The opiod epidemic....

[Jeff Higgins]

Thanks, George. I get the impression you might be the only one who bothered to read this article. The comment you include from the readers' comments pretty much says it all:

Mr. Bloom, thank you for being a such a clear and cogent voice on this topic. With this piece, you cut through the PR nightmare created by those creating the so-called "epidemic" narrative. This article is exemplary and will very likely become one of the seminal works on this topic. It should be sent to every policy-maker in America to help them understand the immense suffering this fake "epidemic" has caused to hundreds of thousands of intractable pain patients, most of whom have suffered the loss of their physicians and their life-saving medications.

Having the ability to relieve pain and suffering with simple medications, but choosing not to do so, is akin to torture. Why would American lawmakers and physicians subject patients with intractable pain syndromes to lives of suffering and suicide, and leave them untreated, when simple solutions exist? Hopefully, your work here will make this clear.

Thank you again. Fantastic work.

Again, this is very much a manufactured crisis, replete with all of the usual tactics. Accusations against an evil corporate entity (America just loves that), hard-hitting TV specials telling us the "real truth" of the matter, endless coverage in every news cycle, and so forth.

I would implore the rest of you to read this article. Do some more research. Question what the breathless pundits are trying to feed you. Not much of it is true.

[kach22i]

Originally Posted by Jeff Higgins

Thanks, George. I get the impression you might be the only one who bothered to read this article. The comment you include from the readers' comments pretty much says it all:..............

You can never know for sure how many people click an article link, well maybe a computer geek can tell but I cannot.

More on who Josh Bloom is, and why his many articles should matter.

Josh Bloom
https://www.acsh.org/profile/josh-bloom

Dr. Josh Bloom, the Director of Chemical and Pharmaceutical Science, is a recognized expert on the opioid crisis and was the first journalist to write a nationally published opinion piece about the unintended consequences of a governmental crackdown on prescriptions opioids (New York Post, 2013). Since that time he has published more than a dozen op-eds in regional and national newspapers on different aspects of the crisis. In that same year, he testified at an FDA hearing and was the only speaker to note that fentanyl was the real killer, something that would be proven years later.

He was also the first writer (2016) to study, dissect and ultimately debunk the manipulated statistics used by the CDC to justify its recommendations for opioid prescribing, which have resulted in draconian requirements for prescribing pain medications as well as government-mandated, involuntary tapering of patients receiving opioid treatment, both of which have caused great harm and needless suffering to chronic pain patients. His 2016 article, "Six Charts Designed to Confuse You," is the seminal work on CDC deception and has been adopted by patient advocacy groups and individuals and has been sent to governors and state legislatures...................

Centers for Disease Control and Prevention (CDC)............I had to look that up because one of the article said standards were being imported from Canada under flawed science.

Maybe Josh's best article yet - shows the math.

2018
The CDC Quietly Admits It Screwed Up Counting Opioid Pills
https://www.acsh.org/news/2018/03/19/cdc-quietly-admits-it-screwed-dishonestly-counting-pills-12717

Traditionally, the Centers for Disease Control and Prevention (CDC) and others have included synthetic opioid deaths in estimates of “prescription” opioid deaths. However, with [fentanyl] likely being involved more recently, estimating prescription opioid–involved deaths with the inclusion of synthetic opioid– involved deaths could significantly inflate estimates.

This false classification would seem to be no more than a trick. By combining legally prescribed opioids with street drugs the CDC has generated phony data that supports its doctrine - that prescription medications are killing people en masse. They are not. Once the fallacy falls away things look quite different (Table 2).

[john70t]

The SFGH lobby was 99% 'undocumented' when I was there.
https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital
Most big hospital ERs negotiate prices for care with major health insurance providers and are considered “in-network.” Zuckerberg San Francisco General has not done that bargaining with private plans, making them “out-of-network.” That leaves many insured patients footing big bills.

Prices have to be advertised (finally)
https://qz.com/1509095/hospital-to-post-the-costs-of-medical-services/amp/

How much big pharma pays doctors database
https://openpaymentsdata.cms.gov/

This is all you need to read.
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain
The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts.
It is truly RICO-worthy conspiracy, designed to subjugate honest taxpaying citizens, and open theft.
Meanwhile the FBI uses heavily swat teams against elderly lobbyists in their pj's.

