An angry M.D. on the optoid crisis

 

Matt Bivens M.D. is an emergency room doctor who writes a blog.  He is angry about how the nation, the drug industry and the medical profession are handling the optoid crisis.   Here are the highlights of the first installment of a series he is writing on the topic.

At the turn of the century, about 20,000 people each year would take an opioid — as a pill, or as a snorted or injected powder — and then stop breathing and die. Those of us working on ambulances or in emergency departments (EDs) could not save them.

But for every death, there are about 20 non-fatal overdoses. So, with bag mask ventilation and opioid reversal agents, we have dragged millions of people back to life. How many suffered anoxic brain injuries, and today are mentally a half-step slower? Unknown.

Overdoses at this scale were a new development, and they were occurring hand-in-hand with the aggressive new marketing and prescribing of opioids. This is the era chronicled so well by popular miniseries — “Dopesick” on Hulu, “Painkiller” on Netflix. In the midst of it, the Sackler family-owned Purdue Pharma pled guilty to a deception campaign meticulously designed to bring about recklessly liberal opioid prescribing. As punishment, the company had to shell out $600 million, and three top executives got multi-million-dollar fines and 400 hours of community service.

That should have been peak “Opioid Crisis.” But it was only 2007. Heck, George W. Bush was still president. The Sacklers were never contrite. They’d been raking in about $1 billion a year for more than a decade. The $600 million fine sounded impressive — but the Sacklers shrugged, cut the government in to the tune of less than 5 percent of the cash rolling in, and got right back to slinging opioids.  And in the 17 years since, everything has gotten terribly worse.

Did it feel like a catastrophe back in 2007, when 20,000 people a year would die, and people were enraged at Purdue?

Or a decade later, in 2017, when President Donald Trump declared it a national emergency, and 50,000 people a year would die?

That’s nothing. For the past three years, we’ve reliably seen 80,000 people each year take an opioid, stop breathing and die.

Can the USA ever end its wars?

Image via Newsweek

We US Americans need to end our wars.  War drains our strength as a nation, and we can’t deal with our other urgent problems – dysfunctional government, financial oligarchy, growing inequality and poverty, drug addiction – until we do.  War keeps the world divided, and unable to unite to deal with global problems – catastrophic climate change, pandemics, the migration crisis.

The United States is currently at war with at least six countries – North Korea, Cuba, Iran, Venezuela, Syria and Russia – and is getting ready add a seventh, China.  All of these are wars of choice.  There is no good reason to be at war with any of these countries.

Technically, of course, we are not at war.  Congress has not declared war on any of these countries.  No uniformed American troops are fighting troops of any of those countries, at least not directly and not in large numbers.

But this is not how wars are fought today.  War is not declared.  It is just waged.  There is no clear boundary between being at war and being “adversarial.” 

War is not limited to fighting by troops.  It includes economic warfare, covert warfare, cyber warfare and proxy warfare, all of which can be just as deadly as armed conflict by troops in uniform.   

Recently two African governments, Chad and Niger, asked the U.S. government to remove its military bases from their soil.  The U.S. Defense Department replied that this is something that will have to be negotiated.  Meanwhile U.S. troops are occupying countries against the will of their governments.  Is this war?

President Biden has criticized Israel for the mass killing of civilians in Gaza, while continuing to provide Israel with money, weapons and military advisers to use those weapons.  Is this war?

When U.S. forces exited Afghanistan in 2021, the U.S. government, along with European allies, blocked the Afghan government from access to its funds in foreign banks, while also cutting off foreign economic aid and grants.  The excuse was that the money could be used to help terrorist.  The result was a collapse of the Afghan economy and a food crisis.  Was this war?

Secretary of State Madeline Albright was famously asked if the blockage of Iraq in the 1990s was worth the deaths of up to 1 million Iraqi children.  Her reply was, yes, it was worth it.  Was this war?  It’s not peace.

My definition of war is that a policy becomes an act of war when it is intended to bring about regime change or when it results in deaths of the innocent.    Or if it is something that a government would only do if it were at war.

This includes attempted assassinations of heads of state (Cuba), support of terrorist groups (Cuba, Iran, Syria), economic blockades (North Korea, Cuba, Iran,  Venezuela, Syria, Russia), confiscation of financial assets (Iran, Venezuela, Syria, Russia), arming of enemies and rebels (Cuba, Iran, Syria, Russia) and cyber warfare (Iran).  

Of course the full extent of cyber warfare and covert warfare is not known.  And this  is not an exhaustive list of U.S. military operations, not all of which are known to the public.