Posted on Feb 25, 2021
The Re-emergence of the Opioid Epidemic and What it Means for Veterans
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Out of the COVID-19 pandemic, an opioid epidemic in our country has re-emerged with a vengeance. Today, according to data from the Centers for Disease Control and Prevention, 220 Americans will lose their lives due to an opioid overdose.
To put the current number of deaths by opioid overdose into perspective, a report on substance use amid COVID-19 indicates that opioid overdoses in the U.S. increased by 42% in May 2020 when compared to May 2019. Data from the Department of Veterans Affairs also tells us that veterans continue to remain more susceptible to opioid overdoses.
The good news is that despite the seemingly overwhelming nature of the situation, COVID-19 has highlighted a number of key areas where there are viable policy options to address the opioid epidemic. However, addressing the epidemic will require targeting populations, particularly veterans, that are at a higher risk for overdose.
But what exactly can and should leadership do?
1. An effective method of preventing opioid overdose is to co-prescribe a drug known as naloxone with all opioid prescriptions. Naloxone has a 75-100% efficacy in blocking or reversing the fatal effects of an opioid overdose by reversing the respiration of individuals who experience extremely delayed breathing or have stopped breathing altogether due to ingesting a lethal amount of opioids.Veterans Affairs hospitals already provide naloxone free of charge to veterans that are enrolled in their care programs. However, veterans receiving care outside of the VA system should have increased access to the life saving drug as well.
States could look to the precedent set by those that have a mandatory co-prescription plan currently in place, or follow the lead of California and Ohio where providing the option of a co-prescription is required for those who may want or feel they need it. Providing naloxone to a greater portion of the veteran population, which has twice the number of overdoses as their civilian counterparts, is perhaps one of the most effective ways that we can prevent death by opioid overdose among veterans.
2. Medical providers can change their approach to treating veteran patients and how they prescribe opioids. Prescribing opioids and other medications should never entirely replace traditional therapy practices, including talk therapy, physical therapy and other effective therapy methods. In fact, a study on the reasons a group of veterans discontinued using opioids as a part of their treatment plan found that they were more likely to do so because their clinician stopped prescribing the opioids as opposed to discontinuing use on their own volition.
This research highlights the critical role that clinicians can play in preventing or combatting addiction through the manner in which they prescribe opioid medications. It must be ensured that clinicians receive proper training both when it comes to prescribing opioids and detecting substance misuse.
3. Ending the opioid crisis and expanding access to substance education, prevention and treatment was a platform on which President Biden ran on during his 2020 campaign. President Biden has a fairly thorough plan laid out on his website for how his administration intends to combat the opioid epidemic. Though the plan does indicate the president’s intention to target vulnerable populations, including veterans, by expanding access to treatment and training VA clinicians in safe opioid prescribing practices, more directives must be included in the plan in order for it to truly impact opioid abuse among veterans. The same can be said for initiatives carried out on the state level. For instance, making expanded access to rural broadband a priority in state legislatures, like Iowa and North Dakota are currently doing, would drastically improve the delivery of telemedicine. Ensuring that veterans have access to both virtual mental and physical healthcare has the potential to assuage opioid use, especially in rural areas of the country.
The public has demanded action for far too long and that demand has only become justifiably heightened in the midst of the pandemic. The political leadership on the state and federal level that we trust to protect and better the lives of veterans must act and use their platforms to help end the opioid epidemic once and for all. This includes providing tailored education, prevention and treatment options to our nation’s heroes.
To put the current number of deaths by opioid overdose into perspective, a report on substance use amid COVID-19 indicates that opioid overdoses in the U.S. increased by 42% in May 2020 when compared to May 2019. Data from the Department of Veterans Affairs also tells us that veterans continue to remain more susceptible to opioid overdoses.
The good news is that despite the seemingly overwhelming nature of the situation, COVID-19 has highlighted a number of key areas where there are viable policy options to address the opioid epidemic. However, addressing the epidemic will require targeting populations, particularly veterans, that are at a higher risk for overdose.
But what exactly can and should leadership do?
1. An effective method of preventing opioid overdose is to co-prescribe a drug known as naloxone with all opioid prescriptions. Naloxone has a 75-100% efficacy in blocking or reversing the fatal effects of an opioid overdose by reversing the respiration of individuals who experience extremely delayed breathing or have stopped breathing altogether due to ingesting a lethal amount of opioids.Veterans Affairs hospitals already provide naloxone free of charge to veterans that are enrolled in their care programs. However, veterans receiving care outside of the VA system should have increased access to the life saving drug as well.
