Epidemic Opiate Fabrications
Anyone who has been on Planet Earth for the past few years has been witness to the nonstop antagonism, belligerence and conflict between the media and the current administration. On any subject, any day, any time, the chasm between the the press and the president has been continuous, complete and beyond compromise. Foreign, domestic, economic, or environmental issues – anything that can be discussed is an arena for epic disagreement.
But there is one claim – only one – on which there is nothing but accord – that the U.S. is in the midst of a deadly opiate epidemic. This is the one issue that the president and his surrogates can discuss that will not be met with instantaneous dispute, disapproval and disavowal, the one topic the press can cover without being immediately categorized by the president as “fake news.”
Am I the only person whose Spidey Senses are tingling?
What on Earth could be more swampy than a government agenda that has spawned dozens of federal agencies in pursuit of a goal that reports posted by government agencies and freely available on the internet conclude can never be accomplished? The War on Drugs has existed for longer than my entire adult life, and in those 47 years, federal drug prohibition activities have cost at least $1.4 trillion in tax dollars (that’s only the funds that the federal government dedicated to the project, and doesn’t count the amounts that have been taken from citizens in the form of civil asset forfeiture, state spending, nor the costs of prosecuting and imprisoning the 90% of inmates convicted at the state or local level for drug law violations).
What would be an easier way for an administration to divert attention from complex issues than to call attention to a topic that the public has been trained by generations of government, media and Hollywood narratives to view as dangerous and controversial?
But there is reason to doubt that there is an epidemic of deaths. First, the definition of epidemic is that it affects a disproportionately large number of individuals within a population. The number of deaths in 2016 that the government counts as being caused by opiates was 42,421, and the national total was 2,744,248. This would mean the deaths attributed to opiates that year were 0.015% of total U.S. deaths.
One would think that the tally of opiate deaths would consist of deaths of people who had consumed an opiate – and no other drug – just prior to death. Perhaps the tally could include people who consumed 2 or more drugs, if each the drugs contained opiates – say codeine cough syrup, oxycodone pain pills, heroin and/or methadone.
In fact, many people counted in the opiate death tally are reported by the government to have consumed other drugs as well as opiate. According to the CDC, fully 70% of individuals counted in the opiate deaths tallies in the years 2010-2014 had consumed one or more additional, non-opiate drugs prior to death. The CDC even conceded that this could even be an underestimate, as some death investigators will choose to focus on a single drug, rather than thoroughly report on multiple drugs.
If we take this into account, and assume the trend continues, the total of opiate deaths in 2016 would drop from 42,421, and 0.015% of the 2,744,248 U.S. deaths in 2016, a number closer to 12,727, or 0.0046%.
A March 2018 publication from the National Institutes of Health reports that 30% of opiate deaths include benzodiazepines as the second drug consumed shortly before death. Benzodiazepines can be deadly in combination with opiates – or when consumed by themselves. It is likely impossible to determine if someone who died soon after taking both an opiate and a benzodiazepine died from the opiate, the benzodiazepine, or both. But to count such a death as an opiate death misrepresents opiates as more deadly and benzodiazepines and/or combining the two, as less deadly. Worryingly, this configuring of the data could be masking a real and higher level of danger from benzodiazepines.
Everyone who was an adult at the turn of the millennium was around for the last big drug epidemic – methamphetamine. During the meth epidemic of the early 2000s, government and media attention focused not on deaths, but on an army of disheveled, emaciated, tooth-losing zombies – trailer trash stereotypes on steroids, and claiming Superfund-Site-levels of contamination in houses, RVs and outbuildings where small scale manufacturing had taken place.
Meth Mouth was not discovered by a dentist or health professional, or a scientist studying a population and discovering a trend. It was the brain child of a deputy working at the Multnomah County Jail in Portland, Oregon. After booking a woman who exhibited psychotic behavior, he dug up a mug shot of her at age 20, and that showed her – quelle surprise – more attractive and less bedraggled. He then perused the jail’s files, and collected mugshots of inmates that exhibited the most dramatic before-and-after declines. The whole thing went viral – shown on TV, in schools, on posters, and so on. The entire project was entirely about publicizing images to frighten the public. There was no attempt to compare meth users with a control group of inmates who never touched meth. There was also no mention that the community doesn’t fluoridate its water.
