The Opiate and Heroin Epidemic in America (1 Viewer)

[The Z Machine]

Shocking no one (or at least not me) the legalization of marijuana has resulted in a surge of addiction and mental illness, particularly among teens.

The whole concept that MJ is harmless is and was bunk.

Your link is to a Daily Mail article, which is a UK tabloid.  I'd prefer to look at actual studies that show this "surge of addiction and mental illness".  Do you have any peer reviewed studies that show this causal relationship?

 

[flapgreen]

Shocking no one (or at least not me) the legalization of marijuana has resulted in a surge of addiction and mental illness, particularly among teens.

The whole concept that MJ is harmless is and was bunk.

No drug is harmless. Anytime you hear someone say a substance has no negative side effects, that should instantly you skeptical. 

 

[SoBeDad]

No drug is harmless. Anytime you hear someone say a substance has no negative side effects, that should instantly you skeptical. 

Agree.  No drug is harmless, and no drug is a panacea or cures everything that ails. The argument for marijuana is that it's safety/efficacy profile is safer than many alternatives. There's mixed evidence. Here's a published study from 2019: Legalized Marijuana Linked to Decline in Opioid Emergencies. The decline was modest, 7.6%, greatest among males 25-44. 

The recreational side is one aspect, the treatment for mood-related disorders and pain is another side which needs more studies to compare to current FDA-approved drugs. 

 

[Sand]

Agree.  No drug is harmless, and no drug is a panacea or cures everything that ails. The argument for marijuana is that it's safety/efficacy profile is safer than many alternatives. There's mixed evidence. Here's a published study from 2019: Legalized Marijuana Linked to Decline in Opioid Emergencies. The decline was modest, 7.6%, greatest among males 25-44. 

The recreational side is one aspect, the treatment for mood-related disorders and pain is another side which needs more studies to compare to current FDA-approved drugs. 

I will say that the application to childhood epilepsy like conditions seems a huge positive.

 

[Sleestak]

Shocking no one (or at least not me) the legalization of marijuana has resulted in a surge of addiction and mental illness, particularly among teens.

The whole concept that MJ is harmless is and was bunk.

Don't really care about recreational MJ one way or the other.

However, medical MJ is the only thing that has worked for my wife's RA.  Keep that baby, do with the bathwater whatever you will.

 

[Chaos Commish]

Don't really care about recreational MJ one way or the other.

However, medical MJ is the only thing that has worked for my wife's RA.  Keep that baby, do with the bathwater whatever you will.

just curious. cbd products/meds or thc? my sis is in misery from RA and cbd didn't help.

 

[Sleestak]

just curious. cbd products/meds or thc? my sis is in misery from RA and cbd didn't help.

Short answer:  she needs the good stuff, not hemp-based CBD "supplements".

The meds needs to be Cannabis-based, with at least a little THC in it along with the anti-inflammatory CBD.  Apparently there is some interaction by which the THC helps the body make better use of the CBD, and you don't need a ton of THC to achieve this so it isn't like you need to get stoned daily to see benefits against RA.

This is Maryland, so they have real cannabis-based meds.  You can get high or low CBD or THC.  Pills, vape, and probably other options.  Knowledgeable professional staff that can help you find something that suits your needs.

My wife doesn't like feeling stoned (don't ask me why) so she opts for high CBD & low THC.  She mainly uses a vape pen as needed.  Usually after noon once she has run all the errands she has planned for the day.  The relief is pretty quick since it is inhaled.  She also takes a "microdose" pill daily, or at least she used to.  She might be down to just the pen.  She hates taking pills.

Improving your diet definitely should be explored.  Also, acupunture has been known to really help with RA.  RA is a frustrating disease because each person reacts differently to various therapies, so there is no magic bullet.  You just have to keep looking to see what helps.  Cannabis-based meds are a very important tool in the toolbox.  Good luck to your sister!

 

[Terminalxylem]

Don't really care about recreational MJ one way or the other.

However, medical MJ is the only thing that has worked for my wife's RA.  Keep that baby, do with the bathwater whatever you will.

Has she tried biologic therapies? Basically anything with a nonproprietary name that end in -mab or -ib. They are monoclonal antibodies that have become the mainstays of contemporary RA therapy.

 

[simey]

just curious. cbd products/meds or thc? my sis is in misery from RA and cbd didn't help.

Over the past year, hydroxychloroquine has helped my sister with her RA.

 

[Sleestak]

Has she tried biologic therapies? Basically anything with a nonproprietary name that end in -mab or -ib. They are monoclonal antibodies that have become the mainstays of contemporary RA therapy.

[Sorry all for the Hi Jack!]

Can you post a few links so I can educate myself on the available biologic therapies?  I'd really appreciate it!

She has not tried any of those.  She was first diagnosed circa 2007.  For a couple years she took the usual meds, methotrexate and/or hydroxychloroquine being the two I remember.  But she hates pills, and hates the known side effects of those meds.  So around 2009/10 she quit with the pills and tried a low-inflammatory diet, which seemed to help.  She also did yoga, cardio, and acupuncture, all of which helped.  Once Maryland passed their MMJ law she got into that with excellent results.  The nice thing is her immune system isn't being suppressed by the normal anti-RA meds.  And her liver isn't being hammered, nor her vision, no TIAs, etc.

My Aunt (also RA) has used Humira and Remicade over the years - the kinds of "-mab" you are probably thinking of.  I'm not sure if wifey is interested in those or not.  Probably not, but it never hurts to get informed!

 

[Sleestak]

Over the past year, hydroxychloroquine has helped my sister with her RA.

Awesome - whatever works!  Plaquenil is the brand name for that and is pretty well tolerated overall.  As I recall the vision should be baselined and then checked regularly to make sure the hydroxy isn't causing problems.

 

[Terminalxylem]

[Sorry all for the Hi Jack!]

Can you post a few links so I can educate myself on the available biologic therapies?  I'd really appreciate it!

She has not tried any of those.  She was first diagnosed circa 2007.  For a couple years she took the usual meds, methotrexate and/or hydroxychloroquine being the two I remember.  But she hates pills, and hates the known side effects of those meds.  So around 2009/10 she quit with the pills and tried a low-inflammatory diet, which seemed to help.  She also did yoga, cardio, and acupuncture, all of which helped.  Once Maryland passed their MMJ law she got into that with excellent results.  The nice thing is her immune system isn't being suppressed by the normal anti-RA meds.  And her liver isn't being hammered, nor her vision, no TIAs, etc.

My Aunt (also RA) has used Humira and Remicade over the years - the kinds of "-mab" you are probably thinking of.  I'm not sure if wifey is interested in those or not.  Probably not, but it never hurts to get informed!