States could look to the precedent set by those that have a mandatory co-prescription plan currently in place, or follow the lead of California and Ohio where providing the option of a co-prescription is required for those who may want or feel they need it. Providing naloxone to a greater portion of the veteran population, which has twice the number of overdoses as their civilian counterparts, is perhaps one of the most effective ways that we can prevent death by opioid overdose among veterans.
2. Medical providers can change their approach to treating veteran patients and how they prescribe opioids. Prescribing opioids and other medications should never entirely replace traditional therapy practices, including talk therapy, physical therapy and other effective therapy methods. In fact, a study on the reasons a group of veterans discontinued using opioids as a part of their treatment plan found that they were more likely to do so because their clinician stopped prescribing the opioids as opposed to discontinuing use on their own volition.
This research highlights the critical role that clinicians can play in preventing or combatting addiction through the manner in which they prescribe opioid medications. It must be ensured that clinicians receive proper training both when it comes to prescribing opioids and detecting substance misuse.
3. Ending the opioid crisis and expanding access to substance education, prevention and treatment was a platform on which President Biden ran on during his 2020 campaign. President Biden has a fairly thorough plan laid out on his website for how his administration intends to combat the opioid epidemic. Though the plan does indicate the president’s intention to target vulnerable populations, including veterans, by expanding access to treatment and training VA clinicians in safe opioid prescribing practices, more directives must be included in the plan in order for it to truly impact opioid abuse among veterans. The same can be said for initiatives carried out on the state level. For instance, making expanded access to rural broadband a priority in state legislatures, like Iowa and North Dakota are currently doing, would drastically improve the delivery of telemedicine. Ensuring that veterans have access to both virtual mental and physical healthcare has the potential to assuage opioid use, especially in rural areas of the country.
The public has demanded action for far too long and that demand has only become justifiably heightened in the midst of the pandemic. The political leadership on the state and federal level that we trust to protect and better the lives of veterans must act and use their platforms to help end the opioid epidemic once and for all. This includes providing tailored education, prevention and treatment options to our nation’s heroes.
Posted in these groups: Addiction Counseling
Substance Use
Department of Veterans Affairs (VA)
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Medical
Substance Use Department of Veterans Affairs (VA) Resources Medical
Posted 5 y ago
Responses: 19
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I was recently shot (20+ years in the Army, no bullet holes. But go be a pizza delivery driver, and all of a sudden my skin is perforated!). When I got to the ER, I was almost immediately given an injection of fentanyl. I am not complaining; I thanked the nurse profusely. But... No one at the ER had asked about my pain. Yes, I was in obvious distress, and yes, the Air Evac team told them I had a GSW, so they knew it wasn't a minor issue (as if the fact that I was Air Evaced didn't already clue them in) but they jumped to fentanyl without asking. Again, I am THANKFUL they did, but it does make me wonder how "routine" it is to immediately shoot up a patient with it.
While in recovery in the hospital, they were pushing an opioid for pain (I believe it was either OxyContin or OxyCodone, but I am not sure). Twice a day, morning and evening like clockwork. Again, there wasn't even a discussion. (And again, I was thankful because I WAS in a lot of pain). But... I had to be the one to say "we can probably back off the opioids now." They were happy to keep giving them to me for my entire stay. And lo, when I was discharged, there it was: a prescription for OxyContin (which I never filled).
I was in pain, the entire time. 6 weeks later, it still hurts to cough or sneeze too hard. But I was SO scared of getting hooked, I chose to come off the "hard stuff" (I was still taking tylenol, an NSAID, and a muscle relaxer for pain, plus other stuff for infections, etc.) and deal with the pain. And you know what... I COULD. Yes, I was in more pain, but the pain was manageable. When I got home, I continued to be in pain, but the pain was manageable.
I think our medical system (and, for the most part, our patients) have become SO scared of pain that we are pushing these drugs more often and (more critically) for a longer duration than necessary. As a society, we need to go back to being OK with a certain amount of pain. No one WANTS to be in pain. And high levels of pain DO add risk to other medical problems, and CAN send people into shock, which its own issue, even when NOT complicating other medical issues. I am not saying we should IGNORE pain. But... very few people have ever died from pain. Plenty have died from opioids.
