UPDATE Opioid Crisis:

More Evidence Affirming Buprenorphine and Methadone Opioid Substitution Treatment (OST, MAT) is Worsening the Lethal Epidemic – Pennsylvania

by Clark Miller

March 24, 2020

As public health resources are increasingly diverted to a medical “fix”” for a worsening, lethal opioid crisis, evidence continues to consistently disconfirm beneficial effects attributable to substitute opioid (buprenorphine, methadone) programs  (opioid substitution treatment, OST, = MAT = MOUD) 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, instead 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”.

shutterstock Suboxone

Below

2019 Evidence Fits the Consistent Invalidating Pattern

In Pennsylvania and its Lehigh County hard-hit by opioid abuse and overdose deaths a naloxone (Narcan) campaign accounts directly for any and all moderation of incidence of lethal opioid ODs, confirming a worsening rather than improving epidemic for the obvious reasons – increasing use of Narcan represents continuously escalating high-risk opioid use, confirmed and measured by worsening opioid injection related infectious disease incidence in Pennsylvania – high-risk use that the continuously expanding medical MAT “fix” was supposed to moderate.

First, to Review

The 2019 trends in Pennsylvania are 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.

That is, as is consistently evidenced in diverse 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 gold standard medical treatment provided to the diseased brains, the more deaths mount.

Overdose deaths US trend The Guardian

Update: Pennsylvania

The continuously worsening trends for Pennsylvania with 2019 data highlight the established failure and harm predicted for MAT, consistently worsening high-risk opioid use – measured by non-lethal opioid overdoses and by infectious disease tied to high-risk opioid use – correlated with increasing provision of the medical “fix” for the non-medical problem of opioid misuse, and not explained by the fentanyl distraction.

From the December 2019 interview –

 

Q: Looking back over 2019, what has been the most promising development in the fight against opioids?
Barishansky: I think one of the successes we’ve seen in Pennsylvania is the wide distribution of naloxone (usually marketed under the brand name Narcan.) I believe at last count, the Pennsylvania Commission On Crime and Delinquency has given out more than 40,000 doses of naloxone. And there have been documented over 9,000 saves just from that naloxone, and we’ve also had a few days where we’ve given away naloxone to the public.
Dr. Beauchamp: I think the efforts made to build the hub-and-spoke models around medication-assisted treatment have been probably the most important step. And to make sure that that we’re able to meet patients where they are, whether it’s in the rural setting, or in the urban setting, whether it’s their specialist office, or their primary care office, or their psychiatrist’s office, we can meet people where they’re already getting care and try to provide medication to support that recovery trajectory.

That is, provision of both OD death-reversing naloxone and the medical substitute opioid fix have expanded significantly.

But there’s a problem, predictably –

 

The bad news? Doctors say a wave of infectious diseases spread through intravenous drug use is on the horizon, methamphetamine and alcohol use is rising . . .

Dr. Beauchamp: I think we have a wave of infectious issues coming our way over the next 10, 20, 30, 40 years that we’re not preparing for adequately. Diseases like HIV, hepatitis C and bloodborne infections.

 

That is, as consistently in other locales, runaway dispersal of diverted, abused substitute opioids has been fueling high-risk use and associated problems, that is, worsening the lethal epidemic.

Statewide, provision of buprenorphine (Suboxone) OST climbed significantly over the years that opioid overdoses continued to climb based on SAMHSA data on newly waivered MAT physicians.

First year waivered providers are allowed to dispense bupe to 30 patients, in following years 100. Crunching the numbers, a gain of 70 was used to figure net gain in OST MAT capacity per year. Statewide increases in capacity for LMP-provided OST, in number of patients:

2014 10,570
2015 12,620
2016 17,580
2017 24,500
Total = 66,270

Philadelphia is experiencing the same trend.

Rosario’s story is an increasingly common one in Philadelphia. Infections stemming from intravenous drug use are on the rise here — from the kinds of bacterial infections that Rosario suffered, to endocarditis. This infection of the the inner lining of the heart chambers and valves occurs when bacteria in the blood attach to the heart. Viruses like HIV, hepatitis C, and hepatitis A are also on the rise among people who use drugs.

The predictable results from Philadelphia are part of a consistent national trend, because runaway provision of substitute opioids – the publicly funded, medical “fix” for the medically-generated opioid crisis –  instead of being a “treatment” is fueling worsening economies of diversion, abuse, and high risk use.

EVIDENCE UNSPUN

As established and explained in a series of related posts here at A Critical Discourse, in contrast to the directly measurable OD death-preventing effects of naloxone use, attribution of any benefit of MAT requires evidence for MAT acting by affecting behaviors of opioid users, specifically by reducing high-risk use, the only mechanism by which MAT would provide benefit.

The confounding effects of naloxone campaigns and resultant reductions in death by overdose have never been adequately controlled for in studies used and spun by the coalition of pharma/medical industry, public health institutions, media and popularizing writers manufacturing “evidence” for the fabricated effectiveness of MAT – exactly as “evidence” was fabricated to support the never-validated runaway over-prescription of schedule II opioids that generated the lethal epidemic.

Indeed, given that any and all reductions in mortality due to overdose by emergency use of naloxone for reversal of lethal respiratory depression at the same time represents – measures – incidence of high-risk opioid use, the evidence simply reinforces the failure of MAT to moderate high-risk use, instead as established by consistent and accumulating evidence reinforces the medical fix as worsening the lethal epidemic.

Cincinnati naloxone

To summarize,

increased use of the emergency response opioid overdose death reversing opioid antagonist naloxone (Narcan) accounts for an apparent slowing and possible reduction of opioid overdose deaths driven by steadily worsening overdose and opioid-related disease incidence due to high-risk use of opioids, those increases associated with and driven by increased provision of addictive, diverted, abused substitute opioids constructed as a form of medical “treatment”, funded by public healthcare resources.

By way of strict analogy, campaigns to increase availability and use of Automated External Defibrillators (AED) to save lives in acute emergency response to atrial fibrillation are expected to be measured as moderating acute deaths due to heart disease in America’s cardiovascular disease epidemic. Increased demand for emergency revival by use of AEDs of course would reflect a worsening heart disease epidemic, not any moderating benefit from treatments to address incidence of cardiovascular disease. Portraying any such moderation of heart disease-related mortality, moderation directly attributable to emergency use of AEDs, as progress in treatment of the heart disease epidemic that is driven largely by modifiable health behaviors would represent profound, if not pathological, deficits in capacity for research literacy, for critical thought and intellectual integrity, and for response to public health need.

That is, the new CDC data – affirming that all evidence, including data evidencing mortality-moderating effects of increased use of emergency revival of potential OD deaths (increased response to increasing high-risk opioid use) – affirms worsening lethal substance use epidemics with fabricated medical “treatments” for the non-medical condition fueling addiction and high-risk use while diverting public healthcare funding away from evidence-based psychosocial treatments and supports.

That is, evidence continues to mount establishing that the substance use epidemics trapping and killing vulnerable Americans are worsening, iatrogenic, and criminal.