Williamson, West Virginia and the Opioid Crisis (Fake News Alert!)

Headline: 20.8 Million Pain Pills Flood Tiny Town in WV

Let’s talk about Williamson, West Virginia, the little town in Mingo County that has been featured in the news for the past several years as a sort of starting point for the opioid epidemic.
IMG_2123_watermark
Downtown Williamson, WV, named for my grandfather’s side of the family!

According to sources, 20 million (give or take about 1 million) pain pills were sent to Williamson, WV, pop. 2900-3200 (depending on your source) over a 10 year period, and that those numbers are insanely high for such a little town. Sources imply the doctors there must be corrupt pill-pushers, with their pockets deep in Big Pharma, and/or Big Pharma picked on this unsuspecting underdog town for the purposes of corporate greed. 

This story is also meant to imply doctors cannot be trusted to prescribe pain pills appropriately, and therefore need major government oversight. Doctors are meant to be seen as directly responsible (along with Big Pharma) for “passing out pain pills like candy” and getting the population hooked on opioids.

The headline’s numbers look insane (which is the point), but NOT ONE article takes demographics into account. That little town’s elderly population consists of 22% elderly (65+), and 56% adults 18-64. Those working adults overwhelmingly hold/held manual labor jobs, which tend to lead to more serious and long-term, even lifelong injuries.


Break It Down:

  • 20 million pills divided by 10 years = 2 million pills per year.
  • To keep things simple, assume ONLY the elderly 65+ gets pain pills. That’s 22% (elderly pop.) x 3,000 (total pop. of town) = 660 elderly people.

  • 2 million pills per year divided by 660 (est. elderly pop.) = 3030 pills/year/elderly person.
  • 3030 pills per year divided by 365 days per year = roughly 8 pills/day.

  • 1 pill lasts 4-6 hours, so 24 hours/4 hours coverage = 6 pills per day*.

  • Before this opioid crisis started, 4-6 pills/day wasn’t an unusual amount, and patients could even sometimes take (gasp) 2 pills at a time, depending on the dosage and their situation.
And those figures are crunched just based on the elderly population alone. If you figure in other older adults like those in the 50-64 age range, that number of pills per day goes down even further.

There is a heroin epidemic, and there is an economic crisis, but as far as Williamson, WV and little towns like it being “flooded” with unnecessary pain pills, I call FAKE NEWS!
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An Open Letter to Dr. Andrew Kolodny

Update 6/27/18: I am overwhelmed by the positive responses I have received for this letter. I would ask that readers also take a look at all the articles and references cited in this piece, and share those as well. Those references go into much, much more detail and research than I have had space or time for here. Thank you all so much for reading and sharing, I believe we will make a difference and win this fight for our lives! #wearehere

See also: A Rock and a Hard Place, The Truth About the Opioid Crisis, and Strangulation on Medicine

Dear Dr. Kolodny,

I am one of millions of chronic pain patients in the United States who has been continually and increasingly oppressed over the past few years by progressively invasive and prohibitive laws at the state and federal levels concerning the delicate relationship between doctors and patients, particularly when it comes to a certain class of drugs, i.e. opiates.

Ever since my very real, physical condition began about 4 years ago, my family and I have been disoriented again and again by a lack of what might be termed, “help,” from doctors. We have discovered a very confused medical community, corruption, and a growing collection of laws being passed so fast and furiously hardly anyone seems to know just what is going on.

This has resulted in doctors leaving my city, doctors outright refusing to accept chronic pain patients (or, if they do accept these patients, refusing to treat them with medications that suit the patient best) or new patients, and unprecedented referrals to pain management clinics and psychiatrists. I have a detailed post planned addressing the pain management clinics, but the psychiatrist referrals were more baffling to me. My local psychiatrists even refused me as a patient about a year ago because, “we don’t see chronic pain patients.” That made sense to me as I don’t suffer from mental illness, still my providers insisted I must be mistaken.


Down the Rabbit Hole

I began researching you and your career last night out of curiosity. I wanted to answer the question, “Who is this Dr. A. Kolodny, that everyone from journalists to policy makers and bloggers keep quoting as an “expert on opiates”?” And I found out. You, sir, are a psychiatrist and board-certified addiction specialist-turned policy maker (1) and buprenorphine (Suboxone) “evangelist” (2).

