UPDATE OPIOID CRISIS:
MORE EVIDENCE THAT BUPRENORPHINE AND METHADONE OPIOID SUBSTITUTION TREATMENT (OST) IS WORSENING AMERICA’S LETHAL EPIDEMICS – COLUMBUS, OHIO
Increased provision of American Medicine’s proven opioid cure is tied to surging high-risk opioid use, incidence of injection-related infective diseases
by Clark Miller
Published March 27, 2019
Updated April 11, 2021; April 6, 2022
BELOW:
In Ohio, new evidence – indicators of high-risk opioid abuse sharply increase over years of heavily increased funding and provision of substitute opioid medical fixes (OST) for the medically-generated opioid crisis, results inconsistent with presumed benefit from OST.
The numbers, as they say, are staggering.
Opioid-related and other drug overdose deaths increasing steadily, now sharply, over decades, 70,000 last year. Seemingly perversely, as population “dose” of the promised, publicly funded U.S. medical industry cure for the medical model “brain disease” of compulsive substance use – dose of substitute opioids that are addictive, diverted and abused – has expanded over the same years.
(from The Guardian – November 29, 2018)
The more proven medical cure provided to the diseased brains, the more deaths mount.
As outlined and discussed in a series of posts on the opioid epidemic and its causes, the false promise of medication assisted treatment (MAT) as implemented is increasingly exposed by critical evaluation of diverse lines of evidence and research from U.S. MAT outcomes and from France’s decades-long, least restrictive, most intensive opioid substitute treatment (OST) campaign in the world, held out as the model for a U.S. medical “fix” with substitute opioids.
As established for the lethal iatrogenic opioid crisis the fix is a response to, the research “evidence” was never credibly supportive and predictive of benefit, instead predictive of a mounting body of evidence of failed outcomes and steadily worsening lethal public health epidemics associated with population “dose” of the medical cure increasing substantially and steadily in the U.S. and model country France. That research – vetted by the same expert professional class responsible for ensuring a research evidence base for the medically appropriate, safe, effective use of addictive opioids for the non-medical condition of common chronic pain – was never subjected to competent critical analysis of research design, interpretation and validity, never subjected to a critical discourse, instead successfully endorsed by popularizing writers in mass media.
Directly BELOW:
In Ohio, new evidence – indicators of high-risk opioid abuse sharply increase over years of heavily increased funding and provision of substitute opioid medical fixes (OST) for the medically-generated opioid crisis, results inconsistent with presumed benefit from OST.
Discussed in a recent post, one of multiple lines of evidence consistently invalidating benefit from OST – high risk opioid use increasing in Canada associated with increasing doses of the OST medical fix –
Over the same time period what should be a valid indicator and measure of changes in prevalence of high-risk opioid use – incidence of injection-related endocarditis – has increased steadily and significantly as well. That’s the opposite of predicted if OST by provision of methadone and bupe were providing benefit by reducing high-risk opioid use.
BELOW: Update – high-risk opioid use (by injection) resulting in Hepatitis C is tied to medical prescription of opioids for the non-medical condition of chronic noncancer pain
New
Media reports for trends in public healthcare spending on the medically-driven medical fixes – bupe, methadone and other medications – in Ohio paint the same picture: of increasing, not moderated, opioid-related overdose deaths and incidence of injection-related infectious endocarditis, a measure of high-risk opioid use – the opposite of predicted if the medical fixes were providing benefit.
Over the past decade, spending in Ohio for medications dispensed to patients with problem opioid use has increased substantially, more than in many states.
Particularly, spending for buprenorphine-based opioid substitution has increased, for example a doubling in Medicaid payment for Suboxone from 2014 to 2016.
Funding has included “Funded programs to train doctors, nurse practitioners and physician assistants in using medication-assisted treatment to battle addiction.”
Despite that use of public healthcare resources for medical fixes for the medically-generated lethal opioid crisis, opioid-related overdose deaths have “spiraled”, increasing to record levels over the same years.
Despite increased state spending, legislation and debate on Ohio’s drug crisis, last year’s [2016] death toll was 33-percent higher, according to the annual report on unintentional drug overdose deaths released Wednesday by the Ohio Department of Health.
