the elements, embraced and utilized by the court, that fabricate against all evidence the lethal myth that practices of American Medicine and medical professionals are generally driven by clinical and ethical competence.

It turns out, demonstrably, that the misprescribing and overprescribing of Schedule II addictive opioids driving generation of the opioid crisis was by the general, standard if not nearly universal, inappropriate prescription of those substances against medical indication and against all relevant longstanding evidence as examined and described in this and multiple other posts.

That is, it was the common medical practice and normalized misprescription of those opioids by tens of thousands of American licensed medical prescribers, not primarily or sufficiently by outlier pill mill doctors, providing the thousands of trickles that became a flood. Prescribing normalized and institutionalized by a consensus of medical, research, and policy experts and authorities for all pain, including common chronic pain, a nonmedical condition without medical treatment.

To stop those trickles that became a flood would have required flagging of the vast majority of indicated-against  opioid prescriptions coming into all pharmacies across America, written by nearly every practicing licensed medical professional (LMP) in America. And continuing –

Overprescription and misprescribing of opioids

has continued over the years and decades of an increasingly lethal epidemic, described here,

here,

here,

here, 

here,

and here

And while continuing to misprescribe, decades into an increasingly lethal opioid crisis, America’s medical professionals only began protecting patient rights and health after forced to at risk of legal violation for failure to meet longstanding, established ethical requirements for any medical intervention – failure to  provide informed consent.

Pharmacies flagging inappropriate opioid prescriptions that generated and continue to fuel the lethal epidemic? That just wouldn’t work, would it.

Part of the lethal myth

that gives the lie to facile rationalizations for the mesmerizing lawsuits is the longstanding manufactured “truth” that goes without saying, that a very small percentage (perhaps 8 percent) of Americans provided the addictive opioids by their doctors (not pill mill doctors) would become dependent on opioids, leaving them vulnerable to continued use by diversion or illicit use. It seems, at least for the Medicaid population, the figure may have been almost a third.

30 percent? Not 8 pecent? 

The importance and potential harm of noncompliance with Medical practice and ethical standards over decades of the persistently worsening crisis is reinforced by new evidence that estimates of potential for development of compulsive high-risk opioid use (“dependence”) – persistently asserted to be no more than about 8 percent of newly-prescribed opioid users – appears to have been much higher in the U.S. Medicaid population, from this report at MedCity News. 

Healthcare providers need better algorithms to predict opioid dependency, especially among Medicaid patients, according to new research from Stanford University and Gainwell.

Stanford researchers teamed up with healthcare technology company Gainwell to use the company’s datasets —  180,000 de-identified Medicaid claims from six states (three in the Southeast, two in the West and one in the Midwest). Their research revealed that among patients who had never taken an opioid, 30% developed an opioid dependency following their first prescription. The study was published last week in PLOS Digital Health.

Pharmacy flagging of suspicious opioid prescriptions would have to have included any prescription for American Medicine’s “proven” medications for American Medicine’s opioid crisis – the buprenorphine (Suboxone) and methadone dispensed in “medication assisted treatment” programs (MAT) and established as with never an evidence base for effectiveness, instead as fueling illicit opioid economies, overdose, and deaths.

How would that be working out? Pharmacies routinely flagging prescriptions for American Medicine’s cure for American Medicine’s opioid crisis, a “proven” cure that, in fact, is established as fueling the lethal epidemic.

Right.

But what about direct, pharmacy-generated warnings

for dangerous opioid prescribing that is not in question, for example the high-risk prescription of a benzodiazepine with an opioid? That combination that has been commonly used by MAT patients and others in the longstanding, pervasive illicit economies and lethal misuse of doctor-prescribed MAT opioids like Suboxone and methadone? The combination that makes life-saving revival with naloxone less predictably life-saving? What about direct warnings to LMP prescribers from pharmacists when that combination is identified? 

Email alerts to practitioners from pharmacists did not reduce concurrent prescribing of opioids and benzodiazepines, a randomized trial showed.

Huh! That’s troubling, a shock. 

