Come with Me If You Want to Live
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If you are under the care of a physician for chronic pain, this Movement is for you. If you are not now, you likely will be some day -- like millions of other Americans including someone you love. Either way, this Movement is for you. When that day comes -- whether it lasts just one day or 10 years -- you will beg your doctors for painkillers ...
... Unless the Fed has its way, in which case these painkillers will vanish from the earth ... and you'll kiss their ass to kill you.
If you are a doctor who treats someone in pain, this Movement is for you. *ALL* doctors should donate. All doctors should ensure this Movement prospers and prevails. Only then will doctors be protected from unlawful prosecution and suspension -- and the people they care about most -- their patients -- protected from unnecessary and unreasonable suffering.
Your Government declared war on you -- the war dubbed "The Opioid Crisis." This is a winnable war. As winnable as it is cruel and unnecessary. A war without warrant or merit. State laws and CDC Guidelines contain a palliative care provision that affords you, the doctor, prescriptive authority and you, the patient, the inalienable right to relief. We need only repel the rogue and the ignorant in the DEA and elsewhere who neglected to read -- or resolved to neglect -- that provision. The fear and tension you bear -- the wedge the Fed has driven between doctors and patients, doctors and DEA-deputized pharmacists, doctors and insurance carriers, and doctors and other doctors -- would NOT exist today -- 4,000 licenses would NOT have been suspended -- millions of pain sufferers would not have been abandoned -- without the complicity of the American Medical Association. The AMA is bound by covenant to defend its physician members and the patients for which they took an oath to do no harm. Defend against charges of overprescribing. Against surveillance and meddling. But the spineless, chinless simps in the AMA turned their backs on ALL of you. And so it is up to all of you to give yourself the platform -- the identity -- the voice -- you sorely need. No one else is speaking for you. Through your donation -- no matter how small -- you send a powerful message to lawmakers who currently believe it is political suicide to come to your aid. That message should be nothing short of "it is political suicide NOT to come to my aid. To allow cops and dead heroin addicts to rewrite healthcare policy. To pander to the grieving survivors of dead heroin addicts whose emotionally unstable and therapeutic protestations are designed to restore dignity to their loved ones by portraying them as victims of industry and as posthumous agents of reform. Good therapy for them. Good eulogies for their loved ones. Torture for chronic pain patients for whom opioids offer the only means to restore quality of life, who use responsibly, and who never develop a use disorder or addiction."
If my Appeal fails to move you, then we embolden all the Government bureaucrats, sanctimonious crusaders, self-aggrandizing careerists, and shameless opportunists who grab for slices of the opioid crisis pie. They are more addicted to the Opioid Crisis than we are to opioids. Like McCarthy's reckless pursuit of communists among us, these hysterics will stop at nothing to cleave you from your liberty, privacy, resources. and due process and usher in a New Regulatory Era. A police state.
The Fed shifted its drug war strategy from one of attacking Supply to one of attacking Demand and, in the process, created a Narrative depicting pharmaceutical houses as international drug cartels, doctors as dealers, and chronic pain patients as addicts.
Citing threatening phone calls from DEA agents, many doctors reduced or suspended their patients' medications, including those of my own mother, who spent the last few months of her life stressing over the threats her oncologist received before she finally succuumbed to advanced metastatic cancer last March. When Attorney General Jeff "Take a Bufferin and Call Me in the Morning" Sessions directed Federal employees involved in this Crusade (DEA, CDC, FDA) to publicly commit to the goal of reducing prescriptions by 30% per annum, the DEA agents took the fight directly to the doctors, and they did not care whose treatments were rescinded in order to reach their quota.
Oxycontin gave my mother her life back. For two years she could not host visits from her grandson, prepare meals for her husband, or attend senior community functions due to the pain, malaise, and mood brought on by her cancer. Oxycontin (and some short-acting oxycodone for occasional breakthrough pain) enabled her to be herself again, bring happiness to those who enjoyed or relied on her, and reduced the burden on caregivers. Now due to what I intend to prove is mass hysteria on a national scale, employers are lobbying their insurance carriers to stop covering Oxycontin and the Fed is planning to file a lawsuit against Oxycontin maker Purdue Pharma. Granted, I believe Purdue Pharma is not above reproach. Like other pharmaceutical companies, they need to expand their data collection and reporting practices beyond adverse effects like nausea and hair loss to include misuse and dependency. Purdue Pharma also probably operated on the untested assumption that extended release formulations pose less risk for dependency than short-acting versions. And Purdue Pharma is guilty of operating like any other American business -- on the profit motive. They do their part by providing a drug that is safe and effective -- and opioids ARE in fact safer for chronic patients than acetaminophen, ibuprofen, Toradol, or aspirin due to their reduced toxicity to major organs. And they should not ne held accountable for the actions of those who abused their product (crushing the pills to liberate their short acting effects) -- abuses committed by those who did not hold valid scripts.
For those of you who think this Nuclear Winter scenario cannot play out, I invite you to consider the following outrageous developments ...
(I) Hospitals are reporting a critical shortage of morphine due to Federal restrictions on the supplies manufactured, distributed, and stored.
(II) The Fed revoked the licenses of 4,000 physicians who exceeded new CDC Prescription Guidelines. The doctors were suspended without due process and without universal standards defining what is a "reasonable quantity." Because the CDC Guidelines are not evidence-based and because it is patently absurd to think there could be one-size-fits-all standards for patients who vary widely in pain type/source, treatment history/tolerance, and genetic sensitivity to pain and to pain medication, the International nonprofit HumanRightsWatch will release an end of year report condemning the CDC for bullying doctors into abandoning their patients outright, a human rights violation the group has compared to police brutality in African nations.
(III) The Fed sued 47 states to set up an Opioid Prescription Monitoring Database. This database has NOT been used to confidentially collect aggregate data but rather to identify and surveil prescriptions on a doctor-by-doctor and patient-by-patient basis. Patients tell me all the time that their physicians receive threatening phone calls from DEA agents who "give them a hard time" or issue instructions to reduce or suspend opioid medications.
(IV) The Fed has met its annual goal of reducing prescriptions by 30%; but over the course of this reduction, heroin overdose fatalities have risen 19%, suggesting that abandoned patients are turning to the Street, to suicide, and to rehabilitation clinics where methadone poses a greater risk than the original painkiller.
(V) As the Fed plans lawsuits against pharmaceutical manufacturer Purdue Pharma, insurance carriers are slavishly complying with employers' demand to cease covering Oxycontin and other opioid painkillers.
(VI) Attorney General Jeff Sessions when questioned about the impact of his response advised people in pain to "take a Bufferin and call me in the morning."
*WHY I NEED YOUR DONATION. WHY YOU NEED TO MAKE THIS DONATION*
I want to fund a Civil Rights Movement for chronic pain sufferers and the physicians who treat them. These people deserve the same rights, protections, and accommodations afforded social minorities, veterans, Native Americans, and persons with disabilities. I want to preserve the integrity of the compassionate care system and the sanctity of the doctor-patient relationship from what I will prove is a mass hysteria / neuroses at the heart of the Federal Crackdown. With each passing month, the Fed denies you and your loved ones even more liberties, resources, and due process. Support for this Movement will in no way compromise care for people who suffer from opioid addiction. There is no reason the Fed needs to drive a wedge between the pain patient and addiction communities. But they have. As they have driven wedges between doctors and pharmacists, doctors and patients, doctors and other doctors, and patients and their own self-esteem (shaming them into thinking they are fringe elements of a society, that they set a bad example, and that they possess a character flaw). The Fed has introduced an element of tension and antagonism into the health care enterprise. State laws have already done well to limit first-time prescriptions for ACUTE injury patients to 7 day supplies. The days of dentists subsidizing adolescent "pill parties" by giving out 60 Percocets in exchange for wisdom teeth are over. The days of unmonitored pill mill doctors offering a continuous and unconditional supply of painkillers to treat the pain with no regard for its root causes have also been shut down. There is no reason to deny the community of patients with CHRONIC pain diagnoses the only treatment plans and medications that have restored some quality of life.
*HOW I INTEND TO USE YOUR DONATIONS*
The following strategies will be employed to launch and lead a Civil Rights Movement that recognizes that chronic pain patients are subject to undue prejudice, discrimination, and adverse impact. The objective is to both raise awareness and to repel interference in the doctor-patient relationship to the detriment of compassionate care. You should know that as long as some funding trickles in, work toward the Movement will not have to wait -- or be contingent on -- meeting the final donation goal.
1. Pain Sufferers Bill of Rights
I composed the The Pain Sufferers Bill of Rights for circulation and signature among our lawmakers at the State and Federal level. This should form the core of something akin to The Americans with Disabilities Act (1990).
