Opioids

Democratic Presidential Candidates Promote Dangerous Opioid Myths

The discussion during last night's debate grossly exaggerated the role of prescription pain pills in opioid-related deaths.

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During last night's Democratic presidential debate, billionaire hedge fund manager Tom Steyer claimed "72,000 people died of opioid overdoses last year" in the United States. That's not remotely true, and the fact that Steyer's blatant misrepresentation went unchallenged says a lot about the shaky empirical basis for political responses to the "opioid epidemic."

Although Steyer said "last year," final numbers for drug-related deaths in 2018 have not been released yet. According to a provisional count published by the U.S. Centers for Disease Control and Prevention (CDC), there were about 68,000 deaths involving illegal drug use in 2018. That's all drug-related deaths, not just "opioid overdoses."

In 2017, according to the CDC's numbers, there were 70,237 drug-related deaths. In about two-third of those cases (47,600), the decedents tested positive for opioids. And although the context of Steyer's statement was a discussion of legally produced pain medication, the records collected by the CDC indicate that three-quarters of opioid-related deaths in 2017 involved illicit drugs such as heroin and fentanyl. Just 30 percent of opioid-related deaths involved prescription analgesics such as hydrocodone and oxycodone, and about two-fifths of those cases also involved heroin or "synthetic opioids other than methadone," the category that includes black-market fentanyl and fentanyl analogs.

Adding more substances to the analysis shows that most records listing a prescription pain reliever also list other drugs: For example, 68 percent of deaths involving prescription opioids in 2017 also involved heroin, fentanyl, cocaine, barbiturates, benzodiazepines, or alcohol. In other words, less than 10 percent of opioid-related deaths involved pain medication by itself, and the actual percentage may be considerably lower, since coroners and medical examiners do not always test for fentanyl and do not always note additional drugs. In New York City, which has one of the country's most thorough systems for reporting drug-related deaths, 97 percent of them involve mixtures.

Although the vast majority of opioid-related deaths involve illegal drugs, last night's discussion focused on pain pills. Sen. Amy Klobuchar (D–Minn.) said companies that manufacture prescription analgesics should pick up the tab for treating opioid use disorder. Steyer said the problem is "drug companies buying the government and getting what they want." Entrepreneur Andrew Yang described opioid-related deaths as "a disease of capitalism run amok." Sen. Kamala Harris (D–Calif.) said she would send drug-company executives to prison because "they are nothing more than some high-level dope dealers." Former HUD Secretary Julian Castro agreed that pain pill manufacturers should face "criminal penalties."

Neither Harris nor Castro explained the legal basis for jailing pharmaceutical executives. Harris alluded to "false advertising," which is a central claim in the myriad lawsuits that cities and states have filed against opioid manufacturers. But that claim is part of efforts to recover civil damages for the harm that the companies allegedly caused by exaggerating the benefits and minimizing the risks of their products. To put people in prison, the government has to identify criminal statutes that they violated. Insofar as these companies produced and sold pain medication in compliance with federal laws and regulations, they committed no crimes, even if you agree than an oversupply of opioids fostered addiction through diversion to nonmedical use.

By contrast, every person who uses prescription analgesics prescribed for others or in a manner not authorized by their own doctors is clearly committing a crime. To their credit, Yang and former Rep. Beto O'Rourke (D–Texas) both said such people should not be treated as criminals. They favor decriminalizing possession of opioids, including heroin and fentanyl, for personal use. But they arrive at that conclusion only by denying the moral agency of people who use opioids for nonmedical purposes.

"We have to let the country know this is not a personal failing," Yang said. "This was a systemic government failing. And then we need to open up safe consumption and safe injection sites around the country, because they save lives."

While Yang's support for decriminalization and harm reduction is welcome, his insistence on portraying illegal drug users as helpless victims of pharmacological slavery promotes dangerous myths about addiction and pain treatment. Unlike pharmaceutical companies and black-market dealers, he suggests, drug users should not be held accountable for their actions, because they cannot help themselves: Opioids are so powerfully addictive that people who take them, even for legitimate medical purposes, are thereafter chemically compelled to continue taking them. O'Rourke reinforced that argument by citing a veteran who said he "bought heroin off the street because he was originally prescribed an opioid at the V.A."

