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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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Culture and Religion

Conservatives, Federalists and people of faith must be a voice for people with intellectual/developmental disabilities

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Conservatives Federalists and people of faith must be a voice for people with intellectualdevelopmen

Last year as a way to help me connect with people, a friend of mine introduced me to a group that had ties to a non-profit group called The Arc. Now the overall purpose of The Arc is to serve people with intellectual and developmental disabilities. The organization’s roots go back to 1936 with the Children’s Benevolent League which was incorporated in Washington State. It would evolve into the Association for Retarded Children (or Citizens) which was the original acronym for ARC. Retarded these days is a politically incorrect term, and thus The Arc has no meaning anymore in itself anymore. I myself do fall into those with intellectual and developmental disabilities.

While I would agree that “retarded” would be a derogatory term and mental disabilities would be a more appropriate term to use, I eventually had to leave my local group of The Arc and it was strictly out of my own choice and my choice alone.

The Arc I soon found out opposed any repeal of the Affordable Care Act. One of the biggest reasons why they support the ACA (aka ObamaCare) is that the law itself allowed for Medicaid expansion, and thus bringing more people into that welfare program including people with disabilities. I also looked at their blog and they were also opposed to the recent signed Tax Cuts and Jobs Act, and while I have my healthy skepticism about this brand new law signed by President Trump, I do think we need to reign in Medicaid spending cause if we don’t, it will eventually go broke and those who have depended on it really suffer.

Sadly, The Arc has been grounded in a belief that only big government can help those with disabilities. The Arc’s long standing tax policy according to them is; “that it should raise sufficient revenues to finance essential programs that help people with disabilities to live and work in the community. The Arc also supports tax policy that is fair and reduces income inequality; people with disabilities are twice as likely to experience poverty.”

The term ‘income inequality’ should be a red flag for anyone who calls themselves a conservative. What does The Arc consider ‘income inequality?” This is just one of those buzz terms that the left has thrown around for years, and The Arc while they want to give people with disabilities a voice, that voice sadly eventually will advocate for more bigger government and higher taxes and regulation. All in the name of helping the intellectual and developmental disabled. The Arc to me is just another organization that is ran by maybe well intended progressives to liberal thinking people.

I would like to ask The Arc why must people be forced to buy expensive health insurance so that they can take the money out of the consumers to spread to the mentally disabled (via government edict) so that they can be insured? The money could have gone to invest in the needs of individual families who work to the bone just to make a living. Progressives have forced people to work harder for other people that they will never meet. Yet this spreading of the wealth is supposed to make us feel good about our government helping others. Some legitimately do need help from the government and others just stay on the dole and contribute to the collapse of the welfare state.

The welfare state is a sacred cow of the progressives because it is used by progressive politicians to buy votes from their constituents. The Arc is no different as progressive politicians are buying favor with them as well. The short term might be favorable to the disabled but if the socialist scheme crashes and big government can’t help them any longer, I can only tell the disabled community to be on guard.

I am not saying that the disabled should not receive government help. What I am saying is that we need to reform welfare programs so that it does not come crashing down like a ton of rocks. I am afraid that eventually the disabled will be weeded out of the population because they are now a burden to our government. If CBS News enjoys the fact that Iceland murders the preborn that have mental disabilities via legal abortion, then that thinking is only a hop, skip and jump away from coming to America and worse.

If you are part of The Arc, and agree with me that The Arc’s advocacy of big government is wrong, we need to figure out a way to create some kind of organization that is not focused on big centralized government but rather embolden those with intellectual and developmental disabilities to be able to live not only independently but in a culture built on liberty and freedom. We now have stable organizations for senior citizens that promotes conservative values (AMAC, 60+, American Seniors Organization) and are true alternatives to the progressive AARP. Now we need conservative alternatives to The Arc.

This article was originally published in The Christian Post.

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Healthcare

Should CVS and Amazon replace Obamacare as the healthcare gatekeepers?

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Should CVS and Amazon replace Obamacare as the healthcare gatekeepers

There’s an interesting article over at Spectator that details how two of the big mergers initiated in 2017 – CVS-Aetna and Amazon-Whole Foods – may be the start of the re-privatization of healthcare. Both mergers seem to be betting on a future with something different from Obamacare, though it’s very unlikely the national government will get out of the healthcare industry altogether.

That’s okay, at least as far as CVS and Amazon are concerned. If things continue heading along the trajectory of Obamacarelite or an adjusted Obamacare without an individual mandate, the two giant companies are poised to do well. If the government gets mostly out of the health insurance industry through a clean repeal of Obamacare, CVS and Amazon will hit the jackpot. Even if nothing changes, the trends towards big dollars going into healthcare means they’re worst-case-scenario is still highly profitable.

Here’s the Spectator:

CVS and Amazon, Not Politicians, Best Bets to Reform Healthcare

https://spectator.org/cvs-and-amazon-not-politicians-best-bets-to-reform-healthcare/Americans spend nearly $3.5 trillion annually on health care. The number rises beyond inflation, with the figure fast approaching a fifth of gross domestic product as we grow older, fatter, and more demanding. CVS and others seek to capitalize, which generally betters attempts to monopolize or subsidize or any other “ize” one can imagine.

CVS and perhaps Amazon, whose acquisition of Whole Foods earlier this year set off speculation, believes that the free market can deliver care more efficiently than the government, which, long before Obamacare, became heavily invested in health (declining lifespans two years running suggest taxpayers do not get much back on their investment).

