A New Study Finds No Correlation Between Opioid Prescriptions and Drug-Related Deaths

“Using data for 2010 through 2019, Aubry and Carr looked at the relationship between prescription opioid sales, measured by morphine milligram equivalents (MME) per capita, and four outcomes: total drug-related deaths, total opioid-related deaths, deaths tied specifically to prescription opioids, and “opioid use disorder” treatment admissions. “The analyses revealed that the direct correlations (i.e., significant, positive slopes) reported by the CDC based on data from 1999 to 2010 no longer exist,” they write. “The relationships between [the outcome variables] and Annual Prescription Opioid Sales (i.e., MME per Capita) are either non-existent or significantly negative/inverse.”
Those findings held true in “a strong majority of states,” Aubry and Carr report. From 2010 through 2019, “there was a statistically significant negative correlation (95% confidence level) between [opioid deaths] and Annual Prescription Opioid Sales in 38 states, with significant positive correlations occurring in only 2 states. Ten states did not exhibit significant (95% confidence level) relationships between overdose deaths and prescription opioid sales during the 2010–2019 time period.””

“Yet the CDC is still pushing the narrative that more opioid prescribing means more opioid-related deaths.”

“In light of what has happened since 2010, Aubry and Carr say, relying on those outdated numbers is highly misleading. They say the CDC’s advice “should be corrected/updated to state no direct correlation has existed” between prescription opioid sales and drug-related deaths or treatment admissions since 2010, and “individualized patient care and public health policy should be amended accordingly.””

After the latest clash with Israel, Gazans’ struggle continues

“Israeli forces launched a preemptive strike against PIJ targets on August 5, Reuters reported, after one of the group’s leaders, Bassam al-Saadi, was arrested in the Occupied West Bank. Israel claims to have hit a number of PIJ targets. However, several civilians, including 17 children, were killed in the clashes, both by Israeli weapons and possibly by errant PIJ rockets intended for Israeli targets. A ceasefire brokered by Egypt, Qatar, Jordan, the US, the UN, and the Palestinian Authority between Israel and the PIJ last Sunday has thus far held; however, an attack on worshipers in Jerusalem’s Old City late on Sunday could portend more violence. At least eight people, including US citizens, were injured in the attack, which was allegedly carried out by a Palestinian resident of East Jerusalem, according to Israeli authorities. They have not yet released his name, and there is no indication that he is affiliated with any larger group, according to Reuters.

Despite the ceasefire, the aftermath of even short-term hostilities in Gaza goes far beyond active bombardments and shelling; the combination of years of violence, a brutal blockade, and state repression has created an enduring crisis. What’s more, there’s little chance to recover before violence breaks out again.

According to initial UN reporting, 360 Palestinians have been injured in the fighting, and Gazans experienced a tightened Israeli blockade of goods and services that led to 20-plus-hour rolling blackouts each day. There were no Israeli deaths or serious injuries, the Associated Press reported”

“The Gaza strip is home to around 2 million Palestinians and has been governed by Hamas since 2007, when the group took control from the Fatah-led Palestinian Authority, which governs the West Bank. The two groups have had no success in creating a unity government over the past 15 years, despite repeated attempts, weakening the Palestinian resistance and further disenfranchising ordinary Palestinians. Although Fatah and Hamas agreed to hold elections in 2021, which would be the first since 2006, those elections have been postponed indefinitely.”

Overturning Roe v. Wade Could Make Maternal Mortality Even Worse

“Giving birth in the U.S. is already far more dangerous than in other wealthy countries. Ending the protections of Roe v. Wade — the 1973 decision that established the constitutional right to abortion — could make it even more so.

Multiple studies have found that the states that already have the tightest restrictions on abortion also have the highest rates of maternal and infant mortality. And that correlation stubbornly persists even after researchers account for some of the other differences between states, like racial demographics and health care policy. Some researchers think that abortion restrictions are part of the reason why pregnancy and childbirth are so much more dangerous in the U.S. — even for people who never wanted an abortion to begin with.