There are a ton of them. Here are the Treatment guidelines. A review of the drugs. - basically they are recommended for people with moderate-severe disease who can’t tolerate/don’t respond to traditional therapies like methotrexate.

The only reason I mention them is they are amazingly effective for some patients, so much so  we hardly see uncontrolled rheumatoid arthritis any more (same goes for psoriasis, inflammatory bowel disease and a few other diagnoses where biologics have become mainstays of therapy.)

Then again, if med MJ is working, may not wanna rock the boat. But biologics may arrest joint destruction, while marijuana is just going to help with pain.

 

[Tau837]

From Overdose, opioid treatment admissions and prescription opioid pain reliever relationships: United States, 2010–2019:

Conclusions: The guideline, guideline update, CDC's public, medical profession, and intergovernmental communications should be corrected/updated to state no direct correlation has existed between POS to OTA, POD, AOD, and TOD since 2010. Individualized patient care and public health policy should be amended accordingly...

The direct correlations used to justify the CDC guideline and guideline update that existed from 1999 to 2010 are no longer present. Starting in 2010, opioid MME per Capita (POS) does not have a “clear correlation” (7) or move “in parallel” (2) or “in lockstep” (8) with OTA, POD, AOD or TOD. The relationships changed from direct to inverse in 2010. These results hold on a national level, in a large majority of states, and even among patients receiving opioid dosages greater than the recommended maximum dosage in the guideline (much less the reduced maximum dosage recommended in the guideline update). Based on the results presented in this paper and the current trends in opioid deaths, the policies of cutting POS to reduce TOD, AOD, POD, and OTA as presented in the guideline and the guideline update are unfounded and ineffective.

POS = Prescription Opioid Sales
OTA = Opioid Treatment Admissions
POD = Prescription Opioid Overdose Deaths
AOD = Any Opioid Overdose Deaths
TOD = Total Overdose Deaths

From New Study Obliterates PROP's Absurd Position On Further Reducing Opioid Prescriptions:

A critically important paper in the journal Frontiers in Pain Medicine concludes that while the rationale for reducing opioid prescriptions to minimize overdose deaths was sound between 2006-2010, during the ensuing decade the opposite was true. Reducing opioid prescriptions during this time dramatically increased deaths and hospitalizations. In other words, what worked 15 years ago is an unmitigated disaster at this time.

From Policymakers Are Stuck in a State of Denial about the True Cause of the Overdose Crisis:

...there is no correlation between prescription rates and non‐medical use or addiction to opioids... The overdose crisis was never about doctors prescribing opioids to their patients in pain...

I have been posting similar perspective on this issue in this thread for more than 7 years now. Anyone looking at the facts and data objectively would have to admit that our government's approach to opioid prescribing at both federal and state levels is not supporting by those facts and data. Will our government ever admit it?

 

[Tau837]

From Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: Bad Faith or Incompetence?:

Concluding Recommendations

Our results strongly suggest that CDC disregarded or disobeyed its own rules and ethical guidelines (111-113) by allowing PROP members and allies to help create the 2016 Guideline, thereby compromising its ethical integrity (1, 4, 23, 34, 36, 119-123). Those physicians acted entrepreneurially to facilitate a moral panic (9-11) about opioid-involved overdose deaths, using a false narrative about overprescribing that successfully changed opioid policy nationally. These policies have unacceptably increased risks of harm for patients in pain (43-45, 48-52, 67-73). Unfortunately, abolishing or repealing the 2016 Guideline and 2022 Draft Guideline, while ethically justifiable, now seems like an impossible task. The federal government has invested too much time and too many resources into the Guidelines to abandon them, especially while MDL suits against opioid manufacturers and distributers are still pending.

What can be done to undo the harms created by the 2016 Guideline and prevent further harm from the 2022 Draft Guideline? We strongly recommend abolishing hard dosing thresholds from the 2022 Draft Guideline, because their misapplication has emboldened involuntary and/or rapid opioid tapers, contributing to patient harms (43-45, 48-52, 67-73). These hard dosing thresholds have been improperly translated into “mandatory policies and laws throughout the country, becoming, in effect a standard of care used by states, payers, pharmacy benefit plans, health care systems and providers (162).” Next, while the 2022 Draft Guideline offers some improved language toward that goal, CDC must unequivocally denounce the false narrative that overprescribing still drives the opioid crisis, as “the particular focus around reduced opioid prescribing has met with limited success and contributed to subsequent waves of the crisis (163).” CDC’s Opioid Workgroup for the 2022 Draft Guideline cited similar concerns about hard dosing thresholds, but also acknowledged the inherent tension between patient versus public or societal health benefits (74). In addition, we call on policymakers to correct the current policy imbalance between patients’ medical autonomy and society’s benefit, acknowledging that physicians have an individualized, fiduciary duty to act in their patients’ best interests which may sometimes reasonably conflicts with public health goals (164). Patients are not monoliths, and physicians cannot treat them individually using a broad policy brush. Physicians’ primary responsibility is to attend the individualized needs of the patients they are treating. Thus, we envision creating an ethics-based, education-focused informed consent process that allows patients to weigh treatment risks versus potential benefits collaboratively to enhance opioid prescribing safety (165).

Furthermore, we identified a 72% rate of nondisclosure of COIs in our study group, which we find ethically unacceptable, considering the purported importance of transparency when creating clinical guidelines (107-110). CDC itself has acknowledged this moral imperative, but hasn’t adhered to its own ethical rules (111-113). Given the apparent inability of the study group authors and the CDC to transparently self-regulate the conflict disclosure process, we encourage medical journals to become more vigilant about identifying authors’ financial and intellectual COIs in submitted manuscripts about opioid policies. This includes holding editors accountable when they deliberately ignore relevant competing interests (123, 126-128).

Finally, if these recommendations fail to restore balanced U.S. opioid policy, we call upon the U.S. House Committee on Oversight and Government Reform to convene a hearing to scrutinize CDC’s use of a Core Expert Group to write its opioid guidelines instead of complying with the supervisory requirements of Federal Advisory Committee Act (166). Alternatively, we would invite the U.S. Department of Justice to investigate why CDC has repeatedly violated internal rules and ethical policies while creating the 2016 Guideline and 2022 Draft Guideline (111-113). Permitting ongoing patients harms from these Guidelines desecrates the sacred trust between prescribing physicians and patients afflicted by chronic pain.

 

[Monty Burns]

Yesterday was the 2 year anniversary for my nephew, age roughly 35, from his Opioid experience. He started taking them thru a prescription for a back injury, got hooked, and then went to the street for them. One night he passed out driving, crashed into a building, and the first cop on the scene had to give him 2 Narcans to bring him back to life. He spent 10 months in rehab and now is recovering. I bring this up as he had a 5 person family, an MBA and a really good job. He managed to salvage his family, lost his job, but did get another with the assistance of his rehab facility in conjunction with his church and he is building his life back. This can happen to anyone. We need a lot more pressure on our government to stop this. How we allow China to openly manufacture the precursor's for these drugs without calling them out for it, then ship them to Mexico and allow the cartels to do the manufacturing and smuggling is beyond me.

