I went to work for the US Public Health Service in November of 1963, I was a pack a day Lucky Strike smoker fresh out of college. Two months later, in January, 1964, my big boss, Luther Terry, the Surgeon General issued his report on smoking and health. That led me to quit and here I am 60 years later at 82 in good health.
My wife is a intern this year, and I share these with her. It give both of us hope that there are physicians who are willing to speak up and call for an accounting.
It is so refreshing to read about this from the perspective of a physician. To me it has felt like there is so much missing from the general journalism about this topic. Thank you for this series.
I'm in Australia and have been involved in addiction treatment since the early 80s and what I see here is a pendulum.
You get a decade where medicos are excessively cautious about prescribing opioids, even for end of life pain relief and maintenance for addicts who've been unable to quit then it swings the other way when the media get enthusiastic about a new synthetic or, most notably, during the drug company generated enthusiasm Matt talks about.
A lot of it is sheep with medical degrees following their key opinion leaders but there's also a big element of regulatory discretion by bureaucrats that can cause real career problems for doctors who don't follow the fads. A former GP of mine was essentially forced out of business because he failed to follow a swing away from opioid prescription in the 1980s during a media moral panic about methadone addiction treatment.
Not sure if it's just a local thing, but here in Australia there's been a lot of recent enthusiasm for Dilaudid as a treatment for addicts (over methadone or buprenorphine) with all the usual arguments wheeled out that it will attract addicts into treatment programs which will eventually wean them off opioids entirely. Well, it will definitely attract addicts.
Another addiction treatment fad pendulum is the periodic reversal of arguments as to whether longer or shorter acting opioids are best for treating addicts. That goes back at least as far as post-WWII when the large number of Royal Navy veterans addicted to morphine inspired doctors to treat them with a shorter acting opioid to 'make it easier for them to come off it'. And so the UK government heroin maintenance program was born.
In my experience some addicts handle short, sharp withdrawal better and others respond better to longer, milder ones. But as anyone in addiction treatment can tell you, physical withdrawal is just the first (and easiest) step in overcoming addiction.
Agree about the Opioid crisis. The crowds of people involved are likely, in the colloquial definition of the term, outright psychopaths, which has some big implications when pondering our system or its messaging regarding other matters.
But in regards to cigarettes, I agree their harmful, but their level of harm may indeed be exaggerated as there were declines in other things in the air over the decades as well, below is just one of the big ones
My wife has been an RN for 28 years and I started laughing when you mentioned the joint commission. Hospitals act like they are getting a colonoscopy when they visit. My wife being an old dog knows it’s all bullshit and how things get all ship shape when they are there and go back to whatever they were doing as soon as they leave. The staffing goes way up when the JC comes around to the point where instead of 7 patients for every nurse it winds up being 2/3 and people are tripping over each other. The biggest scam is that magnet certification hospitals. Her hospital brought in a nurse manager who was able to get magnet certification for a smaller hospital she worked at for many years. They hired her and she worked diligently to get everything in ready for the regulators who decide these things. Once the hospital received that Magnet status? They forced her into retirement with a sideways move they knew she would never accept in customer service. It was a huge scumbag move as this woman was well liked among the nursing staff as she was one of the last that would go to bat for them. The hospital has gone full woke now and the stories my wife could tell you how the HR dept. is run and the decisions they have handed out are beyond comprehension when situations have arised and they got involved. Hospitals are a joke. Medicine is a joke now. Luckily we have found a couple of good Drs. not affliliated with any group (which is another thing entrirely) we have stocked up on medicines and treat ourselves as much as possible. If people only knew how bad it is they would never step foot into another one.
I work in a surgical unit Matt and certainly see the misuse of opioids . Everything you say is 100% correct . The worst is the people who come in with back pain with no diagnosis despite X-rays and CT scans . Standard practice is a Ketamine infusion for 7 days where the pt can dictate the dose . They are usually back in another month for another round . We are creating opioid addiction . And yes that pain scale definitely needs to go. I have had pts who are practically narked saying their pain is 10/10 .
Brilliant, sobering piece. The relative ease with which seemingly well established ideas can be manipulated and upturned is quite frightening. Especially in a realm like medicine, where patients lack and cannot easily build any expertise of their own to question or assess medical decisions.