2. Shaming the AMA into Defending its Physician Members
The Lawmakers are not the only group to abandon its people. Spineless, chinless simps at The American Medical Association have turned their backs on their own physician members. The AMA should defend doctors against charges of overprescribing. The AMA should defend the medical community from Federal surveillance and meddling and from pressure to abandon their clinical decision making, their compassion, and their oath to do no harm. There would be no Crackdown (and no exacerbation of the faux Crisis) without the complicity of the AMA. The AMA has had the power to end this by making public statements or threatening a work stoppage. Keep emeegency and urgent care centers up and running but otherwise stage a walkout until doctors are granted the opportunity to enjoy a modicum of autonomy and trust.
3. Federal Court System
A class action lawsuit (or a suit brought on behalf of a physician charged with overprescribing) against the Federal government would seize, focus, and sustain the attention of journalists and legislators.
The current Administration has not fared well when its immigration policies were dragged into Federal court. One wonders how well the Fed would fare when required to defend its surveillance of physicians and its strategy of patient abandonment. Exhibit A: the impetus for 1 in 10 suicides is pain and lack of access to pain medication. Even as the Fed prosecutes doctors for overprescribing, State health departments continue their policy of prosecuting doctors for withholding pain medication. It's crazy for doctors, but it also means there's still a glimmer of hope for patients.
NOTE: The Response to the Opioid Crisis is not a political issue. Both the Obama and Trump Administrations have embraced the same policy given the leadership is being informed by the same non-appointed Federal bureaucrats.
4. Dedicated Full-Time Coordinator
Your donations would fund a coordinator who would commit no less than 50 hours a week to the cause of launching and leading this Civil Rights Movement.
If you do not have the time or courage to read any further, I ask that you please consider the above -- and know that I have received requests from those who have seen my case against the Fed to bear witness in court to defend them. When the system fails them -- or the world betrays them -- they turn to me.
5. Pharmacy Contract
There is nothing improper about pharmacist shopping. Every pain patient should be cautioned against blindly handing their script to the nearest pharmacy tech without first interviewing the head pharmacist. Engage the pharmacist. Let that pharmacist know that you or others you know have been delayed or inconvenienced by pharmacists with biases against painkillers. Discuss concrete examples and attempt to solicit some reassurance or verbal commitment that this pharmacy will not present such obstacles or else risk losing your business. You are a customer and a patient and you expect a certain level of service. You expect the pharmacist to act in good faith and that unnecessary or unreasonable efforts to challenge scripts will be perceived as harmful and mean-spirited. This is also your opportunity to let the pharmacist know that you will do YOUR part to educate and protect him or her by providing a letter that you composed and had signed by your doctor attesting to certain facts concerning your reasonable and necessary claim to painkillers: (1) your diagnosis, (2) treatment history including non-narcotic avenues currently under exploration or previously exhausted, and (3) your time in that doctor's care. Then put it to the pharmacist: "Given these facts, I need to know now how you woukd handle a monthly request for [INSERT DRUG] in x quantity at y times per day (or as needed)."
If every pain patient took this route, the pharmacist community would feel pressured into treating pain patients as customers and human beings or else lose the business. Some pharmacists would not be unhappy to surrender the business of pain patients because they do not have the stomach for the liability or because their ideology does not permit them to recognize opioids as valid treatments. You should never have to deal with such pharmacists nor with pharmacists who readily comply with a DEA that moved to deputize them in the war on opioids. Safety is job one, yes. But chronic pain sufferers who have been receiving opioids for years are visual proof of their literacy and judiciousness. And repeated calls to the same doctors on behalf of the same patients in an effort to validate a hand-delivered script and question / quibble with the doctor's dose, frequency, or duration is just plain harassment.
One entire chain, CVS, has gambled on a PR stunt that panders to the collective fears concerning opioids. I would avoid CVS altogether. Their pharmacists are less tolerant of pain patients and less knowledgeable of pain management. Many CVS pharmacies by policy will not stock or order oxycodone in sizes > than 10 mg or hydrocodone in sizes > 7.5 mg. Their supply chain reflects current models of what is deemed formulary or preferred, such that the CVS will stock or order Schedule 5 cough syrup containing codeine but not Schedule 2 cough syrup containing hydrocodone. If you have a codeine allergy, if you find it much too weak, or if the antihistamine its paired with (most commonly promethazine) compels you to fall asleep, you are out of luck.
Please donate.
---THE B SIDE ---
Below I present my case against the largely fictionalized Opioid Crisis and the Federal response to its own fiction.
STATISTICAL CASE
Proponents of a Federal crackdown on opioids are fond of two types of data that mislead or confuse. (1) Lawmakers have worked into state bills across the country the dubious statistic that 4 in 5 heroin addicts were once prescribed an opioid, hoping to exploit a vulnerability in the cognitive wiring of its citizens that would cause them to transpose the logic so that they hear/understand that 4 in 5 (80% of) patients prescribed opioids eventually turn to heroin. In actuality, this figure is less than 4% (SAMHSA; NIH). "How can this be?", you ask. Well as it turns out, 4 in 5 people WHO HAVE NEVER TRIED HEROIN were *ALSO* at some point prescribed painkillers. How many people do you know have not had their wisdom teeth removed by age 21? But don't expect to find the rate of heroin use among those prescribed painkillers -- 4% -- in any legislative proposals or Federal speeches. Propaganda requires selective attention. (2) They love to add up as many opioid deaths as they could find Easter-egg-hunt-style until they can make a statement like "more people have died from opioids than have died in the entire Vietnam War." Now through a series of data adjustments I will peel back the layers to reach the only numbers that should matter to the pain management community.
Mm. I can see you are having trouble believing an unemployed social scientist but I assure you I am trained to do two things well. Analyze data. And deconstruct social institutions. For five years I worked for a Federal interagency coordinated by Health & Human Services. FDA. CDC. NIH. DHS. DOL. I worked with them all.
I am going to ask you to grab my hand as I count to three. It's okay. I am not asking you to do anything the Feds wouldn't ask of you. After all, it's THEIR data I'm asking you to trust. Well, the RAW dara at least. Scratch that -- ONLY the raw data.
"ONE."
I am taking you beneath the self-serving gloss. Wave to the row and column totals as you go by. As you go deeper. Beneath the aggregate numbers that THEY chose to add. By the time I have reached the count of three you will have reached the raw data.
"TWO."
As you go deeper, you are undoing their mathematical operations and leaving their assumptions, missions, and prejudices behind. Deeper. When I say "three," you will have found the raw data.
I say "three" ...
"THREE" ...
... Only 46 lives per day are lost to the class of opioids used to treat pain (CDC data). Not 115. When you factor out heroin, fentanyl, & methadone, it's 46. The reason I am asking you to factor out these 3 opioids is that, with the very rare exception of the fentanyl transdermal patch, these are not the medications typically prescribed for pain.
And 50% of these people died because they took the painkiller with another substance. Possibly alcohol. Actually, it's usually alcohol. But it might also be a sedative like Ambien or a benzodiazepine like Xanax.
At this depth you are less likely to blame opioids and more likely to blame polysubstance use. Right about now that 46 is looking a whole lot more like 23.
Now you are ready to know that an estimated 25-45% of those 23 people took opioids as a means to suicide. You know this -- *I* know this -- because the former President of the American Psychiatric Association knows this. Her guestimate comes from an extensive review of the literature. Oquendo is her name.
Now you're thinking we shouldn't blame opioids for the rise in overdoses since 2000. That's the year the CDC and FDA want us to use as a comparison. Okay, I'll bite. You'll bite. Hell we'll ALL bite. And we'll blame depression. Life in 21st Century America is a much better -- much more efficient -- explanation for the rise in overdose fatalities since we took Sting's advice and turned the clock to zero ... "honey." Let's face it. It's a simple fact. And you don't seem the type to ignore a simple fact. I'm talking about the fact some people get hooked on substances that relieve a broader socioeconomic brand of pain. Off-label but effective relief for anxiety. Stress. Resentment. Disappointment.
And then there were -- 23, 22, 21 ... ~ 17.
Some dose recklessly out of frustration with intractable pain. So now you're thinking -- why not blame the pain itself? Lord only knows what our number -- at last count 17 -- looks like now.
The Lord also knows that some of these painkillers were obtained by diversion, not by prescription. Actually we ALL know that. Not just Sherlock Holmes. But the less astute Elizabeth Holmes. People in HOMES across America. Even LARRY Holmes probably knows that.
Of those addicted to Oxycontin, 79% never had a valid script. So how can we blame the pain management and compassionate care enterprise for this.
And then there were ~ 5.
So now you know.
The problem is not opioids. It's heroin.
The problem is not painkillers. It's pain.
The problem is not prescription. It's diversion.
The real epidemic here is MASS HYSTERIA.
Of those prescribed painkillers, only 8-12% develop a use disorder & OF THOSE only 4-6% turn to heroin. The facts make a mockery of Federal meddling in physician treatment of pain.