 

[Dezbelief]

3 fentanyl overdoses over the weekend in my neck of the woods, counterfeit percocets that were actually fentanyl. Ages 13,19 and 21. This makes 22 fentanyl overdoses this year in a town with about the same population as Green Bay.

 

[Tau837]

3 fentanyl overdoses over the weekend in my neck of the woods, counterfeit percocets that were actually fentanyl. Ages 13,19 and 21. This makes 22 fentanyl overdoses this year in a town with about the same population as Green Bay.

That is tragic. It sounds like it has nothing to do with prescription opioids and fits the same "war on drugs" that has been going on for decades.

 

[Dezbelief]

3 fentanyl overdoses over the weekend in my neck of the woods, counterfeit percocets that were actually fentanyl. Ages 13,19 and 21. This makes 22 fentanyl overdoses this year in a town with about the same population as Green Bay.

That is tragic. It sounds like it has nothing to do with prescription opioids and fits the same "war on drugs" that has been going on for decades.

OK, but it seems to be an evolving part of "The Opiate and Heroin Epidemic in America."

 

[ChiefD]

3 fentanyl overdoses over the weekend in my neck of the woods, counterfeit percocets that were actually fentanyl. Ages 13,19 and 21. This makes 22 fentanyl overdoses this year in a town with about the same population as Green Bay.

My greatest fear as a parent.

I can't tell you how many times we have talked to our kids about this drug. We have basically told them: don't ever take ANYTHING resembling a pill from your friends or people you don't know. Don't even take an ibuprofin or tylenol from a friend if you have a headache.

They are now making fentanyl pills that look like candy. A brutal drug.

 

[Terminalxylem]

I think this Summary and Review of prescription practices, especially the “Three waves of Opioid Overdose Deaths” graph, nicely encapsulate the complexity of the problem. Opioid deaths started rising in 1999, commensurate with increased prescriptions, but flattened out in 2010. This corresponded with changes in prescribing practices, and prescription opioid deaths have remained flat-ish ever since. Unfortunately, two subsequent problems have supplanted prescription ODs: heroin first, then synthetic opioid overdoses.

While it’s easy to say policy isn’t preventing non-prescription deaths the last decade or so, it’s less clear what would happen if we loosened the reigns on prescriptions. Moreover, we still prescribe more opioids today than pre-1999 levels, and prescribing practices are anything but uniform.

 

[Major]

You can really see the effects of fentanyl when walking the streets. SF is getting bad or stroll through downtown LA and it's just crazy how many people are like zombies out there. Seems to have some commonalities with the crack epidemic of the 80s - Fent being much cheaper than heroin (crack cheaper than cocaine) and stronger/more addictive.

A lot of bars in NYC now have Narcan on hand due to all the overdoses. Read somewhere there is a bill being proposed requiring all bars in NYC to have Narcan. Crazy world.

 

[ChiefD]

A lot of bars in NYC now have Narcan on hand due to all the overdoses. Read somewhere there is a bill being proposed requiring all bars in NYC to have Narcan. Crazy world.

Every school in our district has Narcan on hand.

 

[Major]

A lot of bars in NYC now have Narcan on hand due to all the overdoses. Read somewhere there is a bill being proposed requiring all bars in NYC to have Narcan. Crazy world.

Every school in our district has Narcan on hand.

Wow. I guess it's a good precaution but I've read somewhere that Narcan isn't as effective on synthetic opioids like fentanyl as it is with heroin. Should be noted, I have no experience with opioids and just an observer.

All the fentanyl in street drugs does makes me lean closer to the side of legalizing everything so quality can be controlled and cartels crushed.

 

[STEADYMOBBIN 22]

3 fentanyl overdoses over the weekend in my neck of the woods, counterfeit percocets that were actually fentanyl. Ages 13,19 and 21. This makes 22 fentanyl overdoses this year in a town with about the same population as Green Bay.

My greatest fear as a parent.

I can't tell you how many times we have talked to our kids about this drug. We have basically told them: don't ever take ANYTHING resembling a pill from your friends or people you don't know. Don't even take an ibuprofin or tylenol from a friend if you have a headache.

They are now making fentanyl pills that look like candy. A brutal drug.

Same thing in our house. I constantly tell them “No pills, no powder, no needles”.

They both have tried weed and we’ve had an open conversation about it. I told them both I don’t want you to smoke weed, but if you’re going to smoke, smoke flower, don’t do that Vape ****.

I lost my brother to a fentanyl overdose two years ago September 1

 

[Tau837]

Moreover, we still prescribe more opioids today than pre-1999 levels, and prescribing practices are anything but uniform.

Of course we are still prescribing more than pre-1999. Pre-1999, pain was not recognized as the fifth vital sign. It is obvious that when it was recognized as such, that resulted in significantly increasing opioid prescriptions, and that is generally appropriate, not inappropriate. Prior to that, pain was significantly untreated/undertreated in this country.

Yes, there were pill mills, etc., and those have been stamped out at this point to the max extent possible.

Opioid prescriptions are at least at a 20 year low right now, so I strongly doubt that whatever difference exists between opioid prescribing today and in 1999 is a legitimate problem.

While it’s easy to say policy isn’t preventing non-prescription deaths the last decade or so, it’s less clear what would happen if we loosened the reigns on prescriptions.

I don't think it is "less clear" at all. Opioid overdose deaths have increased year over year for at least the past 20 years, setting new records every year. Meanwhile, opioid prescribing has been reduced year over year for at least the past 12 years, maybe more. It is clearly demonstrable that there is no correlation between opioid prescriptions and opioid overdose deaths. I have linked multiple articles in this thread that prove that.

Those who want to abuse drugs will find a way to do it. Prescription opioids have very little to do with it. Sadly, that will result in overdose deaths.

But this terrible government focus and policy on restricting opioid prescribing is hurting people who don't divert their drugs or have any other bad "drug seeking" behaviors. I know this because it is harming my wife. It is a terrible thing.

Fortunately, most of you will never experience how terrible this government policy is, since most of you will never have loved ones who are in that minority of citizens who desperately need opiods to treat legitimate serious, severe chronic pain conditions. But if you were in that position, you would know this government approach is awful and wrong.

 

[Chris B.]

3 fentanyl overdoses over the weekend in my neck of the woods, counterfeit percocets that were actually fentanyl. Ages 13,19 and 21. This makes 22 fentanyl overdoses this year in a town with about the same population as Green Bay.

