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UPDATE: MORE EVIDENCE THAT BUPRENORPHINE AND METHADONE OPIOID SUBSTITUTION TREATMENT (OST, MAT) IS WORSENING LETHAL EPIDEMICS – ONTARIO, CANADA

By Clark Miller

Published May 21, 2021

The numbers are staggering  and continue to rise.

Opioid-related and other drug overdose deaths in the U.S. increasing steadily, now sharply, over decades, 70,000 in 2017. 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, from Ontario, Canada additional evidence

for 2019 following false, misleading media/medical assurances of gains against the epidemic: 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.

The evidence follows reports of increasing high-risk opioid use over preceding years associated with increasing opioid-related ED visits and overdose deaths, described here in a previous post, and associated with increasing provision of the medical fix promised to be effective treatment against that high-risk use

Trends in Kentucky in opioid overdoses and treatment

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

And despite efforts of the Medical-Media collusion to fabricate protective disinformation,  the evidence establishes that illicit street fentanyl does not explain away the increases in opioid-related OD deaths due to failure of the medical fix.

 

Updated 2019 data from Ontario points again to worsening high-risk opioid use and OD deaths

with Increased Provision of Medical Substitute Opioid “Treatment”.

TORONTO — The number of opioid-related deaths and emergency department visits continued to rise in Ontario in the first three months of this year, the latest government data shows.
Public Health Ontario said 435 people died from opioid overdoses between January and March — a 40 per cent increase from the same period in 2018 when 307 deaths were reported.
There were 3,420 emergency department visits due to opioid overdoses from April to June, the agency said, nearly a 50 per cent increase over the same period in 2018.

That’s what the consistently accumulating  evidence establishes –

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 disease in Ontario, Canada and in Franklin County (Columbus), Ohio and elsewhere.

And with recent and the new data from Ontario, high-risk use increasing, as measured by opioid-related ED visits is associated with increasing provision of the medical “fix“.

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.

As outlined and discussed in a series of posts on the opioid epidemic and its causes, the false promise of medication assisted treatment (MAT) is increasingly exposed as a lethal fabrication 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.

Mounting, consistently invalidating 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 here:

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 –

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

 

The data from Ontario is 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.

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.

Perhaps there are reasons for these results.

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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