Game Over for Bad Medicine

by Clark Miller

March 7, 2019

Predictably, biomedical interventions for non-medical problems deliver at best no benefit, more likely harm.  Just as psychotherapy for malignant tumors would. Or, equally absurd and criminal, as addictive chemicals for common (psychogenic) chronic pain (psychogenic pain = psychological, generated by unbalanced, distorted, thoughts and feelings about body integrity and injury) would. Did. Are.

STAT opioid deaths

The harm can be costly, not just personally for the Americans deceived to undergo surgeries and other indicated-against procedures for conditions with the only indicated treatments psychotherapies, with no evidence for biomedical interventions.  And costly, for just one example,  to the tune of about $90 billion in healthcare expenses wasted each year on fake medical practices for a non-medical condition.

America has a pathological learning deficit. With those levels of costs – opioid crisis with its mounting death count, $ 90+ billion annually for fraudulent medical practices just for back pain – you’d think there’d be a learning curve, some expression of corrective change generated by responsibilities and obligation for beneficence, protection of public welfare and effective use of public resources. Yes?

No.

Because it’s actually not about learning at all. It’s about unexamined pathologies driving need to secure and protect social status, entitlement, enrichment, and control of capital by institutions and individuals driven by those antisocial traits and needs. Distorted forces immune to concern for suffering, public harm, social justice.

And it’s about the constructed fictions – by the benefitted interests and their rewarded apologists and popularizers – required to protect systems of public resource piracy and diversion.

Fictions to medicalize non-medical conditions like

chronic pain, depressed mood, and . . . problem substance use – a condition established by all lines of evidence over decades of research to be not remotely a biomedical condition, “disease of the brain”, instead not a condition at all but the behavioral symptom of underlying distress, psychic pain, distorted thinking and associated feelings, driving compulsive use of substances (or repeated activities) to soothe, moderate the distress. Established by all lines of relevant research and understanding.

Prove it.

Okay.

Research isn’t for everybody. Let’s look at real, concrete results, the ones right up in our faces, in the morgues, in the ER, in the ground.

Retention rates (patients staying in and successfully completing MAT treatment programs) low and trending to zero in natural community treatment settings, with concurrent misuse of other opioids, other drugs – described in this post:

Doxa Deconstructed: Another Medical Fix Not Supported by Evidence – Suboxone for the Opioid Crisis

Evidence in the anomalous case of a Plumas County, California reversing opioid-related OD deaths pointing to Naloxone as the effective protective factor and against OST – described in this post:

In a California county hard-hit by opioid abuse, reduced death rate points to OD reversal drug naloxone, not opioid substitute Suboxone

Consistent evidence – as the national “dose” of substitute opioid medical “fix” and “anti-addiction drug” buprenorphine has steadily and substantially increased – of a concurrently worsening, lethal epidemic – outlined in this post:

More Signs U.S. Medical Industry Magic Pill Approach to Opioid Crisis on Same Track as Decades-Old Failed French Experiment of Unrestricted Buprenorphine Prescriptions in Primary Care

Rampant, runaway diversion and abuse of the prescribed, addictive substitute opioids in France and the U.S., enough in France to fuel buprenorphine abuse epidemics in another country – described in this post:

The French Connection France’s Decades-Long Unrestricted Buprenorphine (Substitute Opioid) Campaign – Promoted as the “Fix” for U.S. Opioid Crisis – is Fueling Widespread Prescribed Opioid Diversion, Trade and Abuse

Lack of evidence to support the claim of efficacy for MAT/OST in reducing OD deaths or for other benefit, instead evidence for diverse harms – described in this post:

The Science: Following French Failure, Americans Get a Substitute Addictive Opioid as “Fix” for the Opioid Crisis, Marketed as Reducing Overdose Deaths Does It?

OST falsely constructed, branded as “treatment” thereby diverting public resources, attention, and policy away from existing evidence-based treatments for problem substance use including opioid use – described in this upcoming post:

Upcoming Post Opioid Epidemic: For Worsening Crisis French and U.S. Medical Systems Dispense Ongoing Addictive, Abused Substitute Opioids With No Evidence-Based Treatments, Predictable Outcomes
and these posts at A Critical Discourse:

Why Addiction Treatment Doesn’t Work

Why There is No Such Thing as “Addiction” – A Fabrication that Diverts Healthcare Resources to the Criminal Treatment Scams Driving Lethal Public Health Epidemics

Effective Substance Use Treatment Requires Ending All Funding and Treatment for “Addiction” – A Fabrication that Diverts Healthcare Resources to the Criminal Treatment Scams Driving Lethal Public Health Epidemics

Evidence falsifying and dismantling claims by the medical/harm-reduction industry that diverted substitute opioids are primarily or largely used in self-treatment by individuals motivated to stop high-risk opioid use, instead affirming misuse and abuse of diverted prescription opioids – described in this upcoming post:

Update, Opioid Crisis – Word from the Street: The Bupe Economy is About Abuse not Self-Treatment

Wait . . . what? Fabricated medical “treatments” for non-medical conditions predict harm? And deaths? Who knew?