WHY THE FED WANTS / NEEDS AN OPIOID CRISIS
Even if there WAS an "Opioid Epidemic," the Fed has failed to direct the reasonable and necessary resources to fight it. The Fed has bypassed the medical community entirely, using the ATTORNEY General rather than the SURGEON General as the lead executive. This is in direct contrast to how we addressed the Financial Crises in 2008. No one considered terminating the financial industry leaders whose new constructs and products / derivatives caused the Recession. And no one vehemently protested when these executives insisted on keeping their annual million dollar bonuses. Instead, we rehired them to fix the crisis, understanding that no one other than those who created the system would know how to repair it.
We compounded the error when we slapped the "epidemic" label on the crisis (i.e., "the Opioid Epidemic") so we could place it squarely in the jurisdiction of the Centers for Disease Control -- even though this substance use issue has none of the properties associated with contagion or person-to-person transmission.
Is it any wonder that 18 years into this "crisis," the one glaring omission is a social-psychological perspective? Perhaps our political leaders knew that a social psychologist like myself would see right through their plan to engineer a mass hysteria supporting a false narrative.
FEDS NEED SCAPEGOAT & DIVERSION FOR THE REAL CRISES OF WHICH SUBSTANCE USE IS A SYMPTOM
So what do I think they're up to? I think the Fed is using opioids as a scapegoat and diversion from the nation’s true crises -- socioeconomic crises of which substance use in general is one symptom. The Fed is attempting to reverse the direction of causality in portraying opioids as the cause of sagging workforce participation and a rare dip in the U.S. life expectancy. There are too many other confounds in their data analysis indicative of alternative explanations. Scatterplots showing that states with low rates of workforce participation also have the highest rates of opioid prescriptions neglect the true hidden cause – the pain itself. And as much as the Feds like to announce that the number of opioid deaths since 2000 rivals the number of lives lost in the Vietnam War, the truth is that each of three other substances available over the counter – tobacco, alcohol, and sugar – claims orders of magnitude more lives than opioids … and the real cause of the rise in opioid deaths since 2000 is none other than life in 21st Century America. It's interesting that the Fed has chosen 2000 as Year 1 for the Crisis. Since 2000 we have been in the throes of a Software Revolution that changed the way employers evaluate job applicants. Employers abandoned intellectual capital (strategic thinking / analytical acumen / knowledge base) and other educational variables (where did you go to school?; how far did you get?; GPA; GRE scores; major course of study and thesis) in favor of measures they believe are more congruent with fitness for their position, namely software proficiency (x years working a, b, and c software at d level) and chic industry micro-certificates for which 2 weeks and $2,000 earns you an acronym to place after your name to feed this new age of credentialism. Now a PhD in Statistics is no match for a high school graduate with a Six Sigma black belt. Now universities are offering new masters degrees tailored specifically to popular or in-demand positions, such that the PhD in Social Psychology who has since amassed 15 years of experience analyzing data ans managing knowledge for hospitals in so match for a 24-year-old newly minted Master of Health Analytics or Master of Knowledge Management or Change Management. We are in the throes of a crisis characterized by the disarticulation of higher education and industry, which means widespread confusion as to the value of a traditional degree and of course that trillion dollars in student loan debt I keep reading about. Over 40% of these loans are in delinquency or default. For all my education and experience, I have been out of work for all but 4 months since 2012. I have been told my PhD is "just another achievement" rather than what it REALLY is -- access to a living knowledge base. I have even been encouraged to leave my PhD off my resume altogether to avoid looking like an over-educated misfired academic. In no sane world -- or healthy economy -- would such views take hold and gain traction. The use of software to screen applicants (Applicant Tracking Software, or ATS) is the whole reason why you are asked to fill in dozens of HTML fields in online application forms even though all that same basic information is included in the Word copy of your resume you uploaded at their request. Employers want you (and the other 300 - 1800 applicants) to spend 2-3 hours filling out these forms so their ATS could reject your application in 2-3 fractions of a second. ATS is the reason why only 27% of applications see human eyes -- and why we have a growing class of long term unemployed despite the 3.9% unemployment rate. Isn't it interesting? I mean, how do we reconcile 3.9% unemployment with the fact each job ad draws on average somewhere between 300 and 1,800 responses? I mean BESIDES the fact people like me who have been unemployed as long as I have no longer get included in the calculation of the unemployment rate. Can you think of another reason -- something else that might account for this? Yes exactly, very good. I knew you knew your stuff ... it's WORKING Americans. When I apply for a job, I am not competing with other unemployed job seekers whose lives, marriages, and families are a month away from financial w-reckoning. I am competing with a legion of people who already have jobs but who are unhappy with the jobs they have. 78% of WIRKING Americans surveyed are open to a new job, while 33% (that's 41 million) are actively engaged in a search for a new job. We're all still grappling with the fallout from the Great Recession. Many people were forced to take jobs beneath their station. In order to keep their jobs, some have had to work the jobs of three people. And most workers have not seen a raise or promotion in years. And then there are those who suffer from chronic dissatisfaction. These are the people who treat their jobs like day traders treat stocks or like philanderers treat wives. They are always looking for a step up and in the process complicate the fortunes of those job seekers who battle the stigma of having been out of work for an extended period. The Internet, which by 2000 matured into a well-known full-service job and employee search platform, placed the unsmployed job seeker at a disadvantage. Despite the fact we heae nothing but good things about the Internet as a employment search tool, the dirty little secret is that the unemployed job seeker no longer has more time than his working counterparts to pound pavement. No one is on foot anymore with a folder full of paper resumes. Working Americans can create online profiles and search agents so they are just a mouse click away from applying -- or so the employer's internal recruiters can find them in an Internet search on skills without ever having to submit an application. I don't know what you would do 3 years into your unemployment. By then your spouse might have quit the marriage or cozied up to former paramours. By then you may have had to move in with your in-laws, who are starting to work the names of your wife's former (and still single) boyfriends into dinner conversations. Relocating further from your wife's employer may have become a source of tension between them. She may resent you for having to liquidate her retirement income, the taxes on which alone are enough to drive you into bankruptcy and put you at odds with the IRS. Your parents begin revisting every decision you ever made in your life, which are all terrible in hindsight. Everything from your choice of major in college to your selection of a first wife. And don't ne surprised if they stray into conversations that begin "you didn't have to have [INSERT NAME OF ONLY OR YOUNGEST CHILD HERE]." If they gift you any money to help you pay your bills, they have the right to question every decision you ever made and they have the right to advise you on everything from how to approach your current job search to how you should conduct your grocery shopping. You will fast discover how much they think they know about everything, including you. Unemployment destroys everything. Resumes. Then reputations. Then resources. And finally relationships. And unemployment has never been this big a problem in the U.S. for as long as it's been problem. Yes, the unemployment rate is down, and yet the Feds are whining about the stubbornly low workforce participation rate and its downstream effects on new home purchases, student loan delinquency, and a host of other econometrics. Naturally they blame it all on opioids. The opioids have altered our mental status to the point we cannot show up for work or work effectively. Or people remain out of work because near-universal pre-employment drug screening has forced them to choose drug use over work. This raises another important point -- the myths and misconceptions concerning the effects of opioids on the user. Yes, I understand that heroin and that painkillers administered in hospitals by IV are designed to knock you out. But your tablets of oxycodone, hydrocodone, and hydromorphone have the opposite effect. They give you the energy, focus, and disposition conducive to productivity and healthy interactions. Their broad spectrum effect on pain is rivaled only by their broad spectrum effect on mood, as there is nothing more effective for depression, anxiety, stress, and even resentment. These oral painkillers only make you drowsy or "drunk" when dosed inapprpriately or with other substances. Don't take my word for it. The Adverse Event Study on hydromorphone (Dilaudid) revealed that 31% of respondents reported drowsiness or change in mental status on this medication. While 31% is significantly lower than half to argue that cops should not be handing out DUI-Ds if it appears in their blood screen, I still found 31% too high to jibe with my first hand knowledge of hydro users. The very next sentence revealed that of the respondents who make up this 31%, 98% either dosed imappropriately or with another substance. What this data confirms for me is that a major stigma is being propped up by myths and misconceptions. What the data does NOT tell me is why the authorities enable, or possibly even embrace, these myths. I tell you what -- let's come back to that.
I am not quite finished making my point about "life in 21st Century America." I need to be clear on this, because I am citing it as one of the major causes of both the modest increase in substance use since 2000 as well as the Government's claim -- and partial creation -- of an "Opioid Crisis."
