UPDATE: OPIOID CRISIS – IT’S ABOUT AMERICAN MEDICINE
Overprescribing and misprescribing are pervasive, continuing, and lethal
by Clark Miller
Published October 9, 2022
Over past weeks and much longer, I’ve regularly published posts, always with explanations of and links to original data and/or research, establishing disturbing facts and trends counter to corporate media narratives – including that decades into America’s increasingly lethal opioid crisis, misprescribing and overprescribing of opioid drugs remains pervasive and unchallenged, a feature of American Medicine current practices, not attributable to outlier “pill mill” doctors.
And posts, including for example recent posts here and here that describe the coordinated efforts of media, entertainment, and social media to generate distracting cover stories, villains and scapegoats that conveniently and protectively distract from that role of American licensed medical professionals (LMP).
And describing how, most recently, those protections and covers that work to perpetuate a lethal epidemic have included a Supreme Court ruling providing for America’s misprescribing LMPs an effective shield from prosecution if only they are willing to simply lie and state that, of course, they believed when writing the prescriptions that they were acting ethically and in the best medical interests of their patients in the LMP’s clinical judgment. Those qualities of clinical competence, ethical practice, and best intention assumed by the Court to represent the default practice protecting vulnerable Americans in their doctors’ care from harm.
And posts in which findings, evidence, and investigation are described as establishing that the Court’s assumption is demonstrably false. That the default, instead, is misprescribing and overprescribing as continuing, widespread practice in American Medicine on lethal scales that are protected, must be covered and hidden.
Two new published pieces
add to the accumulating body of evidence (partially outlined in an upcoming post “OPIOID CRISIS: FOLLOW THE MONEY, TRUTH IS BURIED UNDER IT”) establishing that continuing practice of over- and misprescription of opioids continues to fuel the crisis. That the indicated-against prescribing is generalized and pervasive, not about outlier “pill mill” doctors, has clear and important implications for that recent Supreme Court decision and for the lethal public health effects of the successful efforts of America’s Medical/Media collusion to create distracting cover stories and scapegoats.
One is a reply to a commentary and buried in Anesthesiology News.
The author’s background is not primarily medical, instead psychiatry, research, and analysis –
Ellis makes the point, as I do in an upcoming post (“OPIOID CRISIS: FOLLOW THE MONEY, TRUTH IS BURIED UNDER IT”) that it has not been the outlier “pill mill” doctors responsible for opioid overprescription fueling the crisis, but continuing, pervasive practices by medical professionals that are indicated against and predict harm.
A sizable evidence base has grown in recent years, identifying and understanding the continued overprescribing of opioids—primarily in hospital systems, not pill mills.(2-4) Many hospital systems are now testing tools such as automated notifications in order to minimize overprescribing.(5) Due to this, prescription opioids continue to play a significant role in the opioid crisis. While some studies show that there were statistically significant reductions in prescribed opioids following the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, the fact remains that the United States still prescribes opioids at significantly higher rates than nearly every other country in the world.
In an earlier video, addressed by the commentary, I noted research conducted using a national surveillance system of people entering treatment for OUD, which indicates that even today, over 90% of individuals with OUD also engage in the nonmedical use of prescription opioids.(6) While unscrupulous physicians and pharmacists who leech high-volume opioids into the market continue to exist, it is unlikely that they are the primary drivers of persistent nonmedical use of prescription opioids today. To wit, the 2020 National Survey on Drug Use and Health shows that of the 9.3 million individuals aged 12 years or older who misused pain relievers in the past year, 42% sourced their opioids from a prescription from a single doctor.(7)
Those “tools” meant to provide means for medical prescribers to become aware of and avoid overprescription and misprescription are not working. For example, Prescription Drug Monitoring Program (PDMP) databases developed for that use have not led prescribers, whether voluntarily or mandated, to change the way they dispense opioids, described for example here and here and in the upcoming post, “DOCTOR NONCOMPLIANCE CONTINUES TO FUEL THE OPIOID CRISIS”. And see the new research below, in this post.