[Sooner or later]

Originally Posted by john70t

The SFGH lobby was 99% 'undocumented' when I was there.
https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital
Most big hospital ERs negotiate prices for care with major health insurance providers and are considered “in-network.” Zuckerberg San Francisco General has not done that bargaining with private plans, making them “out-of-network.” That leaves many insured patients footing big bills.

Prices have to be advertised (finally)
https://qz.com/1509095/hospital-to-post-the-costs-of-medical-services/amp/

How much big pharma pays doctors database
https://openpaymentsdata.cms.gov/

This is all you need to read.
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain
The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts.
It is truly RICO-worthy conspiracy, designed to subjugate honest taxpaying citizens, and open theft.
Meanwhile the FBI uses heavily swat teams against elderly lobbyists in their pj's.

I'll be damned. Actually providing pricing. I am happy today!

[Sooner or later]

I am so happy about posted pricing I have to say it again!


How have I missed that?

[wdfifteen]

Originally Posted by pavulon

That's off by a fair bit. The spectrum on which people experience pain is wide and people writing scripts don't have a crystal ball.

My point was that people writing scripts (and nurses giving advice) behave as if they DO have a crystal ball. “Take this, get ahead of the pain,” assumes they KNOW you are going to be in pain.

[berettafan]

My experience with pain meds when i had kidney stones a few years back had me feeling like a basketball star in a titty bar. everything you could possibly want was being offered to you.

And frankly i appreciated it greatly! but for home i opted to only get the 600mg ibuprofen. some of those meds like diloded (sp?) are so darned pleasant to experience i didn't dare get the home version.

i do take pride in my ability to suffer without meds. although the last time i did that in a docs office they had to get the smelling salts out for me. i found the answer to the question "How much could a simple cyst on the back hurt to cut out?" is "enough to make you pass out".

[Tobra]

Originally Posted by GH85Carrera

When I was recovering from hip replacement surgery I was hooked up to the "dial a smile" morphine pump. If the pain was high, I pushed the button. It would only pump if it had been long enough since the last pump. It did relieve pain and let me sleep. But damn did it cause constipation. If I ever get another hookup to a dial a smile, I will be demanding laxatives on a constant basis.

They are supposed to be giving you stool softeners with the narcotics.

Originally Posted by wdfifteen

My point was that people writing scripts (and nurses giving advice) behave as if they DO have a crystal ball. “Take this, get ahead of the pain,” assumes they KNOW you are going to be in pain.

You still don't get it at all. They know you will have pain, and I am quite certain you did.

The crystal ball is in how well you will deal with that pain, and is the cost benefit from taking opioids worth it to your as an individual.

[Jeff Higgins]

Originally Posted by kach22i

You can never know for sure how many people click an article link, well maybe a computer geek can tell but I cannot.

More on who Josh Bloom is, and why his many articles should matter.

Josh Bloom
https://www.acsh.org/profile/josh-bloom


Centers for Disease Control and Prevention (CDC)............I had to look that up because one of the article said standards were being imported from Canada under flawed science.

Maybe Josh's best article yet - shows the math.

2018
The CDC Quietly Admits It Screwed Up Counting Opioid Pills
https://www.acsh.org/news/2018/03/19/cdc-quietly-admits-it-screwed-dishonestly-counting-pills-12717

Thanks once again, George. For once your mad interwebs research skilz are being put to good use.

This whole thing is no more than a money grubbing farce. Or, no, actually if that were all it was, it would be disgusting enough. In the background we have millions of Americans whose pain is currently being under treated. They are suffering needlessly. They are suffering because some zealots at the CDC and other government agencies smell money. Big money. Big pharma money.

The CDC itself has become no more than a home for zealots with an axe to grind. They long ago became politicized, in a field wherein there is no room for politics. They first came to my attention decades ago when they tried to classify firearms as a "health hazard" in an effort to regulate them as such. Yeah, when the Second Amendment proves too great of a hurdle to overcome in your pursuit of your gun control agenda, simply reclassify guns as a "health hazard", put them on the schedule of controlled substances, and viola - back door gun control.

So, yeah - anything with "CDC" anywhere in the mix needs to be examined with suspicion. They have long ago lost all objectivity and, along with it, any credibility whatsoever.

[kach22i]

Originally Posted by Jeff Higgins

This whole thing is no more than a money grubbing farce.

I'm going to have to say you are only half right.

