DECONSTRUCTED 2. NIH $344 MILLION OPIOID CRISIS MEGASTUDY SECONDARY ANALYSES REAFFIRM LETHALITY OF EXPERT GOLD STANDARD TREATMENTS
Demanding explanation, intervention group overdose deaths from opioid use don’t drop, do for combined opioid + stimulant use, pointing again to lethality of medical and other gold standard treatments
by Clark Miller
Published November 20 , 2024
After predictable outcomes of no benefit from the National Institutes of Health (NIH) study that implemented in treatment communities (versus randomized control communities) expanded provision of MAT medications (substitute opioids methadone and buprenorphine) and of opioid fatal overdose reversing drug naloxone (Narcan), investigators announced intentions to explore “secondary outcomes” by further analyses of the data.
That type of post hoc scrambling for results that you really, really needed is never legitimate in research practice, less so with $344 million in resources to design and implement the research properly to evaluate the identified hypothesis.
What was actually conveyed, messaged, following outcomes that failed to validate “proven”, “gold standard” medical and other “treatments” that have increasingly been administered to diseased brains over decades of increasingly lethal substance use epidemics was something like – in intent if not in tone and word choice – SOMEBODY GENERATE A F##KING SUBSET OF THIS DATA THAT GIVES US A F##KING P VALUE WE CAN USE!
That is to say, there would have had to have been some level of elevated consternation to be faced with what has been established for years, that there never has been and is not now a body of evidence pointing to effectiveness of America’s expert consensus treatments for problem substance use and the associated epidemics, those approaches instead established as fueling the lethal public health crises.
It is important to not avoid the obvious, in this case the pressing question demanding answers that lives depend on:
Why would expert gold standard, proven, medical treatments designed specifically to treat problem, compulsive opioid misuse constituting high-risk use not provide any benefit for high-risk opioid use, while in those intervention communities, somehow overdose deaths were lowered for high-risk use of stimulants with opioids?
We’ll get to those answers, it turns out we already have them.
It is said that one should “be careful of what you wish for”, and that is what may come to mind as we consider the meaning of the results of the analyses for secondary outcomes, described here and elsewhere as providing new outcomes –
The HEALing (Helping to End Addiction Long-Term) Communities Study tested how the implementation of evidence-based tactics has impacted the overdose death epidemic in Ohio, Kentucky, Massachusetts and New York. . . .
Researchers reported in June on the main outcome of HCS – that the intervention did not result in a statistically significant reduction in opioid overdose death rates during the evaluation period. In this study, the authors found that intervention communities had an 8% lower rate of all drug overdoses compared to control communities, which was estimated to represent 525 fewer drug overdose deaths. . . .
Fewer people died with an opioid and a non-cocaine stimulant in their system — like methamphetamine — in areas with the programs. The rate of death fell from 14.1 deaths per 100,000 to 8.9 per 100,000 people in areas with targeted interventions.
The researchers state the finding is statistically significant, and that interventions did not reduce opioid overdose deaths when opioids were mixed with other drugs like cocaine.
“With the prescription medications that started the opioid crisis harder to obtain by the time the trial began, fentanyl was rapidly entering the illicit drug market in combination with methamphetamine, cocaine, counterfeit pills and other stimulants,” states Bridget Freisthler, lead author of the new study and a professor at Ohio State University, in a news release.
“Now we have a whole new group of people developing addiction to opioids,” said Freisthler, Ohio’s principal investigator for the HEALing Communities Study. “It was nice to see that we were able to achieve reductions in overdose deaths involving this combination of opioids, primarily fentanyl and psychostimulants, not including cocaine, because that’s the most recent wave in the epidemic that we’re seeing.”
That background will be important in understanding the differential nature of the outcomes, that –
“Now we have a whole new group of people developing addiction to opioids, . . . involving this combination of opioids, primarily fentanyl and psychostimulants, not including cocaine, because that’s the most recent wave in the epidemic that we’re seeing.”
Our understanding of the meaning of these outcomes, with clear implications for the lethality of an ongoing epidemic, depends on attaining an accurate view of how and why and by whom these drugs and drug combinations are being used.
Let’s start with material from this NPR piece –