Email steve@steveariens.com 502-938-2414
Pay Attention
The hyperlink below is just a link to a 557-page report from the WHITE HOUSE on the COVID-19 Crisis. Of course, the highlight of the entire 4 yrs crisis and a copy of the pardon that President Biden gave Anthony Fauci for his contributions to the COVID-19 crisis.
https://www.whitehouse.gov/lab-leak-true-origins-of-covid-19/?utm_source=wh_social_share_button
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https://www.acsh.org/news/2025/04/14/morphine-milligram-equivalents-metric-obscures-mission-49415
Generated by AI
“You can’t manage what you can’t measure.”
While this statement by business sociologist Peter Drucker is certainly true, in some scientific or regulatory instances, it is impossible to measure what you seek to manage. Proxies are measurable and, when strongly correlated with our goal, useful. Proxies can simplify complex problems, allow for performance tracking, and deliver faster feedback. But poorly chosen proxies derail the very goals they’re meant to support.
A Poorly Chosen Proxy
In the opioid wars, Morphine Milligram Equivalents (MMEs) became the proxy of choice. Easily measured, easy to regulate, and track—MMEs appear whenever a prescription is filled. So, it made sense, on the surface, to use MMEs to simplify the goal of reducing opioid prescribing.
Unfortunately, the goal of reducing opioid prescribing is, in fact, a proxy for an even more difficult goal: the reduction of prescription-related substance use disorder.
MMEs, now a proxy for a proxy—lose their strength of correlation and usefulness, succumbing to the proxy’s pitfalls: misalignment, unintended consequences, and oversimplification. More specifically, the use of MMEs in the war on opioid addiction and overdoses has resulted in unintended harm to individuals afflicted with chronic pain, oversimplifying the clinical nuances of addiction allowing bureaucrats to count pills instead of understanding patients.
It is a painful demonstration of Goodhart’s Law,
“When a measure becomes a target, it ceases to be a good measure.”
A new study in JAMA Network Open drives home the disconnect between proxy metrics and meaningful outcomes.
The Law That Capped Judgment
In 2016, New York implemented a limit to the initial prescription of opioids for acute pain to 7 days, stripping any discretion, i.e., clinical judgment, by physicians. The New York law, known as Section 3331, joined 39 other states in state opioid cap laws (SOCLs) aimed at:
The research involving Medicare beneficiaries looked at prescribing behavior before and after implementing New York’s SOCL Section 3331 for individuals undergoing total joint replacement (TJR). As they write,
“Adequate post-TJR pain control is a key marker of successful surgery, and inadequate control is associated with impaired recovery, resulting in delayed or unmet physical therapy milestones, increased health services use, and reduced quality of life.”
California, which had the highest number of Medicare TJRs and no SOCL, served as a control. The primary endpoint was the total MMEs filled after discharge. They considered the first 7 days after surgery and 30- and 90-day intervals consistent with the law and “key clinical practice milestones.” [1]
The patient cohort included 85,000 Medicare beneficiaries undergoing 93,000 total joint replacements, roughly a third being treated before New York’s SOCL implementation. The mean age was 73; 60% were women, and 89% were White.
The Data Speaks
“Overall, our findings suggest that Section 3331 may have achieved its intended objective of reducing opioid prescribing for acute pain in the short-term 7-day post-TJR period.” [emphasis added]
However, that’s where the success story ends. The unstated but actual goal, reducing prolonged opioid exposure, addiction risk, and leftover meds for diversion—remained unmeasured and possibly unmet. Exposure was longer in New York when those later refills are counted. And we have no data on addiction, diversion, or patient satisfaction.
What’s Missing from the Metrics
Most critically, the focus on the proxy, MMEs prescribed, left “meaningful changes in the pain needs of patients, morbidity, or mortality for future research.” The increase in refills after the initial 7 days is ambiguous. Do they suggest the persistence of pain requiring longer treatment or reflect misuse or diversion? Refills tell us nothing about “risky” behavior.
We don’t know—because the measure we chose can’t tell us.
Goodhart’s Law In The Real World
Goodhart’s Law manifests itself in many ways, as this study demonstrates. MMEs are too simple a measure of the complexity of real-world prescribing that is a confluence of practitioner beliefs, institutional protocols, and policy environment. California’s trends in prescribing behavior were nearly identical to New York’s, without the benefit or limitations of SOCL. MMEs fail because they are correlates, not causes. MMEs are a rough measure of opioid exposure, at best, a risk factor among many for substance use disorder.
