Drug use has a complicated history in the Western World. Not quite two hundred years ago, starting in the Fall of 1839, Britain attacked the nation of China for having the audacity to ban an addictive substance, opium, that the British were selling to the Chinese people. Opiate addiction was rampant in China at the time, and the emperor had issued a prohibition on the drug. Britain destroyed much of the Chinese Navy, forcing China to pay reparations for destroyed opium stocks and to resume trade, which continued until there was another war in 1856 that ended with the burning of the Summer Palace.
This would be like the Nation of Columbia if it had the force to do so, attacking and destroying the American military over the right to ship us cocaine. Now, fentanyl and carfentanyl, made from chemicals sold wholesale to Mexican cartels by China, is flooding across the American border through commercial checkpoints. And the result has been deadly. From 1999 to 2018, the Centers for Disease Control documented 769,935 deaths from drug overdose. At that time, they categorized these as being due to prescription medications OR heroin. This turns out to have been a big and avoidable mistake.
To get government funding, it is not unusual for beneficiaries of those funds to claim an impending crisis is nigh upon us. How many remember the Satanic Panic of the 80s? The dastardly Satanists, identified by their Metallica t-shirts and Steven King novels, were going to bring about the destruction of all good and decent American folk. Experts popped up everywhere to opine in courtrooms how this or that murder bore the marks of “ritualistic abuse.” One “expert” accepted by a court in Arkansas, “Dr.” Dale Griffis, was a retired police officer whose “doctorate” did not require any classes. (West Memphis 3.)
To fight the scourge, local, state, and federal governments spent lots of money on preventative programs, which, since the problem didn’t exist in the first place, were equally effective and unnecessary. “Only” a little more than 200 Americans were wrongfully convicted during the Satanic Panic, with Dan and Fran Keller holding the sad record of over 21 years behind bars before exoneration. It is estimated, however, that there were over 12,000 complaints that turned out to be unsubstantiated. How much worse would it have been if the authorities had accepted all of these at face value?
But the Satanic Panic will pale in comparison, and consequences to the Opioid Panic. To create this panic, heroin, and fentanyl deaths were counted as an overdose by prescription deaths, creating the false impression that American physicians “overprescribing” were responsible for the crisis. This assumption was false. Overdose deaths among drug users who have access to a known drug and concentration are quite rare. I have said it before; three times more people die every year from NSAIDs than heroin. That’s because most drug addicts don’t actually want to die and are cautious to prevent it.
The most likely time for overdose is after an addict is released from jail. During incarceration, they will have reset their pain receptors, and Cytochrome P450 enzymes and the resumption of their ‘usual’ dose can kill them. The way to prevent this is to have buprenorphine or methadone and addiction counseling available in all jails so that these interventions can be started immediately after incarceration. The person can then be given follow-up on release and perhaps an injection of the one-month acting subcutaneous preparations or at least long-acting naltrexone.
I cannot find a single state that has used the hundreds of millions in opioid settlement money to do this. Which disproves any state or federal efforts claim to actually help those suffering from this affliction. I personally suggested such a program to my senators in 2019 and volunteered to help set it up. I’m still waiting for a response. Prescriptions peaked around 2012 and started dropping as physicians recognized that some adjustments were necessary to balance the quality of life benefits of opiate treatment with the increased but still almost unmeasurable increased risk of addiction.
This trend started without any law enforcement intervention, no doors kicked in, or machine guns pointed at patients, but that wasn’t good enough. Never underestimate the ability of a government to take something that is improving slowly and make it horribly worse very rapidly. In 2016, the CDC took it upon itself to create non-evidence-based “guidelines.” These were completely opinion-based, without sufficient input from pain medicine organizations, patient advocates, or even true addiction experts. It was based instead on the judgement of a few researchers with extreme opinions.
