“if you torture the data for long enough, you can make them say anything.”…I believe that is exactly what US CDC and DEA have been doing with their deliberate conflation and mischaracterization of research results on medical prescribing versus opioid-involved overdose mortality.
…richard lawhern ph.d
reported by
youarewithinthenorms.com
NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
SIMPLE MATH, SCIENCE, AND NEW STUDIES FIND DR. RANDY LAMARTINIERE, MD, “NOT GUILTY”
By Josh Bloom — August 9, 2022
A critically important paper in the journal Frontiers in Pain Medicine concludes that while the rationale for reducing opioid prescriptions to minimize overdose deaths was sound between 2006-2010, during the ensuing decade, the opposite was true. Reducing opioid prescriptions during this time dramatically increased deaths and hospitalizations. In other words, what worked 15 years ago is an unmitigated disaster at this time.
Although pain patients and advocates have been screaming about these abuses – mostly on deaf ears – for years, they have been largely ignored. Still, a new study in the journal Frontiers in Pain Medicine demonstrates exactly how wrong-headed our prohibitionist policies have been. The study is long and complex, containing 37 references. I will focus only on the highlights and overall message – that the policy of severe restriction of prescribed opioid drugs may have saved lives 20 years ago, but times have changed.
Following is a set of facts that both pain patients and those who advocate for them are only too familiar with:
- There is no longer a surplus of prescription opioid pain medications in the United States. If anything, there is a “shortage” because doctors and hospitals face pressure, legal and otherwise, to limit the number of pills they prescribe, regardless of the needs of patients.
- This has had devastating consequences for both users and abusers of these drugs as well as doctors, especially those who practice pain management, as the DEA counts every pill that is prescribed and persecutes physicians who “overprescribe.”
- While drugs like oxycodone and hydrocodone were abused with deadly consequences (a positive correlation between prescriptions and deaths) two decades ago this is no longer true.
- Now, heroin, illicit fentanyl and its analogs, and illegal stimulants are the drivers of overdose deaths to the point where prescription opioids now play only a minor part.
- Within the past decade, efforts to further curtail prescriptions have served only to exacerbate overdose fatalities (a negative correlation between prescriptions and deaths) as well as cause unbearable situations for chronic pain patients who have had their medicines forcibly tapered. (Please remind me what country we are living in and how patient rights are (allegedly) of paramount importance).
- Much of this carnage, in my opinion, can be laid at the feet of the Physicians for Responsible Opioid Prescribing (PROP), a shadowy but influential group of self-appointed experts whose members benefit handsomely by becoming highly paid “expert witnesses” representing states that are seeking huge verdicts against manufacturers and distributors of prescription opioids, regardless of whether the company being shaken down has done anything wrong or not.
Aubry and Carr don’t mince words [emphasis mine]:
“The direct correlations used to justify the CDC guideline and guideline update that existed from 1999 to 2010 are no longer present. Starting in 2010… relationships [between prescribing and overdoses] changed from direct to inverse... These results hold on a national level, in a large majority of states, and even among patients receiving opioid dosages greater than the recommended maximum dosage in the guideline (much less the reduced maximum dosage recommended in the guideline update). Based on the results presented in this paper and the current trends in opioid deaths, the policies of cutting [prescription opioid sales[ to prevent deaths and hospital admissions… are unfounded and ineffective.”
THE MORPHINE MILLIGRAM EQUIVALENT IS A FLAWED CONCEPT OF DOSING
The morphine milligram equivalent (MME) dosing is a widely misused approach to standardize and compare the potency of different opioid medications based on their morphine-equivalent dose.
It is based on the assumption that all opioids have equivalent analgesic potency when administered in equianalgesic doses. However, there are some major flaws and limitations to this approach, including:
- Variability of individual response: Patients can vary in their individual response to opioids, and the same dose of a medication can produce different effects in different patients. The MME dosing approach does not consider these individual differences and may lead to inaccurate dosing recommendations for some patients.
- Different pharmacokinetics and pharmacodynamics: Different opioids have different pharmacokinetic and pharmacodynamic properties, which can affect their potency and duration of action. The MME dosing approach does not consider these differences and assumes that all opioids are equally potent, which can result in inaccurate dosing recommendations.
- Lack of consideration of patient characteristics: Patient characteristics such as age, weight, medical conditions, and medication use can affect their response to opioids. The MME dosing approach does not consider these patient factors and may lead to inappropriate dosing recommendations for some patients.
- Inadequate consideration of the risk of overdose: The MME dosing approach focuses primarily on the potency of opioids and does not adequately consider the risk of overdose and other adverse events. This can lead to the overprescribing of opioids and contribute to the opioid epidemic.
Does the sacred 90 MME limit make opioid use safer?
Perhaps where our opioid policies fail worst is the insistence that doctors and patients adhere to the 90 MME or less rule, something I have thoroughly taken apart. Not only is the SCIENTIFIC origin of the 90 MME maximum daily dose mysterious but there is no evidence that it is anything more than an arbitrary number – a dose that could be too high for one patient and too low for another. Safety is one of the arguments for establishing a maximum daily dose, but the Frontiers in Pain Research paper suggests that this is dead wrong.