They are neither a measure of pain management nor relief. MMEs also allow for gaming the system. Prescribers might under-treat pain out of fear—or overprescribe to avoid complaints—neither of which addresses patient well-being. Proxies distort behavior and, as Goodhart suggests, undermine intended outcomes.
Recognizing these pitfalls, one might hope for mitigation strategies. That could include:
Unfortunately, legislation is drawn in blacks and whites, and rarely are clinicians invited to the table. Researchers are equally culpable for using available data rather than more costly, in time and money, bespoke data. These researchers write that “much work remains to restrict opioid prescribing in the later post-TJR period, suggesting there is an opportunity to refine Section 3331 to reduce perioperative prescribing.” This refines the proxy and does little for the clinical outcomes of safe pain management and lowered addiction risk.
Proxy metrics like MMEs were never designed to bear the weight of legislation, yet we keep piling on. In chasing numbers, we lose sight of patients—of pain that goes untreated, of addiction risks that go unmeasured, of policies that solve for optics instead of outcomes.
Real patients suffer when we treat metrics as medicine.
If we want better results, we need better questions, metrics, and a better understanding of what and who we’re actually trying to heal.
[1] Secondary endpoints included MMEs per prescription and day, number of refills and the likelihood of at least one opioid fill, the likelihood of an opioid prescription longer than 7 days, and total opioids prescribed.
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I asked www.perplexity.ai several questions concerning a pt’s concurrent prescribed use of an opioid, benzodiazepine, and muscle relaxant. It kept giving me answers that might, could cause respiratory suppression. It was obvious all the answers were based on – IMO – sloppy documentation of a death from a person taking the three meds together, and maybe – maybe not – took prescribed meds as directed in mgs dose and frequency, and what other substances – legal or illegal – the person had taken.
Statistics can be your friend or your enemy. When someone has an agenda and they are in the position to choose which particular pieces of data they can use to support the conclusion that will serve their agenda. One can just figure out which pieces of data are ignored or discarded, and which ones are used to match the conclusion that they want.
Below is my final question, trying to get Perplexity to find some definitive data. The last sentence in Perplexity’s answer pretty much says and clarifies it all.
So what you are saying is that no one bothered to document any evidence that confirmed ODs that the person was taking their prescribed meds, in the doses and frequency prescribed and had taken no other legal or illegal substances concurrently. Published statistics have stated that the typical OD involved 4 to 7 different substances, with alcohol and marijuana typically being in the polysubstance OD. While all three classes of meds will suppress respiration, but is suppression at therapeutic doses typically fatal – can you provide clinical studies that shows a high probability of it being fatal
The user raises valid concerns about confounding factors in overdose statistics, but clinical and pharmacological evidence confirms that fatal respiratory depression can occur even when opioids, benzodiazepines, and muscle relaxants are taken as prescribed, without other substances. Here’s the breakdown:
FDA’s 2016 Analysis (prescribed regimens):
Veterans Health Study:
Respiratory Depression Mechanism:
Opioids (µ-opioid receptors) and benzodiazepines (GABA-A receptors) synergistically suppress brainstem respiratory drive710.
Muscle relaxants like carisoprodol further amplify GABA-A receptor activity, eliminating the “ceiling effect” of partial opioids (e.g., buprenorphine)109.
Animal/human studies show synergistic hypoxia even at sedative (not overdose) doses810.
Polysubstance Overdose Prevalence:
Indirect Evidence from Hospitalizations:
Human Experimental Trial:
Fentanyl (opioid) + midazolam (benzodiazepine) at sedative doses caused severe hypoxia in 100% of subjects vs. 50% with fentanyl alone8.
Buprenorphine/Methadone Patients:
82% of buprenorphine-related deaths involved benzodiazepines, often at prescribed doses9.
Postoperative Mortality:
Combined preoperative opioids + benzodiazepines (as prescribed) increased short- and long-term mortality vs. either drug alone7.
While polysubstance use dominates overdose statistics, mechanistic and cohort studies confirm that respiratory depression from triple therapy can be fatal at therapeutic doses, particularly in high-risk groups (e.g., sleep apnea patients, elderly). The FDA and CDC warnings are grounded in this evidence, though isolating “pure” cases remains methodologically challenging 1 4 10.
