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Trump’s epic drug fail: The case for safe, legal heroin

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President Trump declared that opioids are now a “National Public Health Emergency.” At the same time he demonstrated his ignorance of important facts. That is likely the fault of Chris Christie’s chairmanship of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Only one of the Commission members, Dr. Bertha Madras, has any subject matter expertise. The other five are elected officials, all of whom have publicly demonstrated allegiance to the idea that the Drug War is the proper way to deal with an epidemic of overdoses.

To say that this is wrong-headed would be the observation of an astute student of the obvious. The War on Drugs was officially declared by Richard Nixon in 1971, but has been going on at least since the Harrison Narcotics Act of 1914. In a century we have experimented with banning one addictive drug, alcohol, only to discover that prohibition does not work. Yet politicians and their lapdogs in the press have slavishly insisted that if we do more of the same, we will eventually get a different result. Albert Einstein famously noted that this is one definition of insanity.

Widely distributing Narcan to drug addicts will probably save some lives when they overdose, but that’s like calling a wrecker to tow you to the tire store when one blows out after all four have been bald for a year. Sometimes you’ll get in safely, but other times you’ll end up injured or dead in an accident.

Dr. Madras is an expert in the cellular biology of addiction, but it is clear from her writings that she is most comfortable with remedies based in formulary controls, claims data surveillance, and education of physicians on reducing opioid risks. This top-down regulatory approach is shared by the congressman, state attorney general, and three governors who fill out the commission. In short, the Commission’s prescription was printed and signed before the Commission ever met. It completely ignores a century of experience in the field.

Opiates 101: A short course

In my 36 years in Anesthesiology, I became intimately familiar with the salient fact that all opiates are essentially the same drug. (See table) All work on the same receptor in the brain. All depress breathing so that in an overdose, the victim completely forgets to breathe until he is completely dead. All cause constipation, nausea, and vomiting. All change how one sees the world, and once your body is used to them, they all cause horrible withdrawal symptoms.

The only material differences between opiates lies in how quickly their effects start, how long they last, and how the drug is administered. In a sense, Remifentanyl is short acting Fentanyl, while Morphine, Heroin, and Dilaudid are delayed release Fentanyl. Oxycodone is essentially an oral form of Morphine. I could go on, but you get the point.

Knowing those facts made it easy for me to administer literally gallons of opiates safely. Had Heroin been legally available, it could have joined Fentanyl, Morphine, and Dilaudid as my front-line drugs for pain. After all, it has the same onset, duration, and side effects as Morphine and Dilaudid, with potency between them.

History 101: Why opium was banned

By now it should be painfully clear that there is no medical reason whatever for Heroin to be banned. It’s a good drug with definite medical utility. And Fentanyl has proven itself to be a very good drug since it was introduced into clinical medicine over fifty years ago. Yet suddenly there are wild cries to eliminate a “public health emergency” from a drug we’ve used safely for decades. Why should this be?

Opium has been used for both intoxicant and medical purposes for as long as we can trace history. It is an extract from a pretty flower that grows wild in many countries. It dulls pain by working more effectively at the endorphin receptor than endorphins, which your brain makes. As long as the strength of the drug is known, it is extremely safe. But do-gooders can’t leave well enough alone. Could it be they see some benefit for themselves?

Opium has been a cash crop for millennia, but by itself isn’t that highly profitable since harvesting and refining it is inexpensive. An addict can easily be supplied for a couple of dollars a day. A supplier needs a large market. Or he can have a smaller market at a higher price.

Our current obsession with the bad habits of others took full flower at the pen of William Randolph Hearst. During the building of the Trans-Continental Railroad, large numbers of Chinese laborers were imported. They took their one day a week off in the nearest shanty town where many smoked opium, got high, and slept it off. Hearst was a blatant racist with the largest megaphone in the country, the Hearst newspapers.

