In the United States, painkillers take more lives than heroin and cocaine combined – Globe and Mail, Oct. 3, 2014

The topic of evidence and where it leads is of interest to me.

Truthiness takes a person elsewhere; truthiness makes for engaging and compelling stories built upon the absence of empirical evidence.

As noted at the link in the previous sentence, More Real: Art in the Age of Truthiness (2012) provides a definition and an overview (pp. 34-35) of “truthiness.” The underlying assumption in the latter study is that “we live in an age of ‘truthiness,’ a time when our understanding of truth may not be bound to empirical evidence – that is, to anything real, provable, or factual” (p. 34).

I do not know if we live in an age of truthiness. I’m not aware of evidence related to such a claim.

In the social construction of meaning that is at the heart of marketing, public relations, and education, among other pursuits, you can build your narrative on the basis of evidence or truthiness, or on a combination of the two. This applies as well, by way of example, to narratives associated with climate change and the concept of climate wars.

The Drug Wars in America, 1940-1973 (2013)

With reference to the distinction between evidence and truthiness, I have previously added updates, on topics related to drugs, at a post entitled The Drug Wars in America, 1940-1973 (Kathleen J. Frydl, 2013). Additional updates have been added at a post entitled Updates to Drug Wars (2013) and related topics.

As noted in the first link in the previous paragraph, my own philosophy as it relates to drugs can be summarized as follows:

Around the time that it was published, I read a book by Charles Tart entitled Altered States of Consciousness: A Book of Readings (1969).

The book introduced me to a concept that I found appealing.

In the book, Charles Tart or some other writer asserts that if one wants to enhance one’s level of consciousness, engaging in  a systematic way in practices such as meditation is more likely to produce favourable results than dabbling with psychedelic substances.

The concept had a strong impact on my efforts to make sense of reality.

I personally don’t see much value in recreational drug use, but I do believe people should be free to indulge in such activities without the risk of criminal record or incarceration.

Solving the painkiller crisis: It’s in the hands of doctors, according to The Globe and Mail.

An Oct. 3, 2014 Globe and Mail article is entitled: “Solving the painkiller crisis: It’s in the hands of doctors.”

The article reinforces themes addressed in previous posts.

In the article, Carly Weeks notes: “The national consumption [of opioid painkillers – compounds descended from the opium poppy] has risen so rapidly that Canada now ranks second per capita only to the United States, where painkillers take more lives than heroin and cocaine combined.”

Among the physicians quoted in the article is Philip Berger, chief of family medicine at St. Michael’s Hospital in Toronto. Dr. Berger notes that the Ontario college of physicians and surgeons “has utterly failed in its duty to protect the public by not scrutinizing the prescribing practices of physicians years ago.”

On the Run: Fugitive Life in an American City (2014)

The article brings to mind another previous post, Alice Goffman’s ‘On the Run’ Studies Policing in a Poor Urban Neighborhood. Goffman’s work provides evidence concerning the policing of inner cities.

What lessons can we draw from the available evidence – as cited in studies and articles referred to at this post – related to drug use in North America?

First, the Toronto Public Library website shares the following blurb regarding Drug Wars in America, 1940-1973 (2013); the blurb is worth a close read:

• The Drug Wars in America, 1940-1973 argues that the U.S. government has clung to its militant drug war, despite its obvious failures, because effective control of illicit traffic and consumption were never the critical factors motivating its adoption in the first place. Instead, Kathleen J. Frydl shows that the shift from regulating illicit drugs through taxes and tariffs to criminalizing the drug trade developed from, and was marked by, other dilemmas of governance in an age of vastly expanding state power. Most believe the “drug war” was inaugurated by President Richard Nixon’s declaration of a war on drugs in 1971, but in fact his announcement heralded changes that had taken place in the two decades prior. Frydl examines this critical interval of time between regulation and prohibition, demonstrating that the war on drugs advanced certain state agendas, such as policing inner cities or exercising power abroad. Although this refashioned approach mechanically solved some vexing problems of state power, it endowed the country with a cumbersome and costly “war” that drains resources and degrades important aspects of the American legal and political tradition.