After focusing attention on meth, the government’s next step was to clamp down on the over-the-counter cold medication Sudafed, which could be used in the manufacture of meth. To this day, purchasing OTC products with the active ingredient phenylephrine requires producing an ID, signing paperwork, and being subject to stringent limits on the amount of medication one can purchase at one time, as well as limits on total monthly purchases.
Once Sudafed became as inconvenient to acquire as spray paint, the meth epidemic receded from public attention. This was not the consequence of a drug war victory in the form of elimination or reduction of black market meth. In fact, according to the NIH, meth availability didn’t decline, and a 2017 DOJ report noted that methamphetamine is, “highly pure and potent and is increasingly available.” This may have been because of a decline in small-scale domestic production using OTC cold tablets, replaced by imports from organizations funding political insurgency in Mexico, such as the Sinaloa Federation (an organization our media calls a “drug cartel” – which is like calling Macy’s a retailer of handkerchiefs).
Our government and media put enormous effort and resources toward convincing the public that meth use was an epidemic that the government was determined to address. The only tangible result was that law-abiding Americans would be subject to irritating, but not insurmountable restrictions on the purchase of over-the-counter remedies.
The meth epidemic was not an unusual episode. It was typical of the wasteful, spasmodic and seemingly endless set of government and media activities that constitute the war on drugs.
By 2017, the meth epidemic had for years been in the out-of-sight/out-of-mind file, and the attention of government and media was intensely focused on opiates.
Typical of media reporting certain numbers and/or statistics to generate public support for further restrictions on prescription opiates is a 2018 article from the Boston Globe headlined, “One-quarter of Mass. residents know someone who died from opiates, survey suggests” and focused on the deaths of approximately 2000 individuals in 2016. One internet search and two arithmetic calculations put this claim into perspective. The population of Massachusetts in 2016 was 6,811,779, 1/4th is 1,702,945. The 2000 decedents were 0.02% of the state’s population. For those 2000 individuals to have known 1,702,945 residents would mean that each individual would have had to have had at least 841 friends or loved ones within the state.
It’s frequently reported that Americans use 80% of the world’s opiate medications – and we are expected to be impressed with this naked total and conclude that it’s obviously too high. We’re only 4.28% of the world’s population, using huge amounts of a drug we’ve long been trained to believe to be terrifyingly deadly. No one is expected to put the 80% in context, and compare it to the 85% of the world’s Ritalin we are also reported to use (Ritalin may be overprescribed, but it isn’t receiving anywhere near the federal attention focused on opiates). We never see a comparison of 2016’s 42,421 opiate deaths with the annual 480,000 deaths from tobacco, a number that’s been a stable total for many years. For every tobacco death, 30 Americans are living with a tobacco-related illness.
We are also not expected to engage some elementary calculations including the reportedly vast consumption of prescribed opiates plus the undeterminable amounts of black market opiates, and the tiny tiny fraction of 1% of deaths attributed to opiates. It’s almost like these numbers from government claims alone suggest that opiates are not very dangerous.
With far less theatrics, our government does collect and report data showing large numbers of Americans suffer chronic and/or severe pain. A report submitted to Congress by the Institute of Medicine in 2011 counted 100 million Americans suffering chronic pain. In 2015 the NIH reported 50 million Americans suffer severe and/or chronic pain. These conditions are legitimate reasons to use opiate medications. The vast amounts of opiates prescribed to Americans are never mentioned in conjunction with these tens of millions of suffering Americans. Another number not juxtaposed is that the U.N. reports that 5.5 billion people live in countries where there is no access to prescription opiates.
One more number: the U.S. uses 30% of the world’s opiates. Not 80%. You can check it out at Politifact (link in sources, below).
With all the hair-on-fire levels of media and government attention, one element of opiate use in current-year America getting absolutely no attention: free needle exchanges.
It’s not only legal to provide free needles to people for injecting illegally-purchased drugs – it’s supported by tax dollars. The facilities that provide the needles (and bleach, distilled water, and testing for diseases including hepatitis and TB) also provide referrals for medical, mental health and social services. Some of the most severe laws in our nation were established to punish use or sale of the very drugs these facilities provide assistance in consuming.
Who knows what levels of opiates the people who frequent needle exchanges are using? Not even the individuals themselves, because prohibition means that the drugs purchased on the black market are of unknown strength, with unknown “inactive” ingredients that may actually also be quite dangerous (lactose may be harmless if swallowed, but injecting it can cause anaphylactic shock, which can rapidly – and fatally – close airways).