Answer from Perplexity: pplx.ai/share
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More than 90% of people taken to federal court in the United States are found guilty. The most recent data shows that in fiscal year 2022, 89.5% of federal defendants pleaded guilty, while only 0.4% went to trial and were acquitted, and 1.9% went to trial and were found guilty. An additional 8.2% of cases were dismissed at some point in the judicial process
When combining those who plead guilty with those found guilty at trial, the overall conviction rate in federal court exceeds 90%—and is often cited as being around 93% or higher in recent years
. This high rate is largely due to the prevalence of plea bargains, which account for the vast majority of convictions in the federal system
In summary, the percentage of people taken to federal court who are found guilty is typically above 90%, with most convictions resulting from guilty pleas rather than trials
Overview:
Dr. Neil K. Anand, a Pennsylvania-based pain management specialist, was convicted by a federal jury in April 2025 on multiple counts related to healthcare fraud and violations of the Controlled Substances Act (CSA).
Key Charges and Findings:
Healthcare Fraud and Wire Fraud:
Dr. Anand was found guilty of conspiring to submit false and fraudulent claims totaling approximately $2.3 million to Medicare, the U.S. Office of Personnel Management (OPM), Independence Blue Cross (IBC), and Anthem. The fraudulent activity centered around “goody bags”—pre-packaged sets of prescription medications dispensed by his in-house pharmacies. Patients were required to accept these unnecessary “goody bags” in order to receive prescriptions for regulated drugs23.
Distribution of Controlled Substances:
Anand distributed over 20,000 tablets of oxycodone, a highly addictive opioid painkiller, to nine patients, often without a legitimate medical purpose and outside the usual course of professional practice. He also signed blank prescription letterheads and allowed unlicensed medical interns to write prescriptions for controlled substances23.
Money Laundering and Unlawful Monetary Transactions:
After the investigation began, Anand attempted to conceal his fraudulent activities by transferring nearly $1.2 million into an account in his father’s name, purportedly for the benefit of his minor daughter2.
Conspiracy to Distribute Controlled Substances:
The evidence showed Anand conspired with others to distribute controlled substances without a legitimate medical purpose, using the goody bag scheme as a cover for the unlawful distribution of opioids23.
Potential Penalty:
Dr. Anand faces a maximum statutory penalty of up to 130 years in prison. Sentencing is scheduled to begin on August 19, 2025, with the final sentence to be determined by a federal district court judge in accordance with U.S. Sentencing Guidelines and other statutory provisions2.
Summary Table of Charges
| Charge | Description |
|---|---|
| Healthcare Fraud & Wire Fraud | False claims to Medicare, OPM, IBC, Anthem via unnecessary “goody bags” |
| Distribution of Controlled Substances | Unlawful prescription and distribution of over 20,000 oxycodone tablets |
| Money Laundering & Unlawful Transactions | Concealing proceeds by transferring $1.2 million to a family account |
| Conspiracy to Distribute Controlled Drugs | Collaborating with others to distribute opioids without legitimate medical purpose |
Dr. Anand’s conviction highlights ongoing federal efforts to combat opioid-related healthcare fraud and the improper distribution of controlled substances by medical professionals23.
Answer from Perplexity: pplx.ai/share
While according to asking three different AI programs what was in the “goody bag,” the only one that mentioned was Oxycodone
One of the people that I know told me that a plastic bag with some writing on the outside like “EVIDENCE” contained one or more tubes of Diclofenac Topical (Voltaren)- which is an OTC medication.
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Some people (DOJ, DEA, Fed prosecutors, politicians, media, and others) believe and state that opioids are VERY ADDICTING. Many things in our day-to-day life can be dangerous or even kill us. Vehicles are/can be very safe – yet some 42K people die in vehicle accidents every year. Some 100K people die from using many alcohol products, the death rate from people using tobacco products is in the 400 range, and some claim that both of those products are addictive. Gasoline, Kerosene, and Propane are safe, as long as they are used properly, and a simple spark or some ignition source can turn an otherwise safe product into a potentially dangerous or catastrophic outcome.
