The New York Times is all over the “narcotic epidemic” this week.
First we had a story about the recommendation for FDA approval of Probuphine, the implantable plastic matchsticks saturated with buprenorphine. The story was mostly about how sticking this drug inside our bodies would reduce overdose deaths from heroin, prevent us from selling buprenorphine (Suboxone) on the streets, and keep us compliant with taking our doses.
The trajectory of the story (“Let’s cure all addicts with this drug!!”) was saved by a CDC physician and a West Virginia University doctor, both of whom said we can’t just implant these sticks into people and send them on their merry way.
But you know what?—that’s exactly what will happen. Because that’s exactly what has been happening for two decades with SSRIs, which were approved for major depression, were never intended for lifetime use, and were recommended for use concurrent with psychiatric therapy. But the NYT has run stories about, gosh, therapy is so expensive! And to get SSRIs you no longer have to see a psychiatrist. You can go to your PCP, who most likely isn’t qualified to treat depression.
But you’re probably diagnosing yourself, so hey.
And you know what else?—the FDA will approve Probuphine for opioid addiction, but dollars to donuts it will be prescribed off-label for other stuff. Also, doctors will up the doses—off-label. Because that’s what happens with drugs. Doctors aren’t bound to prescribe only for approved uses. And they don’t. And doctors usually don’t know much about the drugs they prescribe. Most doctors who prescribe buprenorphine have no idea how strong it is.
I bet you a dollar that many people with opioid addiction who try Probuphine will wind up with permanent bupe implants.
Because doctors know how to get us on this stuff, but they never know how to get us off.
BIG News: Whites Are Dying Of Overdoses.
omg, AND!!: whites are now dying of overdoses faster than blacks. Which is HUGE news.
Because guess which race makes up the majority of the NYT’s audience—and that of the other major media outlets (except AlJazeera).
For the past five or six decades, black heroin addicts have been dying from overdoses (and ancillary illness and crime), and their communities have been bombed out by the war on drugs, but their deaths and mass incarcerations have not spurred the kind of critical, apparently sympathetic spotlight that the media is now turning on white overdose deaths.
The headline (“Drug Overdoses Propel Rise in Mortality Rates of Young Whites”) says young people are dying fastest, but when you get to the graphs, you can see that among women, the age group that’s dying fastest is 45-54—my age group.
Eileen Crimmins, a professor of gerontology at the University of Southern California, said:
For too many, and especially for too many women, they are not in stable relationships, they don’t have jobs, they have children they can’t feed and clothe, and they have no support network.
It seems weird that they spoke to a gerontologist for this story, but in fact among white women it’s the older ones of us who are dying fastest.
We have no support network. She says.
Recovery is all about building a support network. It’s also all about finding out how we can contribute to society, which is how we earn a living.
It’s strange that the Times didn’t put these two stories together. After all, the thinking in one (“painkillers are killing whites”) leads directly into the other (“Probuphine will save painkiller addicts’ lives—because everyone knows dopefiends can’t stay off drugs any other way”).
That is the way treatment is headed, by and large.
There is no reliable science to show that people addicted to opioids have a tougher time staying off their drugs than anyone else addicted to any other drug, as long as we have access to a support network. But the popular idea is that we painkiller addicts have wrecked our neurology for good.
And this is the line scientists will take because their research is funded by pharma. This is the line pharma will take because it will sell more drugs. This is the line physicians will take because prescribing drugs takes less time in the consultation room and helps them avoid the time-consuming work of actually getting to know patients. And this is the line journalists will take because they don’t bother to challenge their “expert” sources’ thinking.
So why are we dying?
Painkillers kill pain—physical and emotional. They numb the human being.
In a larger sense, to get at the real cause of why we’re dying, we could ask what we’re numbing out. What is the pain that we’re bombing out with drugs?
That’s a discussion I’d love to participate in, and that would not only keep people alive in a minimal, technical way but rather help them thrive and also cultivate people’s overall long-term quality of life.
Update, August 2016
You know how I talk above about Probuphine being used off-label? Well guess what—this blog is now getting hits from people searching for “Probuphine off-label.” In the words of Pete Seeger, When will they ever learn?
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