OPIOID FACTS: Are we getting the whole picture? “A Physician’s Perspective”

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OPIOID FACTS: Are we getting the whole picture? “A Physician’s Perspective”

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OPIOID FACTS: Are we getting the whole picture? “A Physician’s Perspective”

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https://medium.com/@ThomasKlineMD/opioi ... cc7e3b0d2e

By Thomas F. Kline MD, for JATH Educational Consortium, LLC, Raleigh NC.

Edited by Leslie Bythewood and Kyle Lorentzen

September 5th, 2018

Editor’s note: The words heroin, opioids, opiates, and narcotics are synonymous with the functional name: Pain Medicines

Is there an epidemic of opioid overdose deaths ?

Not really. The actual increase from 2014 to 2015 was in line with years past, a 0.001% increase. These are street overdose deaths in addiction communities, not in the general public. No particular year was statistically higher than another.

Is addiction rare?

Yes, the rate for the last 100 years has been steady at 0.5% (today CDC reports 1 million heroin addicted/320 million US population = 0.5%).

Why are addiction rates staying the same with so many prescriptions we hear about?

Opiate addiction (not addiction to marijuana, cocaine or amphetamines) needs two things to trigger it: an opioid and the genes for addiction. No genes, no addiction.

Can a person become addicted by taking too much pain medicine or for taking it for a long time?

No, FDA scientists ruled both these fears as being unfounded. Google FDA 2011-P-0818 to see the report. Once on the pain medicine, without becoming addicted immediately, you have virtually no chance of addiction from then on. No cases have been reported of addiction occurring in patients already taking opiate pain medicine. In spite of this; Missouri had threatened to revoke medical licenses if doctors prescribed for more than 90 days (eventually rescinded).

Does the CDC recommend tapering?

No, but they suggest it. The word “taper” appears 42 times, unusual for a document purported to be a medication guideline. As a result of not saying it was bad, nearly 70% of 10 million long-term pain patients have been tapered, against their will. Since 90% actually needed long-term treatment to hold their lives together, the carnage is without belief. If it is working, the medicine should not be tapered, says the CDC, finally, after three years of the worst medical disaster in U.S. history.

Are there really two million with Opioid Use Disorder (OUD)?

A National Survey was done, people were paid $30 and asked if they “ever used their prescription in any way other than what the doctor put on the bottle.” If they said yes, they were diagnosed with Opioid Use Disorder (OUD). OUD is not a valid medical diagnosis in this way. There is an American Psychiatric Association definition that involves far more than this attempt by the U. S. Government to create a new diagnosis. The Substance Abuse and Mental Health Services Administration (SAMHSA) is in error and in violation of federal law 42 USC 1395 by interfering in the practice of medicine. Everybody knows what addiction is. There have been about one million “addicts” or people with heroin-type or type 2 addiction disease over the past several years. It has not been reported or proven that opiate addiction is increasing. The President believes it is true and has ordered new prosecutors to be hired to hunt down doctors. The effect is, more doctors are not prescribing pain medications There is no data to support more opiate addiction is occurring.

Why aren’t there more addicts?

The percentage of type 2 addicts has remained the same since the 1920’s. If you have the genes for type 2 addiction, you will experience unusually intense positive reaction to all opiates, about 0.5% or 1 in 250 people. On the other hand, 99.5% of the population that does not have the gene will not get “high” with a positive reaction and instead will feel drowsy, this is considered to be type 1 “addiction”. This vast majority of the population will never experience opiate addiction. They might experience addiction to cocaine, alcohol or stimulants, but the addiction is different, less hard-wired in the brain (see JATH paper in Medium: “ABC’s of Addiction”). Opiate or Type 2 addiction rates in the United States in 1920, 1950, 1970, and 2016 and currently in Canada, the UK, and Portugal are all coming in at less than 1% and at nearly the exact same prevalence rate of 0.3 to 0.6%. Scientifically, this can only mean one thing — the disease is genetically determined.

Are doctor prescriptions for pain medicine drugs causing more overdose deaths?

No. In the CDC reports of 40,000 deaths, only 500 deaths are occurring across the United States in physician-managed opiate prescription patients. The other 39,500 reported by CDC, terrifying the nation into thinking these are occurring in their neighborhoods, are actually those without medical care, without access to pharmacies, the nation’s heroin addicts, not everyday people under a doctor’s care. This is dishonest data abuse disorder by the CDC.

