Philip Seymour Hoffman, heroin epidemics and an “Open Letter” to the CDC

NOVANEWS
by Alen J. Salerian, M.D. (with Jim Fetzer)

Philip

The death of Philip Seymour Hoffman, like those of John Belushi and of River Phoenix before him, have unleashed a torrent of allegations of a national surge in the use of heroin, where The LA Times trumpeted, “Philip Seymour Hoffman dies amid major comeback of heroin in the U.S.”
But that interpretation of the data has been challenged by one of the nation’s leading experts in psycho-pharmacology, Alen J. Salerian, M.D., who has served as the FBI’s leading psychiatrist and as the head of its Rapid Response Psychiatric Team:

Hoffman and the rumor of a national heroin epidemic

Alen J Salerian, M.D.

The death of actor Philip Seymour Hoffman from an apparent heroin overdose has triggered national headlines of a heroin epidemic ravaging America. As tragic as it was to lose Hoffman, who was a gifted man, a far larger national tragedy has been media-driven misrepresentations about a “phantom” national heroin problem. While the use of heroin itself is a problem for those who resort to it, the nation’s problem with respect to drugs is far more complex than “a heroin epidemic.” And it reflects underlying neuro-psychiatric challenges, such as depression or untreated mental illness.
CDC statistics clearly show that the United States does not have a national heroin problem. The numbers provided by CDC should comfort all of us:
CDC 2008 statistics
When it comes to vital statistics, it is of importance to know that the crucial statistic is not the number of deaths per se but the number of annual fatalities per hundred-thousand population. The simple reason is we are a large country, in which roughly 300,000 people–or 1% of the population–die every year. As a general guideline in a modern and free society, a figure smaller than 3.6 (which averages motorcycle and swimming fatalities) should not be a cause for alarm unless we ban swimming and motorcycling, too.
From a psychiatric perspective, addiction is a complication of an untreated or unrecognized neuro-psychiatric disease, such as obsessive-compulsive spectrum disorder, bipolar disorder or depression. Annually, in a population of a hundred thousand, 11.2 people die of suicide versus less than 1.0—actually, 0.9–from heroin, which is a subgroup of depression or of psychiatric disorders, generally.

A spokesman for the DEA, Rusty Payne, has attributed the rise in the use of heroin to the success of drug smuggling operations, especially crossing the nation’s border from Mexico:

Although the autopsy results for Oscar-winning actor Philip Seymour Hoffman are not yet known, packets of the drug were found Sunday in his New York apartment where he died, a needle sticking in his arm.
“It’s reached epidemic proportions here in the United States,” Drug Enforcement Administration spokesman Rusty Payne said of heroin use.
Payne attributed the problem to a surge in heroin crossing the nation’s southwestern border, where soaring seizures of the drug are a sign of soaring smuggling operations. In 2008, the DEA reported seizing 559 kilograms of heroin at the southwestern border; that more than tripled to 1,855 kilograms in 2012.

The article was supported by graphs showing an increase in the use of heroin across all age groups, which is certainly suggestive of a national epidemic encompassing the nation:
CDC graphs of rise in heroine useage
While investigations into his death continue unabated, “4 arrested on drug charges after death of Philip Seymour Hoffman”, the larger question raised deserves the nation’s attention no less and probably far more: Is this another case in which the CDC is exaggerating the use of drugs in the U.S. for its own political purposes?
His knowledge and expertise in the area of psycho-pharmacology, combined with his admirable candor and integrity, has placed Dr. Salerian at odds with the CDC and, thereby, with the DEA and even the CIA. Their response has been brutal, including an unwarranted raid on his home, which terrorized his wife and daughter, and criminal charges for his prescriptions for his patients, as part of the criminalization of medicine.
The myth of a drug epidemic maintains public support for the War on Drugs, which in turn keeps drug prices and CIA profits high. And now a hit piece in a D.C. rumor mill, The Washingtonian, has been used to attack Alen in a grossly unjust fashion. The death of Philip Seymour Hoffman has been accompanied by highly exaggerated claims about “a heroin epidemic”, which has led Dr. Salerian to contribute to this article and to compose the following “Open Letter” to the Director of the CDC herself.

An Open Letter to the Director, CDC

By Alen J. Salerian, M.D.