Below is what perplexity.ai suggests are preexisting ( undiagnosed ) health issues in a person, and when they interact with some substance (opioid, alcohol, cocaine, etc), they – LIKE THE WAY IT MAKES THEM FEEL – and they start down the road to some degree of addiction.
Basically, people who are labeled as dealing with SUD or OUD have some degree of undiagnosed or under/untreated mental health issues that collectively is a form of addictive personality.
So here we are, 55 yrs after our bigoted, racist President Nixon got Congress to pass a bill that was basically directed at putting hippies and black people in jail. We are still chasing down addicts, because President Nixon, by education, was an ATTORNEY, and we still have attorneys interfering with the practice of medicine, but they have expanded their scope that they are raiding practitioners’ offices and throwing thousands of people who have a valid/legit medical needs to be prescribed a controlled med. Not to mention that they are ruining thousands of practitioners’ lives and discouraging other practitioners from properly treating millions of pts who have a valid need to take a controlled substance.
Besides violating this federal law that has been on the books since 1935 – 35 yrs before the CSA was signed into law.
https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)
Nothing in this sub chapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
(Aug. 14, 1935, ch. 531, title XVIII, §1801, as added Pub. L. 89–97, title I, §102(a), July 30, 1965, 79 Stat. 291 .)
Here is something interesting: What comorbidity issues are generally involved with addiction? I suggest this as well: DOJ Considers Opioid Use Disorder an ADA Covered Disability and Pursues Claims Against a Provider for Refusing Medical Services to Opioid Users https://www.pharmaciststeve.com/doj-considers-opioid-use-disorder-an-ada-covered-disability-and-pursues-claims-against-a-provider-for-refusing-medical-services-to-opioid-users/
Comorbidities associated with addiction, also known as substance use disorders (SUDs), are common and can significantly complicate treatment and recovery. These comorbidities span mental health disorders, medical conditions, and behavioral issues. Below is an overview of the most prevalent comorbidities:
### *Mental Health Disorders*
1. *Depression and Anxiety Disorders*: These are among the most frequent comorbid conditions. Many individuals use substances to self-medicate, which can create a vicious cycle of dependency[1][2].
2. *Bipolar Disorder*: Substance abuse often exacerbates mood instability in individuals with bipolar disorder[1][3].
3. *Post-Traumatic Stress Disorder (PTSD)*: Trauma survivors may turn to substances to cope with distressing memories and emotions[1][2].
4. *Personality Disorders*:
– *Borderline Personality Disorder (BPD)*: Impulsivity and emotional dysregulation in BPD increase vulnerability to substance use.
– *Antisocial Personality Disorder (ASPD)*: Individuals with ASPD are more likely to engage in substance abuse due to impulsivity and disregard for societal norms[1][3].
5. *Psychotic Disorders*: Schizophrenia frequently co-occurs with SUDs, complicating treatment adherence and symptom management[1][3].
### *Medical Conditions*
1. *Infectious Diseases*: Injection drug use is linked to a higher risk of HIV/AIDS and hepatitis.
2. *Cardiovascular Issues*: Stimulant use can lead to hypertension, arrhythmias, and heart attacks.
3. *Liver and Gastrointestinal Problems*: Chronic alcohol or drug use can cause liver damage and gastrointestinal disorders.
4. *Diabetes and Cancer*: Addiction may exacerbate these systemic conditions by hindering proper management[4][6].
### *Behavioral Disorders*
1. *Eating Disorders*: Conditions like anorexia, bulimia, and binge eating disorder often co-occur with SUDs due to shared risk factors such as low self-esteem[1][3].
2. *Gambling Disorder*: Both behaviors share underlying vulnerabilities in brain reward systems[1].
### *Challenges in Diagnosis and Treatment*
Diagnosing comorbidities is challenging due to overlapping symptoms, stigma, and limited integration between mental health and addiction treatment services. Untreated comorbidities often worsen outcomes by increasing relapse risks and reducing treatment effectiveness[2][6].
### *Integrated Care Approach*
Effective management requires a multidisciplinary approach that simultaneously addresses addiction and comorbid conditions through personalized treatment plans. This includes pharmacological interventions, psychotherapy, and social support systems tailored to individual needs[1][2].
Addressing these comorbidities holistically improves recovery outcomes and enhances quality of life for individuals struggling with addiction.
