Tag Archives: drugs

Laws Cause Crime

The government thrives on crisis.  If it doesn’t have one, it will create one, in order to justify wasting more money and grabbing more power.  The “opioid crisis” is a case in point.  To suggest this is a manufactured crisis invites challenge, because I am a lone voice against a deluge of government, media, institutional, industry, and public claimants who insist the “crisis” is real and in need of drastic counter-crisis interventions.

As I recently trudged the forty hours of propaganda training necessary to renew my medical license, I noted a new requirement by the state of Georgia to undergo three hours of training in opioids.  In studying the materials, I also learned about Prescription Drug Monitoring Programs (PDMPs), which are “state-operated databases that collect data on dispensed medications.  They periodically send reports to law enforcement, regulators, and licensing agencies, as part of an effort to control diversion of medication by prescribers, pharmacies, and organized criminals.”

Let’s be clear, here.  The histrionic references to the “opioid epidemic,” this “public health emergency,” and its fatalities usually involve heroin, which is increasingly adulterated with fentanyl.  Heroin is absolutely illegal in the US, so no doctor can prescribe it.  Fentanyl is used in surgery and exists as a patch, and is not injectable.  Most fentanyl is obtained illegally, and some sources say it is coming from China.

So the database to track prescribers and users of controlled substances sounds more like a government control strategy than any genuine attempt to protect users from overdoses.

Meanwhile, as I stewed over the “gotcha game” of putting doctors in the firing line of this artificial crisis—damned if you do and damned if you don’t–I received a notice requiring me to show up in court for federal jury duty.  Unlike jury duty for local court (which I did a month ago), there is a dress code for the feds.  Women must wear a dress or pants suit.  So I hauled out my one dress—a fall dress—and washed most of the musty smell out of it.  Already I was plotting ways to get myself disqualified without going to jail.

I have long protested the almost rabid encroachment of the federal government on individuals, most vividly embodied in drug laws.  I retired over the virtual mandate to prescribe, with psychiatrists marginalized into “medication managers,” and psychotherapy turfed to less expensive psychologists and social workers.

Meanwhile, drug laws as part of the patriarchal government control and revenue machine has a long history.

Wars have been fought over opiates.   Although their medicinal powers have been known for at least 6000 years, in the Middle East, Roman, and Greek civilizations, and Asia, the practice of smoking opium was brought to China in the 1600s by European traders.  By 1729, there was so much addiction that China outlawed it because it made opium smokers unfit for work or the military.  However, the British used slaves in India to grow the opium poppy and to smuggle the drug into China.  Presumably, the Chinese were willing to buy the opium with gold, and gold was leaving the country.  This led to the Opium Wars, which the British won, and through the Treaty of Nanjing and subsequent ones, forced China open to trade with the Western World.

My Goodman and Gillman’s The Pharmacological Basis of Therapeutics claims that “opioids have been the mainstay of pain treatment for thousands of years, and remain so today.” Opiates and opioids are highly addictive, and tolerance to their euphoric effects builds faster than to physical effects, such as respiratory depression.  This can lead to fatal overdoses, as the user takes more and more drug to reach euphoric levels.  When combined with other drugs that depress the respiratory center, like benzodiazepines (such as Valium, Ativan, or Xanax), or alcohol, the risk for fatal overdose is magnified.

The Harrison Narcotics Act of 1914 put the federal government in control of every aspect of the opiate and coca supply-and-distribution chain, as well as insuring taxing power over them.  There are strong arguments that it was a racial discrimination tool.  It was claimed that cocaine was improving Southern blacks’ gun marksmanship and causing them to rape white women.  Chinese immigrants were seducing white women with opium.  Later, the Marijuana Tax Act of 1937 was used to control the Mexican immigrants who had used marijuana as part of their culture for centuries.  US citizens, who had used “cannabis” in their tonics, did not know it was the same substance as the Mexicans’ “marihuana.”

