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Opioid prescriptions, panic, and bad math

The editorial in this month’s Journal of Palliative Medicine: The Pendulum Swings for Opioid Prescribing by Charles F. von Gunten, Editor-in-Chief

I am about to turn 60 years of age. During my professional life as a physician, I have seen the pendulum of attitudes about the role of opioids for treating pain swing its full arc and back again. I only graduated from medical school in 1988! Why does the pendulum need to swing from one extreme to the other? Why can’t it settle in the middle, at rest, where it belongs?

It’s a good editorial and helps point out the capriciousness of how we prescribe based on the fears generated by junk science media (and political opportunism).

I particularly liked this point about the math – we see this kind of thing all the time in drug policy.

It’s a numerator and denominator issue. If you put the number of opioid addicts who were first introduced to opioids as prescription drugs before taking heroin in the numerator, and put all opioid addicts in the denominator you get a very large number. That large number (anywhere from 60% to 100% depending on the population studied) frightened everyone. But it’s the wrong math.

If you put all people with pain who are treated with an opioid and become an addict in the numerator, and all people treated with pain and an opioid in the denominator, you come up with a very small number, somewhere between 0.01% and 4% depending on the kind of pain you are looking at.

[Thanks, Evert]

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22 comments to Opioid prescriptions, panic, and bad math

  • NorCalNative

    Great comment and advice from a savvy physician. Thumbs up Evert.

  • Servetus

    The current opiate hysteria got a boost when presidential candidate Hillary Clinton spoke of some parents approaching her with their kids’ heroin or painkiller problems. Hillary couldn’t resist the bait—another opportunity to make promises that no government has ever been able to keep—promises that retain US bureaucrats and law enforcement as the only solutions to heroin and pain-pill addictions.

    One solution to drug addictions would be new, non-addictive, pain control techniques, but the US government won’t even allow research into pain reduction from cannabinoids—maybe because they believe hippies don’t deserve pain relief. Or perhaps if a pain-relief medication originates with hippies, it’s considered evil. Some of the reasons for rejecting pain control are cultural or religious in nature. The recently sainted Mother Teresa believed pain was good for the soul. That’s why she cleaned used, dulled, hypodermic needles and ordered the painful needles be reused on her unfortunate flock. Given a medieval attitude like that of St. Teresa the Torturer, pain control as a concept can be a tough sell to medical stoics.

    With bureaucrats in charge of their own agenda, drug control remains eliminationist in nature, destined to be used by various alphabet-agencies and the police to knock off members of minorities, black jazz musicians, potential troublemakers, youthful non-conformists, artists, and the odd socialist here and there.

    Secretary Clinton doesn’t advocate for new research grants to create additional classes of non-addictive pain drugs, nor other new methods of pain control. That’s up to Big Pharma, which is unlikely to compete with itself in the pain-relief business. Hillary’s aim is to protect status quo drug enforcement along with its impossible goals and corrupted agenda owing to political expediency, and because there is too much money in it.

  • The game of “the drug war” is whack a mole. The DEA is in charge. Not in charge of science or public safety, but of public alarm and enforcement regimes that keep prisons full and pharmacies and their corporate masters safe from competition.

    Making opiate prescriptions more difficult to obtain induces larger illegal quantities of opiates to circulate on the black market to fill the need.

    This is an old game. The winner is always the DEA whose job Americans think is providing for our safety, when really full prisons seems to be their most observable operational statistic.

    The opiate “problem” timing co-incides with opinion polls that show the public favoring the legalization of marijuana.

    Playing badminton with the press and ranting about alarming usage rates keeps the DEA in a full court press in perpetuity. Fear works.

    Making it generally more difficult for doctors to legitimately prescribe thus hurts the elderly and the ill who desperately need the relief.

    The reality is much darker that that. When the DEA is the one doing the controlling prisons get full, the black market thrives and the DEA has plenty of cash to keep on top of the chaos that they themselves have created with the help of an ignorant and co-operative press.

