There is a crisis-level lack of it in modern American culture. Perhaps the biggest problem is all those who view themselves as mini-saviors or white knights, tripping over themselves to be responsible for others. That is an unhealthy mental/behavioral/relationship condition called, “codependency,” in which one party maintains a narcissistic attitude about the relationship and the world, and the other party smooths every facet of life over for their partner.
A “smoother” (enabler) can be a friend, teacher, doctor, preacher/priest, counselor/psychiatrist/psychologist, a spouse/significant other, parent, adult child, or any other professional or family member. The “smoother” will lie to others to make things seem much more normal than they really are. The “smoother” will make all kinds of excuses to cover over the narcissists’ bad behaviors. The “smoother” will sacrifice all of themselves-friendships, career, family members, interests, body, time, money, and self-respect to make sure the narcissist has it easy.
What the “smoother” gets out of this relationship, is a rush of endorphins; a feeling that they’ve protected, helped, given their all, done something truly great in the world. Everyone craves such feelings, but “smoothers” enable bad behavior so they can continue to feel good about themselves. They are really crippling the narcissist, reducing them to an eternal infant status, instead of helping the narcissist stand on their own two feet, discover their wings, and fly.
The narcissist of course, is waited on hand and foot like a king. The “smoother”/enabler acts as an attack dog to defend the narcissist’s “honor,” to keep them from being hurt, or feeling the slightest pangs from life. But like the stereotypical, spoiled king, narcissists know they could never survive without their “smoother”/enabler. Deep down, they are scared, lonely, bored little children. Both parties are addicted to one another, craving mutual attention and praise. In essence, a codependent relationship is like a cult of one. In order to have healthier people and relationships in America, “smoothers” need to step back, and narcissists need to stand up.
People ask online all the time, “I’m looking for book recommendations featuring a protagonist that- (fill in the blank) is homosexual, is a man, is a strong female, is a minority, is asexual, is a redhead, is a single parent, etc. etc.” It’s even better when readers ask for these roles in their favorite genre.
It isn’t a problem to have strong protagonist characters of a specific type featured in a novel or story or song, but it is a problem to only read books with those kinds of characters; characters who look strikingly like us. And the problem is that we indulge in a kind of literary segregation, only and ever choosing our favorites and leaving the rest-a very wide swath of literature, indeed-to collect dust on the shelves.
The entire point of reading is to explore new people and places and situations we have never encountered and possibly never will. When done right, reading broadens our expanse of understanding and sympathy, it deepens our humanity and imagination, and it takes us to new places. Reading is ultimately about thinking and learning, although reading can be great fun in the process as well. But if all we ever do is read about ourselves or our fantasy-selves, then we, by necessity exclude the rest, resulting in our own echo chamber and perpetuating the very real societal ills of racism, homophobia, and general lack of community we are currently dealing with in American culture. Be diverse in your reading, and encourage your children to be diverse.
Read about protagonists that are mentally or physically disabled; that are your opposite gender; that are a different skin color than you; a different religion; a different culture; a different language (or more challenging/antique one); a different time; who love the things you hate; who hate the things you love. Stretch your mind, and find that it is so much less what we or others look like, than our underlying humanity that connects us.
One of the goals of the film is to blur the lines between legally prescribed medications, illegally obtained/used prescription medication, and heroin, along with abuse of medication and appropriate (responsible) use of medication. Dr. Kolodny wants all opioids (except his favorite, bupenorphine) eradicated, unless a person is actually dying or for immediate post-surgical pain.
Once again, however, the evidence and science do not line up with the film’s or Dr. Kolodny’s claims. For example, this landmark medical study, one of the largest to date concerning opioids by Porter and Jick from 1980, concerning narcotic addiction specifically, reviewed nearly 40,000 hospitalized medical patients. Although nearly 12,000 of those patients “received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients had no history of addiction.” (my emphasis added)
In the film, this screenshot is shown, and the study dismissed out of hand as a “mere paragraph”, a “letter to the editor”, in the New England Journal of Medicine, asserting, “few bothered to check out the source of the study,” implying the NEJM is untrustworthy, even though less than 2 minutes later, the same Journal is cited for a different study the filmmakers do approve of. Going back to Porter and Jick’s study above, although one can clearly see the footnotes in the text, the screenshot makes the full study’s citation unable to be read at the bottom, and then the video pans in, effectively erasing that citation altogether. At the same time, the narrator tells viewers the doctors/research did not draw conclusions about addiction, when a quick scan of this “mere paragraph” shows they obviously did.