Fast forward to 1970, when the Controlled Substances Act (Richard Nixon), instituted a schedule for approved substances.  Both heroin and marijuana were assigned to Schedule I status: no medical benefit and absolutely illegal.

The Drug Enforcement Administration was created as a sub-agency under the Department of Justice on July 1, 1973 to enforce the Controlled Substances Act, among other things.

The “War on Drugs,” begun by President Nixon in 1971, was vigorously pursued by President Ronald Reagan, who took office in 1981.  For-profit prisons began emerging after 1980 to accommodate the massive incarcerations that resulted.  Reagan’s Anti-Drug Abuse Act of 1986 dramatically increased the number of incarcerations and length of sentences for drug-related convictions.  As of 2008, 90.7 percent of federal prisoners were incarcerated for non-violent offenses.  At present, the US has the highest rate of incarceration in the world, 724/100,000 people, compared with Russia in second place, with 581/100,000 doing time in prisons, jails, on probation or parole.  The US has 25% of the entire world’s incarcerated population, with black men comprising almost half.

Laws cause crime, according to me, and drug laws are especially guilty of creating the criminal element that is filling the prisons.  So last week, when the federal judge read the indictments against the young, black, male defendant, who was charged with conspiracy to distribute cocaine, methamphetamine, and marijuana, I knew I could not be impartial.  The judge listed all the members of the federal prosecution team, the local narcotics squad, and the members of the Georgia Bureau of Investigation team who had participated in this gang bang (my take) on this one guy and his lone, white, female attorney.  When the judge asked if anyone had any issues with the federal government, my hand shot up.

I was handed the microphone, stated my name, and said I retired over drug laws.  The judge asked if I could consider the facts of the case as they applied to the laws.  I said the laws themselves are criminal, and, to my mind, the federal government is on trial, here.  It is guilty of practicing medicine, and the defendant is innocent. (That’s how I remember it, anyway.)

“At least she’s honest,” the judge said.  At that point all the lawyers agreed that I would not be a good juror.  I was dismissed and did not get arrested on the way out.

Now, we have the ongoing “opioid crisis,” a new twist on an old theme, once again designed to control through fiat and insider collusion, people’s rights to self-governance.  The institutional powers-that-be have ganged up to push misleading propaganda on the public.  First, the officially prescribed “cure” for this crisis is more money, and more government and institutional control, specifically for “medication-assisted treatment.”

The misrepresentation in reporting shows in its superficiality, with slants calculated to confuse the facts.  First, in reporting numbers of fatal overdoses, heroin is included with other opioids, including prescription pain medications.  Heroin exists in its own category, because no doctor can prescribe it, so there is no legal way to obtain it.  Doctors are being targeted for over-prescribing opioid pain killers, so there’s the push to put more controls on prescribing MDs.

Another flaw in the reported statistics is that “overdoses” are not broken down to determine how many drugs may have contributed to the death.  Accidental overdoses of all medications are increasing, primarily because people are taking too many different medications—not all psychotropics– with cumulative side effects, including respiratory depression.

“Medication-assisted treatment,” is—no matter what they claim—substituting one pill for another, and yet another plank in the pill-pushing platform of the “health-care industry.”  The three drugs approved for treating “opioid use disorder” by the FDA include methadone (an opioid agonist) and buprenorphine (an opioid agonist-antagonist) —both opioids themselves—and naltrexone (an opioid antagonist). Now, “providers” need special licenses and special training to prescribe buprenorphine.

The psychiatric establishment is pushing for more funding for more “addiction specialists” and more legislation to curb this dangerous trend.    FDA Commissioner Scott Gottlieb is pushing for more funding for more treatment and insurance coverage.  They brag about how all the professional and government organizations have joined in “partnership” with drug companies to find ever more effective strategies for treatment.