Again from the piece in Anesthesiology News –
Second, the commentary suggests that consumers of illicit opioids and patients prescribed opioids for chronic pain are separate populations. As one recent commentary in JAMA Health Forum notes, this propagates a “false dichotomy of pain and opioid use disorder.”(8) While the majority of individuals prescribed opioids for chronic pain will not develop OUD, given the number of prescriptions, even if a small percentage of this population develops OUD, this represents a significant public health issue. The commentary, however, believes that there is not a relationship between the illicit opioid crisis and chronic pain management, and if there is one, it is the result of diverted, not prescribed, medications. However, there is evidence that the issue is not as simple and straightforward.
In one study using electronic health records, 64.4% of OUD patients had a chronic pain condition, and of these, 61.8% had chronic pain before their first OUD diagnosis.(9) In another study assessing individuals with OUD and chronic pain, 66.1% indicated their first use of an opioid was a legitimate prescription to treat pain.(10)
No singular pathway leads a patient who is prescribed opioids for chronic pain management to develop OUD. But that pathway does exist, particularly those with psychiatric comorbidities. And what may start out as aberrant behaviors with one’s prescription, tolerance and addiction can advance that prescription opioid use to illicit opioid use, given the constraints of accessibility and cost. The vast majority of individuals with OUD report engaging in the use of prescription and illicit opioids in the month prior to entering treatment.(6)
That evidence of American Medicine’s malpractices is problematic enough,
but in fact misses – and provides a distracting cover for – more systemic, damning, and lethal problems.
Common chronic pain, almost all chronic pain – the frenzied, generalized treatment of which, driven by a pathological collusion of lying and compliant American institutions, generated the opioid crisis – is not a medical condition at all and is not treated effectively by opioids, medications, or other medical interventions.
That has been established for decades, was outlined in Sam Quinones’ seminal work, “Dreamland“, and is explained here and here and here, and here. Every prescription of an opioid for common chronic pain is a misprescription that predicts harm.
The same, essentially, is true for the addictive, schedule II opioids increasingly prescribed as the medical “fix” for American Medicine’s opioid crisis – buprenorphine (Subooxone) and methadone in MAT programs and elsewhere. It is established that they are fueling and worsening the opioid crisis they are branded as “proven” cure for.
What’s that? How could that be? You’ve never seen that in American Media reports?
And you’ve never expected or felt a need for explanations for an increasingly lethal opioid crisis as medical treatments are increasingly available and nearly a year after COVID pandemic stressors have dissipated?
But we’ve digressed,
and in dangerous ways that we must not, ways that fail to recognize the truthfulness, competence, and earned authority of America’s trusted expert class.
Again from the piece in Anesthesiology News –
This pathway exists regardless of the intentions of the prescribing physician. No doubt, the overwhelming majority of physicians seek to fulfill their Hippocratic Oath and provide compassionate chronic pain management to patients in their care.
Americans really, really want to believe that, need deeply to believe that. Would be frightened to question that, particularly Americans who want to keep their jobs as “journalists“.
But the unfortunate truth and indications from the evidence are nearly the opposite.
Medical prescribers, seemingly an “overwhelming majority”, lacking a deterring threat of legal action against them neglected to provide to patients among the most fundamental of protective rights, as obligated by medical standards of practice – the right to informed consent. In this case, the right to be informed of the potential risks of using addictive schedule II substances – opioids – when being prescribed them.
And have failed, as a profession, generally, to use opioid and other drug database systems provided them (like the PDMP) to protect the safety of their patients and others.
And have, as a profession, acknowledged folding under pressure and intimidation to prescribe opioids knowing the risks and the indications against it. That is, knowing that they should not have.
And have, by the thousands, prescribed opioids as motivated by common graft.
And now, this –
Email alerts to practitioners from pharmacists did not reduce concurrent prescribing of opioids and benzodiazepines, a randomized trial showed.
There’s really not much that should need to be said about that, is there.
But I will, shortly, at this upcoming post – OPIOID CRISIS: FOLLOW THE MONEY, TRUTH IS BURIED UNDER IT