His hatred for the “coolie” sprang vividly from the headlines, cartoons, and editorials of his papers. Soon the “opium fiend” was a matter of public condemnation, even though the demon created in the printed word never existed, since opium does not lead to aggressive behavior. Shortly Congress passed the Chinese Exclusion Act of 1882, which prevented further Chinese immigration.

This did not end the frenzy. In 1914 Congress passed the Harrison Narcotics Act, again in the complete absence of evidence that individual consumption of narcotics caused harm to those not engaged in its use. Further, many, in the footsteps of the “coolies,” were able to use the intoxicating drug and continue to live a productive life.

When Harry Anslinger became the first Director of the Federal Bureau of Narcotics in 1930, the War on Drugs (by other names) became fully fledged. Never again would the wisdom of the effort to stamp out drug abuse be seriously questioned in the halls of power. Prohibition of one intoxicant, alcohol (1920-1933) was extended to other intoxicants, the opiates. Unlike alcohol which is consumed across wide socioeconomic classes and has been released from constitutional imprisonment, opiates remain the forbidden fruit.

The benefit of prohibition: Risk premium

While it is clear that, in the absence of proper medical indication, opiates are detrimental to well-being, addicts who are maintained on their meds are no threat to society. Many are able to function at a high level. So what benefit arises from prohibition? As James Carville famously said, “It’s the economy, stupid!”

When intoxicants are prohibited, a “risk premium” is created.

A risk premium is the return in excess of the risk-free rate of return an investment is expected to yield; an asset’s risk premium is a form of compensation for investors who tolerate the extra risk, compared to that of a risk-free asset, in a given investment.

– Investopedia

When drugs are legal, there is no legal risk, and the cost to the consumer is the basic economic cost of the steps of production and distribution. As we noted earlier, this is less than the cost of your daily Starbucks latte’. It’s enough for a basic business but simply lacks the margin to support a criminal enterprise.

When drugs are illegal, a market still remains, since a significant portion of the population has wanted intoxicants throughout history. But now there is a notable risk to supplying the demand. So price increases to cover that risk. The curbside pharmacist has to get his supply somewhere. His supplier has the same problem, so the price goes up more. Now the customer has a problem.

If he’s going to empty his wallet to pay for all that risk, he wants a real bang for his buck. After all, he could end up in jail, too! This potency requirement raises the price on the other steps… again. It’s a vicious cycle. What started out as something cheap has become very expensive. And now there is profit for criminal enterprises.

Those enterprises will want to protect their turf from competition, and now we see violent crime start to appear around the drug trade. Customers who become addicted now have to find ways to support their habits, and various other crimes become common. Note that every level of crime was absent in the open trade for opioids. As soon as drugs became criminalized, bigtime crime moved in, because prohibition creates profits for them.

One more problem arises. How does a dealer keep his customers? He has to provide high quality product. This was demonstrated very well in the late 1960’s when Laotian General Ouana Rattikone marketed “999” heroin. It was a very consistent product so that a safe dose could easily be administered. When competitors made more highly refined heroin, he upped his game and produced “Double Uoglobe Brand” heroin. Reliable quality led to large sales.

Rattikone was in a protected area. Your distributor can’t do the same thing without attracting attention. But he can mix his product with other things. If he cuts it with inert materials, he can spread it further, but competitors will attack his poor quality. On the other hand, if he adds something a bit more potent, such as fentanyl, he will give the appearance of a better product.

Unfortunately, this competitive commercial response is now being seen in multiple markets with radically differing amounts of fentanyl. Now each addict is taking on a new risk every time he administers a dose. It may be worthless or it may completely stop his breathing until he is completely dead.

What if we legalized heroin?

Let’s review the chain of events. Prohibition introduces a risk premium, making crime pay. It also prevents the customer from knowing what dose he is getting. Many users will get overdoses, and many will die. Should we be surprised when that is today’s headline?

