Monday, July 23, 2018

Here's Your "Opioid Crisis": CDC Confirmation

(CDC MMWR July 13 2018) Fentanyl and fentanyl analogs are increasingly involved in opioid overdose deaths, and new fentanyl analogs continue to be identified (1). Carfentanil, the most potent fentanyl analog detected in the United States, is intended for sedation of large animals and is estimated to have 10,000 times the potency of morphine (2). It has recently been reported in an alarming number of deaths in some states. Ohio reported nearly 400 carfentanil-involved deaths during July–December 2016, and Florida reported >500 such deaths for all of 2016 (3,4).
CDC funds 32 states and the District of Columbia (DC) to abstract detailed data on opioid overdose deaths from death certificates and medical examiner and coroner reports through the State Unintentional Drug Overdose Reporting System (SUDORS). Twelve states began reporting in August 2017, and 20 states and DC will begin reporting in August 2018.* CDC analyzed trends in overdose deaths testing positive for carfentanil and other fentanyl analogs during July 2016–June 2017 in 10 SUDORS states (Kentucky, Maine, Massachusetts, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode Island, West Virginia, and Wisconsin). States abstract data on all substances (both opioids and nonopioids) that contributed to death, as well as all substances for which the decedent tested positive.§
During July 2016–June 2017, among 11,045 opioid overdose deaths, 2,275 (20.6%) decedents tested positive for any fentanyl analog, and 1,236 (11.2%) tested positive for carfentanil. Fourteen different fentanyl analogs were detected. Among overdose deaths with fentanyl analogs detected, the analogs were determined by medical examiners or coroners to have contributed to the death in >95% of deaths.

Exactly as I explained to you in a series of posts* way back last September, and now confirmed by months of multi-state research from the CDC, the only "opioid crisis" is more junkies dying from using garage-brewed fentanyl analogs.

Not from Doctor Feelgood writing too many narcotic prescriptions to Ma and Pa for chronic pain control.

Almost like I work at the bleeding edge of that problem, and might, perhaps, have some vague idea of those subjects upon which I speak. Oh, wait, that's exactly what I do.

In short, this is nothing but Darwinism in action, as the current home-cooked get-high concoctions are so strong, Narcan (the antidote of choice for plain old heroin) is too little, too late, so a generation of smack addicts is checking out with a smile on their face, and the needles still sticking in their arm.

Boo frickin' hoo.

I doubt you could find much sympathy for that problem nationwide, even if you dredged with concertina rolls. Even from the nexts-of-kin.

It also shows that the Clinton Foundation-sponsored calls to hype (you should forgive the pun) everyone to stock Narcan, down to pre-school first aid kits, won't do Jack or Squat to help the problem either.

Wait - the Clintons lying for...personal financial gain?? STOP THE PRESSES!!

Just kidding. What else would Clintons do?

If people won't learn not to try that sh*t, go ahead and let them have what they wanted.
The problem self-corrects in one dose, then solves itself forever.

If, however, you'd like to summarily execute the importers, garage-lab drug cookers, and dealers on sight, I have little or no problem with that.

It would also make it a lot tougher if you couldn't get the crap here, because the wall from San Diego to Brownsville was 20 feet high, and everyone trying to get into the country got the same level of groping, X-rays, and cavity searches the TSA routinely applies to handicapped children and 70-year-old Swedish nuns at the airport, while they're allegedly looking for Muslim terrorists.

I don't know everything about everything.
But what I do know about the things I know makes my analysis on it surer than most people's "facts".
Especially when there's a buck to be made in it, for the people selling baloney as steak.

* Linkage: 
Medical Statistics I
Medical Statistics II
Medical Statistics III
Proof Of the Point


Winston Smith said...

'Splain to me again why we don't want more dead felons......

Aesop said...

Sorry Winston...I got nothin'.

tweell said...

Ah, but if the powers that be continue on their course, folks in need will increasingly go for the illegal drugs. Presto, vindication!

Lord knows I was tempted in that direction when my wife was dying of cancer. She didn't have enough liver left to allow for chemo, there was nothing that could be done, and even in hospice I couldn't get her enough pain meds. If I had had a clue where to get illegal opiods, I would have done so.

Anonymous said...

While I don't doubt what you say is true, I have to wonder given the last paragraph you paste:

"During July 2016–June 2017, among 11,045 opioid overdose deaths, 2,275 (20.6%) decedents tested positive for any fentanyl analog, and 1,236 (11.2%) tested positive for carfentanil. Fourteen different fentanyl analogs were detected. Among overdose deaths with fentanyl analogs detected, the analogs were determined by medical examiners or coroners to have contributed to the death in >95% of deaths."