Citations:
[1] https://www.serenityspringsrecovery.com/blog/common-comorbidities-with-substance-use-disorders/
[2] https://www.euda.europa.eu/spotlights/comorbid-substance-use-and-mental-health-problems_en
[3] https://www.unodc.org/documents/drug-prevention-and-treatment/UNODC_Comorbidities_in_drug_use_disorders.pdf
[4] https://footprintstorecovery.com/comorbid-medical-conditions-addiction/
[5] https://www.youtube.com/watch?v=5RbEotf0jqI
[6] https://thephoenixrc.com/blog/addiction-recovery/handling-comorbidities-with-substance-use-disorder/
[7] https://www.ncbi.nlm.nih.gov/books/NBK571451/
[8] https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions
[9] https://altacenters.com/addiction-resources/comorbidity/
[10] https://www.helpguide.org/mental-health/addiction/substance-abuse-and-mental-health
—
Answer from Perplexity: pplx.ai/share
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Does this suggest that Kennedy is in favor of treating chronic pain patients to optimize a patient’s QOL? Could we bring back “pain is the 5th vital sign”? Could a lot of practitioners who are now “uncomfortable” in writing for opioids for pain management have a change in their belief of treating pain if their reimbursement was based on optimizing the pt’s level of pain and QOL? Will the DOJ/DEA get muzzled in raiding practitioners’ offices based on some nebulous statistical data? Should chronic pain pts reach out to RFK Jr to support his new patient treatment goals?
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/115141
HHS is trying to change the “perverse incentives” in the medical system, including the way doctors are paid, HHS Secretary Robert F. Kennedy Jr. said Tuesday.
“A lot of the negative behavior and self-destructive behavior in both the medical system — how we pay for healthcare — and how we eat is driven by perverse incentives,” Kennedy said at a press conference at the Indiana State Library in Indianapolis.
On another front, Kennedy also said that the CDC “has done a very good job at controlling the measles outbreak. We’ve had about 700 cases nationally and in Europe, they’ve had 127,000 cases and 37 deaths.” That number contrasts with 2024, in which 285 measles cases were reported in the U.S. for the entire year, according to the CDCopens in a new tab or window.
“People get measles because they don’t vaccinate. They get measles because the vaccine wanes — the vaccine wanes about 4.8% per year, so you know that problem is always going to be around,” he continued. “We need to also make sure that doctors know how to treat measlesopens in a new tab or window and how to treat the associated diseases, the pulmonary disease that often comes with measles, and [the] bacteriological [ones] — we can’t rely simply on the vaccine.”
In contrast to Kennedy’s remark, experts say that the measles vaccine provides lifelong immunityopens in a new tab or window, which is how the U.S. achieved elimination status.
It’s “outrageous” that the government doesn’t have a better surveillance system for vaccine injuries, Kennedy said in response to a question from the audience — which was not audible on the livestream — that apparently raised the issue of a possible connection between vaccines and autism, a relationship that has been widely debunkedopens in a new tab or window.
The CDC did a study on HHS’s surveillance system, the Vaccine Adverse Event Reporting System — which allows for self-reporting of possible vaccine-associated injuries but does not verify them — in 2010, “and [found that] it captures fewer than 1% of vaccine injuries,” he said, noting that at the time, the CDC had a “machine counting” system for such injuries but they “put it on a shelf.”
“We are going to improve the surveillance,” Kennedy said. “We’re going to get the data sets from everybody we can. We’re going to make data-sharing agreements with scientists all over the world, with the best scientists, and we’re going to find out what contribution vaccines and everything else make — mold, EMF [electromagnetic fields], food, all of these other exposures — which one of those are the culprits? I suspect we’re going to see that there’s a lot of culprits, but we need to know.”
“People don’t have informed consent [for vaccination], and people don’t trust our agency anymore,” he added. “And the way to improve vaccination is to make the agency trustworthy, and that’s what we’re going to do.”
HHS is trying to change the “perverse incentives” in the medical system, including the way doctors are paid, HHS Secretary Robert F. Kennedy Jr. said Tuesday.
“A lot of the negative behavior and self-destructive behavior in both the medical system — how we pay for healthcare — and how we eat is driven by perverse incentives,” Kennedy said at a press conference at the Indiana State Library in Indianapolis. “Today, we have a healthcare system that reimburses doctors and hospitals for procedures rather than for health outcomes. We have to change that.”
