“Danny had chronic, searing pain from an electrocution accident years earlier. For treatment, he and Gretchen, his caretaker, traveled regularly from their home in Georgia to a pain management physician in Beverly Hills, California, to receive pharmaceutical fentanyl. But on November 1, DEA agents suspended the Beverly Hills physician’s narcotics prescribing license, having decided that he was inappropriately prescribing painkillers. A week later, Danny and Gretchen killed themselves.”
“It was the most recent of the many dreadful outcomes that follow when cops practice medicine.”
“The DEA has not formally charged the physician, David Bockoff, who has been practicing medicine with a spotless record in California for 53 years. He was treating many “pain refugees” like Danny: patients with chronic pain, well-managed with opioids, whose previous physicians had either closed after a DEA visit or abruptly cut off their pain medication fearing the wrath of law enforcement.”
“Today, 38 states have laws on the books that limit the dosage and amount of pain relievers doctors can prescribe to their patients. Many of these laws have cast in stone the Centers for Disease Control and Prevention’s now-discredited 2016 Guideline for Prescribing Opioids for Chronic Pain. The guideline came under so much criticism from pharmacologists, clinicians, and academic physicians that the agency revised it this past November. No matter. The flawed 2016 guideline remains the basis of the prescribing laws in most states. Doctors face losing their licenses or, worse, jail time if they violate these laws.”
“All 50 states maintain Prescription Drug Monitoring Programs to surveil all prescriptions issued and filled within the state. These primarily serve as law enforcement tools. In most states, police drug task forces use them to go on warrantless fishing expeditions, hoping to find a doctor to bust for “inappropriate prescribing” or a patient they can arrest for “doctor shopping.” These programs have not reduced the overdose rate. If anything, they have driven non-medical users who cannot obtain diverted prescription pain pills to more dangerous drugs in the black market, causing the overdose rate to increase.”
“opioid-related overdose deaths reached a record high in 2021, exceeding 71,000, 89 percent of which involved illicit fentanyl. Despite a dramatic drop in opioid prescribing, deaths have soared.
According to government data, addiction to prescription pain relievers has been relatively stable at under one percent in this century. Chronic pain patients rarely become addicted to opioids. The overdose crisis is a prohibition-induced crisis. Neither the practice of medicine nor the act of self-medication belongs in the realm of the criminal legal system.”
“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.””
“Substantially reducing the doses of pain medication prescribed for patients on long-term opioid therapy is associated with a threefold increase in suicide attempts and a 69 percent increase in overdoses, according to a study published this week in The Journal of the American Medical Association (JAMA). The study reinforces concerns that the “tapering” encouraged by federal guidelines as a response to the “opioid crisis” causes needless suffering among patients, leading to undertreatment of pain, withdrawal symptoms, and emotional distress.”
“Although the CDC’s advice was not legally binding, and although the guidance said doses should be tapered only when medically appropriate, doctors, lawmakers, insurers, and pharmacies interpreted the agency’s warnings about daily doses exceeding 90 MMEs as a hard limit. “These and other widely disseminated recommendations have led to increased opioid tapering among patients prescribed long-term opioid therapy,” Agnoli et al. note.”
“The CDC is mulling revisions to its advice. “A revised CDC Guideline that continues to focus only on opioid prescribing will perpetuate the fallacy that, by restricting access to opioid analgesics, the nation’s overdose and death epidemic will end,” Mukkamala warned in his letter to the CDC. “We saw the consequences of this mindset in the aftermath of the 2016 Guideline. Physicians have reduced opioid prescribing by more than 44 percent since 2012, but the drug overdose epidemic has gotten worse.””
“After years of steadily moving in tandem, two of America’s worst public health trends diverged during the coronavirus pandemic.
Drug overdose deaths jumped 30 percent last year to 92,500, according to newly released federal data, a sudden surge following years of incremental increases once the opioid epidemic took hold. But suicides actually dropped slightly, from 47,500 in 2019 to 44,800 in 2020.
Those two trends have tracked closely over the past decade, so much so that there is an umbrella term in academia that encompasses both of them (among other things): deaths of despair. Much of the recent stagnation in US life expectancy can be explained by these premature deaths, concentrated especially among young men, and scholars have theorized about the economic and social conditions driving those trends.
That was the situation before Covid-19. So what happened during the pandemic?”
“Last year saw 44,834 Americans kill themselves, according to provisional data from the National Center for Health Statistics (NCHS) and the National Vital Statistics System (NVSS). That’s down from 47,511 in 2019, 48,344 in 2018, 47,173 in 2017, and 44,965 in 2016.
We do not know from the data in question whether the number of attempted suicides changed at all last year.”
“The leading U.S. cause of death last year remained heart disease, with 690,882 heart disease deaths last year. This number has been slowly but steadily ticking up over the past five years, from 633,842 heart disease deaths in 2015.
The second leading cause of death remained cancer, with slightly fewer cancer deaths last year than in 2017–2019. The provisional data list 598,932 cancer deaths last year.”
“In other news related to COVID-19 and mortality: New estimates from the Centers for Disease Control and Prevention (CDC) suggest the virus is deadlier than previous estimates let on.
“According to the ‘best estimate’ in the most recent version of the CDC’s COVID-19 Pandemic Planning Scenarios, 9 percent of people 65 or older who are infected by the COVID-19 virus die from the disease,” notes Reason’s Jacob Sullum.”
“People who attempt suicide with a gun die nine times out of 10, whereas other common means (such as cutting and overdose) are much more survivable. That’s why the New York Secure Ammunition and Firearms Enforcement Act of 2013 (New York SAFE Act) directed mental health professionals to report suicidal patients to a state agency, which could subsequently seize any guns they might own, and add their name to a “no buy” database for five years. Even in New York, though, this provision is controversial and has faced repeated court challenges. We shouldn’t expect to see similar legislation proliferating across the country anytime soon.
Instead, suicide prevention activists have been trying to cultivate a culture of community responsibility among gun owners, asking them to reach out to friends in crisis with an offer to store their guns after a divorce, job loss, death in the family or other trauma. The idea of letting your neighbor or your hunting buddy lock your gun up in his safe for a while might be more palatable than handing it over to the sheriff. Suicide prevention groups have partnered with gun shops and shooting ranges, first in New Hampshire and now in 11 other states, to spread the idea through posters and pamphlets.”
“Many states have gradually lowered the bar to obtain a permit to carry a handgun in public places. The trends have been toward fewer hours of classroom instruction (reduced in some cases to zero), eliminating shooting requirements at the range, and lowering fees. Tennessee now offers a gun carry permit course that can be completed entirely online. Other states, such as Kansas, have eliminated licensure altogether. When Texas lowered training standards for its concealed handgun license in 2013 to just four hours of classroom instruction, lawmakers said that there simply wasn’t enough material to justify the 10 hours previously required. Typical curriculum covers operation of a firearm and some guidance about where and when it might be appropriate to use it. Some gun violence prevention advocates would like to see the curriculum expanded to include strategies in de-escalation, risk avoidance, safe storage and first aid.”
Homicide Harvard Injury Control Research Center. Havard T.H.Chan School of Public Health. FIREARMS AND FAMILY VIOLENCE Arthur Kellermann, Sheryl Heron. 1999. Emergency Medicine Clinics of North America. https://www.sciencedirect.com/science/article/abs/pii/S0733862705700924 Firearm possession and violent death: A critical review Wolfgang Stroebe. 2013. Aggression and Violent