A nurse practitioner on social media this weekend reported her hospital saw 11 deaths in one day due to fentanyl. 6 were under the age of 15. There's something called "rainbow fentanyl" that looks like Sweet Tarts that kids are taking thinking it's candy. Horrible scary stuff.

 

[Terminalxylem]

Moreover, we still prescribe more opioids today than pre-1999 levels, and prescribing practices are anything but uniform.

Of course we are still prescribing more than pre-1999. Pre-1999, pain was not recognized as the fifth vital sign. It is obvious that when it was recognized as such, that resulted in significantly increasing opioid prescriptions, and that is generally appropriate, not inappropriate. Prior to that, pain was significantly untreated/undertreated in this country.

Yes, there were pill mills, etc., and those have been stamped out at this point to the max extent possible.

Opioid prescriptions are at least at a 20 year low right now, so I strongly doubt that whatever difference exists between opioid prescribing today and in 1999 is a legitimate problem.

While it’s easy to say policy isn’t preventing non-prescription deaths the last decade or so, it’s less clear what would happen if we loosened the reigns on prescriptions.

I don't think it is "less clear" at all. Opioid overdose deaths have increased year over year for at least the past 20 years, setting new records every year. Meanwhile, opioid prescribing has been reduced year over year for at least the past 12 years, maybe more. It is clearly demonstrable that there is no correlation between opioid prescriptions and opioid overdose deaths. I have linked multiple articles in this thread that prove that.

Those who want to abuse drugs will find a way to do it. Prescription opioids have very little to do with it. Sadly, that will result in overdose deaths.

But this terrible government focus and policy on restricting opioid prescribing is hurting people who don't divert their drugs or have any other bad "drug seeking" behaviors. I know this because it is harming my wife. It is a terrible thing.

Fortunately, most of you will never experience how terrible this government policy is, since most of you will never have loved ones who are in that minority of citizens who desperately need opiods to treat legitimate serious, severe chronic pain conditions. But if you were in that position, you would know this government approach is awful and wrong.

We’ve been through this before, so I won’t rehash too much.

Up until 2010 or so, opioid deaths were increasing, and the majority of those deaths were prescription drugs. Only after prescribing practices changed did heroin resurface, followed later by illicit fentanyl. While I agree the latter two have turned out to be far more deadly, the flattening of prescription ODs after 2010 is likely at least partially due to changes in policy. And even if they kill less people, diverted prescriptions still contribute to addiction and abuse.

While at 20 year lows (I’m not sure that’s an accurate statement btw - look at the First graph ), we prescribe a ton of opiates, far more than the rest of the developed world. I know you believe Americans have reasons to require more analgesics, but I fundamentally disagree. That’s not a critique of your wife or other people with chronic pain, but more of an acknowledgement there is a lot of subjectivity in pain management. In my limited experience, I’ve seen far more over- than undertreated patients, and I know our culture promotes pills over non-pharmacologic interventions for disease.

 

[Tau837]

While at 20 year lows (I’m not sure that’s an accurate statement btw - look at the First graph )

See Exhibit 2 in Prescription Opioid Trends in the United States. That report was released in December 2020 and used actual data through September 2020 and estimated data for the final quarter of 2020 based on previous trends. From that report:

By the end of 2020, MME per capita is expected to drop to 298, nearing the level seen in 2000, which was 270 MME per capita.

That was nearly two years ago. At that time, opioid prescribing had declined year over year for 9 consecutive years. There is no reason to believe that has not continued in 2021 and 2022, meaning we are almost certainly well beyond a 20 year low. My guess is we are at or close to a 25 year low at this point.

 

[Tau837]

Up until 2010 or so, opioid deaths were increasing, and the majority of those deaths were prescription drugs.

The dataset I pulled from NIH shows a 22 year sample, 1999-2020.

According to that data, prescription opioid deaths accounted for the majority of opioid deaths in 12 of those years, 2002-2013, with a peak of 66% of opioid deaths in 2007.

However, that data is flawed in multiple ways.

From How the CDC Misclassifies Opioid Overdoses (2016):

...the CDC admits in the MMWR, that "some overdose deaths may have been misclassified and the data has limitations.” ...

The DEA reported last year in its National Heroin Threat Assessment Summary that, “Many medical examiners are reluctant to characterize a death as heroin-related without the presence of 6-monoaceytlmorphine (6-MAM), a metabolite unique to heroin, but which quickly metabolizes into morphine. Thus many heroin deaths are reported as morphine-related deaths." ...

Medical examiners and coroners are just now beginning to test for fentanyl because of the sharp rise in overdose deaths in the U.S. and Canada. Both the CDC and the DEA issued advisories about illicit fentanyl overdoses last year, but we don’t know exactly how many deaths there were.

From Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts (2017):

The CDC bases their opioid overdose statistics on all-cause overdose. The US Government Accountability Office (GAO) reported prescription opioid analgesic fatalities from 2003–2008 by searching the National Vital Statistics System (NVSS) database used by the CDC for overdose and other statistics. In published overdose data, the CDC includes all causes (unintentional, suicide, homicide, undetermined) leading to death. In this report, GAO limited their results to unintentional (accidental) overdose leading to death. Compared with published CDC data [72], GAO data for accidental fatal overdose in 2003–2008 were 20–24% lower—not an insignificant difference (Table 2) [73]. Opioid analgesic overdoses of undetermined cause include accidental overdoses of unknown proportion. The nature of accidental (vs intentional) overdose death may evoke a stronger visceral response to a greater danger and has driven the backlash against opioid prescribing. Overdose calculation methods are stated in the technical sections or footnoted fine print of CDC publications, and so may not be noticed by readers. The GAO report is not current, but Table 2 suggests a stable ratio between all-cause vs accidental opioid analgesic deaths.

This shows that 20-24% of the CDC reported prescription opioid fatalities were either due to suicide or homicide or the cause of death was undetermined.

From that same article:

Concurrent heroin and prescription opioid detection by toxicology testing in fatal overdose creates uncertainty over the relative contribution of each agent to death. In such cases, the OD is recorded as both a prescription opioid OD and a heroin OD.

Bottom line, the data is unreliable, and I think it is very likely that prescription opioid death statistics were inappropriately inflated for multiple reasons throughout the period where prescription opioids accounted for the majority of opioid deaths.

 

[Terminalxylem]

While at 20 year lows (I’m not sure that’s an accurate statement btw - look at the First graph )

See Exhibit 2 in Prescription Opioid Trends in the United States. That report was released in December 2020 and used actual data through September 2020 and estimated data for the final quarter of 2020 based on previous trends. From that report:

By the end of 2020, MME per capita is expected to drop to 298, nearing the level seen in 2000, which was 270 MME per capita.

