Red Pill on Opiate Deaths

According to the US federal government and the media we are in the Midst of an Opiate Death Epidemic – overdose deaths surpassing deaths from auto crashes. That would be 40,755 reported overdose deaths (all drug overdoses reported not just opiates) in 2014, versus 35,398 car crash deaths in 2014 in a population of 317,000,000.

Also, according to the federal government’s National Vital Statistics Report “Drugs Most Frequently involved in opiate deaths 2010-2014”, “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.”

1. First,  government statistics are a mess. Overdose deaths do not rank among the the leading causes of death. But looking further, and it becomes clear that with the data that has actually been collected it’s impossible to know if deaths of opiate patients, heroin users or deaths classified as overdose deaths are up, down or steady. That’s because different jurisdictions record different data, including which drugs to investigate, and those lists of drugs may also change over time. It’s not even apples and oranges. More like apples, twigs & very small rocks.

2. This will surprise viewers of Forensic Files or CSI, but most Americans live in a jurisdiction that has not a medical examiner, but a coroner, and most are not required to have any medical or scientific credentials. In 2007, a coroner was elected and serving in Indiana while in High School. A long-serving South Carolina coroner is a full-time building contractor. Only 1/3 of coroners offices have in-house toxicology labs. Only 1/3 of coroners offices have in-house histology labs (histology, study of tissue). One third of offices have no x-ray equipment. There is also a shortage of medical examiners and coroners that has been going on in the US for many years.

3. Not every decedent gets an autopsy. According to Dr. Vincent DiMaio, who served many years as a medical examiner in Bexar County, TX, if we divide the amount spent per year on death investigations by the number of Americans who die, it works out to about $2.50 per dear departed.  Medical examiners and coroners may use the presence of paraphernalia or a pill bottle, or a history of having been prescribed a drug, and may focus on one drug rather than listing numerous drugs on a death certificate. It has happened that a death certificate lists a drug overdose in a body later proven to have no drugs.

4. Opiate testing is expensive and interpreting the results is very complicated. It’s not enough to take a sample from a cadaver and have it test positive for opiates. Without knowing the time of death, a process called postmortem redistribution can cause results that suggest a higher or lower dose than the person actually took. Even if the person took a large dose of opiates prior to death doesn’t mean the person died *because* of the opiates. In 2000, Dr. Stephen Karsh did a study of two groups of methadone users – some who died from something unrelated to opiates (say, being hit by a bus) and the other group whose deaths had been recorded as overdoses. Karsh was looking to see how much higher the levels would be in the latter as compared to the former group. Instead, be found both higher and lower than expected levels in both groups.

5. “Opiate Death” is a bureaucratic category, not a scientific conclusion. The medical examiner or the coroner in the jurisdiction where the death occurs has the legal authority to record “opiate death” even without an autopsy. Here’s some evidence of just *how* bureaucratic this is. In Dec. 2016, the CDC published a study of 59 deaths in Minnesota between 2006 and 2015, of people who died while having a diagnosis of pneumonia and a prescription for an opiate. The CDC was making a case that such deaths should be recorded as “opiate deaths”, not, as pneumonia, as they had been. Pretty strange that during an “epidemic” they were scraping around for a few dozen deaths from years ago.

6. Unlike many substances, from arsenic, cyanide and thallium, to laundry detergent, there is no known reliable deadly dose for opiates. Studies funded by the federal government from the 1920s to Karsh’s study in 2000, show people not only surviving, but entirely unharmed – not even drowsy, from doses the researchers expected to be deadly.

7. Why compare reported numbers of overdoses to car crash deaths? Car crashes are very different from an overdose of any drug or a poisoning from any chemical in that a crash is sudden, one time event, while drugs or poisons may be have been consumed multiple times . Why not compare opiates to tobacco? Tobacco doesn’t just cause lung cancer. Tobacco causes characteristic damage to every organ system of the body, from the stereotypical wrinkles around a smoker’s mouth, to damage to kidneys, liver, reproductive organs, GI tract, blood vessels, heart and lungs. Tobacco can kill decades after the person quit using it. There is no similar pattern of characteristic damage associated with opiate use. In fact, people who are treated  with naloxone for accute overdose show no signs of damage at all.

8. Actual opiate overdose is not the super-rapid, needle-still-in-the-arm phenomenon that has been planted in the popular imagination, such as reported by expert Dr. Robert Anderson of Glasgow University’s Forensic Toxicology Department,  “Sometimes there is no trace of a poison in the blood because it killed the person too quickly. A heroin addict found dead with a needle sticking out of his arm is an example – sometimes there’s no trace of the drug at post-mortem. However, if the person lived long enough [after the morphine was administered] for the blood to get into circulation, it should be present.” In fact, it starts with symptoms like pinpoint irises then slowing of breathing and heartbeat, and finally unconsciousness, and takes from one to twelve hours to lead to death.