One of the participants can be seen on video saying, “We don’t have time for evidence.” I disagree. Unlike bleeding, there’s always time for evidence. The guidelines were taken as holy writs by the DEA and forced onto the state medical boards with the threat of physician prosecutions; this threat was then carried out when things didn’t change fast enough to satisfy the DOJ. Doctors stopped treating pain in droves, prescription rates dropped to 1993 levels, patients were abandoned and sent to the streets to find adulterated heroin and pills, and the death rate from fentanyl poisoning skyrocketed.
Now, the DEA could go back to Congress and demand even more funding, having created a true catastrophe out of a previously self-correcting problem. But that still wasn’t good enough. To ensure the wholesale prosecution of physicians and other prescribing providers, with some pharmacists, dentists, and at least one chiropractor thrown in for good measure, the government needed some help. And it turned to AI. While my training in computer and neuroscience probably gives me a better understanding of the subject than the average person in America, my useful expertise is limited.
For that reason, I depend on the genius of machine learning specialists like Angela Kilby, PhD. Dr. Kilby studied at the London School of Economics and Political Science before completing a PhD at the Massachusetts Institute of Technology. Going on to join the faculty of Northeastern University at the Institute for Experiential A.I. and being credentialed in Natural Language Processing with Deep Learning. She then became a staff and later a senior machine learning researcher at AKASA. AKASA is, according to its LinkedIn page, the preeminent provider of generative AI solutions for the health care revenue cycle.
According to the article by Angela Kilby, an analysis of dispensing data compiled from the DEA’s own ARCOS reporting system, combined with opioid overdose statistics from the CDC’s NCHS Vital Statistics mortality data, 2016, the year the CDC guidelines were published, coincides perfectly with the transition from heroin and prescription overdoses predominating to fentanyl overdoses predominating. Just like during alcohol prohibition, the U.S. government took a societal problem and multiplied it by ten, creating a giant market for criminal enterprises, who, in this case, rapidly began making fake pills and heroin.
I am not unconvinced that China is continuing to supply the cartels with base chemicals necessary for the production of these poisoned pills to get some payback from the Western World for what happened to them so long ago during the opium wars. Or perhaps they saw how effective it was at damaging their own economy and society and decided to use this weapon against its main rival, the USA. To this end, they could not have asked for a more useful assistant than the DEA. By targeting and destroying so many doctors who were earnestly treating addiction and pain, the DEA has helped create a sea of victims.
This wholesale destruction would not have been possible without the help of AI combing through PMP data. I have written about how the data algorithms currently being used to detect addiction and diversion risk across this nation, branding patients as “too at risk” and physicians as “over prescribers,” are biased and inaccurate. My analysis, however, was based on a clinical understanding of the complexity of each individual patient, paired with the stigma that physicians and patients face when confronting the challenge of severe chronic pain or addiction.
Dr. Kilby, however, completed her own, much more data-laden analysis, warning back in 2021 that “machine learning models currently being developed to identify individuals at risk of opioid use disorder and inform clinical decision making around the prescribing of opioids are not well-specified to generate individual scores that correlate with the object of interest, an individual’s heterogeneous treatment effect of receiving an opioid. The results indicate that if doctors were to reallocate prescribing according to the algorithm’s recommendations – prescribing fewer opioids to chronic pain patients and more to patients identified as “low-risk,” they would, at best, make no improvements on existing decision-making and perhaps actually worsen rates of development of opioid use disorder.”
Concluding in the final pages of Algorithmic Fairness in Predicting Opioid Use Disorder that,
“A growing body of research attributes these changing dynamics of mortality and rising overall lethality of the opioid crisis in recent years to increasingly restrictive prescribing practices beginning in the mid-2000s. These restrictions led to a scarcity of illicitly obtained prescription opioids, which can be dangerous or lethal to abuse but are still safer than heroin due to their manufactured nature, which yields a predictable dose with no adulterants. As prescribing restrictions led to a shift away from black market opioid pills and towards heroin (increasingly frequently adulterated with fentanyl) and counterfeit opioid pills containing synthetic fentanyl, the crisis grew more lethal (Evans, Lieber, and Power, 2019).”
I could not agree more.
L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues.
He can be reached on LinkedIn and YouTube.