Your first private clinic was a Suboxone clinic in New York City, established sometime around 2003-2005, and it appears you (and/or other health officials) felt stymied by the federal limit at the time of just 30 patients for such clinics (put in place to stem corruption), because said health officials have been in the background, quietly working away at this very limit which was amended in 2006 (called DATA), to allow 100* patients after 1 year, and is now up in the House for being overturned altogether, along with expanding legal prescribers to nurses and other non-doctor medical staff. And look what has happened as a result:

Health officials, concerned about restricted access, lobbied alongside Reckitt Benckiser for the patient cap to be raised. “Why should we bind a healer’s hands from helping as many as he or she could?” Senator Hatch said, getting an amendment passed in 2006 that allowed doctors, on request, to go from 30 to 100 patients after a year.

The stage was set for more patients, prescriptions and problems. “It’s when the limit was raised from 30 that doctors started to get commercial about it,” said Dr. Art Van Zee, whose buprenorphine program at a federally funded community health center in rural Virginia is surrounded by for-profit clinics where doctors charge $100 for weekly visits, pulling in, he estimated, about $500,000 a year.

“They are not savvy about addiction medicine, don’t follow patients very closely, don’t do urine testing and overprescribe,” he said. “That’s how buprenorphine became a street drug in our area.” https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)

“In the early days of Suboxone, with Reckitt Benckiser barely marketing its own drug, Dr. Kolodny, then a New York City health official, crisscrossed the city with colleagues to spread the word about the new medication, entice public hospitals to try it with $10,000 rewards and urge doctors to get certified.”

https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)

Since at least 2005, you have been marketing buprenorphine as if you had a personal stake in the drug, to government institutions and agencies including prisons, public hospitals, and rehabilitation facilities (2). In the fall of 2013, you were appointed Chief Medical Officer (5), of the largest chain of non-profit detox/rehab facilities in the USA (cited for questionable practices and abuse from at least 2012-2015) (6) called Phoenix House, which received $131 million in June 2013 (7), championing the use of MAT, or “Medication Assisted Treatment”. I wonder which drug Phoenix House used?


Hang ‘Em High?

salem witch hanging.PNG
An innocent “witch” (woman) is hanged at the Salem Witch Trials, much like other innocent pain patients are persecuted.

Since you often cite the United States vs. Purdue Pharma (2007) settlement in your interviews and writings, perhaps you saw an opportunity to expand the use of buprenorphine by targeting and demeaning chronic pain patients as mere “addicts”.
It was odd to me in researching that incident, in the official “Purdue Guilty Plea” document (8), the very words they were condemned for, claiming OxyContin to be “less addictive” and “less subject to abuse and diversion” (8), appear to be the exact words you use time and again when describing the benefits of buprenorphine (2).

Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit. Suboxone has a second active ingredient in the mix, he explains, an anti-overdose drug called naloxone.

It does nothing if you take bupe as directed. But if you sniff bupe or inject it or otherwise try to pack enough into your bloodstream to get high, the naloxone acts like a chemical booby trap, erasing the effects of any opiate, bupe included, and bringing on sweaty, nauseating withdrawal. “That’s the last time you’ll do it,” Kolodny says dryly. https://www.wired.com/2005/04/bupe/

In 2016, your organization, PROP (Physicians for Responsible Opiot Prescribing), got the ear of the CDC and helped to write the now-infamous, misinformed, and rushed guidelines for prescribing opiates. While these guidelines were fairly general in nature, they have been used as a springboard for countless pieces of state legislation and DEA investigations, which has, in turn, led to the above-mentioned abuse and abandonment of chronic pain patients and doctors, as well as opiate shortages in hospitals and ERs (The DEA, in an attempt to prevent diversion of opiates to the black market, has cut production by an incredible 45% in the past 2 years). I imagine that suits you just fine, since you have publicly stated you believe opiates should be discontinued for all but the dying and post-major surgery “for a few days” (https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/), and that “more treatment” is needed (https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses), i.e. MAT/Suboxone clinics like Phoenix House.

'The National Gesture' 1926
“The National Gesture” 1926

You have hailed local municipalities and states in their further pursuit of legal action against American Big Pharma, the companies who make such things as Vicodin and Percocet, but not Suboxone/buprenorphine (which is also an opiate), which is made by an overseas company, Reckitt Benckiser, or Naloxone (Narcan), which is produced in a nasal spray exclusively by Amphastar Pharmaceuticals (10), a relatively new company founded in California in 1996 (11),  whose stock (and Narcan prices) has been rising quite a bit, lately (12, 13). Are you truly against the use of opioids, or just the ones that help pain?


