Today we're going to learn about how the "opioid epidemic" is totally iatrogenic, but not for the reasons you think.

A good place to start is with this piece of news from our listener funded state media: https://www.npr.org/2021/04/27/991349604/why-new-guidelines-for-opioid-treatment-are-a-big-deal

TLDR: yesterday the WH announced new prescribing guidelines for buprenorphine, a very powerful opioid, in a move that had been pending during the trump administration.
the move makes it easier for "providers" to dispense this maintenance med

whereas the trump admin plan was to simply free up doctors (MDs and DOs people who have been through a masters program and apprenticeship), yesterday's move waives the requirement for prior training on opioid abuse disorder and referrals to counseling, and also allows…

not just doctors, but physician assistants, nurse practitioners, midwives — various categories of "providers" — to prescribe the drug to up to 30 patients.

This is hailed as a much needed move to address overdose deaths in the US.

So, in short, it allows all sorts of people who aren't MDs or DOs, who aren't required to undergo the same level of training, who don't have to know anything about opioid abuse disorder, to go ahead and diagnose and treat people for opioid abuse disorder.

Making sense yet?

"Think of the children!" you exclaim.

Well, let's talk about prescription narcotics and the "opioid epidemic," shall we.

We can begin with what the American Medical Association has to say about it: "The nation no longer has a prescription opioid-driven epidemic."

Again, in a 16 June 2020 letter to the CDC:
https://searchlf.ama-assn.org/undefined/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2020-6-16-Letter-to-Dowell-re-Opioid-Rx-Guideline.pdf

"But, surely there WAS one. Otherwise we wouldn't have scapegoated that rich Jewish family."

Yeah, about that whole Sackler family thing…

There's something oddly familiar about this whole thing…

Oh, there we go.

"But, surely this is hyperbole, they had to have been the worst."

Well, let's look at the biggest peddlers of buprenorphine, and current patent holders of Suboxone…

that's a lot of indictments for fraud.

and until Perdue Pharma, Invidor had the distinction of having had the largest judgement against them

but, don't see anyone pogroming the Crossley or Hetherington families

Maybe I'm projecting, or maybe prejudice doesn't exist in business

or in national policy, for that matter

I know, I'm a monster, people are dying

let's look at that one, too

looks a little frightening:

but then let's look at prescriptions:

and then break it down a little more:

so, while annual prescribing rates and daily MME (morphine milligram equivalents) have decreased since 2011, deaths from illicit narcotics have taken off.

Just like the AMA didn't say, there never was a prescription opioid crisis.

so, did something happen in 2011?

Yes, the National Pain Strategy.

As far as the why and whats, I'll leave it to them:

"a cultural transformation" has definitely been effected

did YOU care about prescription narcotics before 2011?

was oxycontin or vicodin a part of the lexicon before House was chomping them down, or the brand names placed in headlines?

Pain as a national economic burden:

Like any good rollout, the thing is rather vague, but these ideas start to come out in interesting ways.

If you want to sit through your own NPS seminar, here's the 2011 paper: https://www.iprcc.nih.gov/sites/default/files/documents/IOM_Pain_Report_508C.pdf

Now, back to the CDC death chart for a moment.

Let's take a look at 2017.

notice how commonly prescribed opioid deaths edge down about 1.5:100,000?

Well, in 2016 we had this nightmare:

"CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016"

https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf

Aside from scare filters on the first page graphics, it has some handy recommendations for "providers" to make to patients who are disabled and/or in intractable constant pain to make them feel better instead of prescribing opiates/opioids

"Why don't you just think your way out of being sick?"

"You'd feel better if you played some tennis."

"I know opioids do nothing more harmful that endorphins (endogenous morphia), but you should take some NSAIDs or Tylenol."

"How about we prescribe some SSRIs off-label. They're much safer and you'll feel better?"

never mind about how SSRIs and cathinones, and opiate replacements like dextromethorphan and methadone all came out of MK-ULTRA.

that's its own dark, dark fucking thread.

but overall, much preferred to opiates with a >6000 year track record, and mid-19th century opioids

the other fun thing thrown into the 2016 CDC guidelines are recommended daily maximum dosages measured in MME.

traditionally, one determined a dose based upon such important factors as body mass, but the CDC, spurned on by the NPS, said no one needs more than 90 MME a day.

this leads us to forced tapering.

and when doctors are reluctant to prescribe to new patients, old patients are being told they don't "need" what they've been taking for years, and literally anyone going to the doctor seeking pain relief is "engaging in drug seeking behavior"…

you get a lot of untreated pain and no clear outlet to get some kind of quality of life, patients are going to do what the NPS recommends and try to handle it themselves.

a notable individual whose self medication for chronic pain was used to blame him for his own murders:

"so, if the 'prescription epidemic' was never about anything other than lowering health care costs associated with an aging population, what about FENTANYL?"

Well.

Why didn't the DEA schedule fentanyl analogues until 2018?

I mean, seriously. I want to know why.

See, the Drug Enforcement Agency — just ask Doug Valentine — plays an integral role as an enforcement agency in telling everyone else, as cops, which drugs are beneficial and which ones are bad.

They also deal drugs and regulate illicit trade, so they should know.

they do this by scheduling the drugs.
Schedule V, you just ask a pharmacist.
Schedule I, these are the very bad drugs that have no medicinal benefit like LSD-25 or heroin — the latter is just another ER drug in some European countries.

Yet, one was still able to purchase fentanyl analogues from chemical supply companies, just like baking soda, until 2018 when the DEA *temporarily* scheduled fentanyl analogues.

And if we remember the AMA's letter, these analogues are key part of what's driving opioid mortality.

Another thing:

If you've ever been admitted for surgery, you've probably been giving fentanyl, and it most likely didn't kill you and everyone in the room or turn everyone instantly into a junkie.

for more on the fentanyl scare, see: @RyanMarino https://twitter.com/RyanMarino/status/1021128899772796930?s=20

This scheduling thing is peculiar, because with designer drugs the DEA tore through Shulgin's books to clamp down on rave drugs, but mass produced fentanyl analogues remain a blind spot until just recently.

I guess Nixon would've never given Elvis that badge if DEA not smart…