If, in fact, doctors do not write “too many” prescriptions, those deaths can be reduced, if not eliminated,is total flimflam. Doctors prescribe “more” because the United States is the only country with a federal police force telling doctors how to write “controlled substance” prescriptions. The DEA does not allow doctors to write for refills, so they have to write individual prescriptions each month.

In Canada and other countries, one prescription is written, say, for six months worth of medicine. We are forced by the DEA to write six separate prescriptions. So, is it the numbers, so actual prescriptions are reported? Yes. Is it the quantity of medicine? No. More dubious data from the federal government blames physicians.

Are too many opioid prescriptions written?

More than what? There is no standard. This claim is frightening to people thinking hordes of “dope fiends” soon will be hitting the streets, spreading crime and debauchery with each additional prescription written. This is not true. It does not matter how many prescriptions there are. Addicts rarely go to pharmacies. The street opiates, cocaine stimulants, etc. are purloined.

So, if we do write a lot of opiate prescriptions, what will happen?

Nothing much, since the amount of opiates floating around will not change the opiate addiction rates. More prescriptions will not cause overdose deaths either. We know that 99.5% of the CDC “overdose deaths” occurring on streets are due to non-prescribed, prescription drugs and heroin. So what we do as physicians will never have an impact on the street overdose death rate. This is an important point, as it is used to frighten Americans into the CDC philosophy that pain medicines don’t work and kill instead — not true.

The number of overdose deaths is surprisingly small, actually. If you hand out bags of “opioids” (the new scary word for opiate pain medicine) at the supermarket, only 1–2 per 1,000 shoppers would have the magic carpet ride and become addicted. It has always been that way. Only a few have the addiction genes, and by age 20, most are already opiate addicted, leaving only 1/1000 susceptible to opiate addiction. The other 999 will never addict, not ever.

Doctors prescribe too much opiate medicine per patient? Shouldn’t the number of prescriptions be limited?

No. Opiates nor insulin have no upper limit mg dosages due to the safety of the drug with respect to direct toxicity. The FDA has not established upper limits for either drug. Both can be safely taken, slowly increased to the endpoint: for relief of pain with opiates, or blood sugar in the case of insulin. IF we do not believe the patients’ reports of pain, then we have a serious problem in the practice of medicine. We believe people when they say they have chest pain and sweating; why not believe them when they say “my pain from my interstitial cystitis is worse.” The concern is, higher doses cause more “overdose deaths” and “addiction”. The FDA has already ruled that this is not true (FDA 2012-P-0818).

Haven’t there have been reports of increased falls in older patients on pain medicine?

No, the reports were false after having been reviewed by the FDA scientists (supra). Many older patients are now in nursing homes, because they could not function without pain medicine due to arthritis pain and stiffness; these patients could not get to the bathroom fast enough with stiff joints, so they became incontinent. Incontinence is the Number One reason for nursing home placements.

Doesn’t cutting back on the availability of opioid pain medicine reduce the chance of addiction ?

No, addicted people will find a source. When the government cuts back on supply, as they are doing now (2017–2018), addicted people go to the streets. If you had no prescription pain medicines in the country, you would still have heroin-addicted people finding it somewhere. You cannot beat the black market by reducing legal supply, as this is what creates black markets in the first place. There has been a nasty criminal empire making huge profits selling heroin, which was made illegal in 1924 in the United States. Type 2 addiction is an intense-seeking disease without regard to consequences and will always win out over “abstinence” treatments.

We see pictures all the time of DEA drug busts. Should we have more agents?

Doing so probably would not help. DEA has only been able to seize about 5% of illegal drugs, as it is. The cartel business plans usually win out.

Opiates given longer than 90 days don’t work and can cause more pain, addiction and overdose.

Not true. FDA reviewed these arguments and found all three false in 2013 (FDA 2012-P-0818). These scary assumptions are made up by lunatic fringe groups ***, such as the “Physicians for Responsible (reduction) of Opioid Prescriptions,” commonly known as “PROP,” a group with the goal to stop the use of opiate pain medicines as both ineffective and dangerous, are not true.

***in the words of an ex-FDA senior official.

Pain medicine prescriptions for broken legs and car wrecks should only be given for three days, the CDC says.