As much as I’d love to see DC remove itself completely from the healthcare business, I’m concerned that the market, even one as big as healthcare, will be swayed too heavily by the big players. That doesn’t mean we need to keep Obamacare or replace it with Obamacarelite to prevent big healthcare companies from running rampant, but it would be nice to see a bunch more smaller players entering the fray. Obamacare has scared many from participating. If mega-companies fill the void, we may be seeing different but equally risky motivations leading us down a dark path. It isn’t the capitalism of it all that worries me. It’s the stifling of innovation from the opposite side of the spectrum, one that’s not dissimilar from the automotive industry’s quashing of alternative energy cars for decades until the demand was too high to ignore over the last decade and a half.

We need to press DC to demolish Obamacare, but we must also keep an eye on the new gatekeepers who would replace DC once they’re out. It can’t get any worse than it is… unless it can. Still, Obamacare is so bad, it’s definitely worth the risk.

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Healthcare

3 reasons McConnell’s plan to ‘move on’ from Obamacare repeal is a huge mistake

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3 reasons McConnells plan to move on from Obamacare repeal is a huge mistake

Senate Majority Leader Mitch McConnell has a plan. He hasn’t made the plan public, but behind closed doors he’s let other Republican lawmakers know his intentions. To the discerning public ear, his plans are coming through crystal clear. He intends to play it safe in 2018 and avoid issues that may contribute to the GOP losing control of the Senate.

Last week on NPR, McConnell laid out a populist approach to the upcoming legislative year. He heralded bipartisanship while pushing away from important controversial issues such as Medicaid, food stamps, and most importantly another attempt to repeal and replace Obamacare.

McConnell Ready To ‘Move On’ From Obamacare Repeal, Others In GOP Say Not So Fast

https://www.npr.org/2017/12/21/572588692/mcconnell-wants-bipartisanship-in-2018-on-entitlements-immigration-and-moreSenate Majority Leader Mitch McConnell wants 2018 to be a year of bipartisanship, even if that means moving on from GOP dreams of cutting welfare and fully rolling back the Affordable Care Act.

The Kentucky Republican on Thursday broke with House Speaker Paul Ryan, R-Wis., on the approach to paring back spending on programs like Medicaid and food stamps. In an interview with NPR, McConnell said he is “not interested” in using Senate budget rules to allow Republicans to cut entitlements without consultation with Democrats.

He painted his reluctance to address the issue in terms of basic political math:

“Well, we obviously were unable to completely repeal and replace with a 52-48 Senate,. We’ll have to take a look at what that looks like with a 51-49 Senate. But I think we’ll probably move on to other issues.”

The reality is he’s not wanting to go into the midterm elections with the Democrats and their mainstream media partners complaining about lost insurance coverage in areas where seats are being contested on Capitol Hill. The two things he doesn’t want to tackle – Obamacare and welfare reform – are election losers in his opinion.

He is probably right about welfare reform, much to the chagrin of Speaker of the House Paul Ryan who has been pushing for entitlement reform since he was a freshman representative. As for Obamacare, he’s absolutely wrong. Here are three reasons why:

Following elimination of individual mandate, premiums will rise

The tax law zeroed out the tax penalty associated with not having healthcare, essentially eliminating the individual mandate for now. Republicans will herald the move while Democrats cook up numbers to show how millions “lost” their healthcare as a result, but it’s how the insurance companies react that will make the real waves.

Premiums will go up. It’s unavoidable without further action on Obamacare. The individual mandate is one of the few things keeping health insurance costs down. By forcing young, healthy Americans to pay for insurance they rarely use, insurance companies are able to mitigate some of the financial damage of other aspects of Obamacare such as mandatory coverage for preexisting conditions. By not forcing people to buy, insurance. companies will be forced to raise premiums and deductibles on everyone else.

It would be irresponsible to drop the mandate without cutting or completely eliminating Obamacare. Now more than ever, a new plan must be put into place that does not have an individual mandate but makes up the difference in ways that do not include spiking prices.

Democrats will use repeal-prevention as campaign ammunition

If McConnell thinks repealing and replacing Obamacare will cause his caucus election pains, he’s in for a surprise. The Democrats will invoke “protecting Obamacare from the GOP” in all of their campaigns. There was a time not so long ago when Americans could stomach losing Obamacare, but support for the ACA has steadily increased since the election.

McConnell will have to peel back a few more layers on his perceptions of Democratic campaign strategy if he wants to know what will hurt the GOP more : repealing Obamacare or giving Democrats the threat of a future Obamacare repeal.

Conservatives won’t stand for it

Republicans have been making the same promise for seven years: give us the House, Senate, and White House and we’ll take down Obamacare. They got their wish. Now, it’s time to deliver.

The shifting sentiment towards Obamacare might settle well with some Republicans, but conservatives won’t be as forgiving. The House Freedom Caucus is already preparing to push for it:

House Republicans reject Mitch McConnell’s plan to ‘move on’ from Obamacare repeal

http://www.washingtonexaminer.com/house-republicans-reject-mitch-mcconnells-plan-to-move-on-from-obamacare-repeal/article/2644219Rep. Mark Meadows, R-N.C., also said Obamacare repeal was “still on the table.” He said President Trump and Sen. Lindsey Graham, R-S.C. — who helped spearhead his own repeal bill with Sen. Bill Cassidy, R-La. — are still on board for repealing the healthcare law.

“I think he is probably just being pragmatic, knowing he has only got 51 votes,” said Meadows, chairman of the conservative House Freedom Caucus, in reference to McConnell’s comments.

If McConnell wants an easy button, he’ll need to help his party earn a 60-seat majority. Otherwise, it’s time to get an Obamacare repeal on the reconciliation table and make it happen as soon as possible. Waiting until after the election may mean we’re waiting for a very long time if they lose their majority.

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