As shocking as if American doctors, decades into American Medicine’s lethal crisis, had continued to fail to provide informed consent – i.e. to discuss potential dangers – to patients being prescribed opioids. 

As troubling as if states mandating LMP prescribers to use a database designed to help them avoid dangerous prescribing made no difference in that prescribing

As pathological as a state health authority enabling that failure and continuing misprescribing. 

But we’ve gotten distracted. It was the Sacklers, big pharma, pharmacies. How could that be in doubt? Those truths are provided everywhere. 

Now that lawsuits against big pharma, evil figures and families, pharmacies and distributors

of the opioids prescribed by America’s licensed medical providers have become a national pastime, a pleasing, media-ready dog and pony show, a soothing, intoxicating distraction, and emerging settlement fund feeding frenzy . . . it all never made sense, did it? Certainly not as a way to control misprescribing and overprescribing that continue unabated and with lethal opioid use continuing to surge post-pandemic.

Of course it made sense, and makes sense!

We must trust America’s expert class and watchdog media on that. It only doesn’t make sense under a delusional belief that the holders of power and cultural capital, those experts, authorities, and institutions entrusted to protect public health and vulnerable Americans are driven by commitment to ethical and competent upholding of those responsibilities, rather than, say, criminally disordered and pathological behaviors.

Outside of that delusion – messaged daily in mass and social media – the distracting, mesmerizing lawsuits are predictable and necessary for the gains they provide.  

FLAWS, BUT NECESSARY GAINS

The gains predicted by and driving the flood of lawsuits against big pharma, pharmacies and distributors as the real villains attacking America and causing opioid deaths (but not, presumably, surging deaths by other substance use epidemics, which will require their own identified villains) are varied and remarkable.

The helpful clarification for Americans of their feelings and thinking as needing to be directed against the identified villains, providing sense of relief and continued confidence in American Media, experts, and systems identifying those villains and the way forward out of the lethal crisis

Distraction of attention away from the actual, established causes for emergence of problem compulsive substance use including harm to children inflicted by their families, stressors and harm by pathology and criminal behaviors of social and economic systems, grossly incompetent and unethical behaviors of American medical institutions and professionals, and the abdication by media, medicine and other institutions of responsibility and competence to protect the public from harm.

Fabrication of identities and roles as protector and public servant by those pursuing the villains with predicted rewards for their aspirations.

Compensation, aclaim and reward for armies of useful idiots promoting, messaging, celebrating, and culturally reinforcing the necessary, soothing fabrications.

Major influx of funding, through settlements, for the failed cronyism and sham treatment systems driving continuously worsening, lethal substance use epidemics.

UNFORTUNATE COSTS

Unfortunately, despite the multiple gains, there are costs incurred by the fabricated distractions

– In the emerging, agitated feeding frenzy triggered by large settlement amounts coming in for doling out, it’s clear that the contenders are the same, longstanding, failed lethal systems that got us where we are now, like an entirely unqualified, nonprofessional workforce in substance use treatment programs. Like addiction counselors and peer support specialists – “The people closest to the problem are also closest to the solution,” Voices Project founder Ryan Hampton said.

And like American rehab –

 

 

– Media/entertainment/medical messaging systems will be more empowered and enabled to generate distraction away from actual causes of compulsive substance use and its effective treatments and prevention, perpetuating and worsening lethal epidemics

– More and more Americans will become trapped in substance use epidemics, becoming ill, overdosing, dying.

 

Vulnerable Americans increasingly trapped

in American Medicine’s increasingly lethal substance use epidemics are left with less than nothing, with media-constructed celebrations of meaningless scapegoating, fingered villains, fabricated to protect failed systems perpetuating those epidemics. Failed, cherished, protected systems perpetuating the harm including American Media, Medicine, religious subcultures, justice and public health and safety, the American family. A cherished, disintegrating delusion.

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.”

– Pierre Bourdieu  Outline of a Theory of Practice (1972)

In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.

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.

Pierre Bourdieu - Outline of a Theory of Practice 1972

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