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How the opioid ‘epidemic’ was built on lies and perpetuated for politics

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How the opioid epidemic was built on lies and perpetuated for politics

I used to love “60 Minutes.” As a teenager, it was a favorite program in our house on Sunday evenings. The show featured all sorts of interesting people and places, with in-depth explorations that stimulated the imagination. Oh, how times have changed!

On February 24, 60 Minutes did a segment about a drug manufacturer who is calling out drug companies for “corrupt,” “immoral,” and “depraved” actions in marketing opioids. Supposedly the incentive for changing the labeling of opioids to allow for extended use is some sort of moral crime. David Kessler, former Commissioner of the FDA said “There are no studies on the safety or efficacy of opioids for long term use.” (8:25 in the video)

Case closed! We need to restrict opioids to two or three days at most. Anything longer than that is bad medicine and gets people killed. But… There are no polite words for the perfidious implications of Kessler’s comment. How do we know this? Let me count the ways.

First, opioids have been used for millennia. Chinese workers on the transcontinental railroad used opium on a weekly basis for years, without any notable adverse effects. American soldiers used them in Vietnam, and their performance in the field was not affected. Overdoses were unusual, since the usual heroin had well known potency. With 20% of the Army on drugs, you’d think that bad effects would be easy to find. Curiously, there was no evidence of mass addiction, either.

Why did they use drugs in their “off” time? They wanted to escape the war that none of them wanted to be part of. The Chinese laborers wanted a break from the brutal conditions on the railroad project. This is basically why urban professionals have beer at the end of a long hard week of work. Mild intoxication is therapeutic for them.

Second, while there may be no studies on extended use, those of us in medicine are painfully aware that while some patients do well without opioids, others require what Dr. Kessler would call “extended” use. This is a result of the Bell curve, or “normal distribution” of response to drugs.

Bell Curve

The person whose knee replacement requires zero opioids is on the left side of this curve, while the one who needs them for two weeks is on the right. Most of us fall somewhere in the middle. Every surgeon and every anesthesiologist lives with this curve every day. Importantly, the difference between the left and right sides of the curve isn’t two or three pain pills. The range is from zero to a hundred or more. And that leads to a key piece of information that 60 Minutes completely ignored.

Most physicians routinely use medications in “off-label” ways. To understand this, we have to point out one part of the Law of the Bureaucrat. Each FDA officer has been hired to “protect the public” from unsafe drugs. This means that people are too stupid to use drugs properly (Unfortunately, this is often all too true, even when explicit instructions are provided). And it means that doctors are too stupid to prescribe them safely, leaving the bureaucrat charged with “protecting the public” as the smartest person in the room. That then means that the bureaucrat must create iron-clad instructions for how medical personnel with more training and experience than him should prescribe the drugs. These instructions become part of “the label.”

Drug reps are only allowed to tell doctors exactly what the label says. They can’t even provide reprints of newer studies with additional information. That would be “off-label marketing,” and the FDA expressly prohibits that. Fortunately, doctors aren’t prevented from reading those journal articles. Shortly, responsible doctors start prescribing in ways that are different from what the Feds said they should do. And millions of patients get new benefits that the Feds haven’t approved.

With regard to opioids, the Feds never approved fentanyl or sufentanyl for the massive doses commonly used in heart surgery. But that never stopped me from administering literally gallons of both. The benefits were far too great to bother asking for permission I wasn’t legally required to get. And with regard to longer term use, we’ve been helping patients with cancer pain and other chronic pain with opioids for decades. These people are physiologically dependent, but you wouldn’t know it, because your co-worker with the bad back keeps coming to work. He’s able to do that because his opioid prescription keeps getting refilled.

The long term benefits of opioids have been well known for a very long time. The long term side effects are equally well known. But the key side effect that is creating the panic does not come from long term medical use. You heard me right. In spite of all the noise about “overprescribing,” that simply is not a problem. Less than 1% of the addicts on the street got their start with prescription opioids. And chronic pain patients rarely die of overdoses.