Oddly, the only other study or source cited in the entire film was another New England Journal of Medicine study (citation not given in film). The narrator allegedly quotes from this unnamed study saying, “76% of those seeking help for addiction, began by abusing prescription meds, primarily oxycontin.” That raises a lot of questions, most importantly, how many people is the study referring to? Why did they begin abusing prescription medication? How did they obtain that medication in the first place (legally or illegally)? How quickly did they transition from prescription medications to whatever they were now seeking freedom from? What were they now abusing? Does it matter what they started on, or is it more important to learn why they started?
Exploring the reasons for addiction and how it occurs is extremely important; some people begin their addiction journey by abusing paint fumes, alcohol, or other drugs/substances, but neither paint nor alcohol requires a prescription to purchase.
But this figure, claims the film, “draws a direct line between Purdue’s marketing of oxycontin and the heroin epidemic.” Yet even the film goes on to admit that once Purdue Pharma addressed the issue of oxycontin abuse via tampering by inventing a tamper-resistant pill, the rates of prescription drug abuse went down and heroin began to rise.
Curiouser and Curiouser…
Also repeated ad nauseum throughout the film, is the unsubstantiated belief that there is no difference between legally prescribed and responsibly used opioid medications and heroin. Prescription opioids like Vicodin (hydrocodone) are consistently and erroneously referred to as “heroin pills” and “synthesized heroin” throughout the film (and elsewhere by Dr. Kolodny). Hydrocodone IS NOWHERE NEAR as strong as heroin, and notice how much stronger bupenorphine is compared to heroin! These charts show the compared strength between common prescribed opioids, and commonly abused street drugs.
More Bad Science…
“Horrible statistics on teens taking opioids. I think a few years ago it was more than 10% of 12th graders.” – Chris Evans, PhD (emphasis added)
Again, this stat gives no source or context leaving out information that would make it less sensationalized. Like the fact many 12th graders undergo a common, painful, but short recovery surgery called “wisdom tooth extraction”, and if 10% are addicted (which neither the stat nor Evans actually states), that means 90% ARE NOT. *It should be noted that Chris Evans, PhD, claims neither to be a medical doctor, pharmacist, drug expert, educator, or any other related expert.
In the second-half of the film, the plight of heroin babies is addressed, and the tragedy of children in foster care due to the heroin epidemic is highlighted, but becomes mischaracterized during an interview with Julie Gaither PhD, MPH, RN, Yale School of Medicine and child abuse researcher, calls it a “prescription opioid epidemic.”
Further confusing the issue, the filmmakers include the drastic, unscientific claims of Joel Hay, PhD Professor of Pharmaceutical Economics and Policy at USC, who is not a medical doctor, clinician, ER doctor, chronic pain patient, or related expert in the field of pain management, yet declares in an interview:
“The damage that’s been done since then [referring to Purdue’s oxycontin marketing], in terms of the number of people taking not only oxycontin, but many types of opioids for conditions that really have–there’s no value for these drugs.” – Joel Hay, PhD Professor of Pharmaceutical Economics and Policy, USC
At one point, the film admits to the high recidivism rate within 1-2 years, of those they interviewed who struggle/struggled with addiction. Therefore, the key to stopping this “epidemic” is bizarrely revealed by Jeanmarrie Perrone, MD Perelman School of Medicine, University of Pennsylvania:
“We need to stop new cases from feeding into it…that’s what we did with Ebola.” (except this isn’t a biological agent spreading like Ebola)-my emphasis
To the filmmakers and Dr. Kolodny, that means preventing access to pain medication, even for legitimate pain.
Destructive Claims About Chronic Pain
Chronic pain is addressed in the film, though in subtle, confusing, and misleading ways. Near the beginning, a female investigative reporter claims, “People with real chronic pain finally got relief from oxycontin; got their lives back.” That should be something to celebrate, right? As the film progressed, 6 people who were originally featured in a Purdue Pharma ad for oxycontin were highlighted. Purdue even did a 2-year follow-up ad with the same people, showing they were neither addicted nor dead from overdose, neither did they feel differently about how their medication had helped them.