Not correct. It would seem that CDC doctors are not seeing many patients. First, the “pick-the-number-out-of-the-air” technique is not valid. There is no support for a three-day prescription, just opinions of CDC and PROP consultants, who have been accused of severe anti-pain and anti-pain medicine biases. Since opiate addiction occurs on the first one or two tablets, such a limitation would not work.

Second, this is an attempt by an agency not tasked with making opiate recommendations to interfere with the practice of medicine (illegal under 42 USC 1395 for all those covered by CMS). Physicians practicing in the real world know that all patients are different. CDC assumes all patients are the same; no study has proven this. This manifesto of pain nihilism causes immense harm and suffering by limiting the dose and by removing the physician or healer from the equation. Suicides, lost jobs, and wrecked relationships are the direct result of the CDC and PROP’s attempts to reduce heroin overdose deaths, which is the wrong solution and will save no lives from overdose. However, the collateral damage has been unrecorded, although required by the CDC Scientific Board. The numbers are too heinous to even imagine — some estimates of 5–7 million lives ruined.

Is it true opiate pain medication does not work for long-term painful disease?

Not true. This is a rumor spread by anti-opioid activists that even worked its way into the CDC Guidelines, which, by restating already disproven (FDA) opiophobic tenets, did not improve the idea’s lack of validity. There is no proof, and I have looked exhaustively.

The CDC recommends limiting the pain medicine dosage.

This was set at 90 mg MED (morphine equivalent dose) to ostensibly prevent addictions and overdose deaths, but is completely arbitrary. Problems can occur at lower doses as well, according to FDA scientists (FDA 2012-P-0818). Only the FDA can change the rules about prescription drugs, not the communicable disease experts at the CDC. The references in the CDC “Guideline” are, by self-confession, of “low” scientific quality and framed by “contextual evidence review,” a newly created medical word for “opinion.” The key is, whose opinion? This was of concern to the U.S. Congress and the Washington Legal Foundation, but never resolved, as the “Guideline” was rushed into law for the VA in December, 2015, then rushed into general publication three months later, March 15, 2016. Thomas Frieden, the director of the CDC at the time agreed to allow publication of potentially unsupportable recommendations, all with “low” scientific quality ratings. There is no category below “low” scientific evidence.

Does it really matter if patients take fewer opioids? Isn’t that better for them?

No, not if you are in pain from surgery, in pain from a broken leg in the ER, or in pain from 30 or so incurable diseases, with pain as a significant component. There are no harms from taking pain medicines. You will not become addicted, unless you already are, and you will not die (only heroin users die from “overdose deaths”). Many of your friends might be taking opiates without noticeable effect, working, safely driving, being caregivers, and being parents and spouses. Mother nature could have not provided a more useful nontoxic solution for pain. Opiates are safer than ibuprofen or Tylenol. “Safe prescribing” implies opiates have not been safely prescribed by feckless doctors, a fact yet to be proven by the opiophobics. “Safe” is a euphemism for “prescribing more than we opiophobes believe causes addiction — an erroneous and dangerous belief.

How much money have we spent reducing supply?

According to the CRS (Congressional Research Service), we have spent about $600 billion on supply reduction. This is a lot of money. The CRS did not address whether it has worked, but we have the same number of addicted people as always, and it seems we have the “worst epidemic in history” on our hands. This is taxpayer money essentially thrown away.

It has been said that most addiction starts in the teenage years.

Yes, 90%, actually. This is when people who have never had opiates are first exposed. Addiction will occur in 4/1000 teens at first exposure. Where are the programs to identify this 90% and to provide early intervention? In 1950, the infamous Henry Anslinger, head of the Federal Narcotics Bureau, disagreed with drug education, saying “it will just make them want more.” Anslinger’s 32 years at the helm of the greatest drug propaganda machine the country has ever seen is responsible for the widespread FOA Phobia* in many citizens and policy makers in the United States today.

(* Fear of Addiction or FOA phobia)

Are teenagers addicted because of the problems many teenagers have?

No. Addiction type 2 is more happenstance, more related to genetic brain chemistry. Selecting an opiate, along with other “drugs” at a party will have an unexpected effect on the 1% with the type 2 addiction gene abnormality producing a “magic carpet ride,” but not so in the other 99% of the population without the gene abnormality who will only experience relaxation and calm but not “going to the moon,” as one addict told me. We must be more forthcoming with teenagers about quickly reporting “magic carpet rides” from first opiate and/or alcohol, not by saying “Don’t do it”, the failed educational principle since 1950, similar to the failed “Don’t have sex” educational principle.