Suppose we legalized drugs? Apologists for prohibition claim we’ll see more addiction and more deaths. Instead “we need more detox and rehab programs.” Should we be surprised that this approach is promoted by people who profit from those programs?

Fortunately, we have laboratories that show what works. One of them is called Portugal. There, heroin was made legal in 2001. Sixteen years have shown that overdose deaths have almost vanished.

Addicts are maintained on steady doses of drugs they get for free from clinics. The total cost is less than that latte’ we mentioned earlier. And, curiously, addicts are slowly weaning themselves off of opioids in an average of ten years.

Imagine that! When they don’t have to resort to crime, addicts are able to maintain relatively normal lives and then act in their own self-interest. And no funds are diverted to unnecessary detox and rehab programs. And, by the way, no funds are spent on expensive drug interdiction efforts. No undercover cops infiltrate drug rings, because there aren’t any.

Suppose the United States was to do this? Our expensive rehab programs would go away, allowing money to be spent where it can actually do some good. But more important, the profit that fuels the Mexican drug cartels would dry up. We wouldn’t have Border Patrol agents running up against heavily armed drug gang members. There will be no need to prosecute the next El Chapo, because he won’t get rich enough to matter or to export his crime to the US.

What’s not to like?

Ted Noel MD is a Board Certified Anesthesiologist with 36 years of experience. He produces a video blog on current political subjects weekly at www.VidZette.com.

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Healthcare

GOP will really, really, really repeal Obamacare if victorious in November

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Good news, America! If we give Republicans control of the House and the Senate in November, they will repeal Obamacare! No, this isn’t an old headline found in the election-year archives from 2012, 2014, or 2016. This promise is now! Today! 2018!

In an interview on Hill TV yesterday, Republican Nation Committee (RNC) spokeswoman Kayleigh McEnany informed voters that if the GOP maintains control of the House and picks up a few seats in the Senate, bada bing, bada boom, the Republicans will pass the Graham-Cassidy Repeal-In-Name-Only healthcare bill—a piece of legislation that does nothing to fix the Obamacare disaster.

“We were a big proponent of Graham-Cassidy. That, of course, was a Senate bill that gave states the power and allowed each state to select what the best way forward was for them on healthcare.

“That was one vote short, and if we maintain the House as we expect we will, pick up a few Senate seats, Graham-Cassidy can become a reality.”

Besides McEnany’s sad and pathetic use of the GOP election-year playbook—make promises, break promises, repeat—Graham-Cassidy failed to pass in the first go around because it fails to do as promised concerning Obamacare repeal.

In an opinion piece on FOX News by Sen. Rand Paul at the time—he was one of the “no” votes—he pointed out how Graham-Cassidy failed to return healthcare decisions to the American people and how it instead created an even greater reliance on the federal government for our healthcare needs. And even though Graham-Cassidy eliminated Obamacare mandates—something that was accomplished in the Tax Cuts and Jobs Act—it “doesn’t repeal a single Obamacare insurance regulation.”

One more thing. Even though Graham-Cassidy was touted at the time within some conservative circles as a step toward Federalism and states rights, the block grants paid to the states by Washington bureaucrats as stipulated in the bill made states more dependent on the federal government, not less.

And for those partial to defending Trump by blaming Congress for the GOP’s failure to keep its promise to repeal Obamacare, the New York liberal supported Graham-Cassidy.

Clearly, the GOP has repeatedly failed to deliver on its promises. This is why Republicans engage in the politics of distraction by holding show votes on vital conservative issues like: abortion, term limits, and balancing the budget. It’s also why the RNC is recycling—for the fourth election year in a row—the promise to repeal Obamacare.

Maybe it’s just me, but I’ve got a feeling that repealing Obamacare will still be an issue in 2020 and will most likely be part of the GOP platform.

Originally posted on The Strident Conservative.

 


David Leach is the owner of The Strident Conservative. His daily radio commentary is distributed by the Salem Radio Network and is heard on stations across America.