No Win

Addictive substitute medicines not only are fueling street and prison economies of illicit high-risk drug abuse and without evidence of benefit over decades of increasing dose, in reducing overdose deaths or high-risk opioid use – they can’t compete with or fix a moving target, the ever-evolving adjustments of a market serving the most basic of human demands – relief from pain, from inner torment and distress.

Fentanyl is the New Black Tar

Now there’s fentanyl, and new wrinkles in the economy. Wrinkles that the fictional, constructed “brain disease” model, in its reductionist, uninformed conception, cannot begin to understand or address: that the substance use problem is a moving, evolving target, always will be, so that attempts to treat symptoms – like behaviors – rather than the underlying psychic distress driving compulsive use was doomed to failure from the start.

Steepening increases in yearly overdose deaths over most recent years are driven by OD deaths involving fentanyl, with contributions from benzodiazepines, used with buprenorphine to enhance its abuse potential. Where there is desperate need there’s a way, and the way is a perpetually moving target. There is no defined disease to treat here.

It was hoped that substitute opioids (used in opioid substitution therapy, OST) like buprenorphine (Subutex, Suboxone) would prove beneficial by binding aggressively (high affinity)  to nerve cell receptor sites outcompeting opioids posing more risk of overdose and diminished functioning due to euphoric/sedative effects, bupe with lower excitation effect (activation) at those receptor sites. For many reasons, bupe in OST has failed to significantly reduce high risk opioid use and OD deaths, instead contributing to economies of opioid abuse.

And there’s a problem, in this evolving street economy of chemical relief for inner pain and distress.

As documented by Sam Quinones in Dreamland, back in the 80s and 90s a new, potent form of heroin from Mexico called “black tar” hit the streets of the southwest and West Coast, then much of the rest of the U.S. , replacing the much less potent diluted white powder heroin that had been around and upending the street economy. Also increasing overdose deaths due to the potency. Nobody saw it coming, any more than they did the explosion of abuse and dependence generated by another economy of abuse: doctor-provided OxyContin and other opioids around the same time period.

shutterstock Suboxone

But fentanyl – and whatever will inevitably follow fentanyl, be mixed with fentanyl, or be alternated with fentanyl to meet users’ needs – as an even more potent substitute, is the new game-changer, because it seems buprenorphine can’t compete. At the nerve cell junctures (synapses) drugs like fentanyl, with exceedingly high activation and affinity, appear to shift the dynamic biochemical equilibrium beyond the capacity of bupe to have an effective moderating or “bridging” effect.

But forget biochemistry. Seriously. Ultimately that’s not what problem substance use is about, at all. When a new, more potent opioid hits the streets with the capacity to provide a return to, to re-experience the lost euphoric rush and sustained euphoric escape that provides relief from psychic pain, all bets are off. The psychological associations and emotion-laden memories will drive compulsive use, bupe or no bupe.

As described to Christopher Moraff writing in Filter

During more than a year of reporting on Philadelphia’s drug culture, I’ve met dozens of active heroin users who are being prescribed Suboxone or its generic equivalent. Almost invariably, they sell the drug in order to buy more-powerful fentanyl. Many are also homeless—and housing stability is probably the most critical component of holistic recovery.

But some physicians say something else could be going on.

“Fentanyl has a tighter binding than Subs so it’s way easier to break through Subs,” said Dr. Aaron Blackledge, founder of Care Practice—an outpatient clinic in San Francisco. In other words, according to Blackledge, while buprenorphine is strong enough to kick an opioid like heroin off the brain’s receptors, it may be no match for high-purity fentanyl—to say nothing of even stronger analogs of the drug, like carfentanil. “And then with the transition to Subs there is this strange disassociation that comes with getting on Subs. [Like an] out-of-body experience. It may depend on how you take it. I have [patient] do it with microdosing.

“I know methadone is hard to come off, but it’s the only thing that seems to work for me.”

Jullian, a middle-aged heroin user from New Jersey who used to intermittently switch to Suboxone bought on the street to take a break from the daily risks of illicit drug use, told Filter that as his body became more accustomed to fentanyl, the buprenorphine became less effective.

“It just stopped working for me,” he said. “There was a time I would take 2 mg at start of the day and be pretty much fine, but then it started not working the same. The last time I took it I was literally sick for four days.

Recently, when Jullian decided he was ready to quit heroin for good, he opted for daily trips to a methadone clinic rather than visit a Suboxone doctor. “I know methadone is hard to come off, but it’s the only thing that seems to work for me.”

Also in Filter, reporting from the street in Philadelphia in 2017 –

For starters, most users already know they’re getting fentanyl, and more and more have developed a taste for the strong rush it provides—as shown by feedback from my sources and research assistants, as well as the increasing prevalence of fentanyl-only results. Two people have told me that they use fentanyl strips to confirm the presence of the drug, rather than avoid it.

