{"id":273156,"date":"2024-09-09T12:00:06","date_gmt":"2024-09-09T11:00:06","guid":{"rendered":"https:\/\/www.transcend.org\/tms\/?p=273156"},"modified":"2025-01-10T15:03:27","modified_gmt":"2025-01-10T15:03:27","slug":"how-the-opiate-conspiracy-widened","status":"publish","type":"post","link":"https:\/\/www.transcend.org\/tms\/2024\/09\/how-the-opiate-conspiracy-widened\/","title":{"rendered":"How the Opiate Conspiracy Widened"},"content":{"rendered":"

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Part III in a series about the sociopathic push by big pharma to cash in on opiate production.
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5 Sep 2024 <\/em>– Many businesses will gleefully sell you a harmful addiction.<\/p>\n

The tobacco industry was supposedly subdued decades ago<\/a> by a historic legal beat-down, yet somehow spends $22 million every day<\/em> promoting its wares. That\u2019s nearly<\/a> a million dollars an hour. Websites for kids<\/a> sport vaping ads. \u201cCigfluencers<\/a>\u201d work the podcasts. And movies are smoke-choked like never before.<\/p>\n

There was a time when a cigarette company could pay a mere $43,000<\/a> for Superman to be thrown into a Marlboro truck by the evil General Zod in front of Marlboro-smoker Lois Lane. (She had never smoked in the comic books, by the way.)<\/p>\n

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\u201cKneel before Zod<\/s> Philip Morris!\u201d<\/figcaption><\/figure>\n<\/div>\n

These days, modern Hollywood supposedly disdains tobacco cash. Yet somehow the movies remain one long, glamorous advertisement for cigarettes. Of this year\u2019s ten Oscar Best Picture nominees, nine<\/a> featured seductive and edgy smoking. (Only \u201cBarbie\u201d did not.)<\/p>\n

The marketeers assure us we\u2019ll be inhaling happiness and hipness. Maybe so, but there are also those hot, lung-damaging fumes \u2014 a reality that eventually catches up and kills about half a million<\/a> of us every year.<\/p>\n

(Brief digression: COVID-19 had a U.S. death toll of about 1.2 million<\/a> over three tough years. Many COVID-19 victims were also smokers, so it\u2019s hard to compare the pandemic and smoking death tolls. That said, we can certainly compare the public health responses<\/em>. When COVID-19 arrived, we shut down the entire planet, and the virus would go on to kill an average of 400,000 Americans a year for three years.<\/em> Smoking has been here all along \u2014 glamorized, marketed to kids \u2014 cheerfully killing 500,000 Americans <\/em>a year, every year, forever.)<\/p>\n

This series focuses on the Opioid Crisis, which has also killed hundreds of thousands and wrecked the lives of millions. But more people are killed each year by tobacco than by opioids \u2014 six times<\/em> more.<\/em> Smokers die 10 years younger<\/a> on average than non-smokers, and even that understates it, because smokers don\u2019t go out easily. Their later years are often needlessly miserable. In the emergency department, I see patients addicted to opioids, including many we have revived after life-threatening overdoses and some we have pronounced dead. But I see far more who have destroyed their lungs. I\u2019ve known many of the longest-suffering smokers for years. They routinely arrive by ambulance struggling to breathe. And many, even those dependent on oxygen, still smoke.<\/p>\n

The tobacco industry has worked hard to cloud our collective understanding of their \u201cproduct\u201d \u2014 which is still the single greatest cause of avoidable mortality in America. They\u2019ve done so via everything from those vintage ads that portrayed \u201cdoctors\u201d lighting up, to the pseudoscience churned out by modern think tanks.<\/a><\/p>\n

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Courtesy of the Truth Tobacco Industry Documents database<\/a>.<\/figcaption><\/figure>\n<\/div>\n

And yet, by comparison, the opioid industry remains a uniquely depressing case.<\/p>\n