Contrary to the impression left by that anecdote, opioid-related deaths typically do not involve patients who accidentally got hooked after they took medication prescribed for pain. Addiction rates among bona fide pain patients are low because the vast majority of people exposed to prescription analgesics do not find their psychoactive effects so appealing that they want to continue using them after their pain has subsided, let alone venture into the black market for substitutes once their prescriptions run out. But these drugs can be powerfully appealing to people in difficult social, economic, and personal circumstances, who generally have histories of substance abuse and take opioids that were not prescribed for them, usually in combination with other drugs.

That observation does not mean these people do not deserve sympathy or help, and it certainly does not mean they should face criminal penalties for conduct that violates no one's rights. But we can look for ways to reduce opioid-related deaths without implying that all opioid prescriptions are inherently suspect, an attitude that causes great harm to patients who need them to relieve acute or chronic pain.

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  1. Suing companies for making these incredibly useful drugs is stupid from a public policy perspective. Even worse is suggesting we should punish pharma executives ex post facto. Opposing public treatment centers to help people that really are “chemically compelled to continue taking them” is also stupid.

    Individual responsibility is huge. We shouldn’t give it up. But ignoring the horrible effects that drug addiction is having on this country in the name of individual responsibility hurts a lot more people than just the addicted individual. The same can be said of homelessness.

    Let the drug-makers make drugs. Drugs are useful. Lets also take care of the negative consequences by funding treatment centers. Maybe the drug companies should help fund some of those centers. Why do we always turn to punishment for every problem in this country?

    Make a useful thing that can also be dangerous if used incorrectly? JAIL TIME
    Make a mistake by using a drug incorrectly? JAIL TIME

    1. Heretic, witch , burn them at the stake!!!!

      1. Pay no attention to the little man behind the curtain, with a lawsuit notice in hand.

        And politicians, “Shocked! Shocked!”

        (Lawyer comes up with silver plate), “Your cut of the lawsuit, sir.”

    2. Well said.

    3. If I could have my way, I’d try just getting government out of all of it and see how that goes. But that’s not going to happen, so I pretty much agree for practical purposes.
      Spending money on treatment is at least less bad than spending it on enforcement which at best is an abject failure and at worst is positively counterproductive if the goal is to lower crime and the harm caused by addiction.

    4. No no no! EVERYTHING IS SO TERRIBLE AND UNFAIR!!!!!

      Individual responsibility? Pfffttt. That just doesn’t square with victim mining and pandering!

      Haha.

    5. Who is personally responsible for this sort of thing?

      Dr. Lonny Shavelson found that 70% of female heroin addicts were sexually abused in childhood.

      Post USA Civil War alcoholism was called “the soldiers disease”

      Addiction is a symptom of PTSD. Look it up.

      1. Hey MSimon,

        We spoke on the phone a couple months ago. It’s good to see you still post here.

        But can you please stop using the word “addict” and “addiction”?

        These are prohibitionist terms. If you look up the word “addict” on Google Ngrams, you can see it was virtually unheard of before 1915, then that same year it literally exploded out of nowhere and zoomed up the chart at a massive greater-than 45 degree angle. 1915 was the EXACT SAME YEAR drug prohibition began. Looking back 100 years from now these terms will be viewed the same as “nigger” and “niggerdom” are today.

        https://books.google.com/ngrams/graph?content=addict&year_start=1800&year_end=2000

        You’re one of the only people that correctly recognize that people take pain relievers to relieve chronic pain.

        If aspirin or prozac were made illegal tomorrow, would that make people that buy contaminated product on the black market and get thrown in prison for possession “prozac addicts” and “aspirin addicts”?

        Of course not. It would make them victims of prohibition.

        It’s the exact same for opiates.

        Whether someone treats their pain with aspirin, prozac, opiates, cannabis, or whatever else – they’re simply someone taking a medicine that helps them.

        And when prohibitionists literally ruin their lives and/or murder them – they’re victims of prohibition.

        As someone living in the UK who legally injects 500mg of pure
        diamorphine (heroin) a day that I purchase once a week at the chemist for £28 a week, all of this talk of “addiction” just seems patently absurd.

