The opioid crisis

Thousands of dollars? In when, the 60’s?

They’ve been flogging them on the shopping channel for as long as I can remember.

I don’t really want to read someones whiz bang lit review, but particularly effective is fair comment for the usual modalities.

If you want a good physotherapy level thing try acupuncture. There is a lot of stuff that we can’t get near explaining with scientific medicine.

Acupuncture has been scientifically demonstrated to be a placebo. I’m not against placebos but you shouldn’t have to pay money for them.

No doubt for some people. Not for me though.

The whole story was just jaw-dropping to me last night.

I mean, I’ve seen for years that the government and lobbyists have a revolving door, and I know that this is theoretically bad. But this is the worst case I’ve ever heard of. The former DEA agents who went to work for these drug distributors knew exactly the right tools to go after to make the DEA ineffective against. I just couldn’t believe this story, it almost belies belief. I mean, holy shit, everyone should watch this story to see it for themselves. I’m still kind of flabbergasted at the whole thing.

I don’t know how those former DEA people sleep at night. There are a lot of people in the Trump Administration and who voted for them that I wonder this about tbh.

I felt the same way. I don’t see 60 Minutes a lot, but for some reason I tuned in last night. I really needed to get to sleep, but I couldn’t believe what I was seeing and watched it all the way through.

Like you, I had an idea things like this went on, but the scale and magnitude of this one really makes me sick and super angry. I know there is a lot of corporate greed in this country, but the scale and reach of this one is quite amazing. There should be a special type of hell reserved for these… I can’t even call them people.

Haha, but if you don’t pay for it a placebo won’t work!

Belief is a funny thing.

Or is that a sublime meta-gag? I choose to believe the latter.

Ho-leee Crap that 60 Minutes piece was really good. And the punchline of the fact that the Congressman who spearheaded defanging the DEA is now Trump’s nominee for drug czar - just mindblowing.

As recently as 10 years ago, medical grade TENS units cost thousands of dollars. Meaning, ones capable of generating enough electricity to be effective, while also offering a level of control that allowed you to customize the frequency and pattern to avoid things like a patient becoming acclimated to a particular pattern. I’m honestly not sure what electronic components have come down in price to enable to new employment in a much wider market (to the extent they’re being sold by companies like ICY-HOT), but seemingly something did.

In terms of “particularly effective”, the literature seems at odds with your opinion. And it’s not like TENS operates via some sort of unknown magical power. The mechanisms by which it is effective are fairly well established and understood. It disrupts the electrical impulses of nerves, and it can increase blood flow to a particular location.

One thing to bear in mind, is that TENS application often is not used to replace other analgesics, but to supplement them, and allow patients to achieve similar results with lower dosages.

TENS can be extremely effective for certain kinds of especially problematic chronic pain, such as diabetic neuropathy, which is often very difficult to manage with traditional drugs. The results of TENS were significantly better than placebo, and resulted in marked improvements in quality of life.

I’m not generally an advocate of alternative medicine mumbo jumbo, but this stuff is actually a legitimate medical technology with a great deal of supporting research.

Every day as many people die of ODs of prescription opioids as were killed in Vegas and several times more than the shooter put in the hospital are hospitalized by non fatal ODs. EVERY SINGLE GODDAMN DAY.

I get that winning the drug war is damn near impossible. I remember hearing about these so called pain clinic in places like Florida and WV where the bus in folks with bogus prescriptions from internet “doctors” and thinking the AMA should crackdown on these doctors and criminal charges. It never occurred to me that the DEA had the authority to prevent the clinics from getting drugs. That’s not a perfect solution but a great step.

However, in my wildest imagination, I couldn’t have imagined an unholy alliance between many in the drug industry, and former DEA regulators and Congress that would aid and abet the murder of 200,000 people over the last decade.

I’m guessing that Trump will withdraw the nomination of Tom Marino, but if he doesn’t I’m going to be leading a letter writing campaign against his confirmation.

Because those have worked so well thus far for all the other wildly unqualified, actively department-sabotaging, death-and-destruction-causing nominations.