It is one thing for a profit-seeking corporation to sell ordinary people a frivolous activity \u2014 smoking cigarettes, binging alcohol, gorging on junk food \u2014 that is harmful. But the opioid manufacturers achieved an entirely new level of immorality. They used actual<\/em> doctors<\/em> to sell their wares \u2014 not a few avuncular, smoking actors in white coats, but tens of thousands of doctors and nurse practitioners. Opioids were not offered as a luxury item or a lifestyle choice, but as solemn and necessary medicine. This was a prescribed addiction. (In one study, four out of five people newly addicted to heroin started with<\/a> a physician\u2019s prescription.) And those who eagerly took cash to help sell this were not sleazy movie studios or soulless social media \u201cinfluencers\u201d, but the most trusted institutions of the House of Medicine.<\/p>\n

Anatomy of a Long Con<\/h4>\n

First comes an idea: Tell doctors that the New England Journal of Medicine<\/em> has discovered that opioids aren\u2019t addictive. How? Easy. Cite a years-old, five-sentence letter to the editor called \u201cPorter & Jick\u201d (see Part II<\/a>). The letter doesn\u2019t actually say that, but the New England Journal<\/em>\u2019s archives also aren\u2019t online before 2011, so for many years the busy, practicing physician won\u2019t find it easy to double-check such claims. Spreadsheets from opioid manufacturers (again, see Part II<\/a>) showed how methodically that fake literature base was generated. One pharmaceutical company made a spoof \u201cDr. Evil\u201d motivational video<\/a> for its staff inviting them all to laugh at how seriously doctors took these \u201cstudies\u201d.<\/p>\n

The next stage: Create trainings and seminars based on this fake literature base. Pay the leading institutions in medicine \u2014 including those that represent all doctors<\/em>, license all doctors<\/em>, and accredit all hospitals<\/em> \u2014 to host said \u201ctrainings.\u201d Force doctors and nurses to sit docilely in the audience, taking notes.<\/p>\n

Every Respectable Source of Medical Education Was Corrupted<\/h4>\n

Doctors and nurses are expected to keep up with medical science. It\u2019s an onus placed upon each individual, and it\u2019s expensive. For example, I spent $579 this year subscribing to Emergency Medicine Abstracts<\/a>\u00a0(\u201cWe review over 600 medical journals each month so you don\u2019t have to\u201d) and an affiliated audio series called\u00a0EM:RAP<\/a>\u00a0(Emergency Medicine Reviews and Perspectives). I also pay $500 a year to be a member of the\u00a0Massachusetts Medical Society<\/a>, which comes with a\u00a0New England Journal of Medicine<\/em>\u00a0subscription. I read the monthly Emergency Medicine News<\/a><\/em>, and I participate in hospital-based online and in-person trainings.<\/p>\n

Some of this I do in a spirit of self-improvement. But I also need continuing medical education credits \u2014 CMEs \u2014 to stay licensed. How many credits, and on what topics, varies by medical specialty and from state to state. (The Federation of State Medical Boards has a summary page here<\/a>.)<\/p>\n

Everyone needs CME. We keep an eye out for it, and welcome it when it\u2019s from a respectable source. So, if the American Medical Association \u2014 the epitome of button-down respectability \u2014 has a CME program, that\u2019s got to be worth a listen, right?<\/p>\n

Well, maybe not:<\/p>\n

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The AMA\u2019s CME courses<\/a> about pain management were assembled and funded by Purdue money.<\/figcaption><\/figure>\n<\/div>\n

CME programs sponsored by the AMA about pain management were prepared by Purdue Pharma-paid physicians in 2003, 2007, 2010 and 2013. For much of this time, the OxyContin\u00ae-maker was also lavishing millions<\/a> of dollars upon the AMA and its associated AMA Foundation, while Purdue\u2019s President Richard Sackler was sitting<\/a> on the AMA Foundation\u2019s board of directors. Even as late as 2016, Purdue was still one of only two \u201cPlatinum Level\u201d donors to the AMA Foundation.<\/p>\n

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The AMA Foundation\u2019s archived website<\/a> thanking Purdue for \u201csupporting public health and medical education.\u201d<\/figcaption><\/figure>\n<\/div>\n

