Tuesday, August 1, 2017

Demand Strong Evidence for All-Too-Familiar Claims of Crisis: "The Opioid Epidemic"

Carl Sagan popularized the excellent rule, "Extraordinary claims require extraordinary evidence," which I'll call (very informally) "Sagan's Law" and to which I'll add what I'll call "Mike Males's Caution": «Politically charged claims that sound really familiar should be viewed with strong skepticism.»
I get this principle from Males's work in the late 20th c. on "The Scapegoat Generation" and "Framing Youth," and his observation that claims of various failings and social pathologies among older US teenagers seemed very much like earlier accusations — sometimes backed with impressive-sounding science — against Blacks, women, Jews, immigrants, and other groups being economically and politically held back by being (mostly figuratively) held down.
Similarly, when we have another crisis epidemic of drug use, keep in mind the last several and ask for really strong evidence that we don't have just problems — and problems best handled as a public health issue, and a public health issue perhaps best seen as just another incarnation of America's drug habits and the US as a drug culture: where you can buy hard, addictive drugs in your local Krogers (check out the liquor sections and cigarettes), and where you are surrounded by ads that promise near-magic improvements in your life if you just take the right pills or drink the right booze (and, soon, smoke a sufficiently fashionable name-brand weed).
With any pain-killer, you're going to get some addiction and a fair amount of abuse; and drug use, like pretty much all things human, is subject to The Iron Law of Fashion about which the Powers That Be usually can't do a whole lot (but will take credit when fashions change: during the longer or, often, shorter period between one crisis and the next). So I'm sure there are problems and serious problems with opioids. 
I want to see serious statistics, though, and serious policies not only dealing with abuse of a pain-killer (more exactly: pain-ameliorator) but also for reducing people's pain. So before you come to get my Tramadol — I can't take NSAIDs any more if I want my kidneys to keep working — I want some stats on social pathologies for opioids per 100,000 population and with careful definition of those pathologies. 
To twist a partial quotation from Karl Marx, «Opiates and opioids are the opium of today's suffering people" and the pharmalogicals are probably less dangerous than fanatical enthusiasms in religion and/or politics. All things considered, opium might've been a fairly sensible choice among the wretched of the Earth in Marx's time — opium reduces pain and hunger — and so might an addiction leading to a fairly quick death. 
We need to hear solid, honest, disinterested statistics and analysis of the current US opioid problem, plus some suggestions for reducing sociological and economic pain, making it less pressing for people to use painkillers.
When US troops came home from Vietnam, Americans felt threatened by a HEROIN EPIDEMIC!!! from the return of hordes of heroin addicts. It didn't happen. Military users were dried out in 'Nam and sent home. Those who returned to a decent life, left their pain in Vietnam, the way most people recovering from surgery leave their pain and heavy narcotics in the hospital. Those who returned to pain and available and relatively cheap heroin, often returned to heroin. 
The situation will be similar with opioids, except I don't think American politics will allow us to even think about reduction of harm from reduction of social and economic pain. Minimally, though, let's apply Sagan's Law and Mike Males's Caution: don't panic, be skeptical, and demand rigorous analysis and compassionate policy.

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