UPDATE OPIOID CRISIS: NO, METHADONE IS NOT THE NEW METHADONE
As opioid deaths mount no longer attributable to invalidated, made-up COVID stressors, American Medicine doubles down on its lethal treatments
by Clark Miller
Published December 18, 2022
It’s hard to keep up these days!
We know – because America’s top experts in medicine and public health have assured us, and because American Media help us understand the confirming consensus – that American Medicine’s gold standard, proven life-saving anti-addition drug buprenorphine (Suboxone) is the effective cure for America’s opioid crisis. That’s certain enough that public funding is increasingly committed to providing it, and its use has increased dramatically over the past years and decades, including more than doubling over recent years by some accounts.
It must be that there is a delay in effectiveness, while a therapeutic level in the diseased brain builds up, like with the SSRIs? But a delay in years maybe? Because . . . well, because the more the fix is provided, the worse things get. And? All those made-up COVID pandemic rationalizations for the insanely surging high-risk opioid and deaths use are now invalidated, a year into dissipation of those stressors.
Little wonder America’s experts
are now heralding the desperate need for new medical measures, and new $billions in public health funds – they are cutting edge researchers and authorities who like to stay right on top of things.
So, have no doubt, buprenorphine, “bupe”, dispensed in MAT (medication assisted treatment) programs along with methadone is effective, the proven cure for compulsive, high-risk opioid use – it’s just that we need to go back to methadone that bupe replaced because of concerns about safety and addictive potential.
And we need to invest new $billions in public funds on another new replacement for bupe – a vaccine for fentanyl! More on that in another post. It will undoubtedly be made clear by experts why an expensive vaccine is needed to replace the proven, “gold standard” medication buprenorphine that is established by expert consensus to be the fix for America’s opiod crisis.
It’s just hard to keep up. Because with so much $public healthcare funds invested and so much benefit gained against the increasingly lethal opioid crisis by use of the proven medication, why would we need to . . .
Well, clearly, that’s for the experts to determine, not you or me.
But let’s take a look anyway.
A preceding post (published February 13 , 2019 and updated April 9, 2021) described aspects of the history of methadone substitution in the context of calls to ease restrictions and expand provision of methadone – as opioid overdoses and deaths sharply increased even with expanding use of buprenorphine.
That history, as outlined, has included as vividly described by Sam Quinones in Dreamland, a picture of the methadone clinic and its immediate environment as essentially a marketplace for economies of illicit opioids and other street drugs. Beth Macy provided similar observations in Dopesick. That picture is congruent with continuing reports on one of the more well-known locales for methadone dispensing, “Methadone Mile” in Boston.
What else do we know about methadone and its effectiveness in America’s decades-long lethal Medical opioid debacle?
From the original post, evidence that –
opioid user retention rates in methadone programs are very low
abuse of additional medications and drugs with methadone is high
presumed benefit for methadone in reduction of lethal overdose lacks evidence versus confounding effect of naloxone revival
as described here (scroll down to “A systematic review of studies assessing functional benefit”), no evidence for the types of functional and psychosocial gains required to attribute benefit to methadone and MAT in lowering risk associated with substance use
with relaxation of controls for doctor methadone dispensing, methadone overdose deaths surged more than fourfold over 8 years –
What types of outcomes might we predict from easing patient safety regulations and controls on dispersing of methadone,
an opioid with significantly greater euphoric effect, greater potential for abuse and lethal overdose than buprenorphine?
Here’s one clue, from Quinone’s Dreamland (p 190) –
Generic methadone, for years strictly an addict-maintenance drug, suddenly started killing, too. As media reports of OxyContin abuse and overdoses spread, some doctors began prescribing methadone for pain instead. . . some doctors figured that methadone was an equally long-lasting painkiller. Plus methadone was generic and cheap; insurance companies covered it. Methadone prescriptions more than quadrupled – from under a million in 1999 to 4.4 million in in 2009 nationwide – mostly for headaches and bodily pain.
. . .
As methadone prescriptions rose, so did overdose deaths involving methadone – from 623 in 1999 to 4,706 in 2007.
More recent evidence and outcomes
including over pandemic years – of relaxed controls for methadone dispensing – are predictable and consistent with methadone’s history.
From this post clear trends in methadone and bupe involvement in OD deaths over the period –
The DC Office of the Chief Medical Examiner (OCME) investigated a total of 17071 deaths due to the use of opioids from January 1, 2016 through August 31, 2021. This report examines the presence of opioids (heroin, fentanyl, fentanyl analogs, morphine, prescription opioids and the general category of opiates) in deaths observed at the OCME.
The two primary opioids forming American Medicine’s cure for American Medicine’s opioid crisis – Buprenorphine and Methadone – became comparable to or significantly more involved in lethal overdoses in 2020 and projecting for 2021 will far surpass lethal involvement of all other prescribed opioids recorded in DC. The clear trend is increase over the years 2018 to 2021 (remember that the values for 2021 in Figure 4 are for January through August only) for the two MAT opioids.