Low workforce participation, a growing class of permanent unemployed due to widespread or systemic biases among employers, and under-employment (dubbed the "new unemployment") is enough to drive people to use substances to alter their moods. The popularity of opioids speaks volumes about the nature of the pain these people are treating. Opioids not only keep them off the proverbial ledge by filling them with the pleasant feelings for the sake of which most of us do anything in this world -- thus giving them a purpose and reason-for-being -- but it restores a vital sense of control. What the world took from them and continues to deny them in the way of secondary reinforcers (i.e., source of income), they reclaim for themselves by way of access to a primary reinforcer (i.e., a pill that makes them happy). It's a path to reparations, recriminations, and revenge devoid of hostility. In fact, many substance users report a newfound capacity to love their enemies.
And we can use more of that in 21st Century America -- an era defined not only by the disruptive and discriminatory effects of the Software and Internet Revolutions but also by the NASDAQ Crash of 2000; 9/11; The Patriot Act; two trillion dollar wars; the bursting of bubbles in the credit and secondary mortgage markets leading to The Great Recession; corporate malfeasance cases (think Enron) including a major bank (Wells Fargo) that created such a pressure cooker sales culture that its employees were opening new accounts and credit cards without the authorization or even awareness of its customers; $5 dollar a gallon gasoline; scandals involving gross negligence or corruption in 15 different Federal agencies including sex scandals in the Secret Service, SEC, FBI, and DHS and political scandals involving the highest office in HHS, DOJ. and the IRS, and an embezzlement and misappropriation scandal in GSA; two divisive Presidential elections both of which exposed a dangerously polarized electorate and one of which may have been influenced by personal data collected by social media (Facebook) and unwittingly made available to (and gamed by) Russian troll farms and political consultancy outfits like Cambridge Analytica; and last but not least an unprecedented 5 year budget impasse on Capitol Hill that introduced into the popular lexicon such terms as continuing resolution, debt ceiling, fiscal cliff, and sequestration. This century is one in which unprecedented numbers of Americans have reported losing faith in nearly every institution. Congressional approval ratings have hovered around 12% since 2000 which is not much better than corporations, universities, or major religions.
FED NEEDS A COMMON ENEMY TO HEAL PARTISAN DIVIDE AND SCARS OF PR SCANDALS
In short, we are suffering major existential crises in vocation, identity, community, and faith. Unfortunately this is not the kind of Crisis that affects us all the same way or that is even being identified and portrayed in a way that brings us all together against a common enemy, as we did for the Great Depression, Prohibition, and World War II. That is why the Government is trying to pin all these contemporary stressors on opioids. Opioids offer us a common enemy capable of healing not only the scars of partisan warfare but also the scars of personal scandal. Just ask Chris Christie. His friend swallowed a handful of Percocets with a bottle of vodka and that my friends is the cause celebre for which you are being asked -- no, told -- you have to give up your rights to painkillers.
FED NEEDS STAND-IN FOR MARIJUANA
An associate by the name of Justin Theobald informed me that the legalization of marijuana threatened to cut into funding for law enforcement, forcing the Attorney-General-led Government to seek out a new villain. Again, opioids offered a convenient solution.
NO TURNING BACK AFTER MONEY CHANGES HANDS
Needless to say, the official declaration of emergency around opioids released Federal funding for all sorts of business ventures, entrepreneurial schemes, major conferences, and a host of new jobs or job titles. We have reached a point of no return where we can honestly say we are more addicted to the Opioid Crisis than we ever were to opioids. When I drop a comment into Linkedin titled "There Is No Crisis," I am immediately attacked by the same opportunists who have been using Linkedin to hawk their anti-opioid products. One fellow wants CMS or private health insurers to mandate his Pill Locker as a prerequisite for prescription. The device intends to eliminate overdoses by regulating access to the pills so the proper dosing and schedule is assured. Of course he is resistant to my claim that his device exposes a findamental misunderstanding of prescription painkiller use by chronic pain patients, whose doctors authorize discretionary adjustments to dosing and schedules to address severity, frequency, and duration of the pain at hand. Lawmakers could have improved the mortality data -- WITHOUT compromising compassionate care -- if only their laws differentiated between acute injury or illness patients and those suffering from chronic pain. Most State laws limit to 7 day supplies opioids for new patients with acute injuries from which they are expected to recover in less than 3 months. Unfortunately the following two forces bring about a situation in which the letter of the law itself, unread by 99% of us, is superseded by a more violent interpretation of the law that takes on a life of its own:
LOST IN TRANSLATION
1. No one reads the text of the new laws.
2. Journalists who announce and characterize the laws do so within a "headline on a deadline" culture. It's ADHD. It's simplicity. It's sensationalism. It's how can we seize the attention of as many people as possible -- and sell as many units as possible -- to people who only have time or patience for 25 words or less and who need to be entertained throughout.
WELLS FARGO SYNDROME
3. The DEA agents do not care whose prescriptions are suspended as long as they meet their individual sales goals. I say sales goals because these people are in love with their careers and will do anything to keep their jobs or take them to the next level. They're bucking for promotion. So when they pick up that receiver to threaten a prescriber, they do so with slightly more urgency than the telemarketing firm staffer selling encyclopedias over the phone. We're talking Wells Fargo Syndrome here. You remember them, right? Their managers pushed employees to sell an average 8 new products to each customer.
The pressure to keep their job and advance their career was so fierce that they resorted to opening new accounts and carda without the authorization or even the awareness of their customers. The laws do not depict the treatment plans for CHRONIC pain patients as criminal and yet this is where the DEA turns to meet the Government's overly ambitious 30% reduction goals and in the process their own personal career ambitions.
DISCONNECT BETWEEN THOSE WHO MAKE / ARE MADE BY THE POLICY
Needless to say, the Government officials creating, implementing, and enforcing these new regulations never suffered a day in their lives. They are hardy Type A raise-your-hand professionals who rose into their positions by burning more midnight oil than the next guy and by embodying the views and agendas of their employer better than their able or distinguished peers.
DIAGNOSIS: MASS HYSTERIA / COLLECTIVE NEUROSIS
As a social psychologist I am familiar with the trademark characteristics of mass hysteria and other forms of collective behavior. We have seen this mass hysteria play out before in 12-15 years of McCarthyism (50s/60s), the response to the bubonic plague, the Salem Witch trials, accusations of sexual abuse in which assailants were implicated by memories later proved false artifacts of hypnotic regression (90s), and accusations of ritual Satanic abuse in California daycare centers (90s). I am confident the Opioid Crisis will eventually be exposed as such an hysteria, but I am unwilling to wait 10-15 years for the American public to have that collective "what-were-we-thinking" epiphany.
*ABOUT THE AUTHOR*
Matthew Giarmo has a PhD in Social-Personality Psychology from Kansas State University (1997), in fulfillment of which he acquired an expertise as both a producer and consumer of scientific knowledge (i.e., research design and analytics) as well as an expertise in the analysis of institutions, personality systems, and social trends.
Since conferment of his PhD, Dr. Giarmo has performed fixed term contract and consulting work for health & hospital systems and for the U.S. Government, including a Federal interagency (PHEMCE) coordinated by the Department of Health & Human Services.
Dr. Giarmo counts among his friends and family many persons under treatment for chronic pain and disability. He has been accompanying loved ones to medical appointments for 25 years and bore witness to changes in the various cultures in which pain management is embedded.
ADDITIONAL WORKS
Games without Frontiers: How the Fed Used Opioids as Scapegoat & Diversion for the Nation's True Crises, September 4, 2018, LinkedIn
https://www.linkedin.com/pulse/games-without-frontiers-how-fed-used-opioids-nations-giarmo-ph-d-/
Virginia's Recipe for Patient Abandonment: A Tale of the Opioid Crisis, November 1, 2017, LinkedIn
https://www.linkedin.com/pulse/virginias-recipe-patient-abandonment-tale-opioid-giarmo-ph-d-/
Connecticut’s War on Controlled Substances: A Case Study in Mass Hysteria, October 30, 2017, LinkedIn
https://www.linkedin.com/pulse/connecticuts-war-controlled-substances-case-study-giarmo-ph-d-/
Kaiser Permanente and the End of Compassionate Care, October 23, 2017, LinkedIn
https://www.linkedin.com/pulse/kaiser-permanente-end-compassionate-care-matthew-giarmo-ph-d-/
Pain Sufferers Bill of Rights, October 29, 2017, LinkedIn
https://www.linkedin.com/pulse/pain-sufferers-bill-rights-how-beat-back-dea-matthew-giarmo-ph-d-/
MAJOR DATA SOURCES
Opioid overdose crisis. National Institute for Drug Abuse. (8-12% of chronic pain sufferers prescribed painkillers develop a use disorder. 21-29% misuse them. 4-6% of those who develop a use disirder transition to heroin).
Opioid Abuse in Chronic Pain -- Misconceptions and Mitigation Strategies. Volkow, N. & McLellan, T. (2016). New England Journal of Medicine. 374: 1253-1263.
Center for Behavioral Health Statistics and Quality. (CBHSQ Data Review). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States (SAMHSA). August 2013.