This data could just be a statistical red herring. But there are ways abortion restrictions could kill people, both directly and indirectly. And scientists say these correlations point toward dangerous disparities in health care access in the U.S. — not just in terms of who can get an abortion, but also in terms of who can get preventative care while pregnant, or even before.”

“Carrying an unplanned pregnancy involves shouldering increased risks of depression, preterm birth, lower birth weight and other complications.”

“Recently released government data shows that 861 women died from causes related to pregnancy and birth in 2020, up from 754 the year before. In population-level terms, the maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births in the U.S., compared with 3.2 deaths per 100,000 live births in Germany in 2019 and 7.9 deaths per 100,000 live births in France in 2015. (The maternal mortality rate calculated by the CDC includes deaths from abortion-related complications, but the organization also calculates that subset separately. In 2019, the death rate from abortion in the United States was minuscule: 0.41 deaths per 100,000 legal abortions between 2013 and 2018.) Infants are also at higher risk of dying in the U.S. than in other wealthy countries. In 2020, the infant mortality rate in the U.S. was 5.4 deaths per 1,000 live births, compared with 1.9 infant deaths per 1,000 live births in Finland and 2.7 infant deaths per 1,000 live births in Spain.

Black Americans are nearly three times more likely than their white counterparts to die as a result of maternal complications, and the risk to Black babies is much higher as well. These disparities are so large that the states with the highest maternal mortality rates are also often states with large Black populations, and researchers have concluded that social factors like inequality and structural racism are playing a huge role in why pregnancy complications kill Americans.

But some researchers think that attempts to restrict abortion access are playing a part too.”

“The simplest explanation is just that giving birth is statistically more dangerous than having an abortion. If the states with the highest mortality rates are the also the ones banning abortion that means more births — and also more deaths.”

“efforts to reduce abortion access have often resulted in the closure of clinics like Planned Parenthood that offer a range of non-abortion-related services. Losing access to preventative health care puts people at a higher risk for all kinds of illnesses that can later cause pregnancy complications. And this effect means the impacts of abortion restriction can overlap and build on the social inequalities that are already harming Black people and babies.”

Suicide Prevention Could Prevent Mass Shootings

“Even once you identify some details that many of the attackers have in common, such a large swath of the population shares these traits that the “profile” is fairly useless for prevention. Red flag laws circumvent that problem by focusing less on a type of person and more on a type of emotional and situational crisis — where the people involved aren’t necessarily “bad guys” but troubled individuals in need of help. Gill thinks of it as a public health approach, analogous to the way we treat physical health problems that are hard to profile.

“We know that raised cholesterol leads to heart problems. We don’t have the ability to predict who in the general population who already has raised cholesterol will go on to have a heart attack. So we put in place prevention policies to try to decrease cholesterol in the whole ‘at risk’ community,” he said.

For the researchers who study mass violence, what’s appealing about red flag laws is that these rules have the potential to shift the emphasis from a cut-and-dried checklist of dangerous traits to a more nuanced system that accounts for a person’s big-picture emotional state.”

“these researchers supported red flag laws because they could create a clear plan of action for friends and family concerned about a loved one’s combination of emotional crisis and violent threats. It creates a place to take concerns, a system to evaluate those concerns and a means of mitigating them. That’s particularly true, researchers said, if national red flag laws are set up so that the system isn’t punitive. Ideally, the process would focus on helping a person get through to the other side of an emotional crisis rather than putting them in jail. It’s also important, the researchers said, to make sure the laws are focused on professional evaluations of overall behavior, not checklists.”

“there’s some evidence this could work. An analysis of records from California, where one of the first red flag laws was enacted in 2016, found at least 21 cases where the laws had been used specifically because people around a person were worried about their potential to commit a mass shooting. As of 2019, none of those people had followed through on that potential. It’s impossible to know, however, how those risks would have played out if the red flag hadn’t been there.

But if those parts work together the way they should, then red flag laws really could be a useful tool for combating the segment of mass shootings that function like very public, violent suicides. “There’s an important piece when we interviewed school shooters and active threat cases,” Randazzo said. “They feel very strongly about two things: They have to carry out the violence, they have no options left, but they also don’t want to do it and hope someone will stop them.””