That was nearly two years ago. At that time, opioid prescribing had declined year over year for 9 consecutive years. There is no reason to believe that has not continued in 2021 and 2022, meaning we are almost certainly well beyond a 20 year low. My guess is we are at or close to a 25 year low at this point.

Your link doesn’t work for me, but I’m not really interested in debating the value of US lows in opioids anyway. Even at our “low” values, we prescribe far more opioids than the rest of the developed world. While it’s possible (probable) underprescribing is rampant worldwide, it’s also pretty likely we’ve overshot the appropriate amount of prescriptions, even if we’re much lower than peak totals.

 

[Terminalxylem]

Up until 2010 or so, opioid deaths were increasing, and the majority of those deaths were prescription drugs.

The dataset I pulled from NIH shows a 22 year sample, 1999-2020.

According to that data, prescription opioid deaths accounted for the majority of opioid deaths in 12 of those years, 2002-2013, with a peak of 66% of opioid deaths in 2007.

However, that data is flawed in multiple ways.

From How the CDC Misclassifies Opioid Overdoses (2016):

...the CDC admits in the MMWR, that "some overdose deaths may have been misclassified and the data has limitations.” ...

The DEA reported last year in its National Heroin Threat Assessment Summary that, “Many medical examiners are reluctant to characterize a death as heroin-related without the presence of 6-monoaceytlmorphine (6-MAM), a metabolite unique to heroin, but which quickly metabolizes into morphine. Thus many heroin deaths are reported as morphine-related deaths." ...

Medical examiners and coroners are just now beginning to test for fentanyl because of the sharp rise in overdose deaths in the U.S. and Canada. Both the CDC and the DEA issued advisories about illicit fentanyl overdoses last year, but we don’t know exactly how many deaths there were.

From Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts (2017):

The CDC bases their opioid overdose statistics on all-cause overdose. The US Government Accountability Office (GAO) reported prescription opioid analgesic fatalities from 2003–2008 by searching the National Vital Statistics System (NVSS) database used by the CDC for overdose and other statistics. In published overdose data, the CDC includes all causes (unintentional, suicide, homicide, undetermined) leading to death. In this report, GAO limited their results to unintentional (accidental) overdose leading to death. Compared with published CDC data [72], GAO data for accidental fatal overdose in 2003–2008 were 20–24% lower—not an insignificant difference (Table 2) [73]. Opioid analgesic overdoses of undetermined cause include accidental overdoses of unknown proportion. The nature of accidental (vs intentional) overdose death may evoke a stronger visceral response to a greater danger and has driven the backlash against opioid prescribing. Overdose calculation methods are stated in the technical sections or footnoted fine print of CDC publications, and so may not be noticed by readers. The GAO report is not current, but Table 2 suggests a stable ratio between all-cause vs accidental opioid analgesic deaths.

This shows that 20-24% of the CDC reported prescription opioid fatalities were either due to suicide or homicide or the cause of death was undetermined.

From that same article:

Concurrent heroin and prescription opioid detection by toxicology testing in fatal overdose creates uncertainty over the relative contribution of each agent to death. In such cases, the OD is recorded as both a prescription opioid OD and a heroin OD.

Bottom line, the data is unreliable, and I think it is very likely that prescription opioid death statistics were inappropriately inflated for multiple reasons throughout the period where prescription opioids accounted for the majority of opioid deaths.

OK, the data are imperfect. That’s unfortunate, but doesn’t negate the problems in our prescribing practices. The whole process is too subjective and variable. What we really need is a standardized way to quantify pain, to facilitate appropriate opiate use.

 

[Tau837]

Even at our “low” values, we prescribe far more opioids than the rest of the developed world.

This is simply untrue as written. I posted a link here that shows that the US fell to 8th globally in per capita opioid sales for the period 2015-2019. As I commented in that post, the article shows that these 7 countries have now surpassed the US (Canada, Switzerland, Germany, Spain, Denmark, Australia, Austria), and Norway, Netherlands, and Belgium were all just behind the US. All of those are OECD countries whose health care/resources are comparable to the US.

And, given the continuing opioid hysteria in the US since 2019, I fully expect that the US has fallen further in this ranking.

What we really need is a standardized way to quantify pain, to facilitate appropriate opiate use.

That would be outstanding, but I don't believe it is possible. As I have posted previously in the thread in our exchanges, every human body is different... with different conditions and pain sources... with differing abilities to metabolize medication... with differing life situations that contribute to more or less stress, anxiety, etc.

If a chronic pain patient is treated by a pain specialist, that doctor and associated staff get to know the patient and can evaluate how that patient's pain presents over the course of a large enough sample of visits. That matters much more than a pain rating on a scale of 1-10.

If I am right, and it is not possible, then we have to find appropriate methods to treat pain without a standardized way to quantify pain. Even if it is possible, we certainly do not have it today, and we as a society and specifically those in the healthcare community owe it to pain patients to do the best they can without it.

Ongoing opioid hysteria is preventing that... we are not coming close to doing our best for those patients.

 

[Terminalxylem]

Even at our “low” values, we prescribe far more opioids than the rest of the developed world.

This is simply untrue as written. I posted a link here that shows that the US fell to 8th globally in per capita opioid sales for the period 2015-2019. As I commented in that post, the article shows that these 7 countries have now surpassed the US (Canada, Switzerland, Germany, Spain, Denmark, Australia, Austria), and Norway, Netherlands, and Belgium were all just behind the US. All of those are OECD countries whose health care/resources are comparable to the US.

And, given the continuing opioid hysteria in the US since 2019, I fully expect that the US has fallen further in this ranking.

What we really need is a standardized way to quantify pain, to facilitate appropriate opiate use.

That would be outstanding, but I don't believe it is possible. As I have posted previously in the thread in our exchanges, every human body is different... with different conditions and pain sources... with differing abilities to metabolize medication... with differing life situations that contribute to more or less stress, anxiety, etc.

If a chronic pain patient is treated by a pain specialist, that doctor and associated staff get to know the patient and can evaluate how that patient's pain presents over the course of a large enough sample of visits. That matters much more than a pain rating on a scale of 1-10.

If I am right, and it is not possible, then we have to find appropriate methods to treat pain without a standardized way to quantify pain. Even if it is possible, we certainly do not have it today, and we as a society and specifically those in the healthcare community owe it to pain patients to do the best they can without it.

Ongoing opioid hysteria is preventing that... we are not coming close to doing our best for those patients.

Thanks for reminding me. I should have said most of the developed world. And my response to that exchange still applies:

Thanks, that’s great news. It’s too bad we can’t have an overall score to serve as proxy for our collective need for opioids, incorporating age, procedures and painful comorbidies, to get a real apples-to-apples comparison between countries. But it’s encouraging that we’re starting to fall in line with some OECD countries.