Second Annual Report of Prescription and Illicit Drug-Related Risks and Outcomes (Centers for Disease Control). .csv file available for download
... Unless the Fed has its way, in which case these painkillers will vanish from the earth ... and you'll kiss their ass to kill you.
If you are a doctor who treats someone in pain, this Movement is for you. *ALL* doctors should donate. All doctors should ensure this Movement prospers and prevails. Only then will doctors be protected from unlawful prosecution and suspension -- and the people they care about most -- their patients -- protected from unnecessary and unreasonable suffering.
Your Government declared war on you -- the war dubbed "The Opioid Crisis." This is a winnable war. As winnable as it is cruel and unnecessary. A war without warrant or merit. State laws and CDC Guidelines contain a palliative care provision that affords you, the doctor, prescriptive authority and you, the patient, the inalienable right to relief. We need only repel the rogue and the ignorant in the DEA and elsewhere who neglected to read -- or resolved to neglect -- that provision. The fear and tension you bear -- the wedge the Fed has driven between doctors and patients, doctors and DEA-deputized pharmacists, doctors and insurance carriers, and doctors and other doctors -- would NOT exist today -- 4,000 licenses would NOT have been suspended -- millions of pain sufferers would not have been abandoned -- without the complicity of the American Medical Association. The AMA is bound by covenant to defend its physician members and the patients for which they took an oath to do no harm. Defend against charges of overprescribing. Against surveillance and meddling. But the spineless, chinless simps in the AMA turned their backs on ALL of you. And so it is up to all of you to give yourself the platform -- the identity -- the voice -- you sorely need. No one else is speaking for you. Through your donation -- no matter how small -- you send a powerful message to lawmakers who currently believe it is political suicide to come to your aid. That message should be nothing short of "it is political suicide NOT to come to my aid. To allow cops and dead heroin addicts to rewrite healthcare policy. To pander to the grieving survivors of dead heroin addicts whose emotionally unstable and therapeutic protestations are designed to restore dignity to their loved ones by portraying them as victims of industry and as posthumous agents of reform. Good therapy for them. Good eulogies for their loved ones. Torture for chronic pain patients for whom opioids offer the only means to restore quality of life, who use responsibly, and who never develop a use disorder or addiction."
If my Appeal fails to move you, then we embolden all the Government bureaucrats, sanctimonious crusaders, self-aggrandizing careerists, and shameless opportunists who grab for slices of the opioid crisis pie. They are more addicted to the Opioid Crisis than we are to opioids. Like McCarthy's reckless pursuit of communists among us, these hysterics will stop at nothing to cleave you from your liberty, privacy, resources. and due process and usher in a New Regulatory Era. A police state.
The Fed shifted its drug war strategy from one of attacking Supply to one of attacking Demand and, in the process, created a Narrative depicting pharmaceutical houses as international drug cartels, doctors as dealers, and chronic pain patients as addicts.
Citing threatening phone calls from DEA agents, many doctors reduced or suspended their patients' medications, including those of my own mother, who spent the last few months of her life stressing over the threats her oncologist received before she finally succuumbed to advanced metastatic cancer last March. When Attorney General Jeff "Take a Bufferin and Call Me in the Morning" Sessions directed Federal employees involved in this Crusade (DEA, CDC, FDA) to publicly commit to the goal of reducing prescriptions by 30% per annum, the DEA agents took the fight directly to the doctors, and they did not care whose treatments were rescinded in order to reach their quota.
Oxycontin gave my mother her life back. For two years she could not host visits from her grandson, prepare meals for her husband, or attend senior community functions due to the pain, malaise, and mood brought on by her cancer. Oxycontin (and some short-acting oxycodone for occasional breakthrough pain) enabled her to be herself again, bring happiness to those who enjoyed or relied on her, and reduced the burden on caregivers. Now due to what I intend to prove is mass hysteria on a national scale, employers are lobbying their insurance carriers to stop covering Oxycontin and the Fed is planning to file a lawsuit against Oxycontin maker Purdue Pharma. Granted, I believe Purdue Pharma is not above reproach. Like other pharmaceutical companies, they need to expand their data collection and reporting practices beyond adverse effects like nausea and hair loss to include misuse and dependency. Purdue Pharma also probably operated on the untested assumption that extended release formulations pose less risk for dependency than short-acting versions. And Purdue Pharma is guilty of operating like any other American business -- on the profit motive. They do their part by providing a drug that is safe and effective -- and opioids ARE in fact safer for chronic patients than acetaminophen, ibuprofen, Toradol, or aspirin due to their reduced toxicity to major organs. And they should not ne held accountable for the actions of those who abused their product (crushing the pills to liberate their short acting effects) -- abuses committed by those who did not hold valid scripts.
For those of you who think this Nuclear Winter scenario cannot play out, I invite you to consider the following outrageous developments ...
(I) Hospitals are reporting a critical shortage of morphine due to Federal restrictions on the supplies manufactured, distributed, and stored.
(II) The Fed revoked the licenses of 4,000 physicians who exceeded new CDC Prescription Guidelines. The doctors were suspended without due process and without universal standards defining what is a "reasonable quantity." Because the CDC Guidelines are not evidence-based and because it is patently absurd to think there could be one-size-fits-all standards for patients who vary widely in pain type/source, treatment history/tolerance, and genetic sensitivity to pain and to pain medication, the International nonprofit HumanRightsWatch will release an end of year report condemning the CDC for bullying doctors into abandoning their patients outright, a human rights violation the group has compared to police brutality in African nations.
(III) The Fed sued 47 states to set up an Opioid Prescription Monitoring Database. This database has NOT been used to confidentially collect aggregate data but rather to identify and surveil prescriptions on a doctor-by-doctor and patient-by-patient basis. Patients tell me all the time that their physicians receive threatening phone calls from DEA agents who "give them a hard time" or issue instructions to reduce or suspend opioid medications.
(IV) The Fed has met its annual goal of reducing prescriptions by 30%; but over the course of this reduction, heroin overdose fatalities have risen 19%, suggesting that abandoned patients are turning to the Street, to suicide, and to rehabilitation clinics where methadone poses a greater risk than the original painkiller.
(V) As the Fed plans lawsuits against pharmaceutical manufacturer Purdue Pharma, insurance carriers are slavishly complying with employers' demand to cease covering Oxycontin and other opioid painkillers.
(VI) Attorney General Jeff Sessions when questioned about the impact of his response advised people in pain to "take a Bufferin and call me in the morning."
*WHY I NEED YOUR DONATION. WHY YOU NEED TO MAKE THIS DONATION*
I want to fund a Civil Rights Movement for chronic pain sufferers and the physicians who treat them. These people deserve the same rights, protections, and accommodations afforded social minorities, veterans, Native Americans, and persons with disabilities. I want to preserve the integrity of the compassionate care system and the sanctity of the doctor-patient relationship from what I will prove is a mass hysteria / neuroses at the heart of the Federal Crackdown. With each passing month, the Fed denies you and your loved ones even more liberties, resources, and due process. Support for this Movement will in no way compromise care for people who suffer from opioid addiction. There is no reason the Fed needs to drive a wedge between the pain patient and addiction communities. But they have. As they have driven wedges between doctors and pharmacists, doctors and patients, doctors and other doctors, and patients and their own self-esteem (shaming them into thinking they are fringe elements of a society, that they set a bad example, and that they possess a character flaw). The Fed has introduced an element of tension and antagonism into the health care enterprise. State laws have already done well to limit first-time prescriptions for ACUTE injury patients to 7 day supplies. The days of dentists subsidizing adolescent "pill parties" by giving out 60 Percocets in exchange for wisdom teeth are over. The days of unmonitored pill mill doctors offering a continuous and unconditional supply of painkillers to treat the pain with no regard for its root causes have also been shut down. There is no reason to deny the community of patients with CHRONIC pain diagnoses the only treatment plans and medications that have restored some quality of life.
*HOW I INTEND TO USE YOUR DONATIONS*
The following strategies will be employed to launch and lead a Civil Rights Movement that recognizes that chronic pain patients are subject to undue prejudice, discrimination, and adverse impact. The objective is to both raise awareness and to repel interference in the doctor-patient relationship to the detriment of compassionate care. You should know that as long as some funding trickles in, work toward the Movement will not have to wait -- or be contingent on -- meeting the final donation goal.
1. Pain Sufferers Bill of Rights
I composed the The Pain Sufferers Bill of Rights for circulation and signature among our lawmakers at the State and Federal level. This should form the core of something akin to The Americans with Disabilities Act (1990).