What Ireland’s Past Can Tell Us About A Post-Roe America

“Ireland’s laws against abortion were some of the most restrictive in the world.2 From 1983 to 2018, “the right to life of the unborn” was equal to the “right to life of the mother,” and the state was empowered to “defend and vindicate that right.” This was enshrined in the Irish Constitution’s Eighth Amendment, which two-thirds of voters approved in a 1983 referendum. Furthermore, under Irish law, performing or obtaining an abortion was punishable by up to 14 years in prison.

Of course, this didn’t stop abortions in Ireland. Abortions happened anyway, both abroad and underground. But the fact that they still happened — and that they were still in demand — didn’t make the effort to legalize them any easier. It took another 35 years for abortion to become legal in Ireland — and a steady stream of activism and high-profile stories of suffering for abortion rights to expand.”

“It took almost a decade for the broader Irish public to become aware of the dire consequences faced by those who are denied abortions. In 1991, a 14-year-old girl was raped by the father of one of her friends. The attorney general filed an injunction prohibiting her and her parents from traveling to England to seek an abortion because the law compelled the state to protect the life of the fetus. During that time, the girl was expressing suicidal thoughts, and a clinical psychologist testified in a court hearing that the girl was at risk of killing herself; ultimately, the Irish Supreme Court decided to set aside the initial court ruling, thus allowing the girl to get an abortion because there was a real threat of suicide.”

“If Ireland is any example, a lot more women in America will have to die or experience mental-health issues before attitudes toward abortion care dramatically shift.”

Would These 4 Gun Controls Prevent Mass Shootings?

“The New York Times reckons that four gun control measures Congress is considering “might have changed the course of at least 35 mass shootings” since 1999—one-third of attacks in which a gunman killed at least four people. While that conclusion is excessively optimistic, the newspaper is at least asking the right question: Are new restrictions on firearms likely to work as advertised?

President Joe Biden, by contrast, simply assumes the wisdom of the policies he favors and the bad faith of anyone who opposes them. “The issue we face is one of conscience and common sense,” he insisted last week, implying that skeptics lack one or both.

Among other things, Biden wants Congress to require background checks for private gun transfers, which means such transactions must be completed through a federally licensed dealer. The Times found that four of the mass killers in the 105 cases it examined bought guns in private transactions.

One of those perpetrators had already failed a background check. One of the other three, the Violence Policy Center reports, “legally bought” a pistol from a gun shop. According to a 2013 review in The Atlantic, it is not clear whether either of the two other killers had disqualifying criminal or psychiatric records.

In at least one case out of 105, then, an expanded federal background-check requirement might have been an obstacle. But that’s assuming private sellers generally would comply with that mandate, and data from states that notionally require “universal background checks” suggest such rules are widely flouted.

The Times found that at least 20 mass murderers used magazines that held more than 10 rounds. The 1994 federal “assault weapon” law, which expired in 2004, prohibited the production and sale of such magazines, and Biden wants Congress to renew that limit.

Even if we assume that the need to switch magazines after firing 10 rounds can make an important difference in mass shootings, the effectiveness of a ban is doubtful. A 2004 report commissioned by the Justice Department found that the 1994 ban had no measurable impact on the use of “large capacity magazines” in crimes, probably “due to the immense stock of exempted pre-ban magazines”—a stock that is even bigger now than it was then.

In 10 of the 105 mass shootings analyzed by the Times, the perpetrators used stolen guns. The paper suggests “safe storage” legislation backed by Biden might have made a difference in those cases.

One such bill would establish a $500 fine for gun owners who fail to secure their weapons in circumstances where a minor “is likely to gain access” to them or in households where a resident is legally barred from possessing firearms. If a minor or prohibited person uses an unsecured gun to injure or kill someone, the owner would face up to five years in prison.

The bill also would provide grants aimed at encouraging states to establish and enforce similar requirements. The idea that such laws could prevent would-be mass shooters from obtaining firearms assumes wide compliance and a lack of alternative sources, both of which are debatable assumptions.