America’s crisis of drug-overdose deaths has largely spared California. At 11.2 deaths per 100,000 people in 2016, California’s rate of fatal overdoses is among the lowest in the nation. But there are signs that is changing.

The epidemic is now largely driven by fentanyl, a synthetic opioid significantly more dangerous than heroin. According to the California department of public health, fentanyl was associated with 81 deaths across the state in 2013, then 135 in 2015, and then 373 in 2017. Though on the rise, that’s still very few compared to other regions.

“We’re a little bit behind everybody else, but we’re still following the same timeline,” Michael Marquesen of the Los Angeles Community Health Project said recently. “I’m sure it’s going to show up everywhere.”

. . .

Fentanyl could have arrived in California before it did other regions of America, and burned through Los Angeles’ vulnerable homeless population. But it didn’t. According to the National Drug Early Warning System, in 2016, fentanyl and its analogues accounted for just 0.2 percent of Los Angeles County drug seizures reported by police. There were 373 deaths attributed to fentanyl in California in 2017; meanwhile, states with much smaller populations, such as Ohio and Pennsylvania, saw 3,446 and 3,656 fentanyl deaths, respectively. Deaths attributed to fentanyl remain low in California compared to most other states. Why?

California’s demand for illicit opioids is largely met by the Sinaloa cartel And, for now, the type of opioid that the cartel has chosen to export to California is black tar heroin.

People who use heroin tell me it is difficult to mix fentanyl into black tar heroin. Fentanyl is commonly a powder and black tar heroin is, as its name suggests, usually sticky to touch. It’s hard to sneak a powder into a substance that’s viscous. In contrast, China white heroin, which predominates in other parts of the country, is a powder, and therefore easily adulterated with fentanyl without giving consumers a clue. In most areas where fentanyl has come to account for a majority of drug-overdose deaths, it has infiltrated supply via markets for China white heroin.

California’s success in avoiding the worst consequences of America’s opioid epidemic is therefore not the result of any government action or less drug use. Instead, Californians largely owe thanks to West Coast drug dealers’ traditional preference for black tar heroin over China white.

But that preference is very likely shifting.

It simply makes no sense for a criminal organization to continue producing and distributing heroin when fentanyl is increasingly available. Heroin requires the cultivation and maintenance of a poppy field, then the transportation of relatively bulky cargo across highly secure borders. Fentanyl can be cooked in a basement laboratory and sent through the US postal system. This reflects analyses showing that drug prohibition tends to incentivize shifts toward the sale of more concentrated forms of drugs.

U48800 is the New Fentanyl

There is no shutting down the desperate ingenuity of American capitalism and profit motive nor that of mood-altering chemical innovation in the evolution and use of ever more potent and creative means to meet as pressing a human need as escape from psychic pain, to gain relief, respite, from the inner distress, fears and pain driving compulsive substance use. No shutting down by prohibition or threat, or punishment, nor by shaming, nor by a fictional higher power or fictional medicinal cures, or the bizarre prescriptions of a religious subculture.

There are only the longstanding, evidence-based therapies established as effective in moderating and providing relief from the causes, the drivers of those compulsive, driven behaviors – the unmet psychic needs, injuries, distress and distortions – therapies that have never been incorporated into the criminal scam comprising treatment as usual (TAU) – what Americans have been brainwashed to pay for and believe constitutes “treatment” – for the fabricated condition of “addiction”. Those longstanding psychotherapies and psychosocial supports that are evidence-based practices (EBP) have never been supported in any meaningful way by public healthcare policy and resources, our resources that are instead diverted away to unsupported medical fixes and harm-predicting  TAU fueling worsening epidemics.

While American Medicine’s fix for American Medicine’s generated opioid crisis – addictive, diverted and abused opioids substituted for other opioids – doesn’t work, and really doesn’t work with new opioids like fentanyl and carfentanil on the streets, it does function as integral currency and consumable in the addictive drug economies of abuse on the street and in prisons. Works partly to provide a euphoric/sedative effect or as a distress- and pain-moderating “bridge” between periods of use of a preferred injectable like heroin or fentanyl. And it’s appreciated as a drug of abuse in prisons, easy to get in and bringing attractive profits for dealers who know how to, after trading a preferred injectable like heroin for someone’s doctor-provided subs, funded by public healthcare resources. The economies of bupe abuse.

The trusted, authoritative, privileged and public-healthcare-funds-controlling medical industry (okay, yeah, the industry that gave us the opioid crisis and this  and this and this), operating under an absurd fictional “brain disease” model of compulsive substance use, operating entirely in ignorance and darkness, out of scope of competence required to understand the causes and nature of problem substance use that includes developmental psychology, behavioral psychology, ACE, trauma, underlying emotional and cognitive distortions – can only do harm, only help to fuel that street economy of diversion and abuse.

Who’s winning in this game? Not the dead and addicted.

 

 

Not the medically “treated”.

Who’s gonna blow this no-win game dead, call it over, stop the deaths-by-negligence?

On a dark wasteland of coverup, cowardice, ignorance, deceit and fake cures – all bets are off.