But won’t people on high dose pain medicine get “high” and become addicted?

No. There has never been a case of a person addicting while on long-term or high-dose pain medicine regimens. No reports of getting high after being on a stable dose have been recorded in any study found. This is due to the lack of brain receptor changes in genetic addition type 2 disease. Only with the genetic mu receptor disease will you get high from opiates — 1%.Type 2 Addiction people have an unusual and extreme positive reaction to opiates, but no one else. This is an important misunderstanding of the two types of addiction. In type 1 addiction, the use of marijuana, cocaine or amphetamines will produce “highs” in most all people, but not in 99% taking opiates.

Do Physicians agree with the CDC guidelines?

No study has been done. Doctors are more driven to follow the CDC guidelines out of fear of reprisal by federal police taking their practices away from them than out of a sense of ethical responsibilities to treat pain and suffering. The word “guidelines” for doctors means something quite different. It means “law,” do it or pay the consequences. Presumably the guideline writers at the CDC were aware of this subtle, but important, connotation. Informal independent surveys show more than 50% of doctors have quit prescribing pain medicine over the last two years. No government agency is collecting this data. This is the first time in centuries that anyone has disbelieved opiate pain medicine works. Opiates still work for 90%+ of patients, according to recent polls and without side effects, or addiction. The prevailing FOA phobia tenet is no one benefits and anybody can addict — a wildly inaccurate belief without merit, justification or factual support. “Run chicken little, the sky is falling in” science.

Most people with long-term pain are just “making it up” to get drugs, to score.

No, 10 million people with 30 or more diseases requiring daily suppression of the pain component are not making it up, nor are they trying to score since none have addiction.

Prescription opioid deaths are increasing at an alarming rate .

False. They have been the same for six years. Heroin deaths have been increasing, an important difference that’s conveniently “forgotten” in many reports. Google {NIH overdose deaths September 2017}, and see the graphs for yourself. Prescription opiate deaths are not increasing, just more FOA thinking and actions.

There does seem to be skyrocketing data abuse disorder (DAD) going on at PROP/CDC. NIH data is solid data and from the mother ship for us doctors.

“Overdose deaths” are the highest they have ever been .

Yes. They have been going up every year since 1970, not 1999, as frequently reported, so, naturally, they are the highest ever. Just like how I am the oldest I have ever been or the United States population is the highest it has ever been.

For patients: are “opioids” really safe for me to take?

Yes, unless you are the rare person with unknown addiction waiting to be triggered with one or two Vicodin or Percocet tablets producing the “magic carpet ride” in 1 in 250, but only in people who have never had an opiate. If this side effect occurs, get thee hence back to the doctor. If it occurs, with any rare side effect, you and your practitioner will just deal with it, just like terrible Stevens-Johnson reaction to other drugs or infections from Humira, or anaphylactic reaction from penicillin. Inform and patient decides, do not “be quiet, I will decide.”

Do people who go to pain clinics need to be monitored closed?

No, monitoring is good for addicted people. There are 20 times more people with painful disease who are not addicted than opiate (Type 2) addicted people. It is rare for an opiate-addicted person to have pain as well. Painful disease patients will not addict, or they would have already gotten addicted after their first or second opiate tablet. Therefore tapering people already on the medication is a fool’s errand. No addictions, no overdose deaths will be prevented and worse yet, the process is harming a large percentage of the ten million who have been identified by NIH as needing long-term opiate treatment. The process of pain medicine discontinuation allows pain to re-emerge in those with legitimate painful diseases, ending in loss-of-life function and even suicide (Google: Medium Suicides Kline).

There is no evidence that people with painful disease will sell their drugs since they would have no pain control. If hustlers do, this is a police matter. Running drug screens wastes money, humiliates patients, and does nothing except to red flag people. Once “flagged,” they will never receive a single pain pill after surgery, in the ER, or for their painful disease states — forever. Profiling is unconstitutional.

There are 55,000 to 60,000 overdose deaths last year.