Key context: Most of this is happening years and years after<\/em> Purdue had already pled guilty<\/a> (in 2007) to fraud and intentional<\/em> deception aimed at creating a world of recklessly liberal opioid prescribing. Purdue admitted it did that, cut the government a check for about 5 percent, and then, as we will see, doubled down on even more egregious<\/em> fraud and deception \u2014 some of that rolled out in these AMA courses.<\/p>\n

What was the AMA, courtesy of opioid-funded marketing<\/s> medical education, teaching us? Advil\u00ae and Motrin\u00ae are dangerous; opioids are safe.<\/p>\n

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From paragraph 256, pg. 107, of the 2015\u00a0Mississippi lawsuit<\/a>. \u201cNSAIDs\u201d are non-steroidal anti-inflammatory drugs like ibuprofen (Advil\u00ae, Motrin\u00ae) and naproxen (Aleve\u00ae). A \u201cKOL\u201d is Pharmaspeak for a \u201cKey Opinion Leader\u201d. Dr. Portenoy was introduced in Part II<\/a> of this series. I have been unable to reach him for comment.<\/figcaption><\/figure>\n<\/div>\n

State Medical Licensing Boards Are Bought Off<\/h4>\n

The AMA sounds like baseball, apple pie and patriotism. It\u2019s the American<\/em> Medical Association, all but wrapped in the flag. But in reality, it\u2019s always been a\u00a0money-focused<\/a> lobbying group. (AMA did not respond to my questions). So, maybe it\u2019s just an outlier? Surely one can trust the Federation of State Medical Boards, if that body chooses to publish guidelines and a 2007 book,\u00a0Responsible Opioid Prescribing<\/em>\u00a0\u2014 proudly described as the \u201cleading continuing medication education (CME) activity for prescribers of opioid medications.\u201d<\/p>\n

After all, if you\u00a0don\u2019t\u00a0prescribe responsibly, it\u2019s the\u00a0state medical board\u00a0that comes for you!<\/p>\n

Yet opioid manufacturers\u00a0also wrote<\/a>\u00a0most of this FSMB booklet. (The Wall Street Journal <\/em>reports<\/a>\u00a0Purdue\u2019s Dr. David Haddox was particularly active.) Companies including Cephalon<\/a>, Endo<\/a> and Purdue then paid the FSMB more than $250,000 to distribute 163,000 copies to physicians. For context, there are\u00a0about 1 million<\/a>\u00a0licensed physicians nationwide \u2014 so that\u2019s one booklet for every six physicians.<\/p>\n

In fact, the FSMB was showered with more than $2 million in opioid cash over the next few years, while opioid manufacturer sales reps marched door to door, hand-delivering these booklets to doctors and nurse practitioners at primary care offices. The Mississippi lawsuit notes (paragraph 163, pg. 60<\/a>) this was a powerful signal:<\/p>\n

Drug companies relied on FSMB guidelines to convey the message that \u201cundertreatment of pain\u201d would result in official discipline \u2026 doctors, who used to believe that they would be disciplined if their patients\u00a0became addicted<\/em>\u00a0to opioids, were [now being] taught that they would be punished instead if they\u00a0failed to prescribe<\/em>\u00a0opioids.<\/p><\/blockquote>\n

Opioid manufacturers found\u00a0Responsible Opioid Prescribing<\/em>\u00a0so business-friendly that they had their sales reps bring it to thousands of pharmacists, too. The New York attorney general\u2019s lawsuit (paragraph 554, pg. 150<\/a>) says the booklet:<\/p>\n

taught that behaviors such as \u201crequesting drugs by name,\u201d \u201cdemanding or manipulative behavior,\u201d seeing more than one doctor to obtain opioids, and hoarding, were not signs of addiction but were all really signs of \u201cpseudoaddiction<\/a>.\u201d<\/p><\/blockquote>\n

\u201cPain\u201d is Abruptly Declared a Vital Sign<\/h4>\n

Enter the Joint Commission on Accrediting Healthcare Organizations, or JCAHO (pronounced JAY-Co). This non-profit used its enormous influence to insist, starting in 2001, that every hospital formally measure the pain of every patient.<\/p>\n

