Wednesday, December 11, 2019

Noted in Passing: the Opioid “Crisis” is Not Due to Prescription Drugs

I've written on the so-called opioid crisis several times in the last few years and have come to the conclusion that the narrative we're being fed simply isn't true; that the stories are manufactured for reasons that aren't necessarily clear, but that could track back to some well known politicians (hint - one of the names is associated with Arkancide).  For example a couple of years ago, Mylan, the company that makes Epinephrine injector pens - the kind used to stop anaphylactic shock in people with allergies to things like bee stings - raised the price a factor of 4x and the media howled like banshees.  The company that makes Naloxone, the drug used to stop people from dying of opioid overdose from dying, raised their price 17x and the media didn't say a word. 

Back on November 20th, the CATO institute put up an article derived from a study published November 1st in The Annals of Emergency Medicine (full text).  The study demonstrates what I've reported here from the start, the numbers of people who become addicted to prescription opioids is too small to match the overdose numbers being seen.
This prospective cohort study by researchers in the Department of Emergency Medicine at Albert Einstein College of Medicine followed 484 “opioid naïve” patients prescribed opioids for acute pain upon release from the emergency department during a six month period. The statewide prescription drug monitoring program was employed in addition to regular follow up telephone interviews. One percent (five patients) met the criteria for persistent opioid use by the end of the follow up period. Four of the five patients still had moderate or severe pain in the affected body part six months after release from the emergency department.
I'm a little surprised to find that it's as much as 1% of the group that were using the opioids persistently, but 484 patients isn't a big number and sometimes small groups give strange results.  The CATO article also talks about a much larger study with a smaller number of misusers in the British Medical Journal.  
The study comes after a much larger retrospective cohort study reported in the BMJ of more than 568,000 opioid naïve patients prescribed opioids for acute postoperative pain between 2008 and 2016. Investigators found a total misuse rate of 0.6 percent. The researchers defined “misuse” as follows:
The primary outcome was an ICD-9 (international classification of diseases, ninth revision) diagnosis code of opioid dependence, abuse, or overdose…Opioid misuse was defined as the presence of at least one of these ICD codes after discharge and encompasses a composite of a wide range of forms of misuse. We included only diagnosis codes related specifically to prescription opioids.
There is simply no correlation between opioid prescription volume and non-medical use or opioid use disorder among people age 12 and over.  Meanwhile, the restrictions on drugs that some patients need are still being withheld as policymakers and law enforcement continue to pressure health care practitioners into undertreating patients in pain. At a recent international breast cancer conference experts stated the under-prescribing of opioids to breast cancer patients in the U.S. is now comparable to treatment in third world countries.

This despite the CDC coming out this April ('19) and saying (my editing), “you guys making drug policy and passing laws got us all wrong.  Those 2016 opioid prescription guidelines we issued were supposed to be just that: guidelines.   We always figured the doctors know best what their patients need.  You doctors should treat the patients who need it for pain.”

Closing words to CATO:
Meanwhile, as prescription volume precipitously drops, the overdose rate continues apace, with fentanyl and heroin now making up the overwhelming majority of overdose deaths. And now methamphetamine is making a comeback as a major cause of drug deaths—15 years after Congress addressed the “meth crisis’ with the Combat Methamphetamine Epidemic Act.
A clear case of, “it didn't work, so let's try it again only harder.”

Today's opioid or fentanyl addicts are not yesterday's patients.  That lie has to die.


  1. Is the "Clinton Connection" due to a company's presence in Arkansas, or related to "donations" made by certain drug companies?

    1. Seems to be the second one.

      Big quoted paragraph, about five paragraphs in.

  2. Follow the money....

    Bet Big Pharma was a bit upset when she lost!

  3. OP Premise:

    As we've hammered home with a pile driver, here, at Borepatch's place, and on our own blog, about 47 times, based purely on facts and reality.
    Nice of someone at CATO to wake up and smell the coffee.

    Also, and exactly like Gun Control, Rx Opioid Control isn't about solving a problem, nor about opioid abuse, it's about control.

    (And by no strange coincidence, the few people who were probably junkies before trying - and failing - to score Rx opiates at the E.D.s of the nation, rather predictably returned to shooting up heroin.

    The ones who tried that with added carfentanil are no longer with us.
    Regretably, we (actually PD and FD, prior to arrival in hospital) saved one such only last week. Pity. Hopefully next time they'll be too late.