True but false. The key adjective missing is heroin overdose deaths, as only 500 or the 60,000 die each year from opiates prescribed and monitored by doctors in the general population, and those may well be deaths from other conditions. The misleading CDC numbers are for ALL overdoses, including antifreeze, cough syrup, speed, cocaine, antidepressants, etc. About 35,000 heroin addicts die each year from not knowing the dosages of the illegal drug they obtained. Only a rare person in the general population dies, but with newspaper coverage it would appear common. Ninety five percent of overdose deaths are “street” overdose deaths, a fact not made clear by PROP/CDC.

Is the PDMP or Prescription Drug Monitoring Program stopping addiction and overdose deaths?

No. The Appriss company that sells profiling and surveillance software to states for one million dollars is not catching very many “doctor shoppers,” the new criminals for the FOA (Fear of Addiction) phobia sweeping the country. Sadly, 60% of “doctor shoppers” are pain patients not being given enough to control their painful diseases, not hustlers. Pharmacists and doctors and practitioners have been involuntarily deputized by the federal drug police as “front line” resources in the “fight” against drugs. This is law enforcement falling outside the scope of the practice of medicine.

Brandeis University named after Justice Louis Brandeis, a giant in cases involving privacy, has taken money from the DoJ/DEA to develop dragnet computers and to send out “unsolicited” reports to provide surveillance on every American patient and doctor or practitioner who receives or writes a prescription for a “controlled substance” (anything that makes you “high”). The federal police are in charge of this, of prescription rules, and of the ability to look into all medical records of those taking opiates. This is thanks to Richard Nixon and his “Controlled Substance Act” of 1970, a political “We got you for drugs” scheme to deal with his political enemies, confirmed in 1994 by John Erhlichman. The DEA was created in 1973 to enforce that specific act. In essence, it was a political police force, at least in the beginning.

Alternative pain control methods are effective.

Yes, but the studies the CDC conducted did not compare them with pain medicine. Tai Chi may be effective versus nothing for joint pain, but pain medicine works better than Tai Chi, facts not discussed in the CDC “Guideline.” In fact, as doctors, we do use alternative methods in conjunction with the primary treatment, not as the primary treatment itself.

It is a sign of addiction when a person asks for specific medication or specific doses in the office or ER.

No. Opiates are very individual. Some work for some, others don’t. People know what works for them, whether an antibiotic, antidepressant or other medicines, and they know the doses that work. Doctors believe you when reporting chest pain, but think you are a liar saying you were awake all night with pain from your CRPS (a systemic pain syndrome). This is a terrible thing, basically saying anyone who knows the effects of their medicines on their bodies is a dope fiend.

It is illegal for doctors to treat the disease of addiction without government permission .

Yes.

Stronger opioid pain medicine can addict more easily.

N o, the FDA (2012-P-0818 ) also found this to be incorrect in their scientific review in 2013. Later, this invalidated premise found its way into the CDC Guidelines of 2016. The FDA is in charge, not the CDC. Stronger is a relative term. You can always take more of a low-power opiate, only then is it “stronger.” It is a silly distinction. It is easier to take one methadone tablet for pain rather than three or four oxycodone tablets, but the opiate power is the same. “Strong or more powerful opiates is an oxymoron, because they are made equivalent by the MME (morphine milligram equivalent) system.

Stronger opioids should be taken off the market because they addict more easily

Not true. Limiting the physician’s choice to individualize pain treatment is unwise and restrictive for no valid reason. It is illegal federal interference in the practice of medicine (section 1801 42 USC 1395) and disruptive to patient care. If a study would be conducted to show this is true, then things would be different. None so far. Fentanyl patches can provide relief for three days, they beat taking oxycodone tablets every four hours. People are very different. Limiting doctors’ choices makes it harder to find the medicine that works since over-the-counter medicines are less effective for controlling pain.

Addiction to opiates can be stopped by stopping the opiate supply.

False. An opiate addiction can be triggered by alcohol as well. Some forms of alcoholism are related to the mu receptor disease addiction, much like heroin addiction. We would need to remove all alcohol, along with all opiates, if we want to “stop the epidemic.” That has been tried and did not work in the 1920s. Supply restriction invariably leads to more deaths, street drugs become harder to find, prices go up, quality drops, and more drugs are added to the mix to make up for shortages. Multi-drug use is the most common cause of street deaths. The main reason supply reduction, which has cost the taxpayers 600 billion dollars, according to the CRS, doesn’t work is because opiate addiction, of the addiction group, is genetic and is triggered by the first couple of tablets of any opiate. The gene A118G is abnormal and is present in only 0.5% of the population, making substance control a waste of time for opiate type 2 addiction.