Never mind that an internet search leads to addicts who extol the highs they experience from buprenorphine.  Addicts are happy with methadone, too, and can fairly easily switch dependencies, especially if they add other drugs.  The high from buprenorphine isn’t as good as with heroin, they claim, but it can be enhanced with benzos like Valium.  The withdrawal is easier than with heroin, but it lasts longer.  Nausea and vomiting are problems.

Never mind that most substance abuse treatment is notoriously ineffective, with most studies following patients for a year or less.  The mainstay of treatment since 1935 has been the non-pharmacological approach of Alcoholics Anonymous and its spin-offs, like Narcotics Anonymous (NA) and Cocaine Anonymous (CA).

So where’s the crisis? It is claimed Prohibition gave rise to organized crime, because the best way to raise the price of anything is to put controls on it.  Do laws cause crime?  With all the lawyers practicing medicine in Congress and in the Supreme Court, I have to wonder if they do.

 

 

 

 

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If I Were in Charge . . .

If I were in charge of things, I would have more enemies than Donald Trump.  I would discriminate against everyone equally.  I would start with the budget and eliminate deficit spending.  Last year’s revenues would be this year’s budget limit.  This would infuriate everyone except the unborn children who are expected to pay for ballooning government debt.

Under the premise that government exists to fund itself, the next obvious bugaboo is taxes.  For people to pay taxes, they either have to be bullied or conned into thinking they will get returns on their investment.  This is why there are so many government jobs, government contractors, and government programs.  “Hire the opposition” is an ancient method of reducing competition and getting cooperation.  If you can’t hire the opposition, you can compromise the competition by making laws against them or throwing them in jail.

Of course, jail costs money, but the cost of competition is higher.  If you’re a monopoly, like the US government, you claim a monopoly over all “economic narrows,” such as the money supply, and over the laws, like drug laws, so that you can create bureaucracies to enforce the laws everywhere in the world.  This is why we have wars, which cost unborn children lots of future money.  This is why we have drug cartels, too, that create enormous competition for governments, unless they buy governments and then protect each other.  This is not only about El Chapo, who just got convicted, but about Pfizer, and all the other government-sanctioned drug cartels that trade so profitably on Wall Street.

If I were in charge, then, I would quit funding wars, bring the military home, and re-write their job descriptions to do the jobs we now hire government contractors to do.  That government competes with the private sector for skilled labor is a given.  Releasing government employees from their monopolistic responsibilities would free the government from doing both its job and that of the private sector, too.  This would save unborn taxpayers lots of future money.

If I haven’t been assassinated or impeached by this point, I would issue a currency that would compete with the Federal Reserve Note.  I would allow the new currency to be used in paying taxes.  People could still use their Federal Reserve Notes to pay income and payroll taxes, which are set up to pay the Fed perpetual interest on federal debt.  If the government is no longer borrowing money to support a deficit, the Federal Reserve would become superfluous. It could collect its Federal Reserve Notes in perpetuity and cost the US government nothing.  Since the income tax pays for stupidity, many people may opt out of paying the Fed to finance government insanity.  Not to stigmatize the mentally ill.  Not all insane people are stupid, and not all stupid people are insane, but, like lawyers, there seems to be a disproportionate percentage of both in elected positions.

I would not waste money on border walls or border security.  The way to stem illegal immigration is to give the immigrants no reason cross the border.  If there were no drug laws, there would be no drug cartels, and no need for CIA, DEA, FDA, DOJ, and the international deep state financial system of commodity drug money.  All those escapees from Guatemala and Honduras could return home safely.

If I haven’t alienated everyone by now, I would make payroll taxes for Social Security and Medicare optional, both for employees and employers.  This would free up today’s money for today’s needs and asset building.  As things stand, the fiat money we have now represents government debt, so the more you have, the more federal debt you have assumed.

