Friday, March 1, 2019

Opioid Control and Gun Control

It's nearly universally stated in the 2A community that gun control isn't about guns; it's about control.  It's looking like the same thing can be said about opioid control, and the governments' responses to the "opioid epidemic".  It doesn't matter if their policies are getting the right results, it only matters as a means to the end of more control over more people.

Background:  I've written on the topic a few times, a simple search in the search bar in the upper left corner of the screen returns the three most relevant posts.  Around the same time I did mine, Aesop at Raconteur Report wrote about opioids in Northern California and I always link to him.  (Parts 1, 2, 3, Final)  Let me share a short version of where I stand from a piece I posted last October.
I think there's a deliberate attempt to conflate prescription opioid problems with illegal heroin overdose.  We don't have a prescription drug problem, we have a "junkies shooting adulterated heroin problem".  So why the public ruse?  The old advise to "follow the money" leads me to the company that makes naloxone, the anti-narcotic drug administered to people in overdose.  It was being pushed that virtually everyone should carry it everywhere as a lifesaver; it was even pushed on librarians to have it available for the library junkies who OD while watching internet porn in the library (do you have that where you live?).  The price of naloxone had gone up 17x.  Going down that rabbit hole led directly to Hillary Clinton and the Obama administration.
A few weeks after I posted that, conservative commentator Eric Bolling lost his son to an overdose.  I truly feel sorry for Eric and his family for the incredible pain they've been subjected to.  On the other hand, Eric has fallen right into the "painkillers = heroin" trap and argues that we use too many opioid pain killers.  His awful emotional pain does not give him the right to inflict physical pain on others.

The problem is that the effort to restrict opioid prescriptions is fueling a black market while leaving people in agonizing pain.  According to Maia Szalavitz, an expert reporter on this subject writing in the NY Times: 
As many as 18 million patients rely on opioids to treat long-term pain that is intractable but not necessarily associated with terminal illness. In 2016, seeking to curb opioid misuse, the Centers for Disease Control and Prevention introduced guidelines outlining a maximum safe dosage and strongly urging doctors to avoid prescribing for chronic pain unless death is imminent. The guidelines were supposed to be voluntary and apply only to chronic pain patients seeing general practitioners. Instead, they have been widely seen by doctors as mandatory.

As a result, thousands of pain medication recipients have had their doses reduced or eliminated. But this attempt to save people from addiction is leaving many patients in perpetual pain — and thus inadvertently ruining, or even ending, lives.
The problem, as usual, is that the Government regulators are starting from a bad assumption.  They assumed today's junkie shooting contaminated fentanyl is yesterday's patient who started out on prescription drugs and got addicted that way.  Only about 8% of people who receive prescription opioids develop addictions.  80% of addicts get started in other, less legal, ways.
As the Journal of Pain Research points out, the government’s campaign is based on a false premise: “Today’s non-medical opioid users are not yesterday’s patients.” Medical users usually do not become addicts.
Wrong assumptions lead to wrong law, and doctors are being threatened with their livelihoods by new regulations.
Prescribing outside the C.D.C. guidelines can lead to scrutiny by medical boards and even the Drug Enforcement Administration — and the result has been that many doctors have either quit prescribing entirely or tapered patients’ doses to fit the guidelines. According to a 2017 Boston Globe survey, nearly 70 percent of family and internal medicine doctors nationwide reported having reduced their prescribing in the previous two years — and nearly 10 percent reported stopping prescribing pain medication entirely. 
The problem with these blanket policies from the CDC or other Big Government agencies is that people are individuals and vary in their response to the pain killers.  Some people can't get by without them.  The VA recently did a study that showed alarming rates of suicidal acts “following discontinuation of opioid therapy.”
Jay Lawrence, a former truck driver, is a case in point. When his doctor refused to continue his medication in early 2017 — even though he had severe pain from spinal cord injuries and was not addicted — he told his wife that he’d had enough. In a park where they’d recently renewed their wedding vows, he fatally shot himself in the chest while she held his hand.
Writing in the Orange County Register, Dr. Jeffrey Singer notes that attacking doctors for prescribing opioids to patients for essential pain relief does nothing to prevent black-market use of opioids or deaths among non-medical users:
A recent report reveals California’s “Death Certificate Project,” is terrorizing doctors into under-prescribing or even abruptly terminating medication for acute and chronic pain patients. The project investigates doctors who have treated patients identified as overdoses on death certificates and considers rescinding their licenses or charging them with homicide.

