MORE EVIDENCE THAT BUPRENORPHINE AND METHADONE OPIOID SUBSTITUTION TREATMENT (OST) IS WORSENING LETHAL EPIDEMICS – MICHIGAN
By Clark Miller
Published June 26, 2019
Updated April 14, 2021
The medical model substitute opioid cure for the medically generated worsening lethal opioid crisis has failed, predictably. It was manufactured, branded and promoted on fabricated evidence for effectiveness just as generation of the crisis was, its failure not explained away by the emergence of fentanyl and constituting a fraudulent diversion of public healthcare funds away from longstanding evidence-based therapies for the non-medical condition of compulsive substance use.
The evidence, critically and competently examined, establishes that the medical “fix” provides no benefit for high-risk opioid use or overdose rates, instead worsening lethal epidemics, and the “evidence” for reduced OD deaths attributable to OST (MAT) used to market the “treatment” doesn’t hold up, never has, instead points to Naloxone as the effective factor in moderating OD 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 professional supplier economy constructed as “medical treatment”.
The new evidence from Michigan
is part of a consistent, invalidating, predictable pattern that disconfirms benefit attributable to OST. That expanding pattern is described in detail in multiple posts at A Critical Discourse for locales within and outside the U.S.
The latest data, from 2015, showed 142 out of 448 Michigan facilities offered what’s called medication assisted treatment, according to amfAR, a foundation that funds AIDS and HIV prevention research. That’s up considerably from a decade ago, when just 87 of 452 facilities offered such treatment.
That’s an increase by 63 percent over a decade ending in 2015, and would have to be assumed to represent a corresponding increase in numbers of problem opioid users provided opioid substitute MAT.
Over that same period that the medical substitute opioid “fix” for the medically generated opioid crisis had been expanding, opioid-involved inpatient stays – a measure of high-risk opioid use – increasing by about a third.
That’s the opposite of predicted if OST (OAT) was providing benefit by reducing high-risk use.
And in a more recent and overlapping time frame, 2012 to 2017, opioid-related overdose deaths due to heroin increased significantly, a result also invalidating of presumed benefit from increased provision of the medical fix.
Due to heroin, not fentanyl.
In 2017, there were 2,033 overdose deaths involving opioids in Michigan—a rate of 21.2 deaths per 100,000 persons, which is higher than the national rate of 14.6 deaths per 100,000 persons. The greatest increase in opioid deaths was seen in cases involving synthetic opioids (mainly fentanyl), from 72 deaths in 2012 to 1,368 in 2017. Deaths involving heroin increased from 263 to 783 deaths in the same 5-year period. Prescription opioid involved deaths also rose from 378 deaths in 2012 to 678 deaths in 2016 but saw a recent decline to 633 deaths in 2017 (Figure 1).
In Michigan, “a crisis still rages” despite increased provision
of medical model substitute opioid “treatment” over more than a decade, and as in other locales consistently, any moderation in opioid-related overdose deaths is attributable directly to naloxone campaigns, not to benefit by the medical fix in reducing high-risk use.
In 2017, opioid-related overdose deaths in Michigan reached a record high, according to the Michigan Department of Health and Human Services. Based on preliminary data, 1,941 of that year’s 2,729 overdose deaths were opioid-related. While that figure represented a 9% increase in opioid-related deaths over 2016, it also represented a slowing of the year-over-year increase in opioid-related deaths, perhaps the result of greater familiarity of Narcan.
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.
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.