The government knows that the best way to control people is to borrow from them or to lend to them.  If you lend something that is valueless, backed only by the “full faith and credit of the federal government,” you are counting on promises made on behalf of those unborn taxpayers to work for future money to pay a debt on nothing.  Thus all investments, except those with practical value–like a debt-free home you live in–are investments in government debt, so “Rah, rah, America,” if you want your old-age nest egg to survive in the Ponzi financial system that depends on future money to pay for present excesses.  Anyone wonder why the US dollar has lost 97% of its value since the Federal Reserve Act was passed in 1913?  The “full faith and credit of the United States,” isn’t worth much anymore.

If I were in charge of things, I would acknowledge that government can barely afford to be in the government-over-the people business, much less in the war business, the agriculture business, the health care business, the social-consciousness business or the business business, so I would dismantle all the government “help” and its corresponding regulation and force people to find their own answers to their own problems, without the Nanny State to tell them what to do and how to do it.

If I were in charge, then, I would make life as easy as possible for myself by divesting myself of responsibility for making decisions for everyone else.  By then everyone would probably be an enemy, but who needs friends when you have peace?

 

Drugs, Drugs, and More Drugs

The pharmaceutical industry in the United States has hoodwinked the public into believing its snake oils are worth the money you pay.  The government, “health care industry,” and insurance companies are happy to comply, and maybe some of them even believe their hype.

This does not stop them from jacking up the prices of necessary medications, like insulin for diabetes.  According to the New York Times, Martin Shkreli set a new record for Wall Street greed when he acquired the rights to Daraprim, a life-saving anti-parasitic drug, in 2015 and hiked the price from $13.50 to $750 a pill overnight.

The NYT says the Trump administration “went ballistic” when Pfizer increased prices a few weeks ago.  This has deterred Pfizer, along with Merck, Roche, and Novartis from raising prices, for now.

But not to worry, if you have stock in a pharmaceutical company, because the FDA and its sympathizers are on your side.  Only worry if your insurance company doesn’t cover the cost of your medications.

You might profit from buying stock in the companies whose drugs the FDA, the “health care industry,” and the insurance companies are pushing, such as the over-the-counter naloxone that is one of four medications promoted for “opioid use disorder.”  In terms of reputation, this “opioid crisis” has spread far and wide, to the highest government offices, academia, psychiatry, newspapers, magazines, television, the internet, the courts, and dinner-table talk.  Its funding has been greatly enhanced by the promoters of public disinformation, yet relevant facts are few.  All the stories have the monotonous flavor of canned worms, opened, sampled and regurgitated for yet another meal.

We are told about opioid-related deaths, the evil drug company that promoted its opioid drug as non-addictive, the lazy or greedy doctors who over-prescribe narcotics, and the glories of “medication-assisted treatment,” or MAT.  Somehow, heroin comes up in all these stories, yet most people should know heroin is nowhere legal in the United States, not even by prescription.  We are rarely told that this magical MAT consists of four drugs, two of which are opiates themselves, or that the federal government has added special training and licensing requirements for administration of its approved protocol. We are not told that “treatment” does not mean “cure.”  No, “cure” would imply eventual freedom from all drugs, a notion that doesn’t serve Wall Street profits.

So let me give you one example of how this scam works.  I hesitate to call it a “conspiracy” (wink, wink), because of the paranoia such a word implies.  I’d rather call it a “consortium” of interrelated interests, all of which stand to profit by exaggerating the problem and presenting expensive but ineffective solutions.

We are told opioid-related deaths have skyrocketed this century, and Oxycontin (oxycodone) is the precipitating culprit.  OxyContin is produced by Purdue Pharma, which indeed does have a shady background.  In 1952, three brothers—Arthur, Raymond, and Mortimer Sackler–all psychiatrists from Queens, New York, purchased Purdue Frederick Company.  Arthur was reputed to be brilliant in psychiatric research and pharmaceutical advertising.  Working for Roche, he found enough uses for Valium (diazepam) to make it the first drug to hit the $100 million mark in revenue.  He also “positioned” Librium (chlordiazepoxide) for Roche.  Valium and Librium are members of the “benzodiazepine” class of drugs, a class that includes Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and others.  Alternatively, oxycodone is a semi-synthetic opioid from thebaine, an opioid alkaloid in the Persian poppy.  It was developed in 1919 in Germany.