    The solution to the opioid epidemic is to ban Narcan for 5 years, and Build The Wall.

    Darwinian elegance will take care of the problem rather rapidly if you do those two things.

    In pretty much about 6 months.

    Bonus: No need for needle exchange programs, and far fewer discards left on streets and beaches, even in sh*tholes like San Franshitsco.

  4. One thing to add is the ongoing court cases against the pharma companies. It's a shakedown by the state governments going after not the problem source, but rather the deep pockets.

    1. We covered that too:

  5. Bans and walls like the ones Aesop proposes are how commies build an iron curtain. There is no unusual 'commie' mindset/worldview that is only present in Chinese, Russians, and Germans of a certain generation, and only produces bad results when they do it; every population everywhere has a lot of commie impulses.

    1. Right, Anonymous genius.

      That's why the Great Wall of China failed, and the Mongol hordes destroyed all Chinese civilization forever, 2000 years before Karl Marx was even born. Oh wait, none of that except the Great Wall ever happened.

      Another Common Core grad comes to demonstrate his expertise.
      Stay in school, kids,
      And Say No To Dopes.

      Dispute the point on the merits next time: explain to the class why you have no locks on your doors, and no doors on your house, and why this therefore proves borders oughtn't be demarcated and defended.

    2. explain to the class why you have no locks on your doors, and no doors on your house, and why this therefore proves borders oughtn't be demarcated and defended.

      Your example is making the psychologically factually false assumption that several hundred million biologically unrelated people in a country are a family, in the same way that ten biologically related people in a family in a single house are.

      Humans in that small and that large group don't relate to each other in the same way. You cannot expand fictive kinship that far, the instinctual firmware won't support it.

    3. Uh, no, and -10 yards and loss of down for trying a handoff to the Straw Man Fallacy.

      Doors on your house have nothing to do with family, or family versus non-family.

      Go back to junior college and beat your professors about the head and shoulders, and demand a full refund of your tuition.

      You put doors on houses and locks on doors because some things deserve securing.
      This includes countries just as much as your own domicile, and for exactly the same reasons: people steal what isn't theirs.
      (If you don't know this includes family, you're really not tall enough for this ride, are you...?)

      I don't lock my door because everyone else is not family.
      I lock my door because everybody is not me;
      my stuff is not everybody's stuff;
      and anybody not me doesn't have any business there uninvited

      Srsly, start with the GED work for high school, then try Hillsdale College online (hell, even Harvard online is better than nothing), and see if you can catch up to the basic understanding and common sense manifestly in lack.

      For the crash course, you might try Hobbes' Leviathan, and the works of John Locke, beginning with Two Treatises on Government, working your way up to Adam Smith's magnum opus The Wealth of Nations. Then you'll have the bare capability of apprehending the meaning of the Declaration of Independence , the U.S> Constitution, and the immediately appended Bill of Rights, on a footing somewhat equal to the thickest clot sitting in Congress anytime between 1775 and 1787.

      Based on your first two ripostes, you'll probably throw them all into a pond as incomprehensible, but I don't want you whinging later you had no chance at all, and going on about how life is so unfair.

      We don't build walls across our borders, nor put doors on our houses, because we're communists.
      We put them there because other people are.

      If you're going to face-pant on the bunny slopes, you might want to pick another hobby.

    4. The Iron Curtain was built to keep people in. The minefields, gun positions and towers were set up to sweep a dead zone in order to kill anyone escaping. Basically making the world's largest prison system, designed to stop people escaping to the free-er West.

      The US Border Wall is meant to keep people out, and to slow the especially talented ones down enough to be picked up by Border Patrol and sent back to Mexico.

      Your analogy is incorrect. Now if Mexico made a wall and dead zone on their side of the border in order to stop people leaving Mexico, you'd be correct. Or if the Border Wall was designed to stop or kill US citizens from leaving and going to Mexico.

      But since the Wall is designed to keep people out, not people in, you are wrong. Very very wrong.

      Imagine this. A US State builds a wall between it and surrounding states to keep people out. Totally moral. I wonder why Nevada hasn't done this to California's border yet. Makes sense, as why would anyone allow a Californian to come into their state and screw it up.

      Turn around the wall's meaning. Design it to keep the state's citizens in. That would be very immoral. VERY VERY Immoral. Like if California built a wall on it's borders to keep people from leaving, in order to access their wealth through more fines and taxation. Totally immoral.