The money grubbing farce was perpetrated by the makers of Oxycodone with a fraudulent marketing campaign claiming their product wasn't as additive as everyone else's.

Doctors handing it out like candy certainly didn't help - how many samples would you like? No length or limit to the amount one can prescribe.

Then we have the bad science imported from Canada of combing categories to fabricate an epidemic.

To what end of why this was done I do not know.

How this is money grubbing unless you are selling stocks in rehabilitation centers or franchising them is a mystery to me.

It is what it is, no need to keep pendulum pushing, that's how shat like this gets started in the first place.

People in pain are not getting the meds they need.

This needs to be fixed.

Junkies out there hooked on perception meds, this too needs to be fixed.

It is not one or the other, it is both.

I do not fully understand the Canadian health profession link (via Andrew Kolodny and David Juurlink), and do not see why being addicted to pain fillers is of importance if your are going to die from cancer anyway. Hey, cancer is painful, go out with a smile I say.


Dec 2016
Addressing the limitations of the CDC guideline for prescribing opioids for chronic noncancer pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135486/

The excessive use of opioids for chronic noncancer pain represents a serious public health problem in Canada, and health care regulators face considerable pressure to adopt stricter policies to curb prescribing practices. In March 2016, the United States Centers for Disease Control and Prevention (CDC) issued a guideline for prescribing of opioids for chronic pain.1 Because it raises many cautions regarding opioid prescribing, and if followed would undoubtedly reduce opioid prescribing and related harms in Canada, many regulators and commentators have welcomed the guideline. However, it does have important limitations.

Public Health Agency of Canada (PHAC) says they have problems up north too.

Overview of national data on opioid-related harms and deaths
https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/data-surveillance-research/harms-deaths.html

Defining a common denominator would go a long way to tagging the problems.

[kach22i]

I found more on the Canadian connection of sharing information and adopting practices.


https://www.painnewsnetwork.org/stories/2018/5/28/when-do-guidelines-become-guidelines

When Do Guidelines Become Guidelines?
May 28, 2018

By Marvin Ross, Guest Columnist

Blaming doctors for failing to prescribe to guidelines that did not exist is the latest in the strange research coming out on the use of opioid pain medication.

That was the case for a recent study led by Dr. Tara Gomes, Dr. David Juurlink and others at the Institute for Clinical and Evaluative Studies (ICES) in Toronto, Canada. Both of these authors have a long list of research reports on opioids and Juurlink was one of the central players in the development of the Canadian guidelines for prescribing opioids for non-cancer pain. Juurlink is also a board member of Physicians for Responsible Opioid Prescribing (PROP), which is notorious for their anti-opioid views.

This particular study, called “Clinical indications associated with opioid initiation for pain management in Ontario, Canada,” is published online in the journal Pain. Gomes and Juurlink set out to evaluate prescribing patterns for patients who are “opioid naïve” to see if their prescriptions complied with guidelines adopted in the U.S. and Canada. In many cases, they did not.

“The U.S. and Canadian clinical guidelines for prescribing opioids for chronic non-cancer pain suggest that doctors should avoid initiating opioids at daily doses above 50 MME," Gomes is quoted saying in an ICES press release.............

....................(Update: Mr. Ross has been informed by the editor of Pain that the Gomes study has been revised to clarify to that the CDC and Canadian opioid guidelines were not in effect during the study period.)

Read the whole article and let us know how this all fits together.

I still feel like all I have is bits and pieces.

Nearly a quarter of all Ontarians newly prescribed opioids received a daily dose exceeding clinical guidelines
https://www.ices.on.ca/Newsroom/News-Releases/2018/Nearly-a-quarter-of-all-Ontarians-newly-prescribed-opioids-received-a-daily-dose

May 16, 2018 Toronto

Nearly a quarter (23.9 per cent) of initial opioid prescriptions in Ontario had a daily dose of more than 50 milligram morphine equivalents (MME), exceeding the suggested dose threshold for opioid prescriptions outlined in North American clinical guidelines, according to a new study from the Institute for Clinical Evaluative Sciences (ICES) and St. Michael's Hospital.

