By R Carter
WBNS posted this headline last week, “Franklin County Coroner’s Office reports 12 suspected overdose deaths in 48-hour span“.
FRANKLIN COUNTY, Ohio — The Franklin County Coroner’s Office said Saturday there’s been a recent spike in suspected overdose deaths. The coroner’s office reported that there have been 12 suspected overdose deaths in a 48-hour span. The coroner warns that recent social distancing can possibly trigger substance use. Despite the need to maintain a physical distance because of the coronavirus outbreak, people are still encouraged to check in on friends and family. The coroner’s office also encouraged people who know someone who’s struggling with addiction to keep naloxone and fentanyl testing strips nearby.
I was taken back by this as there is no medical evidence known that correlates social distancing with increased substance abuse, someone should suggest to the coroner to keep within the boundaries of her specialized profession. As such, this represents a new level of drug abuse hysteria not previously known; raising my concerns over who should have their mental status evaluated. WBNS is also known for its deliberate efforts to dramatize social issues beyond the scope of any practical threat, so it’s not surprising to see them seize this opportunity to fan the flames of drug abuse hysteria, after all, salacious bad news is a great way to generate click events.
As I followed up to look for more references to social distancing and substance abuse, for which I found nothing, I was impressed by the level of denial that operates in individuals we are supposed to trust for rational and objective information regarding health issues. Clearly the Coroners office in Franklin County Ohio slept through the classes on rational objectivity and social responsibility. But it does point to an aspect of human behavior that operates not just in those with a substance abuse problem, but within people in general.
Denial has both beneficial and harmful effects in human behavior. Denial is the belief that something is or isn’t true despite evidence suggesting otherwise, more importantly, and for the most part, denial operates on an unconscious level shaping our perceptions and informing the conclusions we draw. This is a fact which has been used with great success by government agencies and public health officials in the war on opioids. Whether it’s operating on an unconscious level or not, we’ll never know, but the Franklin County Coroners statement is a clear example. A beneficial outcome of denial would be the fighter pilot trained in dogfighting believing that someone else is more likely to crash or be shot down than himself. If you review the real statistics, short of a need for speed, you’d never climb in a fighter jet.
Between 1992 to 1998 of the 2,139 aircraft fatalities recorded; 853 occurred with pilots(A) indicating that for those working in the aviation industry, the chances of a work-related death are 40% greater if you’re a pilot. Despite this fact, aviation pilots continue to believe that such accidents will happen to others and not themselves. This would be an example of a beneficial effect for without this denial, we wouldn’t have an aviation industry and travel between distant points would be more time consuming and costly, therefore the risk-reward ratio is considered acceptable despite the facts saying otherwise.
Now compare that with the denial regarding opioid use in pain management, during and after surgery. If you ask the government they’ll tell you less is better and then quote data such as that in Table 2 which has less to do with opioids and more to do with everything else that can poison you. But let’s also look at opioid abuse, while we have the data to inform us of the death rate for opioid overdoses that is not medicinal, our government will not publish it. Since 2010 nearly every state has kept records on the number of controlled substances prescribed. That data can be easily cross-referenced against opioid overdoses which come from vital statistics, and even though we know states are keeping these stats, they are not publishing the results. Such information would clearly identify what portion of opioid overdoses are from medicinal opioids and which are not.
Up until 2010, the risk-reward ratio was considered low and socially acceptable, it was only after that when a surge in deaths occurred from recreational drug use due to fentanyl analogs, that the current effort to distract the public moved into full gear. As the DEA has stated, “The fact that we cannot arrest our way out of this problem is well recognized by law enforcement“, it was after this that the focus was shifted to the medical profession, where there was a system that allowed tighter control. Since then there’s been an attempt to redefine what is medically acceptable and that definition is not a medical one but a political one passed down through the CDC to give the appearance of being medical. If public health and government have their way, then the common man or woman on the street is supposed to accept that it is better to suffer through with pain than to risk addiction from taking an opioid a week or two longer than what is currently advised. Lower doses for shorter periods of time are supposed to flatten the curve of opioid overdose deaths and the number of people seeking addiction treatment, or at least that is what we are being told. But the data doesn’t bear out this perspective and the government is now hoping, people just don’t notice. So I ask this question, is this rational and have we been given all the facts necessary to support this conclusion? Are our public health officials giving us honest, objective and rational facts, or are we getting someone else’s denial based on their personal values, as we did from the Franklin County Coroner?