Anyone can become addicted if they take strong opioids for long enough.

Not true. This important underpinning for the CDC/PROP thrust to reduce the medical use of opioids was also found false by the FDA science review {2012-P-0818}. Returning GI’s from Vietnam “addicted” to pure, high-dose heroin with a prediction of 100% addiction all had withdrawals indicating possible addiction, but only 2–3% actually addicted after two years of follow-up. The researchers believed many of the 2–3% were addicted prior to service, pushing the number closer to the less than 1% standard. The Hill Tribes in the Golden Triangle (the area where Laos, Thailand and Myanmar meet) who grow the opium plants and who have unfettered exposure have an addiction rate of 0.5%, the same as we do in the United States.

Do opiate addicted individuals frequently have family history of addiction, either opiates or alcohol?

Yes, frequently, but not always. And opiate addiction can occur without a family history.

Are heroin addicts dangerous?

No. Heroin addicts are not “hyped up” on stimulants and do not have personality changes like alcohol, cocaine and amphetamine users do. They are sleepy most of the time. Yes, minor crimes are committed to raise money for the drugs, but almost never violent crimes unless the addict is also on alcohol or other personality-changing drugs.

(The ‘dope fiends” from the movie “Reefer Madness” and governmental moralist campaigns of the Henry Anslinger era were not heroin people, more cocaine and marijuana.)

Addictions are skyrocketing in rural areas.

It seems to be, but no good epidemiological study (medical detectives) has been done yet. Maybe when the pill mills shut down in Florida, the out-of-state cars carrying huge quantities of powerful opiates back home to rural areas in WV, NC, and KY may have been holding the addiction population in check with pills, which is possible. Then the pill supply dried up. Addicts will find heroin in short supply next, after pills dry up — according to addicted people I have spoken with. There are hundreds of rural counties in the United States. So far, I have only heard about a small number. One study showed a large number of counties with the most prescriptions had the fewest deaths.

Most “addicts” are people who make the wrong choices.

Yes and no. For what we are calling Addiction type 1, the form of addiction that has no biochemical withdrawal, choice is involved. People search out MJ, cocaine, and amphetamines. But the serious, “intense-seeking” opiate addiction, or Type 2, does not involve “bad choices,” but involves a triggered biochemical brain abnormality creating the typical “junkie.” Opiate addiction is a treatable disease with MAT (medication assisted treatment). Type 2 addiction does not respond to talk or cognitive therapy. It is the type 2 genetic alteration of opioid brain receptors that is the problem; otherwise, they are normal people from normal families. The addiction is less about choice and more about chance, triggering the very real brain receptor disease, triggered not created.

Haven’t American doctors always prescribed too much pain medicine compared the many other countries?

Essentially, no. American doctors are known to be opiate shy and undertreat. This was addressed in the late 1990’s with an AMA re-education plan to treat pain more humanely. More prescriptions were written, care improved, but then the opiophobes, with FOA (fear of addiction) phobia, turned the clinically appropriate increases around, and without critical thinking or scientific support, deemed prescription pads “the cause of the epidemic.” Because of regulations established by the DEA, and enabled by the “Controlled Substance Act” of 1970, prescriptions can not be refilled, leading to increased prescriptions. The true cause was removal of diamorphine (heroin) from the country in 1924, a mistake we are still living with. For nearly 100 years, the policy of substance control has never worked.

During the Vietnam War, huge numbers of soldiers used pure heroin in 160 mg bags (too much medicine). No reports of large numbers of soldiers dying from heroin overdose have been found in U.S. Army records. The milligram amounts were known. On the streets of America, milligram amounts are unknown, which is the real cause of (street) overdose deaths.

Why do we prescribe more opiates than other countries?

Although we write more prescriptions, we do not necessarily write for more opiate pain medicine. No other country has a federal drug police that regulates their prescription pads. The DEA will not allow refills to be written on our prescriptions. In Canada, they write one prescription with five refills. In the United States, we write five prescriptions, one per month. Looks like we write more, but we don’t really. It’s an illusion that’s used by the anti-opioid movement.

Is it true that a lot of prescriptions lead to addiction and death?

