UPDATE Opioid Crisis:

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

Victoria B.C. Canada

by Clark Miller

May 8, 2019

As public health resources are increasingly diverted to a medical “fix” for a worsening, lethal opioid crisis, evidence continues to mount pointing away from beneficial effects attributable to substitute opioid (buprenorphine, methadone) programs  (opioid substitution treatment, OST) instead to concurrently expanding use of naloxone – (Narcan) the opioid antagonist administered acutely to reverse respiratory depression in life-threatening opioid overdoses – as the factor accounting, directly, for any apparent moderation of national or local decreases in overdose deaths.

naloxone

That is, the evidence, critically examined, says that the medical “fix” is not helping with high-risk opioid use or overdose rates, more likely worsening it, and the “evidence” for reduced OD deaths attributable to OST (MAT) used to market the medical/pharmaceutical/harm-reduction industry “treatment” doesn’t hold up, never has, instead points to Naloxone as the effective factor in slowing deaths. Meanwhile diversion and abuse fueled by a runaway national “dose” of substitute addictive opioids – as in generation of the crisis – is integral to national high-risk opioid use economies – diversion and abuse of addictive opioids driving a street and prison economy; diversion and abuse of public healthcare funds driving a supplier economy constructed as “medical treatment”.

Below: New Evidence Fits the Invalidating Pattern

A new six-part special report by Victoria News paints the same predictable picture as from other areas in Canada and the U.S. – while high-risk opioid use and overdose continue to worsen or not improve in response to increasing provision of the medical model fix for the opioid crisis, any apparent moderation of opioid overdose deaths is directly attributable to campaigns to increase use of the OD death-reversing opioid antagonist naloxone.

The new evidence from Victoria is part of a consistent, invalidating, predictable pattern that disconfirms benefit attributable to OST. That pattern, described in detail in this and multiple posts at A Critical Discourse includes accumulating results from –

Plumas County, California

In Dayton Ohio and Plumas County, California opioid-related overdose deaths climbed . . . and climbed . . . with no observable response to traditional treatment or opioid substitute programs, no response to increasing dose accorss the U.S. of the medical fix for high risk opioid use – addictive substitute opioids.

Then dropped dramatically with the implementation of intensive campaigns to distribute and effectively use the OD death-reversing opioid antagonist naloxone, with no decreases in deaths left to attribute to OST.

Cincinnati, Ohio

Cincinnati, Ohio now joins those anomalous locales –

years of worsening opioid-related OD deaths, associated with increasing dose of the medical cure, until  abruptly with initiation of an intensive naloxone campaign, OD deaths decline.

That’s a pattern that belies claims that OST is effective and warrants massive investment of public healthcare funds, based on unsupported claims that OST reduces overdose deaths.

Arizona

In Arizona, U.S. new mounting evidence: disconfirming prediction of benefit from increasing substitute buprenorphine and methadone medical “fix” for the opioid crisis – indicators of high-risk opioid use (non-fatal opioid overdose) rise significantly in response to medical “treatment” while OD deaths decrease in response to a naloxone campaign.

Rowan County, North Carolina

In Rowan County, North Carolina – as in Plumas County CA, Dayton, OH, and Cincinnati, OH – data and reports of healthcare workers and authorities attribute decreases in opioid OD deaths to directly observed and tracked use of naloxone.

And in Rowan County high-risk opioid use is observed to continue or increase – contrary to expectations if OST was providing benefit.

Bethlehem, Pennsylvania

In Bethlehem, Pennsylvania it’s the same predictable pattern: despite (that is, based on relevant lines of evidence, because of ) increases in provision of MAT with focus on OST, opioid overdoses have steadily and significantly increased over past years, but not overdose deaths, the reduction in deaths directly accountable for by increased provision and use of naloxone. These results consistent with and contributing to mounting, evidence: overdose deaths are not a meaningful measure of presumed effectiveness of opioid substitution, because naloxone campaigns account directly for any apparent decreases.

Increases in non-lethal or total opioid-related overdose incidents in contrast are meaningful, strong evidence of what has become clear, established: expanding provision of the medical “treatment” using the ”anti-addiction” drugs buprenorphine and methadone – addictive and abused substances that are diverted and fuel economies of opioid abuse – are worsening America’s opioid crisis.

Ontario, Canada

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.

Nationally in the U.S.

Nationally the same picture emerges. The National Institute for Drug Abuse (NIDA) has released data attributing in the U.S a gain in number of potentially lethal opioid overdoses reversed by use of Naloxone as increasing, over 2010 to 2014, from 10,171 to 26,463. The NIDA data, through 2014, is almost certainly an underestimate unless we assume that most reversals, including private, are reported and recorded, and incidence of reversals almost certainly has increased in the interval since 2014 as Naloxone programs have expanded, as in Dayton. At a rate of net gain in potentially lethal OD deaths stopped by use of Naloxone of 4,000 per year, almost certainly conservative, Naloxone appears to directly account for any apparent moderation of opioid related overdose deaths in national trend.

New – Evidence from Victoria B.C. Canada

As reported in the opioid crisis special series, provision of buprenorphine OST has been significantly increasing in Victoria, including relaxation of restrictions by the province in 2016 and concerted efforts to start provision of suboxone in ER visits.

Yet since then, there are no signs of high-risk opioid use decreasing, instead increasing or at best not improving, based on levels of emergency medical responses to overdoses and observations of law enforcement. No signs of the expanded provision of medical fix moderating “An epidemic that, despite government acknowledgement and increased resources, is showing no signs of slowing down.”

But overdose deaths, as opposed to high-risk use and overdose, have appeared to level off, and that change is directly attributable, based on recorded incidents of reversals, to a campaign to increase dispersal and use of naloxone: by law enforcement; by emergency medical responders; on the streets; at safe injection sites.

That is, as is consistently evidenced in other locales, emergency responders are saving lives, often repeatedly, by reversing opioid overdoses, accounting for all moderation in lethality trends, leaving none to attribute to OST, while the invalidated medical “treatment” continues to fuel street economies of high-risk opioid use.

The mounting, consistently invalidating pattern was predictable, all along, because there has never been credible evidence to support effectiveness for OST, instead all lines of evidence disconfirm effectiveness and point to increasing harm.

SAMSHA bupe client trends2

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

Overdose deaths US trend The Guardian

And it’s a pattern – as we’ll see and despite efforts of popularizers of the failed medical OST “treatment” – that is not explained away by the known risks of fentanyl.

 

New post coming up at A Critical Discourse:

Fentanyl is the New Purdue Pharma – A Necessary Distraction from the Forces Driving Worsening Lethal Epidemics