The Opioid Epidemic!

mccarthyism
McCarthyism Propaganda

Although your policies, based on inaccurate data (14-15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935 (15), and http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop, have been wildly ineffective at stopping heroin/fentanyl overdoses; although you are not a pharmacologist, opiate researcher, pain doctor, pain patient, surgeon, or even general practitioner; although you ran a private clinic for a short time in 2005 (as far as I’ve been able to learn) that dispensed buprenorphine/Suboxone, you have, for the majority of your career as far as I can tell, been a policy-maker and not directly involved with addiction patients or chronic pain patients whom you recently claimed were simply addicts who needed compassion and “treatment” (and, presumably, Suboxone).

“Many Americans are truly convinced that opioids are helping them. They can’t get out of the bed without them.”

“Policy makers were told by industry-funded pain organizations not to penalize pain patients because of drug abusers. We realized that this wasn’t true. We don’t have these two distinct groups, one for pain patients and the other for drug abusers.” https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/ (15a)


If You’re Not For Us, You’re Against Us

sen. joe mccarthy demonstrates the communist threat
Senator Joe McCarthy Demonstrates the Communist Threat in America

You are cited and quoted in an impressive number of articles and interviews as a compassionate person who wants to see people and their families heal from the devastation of addiction, which is why it surprised me to find quotes from you that didn’t seem, well, “nice.”

It is the FDA’s role to vigilantly regulate the approval, labeling, and promotion of  pharmaceutical products, not that of counties or municipalities. County and municipal lawyers are inadequately qualified to make or enforce federal drug policy, and these lawsuits serve as a vehicle for local governments to seek revenue  through ill-informed measures under the guise of drug abuse prevention. In a May 30,2014, interview with   FDA Week, a CLAAD spokesman voiced these positions and expressed concern that these lawsuits are part of “a trend that will distract us from the real meaningful approaches to reducing prescription drug abuse.”

After reading the interview, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing (PROP)and Chief Medical Officer of Phoenix House,  contacted CLAAD via telephone to condemn its comments. During this conversation, Kolodny threatened that the Internal Revenue Service would revoke CLAAD’s tax-exempt status when alerted to the comments, which he believes conflict with CLAAD’s charitable mission.  CLAAD takes these false allegations and threats very seriously, and  responded in a letter which is publicly available for view on our website.

Critics who categorically dispute the motives of organizations like CLAAD and its diverse coalition members are, at best, narrowly focused. Their zealotry reveals their otherwise undisclosed health insurance industry bias.  At worst, they endanger the lives of people who live with pain and other conditions that can require controlled substances by stifling access to quality care. http://paindr.com/claad-and-phoenix-house-square-off/ (16)

Anyone who questions your authority, expertise, policies, or the efficacy of your pet drug, buprenorphine, is loudly dismissed by you as uneducated (17), addicted (15a), or corrupt (15a, 18), regardless of how closely they actually work with addicts and pain patients (17).

But Dr. Kolodny, I have nothing left to lose — your policies and attitudes have directly impacted my health, my freedom, my ability to be a parent, my work, my hobbies, my family, my finances, my friends, and my personhood. I have no problem announcing to the public, as loudly as I can, “The Emperor is not wearing any clothes!”

emporer has no clothes


Citations

(1) http://www.cecentral.com/search/faculty/136145

(2) https://www.wired.com/2005/04/bupe/

(5) https://www.phoenixhouse.org/news-and-views/news-and-events/phoenix-house-appoints-dr-andrew-kolodny-as-chief-medical-officer/

(4) https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html

(6) https://www.reuters.com/investigates/special-report/usa-rehab-phoenixhouse/

(7) http://www.phoenixhouse.org/wp-content/uploads/2014/06/2013-Financial-Report.pdf

(8) https://assets.documentcloud.org/documents/4378824/Purdue-Guilty-Plea-Copy.pdf

(9)

(10) https://www.npr.org/sections/health-shots/2015/09/10/439219409/naloxone-price-soars-key-weapon-against-heroin-overdoses

(11) http://www.amphastar.com/about-us.html

(12) https://www.equities.com/news/naloxone-stocks-who-s-really-winning-the-battle-against-the-opioid-epidemic