No. The number of prescriptions in the United States has been dropping each year since 2010. We doctors sadly reversed the course of prescribing adequate amounts begun by AMA initiative in 1990’s and the 2000’s. Deaths have been increasing since 2010, leaving the reverse conclusion that reducing prescriptions actually causes more deaths if we use the same line of false logic of causal association (large shoe size correlates with height, so large feet cause tallness). The CDC’s well-trained scientists know better than this, in fact so does the average high school science student. Post hoc, ergo propter hoc, it is called in those honoring the principles of science.

Portugal legalized all drugs, isn’t this just an invitation for more addicts?

You would think so, but the addiction rate dropped in half.

Can addiction can be prevented?

Not in addiction Type 2, the opiate or heroin type addiction. Perhaps in the Addiction type 1 or the choice type addiction, but still hard to accomplish. People who feel bad, people who want a thrill, people who want to be accepted into drug- taking social groups will find substances. Oddly, if they stumble across opiates, like oxycodone or Vicodin, unless they have the A118G gene abnormality, they will not get “high” or addict. The brain in type 2 opiate addiction is hard wired to be triggered by opiates. The only way to prevent the development of the disastrous “Junkie” is to never have an opiate. This is the thrust of the opiophobic leaders. Too bad this is virtually impossible.

Do teenagers get addicted more than others?

Yes! Less than 1% of the population has the gene for type 2 opiate addiction just waiting to be triggered. The disaster of street addiction and death from overdose can be prevented by increased awareness that 4–5 high schoolers per 1000 students will become addicted, but only in those possessing the A118G gene abnormality (a blood test is on the horizon). Ninety percent of type 2 addiction occurs in teenage years. Why has this not been the thrust of the war on drugs? Why is there no talk of teens in all the polemics we read each day? Reviewing articles in the 1950s in the New York Times, most all the concern about addiction was about teenagers with addiction. As well as it should be, since, as said, 90% of addiction occurs in this age group, not because of some brain difference in teenagers,but because it is the first exposure that triggers the heroin type 2 opiate addiction. Early detection can prevent virtually all the subsequent “overdose deaths” (“heroin overdose deaths” cited by the CDC). Why are we not doing this? Seems a lot of talk, no action in the early intervention arena. Widespread education is needed, and fast. In my community, teenagers are dying needlessly due to refusal to provide “first exposure” education instead of chanting “Don’t take drugs”.

Would more policing help?

Not according to police chiefs and federal police officers I have spoken with. Those law enforcement people know this is a medical problem and needs medical attention, not arrests.

Cancer pain is worse than chronic non-cancer pain, so shouldn’t only those with cancer be allowed full treatment?

Not true. No study has shown this to be valid. FDA study above (2012-P-0818) found this to be baseless. Pain is pain. Discriminating against people with the same duration and intensity of pain is cruel, and it is illegal for protected class disabled people.

What can we do about the horrors of addiction?

Addiction and the much larger group of the newly suffering “opioid refugees” are both medical diseases. The one million truly addicted persons (not the two million quoted) need medical treatment and always have. The “criminal model” has not worked since 1915, when it was started by the federal drug police. It will continue to fail, as it did during the Eisenhower, Reagan, Bush, Obama, and Trump administrations. “Wars on drugs” have never reduced deaths, never reduced addiction, never reduced crime, but nonetheless have spent one trillion dollars of wasted taxpayer money since 1915. The solution is very simple: understand the medical nature of the two addiction types, warn people that “going to the moon” is not normal after taking your first opiate pain medicine, and when it happens go to your doctor (after they are taught what to do) and manage your addiction, so you can have a normal life and not die in the streets trying to find your MAT.*

Thomas F, Kline, M.D.,Ph.D
Chronic Disease Specialist
Raleigh, North Carolina
Email: thomasklinemd@gmail.com
web page: thomasklinemd.com

*MAT is Medication Assisted Treatment. People with type 2 opiate addiction have a real disease. It is genetically controlled and happens immediately on exposure to triggers, as in other diseases such as G6PD, porphyria, and PKU. Many don’t want to treat “dope addicts” with more dope, but too bad, these are the medical facts and it works, and has always worked. The “dope treatment” is by doctors in controlled amounts. Obstructing substitution treatment that has worked well in more enlightened countries stops people from suffocating in the streets and does wonders for crime reduction, and is obstructive to the medical goals of treatment for this terrible disease.

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