While in recovery in the hospital, they were pushing an opioid for pain (I believe it was either OxyContin or OxyCodone, but I am not sure). Twice a day, morning and evening like clockwork. Again, there wasn't even a discussion. (And again, I was thankful because I WAS in a lot of pain). But... I had to be the one to say "we can probably back off the opioids now." They were happy to keep giving them to me for my entire stay. And lo, when I was discharged, there it was: a prescription for OxyContin (which I never filled).
I was in pain, the entire time. 6 weeks later, it still hurts to cough or sneeze too hard. But I was SO scared of getting hooked, I chose to come off the "hard stuff" (I was still taking tylenol, an NSAID, and a muscle relaxer for pain, plus other stuff for infections, etc.) and deal with the pain. And you know what... I COULD. Yes, I was in more pain, but the pain was manageable. When I got home, I continued to be in pain, but the pain was manageable.
I think our medical system (and, for the most part, our patients) have become SO scared of pain that we are pushing these drugs more often and (more critically) for a longer duration than necessary. As a society, we need to go back to being OK with a certain amount of pain. No one WANTS to be in pain. And high levels of pain DO add risk to other medical problems, and CAN send people into shock, which its own issue, even when NOT complicating other medical issues. I am not saying we should IGNORE pain. But... very few people have ever died from pain. Plenty have died from opioids.
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MAJ Byron Oyler
First 24-48 hours post op I always encourage patients to take PO narcotics because if we hit a pain crisis and I need to use IV narcotics, I am probably not doing my job. Taking the right amount of narcotics for the pain you are in almost never gets you addicted. It is taking when no longer needed is where the problem begins. Depending on what happened if you are still on the same narcotic dose 48hours out, we need to start looking if something has gone south, not giving more narcotics. Ibuprofen can wreck your kidneys and all NSAIDs if taken to much cause a GI bleed that can kill you.
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SFC Casey O'Mally
Sir I am not at all doubting what you are saying or that opioids are a very useful and relatively necessary tool. I will even agree that, at times, they are the BEST available tool. I am just saying that I thin our societal aversion to pain has gone off the deep end. I am less concerned with using opioids to treat pain than I am with how LONG we use opioids to treat pain.
In my completely-non-expert non-medical opinion, in the majority of cases we should begin backing off / lowering the dose almost as soon as we issue the opioids. A day, maybe two, at full dosage, then whittle away down to zero. Yes, pain will be present. No, that's not always a bad thing, especially when it is present but manageable. (Sometimes it is even helpful to identify problems - rarely in today's days of advanced diagnostics and imaging. But still, feedback of what hurts, where, and how, IS helpful sometimes. But I digress.)
In my completely-non-expert non-medical opinion, in the majority of cases we should begin backing off / lowering the dose almost as soon as we issue the opioids. A day, maybe two, at full dosage, then whittle away down to zero. Yes, pain will be present. No, that's not always a bad thing, especially when it is present but manageable. (Sometimes it is even helpful to identify problems - rarely in today's days of advanced diagnostics and imaging. But still, feedback of what hurts, where, and how, IS helpful sometimes. But I digress.)
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PO2 Robert Cuminale
It wouldn't be Oxycontin (shouldn't be) because it is not for temporary pain but long term chronic pain. More likely it was a Hydrocodone mixture. Until recently Hydrocodone only came in mixture with aspirin or Tylenol or any of the other NSAIDS. The new Hydrocodone is an extended release product for chronic pain. The medical industry is up in arms over this new purpose for Hydrocodone because it feels it is unneeded with Oxycontin filling the need for extended relief medication. Oxycodone is also available with NSAID mixtures. Oxycodone is a stronger better acting pain reliever than Hydrocodone or Morphine. Morphine is weaker than both and the quantity of it is increased to match the other two. If you were taking Oxycontin 20 Mg you will need to take Morphine ER 30 Mg to match the pain relief of the other.
