Politics

Carl Spackler
Posts: 91
Joined: Mon Oct 02, 2017 3:22 pm

Re: Politics

Postby Carl Spackler » Fri Nov 03, 2017 2:06 pm

Speaking of Politics going where it should be barred from treading: Chris Christie should avoid traffic control and doctor patient relationships completely. We are ignoring the street drug crisis which is expanding deaths, the drug pushers and their source providers while stealing legal analgesics from patients in great pain who need them to exist, this is barbaric.

Opioid Commission Mistakenly Blames Pain Treatment for Drug Deaths

The panel wants to make prescription analgesics even harder to obtain.
Governor's OfficeIn the report it published yesterday, the President's Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey Gov. Chris Christie, endorses what has become the standard explanation for the rise in opioid-related deaths during the last decade and a half. "A widely held and supportable view is that the modern opioid crisis originated within the healthcare system," the report says. The problem began, it explains, with "a growing compulsion to detect and treat pain."

According to this narrative, doctors in the late 1990s began to underestimate the risk of addiction and overdose among patients prescribed narcotics for pain. Responding to ill-informed advocacy on behalf of pain patients and deceptive marketing by drug companies, they lost their entirely appropriate fear of opioids and began prescribing them left and right. The surge in prescriptions led to a surge in "iatrogenic addiction" (i.e., addiction caused by treatment) and overdose deaths. To correct that disastrous mistake, the Christie commission says, doctors need to worry less about the suffering caused by untreated pain and more about the dangers posed by painkillers.

That response is fundamentally misguided because the narrative endorsed by the commission is wrong in several crucial ways. Doctors did not mistakenly believe that the dangers posed by opioids had been greatly exaggerated. They correctly believed that the dangers posed by opioids had been greatly exaggerated, and they were right to think that excessive fear of opioids had led to inadequate pain treatment. Contrary to the impression left by a lot of the press coverage, opioid addiction and opioid-related deaths rarely involve drug-naive patients who accidentally get hooked while being treated for pain. They typically involve polydrug users with histories of substance abuse and psychological problems. Attempts to prevent overdoses by closing off access to legally produced narcotics make matters worse for both groups, depriving pain patients of the analgesics they need to make their lives livable while driving nonmedical users into a black market where the drugs are more variable and therefore more dangerous.

"The catalyst of the opioid crisis was a denial of [these drugs'] addictive potential," the Christie commission says. The report does not try to quantify that potential, but survey data and studies of patients help to put it into perspective.

According to the National Survey on Drug Use and Health (NSDUH), 98 million Americans used prescription analgesics in 2015, including both legal and illegal use. About 2 million of them qualified for a diagnosis of "substance use disorder" (SUD) at some point during the previous year. SUD is a catchall category that subsumes what used to be known as "substance abuse" and the more severe "substance dependence." The Substance Abuse and Mental Health Services Administration, which oversees the survey, does not report the breakdown between mild, moderate, and severe SUD. But based on this survey, it looks like somewhere between 1 and 2 percent of prescription opioid users experience addiction in a given year. By comparison, NSDUH data indicate that about 5 percent of past-year drinkers had an alcohol use disorder in 2015. That group was about evenly divided between "abuse" and "dependence."

The NSDUH numbers provide a one-year snapshot. Some studies of patients who take opioids for extended periods of time find higher addiction rates, but they are still generally modest. A 2010 review found that less than 1 percent of patients taking opioids for chronic pain experienced addiction. A 2012 review likewise concluded that "opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence." A 2015 review noted addiction rates in various studies ranging from 3 percent to 26 percent in primary care settings and from 2 percent to 14 percent in pain clinic settings.

The risk of fatal overdose among patients is very low. The CDC cites "a recent study of patients aged 15–64 years receiving opioids for chronic noncancer pain" who were followed for up to 13 years. The researchers found that "one in 550 patients died from opioid-related overdose," which is a risk of less than 0.2 percent. A 2015 study of opioid-related deaths in North Carolina found 478 fatalities among 2.2 million residents who were prescribed opioids in 2010. That's an annual rate of 0.022 percent.

The risk of addiction and overdose is not random. A 2012 study of opioid-related fatalities in Utah found that 87 percent of the decedents had received prescriptions for analgesics in the previous year and 89 percent were reported to have suffered from pain. Those results may seem consistent with the story the Christie commission is telling about pain treatment leading to iatrogenic addiction and death. But when you look at the characteristics of the people whose deaths were attributed to prescription opioids, you see that 61 percent had used illegal drugs, 80 percent had been hospitalized for substance abuse (including abuse of alcohol and illegal drugs as well as prescription medications), 56 percent had a history of mental illness, and 45 percent had been hospitalized for psychiatric reasons other than substance abuse. Troubled people who find emotional relief in various drugs, including prescription opioids, are far more common than accidental addicts like the law school classmate frequently cited by Chris Christie, who died after washing down Percocet pills with a bottle of vodka.