In December, 1995 the US Food and Drug Administration (FDA) approved Purdue’s OxyContin (oxycodone), to treat pain.  It hit the market in 1996. Direct-to-consumer (DTC) advertising of drugs was approved by the FDA in 1997.  Purdue marketed the drug to doctors and the public as a non-addictive treatment for pain.  It reached $45 million in sales the first year, and $1.1 billion by 2000.  By 2000, it was becoming evident that OxyContin was, indeed, addictive, but the FDA still approved a larger, 160-milligram pill for those with high tolerance.

In 2007, in US vs. Purdue Frederick Company, Inc., Purdue pleaded guilty to intent to mislead doctors and patients about the addictive properties of OxyContin.  It paid $600 million in fines, among the largest settlements for pharmaceutical companies in US history.

By 2010, revenues had hit $3.1 billion, or 30 percent of the painkiller market.  Purdue remains a privately held company, in the hands of the Sackler descendants.  It is being served with multiple lawsuits from different states for its role in contributing to the “opioid epidemic.”  According to The Week, Kentucky is one of the worst-hit states.  It has filed twelve claims against Purdue, for false advertising, Medicaid fraud, unjust enrichment, and punitive damages, among others.  The Week also says there was a four-fold increase in prescription painkillers supplied to pharmacies and MD offices between 1999 and 2010.

Meanwhile, The Guardian reported in 2017 that the US constitutes 80 percent of opioid pill production but has only five percent of the world’s population.  It claims the pharmaceutical companies made false claims of an “epidemic of pain,” in the 1990s, and the federal agencies went along.  Pharmaceutical lobbyists got Congress to loosen restraints, and doctors were often reprimanded for not supplying enough.  “Regulators became facilitators,” as the FDA approved one opioid pill after another.

How does this relate to heroin, a known street drug, one might ask.  It’s a good question, for which there are no easy answers.  The idea that prescription painkiller pills are “gateway” drugs to heroin use has been mentioned.  One source notes that heroin is less expensive on the street than OxyContin, which can cost $1/milligram, or $80 for an 80-mg pill.  A more significant problem with heroin, we are told, is that it is increasingly laced with fentanyl, another opiate that is up to 5000 times stronger than heroin.  Synthetic fentanyl is being smuggled in from China.  Heroin is coming from Mexico, some say.  Fact is, there are few facts available in this gigantic obfuscation of facts that characterizes sensationalism.

So we don’t exactly know how prescription pain-killers are related to heroin/fentanyl deaths.

Death from opioids usually comes from respiratory depression.  In other words, people who overdose pass out and stop breathing.  Many other drugs cause respiratory depression, too, and a mixture can have cumulative effects.  It is common for people with chronic pain to take both a narcotic (opioid) and a muscle relaxant/sedative of the benzodiazepine class mentioned above.  The benzodiazepines also cause respiratory depression, as does alcohol.   Too, it’s not clear how many of these opioid-related deaths are complicated by other substances.  One psychiatric journal mentioned that a third of opioid deaths were complicated by benzodiazepines.  It’s probably safe to say that hard-core street addicts could be taking many drugs at any given time.

But our “medication-assisted treatment” bypasses all these inconvenient details.  It does include a drug, naloxone, which reverses the effects of opioids and can save lives in a primary opioid emergency.  It has been around over 45 years and is well known in emergency rooms for its life-saving effects.  Since this crisis began, police and ambulance drivers have had to use it on numerous occasions.  Now, the US Surgeon General Jerome Adams, MD, MPH, has encouraged over-the-counter preparations of naloxone for those with opioid use disorder and their loved ones.  FDA head Scott Gottlieb is also advocating expanded access to treatment, Medicaid funding, and other systemic changes to pay for the problem.