"The U.S. and Canadian clinical guidelines for prescribing opioids for chronic non-cancer pain suggest that doctors should avoid initiating opioids at daily doses above 50 MME. Our study found that nearly one-quarter of Ontarians taking an opioid for the first time received a daily dose exceeding this threshold, and for certain indications such as knee, hip and shoulder surgeries and Caesarean sections, the dose was even higher,” says Dr. Tara Gomes, lead author of the study and a scientist at ICES.................

Prescriptions for opioids have increased sharply in the last decade, making Canada the second highest per-capita user of opioids in the world. Furthermore, 1 in 8 Ontarians was dispensed an opioid in 2016, and Ontario has seen a four-fold increase in overdose deaths in the last 25 years, according to earlier research by Gomes.

I don't see the data collecting people like Tara Gomes as the problem for what's going on in hospitals and doctor's offices, it's the people/organizations combining data incorrectly and forming false conclusions that are the culprits.

[wdfifteen]

Originally Posted by Tobra

You still don't get it at all. They know you will have pain, and I am quite certain you did.

The crystal ball is in how well you will deal with that pain, and is the cost benefit from taking opioids worth it to your as an individual.

Yes, my foot hurt post op. Tylenol, ice, and elevation controlled it well. They didn’t know that, their crystal ball told them I would need tall drugs. So I do get it it. The doc prescribed pain meds, but he didn’t insist I take them, “In case it MIGHT hurt.” He told me to take them, “In case it DOES hurt.” Big difference, and I think it is the difference between offering pain meds and pushing pain meds.

[KFC911]

Originally Posted by wdfifteen

.... The doc prescribed pain meds, but he didn’t insist I take them, “In case it MIGHT hurt.” He told me to take them, “In case it DOES hurt.” Big difference, and I think it is the difference between offering pain meds and pushing pain meds.

Offering opiates to those with the "addictive gene" is a recipe for disaster too. They will take them every time...

Then the addiction is in total control....nothing else...Oxycontin and Pardue. I don't have to read or watch TV....I've seen it first hand. Best back surgeon, best hospital, best everything....except actually managing excruciating post-op pain....for over ten years .

My older sister will die hoplessly addicted to methadone though...that's her world and it sucks. But she's alive...and doing pretty OK now...but no different than a heroin addict on the street....

I have no answers...none.

[widebody911]

At my BIL's apartment complex in San Diego, 3 people OD'd yesterday on fentanyl, 1 fatal.

I have a hard time feeling sorry for people who OD on recreational drugs. A piano falls out of the sky and lands on your head? That's tragic. You're shooting up drugs and take just a little too much? Paging Charles Darwin... Charles Darwin, please pick up the white courtesy phone...

[Craig T]

Originally Posted by widebody911

I have a hard time feeling sorry for people who OD on recreational drugs. A piano falls out of the sky and lands on your head? That's tragic. You're shooting up drugs and take just a little too much? Paging Charles Darwin... Charles Darwin, please pick up the white courtesy phone...

You're so insensitive. It's a "disease" and not their fault.

[Sooner or later]

An opioid radio service announcement has been getting a lot of play.

A lady asks for another prescription but the doctor raises concerns and suggests an anti inflammatory.

[KFC911]

Originally Posted by widebody911

At my BIL's apartment complex in San Diego, 3 people OD'd yesterday on fentanyl, 1 fatal.

I have a hard time feeling sorry for people who OD on recreational drugs. A piano falls out of the sky and lands on your head? That's tragic. You're shooting up drugs and take just a little too much? Paging Charles Darwin... Charles Darwin, please pick up the white courtesy phone...

Yep....a bad batch hits the streets for the first part...but how did most get to the heroin? My life and personal experiences have always been on the "better side" of the economic curve....same results for WAY too many young kids....via pills. Oxycontin on the street is a total "crapshoot" in terms of strength....and it kills too.

[gordner]

Strangely, it is not a bad batch that does it normally, it is a good batch. More pure, more overdoses.

[wdfifteen]

I had an interesting talk with my doc after my surgery this morning. He pointed out that inappropriate pain control can get a head of the healing process, making things worse. You don’t hurt, so you don’t take care of yourself. He told me about a patient of his who had foot surgery in the morning and was out mowing his lawn that afternoon. He felt fine, but his fresh wound was far from fine.

[wdfifteen]

Originally Posted by KC911

Offering opiates to those with the "addictive gene" is a recipe for disaster too. They will take them every time...

Yes, but to Tobra’s point, you shouldn’t withhold pain control from everyone just because some people are easily addicted.