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Healthcare

Minneapolis Police: Uses dangerous drug to sedate criminals

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Minneapolis has some creative people. Too creative for their own good. Somebody probably saw that the guys who take down large animals with tranquilizer darts use darts filled with ketamine. “Hey, if it will take down those animals, why don’t we use it on the animals our police are fighting?” And an immensely stupid program began. It was also illegal, but if we’re controlling bad guys, who cares?

Time for disclosure. I am a doctor. I do not play one on TV. Not only that, I’m an anesthesiologist and used ketamine in my practice. For certain things, it has no equal. But its proper uses are quite limited.

Ketamine comes from a class of drugs called phencyclidines. The street version is known as Angel Dust, and abusers are Dusters. Because ketamine causes profound analgesia (pain relief), Dusters are known for feats of superhuman strength. Broken handcuffs are just one relatively well-known example. At the same time, Dusters may break their own bones. The analgesic effect of ketamine keeps them from realizing the damage they are doing to themselves.

By now, it should be pretty clear that ketamine is no panacea for the problem of sedating troublesome persons being arrested. At the wrong dose in the wrong person, police can put themselves in worse difficulties than when they started. How do you control someone who feels no pain and wants to cause you harm? Flashback to the villain Renard in The World is Not Enough. He is almost impossible to defeat in a fight because he feels no pain. But I guess the Minneapolis wise guys don’t watch James Bond films.

I have to wonder if the police bothered to look at any references. Even Wikipedia would have been helpful. If they had, they’d discover that there are a lot of other problems with ketamine. The first one should have given them a real headache. The primary reason we don’t use ketamine a lot in anesthesia is that it has a high incidence of emergence delirium. In language even an inattentive civil servant can understand, that means that if you give someone ketamine, they can hallucinate. This happens often enough that we try to avoid ketamine except in those odd cases where its other effects make it the best drug available. Just to make a bad problem worse, there are a lot of times when there isn’t anything you can do to stop the delirium. Welcome to hell.

We’ve only scratched the surface. Since Minneapolis police officers obviously consulted Dr. Conrad Murray, we should expect that they got the same level of advice Michael Jackson got. That means that they missed the fact that ketamine can lead to airway obstruction and death. It releases adrenaline, so it can cause hypertension and tachycardia leading to death. Did I mention that it can kill you? And, unlike opioids, you can give all the naloxone you want and it won’t do a bit of good.

But the Minneapolis police officers are really interested in saving lives, so we can let them use this drug they simply don’t understand on patients who aren’t consenting and may suffer badly from its administration. No problem.

The track record is as bad as I suggested up front. Ketamine administration has led to multiple episodes of cardiac and breathing problems, with many patients requiring emergency intubation. Now for a skilled health care provider, intubation is generally no big deal. But you never deliberately put yourself in a position where you create an uncontrolled need for intubation. The moment you do that, you’ll find yourself looking at the impossible situation. With somewhere around fifty thousand intubations under my belt, the next one can still be the one where I have to call a partner in to give it a try. My practice had over eighty anesthesiologists and two hundred nurse anesthetists, so there was usually another set of hands available. But who is the paramedic in the field going to call? Ghostbusters has an unlisted number.

Let’s get one thing clear. Minneapolis police officers did not have a hand on the syringe. They asked the Hennepin County paramedics to administer ketamine. And if a cop asks, how is a paramedic supposed to refuse? But the paramedics are supposed to operate according to a strict protocol, and only give ketamine when a patient is “profoundly agitated, unable to be restrained, or a danger to themselves or others.” It’s clear that this guideline was violated on multiple occasions.

And this brings us to the nub of the matter. Ketamine is properly used only in the sort of situation described in the protocol. In anesthesia, we will also use it in autistic or severely mentally retarded patients who cannot be managed by breathing them to sleep with gases. In short, we mostly use it in the controlled medical equivalent of the field situation.