It is scandalous that we doctors and our patients are the latest victims of America’s war on drugs, while deaths from nonmedical use of licit and illicit drugs continue their exponential and perpetual climb — with no end in sight.

The U.S Centers for Disease Control and Prevention recently released the latest results of the current strategy: opioid-related overdose deaths in 2017 continued their steady climb, increasing 13 percent over 2016 totals. This happened despite the fact that per capita high-dose opioid prescriptions fell 58 percent from 2008 to 2017, while the number of all opioids dispensed fell 29 percent from 2010 to 2017.
Perhaps most damning is this assessment from the CATO Institute.  A study by Harvard’s Jeffrey Miron and others shows the government’s anti-opioid crusade has backfired and actually increased opioid addiction and overdose deaths:
Opioid overdose deaths have risen dramatically in the United States over the past two decades.… The opioid epidemic has resulted from too many restrictions on prescribing, not too few. Rather than decreasing opioid overdose deaths, restrictions push users from prescription opioids toward diverted or illicit opioids, which increase the risk of overdose because consumers cannot easily assess drug potency or quality in underground markets. The implication of this “more restrictions, more deaths” explanation is that the United States should scale back restrictions on opioid prescribing, perhaps to the point of legalization.
Last words not to Cato's Jeffery Miron, but to Maia Szalavitz who started down this road:
Paradoxically, there is a growing medical consensus that patients who are addicted to their pain pills shouldn’t be forced to taper their dosages. The safest treatment for opioid addiction is maintenance with an appropriate opioid: For addiction, the opioids methadone and buprenorphine are the only treatments proved to cut the death rate from overdose by 50 percent or more.

“We have less mercy for people who have chronic pain and are on chronic opioids than we do for somebody who’s using heroin in the streets right now,” said Dr. Kertesz.

Both groups deserve more compassion, including a safe legal harbor for high-dose prescribing for patients who truly need it — as well as for their doctors. Attempting to reduce overdose risk by raising the odds of suicide is both cruel and senseless.


  1. The conflation with heroin addiction and "the opioid epidemic" is a distraction and a justification for almost anything. They are two different issues and if opioids are not going to be used to control chronic pain, something must be used in its place. I agree with you. I smell a scam.

  2. I live with a person in chronic pain. It is scary the control the government has over her life. Restricting our movements (must go to doctor every 30 days, must not go to doctor 27 days from seeing doctor... Pills can only be refilled 28 days after last time, so our lives revolve around every 30 days.) And God forbid us use one of those pill minders and have her opioids in them and we get pulled over because, OMG, we're drug dealing/drug using illegal drug users according to the State, the Feds, and every cop in existence if we don't keep the opioids in their original container and don't have more pills than the prescription allows, OR get caught with a container that has too few pills in it because that means SHE or I are using too many rather than being smart and using pill minders at home...

    Weeee… Are we having fun yet? Because... Well, if you're on chronic pain opioid regime then the Fed Gov mandates the user pee-in-a-cup to make sure the user isn't illegally using.

    And then the real pisser is, as soon as the hospital you are admitted to for, oh, say, a septic gall bladder, finds out that you are on a chronic pain opioid regime, they come flying at you with the NARCAN and take every last drop out of your high levels of opioids out of your system, which because your body is chemically addicted (even though you are not psychologically addicted) to the opioids it (your body) goes into a sudden rapid withdrawal, which shuts your body down like, oh, say, unto death...

    To top off this shite-fest of evilness, the hospital will now give you short-acting small amounts of the long-lasting high levels of opioids that you use to KILL THE DAMNED CHRONIC PAIN. And then, because you've crashed two or more times because of that nasty physical addiction thing, and the low levels of immediate release don't stop the FRAGGIN PAIN THAT IS TEARING YOU APART, you get no sleep and no rest and no healing at all because excruciating pain... (unless some smartass spouse slips you your pain meds when the staff isn't looking...)

    All because some jerks are killing themselves on heroin and illegally gotten opioids.

    Our solution to the problem children out there? One dose/series of doses of NARCAN for your first overdose on illegal drugs (whether illegal-illegal drugs or illegally obtained or illegally used drugs) and that's it. One chance of redemption only.

    After all, that's what they are doing to my wife every time she has to go to the doctor or to a hospital.