While I have no doubt developing countries are under treating pain, what differentiates us from New Zealand, South Korea, France, Japan and Italy? What is ideal per capita daily MME consumption?

To be clear, I think opioids are simultaneously over- and under-prescribed in the US. I see both inadequately treated pain and unnecessary chronic opioid use frequently, as well as substance abuse, though it’s less clear which side of the equation predominates. We definitely need more research and resources funneled into pain management and addiction.

ETA The new quote function is wonky.

 

[Terminalxylem]

And I see no reason why analgesics should be different than any other medication, where appropriate doses can be determined despite differences in individual patient physiology.It’s not impossible to measure pain.

 

[Tau837]

Since we are now repeating posts, I will repost my response:

Thanks, that’s great news. It’s too bad we can’t have an overall score to serve as proxy for our collective need for opioids, incorporating age, procedures and painful comorbidies, to get a real apples-to-apples comparison between countries. But it’s encouraging that we’re starting to fall in line with some OECD countries.

I wouldn't call it great news. It is likely that a lot of pain continues to be undertreated or untreated in the US due to the ongoing opioid hysteria in the US. IMO the pendulum has swung much too far in the wrong direction on this subject, and thousands of good people are suffering.

Meanwhile, we continue to set all-time highs in opioid overdoses every year, because the opioid overdose problem was never strongly correlated to opioid prescribing in the first place. I have probably posted at least 30 articles in this thread that make that clear. The facts are indisputable on this at this point.

While I have no doubt developing countries are under treating pain, what differentiates us from New Zealand, South Korea, France, Japan and Italy?

A lot of the factors I posted about previously come into play here, e.g., culture, relative ages of the populations, their approach to medical and dental treatments/surgeries, etc.

Also, note the study I posted about was for 2015-2019. I expect the US has slipped further down the list over the past 3 years due to the ongoing opioid hysteria in the US.

What is ideal per capita daily MME consumption?

This illustrates a misconception. There is no ideal. Why? Because every human is different, including:

• Differing physical and mental conditions
• Differing pain and diseases
• Differing abilities to metabolize opioids
• Differing life situations, which may help to offset or exacerbate the above

The idea of an "ideal per capita daily MME consumption" has no scientific basis. This is one of the biggest problems with the CDC guidelines.

 

[Tau837]

To be clear, I think opioids are simultaneously over- and under-prescribed in the US. I see both inadequately treated pain and unnecessary chronic opioid use frequently, as well as substance abuse, though it’s less clear which side of the equation predominates. We definitely need more research and resources funneled into pain management and addiction.

I agree wholeheartedly with your last sentence here. But while we await the additional research and resources, we should not make chronic pain patients suffer unnecessarily. But that is what we are doing.

 

[Tau837]

And I see no reason why analgesics should be different than any other medication, where appropriate doses can be determined despite differences in individual patient physiology.

I never said appropriate doses cannot be determined for pain treatment. I said I don't believe there is a standardized way to quantify pain, though I suppose what I really meant was to measure someone's pain in a reliable, accurate manner that enables that person's pain to be placed into some sort of universal scale/spectrum to help determine appropriate opioid medication dosage (if appropriate at all).

Appropriate opioid medication dosages can very clearly be determined through managed pain care in which patients are evaluated and monitored regularly. It is obviously very possible to start out with a dosage and adjust up or down based upon the patient's tolerance to the reaction and the level of pain relief the patient obtains from it, while also weighing the side effects. I have personally seen this for 24 years.

It’s not impossible to measure pain.

I don't think this study means what you imply it means here.

 

[Terminalxylem]

Since we are now repeating posts, I will repost my response:

Thanks, that’s great news. It’s too bad we can’t have an overall score to serve as proxy for our collective need for opioids, incorporating age, procedures and painful comorbidies, to get a real apples-to-apples comparison between countries. But it’s encouraging that we’re starting to fall in line with some OECD countries.

I wouldn't call it great news. It is likely that a lot of pain continues to be undertreated or untreated in the US due to the ongoing opioid hysteria in the US. IMO the pendulum has swung much too far in the wrong direction on this subject, and thousands of good people are suffering.

Meanwhile, we continue to set all-time highs in opioid overdoses every year, because the opioid overdose problem was never strongly correlated to opioid prescribing in the first place. I have probably posted at least 30 articles in this thread that make that clear. The facts are indisputable on this at this point.

While I have no doubt developing countries are under treating pain, what differentiates us from New Zealand, South Korea, France, Japan and Italy?

A lot of the factors I posted about previously come into play here, e.g., culture, relative ages of the populations, their approach to medical and dental treatments/surgeries, etc.

Also, note the study I posted about was for 2015-2019. I expect the US has slipped further down the list over the past 3 years due to the ongoing opioid hysteria in the US.

What is ideal per capita daily MME consumption?

This illustrates a misconception. There is no ideal. Why? Because every human is different, including:

• Differing physical and mental conditions
• Differing pain and diseases
• Differing abilities to metabolize opioids
• Differing life situations, which may help to offset or exacerbate the above

The idea of an "ideal per capita daily MME consumption" has no scientific basis. This is one of the biggest problems with the CDC guidelines.

I don’t believe there is an ideal MME, but I do think, on average, pain med utilization should be roughly equal for populations with similar demographics and medical comorbidities. When a few areas are dramatic outliers, I am less likely to believe those areas have figured out the “right” amount.

 

[Terminalxylem]

And I see no reason why analgesics should be different than any other medication, where appropriate doses can be determined despite differences in individual patient physiology.

I never said appropriate doses cannot be determined for pain treatment. I said I don't believe there is a standardized way to quantify pain, though I suppose what I really meant was to measure someone's pain in a reliable, accurate manner that enables that person's pain to be placed into some sort of universal scale/spectrum to help determine appropriate opioid medication dosage (if appropriate at all).

Appropriate opioid medication dosages can very clearly be determined through managed pain care in which patients are evaluated and monitored regularly. It is obviously very possible to start out with a dosage and adjust up or down based upon the patient's tolerance to the reaction and the level of pain relief the patient obtains from it, while also weighing the side effects. I have personally seen this for 24 years.

It’s not impossible to measure pain.

I don't think this study means what you imply it means here.

While it would be great if every patient had the benefit of a multidiscipliinary team managing the biopsychosocial aspects of chronic pain, the reality is we haven’t allocated resources for that to happen.

Given the limits of our system, we ultimately rely on clinical judgement, and that discretion will always leave some pain under-treated. Minimizing those patients while simultaneously avoiding overprescribing opioids is the challenge. You and I just disagree how close we are to the correct balance between over- and under-treating pain. Absent objective measures, it’s impossible to tell whose perception is more accurate.