[End of blurb]

Secondly, given that, in the United States, “painkillers take more lives than heroin and cocaine combined,” it would make sense to make it a public policy priority to address the overprescription of opioid painkillers. The United States is taking steps in that direction. It would be helpful if Canada were to take similar steps. In the Oct. 3, 2014 Globe and Mail article, Carly Weeks has outlined recommended steps.

Thirdly, I personally don’t see much value in recreational drug use, but I do believe people should, whether they live in inner cities or elsewhere, be free to indulge in such activities without the risking of a criminal record or incarceration.

Fourth, don’t take my word for it. Read the Oct. 3, 2014 Globe article.

Updates

An Oct. 6, 2014 Globe and Mail article is entitled: “Doctors’ groups agree painkillers are over-prescribed.”

An oct. 8, 2014 DB’s Medical Rants article is entitled: “Learning medicine – some principles for teaching.” The post refers to an Oct. 6, 2014 New York Times article entitled” “Better ways to learn.”

An Oct. 9, 2014 CBC article is entitled: “CAMH calls for legalization of marijuana: Current system ‘failing to prevent or reduce the harms’ of pot use, researcher says.”

The article notes:

Anyone who buys pot in criminal markets doesn’t know about its potency or quality. Meanwhile, enforcement of cannabis laws costs Canadians $1.2 billion a year, the centre said.

While decriminalization has some advantages over prohibition, it doesn’t address health harms of cannabis use as strict regulations would, Rehm said, adding the strict regulations proposed set the model apart from other legalization approaches, such as in the U.S.

In May, the Canadian Public Health Association also issued a policy statement saying “Canada needs a public health approach to managing illegal psychoactive substances that de-emphasizes criminalization and stigma in favour of evidence-based strategies to reduce harm.”

Ian Culbert, the group’s executive director, said a different approach is needed than the current “war on drugs.”

“Canadian society isn’t overnight going to embrace this idea of legalization and regulation, so it’s a conversation that we have to have,” he said.’

[End of excerpt]

An Oct. 10, 2014 podcast at CBC’s The Current is entitled: “Debating prescribing opioids for treating chronic pain.” The podcast provides a comprehensive, balanced, and evidence-based overview of the topic.

A Dec. 19, 2015 Guardian article is entitled: “Fatal drug overdoses hit record high in US, government figures show.”

A Feb. 22, 2016 New York Tims article is entitled: “For Mark Willenbring, Substance Abuse Treatment Begins With Research.”

An Aug. 2, 2016 Stat article ie entitled: “Dope Sick: A harrowing story of best friends, addiction — and a stealth killer.”

An Aug. 22, 2016 CBC article is entitled: “Fentanyl found at Prince’s estate mislabelled as weaker opioid: Prince had no prescription for controlled substances in Minnesota in the 12 months before he died.”

An Aug. 23, 2016 Daily Hampshire Gazette article is entitled: “Student athletes cautioned on opioid medication.”

An Aug. 24, 2016 Vancouver Sun article is entitled: “Doctors ‘waking up’ to opioid over-prescription problem in Canada: CMPA [Canadian Medical Protective Association].”

An Aug. 25, 2016 Independent (U.K.} article is entitled: “Illegal drugs are changing the basis of the food chain in rivers: ‘As society continues to grapple with aging wastewater infrastructure and escalating pharmaceutical and illicit drug use, we need to consider collateral damages to our freshwater resources’”.

An Aug. 29, 2016 New Yorker article is entitled: “A Drawdown in the War of Drugs: The President’s commuting of sentences and an end of the use of private prisons signal potentially meaningful changes in how the United States handles drug abuse.”

An Aug. 29, 2016 Globe and Mail article is entitled: “An unprepared Ontario faces imminent fentanyl crisis, groups warn.”

A Nov. 7, 2016 CBC article is entitled: “Curb ‘rampant prescribing of opioids and reduce deaths,’ Canadian doctors say: It’s late, but not too late, for Canada to reduce the toll of opioid overuse and abuse.”

As well, a useful, evidence-based resource is entitled: Cochrane Handbook of Alcohol and Drug Misuse (2012).

A may 19, 2017 CBC article is entitled: “Opioid conflict-of-interest controversy reveals extent of big pharma’s ties to doctors: Financial ties between doctors, hospitals and the pharma field are widely accepted — but rarely discussed.”