It didn\u2019t matter why the patient was there. It could be for a psychiatric crisis, or a pregnancy well-check. We still had to measure their pain. At the Joint Commission\u2019s suggestion, many hospitals began to use 0-to-10 pain scale charts, examples of which can still be found sporting the Purdue logo:<\/p>\n

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From pg. 21 of\u00a0California\u2019s 2019 lawsuit<\/a>\u00a0against Purdue Pharma. Note the Purdue copyright in the bottom left. PartnersAgainstPain.com was also Purdue-affiliated.<\/figcaption><\/figure>\n<\/div>\n

What is the implication of being repeatedly asked, on a schedule, to focus all attention on your pain?<\/p>\n

Imagine being asked out of nowhere to \u201crate your headache.\u201d Surprised, you say, \u201cWell, I don\u2019t have a headache!\u201d A little later, the nurse comes back, because it\u2019s time to talk again about your headache. Do you think you might eventually feel a little headache coming on? If so, the good news is that we have a for-profit medication for that.<\/p>\n

Some of us wryly suggested the Joint Commission ought to address constipation. It was under-assessed, undertreated, a national crisis! Every patient could report their bowel motility on a 0-to-10 scale, and we could medicate to a constipation score of zero. Life in the ER would be one long colonoscopy prep \u2014 but think of the MiraLax\u00ae revenues!<\/p>\n

Never mind. The Joint Commission went further, and arbitrarily declared that the symptom known as \u201cpain\u201d was now a vital sign. It was to be checked regularly, right alongside the actual<\/em> vital signs of blood pressure, respiratory rate, heart rate and temperature.<\/p>\n

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From the Joint Commission\u2019s 2001 Pain Standards<\/a>.<\/figcaption><\/figure>\n<\/div>\n

And it was not just every civilian hospital that would now consider \u201cpain\u201d a vital sign. The Department of Veterans Affairs simultaneously mandated this<\/a> throughout military health institutions. Over at Purdue Pharma, Richard Sackler would\u00a0make sure<\/a>\u00a0his company bought the rights to\u00a0www.5thvitalsign.com<\/strong>. This was going to be gold for them.<\/p>\n

The 100 Days is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.<\/p>\n

On a Scale from 0 to 10, How Much Do You Want Us to Care?<\/h4>\n

Patients asked to \u201crate their pain level\u201d were supposed to understand a score of 10 as the worst pain they\u2019d ever felt or could imagine:<\/p>\n

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While Purdue\u2019s \u201cPartners Against Pain\u201d website is gone, its Purdue-branded pain scales can still be found in corners<\/a> of the Internet.<\/figcaption><\/figure>\n<\/div>\n

Actually, though, patients almost always heard something else:<\/p>\n

\u201cOn a scale of 0 to 10, how much do you want the nurse to pretend to care?\u201d<\/p>\n

Or:<\/p>\n

\u201cOn a scale of 0 to 10, how frustrated and unhappy are you about being here?\u201d<\/p>\n

Some sort of \u201cvital sign\u201d number would emerge from this charade \u2014 and long-standing tradition holds that the doctor must address an abnormal vital sign. Nurses, prodded by Joint Commission-fearing hospital administrators, were poking doctors at regular intervals, and documenting things like: \u201cMD aware of ongoing 7 of 10 pain, this RN awaits orders.\u201d<\/p>\n

The Joint Commission went further. It mandated<\/a> posters on the walls in all patient care areas (including exam rooms and waiting rooms), which should declare: \u201cAll patients have a right to pain relief.\u201d<\/p>\n

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From the Joint Commission\u2019s 2001 Pain Standards.<\/a> Hospitals had to agree to this to stay accredited.<\/figcaption><\/figure>\n<\/div>\n

These posters would become the ally of every addicted-to-OxyContin\u00ae person who ever faked a toothache. They would clutch their face and moan, and indignantly point at the wall.<\/p>\n

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A typical poster<\/a> up in ED waiting rooms from this era. It tells the patients that \u201ctreating pain is our [the hospital\u2019s] responsibility.\u201d It also says that \u201cstudies\u201d \u2014 more accurately, \u201cfake studies created by marketing departments that mostly cite a decades-old five-sentence letter to the editor called Porter & Jick\u201d<\/em> \u2014 \u201cshow that addiction is unlikely. Let\u2019s talk about your fears.\u201d<\/figcaption><\/figure>\n<\/div>\n