It’s likely that Dr. Jeffrey Ho (the director of Hennepin County EMS who happened to graduate from the same medical school I did!) is actually well aware of the proper use of ketamine. He’s a recognized expert in pre-hospital emergency care. And if ketamine is used in the very restricted fashion the policy describes, it’s probably better than most alternatives. But when police decide that they want a set of chemical handcuffs rather than doing their job, we have a problem.

Police work can be difficult and dangerous. But police are not allowed to place people in danger just to make their own life easier. Doing so exceeds the bounds of our social contract with police, and also violates a host of laws. For a paramedic to go along with such an improper request places that paramedic in violation of state laws on the practice of medicine. Their drivers’ license isn’t enough. You follow the protocol or get permission from the supervising ER doc by calling it in.

Hennepin County and the city of Minneapolis have a problem on their hands. Their best bet will be to quietly approach persons who were harmed by this cavalier misuse of ketamine and buy out their legal liability. Then the EMS and police persons involved should be invited to leave. Promptly. Do not pass Go. Do not collect $200.

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Culture and Religion

The Context of Life

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Man #1 shoots Man #2. As a result, Man #2 dies. Is Man #1 a murderer?

Obviously, it depends. Context matters. Did Man #1 fire in self-defense? Did he shoot Man #2 by accident? Was Man #1 part of a legally appointed firing squad or under a hypnotic trance? Was the weapon a prop gun that mistakenly contained live ammunition? There are many points to consider before we can definitively say that an instance of killing constitutes murder.

Let’s try another thought exercise: protesters are gunned down by a neighboring country’s military forces. Is this murder? Is it a breach of international law? Is it a gross violation of human rights?

Again, it depends. Context matters. Are these protesters peaceful, or are they, say, planting landmines, tossing grenades, hurling molotov cocktails, and threatening to invade the country that is firing back at them? Have these protesters sworn to murder and pillage their neighbors until they are eradicated from the earth, all in the name of radical religious zeal? Are upwards of 50 out of the 62 protesters killed members of a terrorist organization?

Here’s another one: are illegal immigrants animals?

That depends; are the immigrants in question members of a ruthless gang that rips the beating hearts out of its victims? Do these immigrants peddle drugs, commit brutal assaults, and routinely rape women? Given the context and Oxford’s alternative definition of “animal” — “a person whose behavior is regarded as devoid of human attributes or civilizing influences, especially someone who is very cruel, violent, or repulsive. Synonyms: brute, beast, monster, devil, demon, fiend” — I think we can deem that perhaps too kind a descriptor.

Some people, however, seem to reject the value of context when it goes against their narrative. For instance, on the issue of calling MS-13 members “animals,” singer John Legend tweeted on Thursday, “Even human beings who commit heinous acts are the same species as us, not ‘animals’. I’m in the hospital with our new son. Any of these babies here could end up committing terrible crimes in the future. It’s easy, once they’ve done so, to distance ourselves from their humanity. … Dehumanizing large groups of people is the demagogue’s precursor to visiting violence and pain upon them.”

While MS-13 undoubtedly deserves any visitation of violence and pain upon them, the most glaring hole in Legend’s argument is that mere hours ago, he wouldn’t have considered “any of these babies” to be the same species as him (except when it’s his own baby). And as an outspoken donor and supporter of Planned Parenthood, he wouldn’t hesitate to defend the visitation of violence and pain upon them. But because of arbitrary abortion arguments, Legend and countless other Leftists ascribe more humanity to murderous villains than preborn babies.

Ironically, the one issue where Leftists insist on considering context is the one topic for which nuance is largely counterproductive — the sanctity of life.