** Chart was edited for clarity and to remove unnecessary data.
The five values indicate that between 2006-2010, There was an excellent correlation (strong model) between:
- Per capita prescribed MME (morphine milligram equivalents) and opioid sales – something that should be obvious. When more opioids are prescribed more will be consumed.
- Total overdose deaths and prescribed per capita MME (from any opioid) and overdose deaths. The more prescription opioid pills available, the more overdose deaths.
- Overdose deaths (from any opioid) and prescribed per capita MME and overdose deaths. The more opioid pills available, the more overdose deaths.
- Overdose deaths (from all opioids) and prescribed per capita MME and overdose deaths.
- The more prescriptions, the more hospital admissions.
So, it is not surprising that Aubry and Carr conclude (4):
For the years covered in the CDC’s original chart (for which MME per Capita data are available, i.e., 2006–2010), the CDC’s claim of positive/direct relationships between TOD [total opioid deaths], AOD [all opioid deaths], POD [prescription opioid deaths], and OTA [Opioid Treatment Admissions/addiction] and Annual Prescription Opioid Sales (i.e., MME per Capita) were validated (91% < R2 <97%), with statistically significant, positive slopes.
Aubry and Carr, Front. Pain Res., 04 August 2022
Sec. Pain Research Methods, https://doi.org/10.3389/fpain.2022.884674
THE GREAT PROSECUTORIAL DECEPTION IN LAW
“OPIOID EPIDEMIC”
IN ESSENCE, DR. RANDY LAMARTINIERE, MD WAS FOUND GUILTY OF PRACTICING MEDICINE CORRECTLY
The Food and Drug Administration (FDA) is responsible for protecting public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation.
It is so ordered.
While one might assume that reducing high-dose opioid administration would prevent opioid-related problems, in fact, the opposite is true:
- The number of prescriptions for greater than 90 MME per day had a strong negative correlation with all overdose deaths and hospital admissions.
- There was no correlation between the number of high-dose prescriptions and deaths from all prescription opioids. No, high-dose prescription opioids do not contribute to overdose deaths.
Perhaps someone from PROP or the CDC can explain this to me because it sure looks like prescribing opioids, whether in high, low, or medium doses has no impact on overdose deaths. Could it perhaps be because the pills are a whole lot safer than the heroin and illicit fentanyl that replaced them?
PATIENT ADVOCATE SCREAMING “MOSTLY ON DEAF EARS“
Susan:
It’s worse now; 2022 now drops; the mme is 50. What we need us to get into congress and intact hearings, including all who were not considered in this new recommendation! Patients, pain mgmt doctors, caretakers, advocates..we have so many pain groups on social media, but it’s support for each other. Basically, we need The News, and personalities, no one listens to us!!
Our Doctors don’t hear us, and the ones that do get arrested!! I’m into these pain diseases for 19 years, CRPS 2, cold, and severe deg disc disease 11 surgeries, and need another; I’m afraid I won’t get adequate pain relief going forward..
I need a cervical to Thoratic surgery to take out all hardware, put in a rod, graph my hip bone! My surgeries were messed up being hit twice at a red light, first was a fully loaded dump truck, 2, was a car at 50 miles per hour that plowed into myself and my husband.
Since, no surgery yet, I now have daily migraines 2-3 a day. My neck is so bad, sleeping is a nightmare too; sleeping upright isn’t that easy.. I’m disgusted with this all, substituting meds for injections that don’t work, but if u say no, they dismiss you, and cut u off!!
We need an act of congress. Obviously, the Ruan decision has done nothing to stop the DEA it, CDC…. Stop the suffering, we hv constitutional rights, and they are being abused…
Thank you
Susanseidmangarcia @ gmail.com
Dian Barnard:
It’s a shame the prosecutors want to come up with anything to win and throwing justice out of the window is appalling! The Holy Trinity was not in any way connected to medical professionals. Just because the police or DEA uses those words doesn’t mean it’s medically disallowed. I would rather trust a doctor on the legal prescribing standard, not the government. What proof did they have? Just someone say so?
C-span video Beau Brindley
https://www.c-span.org/person/?133432/BeauBrindley
Beau Brindley, defense attorney for Drs Steven Henson, Dr. Shakeel Kahn, MD, Dr. Paul Volkman, MD and Dr. Randy Lamartinere, states:
“Beginning with the reversal of Dr. Shakeel Kahn’s conviction, and now the reversal of Dr. Steven Henson’s, my office continues its efforts to dismantle a corrupt system that has scapegoated doctors for an opiate crisis for which they are not responsible.
No more will mere negligence be morphed into drug trafficking by federal prosecutors who want to appear to be fighting the opiate crisis while actually punishing chronic pain patients who need their doctors.”
This Court must accept the decision of Ruan-Khan, decided 9-0 by the Supreme Court of The United States of America, and vacate the guilty verdict of Dr. Randy Lamartiniere, “SO SAY WE ALL.”
FOR NOW, YOU ARE WITHIN
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references:
The Food and Drug Administration (FDA) is responsible for protecting public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation.
