PROPaganda, Part 2 of 2

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. View part 1 here.


Bad Science Leads to Bad Policies

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)

Classic addiction study 'paragraph'
Although one can clearly see the footnotes in the text, the film’s 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.

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.

Opioid strength chartrelative strength of opioids from oral morphine to carafentanil


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.

New Yorker Quote
“The Neuroscience of Pain,” by Nicola Twilley, New Yorker

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 opioids go 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.


Recap

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.
  • It did feature highly emotive language and muckracking techniques.
  • Screaming babies.
  • Bias.
  • 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.

Sources Cited:

http://www.donoharmdocumentary.com/

https://ramblingsoapbox.com/2018/06/26/an-open-letter-to-dr-andrew-kolodny/

https://lptv.org/do-no-harm-the-opioid-epidemic-3/

https://www.addictioncenter.com/treatment/12-step-programs/

https://beittshuvah.org/treatment/residential-program/

https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain?mbid=contentmarketing_facebook_citizennet_paid_magazine_the-neuroscience-of-pain_2-4-visit

https://www.ncbi.nlm.nih.gov/pubmed/18489635

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/

https://www.ncbi.nlm.nih.gov/pubmed/15102251

https://www.ncbi.nlm.nih.gov/pubmed/2873550

https://www.ncbi.nlm.nih.gov/pubmed/18164924

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073133/#!po=13.0952

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940677/


Further Reading:

https://www.politico.com/magazine/story/2018/02/21/the-myth-of-the-roots-of-the-opioid-crisis-217034

http://ehealthmagz.com/2018/07/20/chronic-pain-patients-did-not-cause-opioid-epidemic/#comment-77

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PROPaganda, Part 1 of 2

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.

Medication-Assisted Therapy

“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.

FDA rejects PROPs opioid limits on chronic pain proposal, 2003


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).

Please read part 2 here.


Sources Cited:

 

 

http://www.donoharmdocumentary.com/

https://ramblingsoapbox.com/2018/06/26/an-open-letter-to-dr-andrew-kolodny/

https://lptv.org/do-no-harm-the-opioid-epidemic-3/

https://www.addictioncenter.com/treatment/12-step-programs/

https://beittshuvah.org/treatment/residential-program/

https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf

https://www.cdc.gov/media/releases/2015/p1218-drug-overdose.html

https://www.cdc.gov/drugoverdose/data/statedeaths.html

https://www.medpagetoday.com/publichealthpolicy/publichealth/57336

https://www.nbcnews.com/health/health-news/number-prescriptions-opioid-painkillers-drops-dramatically-u-s-n867791

http://www.supportprop.org/faqs/

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!

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 Opiate 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