This is a good place to mention the manufacturer's claim that Oxycontin will last 12 hours. From the very beginning patients were complaining that they were barely getting 8 hours of pain relief. Doctors began writing prescriptions for regular Oxycodone to supplement the missing hours. I used to take a 20 Mg in the morning because it goes to work faster and then start the Oxycontin 20 Mg four hours later. My pain management clinic changed my prescription to 3 Oxycontin daily. That worked very well. I could go to work where I ran voice and data cabling. It was my business and I was a working owner. I'm now 70 years old and retired. The insurance company reduced it back to two per day partly because of the manufacturer's claim that two tablets were sufficient. Later they refused to let me have Oxycontin because of the cost. I ended up on the Morphine ER 30 Mg which is a lot cheaper. I am disappointed though because the Oxycontin was a better pain reliever. I am allowed three tablets per day. I'm in a lot of pain. I have Spinal Stenosis which has crushed both sciatic nerves with pain from my butt to my feet. Three laminectomies on my spine haven't been too helpful. Injections typically last a couple of days. I also have Bursitis from my left hip to my ankle. Because I don't walk properly I kept getting ingrown toenails on my large toes. They were dug in so deep I had to go to a Podiatrist to dig them out. They were very painful. The nails were trimmed back to remove the part digging in the nail and treated with acid to burn out the nail bed so the nails wouldn't grow in that section of the nail. I also have Psoriatric Arthritis and Calcium Pyrophosphate Crystal Deposition Disease which is another form of Arthritis. It is also called Pseudo Gout.
Chronic Pain patients tire of all the people who say we can just take an NSAID like Tylenol but we crave the drugs so we're faking the pain level.
This is a good place to mention the manufacturer's claim that Oxycontin will last 12 hours. From the very beginning patients were complaining that they were barely getting 8 hours of pain relief. Doctors began writing prescriptions for regular Oxycodone to supplement the missing hours. I used to take a 20 Mg in the morning because it goes to work faster and then start the Oxycontin 20 Mg four hours later. My pain management clinic changed my prescription to 3 Oxycontin daily. That worked very well. I could go to work where I ran voice and data cabling. It was my business and I was a working owner. I'm now 70 years old and retired. The insurance company reduced it back to two per day partly because of the manufacturer's claim that two tablets were sufficient. Later they refused to let me have Oxycontin because of the cost. I ended up on the Morphine ER 30 Mg which is a lot cheaper. I am disappointed though because the Oxycontin was a better pain reliever. I am allowed three tablets per day. I'm in a lot of pain. I have Spinal Stenosis which has crushed both sciatic nerves with pain from my butt to my feet. Three laminectomies on my spine haven't been too helpful. Injections typically last a couple of days. I also have Bursitis from my left hip to my ankle. Because I don't walk properly I kept getting ingrown toenails on my large toes. They were dug in so deep I had to go to a Podiatrist to dig them out. They were very painful. The nails were trimmed back to remove the part digging in the nail and treated with acid to burn out the nail bed so the nails wouldn't grow in that section of the nail. I also have Psoriatric Arthritis and Calcium Pyrophosphate Crystal Deposition Disease which is another form of Arthritis. It is also called Pseudo Gout.
Chronic Pain patients tire of all the people who say we can just take an NSAID like Tylenol but we crave the drugs so we're faking the pain level.
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MAJ Byron Oyler
SFC Casey O'Mally - I just read your reply and you are 100% correct about backing off. Depending on the cause and need for meds, if you do not start coming off them in an appropriate time I call the doctor concerned something is not healing right.
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As a Paramedic at a busy 911 service, I can attest the Opioid problem never went away. It just got overshadowed by all the "The COVID is coming! The COVID is coming!" reactions in the media. Die from a heart attack...COVID! Die from a traumatic injury...COVID! Die from opiate abuse... yep, you guessed it...COVID!! (not trying to downplay the Covid-related deaths but few overall were attributed solely to Covid-19).
Of all the medications I carry on the ambulance, Narcan gets used most frequently.
Of all the medications I carry on the ambulance, Narcan gets used most frequently.
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SSgt Richard Kensinger
And thank you so much for your care and services and you are clearly on the front line. When I served I was an ER medic. Some who came to us were stabilized by medics such as yourself.
Rich
Rich
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PO2 Robert Cuminale
My Uncle is a Cuomo victim. He was a dialysis patient when most of the centers were closing. He was put into a nursing home that didn't have enough portable dialysis machines and contracted and contracted COVID 19 and died two weeks later. Mike was just 6 years older than me at 75. He was more like an older brother.
He probably died of septic poisoning but I'd bet he's listed as a COVID 19 death.
He probably died of septic poisoning but I'd bet he's listed as a COVID 19 death.