Below I’m going to do a deep dive into how data is collected and reported to support the claims that we as a society, should accept living with pain because this is better than risking addiction.
The first thing to note is that when speaking about opioid overdose deaths and addiction, the government lumps prescribed opioids with illegal opioid abuse under one umbrella so, from a statistics point of view, there is no difference. But when reporting on opioid overdose deaths, they make a point of emphasizing that prescribing is the underlying cause, and on this one fact, they publish no data from State PDMP databases to support the claim. This should make everyone quite angry because each of the 50 US states spends on average, $1 Billion a year on tracking opioid prescriptions. Nationwide that cost amounts to between $55-60 billion a year. For that price tag, we have no reports or data telling us, the taxpayers, what we’re getting from it.
Let’s look at a typical CDC report used to draw attention to opioid prescribing as the cause for opioid overdose deaths. I want to emphasize how much of this data, about 94%, has nothing to do with opioids. So while government agencies sight overprescribing as the cause, they offer no definitive data to support the claim and instead use data which is mostly about non-opioid substances. In doing so they greatly exaggerate the real threats and risks. Table 1 below was taken from the CDC Data Brief 81: Drug Poisoning Deaths in the United States, 1980–2008 which for dramatization effects, compares drug poisoning deaths to motor vehicle deaths.
|Motor vehicle accidents||Poisoning||Drug Poisoning|
|Deaths per||Deaths per||Deaths per|
|100,00 population||100,00 population||100,00 population|
|Year||Number of Accidents||Deaths per 100,00||Number of Poisonings||Deaths per 100,00||Number of Drug Poisonings|
Comparing these numbers to the 40% pilot death rate for aviation workers from 1992-1998, the chance of dying from a motor vehicle accident between 1992 – 1998 is minuscule, on average 15.6 per 100,000 population, or 0.0156% while the chances of dying from any type of poisoning, drug-related or not were about half that or 0.004%, and from a strictly drug-related point of view, the death rate was even lower at 0.003%. Keep in mind though, only about half of the drugs in this report represent opioids. Despite these facts, the general perception is that the use of opioids both recreationally and for medical purposes represents an epidemic.
This new perception has changed because of the way the data is compiled and presented. The new narrative we’ve been given is deliberately designed to exploit the built-in predisposition we have for lying to ourselves or believing that something is true for others but not so for the rest of us. To sell the public on the war on opioids, this perception had to change and this is how it was done.
Let’s start with the narrative given by the CDC as quoted here and in the publication from Table 1, “In 2008, over 41,000 people died as a result of poisoning. One of the Healthy People 2020 objectives, retained from Healthy People 2010, is to reduce fatal poisonings in the United States. However, poisoning mortality increased during the Healthy People 2010 tracking period. Drugs—both legal and illegal—cause the vast majority of poisoning deaths. Misuse or abuse of prescription drugs, including opioid analgesic pain relievers, is responsible for much of the increase in drug poisoning deaths.” A more honest look at how the data above is compiled, tells a different story and exposes how the resulting narrative can’t be justified when the real facts are unknown to the general public.
The report from Table 1 sights 99 codes used for compiling the data, but few if anyone takes the time to look up what these codes really represent, if they did they soon recognize that out of the 99 codes, only 6 relate specifically to narcotic opioids. Rest easy, I’ve done that work for you so you can see the man behind the curtain.
