[Peace-discuss] Critique of opiod epidemic

[David Green]

 I've pasted below an informative and skeptical article about the opioid epidemic from Counterpunch, as well as my query to the author and his response. I must admit I've been gullible about the data on the opioid epidemic (which of course relates to Rust Belt counties that voted for Trump), and Sal Rodriguez offers an appropriate antidote, so to speak, that should be of great interest to the activist community. DG
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March 17, 2017 
ManufacturedOpioid Crisis: a Ploy to Salvage the War on Drugs
by Sal Rodriguez In case you haven’t heard,there’s an opioid crisis in America.With majorities of Americans now clearly supportive of marijuana legalization, opioids,a class of drugs used for thousands of years to treat pain and other ailments,have become the latest target of drug warriors and do-gooders alike.“Our nation is in the throes ofa heroin and opioid epidemic,” Attorney General Jeff Sessions said Wednesday.“Overdose deaths more than tripled between 2010 and 2014.  Accordingto the CDC, about 140 Americans on average now die from a drug overdose eachday. That means every three weeks, we are losing as many American lives todrug overdoses as we lost in the 9/11 attacks.”Indeed, according to theCenters for Disease Control and Prevention, more than 33,000 Americans lost their lives in 2015 dueto opioid-related overdoses, including 12,989 deaths associated specificallywith heroin.Candidate Donald Trump suggested, of course, a border wall would help solve the problem,while President Trump has complained America is a “drug-infested”country where “drugs are becoming cheaper than candy bars.”On the other side of the aisle,Democratic Senator Joe Manchin of West Virginia has gone so far as to call fora new war on drugs to combat apparent problem ofopioid use, abuse and overdoses.With so many Americans dying,it’s important to clarify a few things about opioids, the folly of knee-jerkgovernment reaction and the need for harm reduction.Theexaggerated danger of opioidsDespite their reputation,opioids are neither especially addictive nor dangerous on their own.Research has consistently shownthat few individuals who are prescribed opioids ever actually develop a problemwith them.  A 2016 study by Castlight Health, Inc. suggested only about 4.5 percent of individuals who receive opioidprescriptions are abusers. A 2010 Cochrane review of 26 studies found reports of opioidaddiction in only 0.27 percent of patients.Meanwhile, guidelines issued bythe CDC in 2016 for prescribing opioids for chonic pain cited another studywhich followed chronic pain patients who received opioid prescriptions for 13years. The study found that “one in 550 patients died from opioid-relatedoverdose” over the 13 years, which upon reflection is a remarkably low rateconsidering the demographic involved.As for the dangerousness ofopioids, one variable often left out in discussions of opioid overdose is thefact that opioid overdoses tend to involve multiple drugs.A 2014 report from the CDCbased on nationwide emergency room data noted that alcohol was involved in 22.1percent of deaths related to opioid pain relievers, but conceded the figurecould be higher, given wide varieties in how states and localities collect andreport toxicology data.Other, more focused studieshave found incredibly high rates of drug mixing at play in opioid overdoses. A2015 paper looking into opioid overdoses in SanFrancisco from 2010-2012 found that 74.9 percent of opioid overdosedeaths involved other drugs, including cocaine (35.3 percent), benzodiazepines(27.5 percent) and alcohol (19.6 percent). Likewise, data from the New York City Department ofHealth and Mental Hygiene noted that “nearly all (97 percent) overdose deathsinvolved more than one substance.”With respect to heroinspecifically, as a 2003 article published in the Journal of UrbanHealth explained, “The overwhelming majority of overdoses, both fatal andnonfatal, involved the concomitant consumption of heroin with other drugs. Theextensiveness of polydrug use among ‘heroin’ over-doses suggests that ‘polydrugtoxicity’ is a better description of the toxicology of overdose.”Rarely do mainstream mediareports of the opioid crisis mention the prevalence of polydrug toxicity –except for the occasional surge in excitement over fentanyl, a highly potent opioid whichunscrupulous drug dealers sometimes put into heroin to strengthen its effects.(Naturally, the mixture of fentanyl with heroin is more an unintendedconsequence of prohibitionist drug policies and a resistance to harm reductionapproaches than anything else.)Of course, it is much morepolitically lucrative to exaggerate the risk and danger of opioids than toacknowledge the relatively low risk of addiction and the likelihood that harmreduction efforts (like warnings against mixing opioids with other drugs) mightsave lives.Governmentpolicies turned people to heroinAs the prescription and use ofopioids surged in the first decade of the 2000s, so too did the number ofpeople seeking addiction treatment and experiencing overdoses. Rather than takea measured approach, government officials instead pursued policies aimed at restricting access toprescription painkillers, criminalizing and arresting doctors and patients inthe process.The continued rise in overdosedeaths only indicates these approaches haven’t worked to curtail abuse or deathfrom opioid use and misuse.Instead, individuals whopreviously used pharmaceutical opioids have increasingly been pushed towardsheroin use, with heroin use in the United States the highest its been in 20 years.  