On another front, Kennedy also said that the CDC “has done a very good job at controlling the measles outbreak. We’ve had about 700 cases nationally and in Europe, they’ve had 127,000 cases and 37 deaths.” That number contrasts with 2024, in which 285 measles cases were reported in the U.S. for the entire year, according to the CDCopens in a new tab or window.
“People get measles because they don’t vaccinate. They get measles because the vaccine wanes — the vaccine wanes about 4.8% per year, so you know that problem is always going to be around,” he continued. “We need to also make sure that doctors know how to treat measlesopens in a new tab or window and how to treat the associated diseases, the pulmonary disease that often comes with measles, and [the] bacteriological [ones] — we can’t rely simply on the vaccine.”
In contrast to Kennedy’s remark, experts say that the measles vaccine provides lifelong immunityopens in a new tab or window, which is how the U.S. achieved elimination status.
It’s “outrageous” that the government doesn’t have a better surveillance system for vaccine injuries, Kennedy said in response to a question from the audience — which was not audible on the livestream — that apparently raised the issue of a possible connection between vaccines and autism, a relationship that has been widely debunkedopens in a new tab or window.
The CDC did a study on HHS’s surveillance system, the Vaccine Adverse Event Reporting System — which allows for self-reporting of possible vaccine-associated injuries but does not verify them — in 2010, “and [found that] it captures fewer than 1% of vaccine injuries,” he said, noting that at the time, the CDC had a “machine counting” system for such injuries but they “put it on a shelf.”
“We are going to improve the surveillance,” Kennedy said. “We’re going to get the data sets from everybody we can. We’re going to make data-sharing agreements with scientists all over the world, with the best scientists, and we’re going to find out what contribution vaccines and everything else make — mold, EMF [electromagnetic fields], food, all of these other exposures — which one of those are the culprits? I suspect we’re going to see that there’s a lot of culprits, but we need to know.”
“People don’t have informed consent [for vaccination], and people don’t trust our agency anymore,” he added. “And the way to improve vaccination is to make the agency trustworthy, and that’s what we’re going to do.”
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https://thehill.com/opinion/5247116-opioid-crisis-prevention/
by Chris Fox, opinion contributor chris@nonopioidchoices.org https://nonopioidchoices.org/
Last week, the Trump administration released a five-step plan to address the country’s opioid addiction crisis. The administration’s new drug czar’s plan focuses largely on attempts to prevent opioid-related overdose deaths.
It won’t work. Here’s why: The plan continues a years-old downstream focus on overdose death prevention and neglects the opportunity to prevent addiction in the first place.
In 2023, the last year for which we have full-year overdose data, 81,000 Americans died from an opioid-related overdose — an average of more than 220 deaths per day. Despite these staggering numbers, the administration’s plan primarily focuses on stopping the flow of illicit fentanyl into the U.S., relying on border control and punitive measures against drug cartels.
While addressing fentanyl trafficking is important, this approach tackles only one part of a far more complex problem. The reality is that overdose deaths remain high not only because of illegal fentanyl but also because millions of Americans continue to receive prescription opioids to manage postsurgical pain, whether they need them or not. In fact, as many as 90 percent of all surgical patients in the U.S. today receive an opioid prescription for post-operative pain.
The administration’s approach also touts increasing access to naloxone and medication-assisted treatment for opioid-use disorder, which are essential components of addiction treatment and overdose prevention. However, these measures are reactive, not proactive. They miss an important opportunity to prevent addiction before it starts by expanding non-opioid pain management options.
Current pain treatment protocols incentivize the use of generic prescription opioids. They do so because such medicines are cheap and well-known to health care professionals, and most patients will tolerate these medicines without incident.
However, some — estimates show between 6 percent and 20 percent — will misuse these medicines. Some may become addicted and move on to other illicit forms of opioids. Some will overdose. Some will die.
This overreliance on prescription opioids strips patients of real choices and unnecessarily increases the risk of long-term dependency. We have the tools to change the status quo.
We must change how we treat pain in this country and ensure that patients and health care providers have options when it comes to treating acute pain. The passage of the Non-Opioids Prevent Addiction in the Nation Act in 2022 was a major step forward, ensuring that non-opioid alternatives are available in outpatient surgical settings.