So-called overdose deaths typically involve combinations of drugs. In the North Carolina study, for example, benzodiazepines were detected in 61 percent of the deaths attributed to prescription opioids. The numbers in New York City are similar, and that's just for one class of depressants. Over all, more than 90 percent of opioid-related deaths in New York involve drug mixtures. For the most part, people are not dying simply by taking too many pain pills. Even Christie's friend, whom he describes as getting hooked on oxycodone prescribed for back pain, mixed the pills with alcohol.
What's true of prescription opioids is also true of heroin: Most "overdoses" involve combinations. The danger is magnified by the unpredictable potency of black-market heroin, which in turn has been magnified by the recent proliferation of fentanyl as a heroin adulterant and substitute. The dramatic increase in heroin-related deaths since 2010 seems to be driven largely by the crackdown on prescription opioids (including the 2010 reformulation of OxyContin), which has pushed nonmedical users toward more hazardous substances.

The crackdown also has affected patients, leaving many without the medication they need to keep agony at bay and driving some to suicide. The prescription guidelines that the CDC issued last year, which encourage physicians to be stingy with opioids, already have had a noticeable impact on patients' ability to get adequate treatment for their pain. "There are many pain clinics flooded with patients who have been treated previously by their primary care physician," says Jianguo Cheng, president-elect of the American Academy of Pain Medicine. "They have a lot of patients trying to find a physician, and it has been a problem for many, many pain specialists." He says these refugees include patients who have responded well to opioids for years.

The Christie commission thinks there is nothing wrong with the CDC guidelines. In fact, the report recommends updating and extending them to pain specialists. It calls for "a national curriculum and standard of care for opioid prescribers," presumably aimed at reinstilling the good, old-fashioned fear that the commission credits with preventing abuse. The commission thinks patients should no longer be asked about the adequacy of pain treatment in surveys mandated by the Centers for Medicare & Medicaid Services, lest providers "use opioids inappropriately to raise their survey scores." The commission criticizes the campaign to treat pain as "the fifth vital sign," which it blames for encouraging excessive opioid use. It recommends closer and more comprehensive scrutiny of prescription practices.

If the aim is reducing deaths from drug poisoning, there is not much logic to making prescription analgesics even harder to obtain. According to a 2016 analysis of opioid-related deaths in Massachusetts, just 8 percent of the decedents "had an opioid prescription in the same months as their deaths." Prescription opioids were the deadliest drug in just 5 percent of the cases, while 85 percent involved heroin and/or fentanyl.
Today I heard from one of the pain patients I interviewed for an upcoming Reason feature story about recent trends in opioid use. He fits Cheng's description of patients who have functioned well on opioids for years but were arbitrarily cut off by providers in response to the CDC guidelines.

This patient thinks the Christie commission is pushing the government further in the wrong direction. "If they go through with those recommendations," he wrote to me on Twitter, "I may as well drive my car off a cliff. This is horrible news. The CDC will threaten MDs, the DEA will step up their intimidation practices, and the few pain MDs that are left will fold. This is barbaric."

Blue&White
Posts: 447
Joined: Sat Aug 12, 2017 10:01 am

Re: Politics

Postby Blue&White » Mon Nov 06, 2017 4:48 pm

My wife called me a little bit ago and was all excited because there is some article out predicting Betsy DeVos is getting ready to resign. In the article someone was quoted as saying she was the "least effective" secretary of education in the nation's history. My question is: "how can you tell"?

psu_dad
Posts: 213
Joined: Sun Aug 13, 2017 6:59 pm

Re: Politics

Postby psu_dad » Mon Nov 06, 2017 6:31 pm

If they offer you the job at DOE, return half of the $70B budget to the taxpayer and use the other half to buy a copy of Animal House for the video archive of every school in the country. You'll be in the running for "most effective" secretary of education in the nation's history.

“Knowledge is good" -- Emil Faber

Blue&White
Posts: 447
Joined: Sat Aug 12, 2017 10:01 am

Re: Politics

Postby Blue&White » Tue Nov 07, 2017 8:12 pm

The polls in NJ closed at 8:00 PM EST. At 8:02 EST CNN called the election for Murphy (the Democrat). I know the polls all had him winning in a landslide, but .. c'mon. How can you call the election that soon after voting stops? From exit polls? ABC at least has the decency to call it a "projection".

Btw, forget what you hear about the NJ gubernatorial race being "a referendum on Trump". It's not. Chris Christie leaves office as the least popular governor in the state's history, and the Republican's ran his lieutenant governor as their candidate. So, basically, the Democrats ran unopposed.

Carl Spackler
Posts: 91
Joined: Mon Oct 02, 2017 3:22 pm

Re: Politics

Postby Carl Spackler » Wed Nov 08, 2017 10:26 am

Blue&White wrote:The polls in NJ closed at 8:00 PM EST. At 8:02 EST CNN called the election for Murphy (the Democrat). I know the polls all had him winning in a landslide, but .. c'mon. How can you call the election that soon after voting stops? From exit polls? ABC at least has the decency to call it a "projection".