Linda C Degutis Dr. Ph, MSN
Director
National Center for Injury Prevention and Control
Center for Disease Control and Prevention
Atlanta, GA 30333
Dear Dr. Degutis,
I am writing to request your assistance to correct a serious error by CDC that may adversely impact millions of Americans with chronic pain, psychiatric disorders and addiction.
For several years, there has been an alarming message about the devastating impact of opioid overdose fatalities promoted by the Center for Disease Control (CDC). Since 2010–when Vital Signs was launched–CDC has, on a monthly basis disseminated misinformation highlighting an epidemic of increasing opioid overdose deaths.
Determining the  accuracy of the alarm is critically important. This is because opioids are crucial in the treatment of millions of people with various chronic psychiatric conditions and pain and thus a potential false alarm may hurt great many people in need of opioids.
The Institute of Medicine report of June 2011 suggested that 110 million Americans lived with chronic pain and the under-treatment of chronic pain was a national challenge [1]. Furthermore, the advances in neuroscience and neuro-imaging have illustrated brain tissue loss from chronic pain [2]. It is also true that the criminalization of medicine–as part of the war on drugs–adversely impacted the use of opioids due to physician fears.
I hereby address the key misrepresentations by the CDC (printed in bold letters) in relation to an alleged epidemic of opioid-overdose deaths:

A. Prescription opioid pain relievers were involved in 14,800 deaths in 2008. This is an epidemic consistent with more than tripling fatalities in the past decade.
Observation:
Those 14,800 deaths involved benzodiazepines, alcohol, cocaine and over-the-counter pain medications. Attributing those 14,800 fatalities to prescription opioids is therefore inaccurate.

Heroin bar graph

B.  There is currently a growing deadly epidemic of prescription painkiller abuse. These drugs were involved in 14,800 deaths in 2008, more than cocaine and heroin combined.
Observation:
Those 14,800 fatalities represent approximately 4.5 deaths per hundred-thousand population versus 11.2 from suicide, 6 from alcohol, 5.5 from motorcycle accidents, 0.5 from cocaine and 0.5 from heroin.
Of special significance, the comparison with cocaine and heroin is both unscientific and inconsequential, because of their relative insignificance compared to the number of fatalities for other causes, such as from suicide, 11.2, and alcohol, 6. Equally importantly, the message is extremely misleading. The aggressive campaign to present opioid overdose deaths as the leading public menace–in contrast to the conspicuous lack of any campaign to inform the public about the number of depression associated suicidal deaths–conveys an impression via misinformation that is discriminatory against people with psychiatric disorders and problems of addiction.

Numerical comparison

C. There is currently a growing deadly epidemic of prescription painkiller abuse. These drugs were involved in 14,800 deaths in 2008.

Observation:
The current reporting system of opioid deaths is severely flawed due to reliance upon unscientific practices that render the results invalid [3]. In general many recorded cause of death reflect only medical opinion without objective evidence that necessitate great caution until the objective data are available [4]. ICD codes mix together legal and illegal drugs making it impossible to determine specific causation and are ambiguous about intent whether unintentional or suicide [4].
It is conceivable-–and has been directly observed by the first author–-for a sudden-death to be wrongly attributed to methadone based upon its presence in the system regardless of the fact that the blood methadone concentration falls within the therapeutic range. It is reasonable to assume that, because of methadone’s unusually long elimination life of 48 to 72 hours and its regular use by an estimated half a million people, the actual number of deaths attributed to methadone is being significantly exaggerated by current accounting procedures.

The evidence seems to be compelling to conclude that CDC’s alarm of an alleged rising epidemic of opioid overdose deaths is unwarranted and unscientific. In addition, there seems to be little or no objective data to support the current government-sponsored campaign to present prescription opioids as more dangerous and harmful than dozens of other medications with greater risk of adverse events. The effective dissemination of unscientific and misleading information by CDC may not only harm  millions with chronic pain, addiction and treatment refractory psychiatric conditions, but further perpetuates discriminatory practices against people with psychiatric disorders and problems of addiction.
In the spirit of governmental and scientific integrity and of public health, I kindly request that the CDC end its misleading campaign. As importantly, I request that CDC, FDA and other public agencies develop scientific guidelines for recording and reporting deaths associated with opioids, which is indispensable to acquire accurate information and statistics for appropriate programs and procedures. You are welcome to call me at (202) 320-6176; and I would be willing to travel to Atlanta to discuss all of this with you, at your invitation.
Respectfully,
Alen J. Salerian, M.D.
President
Doctors for Equal Rights for People with Mental and Physical Pain

References:

[1]  The Institute of Medicine Report (June 2011)
[2]  Apkarian et al., “Chronic pain is associated with increased prefrontal and thalamic gray brain density”,Journal of Neuroscience (2004) 24:10410–10415.
[3]  Libby, R., The Criminalization of Medicine. Praeger Publishers, 2008.
[4]  Webster, L.; Dasgupta, N., “Obtaining adequate data to determine causes of opioid related overdose deaths”, Pain Medicine (2011) 12:S86-S92.
Alen J. Salerian, M.D., Former Chief Psychiatric Consultant to the FBI’s Emergency Response Team, is President of Doctors for Equal Rights for People with Mental and Physical Pain.

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