 

[Tau837]

Misuse of Rx Opioids by Young Adults Falls to Record Lows

The misuse of prescription opioids by young adults has fallen to the lowest levels ever recorded, according to an annual survey that’s been tracking drug use in the U.S. since 1975. The Monitoring the Future (MTF) survey also found that use of marijuana and hallucinogens by young adults rose to an all-time high last year.

The MTF survey and annual report is a joint project of the National Institute on Drug Abuse (NIDA) and the University of Michigan. Over 28,000 people were surveyed last year, including young adults aged 19 to 30 and adults aged 35 to 60.

Only 1.7% of young adults reported using “narcotics other than heroin,” a poorly named category that refers to the non-medical use of prescription opioids such as hydrocodone and oxycodone. Misuse of prescription opioids has been in a steep decline since reaching a peak of 8.9% in 2006.

 

[Tau837]

How Supporters of CDC Opioid Guideline Hijacked Public Hearing

I continue to be offended by how the CDC has conducted itself throughout this period of opioid hysteria. It would be one thing if they were transparent, and I simply disagreed with their findings and approach. But they are completely non-transparent. The way they have conducted themselves throughout this vendetta period is unconscionable.

 

[Tau837]

A lot of info about the 7 "lies/false narratives" quoted below in this article: Debunking Lies

Do you hear the same myths or false narratives repeated over and over again? Do you ever wish you had all the information in one place so you can counteract these lies? In this section we list common lies/false narratives of anti-opioid zealots/those profiting off of the opioid elimination industry, and we give you all the tools you need to prove them wrong.



LIE/FALSE NARRATIVE: "The USA is 5% of the world's population, but we consume 80% of the world's prescription opioids and 99% of the world's hydrocodone (Vicodin)."

LIE/FALSE NARRATIVE: "80% of heroin users started with a prescription from their doctor."

LIE/FALSE NARRATIVE: "The CDC Guidelines were created with transparency using a wide range of experts with unbiased views. They were based on strong scientific evidence, and the CDC was unaware that the Guidelines could have a negative impact on pain patient outcomes."

LIE/FALSE NARRATIVE: "Studies show that opioids don't work for long-term chronic non cancer pain."

LIE/FALSE NARRATIVE: "The concepts of MME and MME limits are based on solid scientific evidence, and lowering patients to less than 90 MME is always beneficial."

LIE/FALSE NARRATIVE: "Studies show that opioids make pain worse in a common condition called Opioid Induced Hyperalgesia (OIH)."

LIE/FALSE NARRATIVE: "The difference between cancer and non-cancer pain is an evidence-based distinction and one that's easy to determine. Cancer pain has adequate pain treatment."

 

[DJackson10]

Yesterday was the 2 year anniversary for my nephew, age roughly 35, from his Opioid experience. He started taking them thru a prescription for a back injury, got hooked, and then went to the street for them. One night he passed out driving, crashed into a building, and the first cop on the scene had to give him 2 Narcans to bring him back to life. He spent 10 months in rehab and now is recovering. I bring this up as he had a 5 person family, an MBA and a really good job. He managed to salvage his family, lost his job, but did get another with the assistance of his rehab facility in conjunction with his church and he is building his life back. This can happen to anyone. We need a lot more pressure on our government to stop this. How we allow China to openly manufacture the precursor's for these drugs without calling them out for it, then ship them to Mexico and allow the cartels to do the manufacturing and smuggling is beyond me.

Well we did one good thing and got out of Afghanistan were we were taking over opioid fields to get a discount for big Pharm. We need to do a better job of stopping big Pharm. How do you do this? You stop the government officials from getting kickbacks from big pharm or being supported in campaigns by Big Pharm Wall Street, NRA and other big corps. Make laws where congress has to gain $$$ from the people not big corp and can't have any stocks when in office. I think all of that would greatly help. We also need to hold drs who just prescribe this crap just for the money etc.

If we want to stop this epidemic it starts at the top of holding our government officials responsible from county up to congress.

 

[Tau837]

Yesterday was the 2 year anniversary for my nephew, age roughly 35, from his Opioid experience. He started taking them thru a prescription for a back injury, got hooked, and then went to the street for them. One night he passed out driving, crashed into a building, and the first cop on the scene had to give him 2 Narcans to bring him back to life. He spent 10 months in rehab and now is recovering. I bring this up as he had a 5 person family, an MBA and a really good job. He managed to salvage his family, lost his job, but did get another with the assistance of his rehab facility in conjunction with his church and he is building his life back. This can happen to anyone. We need a lot more pressure on our government to stop this. How we allow China to openly manufacture the precursor's for these drugs without calling them out for it, then ship them to Mexico and allow the cartels to do the manufacturing and smuggling is beyond me.

Well we did one good thing and got out of Afghanistan were we were taking over opioid fields to get a discount for big Pharm. We need to do a better job of stopping big Pharm. How do you do this? You stop the government officials from getting kickbacks from big pharm or being supported in campaigns by Big Pharm Wall Street, NRA and other big corps. Make laws where congress has to gain $$$ from the people not big corp and can't have any stocks when in office. I think all of that would greatly help. We also need to hold drs who just prescribe this crap just for the money etc.

If we want to stop this epidemic it starts at the top of holding our government officials responsible from county up to congress.

If you think this "opioid epidemic" is about "Big Pharm" at this point, you should strongly consider starting at the beginning of this thread and reading through it, including reading the linked articles.

The "opioid epidemic" is mainly driven by opioid overdose deaths, which are mainly driven by illegal opioids, which have nothing to do with "Big Pharm."

There are instances of prescription opioids leading to addiction and ultimately to overdose deaths, but those instances are a small minority of the overall population of opioid addicts and overdoses.

 

[Tau837]

Two articles about this sad situation:

• This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor
• DEA Suspension of Doctor’s License Leads to Double Suicide

I did not know this couple, but his pain situation sounds very similar to my wife's.

What the DEA did here was unconscionable IMO. They do not understand the ramifications for innocent patients, and seemingly don't care. It is the most distressing US Government initiative I have ever directly experienced in my lifetime. The information is readily available to show that they should adjust their approach, and they know it is available. It is a willful decision to ignore it. A willful decision to harm millions of innocent citizens who are suffering daily in pain.

We do know the couple in this article: My Story: Why We’re Fighting the DEA. I really feel for them. And I admire them for trying to fight back. Godspeed!

I can identify with the anger, desperation, and anguish both of these couples felt when their pain medication was cut off. It is a fear every chronic pain patient lives with daily.

For my wife and me, we can only pray that her doctor does not get cut off like the doctors referenced in these articles. I don't want to think about what that would mean for us.