When Ed Thompson of Pharmaceutical Manufacturing Research Services tells Bill Whitaker that “the root cause of this epidemic is the FDA’s illegal approval of opioids for the treatment of chronic pain,” he’s simply wrong. This approval did create a marketing change, but for chronic pain patients, it didn’t make a lot of difference. Most pain management specialists and oncologists were already prescribing the drugs when needed for long term care. But this opened the door for unscrupulous doctors to ring the cash register in an already illegal market.

The problem in the US began in earnest when William Randolph Hearst capitalized on racist sentiments against Chinese workers in his newspaper campaign against the “coolee.” He created the myth of the “opium fiend,” who terrorized white women after smoking opium. It was a complete fabrication, but it sold the idea of opium restrictions to moralists and politicians. Who cares about facts when you can “Do something!”?

Next, when Andrew Kolodny says that “as the doses become higher [in response to drug tolerance] the drugs become more dangerous, and the risk of death goes up,” he is not telling the truth. He is pandering to a political narrative. The basic fact is that when you give opioids for an extended period, the endorphin receptors become tolerant to their presence. You do need to give more drug to achieve the same effect. But that very tolerance is what makes the drugs safer in the tolerant patient. Allow me to translate from medical to English.

If I need 10 milligrams of morphine for pain relief after surgery, and I just keep on taking 10 mg, after a while, I won’t get the relief. But my body will not need that degree of relief, so I will start spacing my doses out. This is something we saw in great detail when Patient Controlled Anesthesia (PCA) was introduced to pain management after surgery.

With the “morphine pump,” a patient was able to give himself lots of little doses of an opioid to help with pain after surgery. The PCA was rigged to prevent a repeat dose until 6 minutes after the previous dose, giving it time to work. We never saw overdoses with PCA if the patient was the only person to push the button. Never. As in “not once.” In fact, patients automatically weaned themselves off opioids. This was so safe that now the Acute Pain Service no longer exists in most hospitals. The surgeon signs a protocol sheet, and everything goes on autopilot.

The same thing happens when patients have pain pills at home after surgery. They taper off without thinking about it as the pain level subsides. But suppose they are in that 1% that stays on opioids. Their receptors get tolerant, and need higher and higher doses to get the same response. This means it also takes higher and higher doses to stop the patient from breathing, which is how ODs kill. Kolodny has his facts wrong.

So what kills addicts? Or, perhaps we should ask, why do addicts take overdoses? After all, overdoses given by someone else are rare. Even addicts don’t often try to commit suicide. It’s at this point that we have to step back from the final dose of a street drug, the proximate cause of the overdose, and look for the first step in a series of critical incidents. Like airplane crashes, it’s never just one thing that causes ODs, even if politicians like to have one problem “only they can solve.”

The first thing to note is that all opioids are, in a sense, the same drug. They all work at the same receptor, and they all have the same family of side effects. The primary differences revolve around how fast they start working (onset), how long they last (duration), and how much is required to reach a standard level of effect (potency). Of importance, the more potent a drug is, the more it binds only to the intended receptor, and the fewer side effects it will have (for example, nausea). That means that fentanyl is safer during surgery than morphine, and explains why we rarely use morphine in surgery today.

The next factor is that all the opioids are dirt cheap to manufacture. Virtually all the cost is in distribution. But even including the cost of distribution, Portugal spends about $4 a day on maintaining addicts, Canada about $11, and we should expect similar economies here if implemented. So why is it that El Chapo was worth north of $14 billion from the drug trade? It wasn’t the native cost of drugs. It came from distribution.

Why would anyone pay more than the price of aspirin for a drug that costs the same as aspirin? There’s only one reason: Prohibition. Recall that the soldiers in Vietnam used heroin and the Chinese laborers used opium for stress relief during leave time. There is a relatively fixed portion of the population that wants such intoxicants. With the change in labeling, it became “legal” for unscrupulous doctors to supply those people. But if they can’t get them “legally,” they will find a way to get them illegally.