As mentioned earlier, not all killing is murder, nor is it always unjustified. The right to life is unalienable, meaning it is intrinsic and therefore cannot be given nor taken away by man. It can, however, be surrendered through certain violations of another person’s unalienable rights. This is why many conservatives support capital punishment for perpetrators of homicide and rape. But it’s critical to recognize that this position is taken in order to emphasize the dignity of life and the severity of seriously harming and/or violating it. Similar reasoning is what justifies depriving someone of their unalienable right to liberty after they’ve committed a crime — they’ve automatically surrendered that right based on their actions.

That single caveat aside, any attempt to contextualize the debate for life pushes the dialogue further down a nonsensical rabbit hole designed to cheapen the worth of the weakest among us, or, to borrow Legend’s term, “dehumanize” them. At every turn, the argument gets slipperier and slipperier.

The Left will say that all human life is precious, even murderers, but they don’t extend this philosophy to unborn babies.

“Context!” they scream. “Fetuses aren’t fully human, and they aren’t really alive.”

Even if we gave the Left that argument, we have to ask whether fetal life, though not fully developed, is still worth protecting.

But the Left can’t give a straight answer here either, because while they celebrate a woman’s choice to terminate her unborn child, they cry for the conservation of fetuses that aren’t even human, proclaiming their inherent dignity well before birth. Eagle and sea turtle eggs come to mind, among other examples.

Next, the Left tries to establish what differentiates a human before birth and a human after birth, or rather what about birth makes someone human, but their attempts at context again fall short:

On one hand, they say it’s about viability outside of the womb, but standards of what constitutes viability are fully arbitrary. A baby born at 37 weeks is no more viable than one at 41 weeks that refuses to pop out — but because it’s still in the womb, it’s still not a living human, apparently. A baby born at 25 weeks in a big city is more viable than a baby born at 35 weeks in the boonies. My one-year-old daughter couldn’t survive without constant care from someone else, and neither could many elderly folks.

Other pro-aborts claim that if there’s no heartbeat, there’s no life, yet I don’t see many of them rushing to pull the plug on grandpa because he’s hooked up to a pacemaker.

I’ve heard some say that a baby’s first breath is what makes it human — so what about those who require artificial sources of oxygen? And if air confers humanity, then why aren’t all air-breathing animals human? If it determines life, then what happens when I hold my breath? I have the potential to breathe again, just as a fetus, left alone, has the potential to be born through natural processes.

The same goes for the sentience test. People in comas still enjoy an unalienable right to life.

Under the law, a woman can abort her baby, but if a pregnant woman is murdered, the assailant is charged with double homicide. No context can sensibly explain this double standard.

Some on the Right are guilty of it too. When asked whether abortion is murder, many engage in a similar exercise to the example I presented earlier about whether a shooting death necessarily constitutes murder: “it depends, what are the circumstances?”

There is no nuance to this question. Either the intentional taking of innocent life is murder or it is not. What difference does it make whether the baby was the result of rape or incest? I’ve stated in this very article that rape sometimes requires taking a life — but the baby is not the guilty party. Either life is sacred or it is not, regardless of how it got there.

Others cite the safety of the mother as context, but this argument is likewise flawed. Pursuing a vital cure for a woman’s ailment that indirectly harms the baby isn’t the intentional taking of innocent life but an unfortunate externality, so it’s not murder. And the case for actively terminating a pregnancy to save a mother is virtually identical to a self-defense argument, but again, there’s a problem: a baby is not an aggressor. It does not violate a woman’s rights, and a woman cannot violate the rights of her baby.

And a baby either has rights or it doesn’t. “Unalienable” means a baby doesn’t magically receive rights the moment it exits the birth canal, nor are a human’s rights any less inherent because he or she is dependent on someone or something else to sustain them. From the moment of existence, all human life has worth.

Life is the only consistent position, and it is so straightforward that it requires no nuance. Life either has intrinsic value or it does not. Context matters in almost every discussion of politics. But on the question of life, what people think is context is just an excuse to kill.


Richie Angel is the Editor at Large of thenewguards.net. Follow him and The New Guards on Twitter, and check out The New Guards on Facebook.

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