4 disturbing trends in health care

4 disturbing trends in health care – Praveen Suthrum | KevinMD | Aug 2018

I agree with the author that health care is changing dramatically and not necessarily in a good direction. This article points out some fundamental issues that must be addressed before any “progress” can be made.

It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.

Here are four trends that are changing health care but on the surface are too unsexy for us to care about.  

Diversion of Opioids from Pharma Supply Chain

Diversion of opioids from supply chain –  by Alex Kacik  | September 16, 2017

For years, opioid tablets in the pharmaceutical supply chain have been diverted in massive batches of hundreds of thousands of pills.

This brings to mind that when Slick Willie Sutton was asked why he robbed banks (as opposed to bank customers), ihe said: “because that’s where the money is”. The pharmaceutical supply chain is where the most opioid pills are.

there has been a major push to pinpoint the vulnerabilities in a fragmented pharmaceutical supply chain to stem the flow of illicit prescription drugs.  

How the Fed Used Opioids as Scapegoat

Games without Frontiers: How the Fed Used Opioids as Scapegoat & Diversion for the Nation’s True Crises – by Matthew Giarmo, Ph.D. – Sept 2018

Here’s a guy who lays it out as he sees it, remarkably similar to the view of pain patients. This could be because he took time off to take care of a family member with cancer – he saw firsthand the full destructive force of their pain.

EXECUTIVE SUMMARY

• The problem is not opioids. It’s heroin.
• The problem is not painkillers. It’s pain.
• The problem is not prescription. It’s diversion.

To all those sanctimonious crusaders, self-aggrandizing careerists, and shameless opportunists looking for a piece of the opioid pie, I say that you are more addicted to the opioid crisis than we are to opioids. 

Lies About Prescription Opioid Deaths

Who Is Telling The Truth About Prescription Opioid Deaths? DEA? CDC? Neither? | American Council on Science and Health – By Josh Bloom — November 5, 2018

In this article, Mr. Bloom takes apart the DEA’s exaggerated counts of supposed “prescription drug overdoses”, revealing how the DEA conflates, distorts, and inflates numbers using illogical groupings and obscure details of definitions.

“Controlled Prescription Drugs (CPDs) … are still responsible for the most drug-involved overdose deaths and are the second most commonly abused substance in the United States.”
– 2018 National Drug Threat Assessment. Drug Enforcement Administration, October 2018.

A newly-released 164-page report just issued by the DEA maintains that controlled prescription drugs are killing more Americans than any other type of drug (1); even more than heroin and fentanyl.

But if you’ve been keeping up in this area this sounds very strange. Can it really be true that drugs like Vicodin and Percocet are killing more Americans, especially when one report after another lays the blame on illicit fentanyl and its scary analogs?  

Pain Patients and Doctors Have Civil Rights Too

Pain Patients and Doctors Have Civil Rights Too — Pain News Network – By Richard Dobson, MD – November 2018

Dr. Dobson makes the point that pain patients’ civil rights about being violated because we and our doctors are being criminally punished for crimes committed by others.

In a recent column, I described the diversion of blame for the opioid crisis as an example of “Factitious Disorder Imposed on Another,” [See previous post Diversion of Blame and the Opioid Crisis] a psychiatric condition in which a person imposes an illness on someone who is not really sick.

Recently, the U.S. Department of Justice announced a plea deal in which a former police chief in Florida pleaded guilty to violating the civil rights of innocent people by making false arrests “under color of law.” I think there are some striking parallels between the way these innocent victims were treated and the way that chronic pain patients and their doctors are treated today. 

DEA: Foreign fentanyl a greater risk than diverted pills

DEA: Foreign fentanyl a greater risk than diverted pills – By Eric Scicchitano The Daily Item – Jun 3, 2018

Even the DEA knows that it’s illegal fentanyl that’s fueling the overdose crisis, but any outrage about fentanyl is being co-opted by the tired old war on the entire drug class of  “opioids”.

This assures that all critical distinctions between prescription medication and injected heroin/fentanyl are carefully hidden so the combined “opioid overdose” numbers are large enough to get attention (and money).

Prescription opioids are the only aspect of the overdose crisis that the DEA *can* restrict and regulate, even though it’s proven to be ineffective. They continue prosecuting doctors because they 1) can find them and 2) they don’t shoot back.  

DEA Employees Fail Drug Tests

DEA Employees Fail Drug Tests, Shockingly Face No Serious Consequences – Sept 2015 – By Nick Wing

I found this amusing, but not really surprising. There seems less and less difference between the DEA and the drug dealers it so intimately deals with.

A number of federal employees with the U.S. Drug Enforcement Administration have failed drug tests over the past five years, only to receive short suspensions or other minor reprimands, newly released documents reveal.

According to a Huffington Post review of internal DEA discipline logs, first uncovered by USA Today over the weekend, there have been at least 16 reported instances of employees failing random drug tests since 2010.

Federal Agency Fueling the Opioid Crisis

Opinion | The Federal Agency That Fuels the Opioid Crisis – By Leo Beletsky and Jeremiah Goulka – Sept. 17, 2018

Here’s an Op-Ed by real experts in addiction from the NY Times that puts the blame where it belongs:

Every day, nearly 200 people across the country die from drug overdoses [from ALL drugs, legal and illicit, prescribed or not].The Drug Enforcement Administration, the agency that most directly oversees access to opioids, deserves much of the blame for these deaths.

Because of its incompetence, the opioid crisis has gone from bad to worse. The solution: overhauling the agency, or even getting rid of it entirely. 

Opioid policy fallout

Opioid policy fallout | Medical Economics – Jeff Bendix – May 30, 2018

The epidemic of opioid-related deaths sweeping the country has lawmakers and regulators in Washington, D.C., and state capitals scrambling for answers. And while doctors generally welcome the attention to the crisis, many also fear that the solutions being proposed and enacted will do more harm than good.

The concern among physicians and public health and pain management experts is that laws and regulations designed to limit use of prescription narcotics, however well-intentioned, are yet another constraint on doctors’ ability to treat patients as they think best.  

DEA Revises Opioid-Quota Rules Unchanged

DEA Revises Opioid-Quota Rules, Leaving Out Requested Change by Kerry Dooley Young – July 13, 2018

The Drug Enforcement Administration (DEA) will update its established procedures for setting production quotas for addictive drugs without heeding a recommendation from medical groups regarding shortages of injectable opioids.

The DEA on July 11 announced its final decision on changes to its regulations regarding aggregate production quotas (APQs), which it said were initially issued in 1971.

When a policy is close to 50 years old, it shouldn’t be revised or changed as much as thrown out entirely. So much more is known about medications and drugs in general than 50 years ago, it’s ludicrous that such old policies are still used at all.