But the data from Ohio, like those from Ontario, Canada, provide a more direct measure and evaluation of the effects on high-risk opioid use of increasing provision of the publicly-funded medical “fix” for the medial opioid crisis.
In Franklin County, Ohio, cases of drug-injection-related infectious endocarditis, a measure of injection drug use, have skyrocketed over the years 2012 – 2017.
Specifically, the increase in incidence of those cases increased 436 percent, most of that increase attributable to use of heroin by injection.
Investigators found that overall admissions for infective endocarditis at Ohio State University Wexner Medical Center increased 101% from 2012 to 2017, with most of the increase coming from the 436% jump in drug-related cases. The research, which was presented at the American College of Cardiology (ACC) 2019 Annual Scientific Sessions in New Orleans, LA, found that most of the cases of endocarditis related to drug use involved heroin.
Significant, extended increases in medical provision of buprenorphine and methadone OST should necessarily have resulted in the opposite outcome – decreases over the same time period of high-risk opioid use . . . unless . . . as is generally and predictably the case, the provision of a medical model “treatment”, unsupported and indicated against by research evidence for an entirely non-medical condition – compulsive problem opioid use – has predictably resulted in a worsening of an iatrogenic lethal opioid crisis rather than providing benefit.
Update – high-risk opioid use (by injection) resulting in Hepatitis C is tied to medical prescription of opioids for the non-medical condition of chronic noncancer pain
April, 2022
In the large, retrospective cohort study, probability of high-risk opioid use (by injection) and of associated incidence of injection-related Hepatitis C was from 3 to 5 time greater for long-term opioid prescription users than for individuals not prescribed opioids for pain or prescribed short-term.
Results A total of 382 478 individuals who had more than 1 HCV test were included, of whom more than half were female (224 373 [58.7%]), born before 1974 (201 944 [52.8%]), and younger than 35 years at baseline (196 298 [53.9%]). Participants were followed up for 2 057 668 person-years and 1947 HCV seroconversions occurred. Of the participants, 41 755 people (10.9%) were exposed to long-term prescription opioid therapy at baseline or during follow-up. The HCV seroconversion rate per 1000 person-years was 0.8 among the individuals who were prescription opioid–naive/acute (1489 of 1947 [76.5%] seroconversions; 0.4% seroconverted within 5 years) and 2.1 with long-term prescription opioid therapy (458 of 1947 [23.5%] seroconversions; 1.1% seroconverted within 5 years). In multivariable analysis, exposure to long-term prescription opioid therapy was associated with a 3.2-fold (95% CI, 2.9-3.6) higher risk of HCV seroconversion (vs prescription opioid-naive/acute). In separate Cox models, long-term chronic use was associated with a 4.7-fold higher risk of HCV seroconversion (vs naive/acute use 95% CI, 3.9-5.8), and long-term higher-dose use (≥90 MEQ) was associated with a 5.1-fold higher risk (vs naive/acute use 95% CI, 3.7-7.1).
From the 2022 JAMA report –
To evaluate our hypothesis that injection drug use initiation risk is higher among people dispensed prescription opioids, we used an administrative algorithm with high sensitivity for identifying injection drug use31 to limit our analysis to individuals who were injection drug use–naive at prescription opioid initiation. Furthermore, we expected most HCV seroconversions during follow-up to be related to injection drug use because screening of blood products for HCV was implemented in the early 1990s and our analysis was limited to people with an HCV-negative antibody test in 2000 or later. We found that three-quarters of individuals who seroconverted had evidence of injection drug use after the start of the study, highlighting the role of injection drug use transition in HCV seroconversion.
HIDDEN MEANING –
The study neglected to note that chronic, noncancer pain is almost always non-medical (not physical) in nature and is not treated effectively by opioids or by other medical interventions, instead by cognitive behavioral psychotherapies. As documented and explained here, over the most recent years including pandemic, medical misprescribing of opioids long-term for chronic pain increased and interventions without evidence for effectiveness continued while patients were not referred by their medical providers to the single indicated, evidence-based treatment for chronic, noncancer pain – psychotherapy.
That is, decades into the increasingly lethal opioid crisis, continued misprescription of opioids without evidence of benefit and for the non-medical condition of common chronic pain contributes to surging high-risk opioid use and incidence of injection-related infective disease.