      We're building a border wall to keep people out. We're the Romans building Hadrian's Wall against the Celts. Trying to stop the murdering and raping and destruction of our culture.

      Get it? Wall to keep people out is Good. Wall to keep people in is not-so-good, unless it's a prison. Are we a prison? No? Then shut up until you can make correct analogies.

    5. I applaud your rejection of familial communism for the true morally correct position that every individual mentally-normal adult human is sovereign. Thank you for saving me the trouble of having to establish that.

      Hobbes' /Leviathan/ is particularly hilarious. It claims a theory that humans without government destroy themselves in an orgy of mutual combat, but cites in support exactly zero historical examples of that occurring. Given this theory then obviously the American West was never settled by wagon trains, because as soon as a wagon train got 100 miles West of St. Louis, every human in it must have killed every other human. But maybe you think a government could still reach out and touch a wagon train? Consider pirates, who are not nice people, and were without recourse to the court systems of every country, but lived the purest examples of democracy ever observed. See book

      Redefining the meaning of a word during an argument is a fallacy. Instead of using the word "we" and its synonyms, replace each instance with a more specific description of a set of humans. Then learn what you are really saying: 'Aesop defends walls placed over a line on a map, because Aesop wants to stop trade in intoxicants and employment he doesn't like, and make it easier to steal money at gunpoint from random strangers crossing that line, which he calls taxation, tariffs, customs, duties, green card, work permit, etc.'

      Beans wrote: Like if California built a wall on it's borders to keep people from leaving, in order to access their wealth through more fines and taxation.

      You are not aware that John Kerry back in the 1990's proposed green colored dollars for outside US and red colored dollars inside, and red dollars not exchangeable from outside like the ruble wasn't? You are not aware that US outgoing border crossings can be denied and US passports revoked due to an unpaid IRS tax bill? This is that mechanism you describe, for the purpose you describe. Difference between US today and Soviet Union at its worst is that you currently feel the amount and type of taxation is "legitimate". Aesop wants to build a wall, perhaps using Predator drones, and then it won't matter so much what your political opinion is because "suddenly" the wall is both two-way and high.

    6. Your utter historical ignorance of the extensive, detailed, and excruciatingly complicated contracts and method of governance of wagon trains leaving St. Louis for the frontiers is breathtaking, gob-smacking, and encyclopedic in omission.

      The blisteringly comprehensive government you imagine didn't exist that actually did makes mere home owner's association by-laws look like a libertarian dream by contrast.

      And the comprehensive and draconian articles signed by pirate crews are even more totalitarian than the Hammurabic Code.

      Both of your thus foolishly and ignorantly chosen examples underline the absolute truth of Hobbes' opus in about the ten seconds it took to point this out to you.

      Worse than not knowing any of this is that you didn't know you didn't know any of it.

      Sorry, Baby Duck, but you truly are exactly the sophomoric lackwit I expected (and sorry, but that truth is an absolute defense against accusations of ad hominem), and you really ought to stop reloading until you get some bulletproof shoes. You're running out of toes, and simply not tall enough for the internet, let alone this discussion, and your attempts to counter-argue are risible.

      Step back into the cocoon of quiet anonymity you so richly deserve, I beseech you.

      And take a chance on a secondary education. It might pay off in ways you've never imagined.

  6. The "opioid crisis" is caused by the same thing that brings us alcoholism, uncontrollable gambling, adultery, obesity and all the other miseries humans display and endure. That thing is POOR CHOICES. People KNOWINGLY make choices that are guaranteed to cause misery...and then whine when the predictable outcome occurs. We are a clever species not an intelligent one.

    1. Speaking of intoxicants and the original post, I want the entirety of every kind of drug prohibition repealed. Return to the legislative climate that existed in the US prior to the Harrison Narcotics Act of 1914, when you could send your minor child down to the corner drugstore to pick up Laudanum (opium in alcohol) for Grandma as an over-the-counter non-prescription item. Obviously, without laws strongly controlling narcotics, the US was a complete bunch of losers from 1776-1914. Nobody did anything but get wasted all day. Not even worth reading about what they might have accomplished, because by definition without a War On Drugs they could do nothing worthwhile.

    2. Explain to the class why the exact people living under such "freedom" chose to willingly inflict the Harrison Act et sequellae on themselves, if it was such an unmitigated and unnecessary horror. They can't be both dazzlingly brilliant and so utterly moronic at the same time, so you're going to undermine your entire argument trying to get off the horns of that dilemma, regardless of which one you select.

