Wednesday, October 4, 2017

Doing the Opioid Crisis Rag

Heard a talk from a former New Hampshire House of Representatives Rep, a physician, about the opioid crisis and about all those deaths from Fentanyl in New Hampshire which earned us a shout out from President Swamp Boy about New Hampshire being a "drug infested den."

He showed a slide which showed that New Hampshire, second in the nation in drug deaths, is 49th in spending on drug rehab programs, the suggestion being that if we only weren't so cheap, and valued the lives of these people who are using opioids, we could save them. 

He did not have a slide which showed the expenditures of the other states on the X axis and drug deaths on the Y axis: In other words he did not know if the states which spent the most money on drug rehab programs had fewer deaths, and if this correlation exists is this because there are fewer drug deaths in richer states because when people are rich and have a lot to live for, they don't take drugs?

Of course, there are lots of stories of affluent white kids dying of drug overdoses, but the reasons for that are not well examined, as far as I can see.
A little defensive, are we?

The National Institutes of Health has a National Drug Abuse Institute and on this site they attempt to answer a Frequently Asked Question: Do drug rehab programs actually work?  Intelligently, the authors say, well it depends on what you mean by a program "working." They feature a graph showing that during the actual treatment program, those enrolled in drug rehab programs have fewer drug overdoses, but afterwards a sizable number return to drug use, in about the same proportions as people who are hospitalized for asthma continue to need treatment for asthma and people hospitalized for type 1 diabetes need ongoing treatment.
Oh, that's reassuring. 
Really, what they are saying is like alcoholism, heroin addiction is for life and you need constant attention.

This answer stinks strongly of self interest, the bias of a group of practitioners whose salaries depend on the notion that what they are offering is effective.


Of course, every time the deaths of young people are presented to politicians, they run for cover and talk about the government programs, the spending they are directing at the problem.  This is a shield for the politicians, but as far as I can see, there is precious little evidence these programs or expenditures actually prevent drug deaths in the medium to long run. 
It reminds me of the point in the diabetes lecture when the guy says, well, of course, you have to refer your patients to a registered dietitian and everyone in the audience is thinking--oh, good, now I can wash my hands of that obligation. But, of course, the nutritionists have nothing effective to offer: Well, count your carbs and eat what is pictured on this poster and you will notice absolutely no benefit at all. 

It may be dated, and it is focused on the inner city drug culture, but "The Wire" presents a detailed discussion and depiction, which if people actually watched the 5 seasons, would convince most of them what we are doing and calling "drug rehab" is insanity.


There was an old cynical jibe at the cancer hospitals: More people make a living off cancer than actually die of it.  When I listened to the programs mentioned tonight, involving certification of Drug Rehabilitation Coaches and in patient facilities and outpatient clinics, that came to mind. Lots of people cashing in on the efforts to treat drug addiction and drug deaths are benefiting. The patients, not so much.

Portugal has taken an radically different approach to drug deaths and drug disability: It decriminalized drug use and drug possession and treats addicts as patients.
They still prosecute drug dealers, oddly enough. Not sure how they do this.
But deaths from drug use related HIV, subacute bacterial endocarditis and hep C diagnoses have plummeted in Portugal. 
Until we actually want to face the uncomfortable truths in America about what drug use means, and how we should regard drug abusers, we likely will spend money foolishly, and we'll pat ourselves and our politicians on the back and ignore the real problems and their solutions and the deaths and associated diseases will continue.



Until liberal politicians take a hard look at reality, engage in tough minded analysis of what we call "drug rescue programs" they will continue to look like opportunists who always have an easy answer, and no credibility.


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