If there’s a market for the illegal drugs, there will be a marketer. Enter El Chapo. He’ll provide your drugs, but for a price. Since he’s taking a legal risk, it will be high enough to compensate him for that risk. Economists call this a “risk premium.” Next, since you are opening your wallet, you want the good stuff. You won’t go back to the left street corner if you don’t get quality. So the guy on the right street corner figures out that if he adds fentanyl to your heroin. As the expression goes, “Aye, there’s the rub.”

We’ve described a vicious circle where higher price demands higher quality which again demands higher price. The higher price invites competition, but since the competition is in an illegal market, crime follows. And as users become addicted, they often find themselves committing crimes to pay for those high prices. Did I mention that Canada is able to maintain an addict legally for $11 per day?

Even the Drug Enforcement Agency has noted that prohibition creates massive profits for bad guys. That should raise alarms. If prohibition starts this vicious cycle, and a national experiment with decriminalization (Portugal) has basically eliminated ODs, shouldn’t we start looking in that direction? Drug-related crime in the US was essentially nonexistent until Hearst’s yellow journalism led to restrictions on heroin and other drugs. Crime accelerated as laws got stricter. In short, Congress created the drug cartels. Competition between drug cartels leads to adulteration of heroin with much more potent opioids, and this unknown potency leads people to take doses with unknown risks.

In maintenance programs, known potency drugs are given to patients with extreme safety. And over time, Portugal has seen that about half of addicts will wean themselves off their drugs.

60 Minutes wasn’t satisfied with its story until it slandered drug manufacturers and the FDA with this exchange: (13:40)

Whitaker: “(commentary)… also review new drugs, like Dsuvia, the most powerful opioid pill ever approved. (to Kessler) Just a few weeks ago the FDA approved a new opioid that is a thousand times more powerful than morphine. And this is in the middle of this opioid epidemic. How is that possible?”

Kessler: “I don’t get it. I get your question. I don’t get the agency’s action.”

Whitaker: “Isn’t the FDA supposed to be our watchdogs to protect us?”

Dsuvia is a tablet to be taken under the tongue when severe pain (chronic or cancer) “breaks through.” It is faster in onset than morphine, with a shorter duration. The 30 micrograms in Dsuvia, is equal in effect to 30 milligrams of morphine, a common dose in that situation. Whitaker’s phrasing was a slanderous lie. The FDA did not approve an opioid that was a thousand times more powerful than morphine. It was the same strength. It is a thousand times more potent, so AcelRx Pharmaceuticals created a pill carefully tailored to meet a specific need by only including a thousandth as much.

60 Minutes is complicit in the fear-mongering that is killing large numbers of Americans through poorly considered laws. The only way to eliminate the overdoses is to eliminate the laws. That will bankrupt the drug cartels. But the Overton Window for this sort of action has not yet opened. That means we will likely be seeing more and more examples of Einstein’s Maxim.

“Insanity is when you do something a second time and expect a different answer.”

 


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Healthcare

Funny numbers: California projections show taxpayers will only pay $99 per month per illegal immigrant covered

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Funny numbers California projections show taxpayers will only pay 99 per month per illegal immigrant

Healthcare is very expensive. It was expensive before Obamacare. It was made much more expensive as a result of Obamacare. But apparently it’s not expensive for adult illegal immigrants in California under the age of 25. For them, it apparently only costs $1,100 per year.

According to Fox News:

Gov. Gavin Newsom, D-Calif., signed a bill into law on Tuesday making young illegal immigrants eligible for the Medicaid program in California, making it the first state to offer such taxpayer-funded health benefits to low-income adults age 25 and younger regardless of their immigration status.

State officials said they expected the plan to cover about 90,000 people and cost taxpayers $98 million. California already covered children 18 and younger regardless of immigration status.

[Emphasis added]

Those of us who buy health insurance realize there’s no chance of getting even basic healthcare for $1,100 per year ($1,088.88, to be exact) or $99 per month. If there is, then someone has some major explaining to do about how our costs are so much higher than those of illegal immigrants. Are the just getting sick less? Do their drugs cost less than our drugs? What gives, California?

I’ll go ahead and call BS on this one. If Californians believe Democrats when they say it will only cost $1,100 a year for each illegal immigrant given free health insurance, then they deserve the wool that’s over their eyes.