I haven't read the entire thing but notice vaping got only one mention and in a negative context, so I wanted to share an article I wrote a while back that I think is mostly still applicable:
I've been asked those pain scale questions. I had a nurse tell me it was refreshing to hear I rated my pain as about a "3." She said most people just say "9" or "10." It's the best way to get attention and pills.
Outstanding article Matt, glad Substack served it up to me.
I would just add that there is another entire dimension to this issue that gets overlooked for what will be obvious reasons. I work in corrections and MAT (Medication Assisted Treatment) is all the rage. Heroin and meth addicts who previously could use jail as a time to at least get clean and have another chance upon release are now “helped” by receiving “medications” (most commonly methadone, suboxone, and now even worse subutex to replace suboxone) while incarcerated. This is ostensibly to ease pain of withdrawal, reduce suicidal ideation, reduce chances of OD upon release, and to pass them smoothly off to community social service orgs that will continue to dispense the drugs free to them upon release. Methadone is supposedly meant to be “tapered” over time to wean junkies off their addiction - I know people who have been “tapering” for 15 years, and the withdrawals from methadone are actually worse than those from heroin.
“Big Pharma” lost a settlement for a lot of money, and part of the conditions of that settlement were dispensing that money to fight addictions to their products, as you discuss. Sheriff Depts are writing very successful grants to gain access to millions of dollars over many years and they are using it to expand MAT programs in their facilities. “Big Pharma” didn’t lose in court… they won.
Now, often the biggest single dope dealers in a community are the local governments (through the jails) and social service orgs themselves. The evil is breathtaking, but it’s all about the money.
I should also add that because a dead junkie is an unprofitable junkie, now free narcan/naloxone dispensers are being set up strategically around communities to prevent OD deaths. More profit-seeking masquerading as empathy and good works.
I went to work for the US Public Health Service in November of 1963, I was a pack a day Lucky Strike smoker fresh out of college. Two months later, in January, 1964, my big boss, Luther Terry, the Surgeon General issued his report on smoking and health. That led me to quit and here I am 60 years later at 82 in good health.
My wife is a intern this year, and I share these with her. It give both of us hope that there are physicians who are willing to speak up and call for an accounting.
What, and be labeled a ‘disruptive physician’? Ask me how I know.
It is so refreshing to read about this from the perspective of a physician. To me it has felt like there is so much missing from the general journalism about this topic. Thank you for this series.
I'm in Australia and have been involved in addiction treatment since the early 80s and what I see here is a pendulum.
You get a decade where medicos are excessively cautious about prescribing opioids, even for end of life pain relief and maintenance for addicts who've been unable to quit then it swings the other way when the media get enthusiastic about a new synthetic or, most notably, during the drug company generated enthusiasm Matt talks about.
A lot of it is sheep with medical degrees following their key opinion leaders but there's also a big element of regulatory discretion by bureaucrats that can cause real career problems for doctors who don't follow the fads. A former GP of mine was essentially forced out of business because he failed to follow a swing away from opioid prescription in the 1980s during a media moral panic about methadone addiction treatment.
Not sure if it's just a local thing, but here in Australia there's been a lot of recent enthusiasm for Dilaudid as a treatment for addicts (over methadone or buprenorphine) with all the usual arguments wheeled out that it will attract addicts into treatment programs which will eventually wean them off opioids entirely. Well, it will definitely attract addicts.
Another addiction treatment fad pendulum is the periodic reversal of arguments as to whether longer or shorter acting opioids are best for treating addicts. That goes back at least as far as post-WWII when the large number of Royal Navy veterans addicted to morphine inspired doctors to treat them with a shorter acting opioid to 'make it easier for them to come off it'. And so the UK government heroin maintenance program was born.
In my experience some addicts handle short, sharp withdrawal better and others respond better to longer, milder ones. But as anyone in addiction treatment can tell you, physical withdrawal is just the first (and easiest) step in overcoming addiction.
Thanks. Very informative, and you are a very good writer.
I thought the miniseries about Perdue Pharma called “Dope Sick” was excellent. https://www.imdb.com/title/tt9174558/
thank you for your work and reporting.
Thank you Matt
Agree about the Opioid crisis. The crowds of people involved are likely, in the colloquial definition of the term, outright psychopaths, which has some big implications when pondering our system or its messaging regarding other matters.