    It's to the point I want to track down these idiots, give them a huge dose of NARCAN and ask them pointedly what is so friggin bad in their lives that they have to screw up everyone elses? And if they can't give me a good reason, time to push them off the Cliffs of Oblivion or some other high spot.


    Other than that, how's the weather?

  3. Where does the authority to regulate opioids come from? If a constitutional amendment was required to regulate alcohol, then why not "drugs"?

    Opioids were over-the-counter product in the nineteen-teens, and then this whole regulatory scam came about, making millions for many. When one realizes "who benefits", is it sensible to think that the problems will ever be resolved?

    Either insist on the proper authority, or remove the baseless "requirements", that is the root cause solution.

  4. Pain medications are overly regulated, because of all the "pain clinics" that were dealing tens of thousands of pills per day. We see the exact same thing no with "medical" marijuana. There is no such thing as medical marijuana, BTW. There is medical THC oil, available by prescription from real doctors for real ailments in all 50 States.

    I have compassion for people in pain. They need their medications to get through the day, due to no fault of their own.

    The heroin junkies should be fed to alligators on pay-per-view, not handed more drugs and needles paid for by taxpayers.

  5. Chaplain Tim at the blog, "Blue Collar Prepping" described the mess he is in.

  6. As one who has depended on opioids to approximate functionality since the mid-70s this scares the shit out of me.

  7. You receive all the laws you will obey. They already took away affordable healthcare. They keep asking for your guns. If they think you would get on white prison buses to internment camps, they will send them.

  8. To take McChuck's comment above as a segue: isn't medical marijuana, for pain management, the lead argument for legalization? Big Mary-Jane has partnered with the taxing entity known as the State of California to actively drive free-market farmers out (who knew California wasn't really that into supporting the little guy).
    Lots of establishment tall dogs are fully vested in Big M-J. Not that anyone would try to monetize another human beings pain.

    I can see why Doctors take the CDC recommendations as mandatory. If they don't and there's a problem they will be sued into oblivion by some grifter lawyer. Jurys will assume that the recommendations are necessary and prudent, why else would a gov't entity go to all the trouble to issue them. The Gov't is there to help and would never be capricious, irresponsible, or have a hidden agenda, just ask James Comey or Andrew McCabe. They'll vouch for the Institution's integrity.

  9. Been in healthcare 40+ years....working with doctors all day every day. The problem is multifaceted. First of all conflating effective treatment of pain by a professional with eventual drug abuse is flat out wrong. However doing so provides the convenient excuse for bureaucrats and apparatchiks to DO WHAT THEY DO.....CONTROL THINGS. And control is the driving force behind virtually EVERYONE who seeks public office and power over others. Another complicating factor is that there IS a problem with opioid drugs being over prescribed by doctors. Every state has a handful of MD's who are essentially running 'pill mills' to get rich. Big Pharma offers inducements to doctors to prescribe their products.....including pain meds like Oxycontin. These inducements and the temptation to make easy money ( and while a minority there ARE plenty of doctors who went to med school for ONE get rich) lead a few docs to write scrips by the thousands. And they do this for quite a while before the state
    inevitably steps in and prosecutes. But the wheels of government tend to grind slowly as the aphorism states. So a LOT of damage is done before these bad apples are plucked and prosecuted. And the mainstream physician community tends to turn a blind eye to these bad apples. One of the failings of the physician community is the near total reluctance to discipline other doctors. Physicians are reluctant to hold their associates accountable because to do so would expose THEM to the same risk of being second guessed. And since the doctors won't do it....and NOBODY ELSE but the courts CAN do it this leads to a lot of abuses.
    Like over prescribing by some leading to onerous regulation by the laws.
    What's the solution? Good question. But I do know that leaving the problem to be dealt with by laws and lawyers is not and never will be the best solution.
    Using the courts and laws to deal with such problems is a 'killing flies with a hammer' approach. The fly may die but the damage done by the hammer is seldom minimal.

  10. I went through an issue related to this with my wife. She had outpatient abdominal surgery and she had muscle spasms later that evening. She was screaming her head off because she was in so much pain. She was taken by ambulance and in the ER they refused to give her pain meds. Because they thought she was an addict, despite having surgery earlier in the day. I was so pissed, but I knew exactly why they were doing it- because they cared more about stopping somebody from getting their jolly’s off than a person in pain.