(13) https://thinkprogress.org/pharmaceutical-company-with-monopoly-on-lifesaving-treatment-jacks-up-prices-3883e95f88c7/

(14) https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71

https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/

(15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

(15a) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

https://abcnews.go.com/Health/deaths-drug-overdoses-continue-rise-us-blacks-hispanics/story?id=54094943

(16) http://paindr.com/claad-and-phoenix-house-square-off/

(17) https://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html

(18) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses

https://www.cdc.gov/drugoverdose/prescribing/guideline.html


Further Resources

https://www.cdc.gov/drugoverdose/prescribing/guideline.html

https://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink

http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop

http://nationalpainreport.com/cdc-does-not-comply-with-federal-law-8828305.html

https://www.chronicle.com/article/To-Counter-Opioid-Crisis-NIH/240219

https://www.painnewsnetwork.org/stories/2016/8/11/prop-ends-affiliation-with-phoenix-house

https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/introduction

Prager University Review

   Originally written and posted on Quora, Dec. 19, 2017. See link.

Prager University is an up-and-coming and presumably popular website that targets Millennials and touts freedom of thought and speech. The site is confusing a lot of people who think it is a real school (it’s just a website), and folks are beginning to ask questions.

My first run-in with PragerU was a commercial that made my jaw drop, in which a poised young lady announced confidently that she had learned more from working at McDonald’s than the traditional brick-and-mortar university (a real school) she had attended. She further encouraged everyone to follow her path, in order to leave college debt and liberal indoctrination behind…

This ad is on PragerU’s site. “Stop giving to your Alma Mater (and give to us!)”

PragerU was founded by Dennis Prager, a sixty-nine-year-old, ultra-conservative, Jewish radio talk-show host and author/public speaker with an established agenda for converting people to American conservatism. Dennis Prager – Wikipedia

And that pretty much explains PragerU in a nutshell, too. It’s sole purpose is to convert young people to conservatism through short, easily sharable videos. The biggest issue with PragerU is that the videos present opinions (all of which are actually really old arguments that young people in particular-PragerU’s target audience-may not have heard yet) on provocative questions many people have, as if those opinions were facts.


Cite Your Sources

For example, Crowder’s video, “Democratic Socialism is Still Socialism,” (FreeToThink | PragerU) claims that adding the word “democratic” to “democratic socialism” does not change the meaning at all. The phrase is still equal to “socialism.” Which is an illogical and untrue argument. Adding “un” to “untrue” changes the meaning of “true” entirely, adding “baritone” to “saxophone” specifies an entirely different instrument from a “soprano saxophone,” and adding “jerk” to “chicken” connotes a Jamaican recipe, not a mean bird. jerk chicken – Google Search

Later in that same video, Crowder, talking a mile a minute, shoves together several examples of countries that are neither democratic nor socialist to “prove” his point that democratic socialism is bad, then skips quickly over to Denmark and Sweden, using quotes out of context to confuse the issue. This article from CNN does a fairer job of explaining the terms and ideas, I think. Bernie Sanders’ American Dream is in Denmark – CNNPolitics

If/when you watch PragerU’s “Free to Think” videos (I have not seen all the videos, and am aware that some are done by professors), notice that rarely are facts cited or sources given*, and there are never references at the end or clickable links to research more. Many videos are either confidently-presented misinformation (like the Crowder video above) or simply testimonials/anecdotes with relatable scenarios, like this one by Jay Stephens (FreeToThink | PragerU) about college debt, “College Made Me a Conservative”.


Free to Think Like Us

Another issue is the use of certain words like, “Trigger Warning”, “Snowflakes”, “The Left”, etc. in a subtly derogatory and not informational way. There is clear bias in the way these words and many others are used. Take for example the fascinating video, Gun Rights Are Women’s Rights, in which Katie Pavlich asserts that “men being stronger than women is controversial these days,” (is it?) and ends with a snarky, “it’s called, ‘biology.’”

There are other subtle problems too, like the video, The Biggest Issues in the World Today: Why Do People Become Islamic Extremists, which implies in pictures, text, and speech that only Muslims (especially those outside of the USA) can become religious extremists who kill people. And once again, even though the presenter is an adjunct professor at Georgetown U, he only uses his own stories to prove his points, instead of using verifiable evidence outside of his own experiences.


