WEST VIRGINIA: PREDICTABLY, HIGH RISK OPIOID USE TIED TO OVERDOSE AND HIV SURGES WHILE ACCESS TO PROVEN MEDICAL CURE FOR HIGH RISK OPIOID USE INCREASED

And predictably, trends were present pre-COVID and continue as COVID stressors dissipate

by Clark Miller

Published May 16, 2022

Decades and billions in public health spending into America’s opioid crisis, things are not going well in West Virginia, arguably a state among those most deserving of the near-unversally applied descriptor “hard hit”. 

 As we’ll see, over pre-pandemic years, over COVID and its social stressors, continuing now as those stressors have  been moderating, opioid-involved overdoses and other direct measures of high-risk opioid use – including concerning outbreaks of increased HIV incidence tied to opioid use by injection – are pointing clearly to intractably worsening levels of high-risk and lethal opioid use.

That persistent, mounting toll of illness and death is not for lack of use of public health funds to expand provision over the same period of American Medicine’s proven cure for high-risk opioid use – medical dispensing of the substitute opioids methadone and buprenorphine (Suboxone) as “medication assisted treatment”, MAT

Here’s West Virginia’s Dr. Matthew Christiansen, director of the Office of Drug Control Policy for the Department of Health and Human Resources. 

From a February, 2022 report in The Herald-Dispatch – 

Christiansen was reported as noting an increase in 2021 “in access to medication-assisted treatment (MAT) and medication to treat opioid use disorder”. 

MAT services in West Virginia had been increasing over the past decade and targeting the most hard-hit areas of the state. 

An “incredible expansion” in West Virginia in provision of MAT opioids methadone and Suboxone, American Medicine’s proven cure for high-risk opioid use and associated mortality and morbidity. 

Usefully celebrated for example here, in mass media. 

Despite that, the picture is increasingly grim. From the same news report – 

Continuation of “that rise in overdoses” even as stressors related to COVID restrictions and deprivations have been moderating, dissipating. Stressors like social isolation, asserted by America’s expert and Media consensus as driving pandemic surges in opioid deaths and turning out to have been fabricated, now invalidated

Continuation as well of increasing incidence of injection-related infectious disease, including HIV, in West Virginia. That’s a dark, grim picture, headlined by Politico as “The nightmare everyone is worried about” in West Virginia. 

But from media reports celebrating Dr. Christiansen’s reports of progress – “W. Va. health official sees hope in midst of opioid crisis” – it’s as if those problems don’t exist, as if the great successes against the opioid crisis provided by the proven medical cure over past decades simply needs to be expanded, with more and more public healthcare money. 

That lethal deception – and exemple of the pathologically malfeasant role of America’s Medical/Media collusion in creating, now worsening the opioid crisis – is based partly on the simplest of necessary distortions: the critical difference between what is measured by changes in prevalence of  lethal opioid overdoses versus what is measured by trends in non-lethal overdose. Let’s consider that. 

From an earlier post – 

The more deaths,

the more pressure mounts to divert public healthcare resources to the unvalidated medical model provision of addictive, diverted and abused substitute opioids.

False claims– unsupported by research subjected to competent critical analysis – used to rationalize continued diversion of public healthcare funds to the substitution (opioid substitution treatment = OST) of addictive opioids  (buprenorphine and methadone) focus on apparent reductions, over limited time periods, of deaths due to overdose by opioids, not other measures of presumed benefit. There are reasons for that, as we’ll see.

Prevalence of lethal opioid overdose does not measure effectiveness of MAT, for reasons outlined above, with links to related posts – each post with detailed explanation, linking to primary research and other sources.

That’s why other measures are required,

and why popularizers of OST must focus on the overdose death figures. In a vacuum of credible, competent analysis of research, those results can be spun – by research-illiterate researchers, medical authorities, writers and others – to research-illiterate regulators, media, writers, policy makers and the public. That is, studies pointing to reductions in overdose and/or other deaths when OST has been provided can and have served as useful lies – useful especially to producers of the substitute opioids and to a medical industry desperately in need of evidence to distract attention away from its creation of the lethal epidemic – that it has been the provision of OST, rather than other factors in the uncontrolled and in other ways flawed studies, causing the reductions in mortality.