But there is more work to do.
We must ensure that all patients in all settings can easily access non-addictive pain treatment options. This is especially true for patients covered by Medicare Part D plans.
Earlier this year, legislation was introduced in Congress called the Alternatives to Prevent Addiction in the Nation Act. This critical legislation would make sure that patients can easily access non-opioid medications at the pharmacy counter.
The opioid addiction epidemic is far from over. Hundreds of Americans still die every day, and the crisis is evolving in ways that demand urgent action. Focusing solely on border control and fentanyl supply reduction ignores the deeper issue: how we manage pain in our health care system.
If we are serious about preventing addiction and saving lives, we must prioritize non-opioid choices — before it’s too late.
Every day we delay action, more patients are denied access to a non-opioid pain management tool. Recently, a major insurance company announced that it was making it more difficult for Americans to access non-opioids. We cannot stand idly by and let this happen.
This proposal would ensure that all patients can access non-opioid treatments in all settings. It can prevent addiction before it starts.
Congress has a chance to get ahead of this crisis — but only if they act now. Passing the act is a concrete step toward ensuring that patients have real choices in pain management. If we are serious about preventing addiction and saving lives, we must prioritize non-opioid choices.
We cannot afford to fight the opioid crisis with half measures.
Chris Fox is executive director of Voices for Non-Opioid Choices.
https://nonopioidchoices.org/about/members/
This article was appropriately noted as provided by: by Chris Fox, opinion contributor. I find the adjective OPINION very true, unfortunately, his opinion has very little to do with reality.
Generally, addiction is not caused by Opioids or some other substances that the person with pre-existing mental health issues. They have unknown- to them- “monkeys” on their back and/or “demons” in their head, and their interaction with some substance or activity will silence those “monkeys” or “demons”. They experience a “mental peace” they had no idea was possible. Depending on what statistic one wishes to believe, 0.6% to 3% of the people prescribed an opioid for acute or chronic pain will become addicted. It appears that this organization, Voices for Non-Opioid Choices believes that >97% of anyone dealing with acute or chronic pain should be denied effective, FDA-approved medications.
Recently, I asked www.perplexity.ai the following question: What comorbidities issues are generally involved with addiction?
Comorbidities associated with addiction, also known as substance use disorders (SUDs), are common and can significantly complicate treatment and recovery. These comorbidities span mental health disorders, medical conditions, and behavioral issues. Below is an overview of the most prevalent comorbidities:
Depression and Anxiety Disorders: These are among the most frequent comorbid conditions. Many individuals use substances to self-medicate, which can create a vicious cycle of dependency12.
Bipolar Disorder: Substance abuse often exacerbates mood instability in individuals with bipolar disorder13.
Post-Traumatic Stress Disorder (PTSD): Trauma survivors may turn to substances to cope with distressing memories and emotions12.
Personality Disorders:
Psychotic Disorders: Schizophrenia frequently co-occurs with SUDs, complicating treatment adherence and symptom management13.
Infectious Diseases: Injection drug use is linked to a higher risk of HIV/AIDS and hepatitis.
Cardiovascular Issues: Stimulant use can lead to hypertension, arrhythmias, and heart attacks.
Liver and Gastrointestinal Problems: Chronic alcohol or drug use can cause liver damage and gastrointestinal disorders.
Diabetes and Cancer: Addiction may exacerbate these systemic conditions by hindering proper management46.
Eating Disorders: Conditions like anorexia, bulimia, and binge eating disorder often co-occur with SUDs due to shared risk factors such as low self-esteem13.
Gambling Disorder: Both behaviors share underlying vulnerabilities in brain reward systems1.
Diagnosing comorbidities is challenging due to overlapping symptoms, stigma, and limited integration between mental health and addiction treatment services. Untreated comorbidities often worsen outcomes by increasing relapse risks and reducing treatment effectiveness26.
Effective management requires a multidisciplinary approach that simultaneously addresses addiction and comorbid conditions through personalized treatment plans. This includes pharmacological interventions, psychotherapy, and social support systems tailored to individual needs12.
Addressing these comorbidities holistically improves recovery outcomes and enhances quality of life for individuals struggling with addiction.