 

[Tau837]

Two articles about this sad situation:

• This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor
• DEA Suspension of Doctor’s License Leads to Double Suicide

I did not know this couple, but his pain situation sounds very similar to my wife's.

What the DEA did here was unconscionable IMO. They do not understand the ramifications for innocent patients, and seemingly don't care. It is the most distressing US Government initiative I have ever directly experienced in my lifetime. The information is readily available to show that they should adjust their approach, and they know it is available. It is a willful decision to ignore it. A willful decision to harm millions of innocent citizens who are suffering daily in pain.

We do know the couple in this article: My Story: Why We’re Fighting the DEA. I really feel for them. And I admire them for trying to fight back. Godspeed!

I can identify with the anger, desperation, and anguish both of these couples felt when their pain medication was cut off. It is a fear every chronic pain patient lives with daily.

For my wife and me, we can only pray that her doctor does not get cut off like the doctors referenced in these articles. I don't want to think about what that would mean for us.

Related to this: Judge Won’t Stop DEA Despite Patient Deaths

The entire article is frustrating... enraging. But this is the worst:

Much of the government’s case against Bockoff is dependent on the opinions of Dr. Timothy Munzing, a family practice physician who has created a lucrative second career for himself by working as a consultant for the DEA and DOJ. According to GovTribe, a website that tracks federal contracts, Munzing has made over $3.4 million in the last 8 years working for the government and testifying in dozens of cases against doctors.
“Dr. Munzing will testify that Dr. Bockoff’s patient care fell below the standard of care in California and the prescriptions resulting from several examinations were not for a legitimate medical purpose,” the DEA said in court documents. Munzing was not called to testify before Judge Blumenfeld.
McKeivier says the DEA failed to prove there was any “imminent danger” to Bockoff’s patients, even though Munzing reviewed three years of his medical records.
“The government made an argument that basically disproved itself,” she said. “If you’ve got 3 years of records and in those 3 years of records you cannot point to one example of death, overdose, bodily injury or diversion, then that disproves the fact that any of the danger based on those things is imminent. If for three years you have a track record of it never happening, then how can it be imminent to happen now?”

How can our government do this to its citizens? I am well aware of government dysfunction and apathy (I have worked in DoD contracting for the majority of my career), but this goes beyond that. This is actively harming citizens' health. It is unconscionable.

 

[FairWarning]

Two articles about this sad situation:

• This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor
• DEA Suspension of Doctor’s License Leads to Double Suicide

I did not know this couple, but his pain situation sounds very similar to my wife's.

What the DEA did here was unconscionable IMO. They do not understand the ramifications for innocent patients, and seemingly don't care. It is the most distressing US Government initiative I have ever directly experienced in my lifetime. The information is readily available to show that they should adjust their approach, and they know it is available. It is a willful decision to ignore it. A willful decision to harm millions of innocent citizens who are suffering daily in pain.

We do know the couple in this article: My Story: Why We’re Fighting the DEA. I really feel for them. And I admire them for trying to fight back. Godspeed!

I can identify with the anger, desperation, and anguish both of these couples felt when their pain medication was cut off. It is a fear every chronic pain patient lives with daily.

For my wife and me, we can only pray that her doctor does not get cut off like the doctors referenced in these articles. I don't want to think about what that would mean for us.

Related to this: Judge Won’t Stop DEA Despite Patient Deaths

The entire article is frustrating... enraging. But this is the worst:

Much of the government’s case against Bockoff is dependent on the opinions of Dr. Timothy Munzing, a family practice physician who has created a lucrative second career for himself by working as a consultant for the DEA and DOJ. According to GovTribe, a website that tracks federal contracts, Munzing has made over $3.4 million in the last 8 years working for the government and testifying in dozens of cases against doctors.
“Dr. Munzing will testify that Dr. Bockoff’s patient care fell below the standard of care in California and the prescriptions resulting from several examinations were not for a legitimate medical purpose,” the DEA said in court documents. Munzing was not called to testify before Judge Blumenfeld.
McKeivier says the DEA failed to prove there was any “imminent danger” to Bockoff’s patients, even though Munzing reviewed three years of his medical records.
“The government made an argument that basically disproved itself,” she said. “If you’ve got 3 years of records and in those 3 years of records you cannot point to one example of death, overdose, bodily injury or diversion, then that disproves the fact that any of the danger based on those things is imminent. If for three years you have a track record of it never happening, then how can it be imminent to happen now?”

How can our government do this to its citizens? I am well aware of government dysfunction and apathy (I have worked in DoD contracting for the majority of my career), but this goes beyond that. This is actively harming citizens' health. It is unconscionable.

as always, follow the money. It’s really a shame that our government allows this.

 

[Tau837]

The CDC has abandoned pain patients. Its new opioids guidelines are all for show.

 

[[icon]]

Shocking no one (or at least not me) the legalization of marijuana has resulted in a surge of addiction and mental illness, particularly among teens.

The whole concept that MJ is harmless is and was bunk.

Your link is to a Daily Mail article, which is a UK tabloid. I'd prefer to look at actual studies that show this "surge of addiction and mental illness". Do you have any peer reviewed studies that show this causal relationship?

I too base my medical opinions on Tabloid articles that don't cite any actual peer reviewed studies.

 

[Sand]

Shocking no one (or at least not me) the legalization of marijuana has resulted in a surge of addiction and mental illness, particularly among teens.

The whole concept that MJ is harmless is and was bunk.

Your link is to a Daily Mail article, which is a UK tabloid. I'd prefer to look at actual studies that show this "surge of addiction and mental illness". Do you have any peer reviewed studies that show this causal relationship?

I too base my medical opinions on Tabloid articles that don't cite any actual peer reviewed studies.

NIH ok with you guys?

Implications of Marijuana Legalization for Adolescent Substance Use

Marijuana that is legally available for adults has multiple implications for adolescent substance use. One potential effect that legalization may have is an increase in adolescent use to due increased availability, greater social acceptance, and possibly ...

www.ncbi.nlm.nih.gov

Adolescent marijuana use has been associated with impairment in a number of areas: impaired cognitive functioning,36 increased risk of developing marijuana dependence,37 elevated rates of school dropout,38 an elevated risk of developing psychotic illnesses,39,40 and an increased rate of engaging in risky behaviors.41 Weekly marijuana use under age 18 years has been associated with an eight-point drop in intelligence among those who develop persistent dependence, while those with adult onset of comparable levels of use are less affected; importantly, the loss of cognitive capacity may not recover completely after desisting from marijuana use.42

That is the pertinent part. Mental illness, dependence, school dropout, permanent drop in IQ. Not sure what the outrage is here - I figured these kind of effects were well known and accepted as par for the course. IMO, the onus should be on folks to show this stuff doesn't happen - that it does happen is common sense (and, as can be seen, well documented).