Meanwhile, law-abiding citizens with well-documented medical conditions causing chronic severe pain are being targeted by federal agencies, safe and effective pain medication is demonized, and the president, his surrogates and the media keep pushing a narrative that the crisis in our nation is an opiate death epidemic.
This war has actual casualties. Drug laws were engineered to inflict punishments far more damaging than the side effects of any of the drugs they outlawed, on the theory that people would be frightened out of using. When courts hesitated to inflict the maximum available punishments, legislators grabbed for some crime-fighting cred by enacting mandatory minimums.These full-scale punishments are dished out by courts that, if they prosecuted every U.S. user, would be rendered inoperable. Those users who caught and prosecuted are basically the subject of show trials, performances designed to frighten all the other users. Drug prosecutions are literally a form of Hell on Earth.
Black market products – not being subject to laws regarding accurate labeling and purity standards – damage, and even kill the consumers. Since the days of the Volstead Act, people have not only been harmed by adulterants in black market products, but by adulterants the government requires to be added – notably ethanol produced for industrial use during the 1920s being spiked with wood alcohol, and lung-damaging paraquat sprayed on marijuana fields a few decades later.
Americans are encouraged to view casualties as deserving their fate – even though Americans will also make strenuous efforts to protect their own loved ones from the brunt of the drug war. This has spawned alternatives from the narcotics farm to our current-year treatment industry and drug courts. At the same time, Americans are expected to support increasing restrictions on prescribed opiates in the service of fighting opiate deaths.
Law abiding citizens who have documented histories of medical conditions that cause chronic and severe pain, are drug war casualties. These people cannot be portrayed as violators who brought their situation upon themselves. And yet the full force of the insanity, futility and brutality of the drug was is being pushed onto these innocent sick and disabled Americans.
The casualties that are the focus of all the government rhetoric and screaming headlines, are those who died from opiates (whose actual numbers are unknown but likely less frequent than portrayed). One proposal is glaringly unmentioned by government or press. Just end prohibition. We’ve only had 105 years of drug prohibition, and had 13 years of alcohol prohibition. In neither instance was the U.S. able to make it work.
Our government can’t protect us from every bad thing that can happen to us. Bubblewrapping can prevent cuts and scrapes and broken bones but can still suffocate. Our founders were willing to trust every citizen with instruments that can literally kill. But we are currently not trusted with drugs that can temporarily affect the contents of our minds. These drugs are depicted as inherently dangerous because of the potential for addiction. But the question must be asked. Is it the habituation and cravings that make drug use problematic for society? Why is the notoriously difficult to quit tobacco never cited as an example of addiction leading to antisocial behavior?
Perhaps it’s the behaviors – particularly criminal – that actually affect others, and not the temporarily altered thought patterns or desire to do it again. If we did end prohibition, assault, theft, robbery, fraud, embezzlement and such would still be illegal. Cheating would still be justification for divorce.
The U.S. is in the midst of an epidemic, all right: an epidemic of misinformation, moral panic and sensationalism. One part of the population that could logicallynbe the genesis of a loyal opposition is at home, suffering, because their own government is determined to deprive them of medication that would free them from their pain. And the media plays along.
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sources
Gains Made in Controlling Illegal Drugs, Yet The Drug Trade Flourishes, 1979 report
https://www.gao.gov/assets/130/127984.pdf
According to the CDC, opiate death numbers can’t be accurate
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
The findings in this report are subject to at least three limitations. First, several factors related to death investigation might affect estimates of death rates involving specific drugs. At autopsy, toxicological laboratory tests might be performed to determine the type of drugs present; however, the substances tested for and circumstances under which the tests are performed vary by jurisdiction. Second, in 2013 and 2014, 22% and 19% of drug overdose deaths, respectively, did not include information on the death certificate about the specific types of drugs involved. The percent of overdose deaths with specific drugs identified on the death certificate varies widely by state. Some of these deaths might have involved opioids. This increase in the reporting of specific drugs in 2014 might have contributed to some of the observed increases in drug overdose death rates involving different types of opioids from 2013 to 2014. Finally, some heroin deaths might be misclassified as morphine because morphine and heroin are metabolized similarly (8), which might result in an underreporting of heroin overdose deaths.
How CDC counts “opiate deaths”
https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf
“Relative increases in the death rates involving specific drugs and the rankings of these drugs may be affected by improvements in reporting, real increases in the numbers of death, or both.”