        I live a completely normal life with a family, friends, career, house, car, holidays, etc.

        When I see posters talking about “addiction” and “treatment” it’s like I’m living in another world.

        People take pain relievers to relieve pain. There is NO problem at all. The ONLY problems are caused by prohibition.

        Re-legalize all drugs over-the-counter just like they were for thousands of years for all of history until 1915 when the Harrison Act went into effect.

        Cheers,
        Chris

        1. Amen

    6. Complete fabrication by the dims and the media. Just make it up.

  2. I assume they use the same methods as ‘alcohol related ‘ vehicle deaths? We all know, or should if you’ve read reason for a long time, how bogus those are. Balko made that clear.

    1. Well, if you’re smoking when you got run down by that truck, it’s a ‘smoking related’ death.

  3. Tulsi “In Hawaii, every day is before Labor Day” Gabbard, rockin’ it.

    1. Would. And they got the order wrong in that photo. Bernie should be all the way over on the left…

      1. cameraman in wrong spot.

    2. Did they let her speak for more than 30 seconds?

  4. Thank you, Jacob, for providing us with links to support your claims in yet another well written article.

  5. Sen. Kamala Harris (D–Calif.) said she would send drug-company executives to prison because “I’m a corrupt former prosecutor. It’s what I do. they are nothing more than some high-level dope dealers.

    FTFY

  6. And if one of them undergoes major surgery or suffers a significant injury, they’ll eschew opioids for Advil.

    Right?

    1. Right after they give up their wine, scotch, beer, ect after a long day of ‘serving the people’.

      1. How to Serve 300 Million People

        1. It’s a cookbook!

  7. Kamala thinks it’s cute that you believe the government needs to identify violations of criminal statutes in order to put people in prison.

    1. And she’ll punish facebook for having the temerity to not censor political opponents in the way she wants.

      I just don’t remember falling asleep and dreaming of farce.

  8. politicians promote dangerous myths.

  9. The DEA dictates large reductions in the amount of pain meds that can be produced from 2020 onwards. So, what will legitimate patients who are deprived meds do for their pain? Either suffer, thanks to the Feds, or search out illegal supplies. Seems the DEA wants their jobs as drug warriors guaranteed by upping demand for illicit drugs.

    1. If it saves just one precious child’s life…

      “The Drug Enforcement Administration this week proposed reducing aggregate production quotas for five opioid controlled substances in 2020. The proposal would reduce the amounts of:

      fentanyl by 31%,
      hydrocodone by 19%
      hydromorphone by 25%
      oxycodone by 9%
      oxymorphone by 55%

      The five opioid substances were subject to special scrutiny following the enactment last year of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, which requires DEA to estimate the amount of diversion of the covered substance that occurs in the United States and make appropriate quota reductions. DEA will accept comments on the 2020 proposed aggregate production quotas, which address more than 250 Schedule I and II controlled substances, through Oct. 15.”

      So, you see, by simply not producing the amount that is ‘predicted’ by complex government mathematical formulae to be diverted, diversion will suddenly stop! Every patient who needs pain medicines will be able to get them (if they can find a physician willing to endure a constant government proctoscopy) and economic laws of supply and demand won’t factor in to the equation. Take a lesson from government – THAT is how you ‘solve’ problems!*

      *When the (unintended?) consequences of this latest and greatest policy creates widespread and wholly unecessary suffering, the government will of course need more power to ‘fix’ things. I give it two years, tops, before DEA has full-time staff in every hospital across America. A DEA pharmacist, anaesthesiologist and SWAT team to deal with ‘problem physicians.’ After all, they’re the only people truly qualified to diagnose whether pain is actually excruciating.

  10. The opioid “crisis” is the perfect cause for liberals. It mostly affects poor white people, especially in the South and Midwest. The villain is a massive corporation. And government is the superhero that saves everyone.

    And those buildings that were knocked over in the fighting. Those were civil rights, human dignity, and the trust between doctor and patient. But no one cares about those.

    1. When the bulls fight, the grass suffers! The grass gets covered in bullshit! Only the dung beetles and the shitweasels come out ahead!