Manufacturers of OTC naloxone have jumped to increase prices accordingly.  Narcan intranasal (Adapt Pharma Inc.) retails for $135/dose, more than double its price a few years ago.  Kaleo’s Evzio auto-injector now retails for $4,500, more than 6.5 times its $690 average price in 2014.

What’s not clear about this scenario is how a passed-out opioid over-doser who has stopped breathing will be able to administer the naloxone.  Irreversible brain damage occurs mere minutes after a person stops breathing.  The life-saving medication requires someone alert, quick to recognize the problem, and to administer the antidote.

With all the calls for funding, research, and treatment, no one is admitting that substance use treatment is notoriously ineffective.  FDA head Gottlieb and others are begrudgingly accepting the idea that cure may not be practical, and long-term maintenance must be considered.  So the magic bullet, the aforementioned MAT, or “medication-assisted treatment,” is not a cure.  It is designed to convert illegal opioid use to legal opioid use for perhaps a lifetime.  Of course this will require funding for treatment, for the treating facilities, support staff, the researchers, and for the prescriptions.

Who benefits from this crisis?  Well, the National Institute of Health has earmarked $1.1 billion to develop “scientific solutions,” backed by a $1.3 trillion omnibus package passed by Congress, according to Psychiatric News.

US President Donald Trump has declared the “opioid crisis” a public health emergency.  We have the White House Opioid Commission looking for ways to fund and treat the problem, including such issues as insurance coverage.  It recommends funding for no less than eight professional organizations.

The four approved medications in MAT are naloxone, mentioned above, naltrexone, and opioids buprenorphine and methadone, in case you want to buy stock in the companies.  Insurance company stock will most likely benefit, too.

The common denominator in this “emergency” is the use of more drugs to treat the drug problem in the drug-crazed culture we have created.

Crazies ‘R’ Us

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One of my alter-egos, Kookie the Shrink, with New-Age, eco-friendly, portable, non-pharmaceutical, public domain feel-good idea that hasn’t been invented yet.

Everyone knows psychiatrists are crazy.  Just ask my deceased mother, who claimed psychiatrists enter the profession to solve their own problems.  Fact is, I only began having problems in medical school.  My problems got worse after psychiatry residency, when I started practicing psychiatry in a “health care industry” so saturated with sanctimonious hypocrisy that I was astounded.  No one seemed to notice or care that externally imposed rules and expectations were making a mockery of the principles I was taught in training.  While everyone in the “health care industry” claims to be acting in the patients’ and public’s best interest, the so-called “healers” have become passive tools in a tidal wave of co-dependency that cripples to control and calls it “care.”

While “health care” professionals across the board have succumbed to this debilitating delusion, I feel particularly betrayed by the leadership in my own chosen specialty, because psychiatrists should know better.  I believe the psychiatric establishment has abdicated its philosophical foundations.  Instead of promoting mental health and self-reliance, it is busy kissing up to the profiteers in government, pharmaceutical and insurance industries, and seeking ever new ways to bind patients and the public to its mind-numbing agenda.

Two concurrent trends show how the psychiatric establishment–which depends on pharmaceutical advertising for its numerous professional publications—is desperately seeking relevance in a drug-pushing world.

The first trend, toward “medication-assisted treatment” for “opioid use disorder,” has been heavily embraced by the psychiatric establishment and the mainstream media.  The Friday, August 11, 2017 issue of USA Today claims “Opioids to be declared a national emergency.”  Here, we learn that President Donald Trump “’is drawing documents now’ to officially label the crisis as a national emergency.”  Such a designation would trigger specific tools for federal and state governments, including grants from the Public Health Emergencies Fund, a suspension of some of the patient privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and waive Medicaid restrictions on federal funding for mental health hospital admissions.

