UPDATE Opioid Crisis:

More Evidence that Buprenorphine and Methadone Opioid Substitution Treatment (OST) is Worsening Lethal Epidemics – Canada

by Clark Miller

April 3, 2019

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.

BELOW:

In Ontario, Canada new evidence: indicators of high-risk opioid abuse, independently of opioid-related overdose deaths, 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 yet unsupported benefit from OST.

SAMSHA bupe client trends2

The more medical cure provided to the diseased brains, the more deaths mount.

Overdose deaths US trend The Guardian

As outlined and discussed here at A Critical Discourse 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.

STAT opioid deaths

That mounting evidence has included –

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 post:

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

BELOW:

In Ontario, Canada new evidence: indicators of high-risk opioid abuse, independently of opioid-related overdose deaths, 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 yet unsupported benefit from OST.

Newly emerging and accumulating evidence explained in previous posts with links to primary research includes

A new, large study of opioid-dependent patients in the UK, followed for 12 months after opioid substitute treatment with buprenorphine and methadone, with no findings of significant benefit in reduction of OD deaths, “drug related poisonings” = DRP.

A new, anomalous case of significantly reduced incidence of OD deaths against the continuously worsening national trend – in Dayton, Ohio – where evidence can directly link the reduction to a naloxone campaign, not to OST/MAT.

Additional outcome measures from France inconsistent with benefit from decades of unrestricted medical provision of substitute opioids as “treatment” – France remaining 5th worst of 20 European nations in “high risk opioid use”.

Discussed in recent posts, one of multiple lines of evidence consistently invalidating benefit from OST – drug injection-related infectious endocarditis as a measure of high risk opioid use – has increased in Canada and in Ohio associated with increasing population provision of doses of the OST medical fix.

That’s the opposite of predicted if OST by provision of methadone and bupe were providing benefit by reducing high-risk opioid use.

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.

New

Updated Data For 2017-2018 on Worsening High-Risk Opioid Use With Increased Provision of Medical Substitute Opioid “Treatment”

More than 600 Ontarians died from opioid overdoses in the first six months of last year, new numbers reveal, as overdose prevention sites await word on whether they can continue to operate in the province beyond Sunday.

Public Health Ontario statistics were quietly updated last week to show that 629 people in Ontario died from opioid-related causes from January to June of 2018.

That marked an approximately 15 per cent increase from the same time period in 2017, when 549 people died from opioid-related causes.
Data is also now available for the first nine months of 2018 for hospitalizations and emergency department visits.

There were 6,688 opioid-related emergency department visits in the province, up from 5,909 during the same time frame last year, and 1,544 hospitalizations, which is down from 1,623 from the same time frame last year.

6,688 opioid-related emergency department visits in the province, up from 5,909 during the same time frame last year

 

An increase by 13 percent from 2017 to 2018 in a measure of high-risk opioid use: opioid-related ED visits

That’s Important

Because

as explained in detail in this post and here, evidence for benefit from the medical/pharmaceutical industry medical fix for the medical/pharmaceutical industry-generated lethal opioid crisis requires an explanatory mechanism. Unlike the beneficial lethality-preventing effects of naloxone, observed and counted directly in emergency or medical settings when a user at risk of overdose death is revived by use of naloxone (Narcan), any presumed role of OST in reducing OD deaths or providing other benefit must be achieved, measured, and statistically significant (in credibly designed and interpreted research with durable results and external validity) as reducing high-risk opioid use – that’s how any hypothesized benefit would occur.

But that evidence has never existed. For a number of invalidating reasons. One primary reason is that use of naloxone has increased concurrently with provision of OST. Studies have not been controlled to allow attribution of any reduced opioid-related mortality to OST versus use of naloxone – the potential exposure to naloxone intervention generally reported to be and predicted to be positively associated (correlated) with patient involvement in OST services and associated medical and psychosocial supports.

Another of multiple invalidating factors is the consistently emerging evidence: national data, data from community programs, associated timelines, and OD death prevention data all point coherently to naloxone acting as the protective factor accounting for any apparent reductions in OD deaths, measured directly, leaving no changes for the hypothesized effects of OST to account for.

Equally invalidating: new results here for Ontario, Canada –

As described above,

measurement of changes and trends in opioid-related OD deaths are not determinative to attribute benefit to OST, because in addition to effects of naloxone use, there are too many confounding factors in the studies. It is too difficult to design a powerful, credible study, let alone a controlled study (in which naloxone would not be made available?).
But there are effective ways to measure prevalence of high-risk opioid use: like incidence of opioid injection-related infectious endocarditis; and opioid-related ED visits, apart from OD deaths, as reported in the new data from Ontario, Canada.

TO REPEAT,

Significant, extended increases in medical provision of medical fix buprenorphine and methadone OST should necessarily result in time-frame-congruent decreases over the same time period of high-risk opioid use. Lack of change in high-risk use, along with apparent decrease in incidence of opioid-related OD deaths would point to naloxone as the effective factor, not OST. Lack of change in high-risk use or increase in high-risk use would be invalidating of hypothesized benefit due to OST.

THAT’S WHAT THE EMERGING EVIDENCE POINTS TO –

Worsening (increasing) prevalence of high-risk opioid use in apparent response to increasing provision of the medical fix: high risk use as measured by opioid injection-related infectious endocarditis in Ontario, Canada and in Franklin County (Columbus), Ohio and, one suspects, elsewhere.

And with recent (2017-2018) data from Ontario, high-risk use increasing, as measured by opioid-related ED visits, associated with increasing provision of OST.

In Ontario, Canada, as in other provinces, over past decades and years provision of methadone and buprenorphine has steadily and significantly increased.

Among the health ministries that did respond, overall methadone and suboxone patient counts and costs have increased, perhaps unsurprisingly, just as rates of overdose deaths have continued to rise. And methadone was usually prescribed at much higher rates than suboxone. Recent guidelines published in the Canadian Medical Association Journal deemed suboxone the “preferred first-line treatment” for opioid addiction.

The Ontario health ministry provided the number of patients receiving methadone going back to 2013 — the first year for which data on this is available. The number of methadone patients rose from 39,796 in 2013 to 44,554 in 2017. And the Ontario Drug Benefit program increased its spending on methadone by more than $12 million over four years, paying $46,320,288 for methadone in 2012/2013 and $58,446,216 in 2017/2018. Those amounts do not include patients who received treatment provided in other settings such as in hospitals, so the spending figures are likely an underestimation.

The number of pharmacies in Ontario offering methadone went from 631 in 2008/2009 to 1,234 in 2017/2018.

While Ontario has one of the highest number of patients in Canada, Alberta saw a 50 percent spike in the number of people receiving methadone and suboxone over the last four years: 4,200 patients in 2014/2015 to 8,200 in 2017/2018. British Columbia’s health ministry said the province’s PharmaCare program covered methadone or suboxone for 10,365 patients in 2008/2009 and 22,012 patients in 2016/2017.

Perhaps there are reasons for these results.