Originally a Twitter thread. (Minor edits for clarity) (and some additions)
Koldony seems to miss a major factor in opiates use: demographics. His fav stat is opiate use increased drastically starting in 1997.
Which was the year the oldest Baby Boomers started turning 50, and before occupational repetitive stress injuries were widely acknowledged, and while pre-existing conditions still excluded many people from any health coverage. It’s the largest demographic cohort in history; they’re comfortable with drugs, & occupational abuse of workers was the societal norm for the 20th century.
But Koldony is a neo-Calvinist. (Edit: I don’t care what his actual religion is, his behavior towards both people with OUD and people whose pain is a symptom of a condition show that he has absorbed the very US based cultural Neo-Calvinism that says illness & pain & poverty are visible marks of Cain, inflicted by god so that the righteous know those who are suffering are damned and doomed, and beyond saving. It’s a pervasive cultural thought pattern that influences significant portions of the culture, even amongst people who don’t claim to be Christian or religious at all. It’s the same philosophy that underlies fatphobia, and medical ableism, and medical misogyny, and medical racism and misogynoir.)
Last time I looked at the datasets, the vast majority (75%+) of scrips have consistently been written for people over 50 (mostly over 65). Younger people are almost excluded from opiate scrips, including for C-sections, major orthopedic work, and severe traumatic injuries.
There’s not much of a bio on Koldony, but I’m willing to bet the cost of a new tire that he’s never held a manual labor job for more than a summer. Not long enough to sustain injury. And since he’s a psychiatrist, even his internship was mostly spent sitting on his butt.
Why do age & lack of health insurance matters? Because there’s this amazing gap we saw before ACA — someone who needed a joint replacement often couldn’t afford $20K in cash, but could afford $200 for a doc visit & $50/mo for a scrip from 50 to 65, when Medicare kicked in. There are still a lot of technically elective surgeries that happen in the first couple years after people turn 65, because they couldn’t find the money before. (ETA) So we literally saw a full cohort limping through the pain of ruptured discs and ACLs and eroded tendons — all the soft tissue damage — for years, and coping with that lack of adequate care, either through lack of insurance or fear of using it, with prescription pain killers.
(I note that the opiates problem is mostly a US phenomenon, not as common in places that treat their citizens.) (still exists in other places, but much less prevalent.)
(ETA: I also note that I have a severe disagreement with Koldony’s use of Opiate Use Disorder. As far as I can tell, he thinks that all use of opiates is disordered, and therefore all people who use are hopeless addicts who must be cold-turkey’ed and spend their life in penance and Narcotics Anonymous. (Even if he tries to deny it.) I disagree, clearly, and I don’t even see the problem with doses that increase over long periods of time. If there is no surgical intervention for the issue, then yes, the issue will continue to worsen as the body’s ability to heal it erodes; many surgeries also carry their own significant risk of neuropathy, so a surgical intervention may make the functional problem better while making the pain worse; weight changes; survival may mean working a job that exacerbates a condition, or a comorbidity may arise. Lots of reasons why someone might experience more pain over a decade.
(ETA2: And to be perfectly clear: dependence and the experience of withdrawal are not signs of addiction. If that was the case, then every single person on a psych med in the world fits Koldony’s misuse of addiction. Abrupt discontinuation of whole classes of psych meds carry a major risk of serotonin syndrome because the body has become accustomed to the effect of the med. Just because it has a taper protocol doesn’t mean it’s addictive or misused. And that includes opiates.)
And yes, in the US, people self-medicate. I have not done this bit of data integration yet, but my suspicion is we can track spikes in first meth use (meth is custom built for capitalism & productivity) then opiates, AND we can overlay the maps with private equity scavengers, and it will all look like an obvious heat map. Misery loves dopamine and GABA. When private equity/vampire capitalism comes to a one industry town, misery is the result. Also, any place that has old pipes or a lot of tractors or road dust? Also has a lead problem. One of the effects of low level systemic lead poisoning is undiagnosed attention deficits, which respond GREAT to meth, and also eventually respond well to opiates.
And no, I’m not blaming anyone for using opiates, unlike a certain dude. If they’re what works, that’s what we should use. Having gone through years of puritan pearl clutching over ADHD meds, SSRIs, SNRIs, non-benzos…
If we need a med for it, it doesn’t respond to willpower.
Someone who is really fucking sick of treating other doctors’ iatrogenic medical trauma, who has plenty of trauma patients caused by war, sexual violence & parents, and doesn’t need this bullshit.
PS: stop blaming street opiates use on scrip opiates patients. Most of the shit causing death is either a cartel product or coming from Chinese semi-ghost labs, or both.
PPS: Also — track booze. High blood alcohol is present in most opiate deaths. (Or benzos. Or both.) Booze + 1 is the most regularly deadly combination of substances within the US, but you don’t see Koldony going after Coors, Seagrams, and Bacardi. I wonder why — could his institutions be funded by the most morally bankrupt industry to ever exist?