But in regards to cigarettes, I agree their harmful, but their level of harm may indeed be exaggerated as there were declines in other things in the air over the decades as well, below is just one of the big ones
My wife has been an RN for 28 years and I started laughing when you mentioned the joint commission. Hospitals act like they are getting a colonoscopy when they visit. My wife being an old dog knows it’s all bullshit and how things get all ship shape when they are there and go back to whatever they were doing as soon as they leave. The staffing goes way up when the JC comes around to the point where instead of 7 patients for every nurse it winds up being 2/3 and people are tripping over each other. The biggest scam is that magnet certification hospitals. Her hospital brought in a nurse manager who was able to get magnet certification for a smaller hospital she worked at for many years. They hired her and she worked diligently to get everything in ready for the regulators who decide these things. Once the hospital received that Magnet status? They forced her into retirement with a sideways move they knew she would never accept in customer service. It was a huge scumbag move as this woman was well liked among the nursing staff as she was one of the last that would go to bat for them. The hospital has gone full woke now and the stories my wife could tell you how the HR dept. is run and the decisions they have handed out are beyond comprehension when situations have arised and they got involved. Hospitals are a joke. Medicine is a joke now. Luckily we have found a couple of good Drs. not affliliated with any group (which is another thing entrirely) we have stocked up on medicines and treat ourselves as much as possible. If people only knew how bad it is they would never step foot into another one.
I, for one, am in favor of giving drug seekers Dulcolax.
I work in a surgical unit Matt and certainly see the misuse of opioids . Everything you say is 100% correct . The worst is the people who come in with back pain with no diagnosis despite X-rays and CT scans . Standard practice is a Ketamine infusion for 7 days where the pt can dictate the dose . They are usually back in another month for another round . We are creating opioid addiction . And yes that pain scale definitely needs to go. I have had pts who are practically narked saying their pain is 10/10 .
Brilliant, sobering piece. The relative ease with which seemingly well established ideas can be manipulated and upturned is quite frightening. Especially in a realm like medicine, where patients lack and cannot easily build any expertise of their own to question or assess medical decisions.
I haven't read the entire thing but notice vaping got only one mention and in a negative context, so I wanted to share an article I wrote a while back that I think is mostly still applicable:
https://substack.com/@brittonleokerin/p-148586761
I love this series and will read the whole thing eventually for sure :)
Because I'm not sure that link is the publicly accessible one:
https://brittonleokerin.substack.com/p/vaping-products-shouldnt-be-taxed
this seems a repeat of Purdue Pharma BS
Do you have any criticism of the arguments or do you just not like the conclusion?
is this a joke?
No why do you think it would be?
Really informative. Thank you.
I've been asked those pain scale questions. I had a nurse tell me it was refreshing to hear I rated my pain as about a "3." She said most people just say "9" or "10." It's the best way to get attention and pills.
Yes because people really do hear the question as, “how serious are you about being here?”
Outstanding article Matt, glad Substack served it up to me.
I would just add that there is another entire dimension to this issue that gets overlooked for what will be obvious reasons. I work in corrections and MAT (Medication Assisted Treatment) is all the rage. Heroin and meth addicts who previously could use jail as a time to at least get clean and have another chance upon release are now “helped” by receiving “medications” (most commonly methadone, suboxone, and now even worse subutex to replace suboxone) while incarcerated. This is ostensibly to ease pain of withdrawal, reduce suicidal ideation, reduce chances of OD upon release, and to pass them smoothly off to community social service orgs that will continue to dispense the drugs free to them upon release. Methadone is supposedly meant to be “tapered” over time to wean junkies off their addiction - I know people who have been “tapering” for 15 years, and the withdrawals from methadone are actually worse than those from heroin.
“Big Pharma” lost a settlement for a lot of money, and part of the conditions of that settlement were dispensing that money to fight addictions to their products, as you discuss. Sheriff Depts are writing very successful grants to gain access to millions of dollars over many years and they are using it to expand MAT programs in their facilities. “Big Pharma” didn’t lose in court… they won.
Now, often the biggest single dope dealers in a community are the local governments (through the jails) and social service orgs themselves. The evil is breathtaking, but it’s all about the money.
I should also add that because a dead junkie is an unprofitable junkie, now free narcan/naloxone dispensers are being set up strategically around communities to prevent OD deaths. More profit-seeking masquerading as empathy and good works.