      1. Homer “Grass” Simpson: Mmmmmmmm…bullshit

    2. Haha. You gotta give it to em! These people know story structure, dammit!

      EVERYTHING IS SO TERRIBLE AND UNFAIR!!!!

      Rinse and repeat.

      1. Gozer the Traveller! He will come in one of the pre-chosen forms. During the rectification of the Vuldronaii, the Traveller came as a large and moving Torb! Then, during the third reconciliation of the last of the Meketrex Supplicants they chose a new form for him–that of a Giant Sloar! Many Shubs and Zulls knew what it was to be roasted in the depths of the Sloar that day, I can tell you.

        AKA, the dung beetles and the shitweasels are NOT going to come out ahead on this, forever!

    3. Geez – Haven’t you heard. These politicians up on stage know far more about your personal health than you or your doctor. /s

  11. “We have to let the country know this is not a personal failing,” Yang said. “This was a systemic government failing.

    Then maybe we should be putting the government in prison.

    1. when Kamala is in charge she’ll figure out how

      1. She really is terrible.

      2. By the time she puts herself in prison, maybe then she’ll realize she’s gone too far.

  12. For example, 68 percent of deaths involving prescription opioids in 2017 also involved heroin, fentanyl, cocaine, barbiturates, benzodiazepines, or alcohol.

    68% prescription opioids + 68% heroin + 68% fentanyl + 68% cocaine + 68% barbiturates + 68% benzodiazepines + 68% alcohol = 476% of drug-related deaths. Nearly 500% of drug-related deaths are related to drug use and you don’t think that’s a crisis? And that’s not even counting the much larger number of deaths where autopsies show the presence of dihydrogen monoxide, the real killer.

    1. Dihydrogen monoxide is more addictive than cocaine, which is more addictive than alcohol, which is more addictive than tobacco, which is more addictive than dihydrogen monoxide!!! I’m not sure exactly how that all works… I think that maybe everything is more addictive than everything, and everything ON TOP OF EVERYTHING is even more addictive than EVERYTHING ON TOP OF EVERYTHING!!!

      So just generally BEWARE!!!

      And need I even add… ONLY GOVERNMENT ALMIGHTY can save us all!!!

      1. OMG! So many victims. So much pandering to do! So little time!

        Haha.

        1. Yes, you ARE pandering to your precious ego! In the mistaken belief that your self-aggrandizing posts can even vaguely be found to be interesting or funny, by normal and balanced humans.

          1. Pandering to my own ego? Lame effort, dude.

      2. I’m not sure exactly how that all works… I think that maybe everything is more addictive than everything, and everything ON TOP OF EVERYTHING is even more addictive than EVERYTHING ON TOP OF EVERYTHING!!!

        The worst case of declaring things to be addictive addiction I’ve ever seen.

  13. No, Jacob, under the laws of every state and the USA, once you possess controlled substances a doctor prescribed for you or someone in your household, how you use them is irrelevant to the law.

  14. So of all the completely batshit crazy stuff said last night this is what you’re writing about?

    Everything is relative but the opioid stuff was possibly the most sane moment of the whole evening

  15. Ah, the utterly fact free bashing of all pharmaceuticals, so lucrative for the ever hungry state coffers. It seems to be a favorite of both parties and is swallowed by virtually everybody who has not experienced a recent painful recovery with no more than Tylenol.
    Seeing what I’ve seen, I am not proud of it but I can’t help wishing on these pols, say a crushed femur with a long, complex recovery for which they are given 2 weeks of Tylenol with codeine and then a prescription for acupuncture.

    1. “…and then a prescription for acupuncture.”

      Accompanied with a big smile, wishing them a long and painful recovery.

  16. There is a new guidline from HHS warning docs not to rapidly taper or discontinue opioids for patients with chronic pain.