9. Here’s a Modest Experiment regarding the supposed deadliness of opiates. Since 2011, the 32 states that have execution by lethal injection on the books began having increasing difficulty obtaining 2 of the drugs typically used in the 3-drug combination. One would think that if opiates were so reliably deadly, and could kill so quickly that a user could be found with a needle still in place, that the simplest answer would be to obtain opiates from cases where all appeals were exhausted. So why did the FDA end up seizing from the State of Georgia have its supply of sodium thiopental, obtained via a fradulent use of the address of a London driving school?

In fact, in 2014, Ohio did use an opiate, hydromorphone with the benzodiazepine sedative Midazolam, leading to the condemned prisoner gasping and gagging for 26 minutes. Not exactly the too-fast-to-pull-out-the-needle death we have been told can happen easily even among experienced users. Here’s what Everyday Health says about Midazolam, “Midazolam may cause serious breathing problems that could lead to permanent brain injury or death. You should only receive this medicine if your doctor has equipment to monitor your heart and lungs and provide life-saving medical treatment immediately if your breathing stops.”

Sources:

Prologue

automobile deaths US 2013 -2016

http://www.nsc.org/NewsDocuments/2017/12-month-estimates.pdf

Drug death # may be going up or down:

https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf

1.

CDC drug deaths stats 2010-2014, describes method of searching death records for clues of overdose deaths, both specific drugs & classes of drugs;

https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf

Opiate death #s can’t be accurate according to CDC! Although it’s called “Increases in Drug and Opioid Deaths – United States 2000-2014) Some death certificates only list type of drug, some just “OD” (22% of “Drug deaths in 2013, and 19% of “drug deaths 2014)

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm

2.

Medical examiners v coroners differ by jurisdiction

http://projects.propublica.org/forensics/

High School coroner:

http://www.wthr.com/article/amanda-barnett-indianas-youngest-death-investigator

lack of coroners, MEs

https://www.cbsnews.com/news/families-suffer-due-to-medical-examiner-shortage/.

3.not every corpse gets autopsy,

https://www.cincinnati.com/story/news/2015/01/24/cost-death-morgue-budget-problem/22242687/

Vincent Dimaio Bexar County Tx (as of 2011) US average $2.50/corpse, , SC Coroner/contractor 26 years,”OD” with no drugs at autopsy

https://www.pbs.org/wgbh/pages/frontline/post-mortem/real-csi/

ME or coroner may use clues from scene/med records, or may put one drug (of many) on death certificate

https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf

4.

Hair tests for opiates up to $2000!

Dr Karsh, difficult to find opiates caused a death, postmortem redistribution

http://content.time.com/time/health/article/0,8599,1996831,00.html

5. Dec 2016 CDC pneumonia, opiate deaths

CDC tries to turn 59 deaths/6 yrs in to “drug epidemic”

https://www.painnewsnetwork.org/stories/2017/5/1/the-medias-addiction-to-opioids

6. studies 1920-60s Schaffer Drug Library

http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm

7. Car crash deaths declining, tobacco deaths, organ damage

automobile deaths US 2013 -2016

http://www.nsc.org/NewsDocuments/2017/12-month-estimates.pdf

effects cigs on body, cdc:

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

“Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general.”

27 effects of smoking on the body:

http://www.healthline.com/health/smoking/effects-on-body

Symptoms, timeline of opiate OD

http://www.who.int/substance_abuse/information-sheet/en

Naloxone drug sheet with symptoms

https://www.drugs.com/naloxone.html

8. actual opiate overdose symptoms & timeline

Actual Overdose symptoms

Pinpoint pupils, unconsciousness, respiratory failure

http://www.who.int/substance_abuse/information-sheet/en/

Naloxone drug sheet with symptoms

https://www.drugs.com/naloxone.html

Dr Robert Anderson about death so fast needle still in arm

https://www.theguardian.com/uk/2000/jan/31/shipman.health4

opiate death not that fast, takes from one to 12 hours

http://www.druglibrary.org/schaffer/Library/studies/cu/cu12.htm

9.

http://www.newsweek.com/2014/05/16/states-go-great-lengths-find-lethal-injection-drugs-249154.html

http://blog.amnestyusa.org/us/georgia-execution-drugs-seized-by-dea/

https://www.huffingtonpost.com/2014/02/18/lethal-injection-drug-shortage_n_4811479.html

https://www.everydayhealth.com/drugs/midazolamR