When, “Do No Harm” was made, the filmmakers revealed that many years later, 3 of the original female patients still felt the same way about their medication, while 2 males had died of unrevealed causes. Though all of the patients were older, the film ominously (and potentially slanderously) stated they had died, “of reasons thought to be related to their opioid addiction.” Considering the film’s strict and unscientific stance that anyone who takes opioids for any reason is “addicted”, there is really no way to interpret the narrator’s vague statement. The last patient had been interviewed for a PROP (headed by Dr. Kolodny) commercial sometime prior to the film, and that clip was shown. Since her Purdue commercial debuts, she had lost her insurance and therefore her medication. She never denied having relief from the medication, and never admitted to addiction or feelings of euphoria, but still claimed she, “would probably be dead,” from oxycontin overdose by now, and described the medication as “synthetic heroin”, though it is not clear why she thought that. The narrator went on to describe her as, “one of the lucky survivors.” Her current pain, disability, and lifestyle were never addressed.
Helping Keep Grandma “Clean”?
Without providing evidence from even one pain specialist or any study, the film went on to claim that elderly patients will (not “can”) get addicted to their medication, describing one unnamed grandma who doctor-shopped for reasons unknown (though the film, of course, assumes this grandma was trying to get high), and another grandma named Linda, who had been struggling with apparent over-medication, although the film’s narrator describes Linda as having been “addicted” (neither Linda nor her doctors described her this way). Once a correction in dosing was made (never revealed in the film), Linda was able to have improved quality of life and seemed quite happy, yet the film characterized her story this way, “Linda lost years of quality of life by innocently trusting her doctors…”
Statistically, the elderly make up the majority of the roughly 100 million American chronic pain patients, suffering daily, hourly, from severely painful and debilitating conditions like arthritis, joint pain, hip pain, knee pain, back pain, and more. Many undergo major surgeries with very long recovery times, yet the filmmakers and Dr. Kolodny seem to feel it is imperative to allow elderly people to suffer in unbearable, crippling pain that is easily preventable, in order to “prevent addiction.”
Conflating Pain and Abuse
Yet, while there was no evidence of abuse in either of the elderly women featured, the film quickly switched to the stories of pain patients (all but one suffering from acute, short-term pain) who had started abusing their medications and had quickly progressed to heroin.
Although numerous medical studies (also here, here, here, here, and here) over the decades have shown that pain patients without a prior history of abuse are statistically unlikely to become addicted, the film did not make it clear whether any of these patients had a history of prior abuse or mental illness, and 2 of the 4 obtained their medications illegally from the start. In follow-up interviews it was revealed the one chronic pain patient (middle-aged) had remained clean from all narcotics for at least a year, but had been forced to leave his job due to disability and move in with his parents. He had lost his career, his independence, his finances, and his personal identity (as he describes it in the film), but hey, at least he wasn’t “addicted”.
The next interview (still in the section about chronic pain patients) featured an addiction specialist who stated:
“The most challenging are the opiate addiction patients, because when people are dependent on opiates and it’s controlling their life, you’re dealing with a monster the size of that wall…It changes their thinking.” He goes on to describe the dishonesty associated with addiction.
Another addiction specialist with no clinical experience regarding pain patients, claimed people in chronic pain and their doctors can’t tell the difference between withdrawal and the associated pain, and their chronic pain. It did not seem to occur to that specialist that withdrawal pain will subside in a matter of days, and chronic pain, is, well CHRONIC.
Finally, giant text on the screen reads around the 38 minute mark, “Women over 45 have highest incidence prescription drug overdose,” while the narrator craftily says, “Women over 45 have the highest rate of accidental death–we think it’s accidental–of use and overuse of prescription drugs.” Did you catch that? “Use and overuse of prescription drugs,” which may and may not include prescription opioids. It’s a dirty trick.
Women over 45 have the highest rate of prescription opioid use due to chronic pain, and they also, because of their age, have the highest rate of “prescription drug use”. It’s also true that women outlive men, making the “women over 45” population higher than other groups. It does not mean these women (or men) are addicted, and there is no evidence for that egregious claim!
Most chronic pain patients are trying to live, work, and play, not “get high” or escape their responsibilities. They have a proven track record for both their medical conditions and responsible use of their medication, and it is both discriminatory and defamatory to call them addicts because other people do not use the same medications responsibly or legally.