    Here is a quote from it

    “Risks of rapid tapering or sudden discontinuation of opioids in physically dependentii patients include acute withdrawal symptoms, exacerbation of pain, serious psychological distress, and thoughts of suicide.1 Patients may seek other sources of opioids, potentially including illicit opioids, as a way to treat their pain or withdrawal symptoms.1“

    Risks of rapid tapering or sudden discontinuation of opioids in physically dependentii patients include acute withdrawal symptoms, exacerbation of pain, serious psychological distress, and thoughts of suicide.1 Patients may seek other sources of opioids, potentially including illicit opioids, as a way to treat their pain or withdrawal symptoms.1

    https://www.hhs.gov/opioids/sites/default/files/2019-10/8-Page%20version__HHS%20Guidance%20for%20Dosage%20Reduction%20or%20Discontinuation%20of%20Opioids.pdf

    Some people anyway are listening to the medical community about this hysteria.

    1. I would think Steyer would welcome deaths, from opioids or anything because humans are the number one cause of global warming.

  17. I understand their are certain dangers with opioids, but what disturbs me is the trend in medicalizing everything as an addiction (porn, gambling, caffeine, even nicotine) especially if it doesn’t really harm the “addict”.

    1. We know a few things about addiction.

      Dr. Lonny Shavelson found that 70% of female heroin addicts were sexually abused in childhood.

      Post USA Civil War alcoholism was called “the soldiers disease”

      Addiction is a symptom of PTSD. Look it up.

      1. Can you have PTSD if you think you might be traumatized but have completely blocked it out of your memory? Asking for myself. I think I drink too much because a babysitter diddled me, but there’s a big void in my memory of the day.

      2. Soldier’s disease is opium addiction. Do these sockpuppets EVER crack a book?

        1. The whole “soldier’s disease” concept has been exposed as fraudulent. The term was made up in the 20th century by prohibitionists and was claimed to be a Civil-War era term used to describe veterans who were also morphine consumers. There is absolutely no evidence that this term was ever used in the 19th century.

          “No perjorative nickname for “addicted” veterans, like Soldier’s Disease, appeared in the literature until 1915, and it did not become part of the Conventional Wisdom of drug experts until almost a century after Appomattox.”

          http://www.druglibrary.org/schaffer/history/soldis.htm

          That is a great read that completely destroys the myth of the “Soldier’s Disease”.

          Also, very interesting how the year 1915 keeps coming up – the same exact year drug prohibition started!

    2. The addict is a looter altruist with a gun that’s gonna make things better. Wiping the smile off of peoples faces is prohibitionist Job One.

  18. You have to work and use the computer and internet, and if you can do that and dedicate some time each day then you can do this with no problem.
    I have been working with this for a month and have made over $2,000 already. let me know if you need more help……..Read More

  19. You know what’s fun about not being a Trump fluffer? No matter which details the Democrats get wrong, no matter how their personalities occasionally grate, no matter how many big policies they are dead wrong on, they are not an insane orange man-clown who is making even his closest allies worry over his mental health.

    1. Trump being an insane orange man clown is benign compared to (most of) the Democrats’ pathological inclinations.

      1. Counterpoint: no it isn’t.

    2. No one worries about their mental health because it’s known that they’re batshit crazy and nobody cares beyond ensuring they don’t come to power.

      The front runners at least.

      1. But think how happy y’all will be with a Democrat in office. Endless bitchery for four to eight whole years unencumbered by that talismanic (R) that, for reasons yet to be explained to me, turns nonpartisan freethinking libertarians into slobbering lapdogs.

        1. slobbering lapdogs?

          Pot. Kettle. I believe you two know each other.

          1. I’m admittedly and proudly partisan. I’m voting for Potted Plant (D) in 2020. Not because I think Democrats are perfect angelic beings, but because Republicans are an existential threat to the human species. Perhaps the most serious existential threat it has ever faced. How I wish I were exaggerating.

            The mystery is why libertarians hypocritically lick their nuts at every opportunity. The tax cuts? Everything else is subordinate to that? Tax cuts that don’t even benefit anyone in this room? Just seems kind of cynical for a utopian political worldview. =

            1. Note to foreign readers: there are people in the USA who favor coercion, the initiation of force and currish fawning in the laps of tax collectors. But unlike in countries with no Bill of Rights, here they are a small band of parasites.

              1. So are you against all taxes or what? What is your goddamn thesis here?

                You people are so simple-minded it makes it difficult to talk about anything in an intelligent way.

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