The second trend is the ongoing fight by the American Psychiatric Association (APA) and its state-level affiliates to stop the push by psychologists for prescription privileges.  This is an ongoing turf battle, with bills for psychologist prescribing introduced in multiple state legislatures every year.

The common denominator in these trends is that they are turf battles over drugs.  They have nothing to do with caring for patients, mental health, or the mind’s intrinsic self-healing potential.  The professional contestants, however, all claim they have patients’ best interests in mind.

Contributing factors abound.  In psychiatry, the shift from psychotherapy to medication management has been particularly devastating to professional self-esteem.  Psychiatry, now more than ever, seeks to align with the “scientific” foundations of medicine. Meanwhile, insurance and government have delegated “talk therapy” to less expensive psychologists and social workers.  What used to be 45-minute psychiatric consultations have become 15-minute “med checks.” Freud has been replaced by Prozac.

This follows a general cultural trend toward quick-fix solutions, with pills becoming the treatment of choice in all specialties except surgery.  The rise in illegal drug use can’t compare with the explosion of drugs for medical conditions, vaccines, and pseudo-conditions.  Over-medication is a major cause of accidents, drug interactions, and overdoses.  Unintentional injuries from falls and overdoses from prescription and illegal drugs are now the fourth leading cause of death in the US, according to one study.  Another study cites medical error the third leading cause in hospitalized patients.

The “opioid crisis” is attributed in part to Purdue Pharma’s misrepresenting OxyContin in 1997, when it was introduced, as having low abuse potential.  That same year, the FDA approved direct-to-consumer advertising. Pharmaceutical DTC advertising took off at the turn of the century.

That prescription painkillers fall in a different category from heroin—which cannot be prescribed in the US—bears mention, but they are linked by their black market affiliation.  OxyContin’s introduction on the market, and its aggressive marketing campaign to specialists and family practitioners brought Purdue Pharma $45 million in sales the first year.  That increased to $3.1 billion by 2010, or 30 percent of the prescription painkiller market.  In 2007, Purdue pleaded guilty in a federal lawsuit claiming it intended to mislead doctors and patients about its addictive properties.  It paid $600 million in fines.  The state of Kentucky, the state most ravaged by prescription painkiller and heroin use, has made 12 claims against Purdue, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages.  OxyContin costs up to $1/mg on the street, or up to $80 for an 80 mg tablet.

Other reports say fentanyl, a prescription opioid that can be synthesized by drug traffickers, dramatically increases the risk of fatal overdoses.  Its deadliest component, carfentanil, is five thousand times stronger than heroin.  Add this to the fact that multiple common drugs and alcohol also depress the respiratory center, with a cumulative effect.  Benzodiazepines, like Xanax, are often taken along with opiates.

The “opioid crisis,” is now being traced to pharmaceutical companies and to the FDA, according to The Guardian’s latest report.  (www.theguardian.com/commentisfree/2017/aug/13/dont-blame-addicts-for-americas-opoid-crisis-real-culprits)

The collusion between the psychiatric community and the pharmaceutical industry to push drugs on a gullible public smacks of a cronyism that few seem to recognize.  The FDA-approved “medication-assisted” treatment for opioid use disorder contains two opioids—methadone and buprenorphine—which are also abused.  However, the psychiatric establishment, which has sub-specialties in addiction, has a piss-poor success record with addiction treatment and virtually ignores Alcoholics Anonymous and its spin-offs, like Narcotics Anonymous.  These are peer run, free, and have a better track record than the “experts” can claim, despite their education and degrees.  The APA also ignores non-pharmaceutical treatments like acupuncture, which even the NIH has admitted has utility in chronic pain.  Auricular acupuncture for substance abuse has a long and under-appreciated track record.

Where does psychiatric officialdom stand on the mental health advantages of low-stress lifestyles, nutrition, physical therapy, and exercise?  Ask, and let me know what you find out.