2. Shaming the AMA into Defending its Physician Members
The Lawmakers are not the only group to abandon its people. Spineless, chinless simps at The American Medical Association have turned their backs on their own physician members. The AMA should defend doctors against charges of overprescribing. The AMA should defend the medical community from Federal surveillance and meddling and from pressure to abandon their clinical decision making, their compassion, and their oath to do no harm. There would be no Crackdown (and no exacerbation of the faux Crisis) without the complicity of the AMA. The AMA has had the power to end this by making public statements or threatening a work stoppage. Keep emeegency and urgent care centers up and running but otherwise stage a walkout until doctors are granted the opportunity to enjoy a modicum of autonomy and trust.
3. Federal Court System
A class action lawsuit (or a suit brought on behalf of a physician charged with overprescribing) against the Federal government would seize, focus, and sustain the attention of journalists and legislators.
The current Administration has not fared well when its immigration policies were dragged into Federal court. One wonders how well the Fed would fare when required to defend its surveillance of physicians and its strategy of patient abandonment. Exhibit A: the impetus for 1 in 10 suicides is pain and lack of access to pain medication. Even as the Fed prosecutes doctors for overprescribing, State health departments continue their policy of prosecuting doctors for withholding pain medication. It's crazy for doctors, but it also means there's still a glimmer of hope for patients.
NOTE: The Response to the Opioid Crisis is not a political issue. Both the Obama and Trump Administrations have embraced the same policy given the leadership is being informed by the same non-appointed Federal bureaucrats.
4. Dedicated Full-Time Coordinator
Your donations would fund a coordinator who would commit no less than 50 hours a week to the cause of launching and leading this Civil Rights Movement.
If you do not have the time or courage to read any further, I ask that you please consider the above -- and know that I have received requests from those who have seen my case against the Fed to bear witness in court to defend them. When the system fails them -- or the world betrays them -- they turn to me.
5. Pharmacy Contract
There is nothing improper about pharmacist shopping. Every pain patient should be cautioned against blindly handing their script to the nearest pharmacy tech without first interviewing the head pharmacist. Engage the pharmacist. Let that pharmacist know that you or others you know have been delayed or inconvenienced by pharmacists with biases against painkillers. Discuss concrete examples and attempt to solicit some reassurance or verbal commitment that this pharmacy will not present such obstacles or else risk losing your business. You are a customer and a patient and you expect a certain level of service. You expect the pharmacist to act in good faith and that unnecessary or unreasonable efforts to challenge scripts will be perceived as harmful and mean-spirited. This is also your opportunity to let the pharmacist know that you will do YOUR part to educate and protect him or her by providing a letter that you composed and had signed by your doctor attesting to certain facts concerning your reasonable and necessary claim to painkillers: (1) your diagnosis, (2) treatment history including non-narcotic avenues currently under exploration or previously exhausted, and (3) your time in that doctor's care. Then put it to the pharmacist: "Given these facts, I need to know now how you woukd handle a monthly request for [INSERT DRUG] in x quantity at y times per day (or as needed)."
If every pain patient took this route, the pharmacist community would feel pressured into treating pain patients as customers and human beings or else lose the business. Some pharmacists would not be unhappy to surrender the business of pain patients because they do not have the stomach for the liability or because their ideology does not permit them to recognize opioids as valid treatments. You should never have to deal with such pharmacists nor with pharmacists who readily comply with a DEA that moved to deputize them in the war on opioids. Safety is job one, yes. But chronic pain sufferers who have been receiving opioids for years are visual proof of their literacy and judiciousness. And repeated calls to the same doctors on behalf of the same patients in an effort to validate a hand-delivered script and question / quibble with the doctor's dose, frequency, or duration is just plain harassment.
One entire chain, CVS, has gambled on a PR stunt that panders to the collective fears concerning opioids. I would avoid CVS altogether. Their pharmacists are less tolerant of pain patients and less knowledgeable of pain management. Many CVS pharmacies by policy will not stock or order oxycodone in sizes > than 10 mg or hydrocodone in sizes > 7.5 mg. Their supply chain reflects current models of what is deemed formulary or preferred, such that the CVS will stock or order Schedule 5 cough syrup containing codeine but not Schedule 2 cough syrup containing hydrocodone. If you have a codeine allergy, if you find it much too weak, or if the antihistamine its paired with (most commonly promethazine) compels you to fall asleep, you are out of luck.
Please donate.
---THE B SIDE ---
Below I present my case against the largely fictionalized Opioid Crisis and the Federal response to its own fiction.
STATISTICAL CASE
Proponents of a Federal crackdown on opioids are fond of two types of data that mislead or confuse. (1) Lawmakers have worked into state bills across the country the dubious statistic that 4 in 5 heroin addicts were once prescribed an opioid, hoping to exploit a vulnerability in the cognitive wiring of its citizens that would cause them to transpose the logic so that they hear/understand that 4 in 5 (80% of) patients prescribed opioids eventually turn to heroin. In actuality, this figure is less than 4% (SAMHSA; NIH). "How can this be?", you ask. Well as it turns out, 4 in 5 people WHO HAVE NEVER TRIED HEROIN were *ALSO* at some point prescribed painkillers. How many people do you know have not had their wisdom teeth removed by age 21? But don't expect to find the rate of heroin use among those prescribed painkillers -- 4% -- in any legislative proposals or Federal speeches. Propaganda requires selective attention. (2) They love to add up as many opioid deaths as they could find Easter-egg-hunt-style until they can make a statement like "more people have died from opioids than have died in the entire Vietnam War." Now through a series of data adjustments I will peel back the layers to reach the only numbers that should matter to the pain management community.
Mm. I can see you are having trouble believing an unemployed social scientist but I assure you I am trained to do two things well. Analyze data. And deconstruct social institutions. For five years I worked for a Federal interagency coordinated by Health & Human Services. FDA. CDC. NIH. DHS. DOL. I worked with them all.
I am going to ask you to grab my hand as I count to three. It's okay. I am not asking you to do anything the Feds wouldn't ask of you. After all, it's THEIR data I'm asking you to trust. Well, the RAW dara at least. Scratch that -- ONLY the raw data.
"ONE."
I am taking you beneath the self-serving gloss. Wave to the row and column totals as you go by. As you go deeper. Beneath the aggregate numbers that THEY chose to add. By the time I have reached the count of three you will have reached the raw data.
"TWO."
As you go deeper, you are undoing their mathematical operations and leaving their assumptions, missions, and prejudices behind. Deeper. When I say "three," you will have found the raw data.
I say "three" ...
"THREE" ...
... Only 46 lives per day are lost to the class of opioids used to treat pain (CDC data). Not 115. When you factor out heroin, fentanyl, & methadone, it's 46. The reason I am asking you to factor out these 3 opioids is that, with the very rare exception of the fentanyl transdermal patch, these are not the medications typically prescribed for pain.
And 50% of these people died because they took the painkiller with another substance. Possibly alcohol. Actually, it's usually alcohol. But it might also be a sedative like Ambien or a benzodiazepine like Xanax.
At this depth you are less likely to blame opioids and more likely to blame polysubstance use. Right about now that 46 is looking a whole lot more like 23.
Now you are ready to know that an estimated 25-45% of those 23 people took opioids as a means to suicide. You know this -- *I* know this -- because the former President of the American Psychiatric Association knows this. Her guestimate comes from an extensive review of the literature. Oquendo is her name.
Now you're thinking we shouldn't blame opioids for the rise in overdoses since 2000. That's the year the CDC and FDA want us to use as a comparison. Okay, I'll bite. You'll bite. Hell we'll ALL bite. And we'll blame depression. Life in 21st Century America is a much better -- much more efficient -- explanation for the rise in overdose fatalities since we took Sting's advice and turned the clock to zero ... "honey." Let's face it. It's a simple fact. And you don't seem the type to ignore a simple fact. I'm talking about the fact some people get hooked on substances that relieve a broader socioeconomic brand of pain. Off-label but effective relief for anxiety. Stress. Resentment. Disappointment.
And then there were -- 23, 22, 21 ... ~ 17.
Some dose recklessly out of frustration with intractable pain. So now you're thinking -- why not blame the pain itself? Lord only knows what our number -- at last count 17 -- looks like now.
The Lord also knows that some of these painkillers were obtained by diversion, not by prescription. Actually we ALL know that. Not just Sherlock Holmes. But the less astute Elizabeth Holmes. People in HOMES across America. Even LARRY Holmes probably knows that.
Of those addicted to Oxycontin, 79% never had a valid script. So how can we blame the pain management and compassionate care enterprise for this.
And then there were ~ 5.
So now you know.
The problem is not opioids. It's heroin.
The problem is not painkillers. It's pain.
The problem is not prescription. It's diversion.
The real epidemic here is MASS HYSTERIA.
Of those prescribed painkillers, only 8-12% develop a use disorder & OF THOSE only 4-6% turn to heroin. The facts make a mockery of Federal meddling in physician treatment of pain.