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Having been on Oxycodone for the past 15 years, prescribed by the VA for pain in my legs that just got worse and worse, but I never took more then what was prescribed. I came to the realization that I needed off these drugs and wanted to live a life free of NARCOTICS! My PCP at VA put me on Hydrocodone for 3 months lowering the dose each month and also prescribed a high blood pressure med to keep my heart rate down along with anxiety cause by withdrawal. I’m now 100% opioid free and it feels good to be human again and actually feel life! BEST decision I ever made! I also quit smoking this past month also! You can do anything you put your mind to doing....just do it! The Oxycodone was a horrible cycle of hell, if you want to quit talk to ur VA dr and ask to be tapered off. It was a month of hell, but 2 moth after that were better and now I could not be more happy. Oxycodone is a BAD DRUG that should only be used in the most severe situations w/people with pain.
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What is taking the place of the opioid crisis out of the pandemic is the POLYSUBSTANCE ABUSE CRISIS. This crisis has hit the Northeast worse than the opioid crisis first did. The Polysubstances are opioids, benzodiazepines, amphetamines, Cocaine, Methamphetamine, MDMA, LSD, and special K just to name a few. The Job of being a first responder to a drug overdose has become an overly intense situation when the patient has to be dosed several times with Narcan and no one is really sure exactly what the patient overdosed on!!!
And this problem of Polysubstance Abuse is all over, throughout all walks of life!!! What we need to do is stop looking at who is to BLAME!!!! The BLAME GAME never solved anything.
What needs to be found are EFFECTIVE WORKABLE SOLUTIONS. NO QUICK FIXES either! Those are known as BANDAID SOLUTIONS! Very temporary and usually a waste of much-needed financial aid!
And this problem of Polysubstance Abuse is all over, throughout all walks of life!!! What we need to do is stop looking at who is to BLAME!!!! The BLAME GAME never solved anything.
What needs to be found are EFFECTIVE WORKABLE SOLUTIONS. NO QUICK FIXES either! Those are known as BANDAID SOLUTIONS! Very temporary and usually a waste of much-needed financial aid!
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Opioids never went away, I also think we are leaving one group of antagonists out of it that must share in the blame and the over all costs of treatments. Who are they you may ask, those folks at "metric" related companies. When I worked in Level 1 trauma center in Florida as an ER Tech, monthly we would get from Hospital leadership our scores for the month in satisfaction. It was based on reports from a very well known "metrics" company. It was based on points at first but later it would morph into smiley faces. The goal was to ensure that people felt good and did not leave in pain. Pharma sales reps would come in and leave all sort of stuff for MD's (tickets to games, golf matches and the like, this was prior to a law getting passed to prevent that) , still the goal was to get people to use the product. The rise of Pain Management Clinics started and it was, IMHO, legalized drug dealers. Granted not every doctor was in this racket, but many have a taint around there MD License. We don't hear of these metric companies getting tagged in the law suits, but they played a very important role in it. I worked in a few ER/ED's over the years, and I saw the metrics people and the pharma people working MD's where ever possible. I saw Private MD's in offices who would have signs for sales reps and ask them to leave samples and go as they were too busy (I am not opposed to free samples of non opioid meds, they can help those who can't afford medications). I blame the MD's who wrote the scripts, but I blame the hospital leadership for allowing numbers to be the lead in healthcare over quality of care. I blame the metrics people for twisting numbers, and I blame Big Pharma as well.
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PO2 Robert Cuminale
Blame government as well. A lac of oversight of manufacturers allowed the pill mills in Florida to operate for years unimpeded. Wouldn't a storefront in a strip shopping center surrounded by out of state plates look suspicious? Wouldn't writing prescriptions for 300 or more Oxycontin 40 or 80 Mg tablets a month be considered over prescribing? Almost all states kept a computer system on pharmacies to see how much of certain medicines it was filling. Cardinal was finally caught over distributing millions of opiate tablets.
Where a pain management is matters. In New York you can get the PA to prescribe almost any amount more than he should or ignore your urine tests and see that your intake of opiates is low and when you tell him that you don't always need them or if over that your are supplementing. I live in North Carolina. The Pain Management PA called me after a urine test to as me what I'd been eating because they'd detected another drug. When I said that Id eaten a 1/2 dozen poppy seed bagels he stopped me. I didn't even realize poppy seeds can show up as an opiate in urine. The state here is strict.
Florida has finally cleaned up the pill mills but how many people OD'ed first?