    To hell with the sick and infirm as long as those hippies and minorities are kept in their place – prison or dead.

    “Corrolation is not causation” is not understood outside the scientific community and is used widely by the government and the press to paint a picture of fear guaranteed to keep things in foment for as long as they wish.

    It has worked for at least 40 years now and we stupidly wonder how the drug war still persists.

  • Jean Valjean

    OT
    The Higgs Boson of neuroscience discovered:

    “David Nutt, the government’s former drugs advisor, professor of neuropsychopharmacology at Imperial College London, and senior researcher on the study, said neuroscientists had waited 50 years for this moment. “This is to neuroscience what the Higgs boson was to particle physics,” he said. “We didn’t know how these profound effects were produced. It was too difficult to do. Scientists were either scared or couldn’t be bothered to overcome the enormous hurdles to get this done.”

    https://www.theguardian.com/science/2016/apr/11/lsd-impact-brain-revealed-groundbreaking-images

  • strayan

    Speaking of smart old codgers’ has anyone heard from our couch-mate par excellence kaptinemo? Haven’t seen him post in a while and getting a little worried.

  • Jean Valjean

    Daily Mail hatchet job on Mr. Nice/Howard Marks who died yesterday…. gateway theory recycled, mental illness etc… interesting though that the comments are almost entirely critical of the the Mail’s prohibitionist approach.
    http://www.dailymail.co.uk/news/article-3535043/Dope-dealer-Howard-Marks-s-died-70-seen-liberals-folk-hero-truth-different.html#comments

    • NorCalNative

      My best grow ever was Howard’s “Super Silver Haze.” A really nice plant for Sativa lovers.

      I have a copy of one of his old seed catalogues. I treasure it as a collectable piece of hippie memorabilia.

    • Servetus

      Sadly, the world is less interesting today with Howard Marks’ passing. Besides attending to his social obligations as a marijuana entrepreneur, Howard Marks was a fellow physicist. A difference being he taught physics at Balliol College, Oxford, and I didn’t. Mr. Nice’s videos/literature are definitely worth checking out.

  • Servetus

    The small community of DeBeque, Colorado, has been saved from bankruptcy and dissolution by the new tax revenue it derives from marijuana sales:

    APR 7, 2016–DeBeque once got over a quarter-million dollars in tax revenue from the oil and gas industries, a princely sum for a town of about 500 people. But the collapse of world fuel prices pushed that figure down to $17,000 a year.

    Public policy tyrants once argued that marijuana could never be taxed because people would just grow their own product. Now marijuana is in line to become the rescuer of those hit by a decline and fall of the carbon-based energy industry. King cotton could be the next to feel the burn. Cotton requires a lot of water, herbicides, and pesticides, compared to growing hemp.

    Source: http://thinkprogress.org/economy/2016/04/07/3767441/marijuana-rescues-colorado-town-from-extinction/

  • Jean Valjean

    Ahead of the UN meeting later this month, how fascists in Russia (and the West) love the drug war;

    “The Russian representative dominated the talks, according to one non-American delegate who took part in the negotiations. The Russian Federation pushed back against the medical use of painkillers for palliative care, against needle exchange, against educating doctors or the public about opioids, against the use of Naloxone — an overdose reversal drug — in any setting outside a medical facility, against the entire concept of “harm reduction,” against substitute opioid treatment and, in the end, against the idea of a global approach to drug policy.”

    ‘“It’s been an absolute disaster for the country in terms of public health because you have this runaway HIV epidemic; this runaway, even less well-documented hepatitis epidemic; and crazy mortality,” Matt Curtis, director of policy at Voices Of Community Activists and Leaders-New York, an advocacy group, told HuffPost. “People who use drugs are an incredibly easy scapegoat, a distraction, and a way to get people riled up about morality in society and distract them from the way that the government is ripping people off.”’

    http://www.huffingtonpost.com/entry/russia-drug-policy_us_570d669fe4b08a2d32b83743

    • DdC

      Fitting that we have a Drug Czar.

      and…

      The head of NIDA Propaganda Ministry is Trotsky’s descendant.

