PROPaganda – by Loura

PROPaganda, (Part 1 of 2) – July 2018 – by Loura

Here’s another well-researched and well-written article by Loura Lawrence, from her blog “Rambling Soapbox“. She lays out the history and data explaining why Kolodny might be so insistent that we’re all just addicts and exposes the factual flaws in his anti-opioid PROPaganda.

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 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.

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.

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.”

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

The film never reveals the type of treatment or therapy given at the center,

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

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

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 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.

Not for me. He’s enjoying the spotlight, the accolades, and the pristine aura of infallibility that surrounds him.

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

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.

However, the CDC has NOT estimated anywhere near this number. The recorded number of deaths in 2016 was roughly 42,200.

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.

Wow, he claims to be backed by science and evidence that is continually evolving, yet he refuses to evolve with it.

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!

Much later in the film, Anna Lembke, MD Chief of Addiction Medicine at Standford claims, “Opioids are a proxy for doctor-patient relationships.”

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.

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?

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

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 that had no history of addiction.” (auhor’s 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

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.”

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)

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.

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

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.”

To the filmmakers and Dr. Kolodny, that means preventing access to pain medication, even for legitimate pain. Part 2 coming soon!