The Times says “four of the gunmen might have been stymied” by a law prohibiting federally licensed gun dealers from selling semiautomatic centerfire rifles that accept detachable magazines to anyone younger than 21. That bill, which Biden also supports, avoids the arbitrary distinctions drawn by “assault weapon” bans, which target guns based on functionally unimportant characteristics.

Since the bill does not apply to private transfers, however, adult buyers younger than 21 could still legally obtain semiautomatic rifles. Furthermore, a federal appeals court ruled last month that prohibiting young adults from buying such firearms because a tiny fraction of them might commit violent crimes was inconsistent with the Second Amendment.

Before deciding whether to support policies like these, legislators should rationally weigh their costs and benefits, including their constitutional implications. Biden prefers a different approach, replacing logic and evidence with self-righteous certitude.”

107,000 Overdose Deaths Are the Latest Casualties of the War on Drugs

“Amid the news that the U.S. had reached 1 million deaths from COVID-19, this week saw another grim milestone. The Centers for Disease Control and Prevention (CDC) announced that the U.S. recorded more than 107,000 deaths from drug overdoses last year, a record high. This is a 15 percent increase from 2020, which held the previous record of around 93,000 deaths. While there has been plenty of talk about how many COVID deaths were preventable, it’s also worth considering how many overdose deaths were the result of needlessly draconian government policies.

According to The New York Times, an increasing share of the number of total overdose deaths came from users of synthetic opioids and methamphetamine. The number of deaths from synthetic opioids increased from 58,000 to 71,000; most of these involved fentanyl, which is considerably stronger than morphine or heroin, and its analogs, which are even more potent. It is often mixed with heroin or stamped into counterfeit prescription drugs. Deaths associated with meth also rose from 25,000 to 33,000.

Each increase follows a longer-term trend: A decade ago, meth-related deaths numbered fewer than 2,000, but by 2017, the number had risen to 10,000. Similarly, deaths from fentanyl numbered around 1,600 in 2011 but increased more than tenfold by 2016.

Obviously, there are a number of reasons why people may abuse drugs. But the role of drug prohibition in exacerbating the crisis cannot be overstated.

During the same years that fentanyl use increased, the prescription rates of opioids like OxyContin plummeted. This was no accident: In 2018, then-Attorney General Jeff Sessions bragged about how successful the government’s efforts had been at lowering the rates at which doctors prescribed opioids for pain. And yet, the overdose rate continued to climb, as both addicts and chronic pain patients alike were forced to seek out black-market alternatives.

A few years earlier, in an attempt to combat the spread of meth, Congress restricted the availability of the decongestant Sudafed, while the Drug Enforcement Administration cracked down on homegrown meth labs that used it as an ingredient. As a result, cheap, low-quality meth from Mexico with suspect ingredients filled the gap in supply.

Each case provides a perfect example of what Dr. Jeffrey Singer, a senior fellow at the libertarian Cato Institute, refers to as “like playing a game of ‘Whack-a-Mole,'” in which the government cracks down on a drug, only for its users to seek alternatives, typically in a more dangerous form. Prescription opioids, in particular, certainly do have the potential for abuse, though not to the extent often portrayed in popular media. But for those who genuinely need pain relief and who are suddenly unable to get it, the alternatives are much worse.”

A Record Number of Drug-Related Deaths Shows the Drug War Is Remarkably Effective at Killing People

“Three years ago, President Donald Trump bragged that “we are making progress” in reducing drug-related deaths, citing a 4 percent drop between 2017 and 2018. That progress, a dubious accomplishment even then, proved fleeting. The upward trend in drug-related deaths, which began decades ago, resumed that very year, and 2020 saw both the largest increase and the largest number ever. That record was broken last year, according to preliminary data that the Centers for Disease Control and Prevention (CDC) published this week.

The CDC projects that the total for 2021 will be nearly 108,000 when the numbers are finalized, up 15 percent from 2020, when the number of deaths jumped by 30 percent. Two-thirds of last year’s cases involved “synthetic opioids other than methadone,” the category that includes fentanyl and its analogs. Those drugs showed up in nearly three-quarters of the cases involving opioids.