Dec 2016 CDC report OD deaths not opiates alone
https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf
NIH March 2018
“Opiate deaths” 30% include benzodiazepines – deadly on their own!
https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids
FDA Benzodiazepine warning 2017
https://www.fda.gov/Drugs/DrugSafety/ucm518473.htm
Benzodiazepine deaths
https://www.statnews.com/2016/02/18/benzodiazepines-overdose-deaths/
Cost of toxicology screening of cadaver
https://usaforensics.com/services/
Meth mouth
https://www.oregonlive.com/portland/index.ssf/2014/12/faces_of_meth_10_years_later_i_1.html
https://www.oregonlive.com/pacific-northwest-news/index.ssf/2004/12/the_faces_of_meth.html
Meth availability following Sudafed restrictions
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682593/
Meth increasing availability & purity 2017, drug black market can’t be eliminated
https://oig.justice.gov/reports/2017/a1711.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682593/
US uses too much Rx opiates?
US uses 80% of world Rx opiates: daily mail:
http://www.dailymail.co.uk/news/article-2142481/Americans-consume-80-percent-worlds-pain-pills-prescription-drug-abuse-epidemic-explodes.html
but, US uses 85% of world’s ritalin: https://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html
Tobacco Deaths, Illnesses
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
Prescribed Opiates 2015 US
https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html
at 80%
Chronic Pain population numbers
https://www.thegoodbody.com/chronic-pain-statistics/
this article says 100 million as of 2011, posted 2017
report for Congress from the Institute of Medicine (IOM)
https://www.webmd.com/pain-management/news/20110629/100-million-americans-have-chronic-pain#1
web MD says 100 million as of 2011 (posted 2011)
http://americanpainsociety.org/about-us/press-room/nih-study-shows-prevalence-of-chronic-or-severe-pain-in-u-s-adults
NIH report 2015 – 50 million chronic &/or severe pain as of 2012
https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=16590&LangID=E
Needle Exchanges
https://www.amfar.org/uploadedFiles/_amfarorg/On_the_Hill/3_29_12_SEP_Map_FINAL.pdf
map of all sites in U.S.
CDC 2018
https://www.cdc.gov/hiv/risk/ssps.html
Program Guidance for Implementing Certain Components of Syringe Services Programs, 2016
https://www.cdc.gov/hiv/pdf/risk/cdc-hiv-syringe-exchange-services.pdf
Prohibition Kills
https://reason.com/archives/2015/10/05/prohibition-kills
Lactose as a dangerous cutting agent
https://www.rxlist.com/lactated-ringers-side-effects-drug-center.htm
CDC describing needle exchanges 2010
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5945a4.htm/Syringe-Exchange-Programs-United-States-2008
Autopsies, Medical Examiners & Elected Coroners, Death Investigations
https://www.cdc.gov/nchs/data/databriefs/db67.htm
2011
“In 1972, almost 1 out of 5 deaths were autopsied. From 1972 through 2003, however, the autopsy rate dropped 58 percent from 19.3 percent to 8.1 percent. Although the autopsy rate has increased slightly since 2003, only 8.5 percent, or fewer than 1 out of 10 deaths, were autopsied in 2007”
US Autopsy Rates
2012
https://www.pbs.org/wgbh/frontline/article/more-deaths-go-unchecked-as-autopsy-rate-falls-to-miserably-low-levels/
Coroners and Medical Examiners
http://sites.nationalacademies.org/cs/groups/pgasite/documents/webpage/pga_049924.pdf
Shortages of death investigators
https://www.cbsnews.com/news/families-suffer-due-to-medical-examiner-shortage/.
Death Investigations Limitations
https://nij.gov/topics/law-enforcement/investigations/crime-scene/guides/death-investigation/pages/welcome.aspx
https://www.pbs.org/wgbh/pages/frontline/post-mortem/real-csi/
https://www.cincinnati.com/story/news/2015/01/24/cost-death-morgue-budget-problem/22242687/
Prescription opiates not the problem
https://www.painnewsnetwork.org/stories/2016/12/26/new-cdc-overdose-study-reduces-role-of-pain-meds
US population
http://www.worldometers.info/world-population/us-population/
4.27% of world population
328,427,422 (as of 3/1/2109)
The Narcotics Farm
https://www.scientificamerican.com/article/narcotics-recovery-farm/