We are currently forming the American Conservative Movement. If you are interested in learning more, we will be sending out information in a few weeks.

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Culture and Religion

My Dog My Choice

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My Dog My Choice

Perhaps you have purchased or adopted a dog, rescued a dog even. That dog is yours. If someone harms your dog, they have wronged you and can be taken to court to pay, perhaps even face criminal charges. The dog is your property, and an injustice took place. Under the ideas of John Locke, the state exists to navigate and interpret the injustices that take place. The state is therefore equipped to handle, to whatever capacity the individual state employs, the injustice that takes place. What greater injustice is there than the loss of innocent human life?

Humanization of Animals

If we were to assemble a hierarchy of the value of each animals, dogs would likely rank near the top. After all, the relationship to mankind, through domestication, is the most developed and serves the most functions out of any animal. The trainability of dogs has led to the increase of their value and capacity for humans to have an emotional connection to them. The value we therefore place on our dogs is disproportionately higher than that of other animals.

Our society has humanized animals, most specifically dogs, to rather disturbing levels. Now you do you, for your dog is your property. But the value of a dog is subjectively higher than the value of other items that are also property. For instance, numerous states have laws voiding the liability of someone who rescues a dog from a hotbox car on a hot summer day. You can damage someone’s property to save their property and face no charges.

What if the dog’s owner valued their car window above their own dog? What gives you the right to intervene? What gives the government the right to strip the dog owner the right to sue for damages? What gives the government the right to prosecute animal abuse, if animals are the property of their owners? The anarchist-capitalist crowd has no convincing answer for how animal cruelty can be addressed as they can provide with other crimes. However, the establishment of the state allows the state to address injustices which otherwise could not be interpreted well in a stateless community. Animals are property, but animal cruelty is the result of people abusing their own property for no other cause than cruelty and neglect.

What is the argument for abortion?

The main, remaining, argument for abortion is autonomy. My body my choice. The argument equates abortion to an elective surgery. After all, if they say an unborn fetus is not a person, terminating it is equivalent to Kim Kardashian-West’s butt implants. But the Left can’t describe what “it” is. If it’s not a person, what is it? Rick Santorum got silence in response when he asked this question. Pro abortionist often have not taken their beliefs to their logical conclusion.

Despite science, humans have declared something can be a separate human but not a person until increasingly arbitrary standards such as viability or now birth have been met. But even if a scientifically separate human being is not a moral person, what then is that separate human being? And more importantly, what value does a human being that’s not a person have? My body, my choice. My dog, my choice. Surely a human life is more than a dog’s life even if that human is not the moral equivalent of a person. For mankind is separated from animals, by means of divine creation or the process of evolution; these are two answers to the obvious distinction between man and beast.

Where personhood defines the value of a human being as inherently more than that of an animal, what is the value of a human being that is not a person? Just because a fetus, the pro-abortionists have declared, is not a person, does not mean that the human life does not have value. For if human beings are above animals should that also mean that human life regardless of personhood holds a superior value to animal life? So what then gives you the right to poison this human life? What then gives you the right to inject this human being with a drug that kills it? What then gives you the right to drain the amniotic fluid and dismember the human being as you rip it from the uterus?

Autonomy. That is the answer of the pro-abortion crowd.

Autonomous Tyranny

Initially I wanted to refer to this as privatized tyranny, but autonomous tyranny is a far better, far more applicable to the realms of animals and slavery. The idea that you can do whatever you want to that which is in your domain, even to the point of tyranny, is autonomous tyranny. Where else do we as a society allow autonomous tyranny to exist? The divine right of parents has long been extinguished. There are limits to parental powers and the need to mitigate the abuse of children necessitates these limits for an injustice has occurred when children are abused. The concept of owning a fellow human being has been eradicated, placing yet another limit on autonomous tyranny. So what remains?