Btw, forget what you hear about the NJ gubernatorial race being "a referendum on Trump". It's not. Chris Christie leaves office as the least popular governor in the state's history, and the Republican's ran his lieutenant governor as their candidate. So, basically, the Democrats ran unopposed.


Here is another down vote on Christie. HIs opiate fiasco report to the President will cause the suicide rate of chronic pain patients, particularly vets, and destroy many lives of patients who of no fault of their own other than having daily intractable pain to have their medications reduced or removed while the street trade continues to flourish. Ready, fire, aim Chris. Strike three.

sameoldlama
Posts: 92
Joined: Wed Aug 16, 2017 7:43 am

Re: Politics

Postby sameoldlama » Wed Nov 08, 2017 10:31 am

I think Christie had the lowest favorability rating of any governor anywhere in the history of the country. And I don't think it was his policies so much as his 'tude. When he ran for POTUS he basically abdicated his responsibilities as governor (other than collecting salary, benefit, perks) and was very flippant when he was called out on it. After he bombed in the primaries he basically mailed in the rest of his term and spent his time trying to set himself up with a paycheck in Trump administration, further flipping the bird to the residents on NJ.

But spite has a price and NJ residents are going to find out it's pretty steep if Murphy gets his way.

Blue&White
Posts: 447
Joined: Sat Aug 12, 2017 10:01 am

Re: Politics

Postby Blue&White » Wed Nov 08, 2017 11:30 am

But spite has a price and NJ residents are going to find out it's pretty steep if Murphy gets his way.

I seriously doubt that. What's going to happen, property taxes will go up? Property taxes went up every single year that Christie was in power, too. Despite all his bluster and promises and cuts, the cost of living in NJ continued to rise mostly unabated. Frankly, I think that's another reason the Republicans got creamed - why vote for them if they are going to cut services, give tax breaks to the richest people in the state, and leave everything else as it was. Under Christie people basically ended up paying the same, or more, for less. So, how does Murphy make that worse? I agree he's unlikely to make it better, but I'll take a wager on "worse".

Exit polls in VA and NJ were interesting. I think the Republicans were doomed in NJ no matter what due to Christie fatigue and disgust, but a lot of voters said they were voting for the Democrat to show their disgust for Trump. He got crushed in NJ last November so I don't think he much cares. But, he has to stand up and take notice at what happened in Virginia. Yes, I know he lost VA by 6 points, but the VP nominee was from there. And, Hillary still couldn't carry 50% of that state. But, Northam carried 54% in yesterday's gubernatorial win. And they won a bunch seats in the state legislator and got close to taking over the state. Dems were winning up and down in small elections all over the place. The Republicans had to stand up and take notice of that.

November 2018 is a year away and a lot can happen in a year. But, if it's anything like this year, I think the GOP is in trouble. And, frankly, that's always the way it goes. How many times has a party come in and swept up the presidency and both houses and then 2 years later voters turn on them? Happened to Obama in 2008. Happened to Bush in 2002. Happened to Clinton in 1996. It will likely happen to Trump in 2018. Rinse. Repeat.

psu_dad
Posts: 213
Joined: Sun Aug 13, 2017 6:59 pm

Re: Politics

Postby psu_dad » Wed Nov 08, 2017 12:13 pm

How many times has a party come in and swept up the presidency and both houses and then 2 years later voters turn on them? Happened to Obama in 2008. Happened to Bush in 2002. Happened to Clinton in 1996. It will likely happen to Trump in 2018. Rinse. Repeat.

That's inevitable when you have two parties that aren't worth a bucket of warm spit. Nothing makes Democrats look better than Republicans in charge ... and vice versa.

Carl Spackler
Posts: 91
Joined: Mon Oct 02, 2017 3:22 pm

Re: Politics

Postby Carl Spackler » Wed Nov 08, 2017 12:35 pm

Dad speaks the truth. Inaction and wrong action are the trade marks of the major parties.

sameoldlama
Posts: 92
Joined: Wed Aug 16, 2017 7:43 am

Re: Politics

Postby sameoldlama » Wed Nov 08, 2017 1:59 pm

I think by this point we are all accustomed to politicians claiming they will somehow cut taxes while increasing services and balancing budgets - only to see taxes and fees / services /surcharges increase. NJ has some real long term spending / liability issues that makes that promise simply impossible. The realistic "best you can hope for" is to tackle the spending issues while keeping / increasing revenue. If economic growth can't bring in sufficient revenue then taxes need to increase.

Murphy campaigned of the Robin Hood platform of steal from the rich and give to the poor - he promised lots of freebies, to keep the unsustainable pension program going just as it is and to make NJ like Cali - a sanctuary state - which will further stress public services and budgets.

Most politicians lie when they say they can hold the line on spending and taxes - some make an effort and simply find it impossible to make it happen - this guy is promising to spend like crazy and do everything in his power to steal from the rich and corporations - remember when people fled NJ when Florio went tax crazy (and to a degree he wasn't doing it for new freebies but to get them out of red) - businesses and people with good incomes should start packing now. NJ is on its way to Cali, Illinois style economic meltdown. And I suspect when financial D_Day hits you'll see these states looking for federal bail outs.