There is no body of evidence with results that control

for the most likely of confounding explanations for any moderation of prevalence of overdose deaths – concurrent increased availability and use of the OD death-reversing drug naloxone 

Analysis of research that could have provided credible and meaningful interpretation of available evidence and served to protect public health has instead occurred in a vacuum of research literacy and capacities for critical thought, intellectual integrity, and clinical competence in the relevant areas of behavioral health, psychology, and analysis of research design and interpretation. That lethal vacuum, of course, is how we got a worsening opioid crisis and predictable outcomes like this disinformation threatening public health.

On analysis of the evidence, naloxone use – its reduction of deaths acting and measured directly, unlike presumed benefit from OST – directly accounts for all apparent changes (= decreases) in opioid-related overdose deaths. This result holds when results are available on a local level (e.g. here, here, here, and here) and when national data are examined.

 

Attributing benefit to MAT/OST requires

evidence of reduced high-risk use of opioids associated with provision of the substitute opioids. 

As described in detail in this, this, and other posts, that is the mechanism by which OST could possibly provide benefit.

When outcomes are critically analyzed, the evidence points consistently to provision of the medical model fix or “treatment” for problem opioid use  worsening, not protective for, high-risk use and associated harms including opioid-related mortality. Because high-risk use, measured as non-lethal overdose incidence (eliminating the confounding, established effects of expanding naloxone use and campaigns) has increased nationally and consistently in multiple locales where date are available as dose of the medical cure increases.

The critical distinction applies to the reported results from West Virginia 

As highlighted by the optimistic headline and lead sentence from West Virginia Public Broadcasting, 

“West Virginia’s top addiction official says drug overdose deaths are on the decline.”

The piece goes on to support that any decrease in lethal overdoses – deaths – can be attributed to a campaign to increase availability and use of the overdose death reversing opioid antagonist naloxone, Narcan. 

Christiansen said outreach efforts have expanded in recent years due to state and community programs. Those include an uptick in drug diversion programs for those facing incarceration or child welfare cases, quick response teams, and naloxone distribution.

The state, with the help of harm reduction programs like SOAR in Charleston and the Milan Puskar Health Right in Morgantown, gave out almost 68,000 doses of the overdose reversal treatment in 2021. That’s three and a half times more kits handed out than in 2020.

Christiansen said state data show there is a correlation between increased naloxone distribution and a reduction in overdose calls to EMS.

That’s actually not good news,

any more than it would be good news to find that over a year there was a doubling or tripling of distribution and use of automated external defibrillators (AED) to prevent deaths from sudden cardiac arrest. The prevention of deaths would be a relief, but not what the increase would say about trends in prevalence of heart disease. 

And if that needed doubling or tripling,  over a year, of dispensing and use of AEDs to prevent deaths from cardiac arrests had occurred after decades of increasing use of $billions and billions of public healthcare funds for American Medicine’s preventative cure for heart disease? 

Right. 

hand holding suboxone

The real story here is different:  that by two meaningful measures of problem or high-risk opioid use – prevalence of nonlethal opioid overdoses and of injection related infectious disease – the opioid problem in West Virginia is worsening, at the same time that provision of the medical cure MAT has significantly expanded and while pandemic stressors including isolation have dissipated. Neither of those measures is invalidated by the confounding effects of increased naloxone saves on prevalence of opioid overdose deaths. 

So of course, no responsible source would focus on naloxone-reduced opioid deaths as evidence supporting effectiveness of MAT, while legitimate measures of effectiveness of MAT point in an opposite, lethal direction. 

Would they? 

But what about these trends and patterns of persistent worsening of high risk opioid use, overdoses and injection-related infectious disease while pandemic stressors dissipate and with expanded provision of American Medicine’s cure? Are they anomalous, exceptions, unique to West Virginia? Or part of a generalized phenomenon? 

More to come. 

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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