While the film promotes a zero-tolerance medication approach for chronic pain patients with legitimate, physical disabilities, most of whom are elderly, it also never promotes alternative therapies and legislating insurance coverage for those. It never champions pain research, or offers any real hope for pain patients at all. Chronic pain patients are used, instead, to conflate the false idea that all opioids lead to addiction, and are then left out in the cold, even though there is a large body of consistent evidence proving “less than 4% of those who abuse prescription opioidsgo on to develop heroin addiction.” Meanwhile, the film hypocritically calls for ongoing treatment of addiction using medication, and the number one and two MAT drugs are opioids!
“One of the problems we have with this epidemic is that people are not getting an acute illness that can be treated with surgery, or an antibiotic, or some short course of treatment. People have developed a chronic brain disease that needs management.” –Kelly Clark, MD, MBA, DFSAM, Addiction Medicine and Psychiatry Louisville, KY
I want to know why Dr. Kolodny and the filmmakers of “Do No Harm” feel that those with addiction deserve compassionate, ongoing treatment, including with medications that happen to be opoids (bupenorphine), but law-abiding, responsible chronic pain patients do not deserve the same.
What the film did not have:
It did not feature one pain specialist.
It did not feature more than 2 chronic pain patients;
1 who had been over-medicated in the past and was doing well on a reduced dose (not revealed in the film).
1 who was on no medication and had been forced to leave his job and move in with his parents in his 40s-50s due to his now-unmanaged pain.
It did not feature a pharmacist.
It did not feature a pharmacologist.
It did not feature representatives from the FDA, CDC, NIH, or any other government health agency.
It did not feature more than 1 study to back claims made throughout the film.
It did not feature accurate, verifiable statistics, but it did include a lot of “we think…” and “probably”.
It did not feature what might be termed “facts”.
It did not feature an unbiased approach.
It did not feature personal responsibility.
It did not explain why it is ok for addicts to have ongoing medication assisted therapy for their “chronic disease” of addiction, but not ok for law-abiding chronic pain patients to have ongoing medication assisted therapy for their chronic diseases.
It did not feature alternatives for chronic pain patients, no acknowledgement of their very real pain and disability from lack of treatment, no help at all. Meanwhile, the film strongly criticized hospitals, doctors, and other medical personnel for not finding alternative therapies for addiction patients, for not acknowledging their pain and disability from lack of treatment, from turning them out on the street with no help at all.
It did not show how the suicide rate has gone up an alarming 30% between 1999-2016, the exact years opioid prescribing was strictly reduced and began a downturn. Not only that, the rates have gone up among those age groups most likely to be chronic pain patients.*
What the film did have:
Giant text that read, “From 1999-2017, over 500,000 opioid related deaths.”
Except this stat is untrue. According to the CDC’s own data, the estimated number of deaths during that time frame was 123,560.
Claiming the opioid epidemic can be “traced back to Purdue’s oxycontin,” in 1996, as if the heroin epidemic of 1976 never happened, as if people never used opioids before 1996, and as if doctors haven’t known for literally all of recorded medicine (5000 years) the pros and cons of opioids.
A dizzying back-and-forth and mash-up of arguments that made the film hard to keep up with.
It did feature inflammatory statements about doctors, the FDA, pharmacists, pharmaceutical companies (Purdue Pharma, especially), and the medical community in general. An interesting approach, since Kolodny was quite unhappy with my own “Open Letter…”
It did reiterate everything Kolodny himself has ever said on the subject.
It did manipulate grieving parents, lying to them, and harnessing their natural, good desire to make a positive change; to make their child’s death meaningful. As a parent who has lost a child (though not to heroin or drug overdose), that has made me more upset than anything else in the film, and shows just how low the anti-opioid crusade will go to make itself heard.
Updated 8/9/18 and cut for length. Please see part 2 to view previous info, now in that segment.
“…A Terrible Disease.”
Addiction is, indeed, a terrible thing, and I am glad to see it being recognized, less stigmatized, and more genuine help offered to those struggling. But agenda-driven propaganda will not help those with addiction, in fact it has already been shown to cause harm to both addicts and chronic pain patients, who have found themselves blind-sided in recent years with a new stigma attached to their medical needs, particularly, the medications they need to stave off disability, poverty, loneliness, depression, anxiety, high blood pressure, loss of quality of life, and even early death (by natural-the body can only take so much untreated pain-and suicidal means). Those medications are overwhelmingly opioids.