WHY THE FED WANTS / NEEDS AN OPIOID CRISIS
Even if there WAS an "Opioid Epidemic," the Fed has failed to direct the reasonable and necessary resources to fight it. The Fed has bypassed the medical community entirely, using the ATTORNEY General rather than the SURGEON General as the lead executive. This is in direct contrast to how we addressed the Financial Crises in 2008. No one considered terminating the financial industry leaders whose new constructs and products / derivatives caused the Recession. And no one vehemently protested when these executives insisted on keeping their annual million dollar bonuses. Instead, we rehired them to fix the crisis, understanding that no one other than those who created the system would know how to repair it.
We compounded the error when we slapped the "epidemic" label on the crisis (i.e., "the Opioid Epidemic") so we could place it squarely in the jurisdiction of the Centers for Disease Control -- even though this substance use issue has none of the properties associated with contagion or person-to-person transmission.
Is it any wonder that 18 years into this "crisis," the one glaring omission is a social-psychological perspective? Perhaps our political leaders knew that a social psychologist like myself would see right through their plan to engineer a mass hysteria supporting a false narrative.
FEDS NEED SCAPEGOAT & DIVERSION FOR THE REAL CRISES OF WHICH SUBSTANCE USE IS A SYMPTOM
So what do I think they're up to? I think the Fed is using opioids as a scapegoat and diversion from the nation’s true crises -- socioeconomic crises of which substance use in general is one symptom. The Fed is attempting to reverse the direction of causality in portraying opioids as the cause of sagging workforce participation and a rare dip in the U.S. life expectancy. There are too many other confounds in their data analysis indicative of alternative explanations. Scatterplots showing that states with low rates of workforce participation also have the highest rates of opioid prescriptions neglect the true hidden cause – the pain itself. And as much as the Feds like to announce that the number of opioid deaths since 2000 rivals the number of lives lost in the Vietnam War, the truth is that each of three other substances available over the counter – tobacco, alcohol, and sugar – claims orders of magnitude more lives than opioids … and the real cause of the rise in opioid deaths since 2000 is none other than life in 21st Century America. It's interesting that the Fed has chosen 2000 as Year 1 for the Crisis. Since 2000 we have been in the throes of a Software Revolution that changed the way employers evaluate job applicants. Employers abandoned intellectual capital (strategic thinking / analytical acumen / knowledge base) and other educational variables (where did you go to school?; how far did you get?; GPA; GRE scores; major course of study and thesis) in favor of measures they believe are more congruent with fitness for their position, namely software proficiency (x years working a, b, and c software at d level) and chic industry micro-certificates for which 2 weeks and $2,000 earns you an acronym to place after your name to feed this new age of credentialism. Now a PhD in Statistics is no match for a high school graduate with a Six Sigma black belt. Now universities are offering new masters degrees tailored specifically to popular or in-demand positions, such that the PhD in Social Psychology who has since amassed 15 years of experience analyzing data ans managing knowledge for hospitals in so match for a 24-year-old newly minted Master of Health Analytics or Master of Knowledge Management or Change Management. We are in the throes of a crisis characterized by the disarticulation of higher education and industry, which means widespread confusion as to the value of a traditional degree and of course that trillion dollars in student loan debt I keep reading about. Over 40% of these loans are in delinquency or default. For all my education and experience, I have been out of work for all but 4 months since 2012. I have been told my PhD is "just another achievement" rather than what it REALLY is -- access to a living knowledge base. I have even been encouraged to leave my PhD off my resume altogether to avoid looking like an over-educated misfired academic. In no sane world -- or healthy economy -- would such views take hold and gain traction. The use of software to screen applicants (Applicant Tracking Software, or ATS) is the whole reason why you are asked to fill in dozens of HTML fields in online application forms even though all that same basic information is included in the Word copy of your resume you uploaded at their request. Employers want you (and the other 300 - 1800 applicants) to spend 2-3 hours filling out these forms so their ATS could reject your application in 2-3 fractions of a second. ATS is the reason why only 27% of applications see human eyes -- and why we have a growing class of long term unemployed despite the 3.9% unemployment rate. Isn't it interesting? I mean, how do we reconcile 3.9% unemployment with the fact each job ad draws on average somewhere between 300 and 1,800 responses? I mean BESIDES the fact people like me who have been unemployed as long as I have no longer get included in the calculation of the unemployment rate. Can you think of another reason -- something else that might account for this? Yes exactly, very good. I knew you knew your stuff ... it's WORKING Americans. When I apply for a job, I am not competing with other unemployed job seekers whose lives, marriages, and families are a month away from financial w-reckoning. I am competing with a legion of people who already have jobs but who are unhappy with the jobs they have. 78% of WIRKING Americans surveyed are open to a new job, while 33% (that's 41 million) are actively engaged in a search for a new job. We're all still grappling with the fallout from the Great Recession. Many people were forced to take jobs beneath their station. In order to keep their jobs, some have had to work the jobs of three people. And most workers have not seen a raise or promotion in years. And then there are those who suffer from chronic dissatisfaction. These are the people who treat their jobs like day traders treat stocks or like philanderers treat wives. They are always looking for a step up and in the process complicate the fortunes of those job seekers who battle the stigma of having been out of work for an extended period. The Internet, which by 2000 matured into a well-known full-service job and employee search platform, placed the unsmployed job seeker at a disadvantage. Despite the fact we heae nothing but good things about the Internet as a employment search tool, the dirty little secret is that the unemployed job seeker no longer has more time than his working counterparts to pound pavement. No one is on foot anymore with a folder full of paper resumes. Working Americans can create online profiles and search agents so they are just a mouse click away from applying -- or so the employer's internal recruiters can find them in an Internet search on skills without ever having to submit an application. I don't know what you would do 3 years into your unemployment. By then your spouse might have quit the marriage or cozied up to former paramours. By then you may have had to move in with your in-laws, who are starting to work the names of your wife's former (and still single) boyfriends into dinner conversations. Relocating further from your wife's employer may have become a source of tension between them. She may resent you for having to liquidate her retirement income, the taxes on which alone are enough to drive you into bankruptcy and put you at odds with the IRS. Your parents begin revisting every decision you ever made in your life, which are all terrible in hindsight. Everything from your choice of major in college to your selection of a first wife. And don't ne surprised if they stray into conversations that begin "you didn't have to have [INSERT NAME OF ONLY OR YOUNGEST CHILD HERE]." If they gift you any money to help you pay your bills, they have the right to question every decision you ever made and they have the right to advise you on everything from how to approach your current job search to how you should conduct your grocery shopping. You will fast discover how much they think they know about everything, including you. Unemployment destroys everything. Resumes. Then reputations. Then resources. And finally relationships. And unemployment has never been this big a problem in the U.S. for as long as it's been problem. Yes, the unemployment rate is down, and yet the Feds are whining about the stubbornly low workforce participation rate and its downstream effects on new home purchases, student loan delinquency, and a host of other econometrics. Naturally they blame it all on opioids. The opioids have altered our mental status to the point we cannot show up for work or work effectively. Or people remain out of work because near-universal pre-employment drug screening has forced them to choose drug use over work. This raises another important point -- the myths and misconceptions concerning the effects of opioids on the user. Yes, I understand that heroin and that painkillers administered in hospitals by IV are designed to knock you out. But your tablets of oxycodone, hydrocodone, and hydromorphone have the opposite effect. They give you the energy, focus, and disposition conducive to productivity and healthy interactions. Their broad spectrum effect on pain is rivaled only by their broad spectrum effect on mood, as there is nothing more effective for depression, anxiety, stress, and even resentment. These oral painkillers only make you drowsy or "drunk" when dosed inapprpriately or with other substances. Don't take my word for it. The Adverse Event Study on hydromorphone (Dilaudid) revealed that 31% of respondents reported drowsiness or change in mental status on this medication. While 31% is significantly lower than half to argue that cops should not be handing out DUI-Ds if it appears in their blood screen, I still found 31% too high to jibe with my first hand knowledge of hydro users. The very next sentence revealed that of the respondents who make up this 31%, 98% either dosed imappropriately or with another substance. What this data confirms for me is that a major stigma is being propped up by myths and misconceptions. What the data does NOT tell me is why the authorities enable, or possibly even embrace, these myths. I tell you what -- let's come back to that.
I am not quite finished making my point about "life in 21st Century America." I need to be clear on this, because I am citing it as one of the major causes of both the modest increase in substance use since 2000 as well as the Government's claim -- and partial creation -- of an "Opioid Crisis."
Low workforce participation, a growing class of permanent unemployed due to widespread or systemic biases among employers, and under-employment (dubbed the "new unemployment") is enough to drive people to use substances to alter their moods. The popularity of opioids speaks volumes about the nature of the pain these people are treating. Opioids not only keep them off the proverbial ledge by filling them with the pleasant feelings for the sake of which most of us do anything in this world -- thus giving them a purpose and reason-for-being -- but it restores a vital sense of control. What the world took from them and continues to deny them in the way of secondary reinforcers (i.e., source of income), they reclaim for themselves by way of access to a primary reinforcer (i.e., a pill that makes them happy). It's a path to reparations, recriminations, and revenge devoid of hostility. In fact, many substance users report a newfound capacity to love their enemies.