Under Joint Commission pressure, \u201cpatient satisfaction\u201d was surveyed, and physician groups could collectively lose money for low satisfaction scores. In a 2003 publication<\/a>, the Joint Commission even warned doctors we could get in legal trouble for not giving enough <\/em>drugs: \u201cRecent court cases concerning patients with unrelieved pain,\u201d the publication warned, show that doctors face \u201cnot only the investigation of the overprescription of opioids but increasingly the study of cases of underprescribing.\u201d<\/p>\n

Soon, the Joint Commission (it doesn\u2019t go by JCAHO anymore) was hosting Purdue-designed and -financed CME trainings about it all:<\/p>\n

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One of several Purdue-Joint Commission collaborations.\u00a0Accessed<\/a>\u00a0at UCSF\u2019s Library of\u00a0Opioid Industry Documents<\/a>.<\/figcaption><\/figure>\n<\/div>\n

So here we were. The national groups speaking for all doctors (the AMA), licensing all the doctors (the FSMB), and accrediting all of the hospitals (the Joint Commission), were reveling in opioid cash and singing to the same tune. They were providing doctors and nurses with mandatory \u201ceducation\u201d; forcing us to document that we were giving lots of opioids; warning us we could get in legal or other trouble if the patient <\/em>reported not getting enough pain control.<\/p>\n

The Emergency Department learns to loathe the Joint Commission<\/h4>\n

It was in this era that emergency departments came to solidify our deep and abiding hatred of the Joint Commission. We already loathed the occasional site visits. Middle managers \u2014 terrified that the hospital might somehow lose the favor of medicine\u2019s Death Star and be all but vaporized \u2014 would appear in the ED for the first time in months, or sometimes even years, to tell doctors we could not have a cup of coffee next to our computer because \u201cthe Joint Commission is coming!\u201d<\/p>\n

The Joint Commission thinks it is unfair we blame it for that, and indignantly denies<\/a> that they try to police where the doctors or nurses eat or drink. They say they\u2019re just enforcing federal government workplace safety rules \u2014 it\u2019s not their fault, blame the Feds! Also, they elaborate helpfully<\/a>, as long as no food or drink is near any \u201ccabinets, shelves, counters\u201d or \u201cwork surfaces\u201d \u201cwhere the potential for contamination\u201d exists, everything should be fine!<\/p>\n

I am not alone in having had my paper cup of coffee ceremonially thrown away for my own safety and because \u201cthe Joint Commission is coming!\u201d<\/p>\n

All of which is backstory to the nightmare now unleashed on EDs with the \u201cpain is the 5th vital sign\u201d campaign, and the wall posters about patients\u2019 rights to drugs. People addicted to opioids began pouring angrily into the EDs. The posters on the hospital wall told them we doctors had<\/em> to give them Oxys! We had to do it! Opioid manufacturers had also been running a national multimedia campaign \u2014 with radio and television ads, and patient-facing web pages \u2014 to educate the public about their \u201cright\u201d to pain treatment. Such \u201cknow your rights\u201d campaigns sent even more opioid-hungry people charging furiously our way.<\/p>\n

Many spooked doctors would oblige with a dose of intravenous hydromorphone, known to all by the Purdue Pharma brand-name Dilaudid\u00ae. It is a synthetic opioid, similar to fentanyl but as every ED nurse knows, even more euphoric. Many an addict has requested it by name. Despite the \u201cstudies\u201d (Dr. Evil air quotes) that FSMB and others were boosting about the absurd \u201cpseudoaddiction\u201d concept, having someone scream in your face \u201cGet me Dilaudid!\u201d is probably a red flag for actual addiction.<\/p>\n

Doctors who refused would have to mentally prepare beforehand for the angry and emotionally manipulative confrontations: \u201cYou\u2019re a terrible doctor! You\u2019re going to force<\/em> me to go buy heroin<\/em> to treat this pain! You<\/em> are going to make me a heroin addict! I\u2019m probably going to die from heroin <\/em>because you<\/em> won\u2019t do your job!\u201d<\/p>\n

