PAIN — More on the phony, false, deadly “Opioid Epidemic!”

There is a paper in the 10 Aug 2018 issue of the prestigious (in the meantime) journal Science — published as a “Neuroscience” paper for no apparent reason other than calling it a “neuroscience” paper connotes high respectability — titled: “Opioid prescribing decreases after learning of a patient’s fatal overdose”. The first line in the abstract/intro is: “Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits.” (Bold added and Italics added here and in all subsequent quotes.) There is no citation for any scientific source whatsoever for that statement. Similarly, the first line in the paper is: “The United States is in the grips of its worst drug crisis in history, driven by twin epidemics of illicit and prescription opioid use.”
So now we’re in the grips of an over-prescription epidemic! It would be nice to know exactly how they are quantifying “epidemic” and from where the data upon which they make such an outrageous claim, but that information is, of course, not provided. That would apparently be too scientific for a journal like Science.
And to make matters worse, toward the beginning of that issue of Science, in the “In Brief” section titled RESEARCH (which also connotes respectability), the second of nine brief reviews (also under the heading Neuroscience) titled “Feedback reduces opioid prescriptions” begins with the sentence “Most people addicted to opioids began taking them because they were legally prescribed.” Again, no indication from whence this little factoid — which, although part of the currently acceptable narrative, is dead wrong.
In the first paragraph, the writers note:
“Before the introduction of extended-release and long-acting opioids in the 1990’s, long-term, high-dose opioid therapy was rare. The use of these drugs for cancer pain led to calls to address chronic non-cancer pain with the same agents. Opioid proponents discounted historical evidence for opioid harms by frequently citing studies on small convenience samples. For example, there were more than 600 citations of a five sentence letter to the editor published in the New England Journal of Medicine in 1980 titled, “Addiction rare in patients treated with narcotics”, most in support of opioid safety. These and other factors may have encouraged unwarranted opioid prescribing (bold added).
The second to the last paragraph begins, “Judicious prescribing represents only one of the components necessary to correct the missteps caused by overly enthusiastic use of opioids (bold added) to alleviate pain.” For non-scientists, the word “cause” is almost never used by scientists without extensive and very careful experimental research. And even then, it is rarely used — certainly not with this kind of blatant statement of opinion.
The study purports to be an “intervention” through use of “behavioral insights”, which consists of a letter from the (San Diego) county’s Chief Deputy Medical Examiner notifying the prescriber of a death in their practice, identifying the decedent by name, address, and age. Among the items discussed in the letter are, “five U.S. Centers of Disease Control and Prevention (CDC) guideline-recommended safe prescribing strategies.” They refer to their letter as a “safe prescribing injunction”.
Disregarding for a moment that the CDC Guidelines are based on the opinions of incompetent, biased “experts”, and the fact that, despite the misleading characterization of the article there’s no neuroscience whatsoever about their study, there’s a fairly massive science problem: Even if we assume that all their data were correct, the description of the intervention — the application of “behavioral insights” — and consequently the basis for their interpretation of the study, is shockingly subjective and mischaracterized. The authors, while maintaining that the factor influencing the behavior of prescribing physicians is that of “behavioral insights”, completely ignore a competing alternative hypothesis— that the physicians are responding to the threat implicit in these letters.
If this is the case, and the authors were they truly behavioral scientists — even social scientists — they would know that there is a major, fundamental difference between response to threat and response to a letter of notification (or “behavioral insight”) — ESPECIALLY in terms of Neuroscience. CERTAINLY the authors must know that circuits and centers in the brain associated with threat and fear are vastly different from those associated with the acquisition of insight-driven information. Nevertheless, they steadfastly maintain that their hypothesis stands up to scientific (nay — Neuroscience!) research criteria.
A paper that provides good evidence against the increasingly deadly CDC guidelines is: Manchikanti et al. (2017), Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician (20): 53–592 * ISSN 1533–3159.
It is important to understand that the ongoing effects of these CDC guidelines are destructive and increasingly deadly. Surgical patients are being denied appropriate post-surgical pain control because surgeons have been limited — in an outrageous example of politicians telling surgeons how to practice — to seven (7) days in which to prescribe opioid pain medication for post-operative pain, because patients GENERALLY recover to the point of no longer needing opioid medication after that length of time. However, this does NOT account for patients with severe pathology, the complexity of the proposed surgery, or the severity of post-operative pain. Nevertheless, the surgeon no longer has the ability to prescribe according to the needs of his or her individual patients.