Accordingto the Drug Policy Alliance, “Ninety-four percent of opioid-addictedindividuals who switched from prescription opioids to heroin reported doing sobecause prescription opioids ‘were far more expensive and harder to obtain.’”Of course, for people who haveswitched from pharmaceuticals to heroin due to lack of access to legal painmedication, or those who abuse either pharmaceuticals or heroin for whateverreason, government policy has only made them less safe.And there’s plenty of reason tobelieve government policies have only made opioid and heroin use less safe thanbefore. The increased number of deaths reported in 2016 happened despite decreases in the number of opioidprescriptions and the number of heroin users.HarmreductionDespite the well-documentedrole of polydruguse opioid overdoses, it’s unlikely we’ll see proclamations fromJeff Sessions or Trump or any other prominent politicians warning people toengage in harm reduction when using opioids by foregoing alcohol,benzodiazepines or any other contraindicated drug that could heighten the riskof harm or death from opioid use.Other ideas include gettingallowing individuals with chronic pain to access the medication they needwithout criminalizing their ailment or threatening their doctors withprosecution. Or allowing the operation of safe injection sites and expanding access tomedication-assisted treatment and access to syringe exchange programs andnaloxone, which can effectively reverse opioid overdoses.Of course, a border wall won’tsolve the problems associated with opioid use and abuse, nor will an expansionor perpetuation of prohibitionist policies. Yet, Trump’s budget proposalincludes $175 million in increased expenditures for the Department of Justice“to target the worst of the worst criminal organizations and drug traffickersin order to address violent crime, gun-related deaths, and the opioidepidemic.” It also, of course, includes calls for billions of dollars for hisbeloved wall. Furthermore, Jeff Sessions’ public proclamations have overemphasized the role ofenforcement and drug abuse prevention ideas from the ’80s and ’90s.Alas, the nation’s massiveanti-drug bureaucracies and agencies need some way to stay afloat, even thoughtheir entire mission is predicated on the fraudulent idea that drug prohibitionand enforcement will keep Americans safe and drug-free. Anti-drug crusadespredicated on saving people from themselves or sinister chemicals may bedressed up in good intentions, but as history has shown, they are little morethan ruses to further expand government intervention in our lives and bloat thebudgets of government agencies. Sal Rodriguez is acontributing writer at Solitary Watch. He writes frequently oncriminal justice reform and can be reached at:sal.solitary at gmail.com    Hi Sal, Thank you for the informed and enlightened article onCounterpunch. I must admit I've taken he bait, so to speak. But I have wondered about the color-coded maps that highlightcounties with increased opioid overdose deaths. I think they're likelydeceptive, because they are often large area counties with low populations.They never give you an idea of the proportion of U.S. population that lives inthese counties.  For example: https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0 Regards, David Green Hi David,Thanks for writing. I think you're correct that there is something deceptivewith the color-coding in that it reflects large/low-populated areas aparticular prominence, in much the same way maps that show, for example,electoral breakdowns where one is left with the impression that Republicans orDemocrats are overwhelmingly popular. (These are the sort of maps I'm talkingabout: http://www.politifact.com/truth-o-meter/statements/2016/ dec/04/mike-pence/mike-pence-says-donald-trump-won-most- counties-rep/ )Such maps are revealing something - but naturally we have todig deeper to really get a sense of things.For one, there's no doubt more people are dying than before.Part of this is because the period between 2003 and 2014(the period covered by the color-coded maps) there were increases in thenumbers of both people prescribed opioids and people using heroin. Naturally, alarger set of people engaging in certain risky behaviors will lead to greaternumbers of people subject to risks.But then we get to some of the points I raised in myarticle. 

We have a lot of people shifting from prescription opioids to the black marketas a direct result of government efforts to, as the article you linked stated,"address the misuse of prescription painkillers" - which is to say,setting caps on the number of prescriptions/numbers of pills and arresting doctorsand pharmacists in the process.As we have more total numbers of people using opioids forrecreation or legitimate reasons, we also have a larger set of people who areat risk of avoidable issues like drinking alcohol or taking benzodiazepines orother drugs which put them at risk of opioid overdoses. Reviewing the CDC's ownwebsite on the epidemic, they bury information about the problems of drugmixing. https://www.cdc.gov/drugoverdose/epidemic/And then we have the problem of more people entering theblack market - and the risk of unscrupulous drug dealers adding fentanyl toheroin; and the perennial problem of street heroin varying widely in purity. So, those maps are telling us something,but not as much as we need to really drill down into what's going right andwrong. Regards,Sal 
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