And we can use more of that in 21st Century America -- an era defined not only by the disruptive and discriminatory effects of the Software and Internet Revolutions but also by the NASDAQ Crash of 2000; 9/11; The Patriot Act; two trillion dollar wars; the bursting of bubbles in the credit and secondary mortgage markets leading to The Great Recession; corporate malfeasance cases (think Enron) including a major bank (Wells Fargo) that created such a pressure cooker sales culture that its employees were opening new accounts and credit cards without the authorization or even awareness of its customers; $5 dollar a gallon gasoline; scandals involving gross negligence or corruption in 15 different Federal agencies including sex scandals in the Secret Service, SEC, FBI, and DHS and political scandals involving the highest office in HHS, DOJ. and the IRS, and an embezzlement and misappropriation scandal in GSA; two divisive Presidential elections both of which exposed a dangerously polarized electorate and one of which may have been influenced by personal data collected by social media (Facebook) and unwittingly made available to (and gamed by) Russian troll farms and political consultancy outfits like Cambridge Analytica; and last but not least an unprecedented 5 year budget impasse on Capitol Hill that introduced into the popular lexicon such terms as continuing resolution, debt ceiling, fiscal cliff, and sequestration. This century is one in which unprecedented numbers of Americans have reported losing faith in nearly every institution. Congressional approval ratings have hovered around 12% since 2000 which is not much better than corporations, universities, or major religions.
FED NEEDS A COMMON ENEMY TO HEAL PARTISAN DIVIDE AND SCARS OF PR SCANDALS
In short, we are suffering major existential crises in vocation, identity, community, and faith. Unfortunately this is not the kind of Crisis that affects us all the same way or that is even being identified and portrayed in a way that brings us all together against a common enemy, as we did for the Great Depression, Prohibition, and World War II. That is why the Government is trying to pin all these contemporary stressors on opioids. Opioids offer us a common enemy capable of healing not only the scars of partisan warfare but also the scars of personal scandal. Just ask Chris Christie. His friend swallowed a handful of Percocets with a bottle of vodka and that my friends is the cause celebre for which you are being asked -- no, told -- you have to give up your rights to painkillers.
FED NEEDS STAND-IN FOR MARIJUANA
An associate by the name of Justin Theobald informed me that the legalization of marijuana threatened to cut into funding for law enforcement, forcing the Attorney-General-led Government to seek out a new villain. Again, opioids offered a convenient solution.
NO TURNING BACK AFTER MONEY CHANGES HANDS
Needless to say, the official declaration of emergency around opioids released Federal funding for all sorts of business ventures, entrepreneurial schemes, major conferences, and a host of new jobs or job titles. We have reached a point of no return where we can honestly say we are more addicted to the Opioid Crisis than we ever were to opioids. When I drop a comment into Linkedin titled "There Is No Crisis," I am immediately attacked by the same opportunists who have been using Linkedin to hawk their anti-opioid products. One fellow wants CMS or private health insurers to mandate his Pill Locker as a prerequisite for prescription. The device intends to eliminate overdoses by regulating access to the pills so the proper dosing and schedule is assured. Of course he is resistant to my claim that his device exposes a findamental misunderstanding of prescription painkiller use by chronic pain patients, whose doctors authorize discretionary adjustments to dosing and schedules to address severity, frequency, and duration of the pain at hand. Lawmakers could have improved the mortality data -- WITHOUT compromising compassionate care -- if only their laws differentiated between acute injury or illness patients and those suffering from chronic pain. Most State laws limit to 7 day supplies opioids for new patients with acute injuries from which they are expected to recover in less than 3 months. Unfortunately the following two forces bring about a situation in which the letter of the law itself, unread by 99% of us, is superseded by a more violent interpretation of the law that takes on a life of its own:
LOST IN TRANSLATION
1. No one reads the text of the new laws.
2. Journalists who announce and characterize the laws do so within a "headline on a deadline" culture. It's ADHD. It's simplicity. It's sensationalism. It's how can we seize the attention of as many people as possible -- and sell as many units as possible -- to people who only have time or patience for 25 words or less and who need to be entertained throughout.
WELLS FARGO SYNDROME
3. The DEA agents do not care whose prescriptions are suspended as long as they meet their individual sales goals. I say sales goals because these people are in love with their careers and will do anything to keep their jobs or take them to the next level. They're bucking for promotion. So when they pick up that receiver to threaten a prescriber, they do so with slightly more urgency than the telemarketing firm staffer selling encyclopedias over the phone. We're talking Wells Fargo Syndrome here. You remember them, right? Their managers pushed employees to sell an average 8 new products to each customer.
The pressure to keep their job and advance their career was so fierce that they resorted to opening new accounts and carda without the authorization or even the awareness of their customers. The laws do not depict the treatment plans for CHRONIC pain patients as criminal and yet this is where the DEA turns to meet the Government's overly ambitious 30% reduction goals and in the process their own personal career ambitions.
DISCONNECT BETWEEN THOSE WHO MAKE / ARE MADE BY THE POLICY
Needless to say, the Government officials creating, implementing, and enforcing these new regulations never suffered a day in their lives. They are hardy Type A raise-your-hand professionals who rose into their positions by burning more midnight oil than the next guy and by embodying the views and agendas of their employer better than their able or distinguished peers.
DIAGNOSIS: MASS HYSTERIA / COLLECTIVE NEUROSIS
As a social psychologist I am familiar with the trademark characteristics of mass hysteria and other forms of collective behavior. We have seen this mass hysteria play out before in 12-15 years of McCarthyism (50s/60s), the response to the bubonic plague, the Salem Witch trials, accusations of sexual abuse in which assailants were implicated by memories later proved false artifacts of hypnotic regression (90s), and accusations of ritual Satanic abuse in California daycare centers (90s). I am confident the Opioid Crisis will eventually be exposed as such an hysteria, but I am unwilling to wait 10-15 years for the American public to have that collective "what-were-we-thinking" epiphany.
*ABOUT THE AUTHOR*
Matthew Giarmo has a PhD in Social-Personality Psychology from Kansas State University (1997), in fulfillment of which he acquired an expertise as both a producer and consumer of scientific knowledge (i.e., research design and analytics) as well as an expertise in the analysis of institutions, personality systems, and social trends.
Since conferment of his PhD, Dr. Giarmo has performed fixed term contract and consulting work for health & hospital systems and for the U.S. Government, including a Federal interagency (PHEMCE) coordinated by the Department of Health & Human Services.
Dr. Giarmo counts among his friends and family many persons under treatment for chronic pain and disability. He has been accompanying loved ones to medical appointments for 25 years and bore witness to changes in the various cultures in which pain management is embedded.
ADDITIONAL WORKS
Games without Frontiers: How the Fed Used Opioids as Scapegoat & Diversion for the Nation's True Crises, September 4, 2018, LinkedIn
https://www.linkedin.com/pulse/games-without-frontiers-how-fed-used-opioids-nations-giarmo-ph-d-/
Virginia's Recipe for Patient Abandonment: A Tale of the Opioid Crisis, November 1, 2017, LinkedIn
https://www.linkedin.com/pulse/virginias-recipe-patient-abandonment-tale-opioid-giarmo-ph-d-/
Connecticut’s War on Controlled Substances: A Case Study in Mass Hysteria, October 30, 2017, LinkedIn
https://www.linkedin.com/pulse/connecticuts-war-controlled-substances-case-study-giarmo-ph-d-/
Kaiser Permanente and the End of Compassionate Care, October 23, 2017, LinkedIn
https://www.linkedin.com/pulse/kaiser-permanente-end-compassionate-care-matthew-giarmo-ph-d-/
Pain Sufferers Bill of Rights, October 29, 2017, LinkedIn
https://www.linkedin.com/pulse/pain-sufferers-bill-rights-how-beat-back-dea-matthew-giarmo-ph-d-/
MAJOR DATA SOURCES
Opioid overdose crisis. National Institute for Drug Abuse. (8-12% of chronic pain sufferers prescribed painkillers develop a use disorder. 21-29% misuse them. 4-6% of those who develop a use disirder transition to heroin).
Opioid Abuse in Chronic Pain -- Misconceptions and Mitigation Strategies. Volkow, N. & McLellan, T. (2016). New England Journal of Medicine. 374: 1253-1263.
Center for Behavioral Health Statistics and Quality. (CBHSQ Data Review). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States (SAMHSA). August 2013.
Second Annual Report of Prescription and Illicit Drug-Related Risks and Outcomes (Centers for Disease Control). .csv file available for download
Organizer
Matthew Giarmo
Organizer
Reston, VA