The CDC uses these 99 categories routinely when making the case against prescription opioids, but as you will see, 93 of them include substances such as fertilizer, laxatives and others unrelated to drug abuse mush less the practice of medicine. This fact is never directly eluded to by the CDC, instead, it is hidden in cryptic language using codes and as always ignored by mainstream media, resulting in a naturally inflated truth that fits the desired narrative. If the public were actually aware of how over-inflated the data is, it’s likely we’d see a different response to the war on opioids, one that did not treat every individual as an addict simply waiting for that first prescription, but instead as normal individuals who can exercise good judgment and common sense when using medications for pain.
Table 2(B), ICD-9 and ICD-10 codes used by government agencies and public health when reporting opioid overdose deaths
|Description||Accidental poisoning by and exposure to nonopioid analgesics, antipyretics (aspirin, Tylenol), and antirheumatics (anti-rheumatic drugs)||Accidental poisoning by and exposure to antiepileptic (antiseizure), sedative-hypnotics, antiparkinsonian, and other psychotropic drugs||Accidental poisoning by and exposure to narcotics and psychodysleptic, not elsewhere classified||Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system||Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances||Accidental poisoning by and exposure to alcohol||Accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapors|
|Description||Accidental poisoning by and exposure to other gases and vapors not otherwise classified||Accidental poisoning by and exposure to pesticides||Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances||Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics (aspirin, Tylenol) and antirheumatics (anti-rheumatic drugs)||Intentional self-poisoning by and exposure to antiepileptic (antiseizure), sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified||Intentional self-poisoning by and exposure to narcotics and psychodysleptic, not elsewhere classified||Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system|
|Description||Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances||Intentional self-poisoning by and exposure to alcohol||Intentional self-poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapors||Intentional self-poisoning by and exposure to other gases and vapors||Intentional self-poisoning by and exposure to pesticides||Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances||Assault by drugs, medicaments and biological substances|
|Description||Assault by corrosive substance||Assault by pesticides||Assault by gases and vapors||Assault by other specified chemicals and noxious substances||Assault by unspecified chemical or noxious substance||Poisoning by and exposure to nonopioid analgesics, antipyretics (aspirin, Tylenol) and antirheumatics (anti-rheumatic drugs), undetermined intent||Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified, undetermined intent|
|Description||Poisoning by and exposure to narcotics and psychodysleptic, not elsewhere classified, undetermined intent||Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent||Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent||Poisoning by and exposure to alcohol, undetermined intent||Poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapors, undetermined intent||Poisoning by and exposure to other gases and vapors, undetermined intent||Poisoning by and exposure to pesticides, undetermined intent|
|Description||Poisoning by and exposure to other and unspecified chemicals and noxious substances, undetermined intent||Asphyxiation by gas Injury by tear gas Poisoning by gas||Accidental poisoning by heroin||Accidental poisoning by methadone||Accidental poisoning by other opiates and related narcotics||Accidental poisoning by salicylates (aspirin, Tylenol)||Accidental poisoning by aromatic analgesics, not elsewhere classified|
|Description||Accidental poisoning by pyrazole (nonsteroidal anti-inflammatories) derivatives||Accidental poisoning by antirheumatics (anti-inflammatory)||Accidental poisoning by other non-narcotic analgesics||Accidental poisoning by other specified analgesics and antipyretics||Accidental poisoning by unspecified analgesic or antipyretic (aspirin, Tylenol)||Accidental poisoning by barbiturates||Accidental poisoning by other sedatives and hypnotics|
|Description||Accidental poisoning by chloral hydrate group||Accidental poisoning by paraldehyde||Accidental poisoning by bromine compounds||Accidental poisoning by methaqualone compounds||Accidental poisoning by glutethimide group||Accidental poisoning by mixed sedatives, not elsewhere classified||Accidental poisoning by other specified sedatives and hypnotics|