Puppies and unborn babies. No! Because puppies have protections, we prosecute people who abuse puppies. But people who murder unborn babies have committed a far more egregious offense, for the value of human life is greater than that of a puppy whether you accept personhood when human life begins or at some arbitrary, less logically defendable point in development. Yet the argument of autonomy is the only defense these actions have in the face of the injustice committed. But because an injustice has been committed, the duty of the state is to navigate how we deal with the injustice that took place. The duty of the state is not to bankroll these injustices under the guise of healthcare. The state does not exist to accelerate injustices, for in propagating injustice, the state is elevating its own state of existence to one where it can declare what is just or unjust, rewriting the works of nature and natural law.

It is, however, the duty of the state to interpret how society deals with injustice. Among the most difficult are injustices stemming from autonomous tyranny.

We are currently forming the American Conservative Movement. If you are interested in learning more, we will be sending out information in a few weeks.

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Democrats

Trump leads ‘a socialist’ candidate by 6% in latest ABC-WaPo poll

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Trump leads a socialist candidate by 6 in latest ABC-WaPo poll

For the record, polls at this stage and just about any other stage in the election cycle are absolutely meaningless when it comes to picking winners and losers. One needs only look at the polls leading up to the 2016 election to know this to be true. But we can glean trends and sentiment from them, and the latest poll conducted by ABC News and the Washington Post points to a reality the RNC (and most of America) has known for a while: Socialism sucks.

Against individual candidates among registered voters, the President is in a virtual tie with all but Joe Biden. But against a candidate the voters believe to be “a socialist,” President Trump leads by 6%. Considering two of the top five Democratic candidates are declared socialists and two others have demonstrated clear socialist leanings, it may be confusing to see the discrepancy. The reason is a lack of understanding among some voters who are not aware Bernie Sanders and Elizabeth Warren are unabashed by their socialist tendencies while Kamala Harris and Pete Buttigieg are toeing the line between being socialists and capitalists.

The radical turn by the Democratic Party’s base over the last three years has been shocking to many as policies continue to be rewritten to match the hyper-leftist approach of the radical progressives in the caucus. They started jumping on the Bernie bandwagon shortly after this election loss in 2016, especially after Hillary Clinton failed to defeat President Trump. Now, many socialists are seeing an opportunity in the changing sentiment of the party plus the perceived weakness of the incumbent as reasons to press their far-left agenda.

As of today, the GOP would be wise to make the socialist label sink into the candidates as they approach their nomination process. But even as frontrunner Biden slips in the polls while attempting to retain his status as the only non-socialist with a shot at this point, criticism from the left have made him appear unsure of his perspectives. He’s been claiming to be a progressive since before he announced his candidacy, but he has recently taken to calling out the far-left since his abysmal debate performance. The numbers seem to support this strategy, but it’s a Catch-22.

If he stays a moderate throughout the nomination process, he has a better chance of winning the general election but a lower chance of securing the nomination. The Justice Democrats have made sure the check-boxes required by presidential candidates include all of the most radical proposals floating around such as open borders, the Green New Deal, and Medicare-for-All.

Speaking of healthcare, there was a fact I didn’t know about single-payer that the poll demonstrated. Support for single-payer health insurance was at 62% in 2003. Today, it’s at 52%.

But here’s the truly interesting part. Once people are informed that Medicare-for-All means forcing Medicare to be the sole option for ALL (as the name suggests), support drops even further. I’m still a bit confused why so many Americans are confused by the words “single” in single-payer of “all” in Medicare-for-All. Then again, I still sometimes watch videos of people when they find out Obamacare didn’t mean they got free healthcare. The level of understanding of policies in American is embarrassingly low. Too many people rely on the information supplied to them by their tribe instead of actually trying to understand what’s being proposed.

Once we throw in the border, we seem to have the three vital talking points to hammer into voters for 2020. Socialism is, indeed, awful and the Democrats are pushing it. Single-payer and Medicare-for-All are hated when understood. Lastly, the border… well, we talk enough about the border crisis on this site so readers are very well aware of the potency of that topic come election day.

The strategy by the RNC and White House to slap the “socialist” label on Democrats shouldn’t be difficult. Some Democrats are openly embracing it and others can’t help but push for it in their policies. More Americans need to know this truth.

We are currently forming the American Conservative Movement. If you are interested in learning more, we will be sending out information in a few weeks.

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