      “Not only are we here to protect the public from vicious criminals in the street but also to protect the public from harmful ideas.”
      — Robert Ingersoll,
      first director of the DEA in 1974

      “Ideas are more powerful than guns.
      We would not let our enemies have guns,
      why should we let them have ideas.”
      ~ Joseph Stalin

      I wonder if Putin speaks Klingon?
      So Nixon, Ford, Reagan, Bush and Clinton were Commies?

    • Servetus

      But when it comes to the national staple—vodka—Russia is seriously anti-prohibition. Last year, Czar Putin cut the price of vodka to improve Russian morale and the economy:

      January 22, 2015–Now that the inflation in Russia has climbed to double digits and the ruble has fallen by more than 40 percent, Russia appears desperate for any solution that will ease the economic burden and the impending recession. For the country that regularly indulges in drinking copious amounts of vodka, its price reduction might help citizens take the edge off, literally.

      Vodka, being expensive, was forcing Russians to drink cheaper bootlegged substitutes. What’s more concerning besides the obvious health risks is that the Russian economy doesn’t benefit from the bootlegged variants since they cannot be fully taxed nor regulated. For a country where almost 33 percent of the vodka consumed originates from spurious sources, reducing prices of the legal stuff could greatly help in supporting the national budget.

      Russians consumed nearly 1.2 billion liters of vodka drinks in 2013, according to research from Mintel. Though it may seem like a large amount, the consumption has been down by 12 percent when compared to the previous year. As alcoholism in Russia is considered a major problem (500,000 deaths per year are attributed to the addiction), lowering prices of vodka appears to be a purely economic decision.

      Source: http://www.inquisitr.com/1721383/russia-to-lower-price-of-vodka-to-combat-economic-crises-get-your-russian-booze-16-percent-cheaper/

    • No colitapnms on this end, simply a good piece.

  • Jean Valjean

    Interesting and feasible take on the Democratic primary:

    “Bernie Sanders Will Become Democratic Nominee Even If Clinton Leads in Delegates…….

    “When discussing the issue of why Bernie Sanders will still become Democratic nominee, even if Clinton receives more delegates by late June, let’s take things into context. Bernie Sanders was recently invited to the Vatican by Pope Francis to speak, while Hillary Clinton will be interviewed soon by the FBI. Hundreds of thousands of Americans have attended events to hear Bernie Sanders speak (100,000 people had attended by August of 2015), while Hillary Clinton can’t fathom releasing transcripts of paid Wall Street speeches. Bernie supporters recently rallied outside his childhood apartment in Brooklyn and Sanders delivered an electrifying speech at Bronx Community College. Hillary Clinton recently used a static noise machine to prevent the press from listening to her words at a Denver fundraiser, and this was after roping off reporters last year.”

    http://www.huffingtonpost.com/h-a-goodman/sanders-become-democratic-nominee-even-if-clinton-leads-in-delegates_b_9657952.html

  • This Is the Big Demand on Marijuana We Should Make of the Federal Govt http://tinyurl.com/hyxqobe

    62% – Majority rules.

  • sudon't

    “The meta-message to physicians is clear—be very afraid if you prescribe any opioids to anybody or you will cause them to be an addict and die.”

    Here’s what no one seems to ask: Why is addiction per se bad? If the drug itself isn’t harmful when used correctly, what is the problem with taking it everyday? All problems seem to originate with prohibition in one way or another.
    We need to look at why people overdose. Is it because they’ve tried quitting, then relapsed, not realizing they’d lost much of their tolerance? Whatever the reasons, that is what must be addressed. More prohibition can only exacerbate the problem, as we’ve all seen over and over again.