More consequently, remembering that those figures and trends represent changes for incidence of lethal overdose, we know that the values represented in Figure 4 above are underestimates of high-risk opioid abuse and misuse. That is because, of course, nonlethal overdose is and lethal overdose is not a measure of high-risk opioid abuse and misuse due to intractable confounding effects of shifts in use of naloxone to prevent opioid overdoses from becoming lethal. It’s established that naloxone use has increased significantly over recent and pandemic years – necessarily moderating the values for lethal overdose and misrepresenting to that extent trends in abuse and high-risk use of methadone and other opioids.
These are the predictable results from continued, increasing and less restrictive provision by American Medicine of the prescribed opioids established as fueling America’s increasingly lethal opioid epidemic.
From this post, reports from Ontario Canada where safety standards for pandemic medical dispensing of methadone and bupe were relaxed –
The MAT opioid methadone, with “increased prevalence of take-home OAT doses during the pandemic” was found to have been directly involved in 179 OD deaths pandemic period, compared to 132 pre-pandemic, an increase of 36 percent.
From this post describing strong associations of opioid overdose deaths tied to fentanyl abused with other opioids with overdose subject being provided methadone or Suboxone in a treatment program.
What is an “odds ratio”?
Let’s translate all of that . . .
The results of this large study employing objective evidence as described, are entirely consistent with – more than that, were predictable from – what is established about the predictable epidemiological, medical, and public health effects of relaxing safeguards on and increasing the dispensing of addictive substances established as being without benefit, instead worsening American Medicine’s increasingly lethal opioid crisis .
The results tell us something we already knew , something established for years – that increased dispensing of addictive, diverted, abused drugs without therapeutic benefit and under relaxed safeguards, medically dispensed drugs used as commodity and currency in illicit fentanyl and opioid economies of abuse – would predict increases in high-risk use, overdose and death.
More specifically, the results provide strong collaborating evidence that, as predicted by decades of evidence invalidating presumed benefit from MAT, provision by medical prescription of opioids under MAT is fueling an increasingly lethal opioid crisis.
From this post describing no apparent gain in lowered risk for methadone users attributable to the program compared to new patients at highest risk.
And this post, with evidence of failure of medical prescribers – when mandated – to consult a database designed to help prevent the type of misuse and additional abuse by methadone users that fuels economies of high-risk opioid use, overdose, and deaths.
Prescription drug monitoring programs (PDMPs) have emerged as state‐level interventions intended to curb opioid abuse and over‐prescription. While some states have voluntary PDMPs, others have enacted mandatory or “must-access” programs in which authorized individuals must consult the PDMP before prescribing certain controlled substances. An analysis published in Contemporary Economic Policy reveals that must‐access PDMP implementation does not uniformly reduce prescription retail opioid sales across eight commonly prescribed opioids.
Must-access PDMP implementation had no statistically significant effect on the retail sales of the treatment drugs methadone and buprenorphine.
The findings suggest that PDMP implementation is best considered as part of a broader policy response to the opioid crisis.
“The United States opioid epidemic is a complex problem. These results suggest that must-access PDMP implementation alone cannot fully address the public health issues associated with this ongoing public health crisis,” said corresponding author Collin Hodges, Ph.D., of the University of Central Arkansas.
“methadone and buprenorphine”
Let’s take a look at what’s being said here.
PDMPs are data bases that can be accessed by prescribers (licensed medical professionals LMP) to search for any patient’s history of prescription of opioids and other drugs, thereby useful in detecting “doctor shopping” for multiple, excess prescriptions of a drug or for prescribed substances that are often abused and are potentially dangerous in combination with opioid use.
Consistent with a similar earlier (2018) study, these results don’t support PDMP availability as changing behaviors of doctors entrusted with prescribing opioids safely.
That’s particularly relevant for prescriptions of methadone and buprenorphine
(Subutex, Suboxone), American Medicine’s medical fix for the opioid crisis provided under medication assisted treatment (MAT) programs. Prescription benzodiazepines, for example, are commonly abused by users of Suboxone (“bupe) due to the enhanced euphoric effect. That abuse increases risk of abuse of either substance, challenging revival efforts with the lethal overdose-reversing drug naloxone, And signals failure of the intended purpose of the prescribed bupe under MAT – to reduce overdoses and treat problem opioid use by stopping high-risk use of opioids.
That’s why it is particularly significant that “Must-access PDMP implementation had no statistically significant effect on the retail sales of the treatment drugs methadone and buprenorphine.”
It’s known (also here) and has been for decades, that those MAT “medications” are commonly diverted, abused, and used as currency for “real dope”including fentanyl in street economies of illicit, high-risk opioid use, and are commonly used with high risk in in combination with other prescribed and illicit drugs of abuse.
And in more recent research, a large sample study found the predicted: association of abuse of fentanyl with prescription opioids associated with subjects being in MAT programs.
So, LMPs using PDMPs to research prescription histories prior to prescribing opioids and other drugs would seem the most basic of ethical and professional standards and almost certain, given the levels of established misuse, to alter opioid prescribing.
But they haven’t.