Crazies ‘R’ Us indeed.  The psychiatrists need to get off the drugs and learn to use their minds to heal themselves first.

 

Opiates: Crisis du Jour

Opiate abuse is the crisis du jour in the medical and psychiatric world.  I’ve seen reference to it in the psychiatric journals, in the New York Times, and in the Summer, 2017 issue of Utne magazine.  There are Continuing Medical Education credits available for it.

Do I believe opiate abuse is a new problem, or that it has suddenly grown into the gigantic epidemic the “authorities” claim?  I know there is a push for funding for substance abuse treatment.  Other than that, I believe the “crisis” is fueled by enablers who need to be needed.

First, the literature I read makes no distinction between heroin, which is an absolutely illegal drug in the US, and the other opiates.  There’s a vague claim that the heroin is coming in from Mexico, but I wonder if it’s coming home with troops from Afghanistan, too.  No one has asked that question.

The legal-with-a-prescription opiates are presumed to be used for pain, and apparently there is a growing trend to abuse prescription opiates.  Doctors who prescribe too many of them fall under the DEA’s watchful eye, so I wonder how many doctors are willing to risk their licenses to support an abuse habit.  There are pain clinics sprouting up around the country, specialty clinics in which opiate use is standard.  These are carefully monitored by the DEA, as are pharmacy records that show which docs are prescribing controlled substances.

A large number and variety of substance abuse treatment methods and facilities exist, but effectiveness over the long term is poor.  Most studies into substance abuse treatment only follow patients for a year.  Long term studies are rare.  Alcoholics Anonymous (AA) and its spin-offs, like Narcotics Anonymous and Cocaine Anonymous—with their reliance on the 12-Step Program—have remained the standard since 1935.  These are free programs, peer supported, in which names and paperwork are not required.

My questions about this new “crisis” stems from my cynicism about our current drug-centered world.  The difference between “good” drugs and “bad” drugs is only a matter of legality, according to me.  Drug laws confuse the issue and create problems that needn’t exist.  Even the Psychiatric Times is beginning to take a fresh look at substances such as marijuana, looking to explore its potentially therapeutic effects.  There was a recent article suggesting hallucinogens like LSD and psilocybin might deserve more attention as therapeutic agents, under controlled conditions.

Unintentional injury from accidents and drug overdoses, according to one Continuing Medical Education (CME) course I took, is now in the top five causes of death.  The course didn’t distinguish how the overdoses occurred, but my experience tells me a surprisingly large number of people take ten or more medications, don’t know what they are taking, how to take them, or what they are for.  They don’t know about side effects, and their doctors don’t explain.  They take them “when I feel like I need them.”  or don’t take them at all if they can’t afford the cost.

Direct-to-consumer advertising by pharmaceutical companies has grown exponentially since it was approved by the FDA in 1997.  Pharma spent less than $800 million/year on advertising in 1996, but by 2000, that sum grew to $2.5 billion.  Of that, 20 percent was for psychiatric medications, and these constituted 10 percent of the top 100 selling drugs.

Obviously, there is a great demand for “feel-good” drugs, either over the counter or under the counter, and I have to wonder why.  From what I’ve seen, none of these drugs satisfies the long-term cravings of those who have lost their way.  The psychiatric drugs, like antidepressants, are not proving themselves over time, so there is a constant turnover of medications used to treat depression.  Yet advertising, the “health care industry,” and the world at large seems to believe there is a quick fix to problems, lifestyle problems, relationship problems, financial problems, employment problems, health problems, loneliness problems, and all the problems people’s fantasies tell them should respond to drugs.

As long as people put faith in solutions outside themselves, they will be disappointed, I believe.  Maybe a pill can help, temporarily, but there is no pill for financial problems, unless you’re selling it on the street.

That, in summary, may be the underlying impetus behind the “opiate crisis.”