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.

Opioids, Me, and Numbers

            I'm sitting at my desk debating whether or not to take a Tramadol tablet (50 mg, generic for Ultram): an opioid. I usually take them near bedtime, when I do take them, but not too near since I take other medications then, and the combination can get my sleeping heart rate and blood pressure inconveniently low — or in some other way get me dizzy. I've had the Tramadol prescription for a number of months now, but have only taken a small number and wonder if I'm going to be counted by some activist or other as part of "THE OPIOID EPIDEMIC."

            I think about such things since I've fitfully followed the opioid story in the newspapers and just listened to "Opioid Overdoses: Mass Casualty Zones in America" on 1A, the NPR discussion feature from WAMU in Boston that's replace The Diane Rehm Show.

            Even in so respectable a venue, I heard few significant numbers. A literal epidemic is "the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic" (Wikipedia, "Epidemic").

            What are the rates of opioid overdoses per 100,000 in various areas? Of those, how many per 100,000 population are fatal? How many are intentional suicides? How many are accidental overdoses with prescription drugs produced under FDA supervision? How many are accidental overdoses with street drugs? How many are accidental overdoses from people using the drugs improperly through ignorance of proper dosage and/or a desire to get high?

            I'm an old man, and I've lived through a number of "epidemics" and "crises" hyped in part because people think, correctly, that the best way to get attention (and funding) is mongering fear. So there was an earlier crisis in painkillers — inevitably addicting for some portion of the population — and then a crisis in pain because many people in puritanical ("Suck it up; 'No pain, no gain'") American society couldn't get sufficient or sufficiently-strong pain-killing drugs. And now THE OPIOID EPIDEMIC!

            (Rule of thumb: Last generation's solutions can make for some of this generation's problems.)

            If there were generally knowledge of the relevant numbers, and their implications, we might have an informed discussion of what might be the most effective responses and determine what's politically possible. I'd like that: I spent the biggest part of my life in southwest Ohio, near Dayton, a center of the "epidemic"; and I'm taking, now and then, an opioid. I'd like lower-volume, logically-respectable discussion, starting with statistics using the phrase "per 100,000 population of ____."

            Accidental overdoses from street drugs might be most immediately dealt with by providing FDA-tested, properly labeled drugs. Suicides are a different matter. Both involve serious discussion of difficult political problems. For one thing, if despairing people in Rust Belt America don't kill themselves, what are we, as individuals, communities, and a country, willing to do for them to relieve understandable despair?

* * *

            One of the participants on the 1A panel had as her central talking point, "Addiction is a disease"; all right, but so is cholera — and central to preventing cholera epidemics were public-works sanitation projects. We have to look at drug use in its social context, and drug issues are social and political issues. So two-and-a-half closely-related things to end with: (1) Opioids are pain-killers, so we should expect some addicts. His second point was that we can't talk about "the drug" and "the user." There will probably be a number of drugs for one thing. More important is that social context. So (2) Remember that we did NOT have a heroin epidemic with former military heroin users returning from Vietnam. The great majority were able to leave their pain and heroin back in 'Nam. Those who returned to more pain in the US and available narcotics often went back on the needle. So there's that rule that with any pain-killer, a certain proportion of users will get addicted, to which we can add that opioids are psychoactive, and any drug that can get you buzzed will be abused. But the number of addicts and abusers can be reduced with social support, with reducing their pain, and with moving toward a society where we address compassionately and sensibly — using science and logic, figurative head as well as figurative heart — our problems and don't go immediately and exclusively for a pharmacological quick fix or criminalizing disease.

Marijuana (Yet Again): Drug Policy for American Drug Culture

            In a letter to the editor posted on line on Feb. 3 and later printed in the Ventura County Star, Al Knuth of Camarillo, CA, argues that marijuana is "Not a harmless drug" and notes that he has "personally witnessed the recreational use of marijuana destroy the lives of some relatives, friends and others [… through] divorce, loss of jobs, loss of friends, loss of ambition, criminal acts, etc." and adds, "the use of alcohol causes about 88,000 deaths and more than $224 billion in damages per year in the United States," finally asking rhetorically, "Do we really need to encourage and legalize yet another 'harmless' drug for our society?"

            A very close friend of mine had addiction problems leading to criminal acts, loss of job, divorce, and ultimately his death. His addictions started with beer and cigarettes and ended with beer and cigarettes, but I don't conclude from that personal experience, nor from the clear facts of the harm done by alcohol and tobacco, that we should make nicotine an illegal drug and return to alcohol prohibition.

            What I do conclude is that we need to recognize that mainstream America has drug problems, and we need a rational approach to dealing with them.

            A rational approach would classify drugs dispassionately and scientifically, do the math and public-health analysis, and attempt to limit harm; and a rational approach would get over our puritanical heritage enough to acknowledge that most people use psychoactive drugs because it gives them pleasure and to acknowledge pleasure as a good thing and to be placed in the equations along with harm.

            The US federal and local governments gave up on alcohol prohibition for complex reasons, but most justifiably because capital "P" Prohibition did far more harm than good. If you count jail time as often justified harm, but still harm; if you count sucking people into the US criminal justice system as punishment in itself, even when they're acquitted; if you count punishment disproportionate to crimes (and historically racist) as an outright evil — then marijuana prohibition currently does great harm.

            Better to treat psychoactive drugs as a group and regulate stringently drug pushing. For net harm reduction while allowing drug users to seek pleasure and drug addicts to avoid pain, it would be useful to legalize for those over 18 possession of any recreational drugs while limiting advertising and aggressive marketing. Like, it makes no sense to put people in jail for selling a few grams of marijuana while allowing brilliantly-executed alcohol ads on television and "happy-hour" at your local bar to ramp up the use and abuse of booze.

            We need tough-minded policies on drugs: on all and any drugs, of both underclass and mainstream American drug culture.

            If there are First Amendment issues with limiting advertising and marketing of alcohol as a recreational drug — and there are — well, we dealt with similar issues with tobacco.

            If people aren't doing their jobs because they're stoned fire them: not for using drugs but for not doing their jobs. If people are endangering others because they're driving while zonked, punish them for endangering others. If limiting the pushing of currently legal drugs will result in increased unemployment, then former bartenders and others of the deserving unemployed should be given generous support and aid finding other jobs, and ad agency flacks and marketing folk can be offered retraining for more honest work.