So about 1/5 of all OD deaths were caused by some fentanyl analog. How about the other 4/5 of OD deaths? I doubt that (with a few exceptions) those are the people targeted by the urge to "do something" (i.e. someone getting an opiod for pain management after breaking a hip), but I can picture TPTB using this to claim "only" 20% of ODs were these types of drugs and therefore the rest MUST'VE been from Tylenol with codiene, so we need to jail doctors who prescribe it too much. (Besides, arresting doctors is a lot safer than arresting those poor undocumented immigrants who are just selling the dope Americans won't sell).

Mark D

Anonymous said...

I have always had a fundamental problem with my tax dollars being used to fund revival of people too stupid to understand that opioids are bad things. Add in the cost for training of first responders, the lost opportunity for first responders responding to some other person experiencing a real crisis, the non-payment of hospital bills and other costs incurred by these addicts is an unfair burden to be placing on society. In almost all cases of Narcan revival, the addict will OD again in his/her near future. Give these people a hot shot and be done with them.


Aesop said...

@Mark D

All statistics have limits.

The report doesn't address that not all of the opioid death victims were tested for fentanyl. The tests usually also don't differentiate, nor AFAIK can they, between heroin or Rx meds.
(If anyone's a forensic pathologist, feel free to chime in...)

That part of the report is like saying that Mexican cartels get most of their guns from the US, until you read the fine print, and find out that's "of the guns that could be traced".

The point of the fentanyl analogs is their lethality, rather than necessarily their overall prevalence.

A perfect report would tell you exactly what had killed all those who died, but we have neither the time, the money, nor the scientific capability to say that with sufficient precision.

When a junkie dies with a needle in their arm, they're not going to assume they OD'ed on Percocet or Norco.
They might test for fentanyl and analogs for it, and the fact that it's showing up at all in 20% of decedents is yuuuuuge.

SiGraybeard said...

Next question: I'm just a freakin' engineer and I could see this wasn't about actual prescription pain meds.

So how come I can see it and our Ruling Class can't? How come our Philosopher Kings keep insisting it's better to keep normal people in chronic pain than crack down on heroin addicts? Is it just the corrupt people like the Clintons pocketing the millions, or is it something else?

We've talked about this since back when you did your original bunch of posts and more since then.

This problem ties together a lot of things: the border problems - which brings the abolish ICE movements, the MS-13 narrative and more, along with the nationwide move to legalize marijuana. It ties to the feces-and-discarded-needles-in-the-streets messes springing up from San Fransicko, El Lay, to Seattle. Is somebody trying to get heroin normalized, legalized, and provided on government subsidy?

Anybody check the Open Societies groups for this?

Aesop said...

My guess:

I think it comes down to controlling what they can, because they can, to fix what isn't broken until it is, then come up with a solution that isn't one, tax the whole thing, and pocket crony bux and cartel bribes on the side.

That scratches the itches of greed, power, control, and sadism, in exactly the same way fentanyl maxes out the opioid receptors in junkies.

The fact that it's driven in equal parts by their incompetence and their deliberate malign intervention is the engine, and the afterburner, on that powerplant. That it also kills the junkies while increasing the suffering of the innocents is all secondary to our would-be-overlords pleasing themselves, and getting us to pay for the privilege of entertaining them with our suffering. They'll just find new junkies, and torture a fresh batch of innocents, in due course, because they never imagine that the mule might someday buck them off.

This is why, at the end of the day, some people just need to be strung up by the neck, which will eventually be the only lasting solution.

Until the next batch arises.

RandyGC said...

I am in favor of first responders carrying NARCAN. Not for purposes of INS (Interfering with Natural Selection), but because we've a few cases of first responders walking into situations of getting a lethal contact dose of an opioid in the course of normal operations.

Locally they all know to take precautions when they get an OD call, but it's the non-OD calls that happen to have the stuff in the area that's becoming an issue.

Anonymous said...

For chronic pain patients this whole thing is getting incredibly frustrating and stressful when they of all people don't need more stress heaped on them. Living with chronic, unrelenting, constant pain makes life fucking miserable and having to jump through hoops every month and get treated like some smackhead junkie just adds to the fucking misery. God forbid your 30 day refill lands on a weekend or a holiday. Call the doctor every month, did the doctor's office call the pharmacy? they didn't? The doctor said they did. Play phone tag all day between the doctor's office and pharmacy. Sorry can't pick it up a day early so an extra 30 mile round trip to town. Sorry grandma you have to live in constant pain because somebody somewhere might be getting high on the same type of med you've been on for 20 years.

Getting something as mild as tramadol, which I don't think you can get high on if you tried, is a monthly exercise in frustration. Up until a while ago a physician could write a 6 month or a year scrip for it if he chose to. Even non-narcotics like Klonopin which can help knock back intractable neuropathic pain for spinal cord injury patients and diabetics are the next media crisis and overreaction. Hell, I read junkies are using imodium/loperamide to get high. They'll be requiring a prescription for that next.