Illicit fentanyl, which has become increasingly common as a heroin booster or substitute during the last decade, is now showing up in cocaine, methamphetamine, and counterfeit pills passed off as prescription analgesics or anti-anxiety drugs like Xanax. That phenomenon vividly illustrates the hazards of the black market created by the war on drugs that Trump thought the government was finally winning.

Joe Biden, a supposedly reformed drug warrior, is still keen on “going after drug trafficking and illicit drug profits,” a strategy that has failed for a century but, he figures, might just work this time around. At the same time, Biden talks a lot about drug treatment and other forms of “harm reduction,” including “key tools like naloxone and syringe services programs.” He proudly proclaims that his drug control plan is “the first-ever to champion harm reduction to meet people where they are and engage them in care and services.””

“If we focus on substance rather than words, the real breakthrough will come when politicians understand and acknowledge the nature of the harm that needs to be reduced. It is not just the harm caused by drug abuse but also the harm caused by misguided and counterproductive efforts to address that problem. Prohibition itself is the most obvious example.

Consider one of the harm reduction measures that the Times mentions: the distribution of test strips that can alert drug users to the presence of fentanyl in a substance sold as something else. Those test strips don’t tell you how much fentanyl a bag of powder or a pill contains; they just tell you whether there is a detectable amount. But even that much knowledge is an improvement in a black market where people routinely buy drugs of unknown provenance, composition, and potency.

The danger that fentanyl poses to drug users is not inherent in the drug itself, which can be used safely when you know the dose, as demonstrated by its various medical applications. I was recently given fentanyl, along with midazolam, as a sedative during dental surgery, and I was not at all worried that it would kill me. Patients who receive fentanyl injections in the hospital or use fentanyl patches, lozenges, or nasal spray to relieve severe chronic pain likewise are not dropping dead left and right.

In the black market, by contrast, drug users may not even realize they are buying fentanyl; hence the test strips. Even if they do realize that, they still don’t know the concentration. That potentially lethal ignorance is entirely a product of prohibition. While the proliferation of illicit fentanyl has made drug use more dangerous by increasing variability and uncertainty, those problems are not new. They are inevitable when the government tries to prevent the use of psychoactive substances by banning them.”

“Biden thinks that “going after drug trafficking” will help prevent drug-related deaths. But the pressure from enforcement drives drug traffickers toward more-potent products, which facilitate smuggling by allowing them to pack more doses into the same volume. Alcohol prohibition shifted consumption from beer and wine toward distilled spirits. Drug prohibition gave us heroin instead of opium, fentanyl instead of heroin, and sometimes even-more-potent fentanyl analogs instead of fentanyl.

Given the economics of the black market, interdiction has always been a hopeless proposition. That should be clearer than ever today as the government vainly tries to intercept little packages of fentanyl, each of which contains thousands of doses. But while “going after drug traffickers” has never been a cost-effective way to reduce drug consumption, that does not mean it has not accomplished anything. It has been remarkably effective at making drug use deadlier.”

The Buffalo Massacre Illustrates the Inherent Limitations of ‘Red Flag’ Laws

“A 2012 study that the Department of Defense commissioned after the 2009 mass shooting at Fort Hood in Texas includes an appendix titled “Prediction: Why It Won’t Work.” The appendix observes that “low-base-rate events with high consequence pose a management challenge.” In the case of “targeted violence,” for example, “there may be pre-existing behavior markers that are specifiable.” But “while such markers may be sensitive, they are of low specificity and thus carry the baggage of an unavoidable false alarm rate, which limits feasibility of prediction-intervention strategies.” In other words, even if certain “red flags” are common among mass shooters, almost none of the people who display those signs are bent on murderous violence.

Supporters of red flag laws prefer to ignore this problem. After a mass shooting in a state that has such a law, they argue, as in this case, that it would have worked if only it had been used properly. But the problem goes deeper than that. However you weigh the risk of preventable violence against the risk of taking away innocent people’s rights, this policy has inherent limitations that mean it is bound to fail”