In addition, some less-competent pain-management medical personnel, who would have to pick up prescription of post-operative pain medication after the surgeon’s one week is over, are misinterpreting the CDC guidelines, which were written for PRIMARY CARE, not pain-management clinicians, and were written as voluntary guidelines, not laws. To understand how bad the pain management patient’s position truly is, it is important to understand that pain-management patients are at a distinct disadvantage when dealing with their doctors. If they disagree, or “argue”, they are considered drug-seekers and can be terminated from medical care, which in the case of serious pathology would virtually end the patient’s ability to function professionally and in her or his family. The unlucky patients in this position will just have to put off surgery until, if, sanity returns to the medical practice of pain-management.
Moreover, there is an increasing problem — studiously not covered by the news media and ignored by politicians and the DEA — of pain patients having their medication reduced to inadequate levels or terminated altogether, destroying their quality of life to the point that they can no longer function. An increasing number of these patients feel forced to choose suicide as the only way out. Others have been forced to look to street drugs to try to control uncontrollable pain, and some, like Prince, not knowing what you get when you buy on the street, die of overdose. And to make matters criminally worse, proponents of the so-called opioid epidemic will try to use this as one more example of an overdose death that started with prescription of opioid medications by a physician, when in fact the decedent’s death is on the head of, and due to the actions of the very people making this claim.
For some reason, reason has been hijacked and lunacy spreads in the form of a manufactured Opioid Epidemic. Panic has taken over, from government to the media to members of the medical community who are afraid of losing their license or being repeatedly audited by the DEA for doing their job. Physicians are having their prescriptions second-guessed by a hopefully small number of incompetent pharmacists who will refuse to fill a legitimate prescription/order because of their concerns and worries about being audited repeatedly by DEA.
And those who ultimately suffer are medically legitimate pain patients who, through no fault of their own, are suffering medical conditions causing a level and degree of pain that those making these foolish, ignorant, and baseless claims, recommendations, and guidelines, have absolutely no clue as to what they mean by that word “pain.” It is definitely not the same thing as what the nabobs and nitwits mean when they brag that they can ignore pain, or just take a couple Tylenol and it goes away just like ‘that’.
The statement that long-term narcotic pain management does not work is an outright lie, based on phony and disingenuous misuse of statistics and faulty, manipulative mis-reporting of research.
I cannot tell you why this is happening, nor what is the incentive or reason behind the actions of those who would do so much damage to so many for no good reason. I only know that it is spreading, it is wrong, and it has got to stop. The fact that these policies are killing people, and that the statements being made as fact are lies based on the biased misrepresentations of paid “experts”, must come out.
To quote Richard A. Lawhern, Ph.D., from his important paper: “Message to the CDC: Tear down your walls of silence” (available on Medium: https://medium.com/@redlawhern/message-to-the-cdc-tear-down-your-walls-of-silence-c3c5109c6dcc):
“(The) CDC is desperately wrong on central assumptions that the hired consultants who wrote the Guidelines brought with them when they started their year-long writing process:
(1) It is claimed that America’s public health crisis in opioid addiction and overdose deaths has been caused by “over-prescribing” of medical opioids to patients with pain. Supposedly, doctors were either careless, greedy, or deceived by evil pharmaceutical companies into ignoring risks of drug dependence or addiction. Now their patients are suffering for their carelessness.
(2) It is also claimed that opioid analgesics are ineffective for pain when used over long time periods.
(3) Finally, it is claimed that safe and effective alternative therapies exist that can reliably replace opioid pain killers — and that they should be preferred over opioids.
All three of these assumptions are provably wrong. And published data from US healthcare agencies and others demonstrate they are wrong, beyond any reasonable contradiction.”
Also, from Dr. Lawhern’s paper:
“In two large scale studies published in 2016 and 2018, opioid abuse and prolonged prescribing of opioids were evaluated for 650,000+ patients given opioids for the first time to control pain after surgery. Fewer than 0.6% were diagnosed with opioid abuse within an average of 2.5 years. [xiv] Many of those diagnoses were likely false alarms due to the poor training of general practitioners in the assessment of both pain and addiction.”
That is 650,000 post-surgical pain patients, of whom fewer than 0.6% were diagnosed with opioid abuse within an average of 2.5 years! Does that sound like overprescription? Like an “epidemic” of patients legitimately prescribed pain medication who suddenly throw their lives away and act like drug addicts? No? But that’s what you are led to think, by the media, by your government, by politicians, and by incompetent or fraudulent members of the medical community.
Please, the next time you hear someone going on about the opioid epidemic and the vast sea of overprescribing of opioid pain medication or any of the other subjects mentioned above, set them straight. Let them know the truth about what is happening — that for 20 years patients (finally) treated with appropriate levels of pain control medication have been able to function and live a full life, without becoming addicts or dying of an overdose. Now those patients are dying, but not because of pain medication, but due to the lack of it. The War on Drugs has become a War on Patients, and the patients are losing.