|Description||Accidental poisoning by an unspecified sedative or hypnotic||Accidental poisoning by phenothiazine-based tranquilizers||Accidental poisoning by butyrophenone-based tranquilizers||Accidental poisoning by benzodiazepine-based tranquilizers||Accidental poisoning by other specified tranquilizers||Accidental poisoning by an unspecified tranquilizer||Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics|
|Description||Suicide and self-inflicted poisoning by barbiturates||Suicide and self-inflicted poisoning by other sedatives and hypnotics||Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents||Suicide and self-inflicted poisoning by other specified drugs and medicinal substances||Suicide and self-inflicted poisoning by unspecified drug or medicinal substance||Suicide and self-inflicted poisoning by agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers||Suicide and self-inflicted poisoning by corrosive and caustic substances|
|Description||Suicide and self-inflicted poisoning by arsenic and its compounds||Suicide and self-inflicted poisoning by other and unspecified solid and liquid substances||Assault by drugs and medicinal substances||Assault by other solid and liquid substances||Assault by other gases and vapors||Assault by unspecified poisoning||Poisoning by barbiturates, undetermined whether accidentally or purposely inflicted|
|Description||Poisoning by other sedatives and hypnotics, undetermined whether accidentally or purposely inflicted||Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted||Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted||Poisoning by unspecified drug or medicinal substance, undetermined whether accidentally or purposely inflicted||Poisoning by corrosive and caustic substances, undetermined whether accidentally or purposely inflicted||Poisoning by agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers, undetermined whether accidentally or purposely inflicted||Poisoning by arsenic and its compounds, undetermined whether accidentally or purposely inflicted|
|Description||Poisoning by other and unspecified solid and liquid substances, undetermined whether accidentally or purposely inflicted||Poisoning by gas distributed by pipeline, undetermined whether accidentally or purposely inflicted||Poisoning by liquefied petroleum gas distributed in mobile containers, undetermined whether accidentally or purposely inflicted||Poisoning by other utility gas, undetermined whether accidentally or purposely inflicted||Poisoning by motor vehicle exhaust gas, undetermined whether accidentally or purposely inflicted||Poisoning by other carbon monoxide, undetermined whether accidentally or purposely inflicted||Poisoning by other specified gases and vapors, undetermined whether accidentally or purposely inflicted|
|Description||Poisoning by unspecified gases and vapors, undetermined whether accidentally or purposely inflicted||Injury due to legal intervention by gas||
Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted
Poisoning by barbiturates, undetermined whether accidentally or purposely inflicted
Poisoning by other sedatives and hypnotics, undetermined whether accidentally or purposely inflicted
Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted
|Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted|
Poisoning by unspecified drug or medicinal substance, undetermined whether accidentally or purposely inflicted
If you clicked on some of the links assigned to these code in the column headers, you will see that most have nothing to do with controlled substances much less opioids. For example, you may ask yourself as I did, why code E980.4 which includes deaths from excessive laxative use would be counted along with overdose deaths and then labeled as a contributing cause for prescription opioid overdoses? This kind of step and shuffle have been used by the CDC since before 2010, in fact, between 2008 and 2012, there was a concentrated effort across all government agencies and standards-setting committees, to broaden the definition of what constitutes a poisoning. Under that new definition of what constitutes a poisoning, water would be included if you drowned while drinking a glass of it. Doing this made it much easier to inflate the numbers which now appears on these reports.
These facts are lost on the CDC simply because the agency is an extension of the political leadership in this country, their continued use of such data over the objections of more rational and objective leaders in healthcare is an indication that the war on opioids is more of an ideological war than a war for improving the health and wellbeing of Americans. This is the only rational conclusion when such data is the basis of denying pain medication or generally speaking, adequate pain relief to the 65 million people who have surgery each year and the more than 15 million Americans who require opioids for chronic pain management.
- “Flying Too High: Worker Fatalities in the Aeronautics Field“, US Bureau of Labor Statistics
- Data Brief 81: Drug Poisoning Deaths in the United States, 1980-2008