      Seeing how you unpaint yourself out of that corner, without noting that the people who lived under its "blessings" decided it was a nightmare, without damning your own argument, should be about as likely as pulling your head out without a crowbar.

      Come on, lad, show us how you unpunch that Tar Baby.

  7. The challenge was, your predicted social meltdown without a government imposing rules about drugs doesn't match the actual prosperity observed prior to 1914. The War On Drugs theory is disproven.

    If you can't accurately observe the prosperity seen without drug laws, why should I trust you to accurately observe the regulatory climate in wagon trains? Your ideology predicts social meltdown without a government imposing rules; your claims downstream of that are probably circular.

    Explain to the class why the exact people living under such "freedom" chose to willingly inflict the Harrison Act et sequellae on themselves

    Similarly, why did the German Jews vote to exterminate themselves? Answer is, they didn't, and the analysis mistake is assuming all political actors have identical knowledge, interests, and values. Read the Domestic Background section of the wiki page. Racist lies, church people wanting power, and probably some industry banning its competition, just like the hemp ban advantaged trees used for paper.

    1. The challenge was, your predicted social meltdown without a government imposing rules about drugs doesn't match the actual prosperity observed prior to 1914. The War On Drugs theory is disproven.

      1) The challenge was, you posting anything that referenced anything I actually typed, rather than responding to the Straw Man Fallacy voices in your head. Nop such "theory" was ever expounded. Own goal.

      2) You don't get to extrapolate history in reverse order, even granting your fever-swamp concoctions. O for 2.

      3) If prosperity is your marker, 1914's level is buried by the republic since the War On Drugs. So we've established that you're as well-versed in economics as you are in history. Strike three.

      4) nobody asked for your trust. The historical facts of governing compacts of wagon trains are well-known, and available to anyone with a level of reading comprehension clearly just beyond yours. Strike four.

      5) I posited nor predicted no such future, so we're back to you substituting your imagination for actual written statements. Strike five.

      6) The German Jews never "voted to exterminate themselves". Pulling wild non-sequitirs out of your fourth point of contact isn't making any case you imagine. Strike six.

      7) The exact Americans you imagine were so free and prosperous did vote for exactly the changes you think were so contrary to their interest. Unlike you, they actual saw the situation you describe as better first-hand, and decided it wasn't so great. Explain that, without recourse to self-serving vague hand-waving and self-serving bloviation. But that would require historical knowledge, or which you're entirely bankrupt, and a degree of critical thinking you have yet to master. Strike seven.

      8) You've yet to cite a single historical incident or reality that withstands even cursory scrutiny. You have literally booted every single example you've attempted to use. You've muffed history, politics, economics, and basic logical rhetoric to a level of incompetence usually reserved for frothing Ayn Randian fanboys, big "L" Libertarians, and sitting Democratic senators. Sam Eliot's "A Special Kind Of Stupid" would seem to apply to you. Strike eight.

      9) Perhaps this is news to you, but Wikipedia isn't something to point to as a reference, unless your general fund of information is so bankrupt you cannot find anything else. It occasionally stumbles over factual data, but owing to general unreliability, capricious editing, and the power of stupid people in large groups, the best thing to be said of it is that it's worth every penny you pay for it. Strike nine.

      You've wasted an entire inning, and simply dug yourself in three feet deeper.
      Well played.

    2. M: An argument isn't just contradiction.

      O: Well! it CAN be!

      M: No it can't!

      M: An argument is a connected series of statements intended to establish a proposition.

      O: No it isn't!

      M: Yes it is! It isn't just contradiction.

      O: Look, if I argue with you, I must take up a contrary position!

      M: Yes but it isn't just saying 'no it isn't'.

      O: Yes it is!

      M: No it isn't!

      O: Yes it is!

      M: No it isn't!

      O: Yes it is!

      M: No it ISN'T! Argument is an intellectual process. Contradiction is just the automatic gainsaying of anything the other person says.

      O: It is NOT!

      M: It is!

      O: Not at all!

      M: It is!

      (The Arguer hits a bell on his desk and stops.)

      O: Thank you, that's it.

    3. An argument generally has to have some point of contact with reality, rather than being just whatever diaper spackle some lunatard pulls out of his underpants and smears on the wall.