A 2018 documentary called, “Do No Harm: An Opioid Epidemic,” featuring Dr. Andrew Kolodny (to whom I recently wrote an open letter) and “working closely with Dr. Kolodny and PROP“, is a classic propaganda film that’s been influencing a lot of viewers and, therefore, a lot of lives. I viewed this film a few nights ago, and 90 minutes and 9 pages of handwritten notes later, I began writing this *series of posts.
The film begins by insulting doctors, painting a portrayal of Purdue Pharma as an “evil” corporation (and, by extension, their products, aka opioids), castigating chronic pain patients (presumably for having the audacity to be in pain that only responds to opioids), and throwing out odd claims without sources of any kind. For example, one of the closing statements says:
“While watching this documentary, 6 Americans have probably died from an overdose.” -Narrator (my emphasis added)
We’re off to a great start already!
Throughout the film, people struggling with addiction are consistently portrayed as “brave survivors” and innocent victims who just didn’t know what they were getting into. A few blame Purdue Pharma (in particular) in the interviews, while others have a hard time admitting they did wrong or chose poorly. According to Alcoholics Anonymous, one of the classic first steps to addiction recovery is, “Admit you have a problem,” not “blame someone else.” Other steps include:
Make a searching and fearless moral inventory of ourselves.
Admit to God, to ourselves and to another human being the exact nature of our wrongs.
Make a list of persons we had harmed, and become willing to make amends to them all.
Make direct amends to such people wherever possible, except when to do so would injure them or others.
Continue to take personal inventory and when we were wrong promptly admitted it.
Even Do No Harm admits the high recidivism rate of all those interviewed as poster-recovered-addicts (all clients from the Beit T’Shuvah Recovery Center). Out of approximately 11 people (the film jumps back and forth quite a bit), 2 went back to heroin within 2 years or less, and 5 are never even followed up with. One interviewee who was also an employee at the Recovery Center, said, “You see people coming and going all the time. It’s sad.” The film never reveals the type of treatment or therapy given at the center, but an internet search for the site and phone call to the center, proved that medication-assisted treatment (typically Suboxone/Subutex, a popular form of bupenorphine) “may be used, if deemed appropriate by the resident psychiatrist there.” Furthermore, the site claims they do use a 12-step recovery model, based on AA, though the statements of the interviewees and the purpose of the documentary itself, don’t seem to line up with those recovery values.
“We have to keep people alive so that they can recover,” states Casey’s mom, tearfully. Dr. Kolodny and the filmmakers of “Do No Harm” seem to think “recovery” means ongoing bupenorphine treatment for everyone, and sickeningly hints at the end of the film that all those dead children featured would probably be alive today, if bupenorphine had been a part of their treatment. For many people, medication-assisted therapy (MAT) is a part of their treatment, with highly mixed results. Furthermore, while heroin has a relative strength of 5x potency of oral morphine, bupenorphine has a relative strength of 40x, while hydrocodone (Vicodin) has a potency strength of -100x and oxycodone (the generic, short-acting version of Purdue Pharma’s oxycontin) has about 1x!see chart below.
In a separate phone conversation I had with Dr. Kolodny, as well as nearly every news article featuring him, Kolodny reiterates his strong support for MAT, or ongoing management of addiction symptoms and behavior using drugs. Dr. Kolodny’s drug of choice for such treatment has long been bupenorphine, an opioid sometimes combined with Nalaxone (popularly known as Narcan). Why would he promote this opioid, while staunchly condemning all the rest, I asked? “Because of the Naloxone element,” he told me, people are less likely to die or even overdose to begin with.
He’s been singing bupenorphine’s praises for decades, even formerly heading up a large chain of addiction centers called Phoenix House that touted heavy use of MAT. But investigative articles have been coming forth more and more, showing how Suboxone has been increasingly “diverted” for abuse, and may be complicit in a rise of overdose deaths. When I asked Dr. Kolodny about this on the phone, he dismissed these articles as “bad journalism.”
Dr. Kolodny’s apparent obsession with opioids is hard to understand. While certainly a major issue that needs addressed (and has been), heroin is not the only drug people overdose on (and drugs are not the only things people can be destructively addicted to), and in fact, cocaine has been consistently number 2 and 3 for overdose deaths in 2010-2014 (Table B), according to the CDC. Other drugs include fentanyl (the illicit kind, not the prescription kind), methamphetamine (which is on the rise), hydrocodone (Vicodin/norco), and benzodiazepines (anti-anxiety medications).