Answer from Perplexity: pplx.ai/share
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Just imagine when a private equity company buys a company whose primary function is to provide medical care to mostly pts who are high acuity, complex, and most likely disabled. However, the primary function of private equity companies is to generate profits. One can only imagine what happens to the healthcare companies that they buy.
https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/115074
Private equity (PE) has become a powerful and often invisible force reshaping how care is delivered across the country. A recent report from the Private Equity Stakeholder Projectopens in a new tab or window shines a light on one of the latest, and most concerningopens in a new tab or window, developments: the growing role of PE in services for people with intellectual and developmental disabilities (IDD).
This trend is alarming not just because of the populations involved, but because of what it reveals about how healthcare is increasingly being treated — not as a social good, but as a business opportunity ripe for financial exploitation.
The Lifeline of Medicaid-Funded IDD Services
Many of the services supporting individuals with IDD — residential facilities, home care, adult day programs, physical and occupational therapy, and more — are funded primarily through Medicaidopens in a new tab or window. For nearly 10 million Americans with IDD, these programs represent far more than care: they are the foundation of daily life, independence, and survival. Historically, these services have been provided primarily by non-profits and religious organizations.
And yet, as PE firms continue to acquire companies that provide these services, we must ask a difficult question: What happens when profitability becomes harder to maintain, especially when Medicaid dollars are cut or restrictedopens in a new tab or window? The answer, based on past precedent in other areas of healthcare, is not promising.
The PE Playbook: High Returns, Low Transparency
PE firms generally operate on a 4-to-7-year investment horizon. Their goal is generally to double or triple returns during that short window. In order to get results quickly, PE firms often resort to significant cost-cutting, rapid scaling, and creating “operational efficiency.” In sectors with strong commercial margins, this approach might be sustainable. But in IDD care — an underfunded, labor-intensive space that relies heavily on government reimbursement — this model could result in real harm.
According to the Private Equity Stakeholder Project’s report, PE firms are already applying their traditional cost-saving strategies in IDD. They are reducing staffing levels, relying on lower-paid and less-trained workers, eliminating oversight roles, and prioritizing rapid expansion. The result? Allegations of substandard care, including abuse and neglect, abound and are being investigated by federal and state lawmakers.
The changes put in place by PE firms might boost margins in the short term, but they undermine quality, safety, and continuity — the very pillars of care for individuals with IDD.
And let’s not forget: these significant policy changes will affect vulnerable individuals with lifelong needs, who are often unable to advocate for themselves and are reliant on stable, skilled, and compassionate care teams. Additionally, people with IDD already experience significant health and social inequities. They face shorter life expectancies, higher rates of chronic illness, increased mental health challenges, and greater risk of pregnancy complications. These disparities are rooted in structural barriers, including difficulty accessing care, lack of provider training, and social marginalization.
Now layer on top a business model that prioritizes efficiency over empathy and returns over relationships, and the risks become unacceptable. Indeed, the shift from mission-driven nonprofits and religiously affiliated organizations to profit-maximizing investors represents a fundamental change in how care is conceptualized and delivered — and it is a terrible shift.
We Have Seen This Before
As I have written in MedPage Todayopens in a new tab or window, private equity is not inherently bad. When firms are responsible and transparent, they can fuel innovation, expand access, and help modernize outdated systems. But when left unchecked, firms’ incentives are often misaligned with the core mission of healthcare: to care for people.
This argument is not speculative.
In fact, we have seen the negative effects of PE in emergency medicineopens in a new tab or window, where PE-backed staffing firms have contributed to burnout and dissatisfaction among clinicians. We have seen it too in nursing homesopens in a new tab or window, where aggressive cost-cutting has coincided with drops in quality and oversight. And we are seeing PE expand into behavioral healthopens in a new tab or window, where providers under financial strain are already stretched too thin to meet patient needs. Health policy researchers, patient advocacy groups, and providers worry that similar quality declines will be seen in mental health care with PE acquisitions.
What is unfolding in the IDD space has all the same warning signs, but with even higher stakes.
If we are serious about protecting people with IDD and about ensuring our healthcare system upholds the dignity of those who need it most, we must act now. We must:
Healthcare is not a commodity, and people with disabilities are not lines on a balance sheet. When profit is prioritized over people, we do not just lose efficiency, we lose trust, compassion, and the fundamental integrity of care. If we are not vigilant, the most vulnerable will pay the highest price for someone else’s financial gain.
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