Over time, the cunning opioid-seekers would present more sympathetically, in apparent extremis \u2014 \u201cMy back! My back!\u201d \u2014 and then, instead of imperious demands, they would, through gasps of pain, tell us this had happened before, and \u201cthe only thing that worked was a drug that begins with a D, it was called D-something.\u201d<\/p>\n

Across America, the patient asking for \u201cthe drug that begins with a D\u201d is a known emergency medicine trope. As a medical student in Washington D.C., I once watched in horrified awe as a resident physician innocently named two dozen drugs that began with the letter D, pretending to try to figure out what the ever-more-frustrated patient wanted:<\/p>\n

\u201cWas it Diphenhydramine?\u201d
\n\u201cNo.\u201d
\n\u201cDoxycycline?\u201d
\n\u201cUh, No.\u201d
\n\u201cDarbepoetin?\u201d
\n\u201cNo.\u201d
\n\u201cDicyclomine! I bet it was Dicyclomine! No? Hmm. Diltiazem?\u201d
\n\u201cNo!\u201d
\n\u201cDivalproate? Doxylamine? Dobutamine? Dulcolax? Digoxin? Dexmedetomidine? Duloxetine? Diflucan?\u201d<\/em><\/p><\/blockquote>\n

On other occasions, when an ED team did not have the energy or bandwidth to manage a manipulative and threatening patient, they might pay him off to leave with a script for, say, 20 oxycodone tablets.<\/p>\n

Over the years, as the overdose cases poured in and the death toll soared, the Joint Commission began to have second thoughts. The \u201cright to pain relief\u201d posters came down. Everyone tried to pretend that the \u201cpain is a vital sign\u201d campaign had never happened. ED doctors began to push back, and to criticize colleagues who\u2019d negotiate with terrorists. In some places, new posters went up on the walls, declaring this was an \u201cOxy-Free ED<\/a>\u201d \u2014 warning patients up front not to expect to leave with an opioid prescription. (My physician group in Massachusetts tried to put such posters up in 2015, but the lawyers said we couldn\u2019t.)<\/p>\n

Either way, the new hard line \u2014 don\u2019t expect to leave with an opioid prescription unless your shattered femur was sticking out of your thigh \u2014 corresponded with a relatively rapid disappearance of the manipulative, demanding opioid-seeker. They mostly stopped coming. At this same time, OxyContin\u00ae was reformulated to make it harder to grind up and inject; and CDC reports a second wave of the Opioid Crisis kicked off with the rise of heroin. Just as threatened, they all did go buy heroin instead:<\/p>\n

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From the CDC website. The Opioid Crisis starts in the 1990s with prescriptions. Then in 2010, OxyContin\u00ae is made abuse-resistant even as EDs start pushing back against the madness being preached by the AMA, the Federation of State Medical Boards and the Joint Commission \u2014 and thus the addicted, in 2010 or so, turn to heroin, followed soon by cheaper fentanyl.<\/p><\/div>\n

The Joint Commission: Defiantly Contrite, Owning up to Nothing<\/h4>\n

Cities and towns enraged by the opioid crisis have sued<\/a>\u00a0the Joint Commission. (This non-profit brought in more than<\/a> $250 million in 2022). It has issued halfhearted\u00a0mea culpas.<\/em>\u00a0A few years ago, a top official there\u00a0e-mailed\u00a0<\/a>CNN<\/a><\/em>\u00a0to agree that insistently telling doctors to stop with the \u201cexaggerated\u201d concerns about addiction \u201cwas an important contributor to inappropriate prescribing patterns for opioids and the subsequent opioid epidemic.\u201d He went on to admit:<\/p>\n

\u201cThe Joint Commission was one of the dozens of individual authors and organizations that developed educational materials for pain management that propagated this erroneous information.\u201d<\/p><\/blockquote>\n