Conspiracy Theories

PragerU videos and PragerU sponsored speakers’ videos, reveal a general theme of victimization, conspiracy, and persecution against conservatives. This narrative allows PragerU fans to reasonably “fight back in self-defense” (just like Jesus didn’t say), and continue to express moral outrage over events that are not as they seem.

Take for example, the several banners on PragerU’s site that claim YouTube has discriminatorily targeted PragerU for Restricted Access on a host of PragerU’s videos, which they outline here:   PragerU has gone so far as to launch a lawsuit, garner signatures for petitions, and (of course) ask for donations to “help free the videos.” But when I visited YouTube via a private browser of which I was not signed in, I was able to access several of the videos (I did not test all 40) PragerU claimed could not be accessed by children “for educational purposes.”

Furthermore, it looks as if PragerU took down several videos in their own list themselves; YouTube’s stated policy regarding Restricted Access includes political videos; and finally, yes, some of the videos are meant to be downright inflammatory (and if you have a problem with it, you’re clearly a liberal snowflake).

Gee, I wonder why this one is deemed offensive by some?

Education or Bust

If you investigate the folks who speak in the videos or write articles (for other conservative organizations with close ties to PragerU), you will find some interesting trends including a surprising lack of credentials among the “Free to Think” videos presenters, many adjunct professors or research analysts from private universities (most with a current strong religious leaning like Georgetown and Duke), and the same few websites featuring the same people again and again like TownHall.com and the Cato Institute.

Matt Walsh is one such person I’ve investigated before, who has run his own controversial opinion blog for years (Militant Christianity and Matt Walsh’s Misinterpretation of the Gospel of Peace). I have never been able to learn if he has a college degree or what he majored in, and citation of facts (or even Biblical concepts) is something consistently lacking in his writing. But he is bombastic and gets attention, so people follow along.

Caroline Kitchens is another writer/speaker who appears to have gone to college at Duke U, but never states that she graduated or in what area. Yet these people are deriding college and higher education when they’ve seemingly never been or completed a degree!

No one can “get educated” from a series of 5-minute videos. Take it from me, a highschool reading tutor: education takes a lot of work, reading, study, and guidance, no matter your field. There are no shortcuts.


Mission: Engage!

To put it bluntly, PragerU is not about education but political and even religious indoctrination. The people behind PragerU want young, relatable-sounding and looking spokespeople who will say what PragerU wants them to say, to convince other young people to follow conservatism. Many other Christian churches and groups seek to “reclaim” the “lost Millennials” who have been leaving ultra-conservative churches in droves in the past few years as well. how to reclaim millennials for god

Ironically, many of the pertinent questions and important issues PragerU addresses were created or aggravated by…(wait for it)…conservatism. I’m a living, breathing example of the damage such ideas can cause:

Bringing Back Child Labor?
The Ideology of Underage Marriages in Conservative Christianity
Loura Lawrence’s answer to What is the most frightening moment you have ever experienced?

We absolutely need to talk about all the different issues and problems plaguing our country. We absolutely need to hear different viewpoints (hint: there are more than just 2 sides). But we also must absolutely have our opinions informed by facts, not just pretty/handsome faces, “nice” people, confident people, slick videos, or fast talkers.

Note:

*I tried to look up the quote and study by David Kopel of Denver U cited in the video, “Gun Rights are Women’s Rights,” but could not find the study. I also learned that he was an adjunct professor at Denver U, that he is a member of the NRA, and a long-time gun rights advocate. Gun Rights Are Women’s Rights

The Truth About the Opioid Crises

I’m resharing this article I wrote 3 years ago. 3 years and things have only gotten worse. The facts need to come out now, more than ever before. People are dying!

See also: An Open Letter to Dr. Kolodny, A Rock and a Hard Place, and Strangulation on Medicine

The Rambling Soapbox

Previously titled, “On Opioids: America’s Drug Addictions and the Wacky Laws that Perpetuate Them.”vintage heroinTwo years ago, a little silver car sat parked outside our home. As the sun was going down an ambulance, police cruiser, and firetruck suddenly arrived to pull an unconscious young woman with a bobbing ponytail out from the driver side of the car. A bottle of heroin had been found next to her. I never saw that young woman again, and the police came to impound her car a few days later.

Last July, I sat in the small chapel at a local funeral home staring at the body of my husband’s cousin. Only 29 years old, living less than a mile from our house, married and a daddy-to-be, and there he lay in an open coffin looking sound asleep. After months of staying clean he had found a dealer in the apartment complex he…

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