Opioids – Government Impotent Ignorance Prevails!

Update 10/31/2017:  Politicians blame doctors and pharmacies for the opioid crisis, despite the CDC reports that show that illegal drugs are the main source of overdose deaths.

According to the CDC report for 2016, most lethal effects of the opioid epidemic are coming from the streets and not out of doctors’ offices and pharmacies.

“Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths in multiple states, with a variety of fentanyl analogs increasingly involved, if not solely implicated, in these deaths,” the CDC’s Julie O’Donnell, John Halpin, and colleagues reported.

“Fentanyl was involved in more than 50 percent of opioid overdose deaths, and more than 50 percent of deaths testing positive for fentanyl and fentanyl analogs also tested positive for other illicit drugs.”

But where has the government focused attention?  President Trump declared the opioid crisis a national emergency, proposed further restrictions on physicians, and, abstinence to potential drug abusers.  Why do authorities do this?  Because they are ignorant and unable to stop the illegal drug manufacture, sale, or use.

Highly publicized articles, including grandstanding lawsuits by states’ attorneys’ general are pandering to news hungry media and ignoring the pain inflicted on compassionate pain management. Death by dying method (drug overdose), without distinguishing source (legal vs. illegal) is a misleading abuse of authority and power.

The recent blitz campaign against opioid drugs is terribly flawed.  According to the latest official data from the National Institute on Drug Abuse (as of 2015) more than 52,000 people died of drug overdoses in 2015.  Sad, we lost fewer to drugs than to automobiles (38,000), plus homicide (16,000), and slightly fewer than those lost to suicides (43,000).

But of the 52,000, how many died of prescription drugs vs. illegal drugs?  Nearly, 30,000 (58%) died from prescription drugs, the balance of 22,000 (42%) died from illicit drugs.

Opioids include prescription drugs derived from opium (such as heroin), and synthetic drugs (e.g. fentanyl) which are both prescribed, and sold illegally (manufactured and sold to drug dealers).  These illegal synthetic opioids are largely responsible for the spike in overdose deaths, because they are 100 to 10,000 times stronger than morphine.  Drug dealers mix them with heroin or other drugs to enhance the strength.  The potency is often inconsistent and unknown to the user.  Illegal fentanyl is a popular additive which is 100 times stronger than morphine.  Even a slight mismeasurement is multiplied by 100.

CDC is foreclosing options for legal, and legitimate pain medicine, even though illegal drugs are aggravating the overdose statistics.  They are implying that doctors are responsible through overprescribing opioids to pain patients.  Pain management specialists, who deal with chronic pain patients are often ignoring real suffering by undertreating the pain to avoid criticism from the CDC.

Readers who have real spine and neck problems know what pain is, even after surgery and other efforts to repair the damage.  I have talked to people just beginning treatment and surgery, who are being given glorified Advil and other ineffective drugs, when what their pain indicates is opioids.  Some people do get addicted and abuse opioids.  I do not dispute that.  But, not everyone who takes pain medicine becomes an addict, even though they depend on the relief they get from their prescriptions.  Dependency is not the same as addiction.  It does not automatically lead to ever-increasing desire for more and more.

Carfentanil is the scariest invention yet.  10,000 more powerful than morphine, this relative of fentanyl has been a recent bogeyman for illicit drug users.  Primary producer:  China (recently banned).  This drug is meant to tranquilize elephants. As little as 20 micrograms will kill you.

This scary substance is, knowingly or unknowingly, used as a cheap booster for other illegal drugs, mostly out of Mexico.  Think you are buying heroin, or meth?  Think again.  Houston police recently seized what they thought was methamphetamine and found lethal amounts of carfentanil instead.

The old days of drug abuse are officially over with the advent of this drug.  The next terrorist attack could easily be a batch of white powder.  A car bomb or suicide vest filled with this drug could kill hundreds or thousands, including first responders.

The point, let legitimate pain-management doctors do their jobs; spend the millions of dollars now devoted to opioid suppression on the true shadow of death: illegal superopiods.

 

 

 

 

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Care Denial – The Truth About Health Care “Coverage”

Much talk about insuring people for health care needs.  The giant bedpan in the room is availability.  What good is having Medicare, Medicaid, exchange plans, if you cannot find a doctor for hundreds of miles who will accept your provider’s coverage?  Just look.

The pundits talk about providing millions of people “access” to healthcare; however, they cannot explain why many of the “covered” still do what they did when they had no insurance, go the emergency room of the public hospital known to be the one that cannot turn them down.

Health insurers specify what they will cover and what the insured must pay, in terms of dollars and percentages.  What they do not spell out, is the amounts they are willing to pay the doctors and hospitals for various treatments.  The doctors and hospitals that are willing to accept the insurer’s terms are added to a “network.”  If the insured uses these doctors and hospitals, “in network,” the patient pays less; “out-of-network” providers, the insured pays much more.

Medicare, and the related private insurance plans are shunned by many healthcare providers because of the intense complexity of coding rules, poorer reimbursement rates, and 6-month slow-pay of claims.  I cannot blame them for wanting the easiest, most profitable patients, but look at what that does to retirees:  it shoves them into the offices of the newest, least experienced doctors, who do not have privileges at the best hospitals.

Another specious barrier doctors erect is “not accepting new patients.”  If that is true, why do they prominently promote their doctors, facilities, and services?  Why do they list the insurance plans they accept, on fancy websites?  What do they do when patients get well, move, change, outgrow their need, or die?  Who takes their places?  Are there waiting lists?  This policy seems wildly inconsistent, and dubious to me.

Today’s labyrinth of laws, maze of insurance coverages, intricacies of medical practice, incorporation of hospitals, vast array of medical devices, tests, and procedures, and incomprehensible myriads of drugs and medicines, are the starting point of future choices.  The concept of choosing your doctors, clinics, and hospitals still appeals to me.  If all health insurance policies must meet some minimum standards of coverage, why should health providers exclude any of them?

We have a historic opportunity to put features into the fabric of healthcare; the federal government has more incentives and flexibility to “get it right” as they formulate new laws.  Why not pass a new law called “The Available Care Act?”  If you accept anything except cash for medical services or goods, you accept the coverage of any patient who walks in your door.