Where a pain management is matters. In New York you can get the PA to prescribe almost any amount more than he should or ignore your urine tests and see that your intake of opiates is low and when you tell him that you don't always need them or if over that your are supplementing. I live in North Carolina. The Pain Management PA called me after a urine test to as me what I'd been eating because they'd detected another drug. When I said that Id eaten a 1/2 dozen poppy seed bagels he stopped me. I didn't even realize poppy seeds can show up as an opiate in urine. The state here is strict.
Florida has finally cleaned up the pill mills but how many people OD'ed first?
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PO2 Robert Cuminale
PO2 Robert Cuminale - I've been a chronic pain patient for about 15 years. I have spinal stenosis that has crushed four discs and both sciatic nerves. The pain is unrelenting. I've been through every pain killer in that time. I have always been strictly observed via urine tests to ensure that I really need medications or if I'm faking it and selling the pills. I have always been limited as to quantity no matter what I was taking. As a general rule I am allowed no more than 90 pills per month. When I have surgery the hospital can control my pain medication with approval from the pain clinic while I am there. I can be discharged with a limited amount. surgical pain subsides in a few days. In one case I had extreme nerve pain and still could not get extra medication. I asked for and got a topical mix that I could apply and it did help. That pain subsided after about four weeks.
I sometimes resent the strictness but I know that it's for my protection. I went through the 1960s and 1970s as a teen and young adult and lost a lot of friends to drugs. Some just died and some just became lost. I had it in my own family.
The only place I hear about slackness in controls is from people in New York City.
I sometimes resent the strictness but I know that it's for my protection. I went through the 1960s and 1970s as a teen and young adult and lost a lot of friends to drugs. Some just died and some just became lost. I had it in my own family.
The only place I hear about slackness in controls is from people in New York City.
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Opioid Overdoses by prescription pain patients usually involve (90%) other drugs and/or Alcohol, usually benzodiazepines such as Valium and Xanax. We need to stop linking Prescription opioid overdoses and deaths with heroin/Fentanyl overdoses and deaths. They are not related. Yes some former pain management patients turned to heroin/Fentanyl , but only after being savagely removed from pain management treatment for no reason other then the CDC's misguided recommendations or minor violations of pain contracts. God forbid you have a beer on occasion or a glass of wine or two then get called in for testing a few days later. In today's environment you will get cut off and thrown out of a clinic fr anything.
In the State of Maine My doctor cannot legally prescribe over the CDC recommenced levels but Doctors can prescribe drugs for assisted suicide to purposely end my life. Please explain that to me.
The missing link in Pain Management is insurance companies who will only pay for pain management in the form of pills and shots.
In the State of Maine My doctor cannot legally prescribe over the CDC recommenced levels but Doctors can prescribe drugs for assisted suicide to purposely end my life. Please explain that to me.
The missing link in Pain Management is insurance companies who will only pay for pain management in the form of pills and shots.
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I had a neck injury in 2009 while deployed. When I returned home my PA referred me to pain management, which at the time was off post. The pain management doctor started me on a very low dose of hydrocodone. I gradually built up a tolerance to it and he would keep upping the dosage. 5 years later I was taking a total of 180mg of extended release morphine per day. I was living in a drug enduced fog and didn’t know how bad it was until I finally quit cold turkey.
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"according to data from the Centers for Disease Control and Prevention, 220 Americans will lose their lives due to an opioid overdose."
220 people from a population of 328+ million people?
Is the opioid crisis an actual threat, or is it a made-up crisis? Or is it simply busy work for our huge bureaucracies?
Doctors have been responsibly prescribing opioid medications for generations helping millions of people live better lives. Not anymore. The DEA is all over this like a cheap suit. It's the first common drug that they can actually control. They have the names of the manufacturers, the distributors, the doctors, and their patiants putting ridiculous increases in the cost of obtaining them along with unbelievable monitoring and control.
Meanwhile, just about any drug, anyone wants is readily available on any city street.
This must be what we all want, a huge over-controlling ineffective nanny state.
220 people from a population of 328+ million people?
Is the opioid crisis an actual threat, or is it a made-up crisis? Or is it simply busy work for our huge bureaucracies?
Doctors have been responsibly prescribing opioid medications for generations helping millions of people live better lives. Not anymore. The DEA is all over this like a cheap suit. It's the first common drug that they can actually control. They have the names of the manufacturers, the distributors, the doctors, and their patiants putting ridiculous increases in the cost of obtaining them along with unbelievable monitoring and control.
Meanwhile, just about any drug, anyone wants is readily available on any city street.
This must be what we all want, a huge over-controlling ineffective nanny state.
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