Two longer articles by the same Joint Commission leader, published in 2017 first<\/a> in the\u00a0Journal of the American Medical Association<\/em> and then as a freestanding pamphlet<\/a>, were more defiant. Crucially: Neither ever mentions that the Joint Commission took money from Purdue Pharma and others in return for letting opioid manufacturers design and run Joint Commission-branded \u201ceducation\u201d.<\/p>\n

Of course not. Why go there?\u00a0(When I asked the Joint Commission, a 501\u00a93 charity, who paid them how much, they replied they \u201ccannot comment on topics that are currently under legal review.\u201d)<\/p>\n

Instead, we are told the Joint Commission erred out of\u00a0enthusiasm<\/em>\u00a0\u2014 it was swept up in \u201ca bold attempt to address widespread undertreatment and underassessment of pain\u201d \u2014 never mind that this was probably never a widespread <\/em>problem in the first place, until opioid-makers started shrieking otherwise. (Again, the Joint Commission accredits hospitals<\/em>. We are talking about people who show up in pain at the hospital<\/em>. They have a kidney stone, or broke three ribs falling off of a ladder, and now they\u2019re at the hospital for that<\/em>. Not providing pain medication for these people would be like Starbucks not making coffees. So, how<\/em> was it decided that their pain was not getting assessed or treated? By opioid manufacturers, that\u2019s how.)<\/p>\n

The Joint Commission states that, alas, it had to step forward: \u201cMany doctors were afraid to prescribe opioids despite a widely-cited article suggesting that addiction was rare when opioids were used for short-term pain\u201d \u2014 that widely-cited article being \u2014 incredibly \u2014 wait for it \u2014 yes \u2014 the by-then infamous Porter & Jick five-sentence letter to the editor.<\/p>\n

It\u2019s a nice demonstration of the intellectual fogginess of this world that the same author<\/em>, in a list of \u201clessons learned\u201d, concludes his same article<\/em> by complaining about everyone else\u2019s<\/em>\u00a0over-reliance on the flawed Porter & Jick letter \u2014 apparently forgetting he had just cited it above to justify bold action:<\/p>\n

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The Joint Commission was concerned that doctors across America weren\u2019t slinging opioids fast enough, even though marketing departments had been \u201cwidely citing\u201d and misrepresenting a five-sentence letter, and urging us to do so. So, the commission stepped in, and forced hospitals to give more opioids. Later, when this blew up in their face, the commission complained (in passive voice) that a five-sentence letter from the 1980s never deserved all of this attention \u2014 completely missing the point that this letter was intentionally<\/em> misused, as part of a conspiracy by opioid manufacturers.<\/figcaption><\/figure>\n<\/div>\n

_____________________________________________<\/p>\n

\"\"<\/a>Matt Bivens, M.D. is a full-time ER doctor. Board-certified in emergency and addiction medicine. EMS medical director for 911 services. Former Russia-based foreign correspondent, newspaper editor and Chechnya war correspondent. Reluctant student of nuclear weapons.<\/em><\/p>\n

 <\/p>\n

Next time, Part IV<\/strong>: Is there anyone in medicine who can\u2019t be bought?<\/p>\n

Part I:<\/a> A deep dive into the sociopathy of the Opioid Crisis.
\nPart II:<\/a> The conspiracy to game the medical literature.
\nPart III<\/strong>: The conspiracy widens.<\/em><\/p>\n

Go to Original – racket.news<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

5 Sep 2024 – Preying on Pain – Many businesses will gleefully sell you a harmful addiction. The sociopathic push by big pharma to cash in on opiate production. <\/p>\n","protected":false},"author":4,"featured_media":273159,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[242],"tags":[887,232,2357,857,1563,734,1717,1102,70],"class_list":["post-273156","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exposures","tag-big-pharma","tag-capitalism","tag-emotional-health","tag-exploitation","tag-expose","tag-mental-health","tag-opioids","tag-public-health","tag-usa"],"_links":{"self":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/273156","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/comments?post=273156"}],"version-history":[{"count":3,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/273156\/revisions"}],"predecessor-version":[{"id":273162,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/273156\/revisions\/273162"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media\/273159"}],"wp:attachment":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media?parent=273156"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/categories?post=273156"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/tags?post=273156"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}