The film throws shocking stats around — stats that have also appeared in other media — such as:
“The Centers for Disease Control and Prevention estimates that more than 500,000 people in the United States have died from overdoes of opioids since the year 2000.”
Thankfully, this is not accurate, neither is the study sourced in the film. Rather, this CDC media release from 2015 which states, “nearly a half-million Americans” have died from prescription opioid overdoses and heroin OD, is not shown via stats, just statements, by Tom Frieden, the then-CDC head until 2016. https://www.cdc.gov/media/releases/2015/p1218-drug-overdose.html. However, the CDC has NOT estimated anywhere near this number. The recorded number of deaths in 2016 was roughly 42,200, 5 times higher than in 1999, or roughly 8400. Even assuming that the death toll was 40,000 (it wasn’t) each year from 2000-2015, you still only get 200,000, not 500K. https://www.cdc.gov/drugoverdose/data/statedeaths.html
Even when presented with current studies and facts, Dr. Kolodny refuses to update his methods, teachings, or beliefs according to data and science. Although he invited me to share updated studies with him via email, he never responded to my email or a Tweeted reminder from myself. He goes so far as to directly blast anyone or any study that disagrees with his teachings, throwing them under the proverbial bus for not being as unbalanced in approach as he is.
Attacking Doctors and Other Medical Professionals (Along with the FDA, Purdue Pharma, and Whomever Else is Convenient)
The opening statement of the film reveals all:
“The drug companies are the cartel, the doctors are the pushers, and the pharmacists are the suppliers: that’s how the DEA is seeing it.” –Mark Borovitz, Rabbi/CEO, Beit T’Shuvah Recovery [Addiction] Center
That hard-line idea is pushed repeatedly throughout the film. In just the first 2 minutes, the notion of corrupt doctors, evil pharmaceutical companies, and irresponsible pharmacies, is reiterated 3 different times!
The narrator says early in the film that Purdue Pharma’s goal in marketing oxycontin was, “corrupting doctors and nurses to sell the Kool-Aid,” and later on at the 21 min. mark, giant text reads, “The Epidemic Spreads: From the Doctor’s Office to the Street.”
Much later in the film, Anna Lembke, MD Chief of Addiction Medicine at Standford claims, “Opioids are a proxy for doctor-patient relationships.” She then goes on to describe the euphoric high that addicts experience (it should be emphasized that the majority of pain patients do not experience this euphoric high), ending with, “…you feel cradled [by the doctor]…You thank them, the doctor feels gratified, the doctor writes another script.”
A chronic pain patient featured in the film, who had probably been over-medicated for a number of years and had since been tapered down from her previous fentanyl patches and oxycondone to a new, unrevealed dose, is described at the end of film by the narrator, “Linda lost years of quality of life by innocently trusting her doctors to do no harm.”
The film then switches tactics to blast the FDA for it’s “ludicrous” (and alleged conspiracy-theory) decision to add pain as the 5th vital sign in the 90s (actually a 2001 Joint Commission decision), because it was allegedly paid big money by Purdue Pharma. While no evidence has yet been found for this claim, the film blames “dark money”. Kolodny’s still pretty sore, I guess, that the FDA didn’t acquiesce to his demands in 2013 to strictly limit the use of opioids in chronic pain (see image below). Allegations are lobbed about an “unholy alliance” between the FDA and Purdue to get oxycontin approved, although this is exactly what the FDA does: approve pharmaceuticals if they meet government standards.
Bad Science Leads to Bad Policies
Giant text on the screen reads, “Over 259 million opioids prescribed per year,” while narration adds, “at the height of the epidemic”. But which year is being referred to? Which study is being referenced? There are an estimated 326 million people currently in America, and we document EVERY prescription written, which means 1 prescription every month for chronic pain patients, or roughly 21.5 million per month. That’s only about 6.6% of the total population. Don’t the filmmakers know that the rate of opioid prescribing WAS ALREADY GOING DOWN by 2012, presumably because of far stricter state laws? Yet another bit of giant text reads, “From 1999-2017, over 500,000 opioid-related deaths.” Except that turns out not to be true at all. More like roughly 123,560, less than a quarter of the “estimated” number of deaths, according to the CDC (Table B).