I’m not sure where the research is, but some folks are also having success with topical Cannabis applications and joint/back pain. Here’s the best article I found from a quick googling:

Topicals are cannabis-infused lotions, balms, and oils that are absorbed through the skin for localized relief of pain, soreness, and inflammation. Because they’re non-psychoactive, topicals are often chosen by patients who want the therapeutic benefits of marijuana without the cerebral euphoria associated with other delivery methods…

…Cannabis-infused lotions, salves, oils, sprays, and other transdermal methods of relief work by binding to a network of receptors called CB2. These CB2 receptors are found throughout the body and are activated either by the body’s naturally-occurring endocannabinoids or by cannabis compounds known as “phytocannabinoids” (e.g., THC, CBD).

Even if a topical contains active THC, it still won’t induce that intense “high” you’d get from smoking or ingesting cannabis. With most topicals, cannabinoids can’t breach the bloodstream; they only penetrate to the system of CB2 receptors.

It is definitely hit and miss when it comes to Cannibis-based treatments. It did nothing to help my mom, or another friend, but it’s what got the owner of a local medical MJ dispensary excited about medical MJ.

More MJ info in relationship to the opioid crisis:

Marijuana legalization in Colorado led to a “reversal” of opiate overdose deaths in that state, according to new research published in the American Journal of Public Health.

“After Colorado’s legalization of recreational cannabis sale and use, opioid-related deaths decreased more than 6% in the following 2 years,” write authors Melvin D. Livingston, Tracey E. Barnett, Chris Delcher and Alexander C. Wagenaar.

The authors stress that their results are preliminary, given that their study encompasses only two years of data after the state’s first recreational marijuana shops opened in 2014.

It may be preliminary, but it sure looks like it could be statistically significant.

It’s not enough, but no one solution ever will be. But if legal canabis can drop it 6%, if tighter DEA policy another 15%, malpractice against drug dealer doctors can drop it another… well you get the idea. Basically take a whole bunch of small steps to a larger solution.

It helps legal mj has a bunch of other positives, including the only one politicians respond to. Money.

The conclusion fits my worldview but that is extremely misleading statistics/econometrics, I am surprised to see it published. Take a close look at the graph:

https://img.washingtonpost.com/blogs/wonkblog/files/2017/10/recreational_opiates.png

They estimate a linear time trend between 2000 and 2014, and then a linear trend from 2014 and find it is slightly negative. Done, let’s type up that “Legal marijuana is saving lives in Colorado” headline! Wait…

There’s a few common tricks I see all the time in economic analysis to get the conclusion they want:

  • Look at that linear trend between 2000 and 2014. You see that 2006 and 2010 is mostly above the trend line, while 2010 and 2014 is mostly below the trend line. This matters because you can have a situation where deaths are higher after a policy intervention than for years prior to an intervention, yet the tread line post-intervention is still negative.
  • The trend lines don’t completely connect at the break, it starts at a higher point after the intervention. If you restrict the line to connect that negative slope will get much flatter.
  • Indeed, the main reason that second trend line is negative is because deaths start out very high post intervention, and ameliorate in more recent months.
  • They don’t consider more realistic non-linear trends, like a still very simple second-order polynomial, which would undoubtedly show no change post legalization just by looking at the time series. Then again, a result like that probably won’t get published.

So after applying a regression that is the textual embodiment of the phrase “a little bit of knowledge can be a dangerous thing”, they come to the amazing conclusion that even though the amount of deaths two years post-legalization is higher than the four years pre-legalization (check the graph closely to confirm this, I don’t have the raw data to calc the numbers myself), legalized marijuana is saving lives. They might not explicitly say that in the article, but it’s so clear this small journal piece is academic clickbait for dramatic news headlines.

There’s also the fact that even if there were a significant drop, you don’t necessarily have causation. The article itself notes that confounding unobserved factors might have caused any drop, yet in the conclusion they don’t mind graciously acknowledging the “apparent public health benefit” they have found while neutrally and dispassionately pursuing science. To think it took 4 PhDs to produce this, for shame.

The issue left unsaid on Congress passing the law neutering the DEA:
Money in politics, with pharma leading the way.

Sanders (and maybe trump’s faux populism, where populism turns out to mean billionaires in the cabinet and simply giving corporate interest carte blanche for their wishlists ) resonates with people because I think the populace knows on an intuitive level that elected office is now service to the donor class and lobbyists (with a big payoff at the end of a term by in-turn becoming a lobbyist.)

We’re left with a broken political system not only abandoning its democratic principles and purpose but now with a return to the insidious politics of “white nationalism” (see: evangelicals, the tea party and red hats.)

I see Marino withdrew his name for the Drug Czar. I would like to say it was shame but my assumption is the WH made him.

Full story: